Human-centered implementation research: a new approach to develop and evaluate implementation strategies for strengthening referral networks for hypertension in western Kenya

Abstract Background Human-centered design (HCD) is an increasingly recognized approach for engaging stakeholders and developing contextually appropriate health interventions. As a component of the ongoing STRENGTHS study (Strengthening Referral Networks for Management of Hypertension Across the Health System), we report on the process and outcomes of utilizing HCD to develop the implementation strategy prior to a cluster-randomized controlled trial. Methods We organized a design team of 15 local stakeholders to participate in an HCD process to develop implementation strategies. We tested prototypes for acceptability, appropriateness, and feasibility through focus group discussions (FGDs) with various community stakeholder groups and a pilot study among patients with hypertension. FGD transcripts underwent content analysis, and pilot study data were analyzed for referral completion and reported barriers to referral. Based on this community feedback, the design team iteratively updated the implementation strategy. During each round of updates, the design team reflected on their experience through FGDs and a Likert-scale survey. Results The design team developed an implementation strategy consisting of a combined peer navigator and a health information technology (HIT) package. Overall, community participants felt that the strategy was acceptable, appropriate, and feasible. During the pilot study, 93% of referrals were completed. FGD participants felt that the implementation strategy facilitated referral completion through active peer engagement; enhanced communication between clinicians, patients, and health administrators; and integrated referral data into clinical records. Challenges included referral barriers that were not directly addressed by the strategy (e.g. transportation costs) and implementation of the HIT package across multiple health record systems. The design team reflected that all members contributed significantly to the design process, but emphasized the need for more transparency in how input from study investigators was incorporated into design team discussions. Conclusions The adaptive process of co-creation, prototyping, community feedback, and iterative redesign aligned our implementation strategy with community stakeholder priorities. We propose a new framework of human-centered implementation research that promotes collaboration between community stakeholders, study investigators, and the design team to develop, implement, and evaluate HCD products for implementation research. Our experience provides a feasible and replicable approach for implementation research in other settings. Trial registration Clinicaltrials.gov, NCT02501746, registration date: July 17, 2015,

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Human-Centered Implementation Research: A New Approach to Develop and Evaluate Implementation Strategies for Strengthening Referral Networks for Hypertension in western Kenya

10.21203/rs.3.rs-252907/v2 ◽

2021 ◽

Author(s):

McKinsey M. Pillsbury ◽

Eunice Mwangi ◽

Josephine Andesia ◽

Benson Njuguna ◽

Gerald S. Bloomfield ◽

...

Keyword(s):

Pilot Study ◽

Implementation Research ◽

Implementation Strategy ◽

Controlled Trial ◽

Implementation Strategies ◽

Study Data ◽

Design Team ◽

Community Stakeholder ◽

Clinical Records ◽

Referral Completion

Abstract BackgroundHuman-centered design (HCD) is an increasingly recognized approach for engaging stakeholders and developing contextually appropriate health interventions. As a component of the ongoing STRENGTHS study (Strengthening Referral Networks for Management of Hypertension Across the Health System), we report on the process and outcomes of utilizing HCD to develop the implementation strategy prior to a cluster-randomized controlled trial.MethodsWe organized a design team of 15 local stakeholders to participate in an HCD process to develop implementation strategies. We tested prototypes for acceptability, appropriateness, and feasibility through focus group discussions (FGDs) with various community stakeholder groups and a pilot study among patients with hypertension. FGD transcripts underwent content analysis, and pilot study data were analyzed for referral completion and reported barriers to referral. Based on this community feedback, the design team iteratively updated the implementation strategy. During each round of updates, the design team reflected on their experience through FGDs and a Likert-scale survey.ResultsThe design team developed an implementation strategy consisting of a combined peer navigator and a health information technology (HIT) package. Overall, community participants felt that the strategy was acceptable, appropriate, and feasible. During the pilot study, 93% of referrals were completed. FGD participants felt that the implementation strategy facilitated referral completion through active peer engagement; enhanced communication between clinicians, patients, and health administrators; and integrated referral data into clinical records. Challenges included referral barriers that were not directly addressed by the strategy (e.g. transportation costs) and implementation of the HIT package across multiple health record systems. The design team reflected that all members contributed significantly to the design process, but emphasized the need for more transparency in how input from study investigators was incorporated into design team discussions.ConclusionsThe adaptive process of co-creation, prototyping, community feedback, and iterative redesign aligned our implementation strategy with community stakeholder priorities. We propose a new framework of human-centered implementation research that promotes collaboration between community stakeholders, study investigators, and the design team to develop, implement, and evaluate HCD products for implementation research. Our experience provides a feasible and replicable approach for implementation research in other settings.Trial registration: Clinicaltrials.gov, NCT02501746, registration date: July 17, 2015, https://clinicaltrials.gov/ct2/show/NCT02501746

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Human-Centered Implementation Research: A New Approach to Develop and Evaluate Implementation Strategies for Strengthening Referral Networks for Hypertension in western Kenya

10.21203/rs.3.rs-252907/v1 ◽

2021 ◽

Author(s):

McKinsey M. Pillsbury ◽

Eunice Mwangi ◽

Josephine Andesia ◽

Benson Njuguna ◽

Gerald S. Bloomfield ◽

...

Keyword(s):

Pilot Study ◽

Implementation Research ◽

Implementation Strategy ◽

Controlled Trial ◽

Implementation Strategies ◽

Study Data ◽

Design Team ◽

Community Stakeholder ◽

Clinical Records ◽

Referral Completion

Abstract BackgroundHuman-centered design (HCD) is an increasingly recognized approach for engaging stakeholders and developing contextually appropriate health interventions. As a component of the ongoing STRENGTHS study (Strengthening Referral Networks for Management of Hypertension Across the Health System), we report on the process and outcomes of utilizing HCD to develop the implementation strategy prior to a cluster-randomized controlled trial.MethodsWe organized a design team of 15 local stakeholders to participate in an HCD process to develop implementation strategies. We tested prototypes for acceptability, appropriateness, and feasibility through focus group discussions (FGDs) with various community stakeholder groups and a pilot study among patients with hypertension. FGD transcripts underwent content analysis, and pilot study data were analyzed for referral completion and reported barriers to referral. Based on this community feedback, the design team iteratively updated the implementation strategy. During each round of updates, the design team reflected on their experience through FGDs and a Likert-scale survey.ResultsThe design team developed an implementation strategy consisting of a combined peer navigator and a health information technology (HIT) package. Overall, community participants felt that the strategy was acceptable, appropriate, and feasible. During the pilot study, 93% of referrals were completed. FGD participants felt that the implementation strategy facilitated referral completion through active peer engagement; enhanced communication between clinicians, patients, and health administrators; and integrated referral data into clinical records. Challenges included referral barriers that were not directly addressed by the strategy (e.g. transportation costs) and implementation of the HIT package across multiple health record systems. The design team reflected that all members contributed significantly to the design process, but emphasized the need for more transparency in how input from study investigators was incorporated into design team discussions.ConclusionsThe adaptive process of co-creation, prototyping, community feedback, and iterative redesign aligned our implementation strategy with community stakeholder priorities. We propose a new framework of human-centered implementation research that promotes collaboration between community stakeholders, study investigators, and the design team to develop, implement, and evaluate HCD products for implementation research. Our experience provides a feasible and replicable approach for implementation research in other settings.Trial registration: Clinicaltrials.gov, NCT02501746, registration date: July 17, 2015, https://clinicaltrials.gov/ct2/show/NCT02501746

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Feasibility and acceptability of two incentive-based implementation strategies for mental health therapists implementing cognitive-behavioral therapy: a pilot study to inform a randomized controlled trial

Implementation Science ◽

10.1186/s13012-017-0684-7 ◽

2017 ◽

Vol 12 (1) ◽

Cited By ~ 6

Author(s):

Rinad S. Beidas ◽

Emily M. Becker-Haimes ◽

Danielle R. Adams ◽

Laura Skriner ◽

Rebecca E. Stewart ◽

...

Keyword(s):

Mental Health ◽

Randomized Controlled Trial ◽

Pilot Study ◽

Cognitive Behavioral Therapy ◽

Behavioral Therapy ◽

Controlled Trial ◽

Implementation Strategies ◽

Cognitive Behavioral ◽

Randomized Controlled ◽

Mental Health Therapists

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A DOUBLE-BLIND PLACEBO-CONTROLLED TRIAL OF PROPHYLACTIC ACETAMINOPHEN TO PREVENT EPIDURAL-FEVER: PILOT STUDY DATA

Anesthesiology ◽

10.1097/00000542-200204001-00014 ◽

2002 ◽

Vol 96 (4) ◽

pp. NA-NA

Author(s):

L. Goetzl ◽

T. Evans ◽

J. Rivers ◽

E. Lieberman

Keyword(s):

Pilot Study ◽

Controlled Trial ◽

Study Data ◽

Double Blind ◽

Double Blind Placebo

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We have the program, what now? Development of an implementation strategy to bridge the research-practice gap prevalent in exercise oncology

10.21203/rs.3.rs-40435/v1 ◽

2020 ◽

Author(s):

Mary Ann Kennedy ◽

Sara Bayes ◽

Robert U. Newton ◽

Yvonne Zissiadis ◽

Nigel A. Spry ◽

...

Keyword(s):

Implementation Strategy ◽

Implementation Strategies ◽

Study Data ◽

Treatment Center ◽

Advisory Group ◽

Science Literature ◽

Implementation Barriers ◽

Oncology Research ◽

Specific Implementation ◽

Exercise Oncology

Abstract Background Exercise has emerged as a promising therapy for people with cancer. Novel programs have been developed to translate this research into practice; however, implementation barriers have limited their success. The aim of this study was to employ the implementation mapping protocol to develop an implementation strategy to effectively support programming of a co-located exercise clinic and cancer treatment center. Methods The Implementation Mapping protocol, which consists of five specific, iterative tasks, was employed for this study. Data from interviews, surveys, clinic records, and implementation science literature was used to develop a comprehensive implementation strategy for the co-located exercise clinic. A stakeholder advisory group advised throughout the process. Results The organization’s general manager was identified as the program adopter; oncologists, center leaders, and various administrative staff as program implementers; and the operations manager as the program maintainer. Twenty performance objectives were identified and used to inform the development of a comprehensive theory-based implementation plan consisting of seven implementation strategies across the individual and organizational levels, including use of program champions and an implementation advisor, and revision of professional roles. Finally, an evaluation plan was developed to measure the success of the implementation strategy. Conclusion Successful translation of exercise oncology research into practice requires context-specific implementation plans. The Implementation Mapping protocol provided a roadmap to guide development of a robust implementation strategy that considered all ecological domains, was informed by theory, and demonstrated an extensive understanding of the implementation context. Strong research-practitioner partnerships and effective stakeholder engagement were critical to successful execution of the protocol.

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Program description and implementation findings of MyCare: enhancing community mental health care in Tasmania, Australia

Australian Journal of Primary Health ◽

10.1071/py20046 ◽

2020 ◽

Vol 26 (5) ◽

pp. 374

Author(s):

Renee O'Donnell ◽

Darshini Ayton ◽

Bengianni Pizzirani ◽

Melissa Savaglio ◽

Debra Fast ◽

...

Keyword(s):

Mental Health ◽

Implementation Strategy ◽

Controlled Trial ◽

Implementation Strategies ◽

Health Programs ◽

Successful Implementation ◽

Health Issues ◽

Community Based ◽

Mental Health Issues ◽

Mental Health Programs

Since 2014, Tasmania has experienced unprecedented rates of hospitalisations related to mental health issues. To address reliance on such acute-based care, government funding was invested to enhance community-based care, which, in turn, led to the development of MyCare. This paper represents the initial phase of a larger body of work (i.e. an effectiveness-controlled trial of MyCare) that describes the MyCare program and the successful implementation strategy underpinning the program. The implementation of MyCare was evaluated with 41 key stakeholders (staff, clients and senior executives) using semistructured interviews and focus groups, informed by the Consolidated Framework for Implementation Research (CFIR). According to stakeholders, three CFIR constructs that were directly addressed by the program, namely Tension for Change, Evidence Strength and Quality, and Available Resources for Implementation, facilitated the successful implementation of MyCare. In contrast, a feature of the program that impeded implementation was Patient Needs and Resources, which restricted program access to those with the most severe mental health issues. The reporting of implementation strategies underpinning mental health programs is rare. This study describes the implementation strategy underpinning a community-based mental health program that was successful in facilitating program uptake. We encourage other researchers to not only report on implementation findings, which may help avoid replication failure, but also to apply these innovative implementation processes (i.e. address the tension for change and ensure the program is evidence informed and that sufficient resources are available for implementation) within mental health programs to aid successful uptake.

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Implementation of the Swedish Guideline for Prevention of Mental ill-health at the Workplace: study protocol of a cluster randomized controlled trial, using multifaceted implementation strategies in schools

BMC Public Health ◽

10.1186/s12889-019-7976-6 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Lydia Kwak ◽

Caroline Lornudd ◽

Christina Björklund ◽

Gunnar Bergström ◽

Lotta Nybergh ◽

...

Keyword(s):

Risk Factors ◽

Mental Disorders ◽

Sick Leave ◽

Study Protocol ◽

Implementation Strategy ◽

Common Mental Disorders ◽

Controlled Trial ◽

Implementation Strategies ◽

Implementation Effectiveness ◽

Educational Meeting

Abstract Background Given today’s high prevalence of common mental disorders and related sick leave among teachers, an urgent need exists for a more systematic approach to the management of social and organizational risk factors within schools. In 2015, we launched the first Swedish occupational health guideline to support a structured prevention of these risks at the workplace. The existence of guidelines does however not guarantee their usage, as studies show that guidelines are often underused. Knowledge is therefore needed on effective implementation strategies that can facilitate the translation of guidelines into practice. The primary aim of the randomized waiting list-controlled trial described in this study protocol is to compare the effectiveness of a multifaceted implementation strategy versus a single implementation strategy for implementing the Guideline for the prevention of mental ill-health at the workplace within schools. The effectiveness will be compared regarding the extent to which the recommendations are implemented (implementation effectiveness) and with regard to social and organisational risk factors for mental ill-health, absenteeism and presenteeism (intervention effectiveness). Methods The trial is conducted among primary schools of two municipalities in Sweden. The single implementation strategy is an educational strategy (an educational meeting). The multifaceted strategy consists of the educational meeting, an implementation team and a series of workshops. The outcome measure of implementation effectiveness is guideline adherence. The primary outcome of intervention effectiveness is exhaustion. Secondary outcomes include demands at work, work organization and job contents, interpersonal relations and leadership, presenteeism, work performance, recovery, work-life balance, work-engagement, self-reported stress, self-perceived health, sickness absence and psychosocial safety climate. Process outcomes as well as barriers and facilitators influencing the implementation process are assessed. Data will be collected at baseline, 6, 12, 18 and 24 months by mixed methods (i.e. survey, focus-group interviews, observation). Discussion The study described in this protocol will provide valuable knowledge on the effectiveness of implementation strategies for implementing a guideline for the prevention of common mental disorders within schools. We hypothesize that successful implementation will result in reductions in school personnel’s perceived social and organizational risk factors, mental ill-health and sick-leave. Trial registration ClinicalTrials.gov ID: NCT03322839 (trial registration: 09/19/2017).

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