scholarly journals A more practical guide to incorporating health equity domains in implementation determinant frameworks

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Eva N. Woodward ◽  
Rajinder Sonia Singh ◽  
Phiwinhlanhla Ndebele-Ngwenya ◽  
Andrea Melgar Castillo ◽  
Kelsey S. Dickson ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Health Equity ◽  
Clinical Encounter ◽  
Prior Work ◽  
Consensus Process ◽  
Implementation Framework ◽  
Research And Practice ◽  
Societal Context ◽  
Practical Guidance ◽  
Relevant Factors

Abstract Background Due to striking disparities in the implementation of healthcare innovations, it is imperative that researchers and practitioners can meaningfully use implementation determinant frameworks to understand why disparities exist in access, receipt, use, quality, or outcomes of healthcare. Our prior work documented and piloted the first published adaptation of an existing implementation determinant framework with health equity domains to create the Health Equity Implementation Framework. We recommended integrating these three health equity domains to existing implementation determinant frameworks: (1) culturally relevant factors of recipients, (2) clinical encounter or patient-provider interaction, and (3) societal context (including but not limited to social determinants of health). This framework was developed for healthcare and clinical practice settings. Some implementation teams have begun using the Health Equity Implementation Framework in their evaluations and asked for more guidance. Methods We completed a consensus process with our authorship team to clarify steps to incorporate a health equity lens into an implementation determinant framework. Results We describe steps to integrate health equity domains into implementation determinant frameworks for implementation research and practice. For each step, we compiled examples or practical tools to assist implementation researchers and practitioners in applying those steps. For each domain, we compiled definitions with supporting literature, showcased an illustrative example, and suggested sample quantitative and qualitative measures. Conclusion Incorporating health equity domains within implementation determinant frameworks may optimize the scientific yield and equity of implementation efforts by assessing and ideally addressing implementation and equity barriers simultaneously. These practical guidance and tools provided can assist implementation researchers and practitioners to concretely capture and understand barriers and facilitators to implementation disparities.

A More Practical Guide to Incorporating Health Equity Domains in Implementation Determinant Frameworks

2020 ◽  
Author(s):  
Eva N Woodward ◽  
Rajinder Sonia Singh ◽  
Phiwinhlanhla Ndebele-Ngwenya ◽  
Andrea Melgar Castillo ◽  
Kelsey S. Dickson ◽  
...  
Keyword(s):  
Health Care ◽  
Health Equity ◽  
Clinical Encounter ◽  
Cultural Factors ◽  
Prior Work ◽  
Consensus Process ◽  
Implementation Framework ◽  
Research And Practice ◽  
Societal Context ◽  
Practical Guidance

Abstract Background: Due to striking disparities in implementation of healthcare innovations, it is imperative researchers and practitioners can meaningfully use implementation determinant frameworks to understand why disparities exist in access, receipt, use, quality, or outcomes of health care. Our prior work documented and piloted the first published adaptation of an existing implementation determinant framework with health equity domains to create the Health Equity Implementation Framework. We recommended integrating these three health equity domains to existing implementation determinant frameworks: 1) cultural factors of recipients, 2) clinical encounter, or patient-provider interaction, and 3) societal context (including but not limited to social determinants of health). This framework was developed for health care and clinical practice settings. Some implementation teams have begun using the Health Equity Implementation Framework in their evaluations and asked for more guidance.Methods: We completed a consensus process with our authorship team to clarify steps to incorporate a health equity lens into an implementation determinant framework.Results: We describe steps to integrate health equity domains into implementation determinant frameworks for implementation research and practice. For each step, we compiled examples or practical tools to assist implementation researchers and practitioners in applying those steps. For each domain, we compiled definitions with supporting literature, showcased an illustrative example, and suggested sample quantitative and qualitative measures.Conclusion: Incorporating health equity domains within implementation determinant frameworks may optimize the scientific yield and equity of implementation efforts by assessing and ideally, addressing, implementation and equity barriers simultaneously. These practical guidance and tools provided can assist implementation researchers and practitioners to concretely capture and understand barriers and facilitators to implementation disparities.

scholarly journals A Practical Guide to Incorporating Health Equity Domains in Implementation Frameworks

2020 ◽  
Author(s):  
Eva N Woodward ◽  
Rajinder Sonia Singh ◽  
Phiwinhlanhla Ndebele-Ngwenya ◽  
Andrea Melgar Castillo ◽  
Kelsey S. Dickson ◽  
...  
Keyword(s):  
Implementation Science ◽  
Health Equity ◽  
Implementation Research ◽  
Clinical Encounter ◽  
Implementation Framework ◽  
Research And Practice ◽  
Practical Guide ◽  
Interview Guide ◽  
Practical Guidelines ◽  
Science Framework

Abstract Background: Due to limited systematic integration of health equity and implementation science, it is imperative to provide researchers and practitioners tools to guide implementation in settings where there is inequitable implementation of an intervention. Our prior work documented and piloted the first published adaptation of an existing implementation science framework with health equity determinants to create the Health Equity Implementation Framework. We suggested how others’ might adapt their preferred implementation science frameworks with three health equity domains: 1) cultural factors of recipients, 2) clinical encounter, or patient-provider interaction, and 3) societal influences (including but not limited to social determinants of health). This manuscript is a practical guide to utilize three health equity domains in implementation research and practice.Methods: We describe in greater depth than in our previous publication domains typical in implementation determinants frameworks and three adaptations: domains known to affect health equity. For each domain, we compiled definitions with supporting literature, defined relevant subdomains, showcased an illustrative example, and suggested sample measures, both quantitative and qualitative.Results: We describe how to incorporate the three health equity domains in one’s preferred implementation science framework, or how to use the Health Equity Implementation Framework specifically. Practical guidelines follow ten published recommendations on how to use frameworks in implementation research and practice. We describe a new case study in which the framework guided evaluation.Conclusions: Incorporating health equity domains within implementation frameworks may optimize the scientific yield and equity of implementation efforts by assessing and ideally, addressing, implementation and equity barriers simultaneously. The practical guidance and tools provided can assist implementation scientists and practitioners to concretely address inequity in implementation across populations to capture and analyze information used to assess health outcomes.Contributions to the LiteratureSpecific definitions of implementation and three health equity domains with examples of how they have been applied in published literature and sample measures.Practical tools, including a qualitative interview guide and codebookCase study of how the Health Equity Implementation Framework guided analysis in an implementation study

scholarly journals So What? Implications of Network Theory for Research and Practice

2021 ◽  
Author(s):  
Payton J. Jones ◽  
Donald Robinaugh
Keyword(s):  
Clinical Practice ◽  
Network Theory ◽  
Medical Model ◽  
Signs And Symptoms ◽  
Psychological Problems ◽  
Research And Practice ◽  
Behavioral Therapies ◽  
Cognitive Behavioral Therapies ◽  
Disease Entities ◽  
The Brain

Research and practice in psychiatry and clinical psychology have been guided by differing schools of thought over the years. Recently, the network theory of psychopathology has arisen as a framework for thinking about mental health. Network theory challenges three assumptions common in the field: (1) psychological problems are caused by disease entities that exist independently of their signs and symptoms, (2) classification and diagnosis of psychological problems should follow a medical model, and (3) psychological problems are caused by diseases or aberrations in the brain. Conversely, it embraces many other assumptions that are already well accepted in clinical practice (e.g., the interaction of thoughts, behaviors, and emotions, as posited in cognitive-behavioral therapies) and integrates those assumptions into a coherent framework for research and practice. We review developments in the network theory with a focus on anxiety-related conditions, discuss future areas for change, and outline implications of the theory for both research and clinical practice.

scholarly journals Moving Stroke Rehabilitation Research Evidence into Clinical Practice: Consensus-Based Core Recommendations From the Stroke Recovery and Rehabilitation Roundtable

2019 ◽  
Vol 33 (11) ◽  
pp. 935-942 ◽  
Author(s):  
Janice J. Eng ◽  
Marie-Louise Bird ◽  
Erin Godecke ◽  
Tammy C. Hoffmann ◽  
Carole Laurin ◽  
...  
Keyword(s):  
Health Care ◽  
Clinical Practice ◽  
Service Delivery ◽  
Health Care Providers ◽  
Stroke Rehabilitation ◽  
Research Evidence ◽  
Stroke Recovery ◽  
Care Providers ◽  
Consensus Process ◽  
International Consensus

Moving research evidence to practice can take years, if not decades, which denies stroke patients and families from receiving the best care. We present the results of an international consensus process prioritizing what research evidence to implement into stroke rehabilitation practice to have maximal impact. An international 10-member Knowledge Translation Working Group collaborated over a six-month period via videoconferences and a two-day face-to-face meeting. The process was informed from surveys received from 112 consumers/family members and 502 health care providers in over 28 countries, as well as from an international advisory of 20 representatives from 13 countries. From this consensus process, five of the nine identified priorities relate to service delivery (interdisciplinary care, screening and assessment, clinical practice guidelines, intensity, family support) and are generally feasible to implement or improve upon today. Readily available website resources are identified to help health care providers harness the necessary means to implement existing knowledge and solutions to improve service delivery. The remaining four priorities relate to system issues (access to services, transitions in care) and resources (equipment/technology, staffing) and are acknowledged to be more difficult to implement. We recommend that health care providers, managers, and organizations determine whether the priorities we identified are gaps in their local practice, and if so, consider implementation solutions to address them to improve the quality of lives of people living with stroke.

scholarly journals Advances in Clinical Decision Support: Highlights of Practice and the Literature 2015-2016

2017 ◽  
Vol 26 (01) ◽  
pp. 125-132
Author(s):  
R. A. Jenders
Keyword(s):  
Clinical Practice ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Negative Impact ◽  
Clinical Care ◽  
Clinical Decision ◽  
Theory Approach ◽  
Research And Practice ◽  
Work Related ◽  
Active Research

Summary Introduction: Advances in clinical decision support (CDS) continue to evolve to support the goals of clinicians, policymakers, patients and professional organizations to improve clinical practice, patient safety, and the quality of care. Objectives: Identify key thematic areas or foci in research and practice involving clinical decision support during the 2015-2016 time period. Methods: Thematic analysis consistent with a grounded theory approach was applied in a targeted review of journal publications, the proceedings of key scientific conferences as well as activities in standards development organizations in order to identify the key themes underlying work related to CDS. Results: Ten key thematic areas were identified, including: 1) an emphasis on knowledge representation, with a focus on clinical practice guidelines; 2) various aspects of precision medicine, including the use of sensor and genomic data as well as big data; 3) efforts in quality improvement; 4) innovative uses of computer-based provider order entry (CPOE) systems, including relevant data displays; 5) expansion of CDS in various clinical settings; 6) patient-directed CDS; 7) understanding the potential negative impact of CDS; 8) obtaining structured data to drive CDS interventions; 9) the use of diagnostic decision support; and 10) the development and use of standards for CDS. Conclusions: Active research and practice in 2015-2016 continue to underscore the importance and broad utility of CDS for effecting change and improving the quality and outcome of clinical care.

scholarly journals Implications of conflicting definitions of probability to health risk communication: a case study of familial cancer and genetic counselling

2007 ◽  
Vol 31 (1) ◽  
pp. 24 ◽  
Author(s):  
Kieran C O'Doherty
Keyword(s):  
Clinical Practice ◽  
Health Risk ◽  
Risk Communication ◽  
Genetic Counselling ◽  
Health Professionals ◽  
Health Research ◽  
Familial Cancer ◽  
Health Sciences ◽  
Research And Practice

The question of what probability actually is has long been debated in philosophy and statistics. Although the concept of probability is fundamental to many applications in the health sciences, these debates are generally not well known to health professionals. This paper begins with an outline of some of the different interpretations of probability. Examples are provided of how each interpretation manifests in clinical practice. The discipline of genetic counselling (familial cancer) is used to ground the discussion. In the second part of the paper, some of the implications that different interpretations of probability may have in practice are examined. The main purpose of the paper is to draw attention to the fact that there is much contention as to the nature of the concept of probability. In practice, this creates the potential for ambiguity and confusion. This paper constitutes a call for deeper engagement with the ways in which probability and risk are understood in health research and practice.

Narrative resistance in social work research and practice: Counter-storying in the pursuit of social justice

2017 ◽  
Vol 16 (2) ◽  
pp. 189-205 ◽  
Author(s):  
Suzanne McKenzie-Mohr ◽  
Michelle N Lafrance
Keyword(s):  
Social Justice ◽  
Social Work ◽  
Social Workers ◽  
Master Narratives ◽  
Research And Practice ◽  
Social Work Research ◽  
Counter Narratives ◽  
Practical Guidance

In this article, we propose ‘narrative resistance’ as a potent and useful concept for both social work research and practice. A concept that attends to power and oppression, narrative resistance provides a platform for tangible applications to support people’s efforts to resist harmful storyings of their lives. The aim of this article is to provide practical guidance for how social workers can attend to and support people’s acts of narrative resistance. This is achieved by introducing the functions of narrative in people’s lives and its inextricable links to power; discussing ‘master narratives’ and their potential for harm; and exploring narrative resistance by articulating the role of ‘counter narratives’ as a means to ‘talk back’ to injurious master narratives. The remainder of the article outlines considerations, skills and tools required to enhance counter-storying efforts in the service of emancipatory change. We spotlight examples of narrative resistance in the literature to illustrate the pragmatic mobilization of this work.

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