Barriers and facilitators to the implementation of osteoarthritis management programmes in primary or community care settings: a systematic review and qualitative framework synthesis protocol

Despite consistent international guidelines for osteoarthritis (OA) management, evidence-based treatments are underutilised. OA management programmes (OAMPs) are being implemented internationally to address this evidence-practice gap. An OAMP is defined as a ‘model of evidence-based, non-surgical OA care that has been implemented in a real-world setting’. Our objective is to identify, synthesise and appraise qualitative research identifying anticipated or experienced micro (individual/behavioural), meso (organisational) or macro (context/system) level barriers or facilitators to the implementation of primary or community care-based OAMPs. Five electronic databases will be searched for papers published between 2010 and 2021. Qualitative or mixed-methods studies that include qualitative data on the anticipated or experienced barriers or facilitators to the implementation of primary or community care-based OAMPs, from the perspective of service users or service providers, will be included. The review will be reported using the PRISMA and ENTREQ guidelines. A data extraction form will be used to provide details of the included studies. Data will be analysed and identified barriers and facilitators will be mapped onto an appropriate implementation framework, such as the Theoretical Domains Framework. The appropriate JBI critical appraisal tools will be used to assess methodological quality, while the GRADE‐CERQual approach will be used to assess confidence in the findings. Translation of evidence-based guidelines into practice is challenging and reliant on the quality of implementation. By comparing and contrasting anticipated and experienced barriers, this review will determine the extent of congruence between the two, and provide valuable insights into the views and experiences of key stakeholders involved in the implementation of OAMPs. The mapping of identified barriers and facilitators to behaviour change theory will enhance the applicability and construct validity of our findings and will offer significant utility for future development and implementation of OAMPs. Registration: This protocol was registered with PROSPERO (CRD42021255698) on 15/07/21.

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Barriers and Facilitators That Influence Providers’ Ability to Educate, Monitor, and Treat Substance Use in First-Episode Psychosis Programs Using the Theoretical Domains Framework

Qualitative Health Research ◽

10.1177/1049732321993443 ◽

2021 ◽

pp. 104973232199344

Author(s):

Oladunni Oluwoye ◽

Elizabeth Fraser

Keyword(s):

Substance Use ◽

Behavior Change ◽

Theoretical Domains Framework ◽

First Episode Psychosis ◽

Barriers And Facilitators ◽

First Episode ◽

Evidence Based ◽

Behavior Change Techniques ◽

Episode Psychosis ◽

And Behavior

In this qualitative study, we explore providers’ experiences with addressing substance use among individuals with first-episode psychosis (FEP) enrolled in coordinated specialty care (CSC) programs. Three focus groups were conducted with 24 providers from CSC programs for FEP in Washington. Questions were focused on barriers and facilitators to addressing substance use using the Theoretical Domains Framework (TDF) as a guide. Thematic analysis was used to code all transcripts. Identified TDF domains were then mapped onto the COM-B (Capability, Opportunity, Motivation, Behavior) intervention functions and behavior change techniques. Seven theoretical domains were identified as the most relevant to addressing substance use: “Knowledge,” “Skills,” “Environmental Context and Resources,” “Social Influences,” “Social and Professional Role and Identity,” “Beliefs about Capabilities,” and “Reinforcement.” The use of the TDF provides a framework to explore barriers and facilitators for targeting substance use and suggestions for behavior change techniques when considering implementation of evidence-based strategies to enhance CSC models.

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Evaluating the national multisite implementation of dialectical behaviour therapy in a community setting: A mixed methods approach

10.21203/rs.2.14353/v2 ◽

2019 ◽

Author(s):

Daniel Flynn ◽

Mary Joyce ◽

Conall Gillespie ◽

Mary Kells ◽

Michaela Swales ◽

...

Keyword(s):

Mixed Methods ◽

National Level ◽

Team Leader ◽

Barriers And Facilitators ◽

Future Research ◽

Evidence Based ◽

Community Settings ◽

Team Leaders ◽

Implementation Framework ◽

Mixed Methods Approach

Abstract Background The implementation of evidence-based interventions for borderline personality disorder in community settings is important given that individuals with this diagnosis are often extensive users of both inpatient and outpatient mental health services. Although work in this area is limited, previous studies have identified facilitators and barriers to successful DBT implementation. This study seeks to expand on previous work by evaluating a coordinated implementation of DBT in community settings at a national level. The Consolidated Framework for Implementation Research (CFIR) [1] provided structural guidance for this national level coordinated implementation.Methods A mixed methods approach was utilised to explore the national multi-site implementation of DBT from the perspective of team leaders and therapists who participated in the coordinated training and subsequent implementation of DBT. Qualitative interviews with DBT team leaders ( n = 8) explored their experiences of implementing DBT in their local service and was analysed using content analysis. Quantitative surveys from DBT therapists ( n = 74) examined their experience of multiple aspects of the implementation process including orienting the system, and preparations and support for implementation. Frequencies of responses were calculated. Written qualitative feedback was analysed using content analysis.Results Five themes were identified from the interview data: team formation, implementation preparation, client selection, service level challenges and team leader role. Participants identified team size and support for the team leader as key points for consideration in DBT implementation. Key challenges encountered were the lack of system support to facilitate phone coaching and a lack of allocated time to focus on DBT. Implementation facilitators included having dedicated team members and support from management.Conclusions The barriers and facilitators identified in this study are broadly similar to those reported in previous research. Barriers and facilitators were identified across several domains of the CFIR and are consistent with a recently published DBT implementation Framework [2]. Future research should pay particular attention to the domain of characteristics of individuals involved in DBT implementation. The results highlight the importance of a mandated service plan for the coordinated implementation of an evidence-based treatment in a public health service.

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Evaluating the national multisite implementation of dialectical behaviour therapy in a community setting: A mixed methods approach

10.21203/rs.2.14353/v3 ◽

2020 ◽

Author(s):

Daniel Flynn ◽

Mary Joyce ◽

Conall Gillespie ◽

Mary Kells ◽

Michaela Swales ◽

...

Keyword(s):

Content Analysis ◽

Mixed Methods ◽

National Level ◽

Team Leader ◽

Barriers And Facilitators ◽

Evidence Based ◽

Community Settings ◽

Team Leaders ◽

Implementation Framework ◽

Mixed Methods Approach

Abstract Background: The implementation of evidence-based interventions for borderline personality disorder in community settings is important given that individuals with this diagnosis are often extensive users of both inpatient and outpatient mental health services. Although work in this area is limited, previous studies have identified facilitators and barriers to successful DBT implementation. This study seeks to expand on previous work by evaluating a coordinated implementation of DBT in community settings at a national level. The Consolidated Framework for Implementation Research (CFIR) [1] provided structural guidance for this national level coordinated implementation. Methods: A mixed methods approach was utilised to explore the national multi-site implementation of DBT from the perspective of team leaders and therapists who participated in the coordinated training and subsequent implementation of DBT. Qualitative interviews with DBT team leaders (n = 8) explored their experiences of implementing DBT in their local service and was analysed using content analysis. Quantitative surveys from DBT therapists (n = 74) examined their experience of multiple aspects of the implementation process including orienting the system, and preparations and support for implementation. Frequencies of responses were calculated. Written qualitative feedback was analysed using content analysis. Results: Five themes were identified from the interview data: team formation, implementation preparation, client selection, service level challenges and team leader role. Participants identified team size and support for the team leader as key points for consideration in DBT implementation. Key challenges encountered were the lack of system support to facilitate phone coaching and a lack of allocated time to focus on DBT. Implementation facilitators included having dedicated team members and support from management. Conclusions: The barriers and facilitators identified in this study are broadly similar to those reported in previous research. Barriers and facilitators were identified across several domains of the CFIR and are consistent with a recently published DBT implementation Framework [2]. Future research should pay particular attention to the domain of characteristics of individuals involved in DBT implementation. The results highlight the importance of a mandated service plan for the coordinated implementation of an evidence-based treatment in a public health service.Trial Registration: ClinicalTrials.gov ID: NCT03180541; Registered June 7th 2017 ‘retrospectively registered’

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Main Factors Leading to Supplier-Induced Demand in Iran: A Comprehensive Review

Health Scope ◽

10.5812/jhealthscope.96366 ◽

2020 ◽

Vol 9 (2) ◽

Author(s):

Hesam Seyedin ◽

Mahnaz Afshari ◽

Parvaneh Isfahani ◽

Amir Rakhshan ◽

Ebrahim Hasanzadeh ◽

...

Keyword(s):

Health Systems ◽

Service Providers ◽

Data Extraction ◽

Risk Of Bias ◽

Induced Demand ◽

Persian Language ◽

Factors Influencing ◽

Meta Level ◽

Data Extraction Form ◽

Four Levels

Context: Supplier-induced demand (SID) is one of the challenges of health systems, leading to unbearable expenses, particularly for people. Objectives: The present study aimed to investigate the factors leading to SID in Iran. Data Sources: The present study is a comprehensive systematic review focusing on studies of SID up to the end of May 2018 in six English databases, five Persian databases, and two search engines. The exclusion criteria were publications in languages other than Persian and English and publications after May 2018. Data Extraction: A data extraction form was used to record authors' names and specifications, year of publication, the city of the study, language, purpose, methodology, data collection method, and factors influencing the induced demand. The risk of bias was assessed using a standard risk of bias tool. Results: We found 514 papers. Eventually, 16 papers met the inclusion criteria, and they were selected for the study. We found 11 papers in the Persian language and five articles in English. The design of 37.5% of the articles was qualitative, 31.25% analytical, 25% descriptive-analytical, and 6.25% descriptive. Factors influencing SID were classified at four levels including meta-level (Ministry of Health and Medical Education (MoHME)), macro-level (universities of Medical Sciences), meso-level (service providers), and micro-level (patients). Conclusions: According to the results of this research, creating SID can lead to serious challenges for health systems, service providers, patients, and insurance organizations. Therefore, health managers and policymakers need to design appropriate strategies such as adopting the evidence-based approach to purchasing services by the insurer and approval of standards and rules to reduce such SID.

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Evaluating methodological quality of Prognostic models Including Patient-reported HeAlth outcomes iN oncologY (EPIPHANY): a systematic review protocol

BMJ Open ◽

10.1136/bmjopen-2018-025054 ◽

2018 ◽

Vol 8 (10) ◽

pp. e025054 ◽

Cited By ~ 2

Author(s):

Nina Deliu ◽

Francesco Cottone ◽

Gary S Collins ◽

Amélie Anota ◽

Fabio Efficace

Keyword(s):

Systematic Review ◽

Systematic Reviews ◽

Methodological Quality ◽

Data Extraction ◽

Prognostic Models ◽

Published Data ◽

Evidence Based ◽

Patient Reported ◽

Data Extraction Form

IntroductionWhile there is mounting evidence of the independent prognostic value of patient-reported outcomes (PROs) for overall survival (OS) in patients with cancer, it is known that the conduct of these studies may hold a number of methodological challenges. The aim of this systematic review is to evaluate the quality of published studies in this research area, in order to identify methodological and statistical issues deserving special attention and to also possibly provide evidence-based recommendations.Methods and analysisAn electronic search strategy will be performed in PubMed to identify studies developing or validating a prognostic model which includes PROs as predictors. Two reviewers will independently be involved in data collection using a predefined and standardised data extraction form including information related to study characteristics, PROs measures used and multivariable prognostic models. Studies selection will be reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, with data extraction form using fields from the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS) checklist for multivariable models. Methodological quality assessment will also be performed and will be based on prespecified domains of the CHARMS checklist. As a substantial heterogeneity of included studies is expected, a narrative evidence synthesis will also be provided.Ethics and disseminationGiven that this systematic review will use only published data, ethical permissions will not be required. Findings from this review will be published in peer-reviewed scientific journals and presented at major international conferences. We anticipate that this review will contribute to identify key areas of improvement for conducting and reporting prognostic factor analyses with PROs in oncology and will lay the groundwork for developing future evidence-based recommendations in this area of research.Prospero registration numberCRD42018099160.

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Development of a hospital deprescribing implementation framework: A focus group study with geriatricians and pharmacists

Age and Ageing ◽

10.1093/ageing/afz133 ◽

2019 ◽

Vol 49 (1) ◽

pp. 102-110 ◽

Cited By ~ 3

Author(s):

Sion Scott ◽

Michael J Twigg ◽

Allan Clark ◽

Carol Farrow ◽

Helen May ◽

...

Keyword(s):

Patient Monitoring ◽

Hospital Setting ◽

Theoretical Domains Framework ◽

Evidence Based ◽

Focus Group Study ◽

Implementation Framework ◽

Barriers And Enablers ◽

Behavioural Determinants ◽

Caregiver Attachment ◽

Influence Perceptions

Abstract Background over 50% of older people in hospital are prescribed a pre-admission medicine that is potentially inappropriate; however, deprescribing by geriatricians and pharmacists is limited. This study aimed to characterise geriatricians’ and pharmacists’ barriers and enablers to deprescribing in hospital. It also intended to develop a framework of intervention components to facilitate implementation of hospital deprescribing. Methods fifty-four geriatricians and pharmacists representing four UK hospitals attended eight focus groups. We designed a topic guide to invite discussions about barriers and enablers to deprescribing. After thematic analysis, themes were mapped to the theoretical domains framework (TDF), enabling prioritisation of domains for behaviour change. We then identified evidence-based intervention components for changing behaviour within prioritised TDF domains. Results geriatricians and pharmacists described several deprescribing enablers in the hospital setting including alignment with their role and generalist knowledge, and routine patient monitoring. Five prioritised TDF domains represent the key barriers and enabler: patient and caregiver attachment to medication (social influence); perceptions that deprescribing is riskier than continuing to prescribe (beliefs about consequences); pharmacists’ working patterns limiting capacity to support deprescribing (environmental context and resources); deprescribing being a low hospital priority (goals) and incentives to deprescribe (reinforcement). Prioritised TDF domains aligned with 44 evidence-based intervention components to address the barriers and enabler to hospital deprescribing. Conclusion the behavioural determinants and their associated intervention components provide a hospital deprescribing implementation framework (hDIF). Intervention components should be selected from the hDIF to provide a theory and evidence-based intervention tailored to hospital contexts.

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Provider Resistance to Evidence-Based Practice in Schools: Why It Happens and How to Plan for It in Evaluations

10.3768/rtipress.2019.rb.0020.1905 ◽

2019 ◽

Cited By ~ 2

Author(s):

Lissette M. Saavedra ◽

Antonio A. Morgan-Lopez ◽

Anna C. Yaros ◽

Alex Buben ◽

James V. Trudeau

Keyword(s):

Mental Health ◽

Evidence Based Practice ◽

Service Providers ◽

Evidence Base ◽

Future Research ◽

Evidence Based ◽

Health Service Provision ◽

Early Implementation ◽

Evidence Based Treatments ◽

Mental Health Service Provision

Evidence-based practice is often encouraged in most service delivery settings, yet a substantial body of research indicates that service providers often show resistance or limited adherence to such practices. Resistance to the uptake of evidence-based treatments and programs is well-documented in several fields, including nursing, dentistry, counseling, and other mental health services. This research brief discusses the reasons behind provider resistance, with a contextual focus on mental health service provision in school settings. Recommendations are to attend to resistance in the preplanning proposal stage, during early implementation training stages, and in cases in which insufficient adherence or low fidelity related to resistance leads to implementation failure. Directions for future research include not only attending to resistance but also moving toward client-centered approaches grounded in the evidence base.

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Barriers and facilitators to provide quality TIA care in the Veterans Healthcare Administration

Neurology ◽

10.1212/wnl.0000000000004739 ◽

2017 ◽

Vol 89 (24) ◽

pp. 2422-2430 ◽

Cited By ~ 6

Author(s):

Teresa M. Damush ◽

Edward J. Miech ◽

Jason J. Sico ◽

Michael S. Phipps ◽

Greg Arling ◽

...

Keyword(s):

Care Facility ◽

Clinical Staff ◽

Barriers And Facilitators ◽

Audit And Feedback ◽

System Level ◽

Evidence Based ◽

Veterans Health ◽

Health Administration ◽

Cross Sectional

Objective:To identify key barriers and facilitators to the delivery of guideline-based care of patients with TIA in the national Veterans Health Administration (VHA).Methods:We conducted a cross-sectional, observational study of 70 audiotaped interviews of multidisciplinary clinical staff involved in TIA care at 14 VHA hospitals. We de-identified and analyzed all transcribed interviews. We identified emergent themes and patterns of barriers to providing TIA care and of facilitators applied to overcome these barriers.Results:Identified barriers to providing timely acute and follow-up TIA care included difficulties accessing brain imaging, a constantly rotating pool of housestaff, lack of care coordination, resource constraints, and inadequate staff education. Key informants revealed that both stroke nurse coordinators and system-level factors facilitated the provision of TIA care. Few facilities had specific TIA protocols. However, stroke nurse coordinators often expanded upon their role to include TIA. They facilitated TIA care by (1) coordinating patient care across services, communicating across service lines, and educating clinical staff about facility policies and evidence-based practices; (2) tracking individual patients from emergency departments to inpatient settings and to discharge for timely follow-up care; (3) providing and referring TIA patients to risk factor management programs; and (4) performing regular audit and feedback of quality performance data. System-level facilitators included clinical service leadership engagement and use of electronic tools for continuous care across services.Conclusions:The local organization within a health care facility may be targeted to cultivate internal facilitators and a systemic infrastructure to provide evidence-based TIA care.

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Aligning Perspectives?—Comparison of Top and Middle-Level Managers’ Views on How Organization Influences Implementation of evidence-based practice

The British Journal of Social Work ◽

10.1093/bjsw/bcz085 ◽

2019 ◽

Vol 50 (4) ◽

pp. 1126-1145 ◽

Cited By ~ 3

Author(s):

Annika Bäck ◽

Ulrica von Thiele Schwarz ◽

Henna Hasson ◽

Anne Richter

Keyword(s):

Social Services ◽

Organizational Context ◽

Middle Managers ◽

Evidence Based Practice ◽

Theoretical Domains Framework ◽

Middle Level ◽

System Level ◽

Evidence Based ◽

Process Data ◽

Staff Level

Abstract A supportive organizational context is important for successfully implementing evidence-based practice (EBP). Managers have an important role in creating organizational prerequisites for EBP. The present study compared how top- and middle-level managers describe the process of implementing EBP and the factors influencing this process. Data were collected through interviews with twenty-two managers in social services, and analysed with thematic deductive analysis based on the Theoretical Domains Framework (TDF) and the COM-B model. Findings showed that top-level managers focused more on strategic- and system-level issues, e.g. external comparisons, dialogue with authorities and creating support systems, while the middle managers focused on the operative implementation at staff level, i.e. motivating and involving staff. Furthermore, the two groups had different understandings of EBP. To conclude, there needs to be an alignment in the understanding of, and support for, EBP between the different levels of managers. To create a mutual understanding of what EBP entails and to clearly communicate how the organization applies the different steps of the EBP process could be crucial steps in enabling the implementation of EBP, and needs to be done in dialogue between middle- and top-level managers.

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