Evaluating the national multisite implementation of dialectical behaviour therapy in a community setting: A 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/v1 ◽

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.Trial Registration: ClinicalTrials.gov ID: NCT03180541; Registered June 7th 2017 ‘retrospectively registered’

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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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Patient and public involvement in numerical aspects of trials: a mixed methods theory-informed survey of trialists’ current practices, barriers and facilitators

BMJ Open ◽

10.1136/bmjopen-2020-046977 ◽

2021 ◽

Vol 11 (3) ◽

pp. e046977

Author(s):

Beatriz Goulao ◽

Camille Poisson ◽

Katie Gillies

Keyword(s):

Mixed Methods ◽

Online Survey ◽

Public Involvement ◽

Theoretical Domains Framework ◽

Patient And Public Involvement ◽

Barriers And Facilitators ◽

Future Research ◽

Mixed Methods Approach ◽

Scarce Resources ◽

The Public

ObjectiveWe aimed to find out if trialists involve patients and the public in numerical aspects of trials, how and what are the barriers and facilitators to doing it.DesignWe developed a survey based on the Theoretical Domains Framework. We used a mixed methods approach to analyse the data and to identify important domains.SettingOnline survey targeting UK-based trial units.ParticipantsStakeholders working in UK-based clinical trials, 18 years old or over, understand English and agree to take part in the study.Outcome measuresTrialists’ behaviour of involving patients and the public in numerical aspects of trials and its determinants.ResultsWe included 187 respondents. Majority were female (70%), trial managers (67%) and involved public and patient partners in numerical aspects of trials (60%). We found lack of knowledge, trialists’ perception of public and patient partners’ skills, capabilities and motivations, scarce resources, lack of reinforcement, and lack of guidance were barriers to involving public and patient partners in numerical aspects of trials. Positive beliefs about consequences were an incentive to doing it.ConclusionsMore training, guidance and funding can help trialists involve patient and public partners in numerical aspects, although they were uncertain about public and patient partners’ motivation to be involved. Future research should focus on identifying public and patient partners’ motivations and develop strategies to improve the communication of numerical aspects.

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Nutritional status, food choices, barriers and facilitators to healthy nutrition in pregnant women with severe mental illness: a mixed methods approach

Journal of Human Nutrition and Dietetics ◽

10.1111/jhn.12752 ◽

2020 ◽

Vol 33 (5) ◽

pp. 698-707

Author(s):

J. Frayne ◽

Y. Hauck ◽

P. Sivakumar ◽

T. Nguyen ◽

H. Liira ◽

...

Keyword(s):

Mental Illness ◽

Mixed Methods ◽

Nutritional Status ◽

Severe Mental Illness ◽

Pregnant Women ◽

Food Choices ◽

Barriers And Facilitators ◽

Mixed Methods Approach ◽

Healthy Nutrition

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The psychological and ideological foundations of meat consumption, vegetarianism, and veganism

10.26686/wgtn.17142983 ◽

2021 ◽

Author(s):

◽

Madeline Judge

Keyword(s):

Mixed Methods ◽

Thematic Analysis ◽

Process Models ◽

Dual Process ◽

Future Research ◽

Discussion Forums ◽

Convenience Sample ◽

Mixed Methods Approach ◽

Positive Attitudes ◽

Attitude Measures

<p>Despite increasing evidence suggesting that plant-based diets may have multiple benefits over animal-based diets (e.g., Craig & Mangels, 2009; Stehfest, et al., 2009), vegetarians and vegans tend to represent a minority of most Western populations. This thesis investigated the social and ideological foundations of perceptions of vegetarians and vegans in Western societies, and also explored the potential role of visions of the future in motivating support for social change towards plant-based diets. For my first two studies, I adopted a mixed methods approach to understanding perceptions of vegetarians and vegans in Western societies (Creswell, 2014). Study 1 was a thematic analysis of 44 online discussion forums containing evaluations of vegetarians and vegans as social groups, and the analysis was informed by discursive and rhetorical psychology (Billig, 1996; Potter, 1996). In my interpretations of the data, I highlighted the flexible and argumentative nature of expressing ‘attitudes’ towards vegetarians and vegans. I also discussed these discourses in relation to the wider ideological dilemmas of liberal individualism, rationality versus emotions, diet and health, and the human-animal relationship. In Study 2, I drew on the discourses in Study 1 to develop a survey-based investigation of attitudes towards vegetarians and vegans, in a sample recruited from the general population of Aotearoa New Zealand (N = 1326). Two attitude measures were developed based on a previous scale assessing attitudes towards vegetarians (Chin, Fisak & Sims, 2002). Attitudes towards both vegetarians and vegans were generally positive; however, attitudes towards vegans were significantly less positive than attitudes towards vegetarians. Subsequent analyses tested two dual-process motivational models of social worldviews, ideological attitudes and outgroup attitudes (Duckitt, 2001), in the prediction of non-vegetarian attitudes towards vegetarians and vegans. The dual-process models fit the data well, suggesting that ideological motivations to maintain social cohesion and social inequality were associated with increasingly less positive attitudes towards vegetarians and vegans. I proposed that these associations may be due to vegetarians and vegans representing a challenge to social traditions, and a rejection of human dominance over animals. In Study 3, I adopted a mixed methods approach to understanding visions of plant-based futures, in a convenience sample of first-year university students (N = 506). Study 3a involved a thematic analysis of participants’ visions of potential future NZ societies, where most of the population now consumes plant-based, vegetarian, or vegan diets. Dominant themes included changes to health, the environment, and the economy, as well as changes to individual traits and values. In Study 3b, non-vegetarian participants were randomly assigned to imagine plant-based, vegetarian or vegan futures, and then completed a survey of collective future dimensions and support for plant-based policies (drawing from Bain, Hornsey, Bongiorno, Kashima, & Crimston, 2013). The strongest predictors of support for plant-based policies were visions of a vegetarian future as reducing societal dysfunction, and visions of a vegan future as increasing warmth in individuals. I concluded the thesis by reviewing the theoretical implications of the current research, discussing future research directions, and proposing some suggestions for the advocacy of plant-based diets.</p>

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Implementation of Social Needs Screening in Primary Care: A Qualitative Study Using the Health Equity Implementation Framework

10.21203/rs.3.rs-455846/v1 ◽

2021 ◽

Author(s):

Connor Drake ◽

Heather Batchelder ◽

Tyler Lian ◽

Meagan Cannady ◽

Morris Weinberger ◽

...

Keyword(s):

Primary Care ◽

Health Outcomes ◽

Health Equity ◽

Social Needs ◽

Barriers And Facilitators ◽

Future Research ◽

Implementation Barriers ◽

Patient Acceptability ◽

Implementation Framework ◽

Clinical Encounters

Abstract Background: Screening in primary care for unmet individual social needs (e.g., housing instability, food insecurity, unemployment, social isolation) is critical to addressing the deleterious effects on patients’ health outcomes. Evidence is needed regarding approaches to implementing such screening in routine clinical encounters to enhance social care integration. To our knowledge, this is the first study to apply an implementation science framework to identify implementation factors and best practices.Methods: Guided by the Health Equity Implementation Framework (HEIF), we collected qualitative data from providers and patients to evaluate barriers and facilitators to implementing the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE), a standardized social needs screening and response protocol, in a federally qualified health center. Eligible patients (n = 2,192) who received the PRAPARE as a standard of care at three of the center’s clinics (Adult Medicine, Family Medicine, and Pediatrics) were invited to participate in semi-structured interviews. We also obtained front-line clinician perspectives in a semi-structured focus group. We used HEIF domains to inform a directed content analysis.Results: Patients and clinicians (i.e., case managers) reported implementation barriers and facilitators across multiple levels (e.g., clinical encounters, patient and provider factors, inner context, outer context, and societal influence). Implementation barriers included structural and policy level determinants related to resource availability, discrimination, and administrative burden. Facilitators included evidence-based clinical techniques for shared decision making (e.g., motivational interviewing), team-based staffing models, and beliefs related to alignment of the PRAPARE with patient-centered care. We found high levels of patient acceptability and opportunities for adaptation to increase equitable adoption and reach.Conclusion: Our results provide practical insight into the implementation of the PRAPARE or similar social needs screening and response protocols in primary care. Our findings highlight the dynamic relationship between barriers and facilitators to implementation at the individual encounter, organizational, community, and societal levels. Future research should focus on developing discrete implementation strategies to promote social needs screening and response, and associated multisector care coordination to improve health outcomes and equity for vulnerable and marginalized patient populations.

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Knowledge Management Paradigms, Philosophical Assumptions: An Outlook on Future Research

American Journal of Management ◽

10.33423/ajm.v18i3.74 ◽

2018 ◽

Vol 18 (3) ◽

pp. 61-74

Keyword(s):

Knowledge Management ◽

Mixed Methods ◽

Critical Realism ◽

Future Research ◽

Mixed Methods Approach ◽

Management Paradigms

This study informs knowledge management (KM) research assessing the philosophical assumptions and paradigms that have formed around the discipline. Reviewing positivism, critical realism, interpretivism or constructivism, and pragmatism the researcher suggests to draw on constructivism to inform KM theory. Moreover, it is suggested that a mixed methods approach is the most suitable to engage in research on KM so that a flexibility can be maintained that will allow to detect what KM is and how knowledge can be managed.

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A Limb Hypothermia Wearable for Chemotherapy-Induced Peripheral Neuropathy: A Mixed-Methods Approach in Medical Product Development

Frontiers in Digital Health ◽

10.3389/fdgth.2020.573234 ◽

2020 ◽

Vol 2 ◽

Author(s):

Jonathan Binder ◽

Ertu Unver ◽

Jane Clayton ◽

Patrick Burke ◽

Richard Paxman ◽

...

Keyword(s):

Mixed Methods ◽

Peripheral Neuropathy ◽

Medical Device ◽

Development Process ◽

Central Component ◽

Evidence Based ◽

Device Design ◽

Mixed Methods Approach ◽

Medical Device Design ◽

Hands And Feet

Chemotherapy-Induced Peripheral Neuropathy (CIPN) is a common dose-limiting side-effect of taxane-based chemotherapy, causing progressive and often irreversible pain/sensitivity in the hands and feet. Prevention/treatments for CIPN are not well-developed and urgently needed. Limb cryocompression during chemotherapy has demonstrated promising early data of preventing/reducing CIPN severity. Currently there are no medical devices available that are dedicated to the specific requirements of CIPN prevention. As part of our ongoing development of a dedicated CIPN-prevention limb cryocompression system, this study documents the design & development of the wearable arm wrap, a central component of the system, from initial concept to a trial-ready prototype. A collaborative and multidisciplinary approach was adopted to address the complex and high-risk nature of this SME (Small Medium Enterprise)-centered medical device design & development process. The complementary collaboration unites multidisciplinary expertise spanning the scope of the project. Alongside the clinical, academic, and design & development expertise, the integration of commercial expertise is imperative to promote the market viability, and ultimate success, of the development. As the global leading experts in scalp cooling specializing in the prevention of chemotherapy-induced alopecia, UK-based SME Paxman Coolers Ltd is optimally positioned to support the commercial and regulatory dimensions. Development and adoption of a novel mixed-methodology (HudPAX) facilitated the integration of evidence-based and user-centered techniques to optimize the design & development approach and ensure integration of all critical design inputs. Alpha prototypes were designed through evidence-based approaches, with data from existing clinical trials utilized to determine the preliminary design inputs, alongside 3D ergonomic data. Investigations utilized computer-aided design, rapid prototyping, additive manufacturing, sketch modeling, and fast ideation. User-based approaches facilitated stakeholder-feedback through expert focus groups, informing further design & development and projecting the design into the next stage, Beta prototyping, for use in large-scale efficacy trials and upscaling manufacturing. This paper demonstrates a novel mixed-methods approach, which promotes cross-sector multidisciplinary collaboration, to address the complex multi-layered challenges posed by an early-stage medical device design & development process.

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