Evaluation of the Implementation Process of the Mobile Health Platform ‘WelTel’ in Six Sites in East Africa and Canada Using the Modified Consolidated Framework for Implementation Research (mCFIR)

Abstract Background: Health systems globally are investing in integrating secure messaging platforms for virtual care in clinical practice. Implementation science is essential for adoption, scale-up, spread and maintenance of complex evidence-based solutions in clinics with evolving priorities. In response, the mHealth Research Group modified the existing Consolidated Framework for Implementation Research (mCFIR) to evaluate implementation of virtual health tools in clinical settings. WelTel® is an evidence-based digital health platform widely deployed in various geographical and health contexts. Objectives: To identify the facilitators and barriers for implementing WelTel and to assess the application of the mCFIR tool in facilitating focus groups in different geographical and health settings. Methodology: Both qualitative and semi-quantitative approaches were employed. Six mCFIR sessions were held in three countries with 51 key stakeholders surveyed. The mCFIR tool consists of 5 Domains and 25 Constructs and was built and distributed through Qualtrics XM. “Performance ” and “Importance” scores were valued on a scale of 0 to 10 (Mean + SD). Descriptive analysis was conducted using R computing software. NVivo 12 Pro software was used to analyze mCFIR responses and to generate themes from the participants’ input. Semi-structured interviews were conducted with the focus group facilitators to understand their experience using the mCFIR tool. Results: We observed a parallel trend in the scores for Importance and Performance. Of the five Domains, Domain 4 (End-user Characteristics) and Domain 3 (Inner Settings) scored highest in Importance (8.9 + 0.5 and 8.6 + 0.6, respectively) and Performance (7.6 + 0.7 and 7.2 + 1.3, respectively) for all sites. Domain 2 (Outer Setting) scored the lowest in both Importance and Performance for all sites (7.6 + 0.4 and 5.6 + 1.8). Areas of strengths included timely diagnosis, immediate response, cost-effectiveness, user-friendliness, and simplicity. Areas for improvement included training, phone accessibility, health authority’s engagement, and literacy. Conclusion: The mCFIR tool allowed for a comprehensive understanding of the barriers and facilitators to the implementation, reach, and scale-up of digital health tools. Participants emphasized the importance of creating partnerships with external organizations and health authorities in order to achieve sustainability and scalability.Trial Registration: NCT02603536 – November 11, 2015NCT01549457 – March 9, 2012

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Evaluation of the Implementation Process of the Mobile Health Platform ‘WelTel’ in Six Sites in East Africa and Canada Using the Modified Consolidated Framework for Implementation Research (mCFIR)

10.21203/rs.3.rs-110557/v1 ◽

2020 ◽

Author(s):

Samia El Joueidi ◽

Kevin Bardosh ◽

Richard Musoke ◽

Binyam Tilahun ◽

Maryam Abo Moslim ◽

...

Keyword(s):

Implementation Research ◽

Digital Health ◽

Descriptive Analysis ◽

Scale Up ◽

Implementation Process ◽

Evidence Based ◽

Structured Interviews ◽

User Friendliness ◽

Domain 3 ◽

And Performance

Abstract Background: Health systems globally are investing in integrating secure messaging platforms for virtual care in clinical practice. Implementation science is essential for adoption, scale-up, spread and maintenance of complex evidence-based solutions in clinics with evolving priorities. In response, the mHealth Research Group modified the existing Consolidated Framework for Implementation Research (mCFIR) to evaluate implementation of virtual health tools in clinical settings. WelTel® is an evidence-based digital health platform widely deployed in various geographical and health contexts. Objectives: To identify the facilitators and barriers for implementing WelTel and to assess the application of the mCFIR tool in facilitating focus groups in different geographical and health settings. Methodology: Both qualitative and semi-quantitative approaches were employed. Six mCFIR sessions were held in three countries with 51 key stakeholders surveyed. The mCFIR tool consists of 5 Domains and 25 Constructs and was built and distributed through Qualtrics XM. “Performance ” and “Importance” scores were valued on a scale of 0 to 10 (Mean + SD). Descriptive analysis was conducted using R computing software. NVivo 12 Pro software was used to analyze mCFIR responses and to generate themes from the participants’ input. Semi-structured interviews were conducted with the focus group facilitators to understand their experience using the mCFIR tool. Results: We observed a parallel trend in the scores for Importance and Performance. Of the five Domains, Domain 4 (End-user Characteristics) and Domain 3 (Inner Settings) scored highest in Importance (8.9 + 0.5 and 8.6 + 0.6, respectively) and Performance (7.6 + 0.7 and 7.2 + 1.3, respectively) for all sites. Domain 2 (Outer Setting) scored the lowest in both Importance and Performance for all sites (7.6 + 0.4 and 5.6 + 1.8). Areas of strengths included timely diagnosis, immediate response, cost-effectiveness, user-friendliness, and simplicity. Areas for improvement included training, phone accessibility, health authority’s engagement, and literacy. Conclusion: The mCFIR tool allowed for a comprehensive understanding of the barriers and facilitators to the implementation, reach, and scale-up of digital health tools. Participants emphasized the importance of creating partnerships with external organizations and health authorities in order to achieve sustainability and scalability.Trial Registration: · NCT02603536 – November 11, 2015· NCT01549457 – March 9, 2012

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Evaluation of the Implementation Process of the Mobile Health Platform ‘WelTel’ in Six Sites in East Africa and Canada Using the Modified Consolidated Framework for Implementation Research (mCFIR)

10.21203/rs.3.rs-144180/v1 ◽

2021 ◽

Author(s):

Samia El Joueidi ◽

Kevin Bardosh ◽

Richard Musoke ◽

Binyam Tilahun ◽

Maryam Abo Moslim ◽

...

Keyword(s):

Implementation Research ◽

Digital Health ◽

Descriptive Analysis ◽

Scale Up ◽

Implementation Process ◽

Evidence Based ◽

Structured Interviews ◽

User Friendliness ◽

Domain 3 ◽

And Performance

Abstract BackgroundHealth systems globally are investing in integrating secure messaging platforms for virtual care in clinical practice. Implementation science is essential for adoption, scale-up, spread and maintenance of complex evidence-based solutions in clinics with evolving priorities. In response, the mHealth Research Group modified the existing Consolidated Framework for Implementation Research (mCFIR) to evaluate implementation of virtual health tools in clinical settings. WelTel® is an evidence-based digital health platform widely deployed in various geographical and health contexts. ObjectivesTo identify the facilitators and barriers for implementing WelTel and to assess the application of the mCFIR tool in facilitating focus groups in different geographical and health settings. MethodologyBoth qualitative and semi-quantitative approaches were employed. Six mCFIR sessions were held in three countries with 51 key stakeholders surveyed. The mCFIR tool consists of 5 Domains and 25 Constructs and was built and distributed through Qualtrics XM. “Performance ” and “Importance” scores were valued on a scale of 0 to 10 (Mean + SD). Descriptive analysis was conducted using R computing software. NVivo 12 Pro software was used to analyze mCFIR responses and to generate themes from the participants’ input. Semi-structured interviews were conducted with the focus group facilitators to understand their experience using the mCFIR tool. ResultsWe observed a parallel trend in the scores for Importance and Performance. Of the five Domains, Domain 4 (End-user Characteristics) and Domain 3 (Inner Settings) scored highest in Importance (8.9 + 0.5 and 8.6 + 0.6, respectively) and Performance (7.6 + 0.7 and 7.2 + 1.3, respectively) for all sites. Domain 2 (Outer Setting) scored the lowest in both Importance and Performance for all sites (7.6 + 0.4 and 5.6 + 1.8). Areas of strengths included timely diagnosis, immediate response, cost-effectiveness, user-friendliness, and simplicity. Areas for improvement included training, phone accessibility, health authority’s engagement, and literacy. ConclusionThe mCFIR tool allowed for a comprehensive understanding of the barriers and facilitators to the implementation, reach, and scale-up of digital health tools. Participants emphasized the importance of creating partnerships with external organizations and health authorities in order to achieve sustainability and scalability.Trial Registration: NCT02603536 – November 11, 2015NCT01549457 – March 9, 2012

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Evaluation of the implementation process of the mobile health platform ‘WelTel’ in six sites in East Africa and Canada using the modified consolidated framework for implementation research (mCFIR)

BMC Medical Informatics and Decision Making ◽

10.1186/s12911-021-01644-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Samia El Joueidi ◽

Kevin Bardosh ◽

Richard Musoke ◽

Binyam Tilahun ◽

Maryam Abo Moslim ◽

...

Keyword(s):

Mobile Health ◽

Implementation Research ◽

Text Messaging ◽

Digital Health ◽

Descriptive Analysis ◽

Scale Up ◽

Evidence Based ◽

User Friendliness ◽

Domain 3 ◽

And Performance

Abstract Background Health systems globally are investing in integrating secure messaging platforms for virtual care in clinical practice. Implementation science is essential for adoption, scale-up, spread and maintenance of complex evidence-based solutions in clinics with evolving priorities. In response, the mobile Health (mHealth) Research Group modified the existing consolidated framework for implementation research (CFIR) to evaluate implementation of virtual health tools in clinical settings. WelTel® is an evidence-based digital health platform widely deployed in various geographical and health contexts. The objective is to identify the facilitators and barriers for implementing WelTel and to assess the application of the mCFIR tool in facilitating focus groups in different geographical and health settings. Methods Both qualitative and descriptive quantitative approaches were employed. Six mCFIR sessions were held in three countries with 51 key stakeholders. The mCFIR tool consists of 5 Domains and 25 constructs and was distributed through Qualtrics Experience Management (XM). “Performance” and “Importance” scores were valued on a scale of 0 to 10 (Mean ± SD). Descriptive analysis was conducted using R computing software. NVivo 12 Pro software was used to analyze mCFIR responses and to generate themes from the participants’ input. Results We observed a parallel trend in the scores of Importance and Performance. Of the five Domains, Domain 4 (End-user Characteristics) and Domain 3 (Inner Settings) scored highest in Importance (8.9 ± 0.5 and 8.6 ± 0.6, respectively) and Performance (7.6 ± 0.7 and 7.2 ± 1.3, respectively) for all sites. Domain 2 (Outer Setting) scored the lowest in both Importance and Performance for all sites (7.6 ± 0.4 and 5.6 ± 1.8). The thematic analysis produced the following themes: for areas of strengths, the themes brought up were timely diagnosis and response, cost-effectiveness, and user-friendliness. As for areas for improvement, the themes discussed were training, phone accessibility, stakeholder engagement, and literacy. Conclusion The mCFIR tool allowed for a comprehensive understanding of the barriers and facilitators to the implementation, reach, and scale-up of digital health tools. Amongst several important findings, we observed the value of bringing the perspectives of both end users (HCPs and patients) to the table across Domains. Trial Registration: NCT02603536 – November 11, 2015: WelTelOAKTREE: Text Messaging to Support Patients With HIV/AIDS in British Columbia (WelTelOAKTREE). NCT01549457 – March 9, 2012: TB mHealth Study—Use of Cell Phones to Improve Compliance in Patients on LTBI Treatment.

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Assessment of campus community readiness for tailoring implementation of evidence-based online programs to prevent risky substance use among university students in Germany

Translational Behavioral Medicine ◽

10.1093/tbm/ibz060 ◽

2019 ◽

Author(s):

Frauke Wichmann ◽

Michael Braun ◽

Thomas Ganz ◽

Johanna Lubasch ◽

Thomas Heidenreich ◽

...

Keyword(s):

Substance Use ◽

Program Implementation ◽

Implementation Process ◽

Evidence Based ◽

Community Readiness ◽

Substance Use Prevention ◽

Structured Interviews ◽

Online Interventions ◽

Online Programs ◽

German Universities

Abstract Research suggests that online interventions preventing risky substance use can improve student health. There is an increasing interest in transferring evidence-based online programs into university health promotion practice. However, little is known about how to best tailor the implementation process to capacities and context of individual universities. The purpose of this study was to assess the level of readiness (capacity) of German universities concerning the implementation of evidence-based online programs for risky substance use prevention employing an adapted Community Readiness Assessment (CRA) and to develop tailored action plans for implementation. The CRA involved 43 semi-structured interviews with key persons at 10 German universities. The interviews addressed five dimensions (knowledge of efforts, leadership, community climate, knowledge of the issue, and resources) at nine possible readiness stages (no awareness—ownership) and additional contextual factors. Overall, readiness for implementing online interventions across universities was rather low. Universities readiness levels ranged between the denial stage with a score of 2.1 and the preplanning stage with a score of 4.4. University-specific readiness was very heterogeneous. On the basis of the results of the CRA, universities received feedback and options for training on how to take the necessary steps to increase readiness and to prepare program implementation. The adapted version of the CRA was well suited to inform future implementation of evidence-based online programs for the prevention of risky substance use at participating universities.

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Implementation Science in Nutrition: Concepts and Frameworks for an Emerging Field of Science and Practice

Current Developments in Nutrition ◽

10.1093/cdn/nzy080 ◽

2018 ◽

Vol 3 (3) ◽

Cited By ~ 13

Author(s):

Alison Tumilowicz ◽

Marie T Ruel ◽

Gretel Pelto ◽

David Pelletier ◽

Eva C Monterrosa ◽

...

Keyword(s):

Implementation Science ◽

Program Implementation ◽

Implementation Research ◽

Scale Up ◽

Implementation Process ◽

Implementation Quality ◽

Wide Range ◽

Intervention Policy ◽

Culture Of Inquiry ◽

National Governments

AbstractMalnutrition in all its forms has risen on global and national agendas in recent years because of the recognition of its magnitude and its consequences for a wide range of human, social, and economic outcomes. Although the WHO, national governments, and other organizations have endorsed targets and identified appropriate policies, programs, and interventions, a major challenge lies in implementing these with the scale and quality needed to achieve population impact. This paper presents an approach to implementation science in nutrition (ISN) that builds upon concepts developed in other policy domains and addresses critical gaps in linking knowledge to effective action. ISN is defined here as an interdisciplinary body of theory, knowledge, frameworks, tools, and approaches whose purpose is to strengthen implementation quality and impact. It includes a wide range of methods and approaches to identify and address implementation bottlenecks; means to identify, evaluate, and scale up implementation innovations; and strategies to enhance the utilization of existing knowledge, tools, and frameworks based on the evolving science of implementation. The ISN framework recognizes that quality implementation requires alignment across 5 domains: the intervention, policy, or innovation being implemented; the implementing organization(s); the enabling environment of policies and stakeholders; the individuals, households, and communities of interest; and the strategies and decision processes used at various stages of the implementation process. The success of aligning these domains through implementation research requires a culture of inquiry, evaluation, learning, and response among program implementers; an action-oriented mission among the research partners; continuity of funding for implementation research; and resolving inherent tensions between program implementation and research. The Society for Implementation Science in Nutrition is a recently established membership society to advance the science and practice of nutrition implementation at various scales and in varied contexts.

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Identifying Enablers of Participant Engagement in Clinical Trials of Consumer Health Technologies: A Qualitative Study of flu@home (Preprint)

10.2196/preprints.26869 ◽

2020 ◽

Author(s):

Spurthy Dharanikota ◽

Cynthia M LeRouge ◽

Victoria Lyon ◽

Polina Durneva ◽

Matthew Thompson

Keyword(s):

Clinical Trials ◽

Technology Acceptance ◽

Attribution Theory ◽

Financial Incentives ◽

Large Scale ◽

Digital Health ◽

Drop Out ◽

Evidence Based ◽

Structured Interviews ◽

Health Technologies

BACKGROUND Clinical trials are fraught with challenges such as inadequate enrollment, lack of fidelity to interventions, and high drop-out rates. However, such trials are essential to support large-scale implementation of crucial consumer healthcare technologies (CHTs) such as smartphone supported home diagnostic tests (Smart-HT). A rise in the recent trend of self-managing health using CHTs highlights the importance of efficient and successful CHT trials. Understanding the reasons underlying individuals’ participation in trials could inform the design and execution of future trials of CHTs. OBJECTIVE We aimed to identify the enablers of participation in clinical trials of CHTs and summarize our findings in an evidence-based framework. We used an instantiation of a specific CHT currently in trial, Smart-HT, which is an app accompanied by home-based diagnostic testing of influenza called flu@home. METHODS Based on the digital health engagement model (DIEGO) and technology acceptance model (TAM), we proposed a preliminary research framework of enablers for participants’ engagement in trials of CHTs. Further, based on the attribution theory, we categorized the enablers into dispositional and situational factors. The framework guided the confidential and semi-structured interviews and resultant transcript coding. 31 individuals who previously participated in the diagnostic accuracy pilot study of flu@home were recruited to complete the semi-structured interviews via email and received a 25$ gift card once completing the interview. RESULTS In addition to finding support and a detailed understanding of the proposed preliminary framework, we identified new themes in our analysis that extend our evidence-based framework. Situationally, we found that financial incentives and insurance status influenced trial engagement for flu@home. Motivation to advance medical research, personal innovativeness, altruism, curiosity, positive attitude, and potential to minimize doctor’s visits emerged as new dispositional enablers for trial engagement in our study. CONCLUSIONS Our findings and proposed framework provide insights into the context of trial engagement for CHTs that require testing, particularly an instantiation of Smart-HT involving testing for influenza. We suggest several trial design and trial engagement strategies to enhance these trials' financial and scientific viability, paving the way for advancements in patient care. Furthermore, our study also offers practical strategies to trial organizers to enhance participants’ enrollment and engagement in clinical trials of CHTs.

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Furthering Dissemination and Implementation Research

10.1093/oso/9780190683214.003.0018 ◽

2017 ◽

Cited By ~ 2

Author(s):

Lawrence W. Green ◽

Mona Nasser

Keyword(s):

Systematic Reviews ◽

Implementation Research ◽

External Validity ◽

Evidence Based Practice ◽

Internal Validity ◽

Implementation Process ◽

Dissemination And Implementation ◽

Evidence Based ◽

Evidence Based Practices ◽

Dissemination And Implementation Research

This chapter raises questions about the reliability of much “evidence-based practice” disseminated from the original studies and systematic reviews of those studies, insofar as they were often conducted and reviewed with inadequate attention to external validity. Important issues are raised for dissemination and implementation researchers. Indeed, the pressure on investigators to provide for increasingly rigorous controls on threats to internal validity, and to exclude studies that fall below standards for internal validity, has made many such sources of evidence more suspect in their external validity and less credible to the practitioners or policymakers who would adopt them. Greater attention is needed to ways to incorporate considerations of external validity into studies and in systematic reviews of studies to produce more generalizable evidence, and greater attention to practice-based evidence that can complement the more formal evidence-based practices in the process of implementing and evaluating the dissemination and implementation process

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PREVENT Policing in Practice—The Need for Evidenced-Based Research

Policing A Journal of Policy and Practice ◽

10.1093/police/paz049 ◽

2019 ◽

Author(s):

Paul Dresser

Keyword(s):

Evidence Based ◽

Structured Interviews ◽

Counter Terrorism ◽

The Third ◽

Wide Range ◽

And Performance ◽

Evidenced Based ◽

The Uk

Abstract This article examines the PREVENT agenda, part of the UK government’s counter-terrorism strategy, CONTEST. Informed by semi-structured interviews conducted with a Special Branch PREVENT team, as well as individuals drawn from various security disciplines, this article highlights several practical barriers to realizing collaborative counter-radicalization. This is important given the third objective of PREVENT: to work with a wide range of institutions where there are risks of radicalization. This article departs from analyses that have examined PREVENT in the context of suspect profiling; rather, the focus is on illuminating the implementation, (re)configuration and performance of PREVENT policing. The article concludes by advocating the necessity for evidence-based research—this proffers pragmatic implications for the governance of counter-terrorism.

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Using Implementation Science Strategy Mapping on the Age-Friendly Health System's 4Ms Journey

Innovation in Aging ◽

10.1093/geroni/igab046.1409 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 365-365

Author(s):

Mary Dolansky ◽

Anne Pohnert ◽

Sherry Greenberg

Keyword(s):

Implementation Science ◽

Scale Up ◽

Implementation Strategies ◽

Mapping Method ◽

Evidence Based ◽

Systematic Process ◽

Implementing Change ◽

Implementation Outcomes ◽

Adoption And Implementation ◽

And Performance

Abstract Background Implementation science is the study of methods to promote the adoption and integration of evidence-based practices into routine health care to improve the quality of care. The purpose of this study was to use Implementation Mapping to guide the implementation of The John A. Hartford evidence-based Age-Friendly Health Systems (AFHS) 4Ms Framework: What Matters, Medications, Mentation, and Mobility. Methods Implementation Mapping, a systematic process for planning implementation strategies, guided the 9-month integration of the 4Ms Framework in the 1,100 MinuteClinics across the US. Implementation Mapping includes five tasks: (1) conduct an implementation needs assessment and identify program adopters and implementers; (2) state adoption and implementation outcomes and performance objectives, identify determinants, and create matrices of change objectives; (3) choose theoretical methods (mechanisms of change) and select or design implementation strategies; (4) produce implementation protocols and materials; and (5) evaluate implementation outcomes. Results The implementation plan, developed by the implementation mapping method, was carried out over 9-months. Seven implementation strategies were identified from the Expert Recommendations for Implementing Change (ERIC) project including the provision of education, electronic health record integration, internal champion facilitation, cues to action, and a dashboard to monitor progress. To date, the implementation mapping has resulted in the adoption of the 4Ms by 1145 providers (37%). Monitoring of the adoption of the 4Ms Framework and consideration of future implementation strategies is ongoing. Conclusions Implementation Mapping provided a systematic process to develop strategies to improve the adoption, implementation, sustainment, and scale-up of the evidence-based 4Ms Framework.

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Evaluating factors that influenced the successful implementation of an evidence-based neonatal care intervention in Chinese hospitals using the PARIHS framework

10.21203/rs.3.rs-711452/v1 ◽

2021 ◽

Author(s):

Jieya Yue ◽

Jun Liu ◽

Yingxi Zhao ◽

Sarah Williams ◽

Bo Zhang ◽

...

Keyword(s):

Scale Up ◽

Improve Patient Care ◽

Successful Implementation ◽

Evidence Based ◽

Hospital Level ◽

Structured Interviews ◽

Knowledge And Beliefs ◽

Tertiary Hospitals ◽

Parihs Framework ◽

Study Participants

Abstract Background Evidence based interventions (EBIs) can improve patient care and outcomes. Understanding the process for successfully introducing and implementing EBIs can inform effective roll-out and scale up. The Promoting Action on Research Implementation in Health Services (PARIHS) framework can be used to evaluate and guide the introduction and implementation of EBIs. To gain an understanding of the utility of the PARIHS framework in China and investigate how important each of its constructs (evidence, context and facilitation) and sub-elements are perceived to be to successful implementation of EBIs in a Chinese setting, we used the framework to assess the implementation of an evidence-based neonatal intervention (kangaroo mother care, KMC) recently introduced in selected Chinese hospitals. Method We conducted clinical observations and semi-structured interviews with 10 physicians and 18 nurses in five tertiary hospitals implementing KMC. Interview questions were organized around issues including knowledge and beliefs, resources, culture, implementation readiness and climate. We used directed content analysis to analyze the interview transcript, amending the PARIHS framework to incorporate emerging sub-themes. We also rated the constructs and sub-elements on a continuum from “low (weak)”, “moderate” or “high (strong)” highlighting the ones considered most influential for hospital level implementation by study participants. Results Our finding suggest that clinical experience, culture, leadership, evaluation, and facilitation are highly influential sub-elements for EBI implementation in China. External evidence had a moderate impact, especially in the initial awareness raising stages of implementation and resources were also considered to be of moderate importance, although this may change as implementation progresses. Patient experience was not seen as a driver for implementation at hospital level. Conclusion The PHARIS framework can be a useful tool for planning and evaluating EBI implementation in China. However, it’s sub-elements should be assessed and adapted to the implementation setting.

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