scholarly journals Contextual Barriers and Enablers to Safewards Implementation in Victoria, Australia: Application of the Consolidated Framework for Implementation Research

2021 ◽  
Vol 12 ◽  
Author(s):  
Justine Fletcher ◽  
Lisa Brophy ◽  
Jane Pirkis ◽  
Bridget Hamilton
Keyword(s):  
Implementation Research ◽  
Qualitative Data ◽  
Routine Practice ◽  
Ward Staff ◽  
Effective Implementation ◽  
International Evidence ◽  
Barriers And Enablers ◽  
Implementation Period ◽  
Service Environments ◽  
Key Staff

Background: Safewards is a complex psychosocial intervention designed to reduce conflict and containment on inpatient mental health units. There is mounting international evidence of the effectiveness and acceptability of Safewards. However, a significant challenge exists in promising interventions, such as Safewards, being translated into routine practice. The Consolidated Framework for Implementation Research (CFIR) provides a framework through which to understand implementation in complex health service environments. The aim was to inform more effective implementation of Safewards using the CFIR domains and constructs, capitalizing on developing an understanding of variations across wards.Method: Seven Safewards Leads completed the Training and Implementation Diary for 18 wards that opted in to a trial of Safewards. Fidelity Checklist scores were used to categorize low, medium and high implementers of Safewards at the end of the 12-week implementation period.Results: Qualitative data from the diaries were analyzed thematically and coded according to the five CFIR domains which included 39 constructs. Twenty-six constructs across the five domains were highlighted within the data to have acted as a barrier or enabler. Further analysis revealed that six constructs distinguished between low, medium, and high implementing wards.Discussion: Our findings suggest that for implementation of Safewards to succeed, particular attention needs to be paid to engagement of key staff including managers, making training a priority for all ward staff, adequate planning of the process of implementation and creating an environment on each inpatient unit that prioritize and enables Safewards interventions to be undertaken by staff regularly.

scholarly journals Implementation Research: Embracing Practitioners' Views

2018 ◽  
Vol 61 (3) ◽  
pp. 645-657 ◽  
Author(s):  
Julie L. Feuerstein ◽  
Lesley B. Olswang ◽  
Kathryn J. Greenslade ◽  
Patricia Dowden ◽  
Gay Lloyd Pinder ◽  
...  
Keyword(s):  
Early Intervention ◽  
Young Children ◽  
Implementation Research ◽  
Qualitative Data ◽  
Physical Disabilities ◽  
Critical Role ◽  
Implementation Process ◽  
Routine Practice ◽  
Intentional Communication ◽  
The Impact

Purpose This research explores practitioners' perspectives during the implementation of triadic gaze intervention (TGI), an evidence-based protocol for assessing and planning treatment targeting gaze as an early signal of intentional communication for young children with physical disabilities. Method Using qualitative methods, 7 practitioners from 1 early intervention center reported their perceptions about (a) early intervention for young children with physical disabilities, (b) acceptability and feasibility in the use of the TGI protocol in routine practice, and (c) feasibility of the TGI training. Qualitative data were gathered from 2 semistructured group interviews, once before and once after TGI training and implementation. Results Qualitative results documented the practitioners' reflections on recent changes to early intervention service delivery, the impact of such change on TGI adoption, and an overall strong enthusiasm for the TGI protocol, despite some need for adaptation. Conclusion These results are discussed relative to adapting the TGI protocol and training, when considering how to best bring about change in practice. More broadly, results highlighted the critical role of researcher–practitioner collaboration in implementation research and the value of qualitative data for gaining a richer understanding of practitioners' perspectives about the implementation process.

scholarly journals Implementation Research Training Framework 2.0: Making the whole greater than the parts

2021 ◽  
Author(s):  
Keyword(s):  
Implementation Research ◽  
Research Training ◽  
Scale Up ◽  
Health Impact ◽  
Routine Practice ◽  
Tropical Diseases ◽  
Middle Income ◽  
Middle Income Countries ◽  
And Training ◽  
New Framework

Clinical innovations alone do not generate public health impact. Implementation research (IR) is a powerful tool for identifying the bottlenecks impeding scale up efforts and helping to turn scientifically tested solutions into routine practice. To enhance the ability of investigators in low- and middle-income countries (LMICs) to design, conduct and interpret IR, several actors, such as the Special Programme for Research and Training in Tropical Diseases (TDR), have sought to strengthen researchers' capacity to design and undertake IR. This report outlines the development of a new framework for IR training in LMICs to inspire thinking and discussion on how training approaches can best serve learners' needs.

Getting it right first time: implementation of laparoscopic pyloromyotomy without a learning curve

2021 ◽  
Vol 103 (2) ◽  
pp. 130-133
Author(s):  
GS Arul ◽  
W Moni-Nwinia ◽  
G Soccorso ◽  
M Pachl ◽  
M Singh ◽  
...  
Keyword(s):  
Learning Curve ◽  
New Technologies ◽  
Wound Dehiscence ◽  
Learning Curves ◽  
Routine Practice ◽  
Female Ratio ◽  
Day Range ◽  
Implementation Period ◽  
Mucosal Perforation ◽  
Laparoscopic Pyloromyotomy

Introduction Laparoscopic pyloromyotomy is now an accepted procedure for the treatment of pyloric stenosis. However, it is clear that during the implementation period there are significantly higher incidences of mucosal perforation and incomplete pyloromyotomy. We describe how we introduced a new laparoscopic procedure without the complications associated with the learning curve. Materials and methods Five consultants tasked one surgeon to pilot and establish laparoscopic pyloromyotomy before mentoring the others until they were performing the procedure independently; all agreed to use exactly the same instruments and operative technique. This involved a 5mm 30-degree infra-umbilical telescope with two 3mm instruments. Data were collected prospectively. Results Between 1 January 2013 and 31 December 2017, 140 laparoscopic pyloromyotomies were performed (median age 27 days, range 13–133 days, male to female ratio 121:19). Fifty-five per cent of procedures were performed by trainees. Complications were one mucosal perforation and one inadequate pyloromyotomy. There were no injuries to other organs, problems with wound dehiscence or other significant complications. The median time of discharge was one day (range one to six days). Conclusion Our rate of perforation and incomplete pyloromyotomy was 1.4%, which is equivalent to the best published series of either open or laparoscopic pyloromyotomy. We believe that this resulted from the coordinated implementation of the procedure using a single technique to reduce clinical variability, increase mentoring and improve training. This approach appears self-evident but is rarely described in the literature of learning curves. In this age of increased accountability, new technologies should be incorporated into routine practice without an increase in morbidity to patients.

scholarly journals Familiar but neglected: identification of gaps and recommendations to close them on exclusive breastfeeding support in health facilities in Malawi

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Alinane Linda Nyondo-Mipando ◽  
Mai-Lei Woo Kinshella ◽  
Sangwani Salimu ◽  
Brandina Chiwaya ◽  
Felix Chikoti ◽  
...  
Keyword(s):  
Exclusive Breastfeeding ◽  
Qualitative Data ◽  
Health Workers ◽  
Newborn Care ◽  
Health Systems Strengthening ◽  
World Health ◽  
Standards Of Care ◽  
Routine Practice ◽  
Breastfeeding Support ◽  
Care Assessment

Abstract Background Exclusive breastfeeding is widely accepted as a key intervention with proven efficacy for improving newborn survival. Despite international commitments and targets to support and promote breastfeeding, there are still gaps in meeting and maintain coverage in many sub-Saharan African countries. This paper aimed to triangulate the perspectives of health workers, mothers, and their family members with facility assessments to identify gaps to improve breastfeeding support in in Malawi. Methods The study on breastfeeding barriers and facilitators was conducted in 2019 at one tertiary hospital and three secondary-level hospitals in Malawi. We conducted 61 semi-structured interviews with health workers, postnatal mothers, grandmothers, aunts, and fathers. In 2017, we carried out a neonatal care facility assessment using the World Health Organization (WHO) Integrated Maternal, Neonatal, and Child Quality of Care Assessment and Improvement Tool. Qualitative data were analysed using a thematic analysis approach within the Systems Framework for Health Policy. Results The district-level hospitals rated high with an average score of 4.8 out of 5 across the three facilities indicating that only minor improvements are needed to meet standards of care for early and exclusive breastfeeding. However, the score fell to an average of 3.5 out of 5 for feeding needs with sick neonates indicating that several improvements are needed in this area. The qualitative data demonstrated that breastfeeding was normalized as part of routine newborn care. However, the focus on routine practice and reliance on breastfeeding knowledge from prenatal counselling highlights inequities and neglect in specialized care and counselling among vulnerable mothers and newborns. Revitalisation of breastfeeding in Malawian facilities will require a systems approach that reinforces policies and guidelines; contextualises knowledge; engagement and empowerment of other relatives to the baby and task-sharing among health workers. Conclusions Breastfeeding is accepted as a social norm among health workers, mothers, grandmothers, aunts, and fathers in Malawi, yet vulnerable groups are underserved. Neglect in breastfeeding support among vulnerable populations exacerbates health inequities. Health systems strengthening related to breastfeeding requires a concerted effort among health workers, mothers, grandmothers, aunts, and fathers while remaining grounded in contexts to support family-centered hospital care.

scholarly journals Perception of Teacher Educator Regarding Course Guides for B.ED (Hons) and ADE (Associate Degree in Education) Program & Provision of Resources for Effective Implementation of the Program

2018 ◽  
Vol III (I) ◽  
pp. 57-70
Author(s):  
Shazia Abdul Malik ◽  
Umbreen Ishfaq ◽  
M Saeed Khan
Keyword(s):  
Prospective Teachers ◽  
Associate Degree ◽  
Qualitative Data ◽  
Teacher Educators ◽  
Teacher Educator ◽  
Research Problem ◽  
Learning Approaches ◽  
Effective Implementation ◽  
Teaching Learning ◽  
Course Outcomes

The study analyzes curriculum document (teacher course guides) of ADE and B.Ed. (Hons) programs in terms of Assessment Tasks, Teaching Learning Approaches, Course Outcomes and Course Description. Study also focuses on prospective teachers and teacher educator’s perceptions about these teacher course guides and their execution in class room at selected Teachers’ Training Institutes. The sample comprises three universities and four Regional Institutions of Teacher Education offering B.Ed. (Hons) and ADE programs. Researcher congregated data from 21 teacher educators teaching to prospective teachers enrolled in ADE and B.Ed. (Hons) in the chosen institutions. Mixed methods (approach) were used to collect quantitative as well as qualitative data for extensive analysis of the research problem. The qualitative data was collected through a check list and quantitative data was collected through questionnaire. The manuscripts (Draft guide for teaching instructor) for B.Ed. (Hons). Experts developed curriculum meets the requirement of the society of Pakistan with the purpose to create more competent, proficient and well-informed teaching instructors. Effective implementation of teacher guides need improvement in terms of availability of resources like well-equipped class rooms, computer lab, library, learning materials and Information and Communication Technology.

scholarly journals An Evaluation of Texture Modified Diets Compliant with the International Dysphagia Diet Standardisation Initiative in Aged-Care Facilities Using the Consolidated Framework for Implementation Research

2021 ◽  
Author(s):  
Xiaojing Sharon Wu ◽  
Anna Miles ◽  
Andrea Braakhuis
Keyword(s):  
Quality Of Care ◽  
Implementation Research ◽  
Aged Care ◽  
Successful Implementation ◽  
Site Specific ◽  
Barriers And Enablers ◽  
Care Facilities ◽  
Aged Care Facilities ◽  
Specific Implementation

Abstract Background: Texture modified diets (TMDs) are commonly prescribed for older adults with swallowing difficulties to improve swallowing safety. The International Dysphagia Diet Standardization Initiative (IDDSI) provides a framework for terminology, definitions and testing of TMDs. This observational mixed-method study used the Consolidated Framework for Implementation Research (CFIR) to establish the barriers and enablers to IDDSI adoption in aged-care facilities (ACFs).Methods: Five New Zealand ACFs who had adopted IDDSI >12 months previously were recruited. Evaluation tools were developed based on CFIR constructs, integrating data from i) mealtime observations; ii) manager interviews and iii) staff (nursing, carers and kitchen) self-administrated surveys. Results: All facility and kitchen managers were IDDSI-aware and had access to online resources. Three sites had changed to commercially compliant products post-IDDSI adoption, which had cost implications. Awareness of IDDSI amongst staff ranged from 5-79% and <50% of staff surveyed felt sufficiently trained. Awareness was greater in large sites and where IDDSI was mandated by head office. Managers had not mandated auditing and they felt this had led to reduced perceived importance. Managers felt staff required more training and staff wanted more training, believing it would improve food safety and quality of care. Lack of a dedicated project leader and no speech pathologist onsite were perceived barriers. Collaboration between healthcare assistants, kitchen staff and allied health assisted implementation. Conclusion: ACF staff were aware of IDDSI but staff awareness was low. Using the CFIR, site-specific and generic barriers and enablers were identified to improve future implementation effectiveness. Managers and staff want access to regular training. Multidisciplinary collaboration and improving communication are essential. ACFs should consider TMD auditing regularly. Successful implementation of IDDSI allows improvement of quality of care and patient safety but requires a systematic, site-specific implementation plan.

scholarly journals Barriers and enablers for the implementation of clinical practice guidelines in China: a mixed-method study

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e026328 ◽  
Author(s):  
Yinghui Jin ◽  
Zimeng Li ◽  
Fei Han ◽  
Di Huang ◽  
Qiao Huang ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Mixed Method ◽  
Medical Staff ◽  
Qualitative Data ◽  
Medical Practitioners ◽  
Barriers And Enablers ◽  
Class A ◽  
Tertiary Hospitals

ObjectivesThe aim of this study was to explore perspectives and reasoning of medical staff from Class A tertiary hospitals about the factors hindering and facilitating the uptake and use of clinical practice guidelines (CPGs) during medical procedures.DesignMixed-method research study to collect and analyse both quantitative and qualitative data.SettingClass A tertiary hospitals in China.ParticipantsThe inclusion criteria for the questionnaire survey and qualitative research were (1) medical practitioners and (2) years of practice: above 5 years in a tertiary hospital.MethodsQuestionnaires were distributed to medical staff in 11 cities to collect quantitative data. Frequency and ranking of barriers and enablers were analysed. Spearman correlations were computed to explore the correlation between years of practice, professional title ranking and educational background with self-reported guideline adherence. Using a constructivist grounded theory method, qualitative data were generated via in-depth face-to-face interviews with Chinese medical practitioners.ResultsA total of 359 medical practitioners were surveyed and 32 medical practitioners interviewed in 11 cities. Higher frequency and higher ranking of barriers all converged on ‘lack of access’, ‘less convenient’, ‘lack of applicability’ and ‘lack of evidence from Chinese sample’. Higher frequency and higher ranking of enablers converged on ‘Short formats presentation’, ‘Utilisation of various media’, ‘Information visualisation’ and ‘Linking to patient electronic medical records’. There were no relationships between characteristics of respondents with self-reported adherence. This research produced a theoretical understanding of the experience of medical practitioners when using guidelines. Themes identified were as follows: existing intrinsic flaws in guidelines, deficient or incomplete system mechanism and being ambiguous.ConclusionOur findings provide a comprehensive and culturally sensitive perspective in understanding guideline implementation in China. Strategies addressing those barriers should be further discussed and researched in the future.

“All We Had Were the Streets”: Lessons Learned From a Recreation-Based Community Health Space for Young Black MSM and Trans Women Across the HIV Prevention and Care Continuum

2018 ◽  
Vol 30 (4) ◽  
pp. 309-321 ◽  
Author(s):  
Brian Adams ◽  
Sarah Krier ◽  
Jess Netto ◽  
Nayck Feliz ◽  
M. Reuel Friedman
Keyword(s):  
Community Engagement ◽  
Community Health ◽  
Service Provision ◽  
Qualitative Data ◽  
Lessons Learned ◽  
Black Msm ◽  
Transgender People ◽  
Implementation Period ◽  
Sex With Men ◽  
Young Black Msm

Young Black men who have sex with men (MSM) and transgender people experience disparities in HIV incidence and HIV outcomes. To effectively engage these communities in HIV-related programming, we developed a recreation-based community health space. We sought to examine the challenges and successes in implementing this program. Qualitative data were collected from federal progress reports and by a process evaluator who recorded interviews with staff, stakeholders, and participants. These data were coded for themes related to barriers and successes. We consolidated themes into four key domains: community engagement, service provision, stigma, and violence. Each of these domains was determined to significantly affect programmatic success during the implementation period. Young Black MSM and transgender people experience stigmas that pose challenges to effective engagement in HIV-related programming. These lessons learned offer strategies for community engagement and for addressing violence and stigma to maximize programmatic effectiveness.

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