scholarly journals Barriers and Facilitators to the Implementation of the Pathways to Comorbidity Care (PCC) Training Package for the Management of Comorbid Mental Disorders in Drug and Alcohol Settings

2021 ◽  
Vol 1 ◽  
Author(s):  
Eva Louie ◽  
Vicki Giannopoulos ◽  
Andrew Baillie ◽  
Gabriela Uribe ◽  
Katie Wood ◽  
...  
Keyword(s):  
Training Program ◽  
Clinical Supervision ◽  
Implementation Process ◽  
Barriers And Facilitators ◽  
Online Information ◽  
Information Portal ◽  
Leadership Engagement ◽  
Outer Setting ◽  
Inner Setting ◽  
Drug And Alcohol

Background: We have previously reported that the Pathways to Comorbidity Care (PCC) training program for alcohol and other drug (AOD) clinicians improved identification of comorbidity, self-efficacy, and attitudes toward screening and monitoring of comorbidity. We aimed to identify barriers and facilitators of implementation of the PCC training program in drug and alcohol settings.Methods: The PCC training program was implemented across 6 matched sites in Australia as per (1), and 20 clinicians received training. PCC training included seminar presentations, workshops conducted by local “clinical champions,” individual clinical supervision, and access to an online information portal. We examined barriers and facilitators of implementation according to the Consolidated Framework for Implementation Research.Results: Barriers included inner setting (e.g., allocated time for learning) and characteristics of individuals (e.g., resistance). Facilitators included intervention characteristics (e.g., credible sources), inner setting (e.g., leadership), and outer setting domains (e.g., patient needs). Clinical champions were identified as an important component of the implementation process.Conclusions: Barriers included limited specific allocated time for learning. A credible clinical supervisor, strong leadership engagement and an active clinical champion were found to be facilitators of the PCC training program.

scholarly journals Implementation of a multi-modal training program for the management of comorbid mental disorders in drug and alcohol settings: Pathways to Comorbidity Care (PCC)

2021 ◽  
Author(s):  
Eva Louie ◽  
Kirsten C Morley ◽  
Vicki Giannopoulos ◽  
Gabriela Uribe ◽  
Katie Wood ◽  
...  
Keyword(s):  
Training Program ◽  
Clinical Supervision ◽  
Self Efficacy ◽  
Implementation Process ◽  
Barriers And Facilitators ◽  
Control Group ◽  
Online Information ◽  
Knowledge And Attitudes ◽  
Inner Setting ◽  
The Impact

Background Clinical guidelines recommend evidence-based treatments for comorbid mental and substance use disorders but these are not reliably translated into practice. We aimed to evaluate the impact of the Pathways to Comorbidity Care (PCC) training program for alcohol and other drug (AOD) clinicians to improve the management of comorbidity and to identify barriers and facilitators of implementation according to the Consolidated Framework for Implementation Research (CFIR). Methods A controlled before-and-after study using PCC training was conducted across 6 matched sites in Australia including 35 clinicians. Controls received standard workplace training. PCC training included seminar presentations, workshops conducted by local ′clinical champions′, individual clinical supervision, and access to an online information portal. A mixed methods approach examined i) identification (screening, assessment) and treatment (treatment, referral) of comorbidity in practice (N = 10 clinical files per clinician), ii) self-efficacy, knowledge and attitudes of clinicians, iii) barriers and facilitators of implementation. Results Significant improvements were observed in the PCC group but not the control sites with regards to the rate of clinical files showing identification of comorbidity (+50% v -12% change from baseline respectively; X2 (1, N = 340) = 35.29, p = .01) with only a trend for improvements in the rate of files demonstrating treatment of comorbidity (X2 (1, N = 340) = 10.45, p = .06). There were significant improvements in the PCC relative to the control group for clinician self-efficacy (F (1,33) = 6.40, p = .02) and knowledge and attitudes of comorbidity monitoring (F (1,33) = 8.745, p = .01). Barriers included inner setting (e.g. allocated time for learning) and characteristics of individuals (e.g. resistance). Facilitators included intervention characteristics (e.g. credible sources), inner setting (e.g. leadership) and outer setting domains (e.g. patient needs). Clinical champions were identified as an important component of the implementation process. Conclusions The PCC training package effectively improved identification of comorbidity, self-efficacy and attitudes towards screening and monitoring of comorbidity. Specific barriers included provision of allocated time for learning. Specific facilitators included provision of a credible clinical supervisor, strong leadership engagement and an active clinical champion.

Application of the Non-adoption, Abandonment, Scale-up, Spread and, Sustainability (NASSS) Framework to evaluate the role of technology in the Pathways to Comorbidity Care (PCC) implementation project to improve management of comorbid substance use and mental disorders

2020 ◽  
Author(s):  
MariaGabriela Uribe Guajardo ◽  
Andrew James Baillie ◽  
Eva Louie ◽  
Vicki Giannopoulos ◽  
Katie Wood ◽  
...  
Keyword(s):  
Substance Use ◽  
Clinical Supervision ◽  
Mental Health Problems ◽  
Scale Up ◽  
Structured Interview ◽  
Barriers And Facilitators ◽  
Self Report ◽  
Evidence Based ◽  
Face To Face ◽  
Drug And Alcohol

Abstract (250 words)In substance use treatment settings, there is a high prevalence of comorbid mental health problems. Yet an integrated approach for managing comorbidity, implementation of evidence-based intervention in drug and alcohol settings remains problematic. Technology can help the adoption of evidence-based practice and successfully implement effective treatment health care pathways. This study sought to examine aspects of electronic resources utilisation (barriers and facilitators) by clinicians participating in the PCC training. MethodA self-report questionnaire and a semi-structured interview was designed to measure overall satisfaction with the PCC portal and e-resources available throughout the 9-month intervention for participating clinicians. An adapted version of the ‘Non-adoption, Abandonment, Scale-up, Spread and, Sustainability’ (NASSS) framework was used to facilitate discussion in regards to the study findings. ResultsA total of 20 clinicians from drug and alcohol services responded to all the measures. Facilitators of portal use included: i. clinician acceptance of the PCC portal; ii. guidance from the clinical supervisor or clinical champion that encouraged the use of e-resources. Some of the barriers included: i. complexity of the illness (condition), ii. clinicians’ preference (adopter system) for face-to-face resources and training modes (e.g. clinical supervision, clinical champion workshops), and iii. lack of face-to-face training on how to use the portal (technology and organisation).ConclusionBased on the NASSS framework, we were able to identify several barriers and facilitators including such as the complexity of the illness, lack of face-to-face training and clinician preference for training mediums. Recommendations include ongoing consultation of clinicians to assist in the development of tailored e-health resources and offering in-house training on how to operate and effectively utilise these resources.

scholarly journals Factors associated with adherence to guideline-recommended cardiovascular disease prevention among HIV clinicians

2021 ◽  
Author(s):  
Karla I Galaviz ◽  
Jonathan A Colasanti ◽  
Ameeta S Kalokhe ◽  
Mohammed K Ali ◽  
Igho Ofotokun ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Blood Glucose ◽  
Peer Pressure ◽  
Median Score ◽  
Factors Associated ◽  
Preventive Practices ◽  
Leadership Engagement ◽  
Clinician Beliefs ◽  
Inner Setting

Abstract Integrating cardiovascular disease (CVD) prevention in routine HIV care remains a challenge. This study aimed to identify factors associated with adherence to guideline-recommended CVD preventive practices among HIV clinicians. Clinicians from eight HIV clinics in Atlanta were invited to complete an online survey. The survey was informed by the Consolidated Framework for Implementation Research and assessed the following: clinician CVD risk screening and advice frequency (never to always), individual characteristics (clinician beliefs, self-efficacy, and motivation), inner setting factors (clinic culture, learning climate, leadership engagement, and resources available), and outer setting factors (peer pressure and patient needs). Bivariate correlations examined associations between these factors and guideline adherence. Thirty-eight clinicians completed the survey (82% women, mean age 42 years, 50% infectious disease physicians). For risk screening, clinicians always check patient blood pressure (median score 7.0/7), while they usually ask about smoking or check their blood glucose (median score 6.0/7). For advice provision, clinicians usually recommend quitting smoking, controlling cholesterol or controlling blood pressure (median score 6.0/7), while they often recommend controlling blood glucose, losing weight, or improving diet/physical activity (median score 5.5/7). Clinician beliefs, motivation and self-efficacy were positively correlated with screening and advice practices (r = .55−.84), while inner setting factors negatively correlated with lifestyle-related screening and advice practices (r = −.51 to −.76). Peer pressure was positively correlated with screening and advice practices (r = .57–.89). Clinician psychosocial characteristics and perceived peer pressure positively influence adherence to guideline-recommended CVD preventive practices. These correlates along with leadership engagement could be targeted with proven implementation strategies.

scholarly journals “We understand our community”: implementation of the Healthy Eating Healthy Aging program among community-based organizations

2020 ◽  
Author(s):  
Judy Leong ◽  
Sou Hyun Jang ◽  
Sonia K Bishop ◽  
Emily V R Brown ◽  
Eun Jeong Lee ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Healthy Eating ◽  
Healthy Aging ◽  
Successful Implementation ◽  
Evidence Based ◽  
Semistructured Interview ◽  
Community Based ◽  
Community Based Organizations ◽  
Outer Setting ◽  
Inner Setting

Abstract Cardiovascular disease is the second leading cause of death in the USA among Asian Americans and Pacific Islanders (AAPIs) over the age of 65. Healthy Eating Healthy Aging (HEHA), an evidence-based heart health program, can provide culturally appropriate nutrition education to decrease the risk of cardiovascular disease. Community-based organizations (CBOs) are optimal settings to implement community-based programs. However, there is inadequate research on how evidence-based interventions like HEHA are implemented in CBOs. This study examined processes that facilitated the implementation of HEHA among CBOs serving older AAPIs. Twelve representatives from CBOs that implemented the HEHA program were recruited to participate in a semistructured interview. All the participants were CBO directors or senior managers. A semistructured interview guide was created and informed by the Consolidated Framework for Implementation Research (CFIR) to capture how HEHA played into the five domains of CFIR: (a) intervention characteristics, (b) outer setting, (c) inner setting, (d) characteristics of the individuals, and (e) process. Data analysis captured themes under the CFIR domains. All five CFIR domains emerged from the interviews. Under intervention characteristics, three constructs emerged as facilitating the implementation of HEHA: (a) the participant’s beliefs around the quality of the HEHA program and its ability to promote healthy eating, (b) HEHA’s adaptability to different AAPI subgroups, and (c) perceptions of how successfully HEHA was bundled and assembled. Under outer setting, the participants described the community’s need for healthy eating programs and how the HEHA program meets that need. Four constructs emerged under inner setting: (a) the CBO’s structural characteristics and social standing in the community; (b) resources dedicated to the implementation and ongoing operations, including funding, training, education, physical space, and time; (c) the culture of the CBO; and (d) the participant’s commitment and involvement in marketing, promotion, and implementation of HEHA. Under characteristics of individuals, participants’ described their desire to learn the content of HEHA and deliver them successfully. Under process, participants described strategies to engage relevant individuals to facilitate HEHA implementation. The interviews with CBO representatives provided insights into CFIR domain constructs that facilitated the implementation of HEHA. CBOs are key settings for community health education. Understanding processes that lead to the successful implementation of evidence-based interventions among CBOs is critical for accelerating the dissemination and implementation of best practices.

scholarly journals Peer-support to increase uptake of screening for diabetic retinopathy: process evaluation of the DURE cluster randomized trial

2020 ◽  
Vol 48 (1) ◽  
Author(s):  
Nyawira Mwangi ◽  
Covadonga Bascaran ◽  
Jacqueline Ramke ◽  
Mathew Kipturgo ◽  
Min Kim ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Process Evaluation ◽  
Peer Support ◽  
Scale Up ◽  
Individual Characteristics ◽  
Policy Framework ◽  
Relative Advantage ◽  
Outer Setting ◽  
Cluster Randomized ◽  
Inner Setting

Abstract Background There is limited evidence on how implementation of peer support interventions influences effectiveness, particularly for individuals with diabetes. We conducted a cluster randomized controlled trial to compare the effectiveness of a peer-led health education package versus usual care to increase uptake of screening for diabetic retinopathy (DR). Methods Our process evaluation used a mixed-method design to investigate the recruitment and retention, reach, dose, fidelity, acceptability, and context of implementation, and was guided by the Consolidated Framework for Implementation Research (CFIR). We reviewed trial documents, conducted semi-structured interviews with key informants (n = 10) and conducted four focus group discussions with participants in both arms of the trial. Three analysts undertook CFIR theory-driven content analysis of the qualitative data. Quantitative data was analyzed to provide descriptive statistics relevant to the objectives of the process evaluation. Results The trial had positive implementation outcomes, 100% retention of clusters and 96% retention for participants, 83% adherence to delivery of content of group talks (fidelity), and 78% attendance (reach) to at least 50% (3/6) of the group talks (dose). The data revealed that intervention characteristics, outer setting, inner setting, individual characteristics, and process (all the constructs of CFIR) influenced the implementation. There were more facilitators than barriers to the implementation. Facilitators included the relative advantage of the intervention compared with current practice (intervention characteristics); awareness of the growing prioritization of diabetes in the national health policy framework (outer setting); tension for change due to the realization of the vulnerability to vision loss from DR (inner setting); a strong collective sense of accountability of peer supporters to implement the intervention (individual characteristics); and regular feedback on the progress with implementation (process). Potential barriers included the need to queue at the eye clinic (intervention characteristic), travel inconveniences (inner setting), and socio-political disruption (outer setting). Conclusions The intervention was implemented with high retention, reach, fidelity, and dose. The CFIR provided a valuable framework for evaluating contextual factors that influenced implementation and helped to understand what adaptations may be needed during scale up. Trial registration Pan African Clinical Trials Registry: PACTR201707002430195 registered 15 July 2017

scholarly journals The implementation process of the Confident Birth method in Swedish antenatal education: opportunities, obstacles and recommendations

2020 ◽  
Author(s):  
Sofia Jansson ◽  
Sepideh Farahshoor ◽  
Karolina Linden ◽  
Malin Bogren
Keyword(s):  
Implementation Process ◽  
Lessons Learned ◽  
Successful Implementation ◽  
First Line ◽  
Line Managers ◽  
Antenatal Education ◽  
Individual Interviews ◽  
Information And Communication ◽  
Antenatal Clinics ◽  
Inner Setting

Summary Antenatal clinics in western Sweden have recently invested in a birth method called Confident Birth. In this study, we investigate midwives’ and first line managers’ perceptions regarding the method, and identify opportunities and obstacles in its implementation. Semi-structured individual interviews were conducted with ten midwives and five first line managers working in 19 antenatal clinics in western Sweden. The Consolidated Framework for Implementation Research was used in a directed content analysis approach. Intervention Characteristics—such as perceptions about the Confident Birth method—were found to have equipped the midwives with coping strategies that were useful for expecting parents during birth. Outer Setting—the method was implemented to harmonize the antenatal education, and provided a mean for a birth companionship of choice. Inner setting—included time-consuming preparations and insufficient information at all levels, which affected the implementation. Characteristics of individuals—, such as knowledge and believes in the method, where trust in the method was seen as an opportunity, while long experience of teaching other birth preparatory methods, affected how the Confident Birth method was perceived. Process—such as no strategy for ensuring that the core of the method remained intact or plans for guiding its implementation were major obstacles to successful implementation. The findings speak to the importance of adequate planning, time, information and communication throughout the process to have a successful implementation. Based on lessons learned from this study, we have developed recommendations for successful implementation of interventions, such as the Confident Birth, in antenatal care settings.

Barriers and Facilitators to Implementing Exercise is Medicine Canada on Campus Groups

2019 ◽  
Vol 20 (5) ◽  
pp. 751-759
Author(s):  
Brittany M. McEachern ◽  
Julia Jackson ◽  
Susan Yungblut ◽  
Jennifer R. Tomasone
Keyword(s):  
Thematic Analysis ◽  
Health Care Professionals ◽  
Barriers And Facilitators ◽  
Semistructured Interview ◽  
Group Leaders ◽  
Local Contexts ◽  
Health Initiatives ◽  
Inner Setting ◽  
Group Member ◽  
Common Barriers

The Exercise is Medicine Canada on Campus (EIMC-OC) program was established in 2013 to provide opportunities for students to promote physical activity in their campus communities. Currently, 38 EIMC-OC groups are in operation, and each has encountered challenges and enablers that have yet to be formally documented. This project aimed to (1) identify barriers and facilitators when implementing an EIMC-OC group and (2) investigate levels of implementation at which the barriers and facilitators operate. Throughout winter 2016, 22 EIMC-OC group leaders representing 12 groups contributed data. Participants completed a survey and a semistructured interview developed using the Consolidated Framework for Implementation Research (CFIR). Interviews were transcribed and underwent thematic analysis. Eighteen barriers and 24 facilitators were identified, with four influencers cited as both a barrier and a facilitator. Common barriers included group member time constraints and communicating with health care professionals. Common facilitators included collaborating with other groups and advertising. Most influencers corresponded to the inner setting and process CFIR domains. Findings from this study suggest that EIMC-OC groups face similar barriers and facilitators despite varying local contexts. The influencers identified highlight recommendations to enhance the success of the EIMC-OC program and other multisite health initiatives at academic institutions.

scholarly journals What hinders and facilitates the implementation of nurse-led interventions in dementia care? A scoping review

2020 ◽  
Author(s):  
Melanie Karrer ◽  
Julian Hirt ◽  
Adelheid Zeller ◽  
Susi Saxer
Keyword(s):  
Scoping Review ◽  
Implementation Process ◽  
Dementia Care ◽  
Barriers And Facilitators ◽  
Successful Implementation ◽  
Evidence Based ◽  
Management Support ◽  
Implementation Processes ◽  
Culture Of Care ◽  
People With Dementia

Abstract Background The implementation of evidence-based interventions for people with dementia is complex and challenging. However, successful implementation might be a key element to ensure evidence-based practice and high quality of care. There is a need to improve implementation processes in dementia care by better understanding the arising challenges. Thus, the aim of this study was to identify recent knowledge concerning barriers and facilitators to implementing nurse-led interventions in dementia care. Methods We performed a scoping review using the methodological framework of Arksey and O’Malley. Studies explicitly reporting on the implementation process and factors influencing the implementation of a nurse-led intervention in dementia care in all settings were included. We searched eight databases from January 2015 until January 2019. Two authors independently selected the studies. For data analysis, we used an inductive approach to build domains and categories. Results We included 26 studies in the review and identified barriers as well as facilitators in five domains: policy (e.g. financing issues, health insurance), organisation (e.g. organisational culture and vision, resources, management support), intervention/implementation (e.g. complexity of the intervention, perceived value of the intervention), staff (e.g. knowledge, experience and skills, attitude towards the intervention), and person with dementia/family (e.g. nature and stage of dementia, response of persons with dementia and their families). Conclusions Besides general influencing factors for implementing nursing interventions, we identified dementia-specific factors reaching beyond already known barriers and facilitators. A pre-existing person-centred culture of care as well as consistent team cultures and attitudes have a facilitating effect on implementation processes. Furthermore, there is a need for interventions that are highly flexible and sensitive to patients’ condition, needs and behaviour.

scholarly journals Applying an intersectionality lens to the Theoretical Domains Framework: a tool for thinking about how intersecting social identities and structures of power influence behaviour

2020 ◽  
Author(s):  
Nicole Etherington ◽  
Isabel Braganca Rodrigues ◽  
Lora Giangregorio ◽  
Ian D. Graham ◽  
Alison M Hoens ◽  
...  
Keyword(s):  
Theoretical Domains Framework ◽  
Implementation Process ◽  
Barriers And Facilitators ◽  
Implementation Barriers ◽  
Modified Delphi ◽  
Delphi Approach ◽  
Effective Interventions ◽  
Novel Approach ◽  
Interdisciplinary Framework ◽  
Context Shapes

Abstract Background: A key component of the implementation process is identifying potential barriers and facilitators that need to be addressed. The Theoretical Domains Framework (TDF) is one of the most commonly used frameworks for this purpose. When applying the TDF, it is critical to understand the context in which behaviours occur. Intersectionality, which accounts for the interface between social identity factors (e.g. age, gender) and structures of power (e.g. ageism, sexism), offers a novel approach to understanding how context shapes individual decision-making and behaviour. We aimed to develop a tool to be used alongside applications of the TDF to incorporate an intersectionality lens when identifying implementation barriers and enablers. Methods: An interdisciplinary Framework Committee (n=17) prioritized the TDF as one of three models, theories, and frameworks (MTFs) to enhance with an intersectional lens through a modified Delphi approach. In collaboration with the wider Framework Committee, a subgroup considered all 14 TDF domains and iteratively developed recommendations for incorporating intersectionality considerations within the TDF and its domains. An iterative approach aimed at building consensus was used to finalize recommendations.Results: Consensus on how to apply an intersectionality lens to the TDF was achieved after 12 rounds of revision. Two overarching considerations for using the intersectionality alongside the TDF were developed by the group as well as two to four prompts for each TDF domain to guide interview topic guides. Considerations and prompts were designed to assist users to reflect on how individual identities and structures of power may play a role in barriers and facilitators to behaviour change and subsequent intervention implementation. Conclusions: Through an expert-consensus approach, we developed a tool for applying an intersectionality lens alongside the TDF. Considering the role of intersecting social factors when identifying barriers and facilitators to implementing research evidence may result in more targeted and effective interventions that better reflect the realities of those involved.

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