Barriers and Facilitators in the Strengthening Families Program (SFP 10–14) Implementation Process in Northeast Brazil: A Retrospective Qualitative Study

This study analyzed contextual barriers and facilitators in the implementation of Strengthening Families Program (SFP 10–14), Brazilian version, a family-based preventive program focused on the prevention of risk behaviors for adolescent health. SFP 10–14 was implemented between 2016 and 2017 for socioeconomically vulnerable families in four Northeast Brazilian states as a tool of the National Drug Policy. A retrospective qualitative study was carried out in which 26 implementation agents participated. Data from 16 individual interviews and two group interviews were analyzed through content analysis. The most recurrent barriers were the group facilitators’ working conditions, weak municipal administration, precarious infrastructure, inadequate group facilitator training methodologies, low adherence of managers and professionals, and funding scarcity. The conditions highlighted as favorable to the implementation were proper intersectoral coordination, engagement of involved actors, awareness of public agency administrators, municipal management efficacy, and efficient family recruitment strategies. Favorable political contexts, engagement of implementation agents, and intersectoral implementation strategies were identified as central to the success of the implementation of SFP 10–14, especially in the adoption of the intervention, community mobilization, and intervention delivery stages. Further studies should combine contexts, mechanisms, and results for a broad understanding of the effectiveness of this intervention in the public sector.

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Differential impacts of the Brazilian Strengthening Families Program (SFP 10-14): A study into changes in the parenting styles of vulnerable families

Children and Youth Services Review ◽

10.1016/j.childyouth.2020.105794 ◽

2021 ◽

Vol 121 ◽

pp. 105794

Author(s):

Nádia Prazeres Pinheiro-Carozzo ◽

Sheila Giardini Murta ◽

Jorge Júlio de Carvalho Valadas Gato ◽

Anne Marie Germaine Victorine Fontaine ◽

Luís Gustavo do Amaral Vinha

Keyword(s):

Parenting Styles ◽

Vulnerable Families ◽

Strengthening Families Program ◽

Strengthening Families

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Refining contextual inquiry to maximize generalizability and accelerate the implementation process

Implementation Research and Practice ◽

10.1177/2633489521994941 ◽

2021 ◽

Vol 2 ◽

pp. 263348952199494

Author(s):

Molly Davis ◽

Rinad S Beidas

Keyword(s):

Best Practices ◽

Behavioral Health ◽

Implementation Strategies ◽

Implementation Process ◽

Barriers And Facilitators ◽

Plain Language ◽

Scientific Rigor ◽

Implementation Context ◽

Practice Gap ◽

Scaling Out

Background: While contextual inquiry, or in-depth mixed-methods work to study the implementation context, is critical for understanding the setting in which a behavioral health evidence-based practice (EBP) will be implemented, current methods to determine potential barriers and facilitators to implementation are often conducted in a single setting and/or for a single EBP per study, often taking 1–2 years to complete. To maximize generalizability and reduce the research-to-practice gap efficiently, it is important to move toward cross-sector and/or cross-EBP contextual inquiry. Methods: In this viewpoint, we argue for (a) collaborative research studies that seek to identify determinants of implementation that are similar and unique across different settings and EBPs, using rapid approaches when possible; (b) enhanced synthesis of existing research on implementation determinants to minimize duplication of contextual inquiry efforts; and (c) clear rationale for why additional in-depth or rapid contextual inquiry is needed before it is conducted. Throughout this viewpoint, the need to balance scientific rigor and speed are considered. Conclusions: Overall, this viewpoint seeks to encourage researchers to consolidate and share knowledge on barriers and facilitators to implementation to prepare for the scaling out of much needed implementation strategies and interventions for improving health. Plain language summary: Significant time and resources are often devoted to understanding what makes it easier or harder to use best practices for behavioral health concerns in health care settings. The goal of the current viewpoint is to offer ways to streamline this process so that high-quality behavioral health services can reach the patients that need them more quickly. In particular, we advocate for ways to share knowledge among researchers and learn from prior findings to more efficiently identify what makes it easier or harder to use best practices for addressing behavioral health problems in a given setting (e.g., primary care, schools, specialty mental health).

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Improving hospital systems for disadvantaged children and babies

Children Australia ◽

10.1017/s1035077200005332 ◽

2002 ◽

Vol 27 (4) ◽

pp. 33-35 ◽

Cited By ~ 1

Author(s):

Julie Hall

Keyword(s):

Children's Hospital ◽

Disadvantaged Children ◽

Vulnerable Families ◽

The Social ◽

Children’S Hospital ◽

History Of ◽

Hospital Systems ◽

Strengthening Families Program ◽

Strengthening Families

In this paper, I will discuss the importance of early intervention with vulnerable families where children and babies may be at risk of neglect and disadvantaged by their social circumstances in accessing appropriate, preventative support services. I will describe the Strengthening Families Program located in the Social Work Department of the Royal Children's Hospital, which provides a model for interdisciplinary and intersectoral (welfare and health) collaboration. The Program offers care management to individual families and is working towards systemic changes in the hospital's response to these families. Finally, I will illustrate aspects of the work of the Royal Children's Hospital Strengthening Families Program with a case study wherein a recent history of domestic violence impacted on the family's capacity to access health and welfare services for both mother and children.

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Evaluation of multi-level barriers and facilitators in a large diabetic retinopathy screening program in federally qualified health centers: a qualitative study

Implementation Science Communications ◽

10.1186/s43058-021-00157-2 ◽

2021 ◽

Vol 2 (1) ◽

Author(s):

Ana Bastos de Carvalho ◽

S. Lee Ware ◽

Tamara Belcher ◽

Franceska Mehmeti ◽

Eric B. Higgins ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Qualitative Study ◽

Underserved Populations ◽

Implementation Strategies ◽

Structured Interview ◽

Health Centers ◽

Barriers And Facilitators ◽

Federally Qualified Health Centers ◽

Multi Level ◽

Inner Setting

Abstract Background Recommended annual diabetic retinopathy (DR) screening for people with diabetes has low rates in the USA, especially in underserved populations. Telemedicine DR screening (TDRS) in primary care clinics could expand access and increase adherence. Despite this potential, studies have observed high variability in TDRS rates among clinics and over time, highlighting the need for implementation supports. Previous studies of determinants of TDRS focus on patients’ perspectives, with few studies targeting upstream multi-level barriers and facilitators. Addressing this gap, this qualitative study aimed to identify and evaluate multi-level perceived determinants of TDRS in Federally Qualified Health Centers (FQHCs), to inform the development of targeted implementation strategies. Methods We developed a theory-based semi-structured interview tool based on the Consolidated Framework for Implementation Research (CFIR). We conducted 22 key informant interviews with professionals involved in TDRS (administrators, clinicians, staff). The interviews were audio-recorded and transcribed verbatim. Reported barriers and facilitators were organized into emergent themes and classified according to CFIR constructs. Constructs influencing TDRS implementation were rated for each study site and compared across sites by the investigators. Results Professionals identified 21 main barriers and facilitators under twelve constructs of the five CFIR domains. Several identified themes were novel, whereas others corroborated previous findings in the literature (e.g., lack of time and human resources, presence of a champion). Of the 21 identified themes, 13 were classified under the CFIR’s Inner Setting domain, specifically under the constructs Compatibility and Available Resources. Themes under the Outer Setting domain (constructs External Incentives and Cost) were primarily perceived by administrators, whereas themes in other domains were perceived across all professional categories. Two Inner Setting (Leadership Engagement, Goals and Feedback) and two Process (Champion, Engaging) constructs were found to strongly distinguish sites with high versus low TDRS performance. Conclusions This study classified barriers and facilitators to TDRS as perceived by administrators, clinicians, and staff in FQHCs, then identified CFIR constructs that distinguished high- and low-performance clinics. Implementation strategies such as academic detailing and collection and communication of program data and successes to leadership; engaging of stakeholders through involvement in implementation planning; and appointment of intervention champions may therefore improve TDRS implementation and sustainment in resource-constrained settings.

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Establishing the Effectiveness of Enhanced Implementation Methods in Preventative Behavioral Health

10.1101/2020.09.25.20200444 ◽

2020 ◽

Author(s):

Sarah A. Stoddard ◽

Barrett Wallace Montgomery ◽

Leah D. Maschino ◽

Kristen Senters Young ◽

Julia W. Felton ◽

...

Keyword(s):

Substance Use ◽

Health Services ◽

Behavioral Health ◽

Implementation Strategies ◽

Great Promise ◽

Evidence Based ◽

Behavioral Health Services ◽

Strengthening Families Program ◽

Strengthening Families ◽

Organizational Needs

Background: More than 20 million Americans ages 12 and older have a past-year substance use disorder. Majority-minority cities, including Flint, MI, suffer disproportionately from higher rates of substance use and are less likely to have access to evidence-based prevention and treatment interventions relative to predominately White and wealthier cities. Thus, identifying approaches that can improve implementation of evidence-based substance use practices is a critical public health goal. In the current report, we provide a detailed protocol for the implementation and evaluation of the Strengthening Flint Families initiative, a community-based implementation study of a multi-level behavioral health intervention that includes peer recovery coaching, the Strengthening Families Program, and a multimedia campaign. Our goal is to improve family resilience and reduce behavioral health disparities in the Flint community, as an example of how this could be done in other communities. Our overall strategy includes community-informed implementation enhancements to increase adoption and sustainment of evidence-based behavioral health services. Methods: This project has 4 phases that align with study aims- 1) a systematic assessment of behavioral health organizations in the Flint Area to understand organizational needs and strengths in Flint; 2) tailoring implementation strategies for one individual-level evidence-based practice, peer recovery coaching, and one family-level evidence-based program, the Strengthening Families Program; 3) building capacity and promoting sustainability; and 4) evaluating primary (implementation) and secondary (effectiveness) outcomes. Implementation outcomes are derived from the RE-AIM framework and effectiveness outcomes will be assessed at the individual, family, and community levels. Discussion: Understanding and addressing the behavioral health organizational needs, strengths, and barriers to program adoption and referral in Flint offers great promise to strengthen the behavioral health network of providers serving Flint residents. Moreover, understanding barriers to accessing and implementing behavioral health services in low-resource communities may prove to be a valuable tool for discovering the most effective implementation methods tailored to specific organizations. These evidence informed approaches may prove useful for cities outside of Flint.

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Implementation analysis of patient reported outcomes (PROs) in oncological routine care: an observational study protocol

Health and Quality of Life Outcomes ◽

10.1186/s12955-019-1262-2 ◽

2020 ◽

Vol 18 (1) ◽

Cited By ~ 3

Author(s):

Mirja Gianna Görlach ◽

Theresa Schrage ◽

Carsten Bokemeyer ◽

Nicolaus Kröger ◽

Volkmar Müller ◽

...

Keyword(s):

Observational Study ◽

Patient Care ◽

Cancer Care ◽

Medical Staff ◽

Patient Reported Outcomes ◽

Implementation Strategies ◽

Implementation Process ◽

Routine Care ◽

Barriers And Facilitators ◽

Patient Reported

Abstract Background The successful implementation of patient-reported outcomes (PROs) in clinical routine faces many challenges, first and foremost the lack of consideration thereof in the patient care process. The aim of this study will be to first identify relevant barriers and facilitators and then design suitable implementation strategies which will be evaluated to improve the effectiveness of a PRO measure assessment in inpatient and outpatient cancer routine care. Methods During the preparation phase, interviews with oncological patients (N = 28) and medical staff (N = 4) as well as focus groups with medical staff (N = 18) across five different departments caring for cancer patients were conducted. On the basis of these, qualitative content analysis revealed relevant barriers and facilitators for implementation of PROs in cancer care. Subsequently, implementation strategies and a model of implementation were developed. In the study phase, implementation strategies will be evaluated based on nine different implementation outcomes in five different oncological clinics. Evaluation of the implementation process will take place during three months in each clinic and data will be conducted pre, while and post implementation of the PRO measure. Therefore a sample size of 60 participants of whom 30 staff members and 30 participants will be questioned using existing and newly developed implementation outcome evaluation instruments. Discussion Key to improving the effectiveness of PRO assessment in the time-critical clinical environment is the utilization of easy-to-use, electronic PRO questionnaires directly linked to patients’ records thereby improving consideration of PROs in patient care. In order to validate the effectiveness of this implementation process further, an evaluation parallel to implementation following an observational study design with a mixed-methods approach will be conducted. This study could contribute to the development of adequate evaluation processes of implementation of PROs to foster sustainable integration of PRO measures into routine cancer care. Trial registration This study was registered at Open Science Framework (https://osf.io/y7xce/).

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Reducing unnecessary vitamin testing in general practice: barriers and facilitators according to general practitioners and patients

BMJ Open ◽

10.1136/bmjopen-2019-029760 ◽

2019 ◽

Vol 9 (10) ◽

pp. e029760 ◽

Cited By ~ 3

Author(s):

H. Hofstede ◽

H.A.M. van der Burg ◽

B.C. Mulder ◽

A.M. Bohnen ◽

P.J.E. Bindels ◽

...

Keyword(s):

Primary Care ◽

Vitamin D ◽

General Practice ◽

Qualitative Study ◽

General Practitioners ◽

Implementation Strategies ◽

Barriers And Facilitators ◽

Care Practice ◽

Registration Number ◽

Test Ordering

ObjectiveThere has been an increase in testing of vitamins in patients in general practice, often based on irrational indications or for non-specific symptoms, causing increasing healthcare expenditures and medicalisation of patients. So far, there is little evidence of effective strategies to reduce this overtesting in general practice. Therefore, the aim of this qualitative study was to explore the barriers and facilitators for reducing the number of (unnecessary) vitamin D and B12laboratory tests ordered.Design and settingThis qualitative study, based on a grounded theory design, used semistructured interviews among general practitioners (GPs) and patients from two primary care networks (147 GPs, 195 000 patients). These networks participated in the Reducing Vitamin Testing in Primary Care Practice (REVERT) study, a clustered randomized trial comparing two de-implementation strategies to reduce test ordering in primary care in the Netherlands.ParticipantsTwenty-one GPs, with a maximum of 1 GP per practice who took part in the REVERT study, and 22 patients (who were invited by their GP during vitamin-related consultations) were recruited, from which 20 GPs and 19 patients agreed to participate in this study.ResultsThe most important factor hampering vitamin-test reduction programmes is the mismatch between patients and medical professionals regarding the presumed appropriate indications for testing for vitamin D and B12. In contrast, the most important facilitator for vitamin-test reduction may be updating GPs’ knowledge about test indications and their awareness of their own testing behaviour.ConclusionTo achieve a sustainable reduction in vitamin testing, guidelines with clear and uniform recommendations on evidence-based indications for vitamin testing, combined with regular (individual) feedback on test-ordering behaviour, are needed. Moreover, the general public needs access to clear and reliable information on vitamin testing. Further research is required to measure the effect of these strategies on the number of vitamin test requests.Trial registration numberWAG/mb/16/039555.

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