Promising Strategies to Support COVID-19 Vaccination of Healthcare Personnel: Insights from the VHA National Implementation

Background As of August 2021 up to 30% of Americans were uncertain about taking the COVID-19 vaccine. Some healthcare personnel (HCP) also delayed or declined vaccination. Objective Identify barriers and facilitators of Veterans Health Administration (VHA) HCP vaccination program Design: Key informant interviews with employee occupational health (EOH) providers Participants: 38 VHA EOH providers representing 26 of VHA’s regionally diverse healthcare systems. Approach: Thematic analysis elucidated 5 key themes, and specific strategies recommended by EOH Key Results: Implementation themes included: 1) Leverage diverse skillsets through multidisciplinary effort, specifically COVID-19 vaccination teams with clear goals/roles. 2) “Focus like a laser”: invest in processes and align resources with priorities, including specific strategies of: creating detailed processes, eg. logistics plan to prevent wastage and allocate excess vaccine doses; addressing time trade-offs for personnel involved in vaccine clinics by suspending everything non-essential; designating process/authority to shift personnel where needed; and proactively involving leaders to support resource allocation/alignment. 3) Expect and accommodate vaccine buy-in occurring over time, including specific strategies of: preparing for some HCP slow buy-in; aligning buy-in facilitation with identities and motivation; encouraging word-of-mouth and hyper-local testimonials. 4) Overcome misinformation through trustworthy communication, with specific strategies including: tailoring communication to individuals and addressing COVID vaccines “in every encounter”; leveraging proactive institutional messaging (e.g., townhalls, Q&As) to reinforce information; inviting bi-directional conversations about hesitancy. 5) Use existing and newly developed communication channels to foster sharing and learning across teams and sites, eg. a national VHA EOH listserv. Conclusions Expecting deliberation allows systems to prepare for complex distribution logistics, and conversations that are trustworthy, bi-directional, and identity-aligned - overall supporting mandate goals. Ideally, organizations 1) provide time for conversations about vaccines; those conversations would 2) address individual concerns and foster bi-directional shared decision-making, 3) be informed by identity-based motivation, and 4) delivered by identity-concordant individuals.

Infection prevention and control (IPC) implementation in low-resource settings: a qualitative analysis

Background The coronavirus disease-2019 (COVID-19) pandemic has again demonstrated the critical role of effective infection prevention and control (IPC) implementation to combat infectious disease threats. Standards such as the World Health Organization (WHO) IPC minimum requirements offer a basis, but robust evidence on effective IPC implementation strategies in low-resource settings remains limited. We aimed to qualitatively assess IPC implementation themes in these settings. Methods Semi-structured interviews were conducted with IPC experts from low-resource settings, guided by a standardised questionnaire. Applying a qualitative inductive thematic analysis, IPC implementation examples from interview transcripts were coded, collated into sub-themes, grouped again into broad themes, and finally reviewed to ensure validity. Sub-themes appearing ≥ 3 times in data were highlighted as frequent IPC implementation themes and all findings were summarised descriptively. Results Interviews were conducted with IPC experts from 29 countries in six WHO regions. Frequent IPC implementation themes including the related critical actions to achieve the WHO IPC core components included: (1) To develop IPC programmes: continuous advocacy with leadership, initial external technical assistance, stepwise approach to build resources, use of catalysts, linkages with other programmes, role of national IPC associations and normative legal actions; (2) To develop guidelines: early planning for their operationalization, initial external technical assistance and local guideline adaption; (3) To establish training: attention to methods, fostering local leadership, and sustainable health system linkages such as developing an IPC career path; (4) To establish health care-associated (HAI) surveillance: feasible but high-impact pilots, multidisciplinary collaboration, mentorship, careful consideration of definitions and data quality, and “data for action”; (5) To implement multimodal strategies: clear communication to explain multimodal strategies, attention to certain elements, and feasible but high-impact pilots; (6) To develop monitoring, audit and feedback: feasible but high-impact pilots, attention to methods such as positive (not punitive) incentives and “data for action”; (7) To improve staffing and bed occupancy: participation of national actors to set standards and attention to methods such as use of data; and (8) To promote built environment: involvement of IPC professionals in facility construction, attention to multimodal strategy elements, and long-term advocacy. Conclusions These IPC implementation themes offer important qualitative evidence for IPC professionals to consider.

Infection Prevention and Control (IPC) Implementation in Low-Resource Settings: A Qualitative Analysis

BackgroundThe coronavirus disease-2019 (COVID-19) pandemic has again demonstrated the critical role of effective infection prevention and control (IPC) implementation to combat infectious disease threats. Standards such as the World Health Organization (WHO) IPC minimum requirements offer a basis, but robust evidence on effective IPC implementation strategies in low-resource settings remains limited. We aimed to qualitatively assess IPC implementation themes in these settings.MethodsSemi-structured interviews were conducted with IPC experts from low-resource settings, using a standardised questionnaire. Applying a qualitative inductive thematic analysis, IPC implementation examples from interview transcripts were coded, collated into sub-themes, grouped again into broad themes, and reviewed to ensure validity. Sub-themes appearing ≥3 times in data were highlighted as frequent IPC implementation themes and all findings were summarised descriptively.ResultsInterviews were conducted with IPC experts from 29 countries in six WHO regions. Frequent IPC implementation themes to achieve the WHO IPC core components included: 1) To develop IPC programmes: continuous advocacy with leadership, initial external technical assistance, stepwise approach to build resources, use of catalysts, linkages with other programmes, role of national IPC associations and normative legal actions; 2) To develop guidelines: early planning for their operationalization, initial external technical assistance and local guideline adaption; 3) To establish training: attention to methods, fostering local leadership, and sustainable health system linkages such as developing an IPC career path; 4) To establish health care-associated (HAI) surveillance: feasible but high-impact pilots, multidisciplinary collaboration, mentorship, careful consideration of definitions and data quality, and “data for action”; 5) To implement multimodal strategies: clear communication to explain multimodal strategies, attention to certain elements, and feasible but high-impact pilots; 6) To develop monitoring, audit and feedback: feasible but high-impact pilots, attention to methods such as positive (not punitive) incentives and “data for action”; 7) To improve staffing and bed occupancy: participation of national actors to set standards and attention to methods such as use of data; and 8) To promote built environment: involvement of IPC professionals in facility construction, attention to multimodal strategy elements, and long-term advocacy.ConclusionsThese IPC implementation themes offer important qualitative evidence for IPC professionals to consider.

Examining the implementation of the Healthy Kids Community Challenge

Introduction: The Healthy Kids Community Challenge (HKCC) was a community-based, multi-stakeholder obesity prevention program aimed at children and youth in Ontario, which was funded and coordinated by the Ministry of Health and Long-term Care from 2015-2018. This project contributed to the process evaluation of the HKCC, which is being carried out by Public Health Ontario. The objective of my research was to identify and understand the barriers and facilitators to implementation of the HKCC, from the perspective of members of the Local Steering Committees (LSCs), who were directly involved in implementation. Methods: 10 questions from the 2018 LSC Survey were coded and thematically analyzed, using NVivo 11.0 software, according to the themes presented within Durlak and Dupre’s Ecological Framework for Effective Implementation. Themes were summarized according to barriers, challenges, factors associated with implementation, strategies communities used to engage partners and reach vulnerable populations, as well as positive experiences. The findings were presented in a report which featured a rich, qualitative account, accompanied by direct quotations and code frequency charts. Results: A number of perceived barriers to implementation were identified, including program structure (i.e., tight timelines, short duration), low SES (i.e., barriers related to lack of time, transportation and access to childcare, as well as difficulty accessing HKCC information) and geography and transportation (i.e., to access programming). Some important perceived facilitators of implementation included: funding, partnerships, HKCC messaging, and an inclusive, accessible approach to planning events. Participants expressed interest in sustaining programs and partnerships beyond the HKCC funding period, although the loss of provincial funding was identified as a challenge. Participants also noted potential for sustainability, particularly related to increased cross-sectoral collaboration and increased capacity for community-based health promotion. Implications: The results could be used to improve implementation of future community-based, multi-stakeholder health promotion programs. They might also offer insight into how to tailor the implementation process of large-scale community-based health promotion programs to local contexts.

Implementing RTI in Two Rural Elementary Schools: Encouraging Beginnings and Challenges for the Future

Response to Intervention (RTI) models are currently being implemented in many school districts nationwide. However, at a time when interest in RTI is high, the extent to which it is being implemented effectively in rural schools is largely unknown. Teachers and administrators in two rural elementary schools in the Southeastern United States who were part of a state-wide RTI pilot project participated in this study. Interviews were conducted along with field observations of classroom instruction and team problem-solving meetings. Using a multi-step process for data analysis, various implementation themes emerged related to tiered instruction, data-based decision making, support for model implementation, and collaboration. Findings in these areas support issues raised in the literature regarding factors in rural schools that may impede or enhance fidelity of model implementation. Implications for practice and future research are discussed.

How do we actually put smarter snacks in schools? NOURISH (Nutrition Opportunities to Understand Reforms Involving Student Health) conversations with food-service directors

ObjectiveIn autumn 2012, Massachusetts schools implemented comprehensive competitive food and beverage standards similar to the US Department of Agriculture’s Smart Snacks in School standards. We explored major themes raised by food-service directors (FSD) regarding their school-district-wide implementation of the standards.DesignFor this qualitative study, part of a larger mixed-methods study, compliance was measured via direct observation of foods and beverages during school site visits in spring 2013 and 2014, calculated to ascertain the percentage of compliant products available to students. Semi-structured interviews with school FSD conducted in each year were analysed for major implementation themes; those raised by more than two-thirds of participating school districts were explored in relationship to compliance.SettingMassachusetts school districts (2013: n 26; 2014: n 21).SubjectsData collected from FSD.ResultsSeven major themes were raised by more than two-thirds of participating school districts (range 69–100 %): taking measures for successful transition; communicating with vendors/manufacturers; using tools to identify compliant foods and beverages; receiving support from leadership; grappling with issues not covered by the law; anticipating changes in sales of competitive foods and beverages; and anticipating changes in sales of school meals. Each theme was mentioned by the majority of more-compliant school districts (65–81 %), with themes being raised more frequently after the second year of implementation (range increase 4–14 %).ConclusionsFSD in more-compliant districts were more likely to talk about themes than those in less-compliant districts. Identified themes suggest best-practice recommendations likely useful for school districts implementing the final Smart Snacks in School standards, effective July 2016.

Consumers’ and Providers’ Perceptions of Utilizing a Computer-Assisted Cognitive Behavioral Therapy for Childhood Anxiety

Background: Computer-assisted cognitive behavioral therapy (CCBT) programs for childhood anxiety are being developed, although research about factors that contribute to implementation of CCBT in community mental health centers (CMHC) is limited. Aim: The purpose of this mixed-methods study was to explore consumers’ and providers’ perceptions of utilizing a CCBT for childhood anxiety in CMHC in an effort to identify factors that may impact implementation of CCBT in CMHC. Method: Focus groups and interviews occurred with 7 parents, 6 children, 3 therapists, 3 project coordinators and 3 administrators who had participated in CCBT for childhood anxiety. Surveys of treatment satisfaction and treatment barriers were administered to consumers. Results: Results suggest that both consumers and providers were highly receptive to participation in and implementation of CCBT in CMHC. Implementation themes included positive receptiveness, factors related to therapists, treatment components, applicability of treatment, treatment content, initial implementation challenges, resources, dedicated staff, support, outreach, opportunities with the CMHC, payment, and treatment availability. Conclusion: As studies continue to demonstrate the effectiveness of CCBT for childhood anxiety, research needs to continue to examine factors that contribute to the successful implementation of such treatments in CMHC.