Implementation of an electronic patient-reported measure of barriers to antiretroviral therapy adherence with the Opal patient portal: Protocol for a mixed method type 3 hybrid pilot study at a large Montreal HIV clinic

Background Adherence to antiretroviral therapy (ART) remains problematic. Regular monitoring of its barriers is clinically recommended, however, patient-provider communication around adherence is often inadequate. Our team thus decided to develop a new electronically administered patient-reported outcome measure (PROM) of barriers to ART adherence (the I-Score) to systematically capture this data for physician consideration in routine HIV care. To prepare for a controlled definitive trial to test the I-Score intervention, a pilot study was designed. Its primary objectives are to evaluate patient and physician perceptions of the I-Score intervention and its implementation strategy. Methods This one-arm, 6-month study will adopt a mixed method type 3 implementation-effectiveness hybrid design and be conducted at the Chronic Viral Illness Service of the McGill University Health Centre (Montreal, Canada). Four HIV physicians and 32 of their HIV patients with known or suspected adherence problems will participate. The intervention will involve having patients complete the I-Score through a smartphone application (Opal), before meeting with their physician. Both patients and physicians will have access to the I-Score results, for consideration during the clinic visits at Times 1, 2 (3 months), and 3 (6 months). The implementation strategy will focus on stakeholder involvement, education, and training; promoting the intervention’s adaptability; and hiring an Application Manager to facilitate implementation. Implementation, patient, and service outcomes will be collected (Times 1-2-3). The primary outcome is the intervention’s acceptability to patients and physicians. Qualitative data obtained, in part, through physician focus groups (Times 2–3) and patient interviews (Times 2–3) will help evaluate the implementation strategy and inform any methodological adaptations. Discussion This study will help plan a definitive trial to test the efficacy of the I-Score intervention. It will generate needed data on electronic PROM interventions in routine HIV care that will help improve understanding of conditions for their successful implementation. Clinical trial registration ClinicalTrials.gov identifier: NCT04702412; https://clinicaltrials.gov/.

The Strategy to Implement Work-Based Learning through Field Work Practices in Vocational High Schools (Multiple Case Studies in Malang Regency and Blitar City)

This study aims to identify and describe the strategy for implementing work-based learning through fieldwork practices in vocational high schools which include (1) WBL-FWP implementation strategy planning; (2) WBL-FWP implementation strategy; (3) Evaluation of the WBL-FWP implementation strategy; (4) Supporting and inhibiting factors for WBL-FWP Implementation, and (5) Impact on WBL-FWP implementation. This study uses a qualitative approach and the type of research is Multi Cases, the research was conducted at VHS Turen and VHS Islam 1 Blitar. Sources of data were obtained from the principal, vice-principal for public relations, the Chair of the WBL-FWP Working Group, the WBL-FWP Supervisor, and the WBL-FWP Instructor. Collecting data using free and in-depth interviews, study documentation, and observation. The findings show that: (1) WBL-FWP implementation strategy planning is carried out by MoU with linear industry, WBL-FWP supporting industrial practice equipment, and student preparation with WBL-FWP program socialization and debriefing; (2) The WBL-FWP implementation strategy is carried out structurally, the WBL-FWP is implemented for 6 months and there is a pick-up after students complete the WBL-FWP; (3) Evaluation of the WBL-FWP implementation strategy includes the assessment of industrial work results and the assessment of supervisors; (4) The supporting and implementing factors of WBL-FWP are the enthusiasm and full support of all school residents and the limitations of the industry as the location of WBL-FWP, the presence of students to improve products, teachers gain experience and apply learning in schools, and students gain competence in industry; (5) The impact of the existence of WBL-FWP is that the name of VHS will be better known, and students will also gain knowledge outside and know more about how to communicate, socialize with those around them.

Efficacy of an Enhanced Implementation Strategy to Increase Parent Engagement with a Health Promotion Program in Childcare

Previous efforts to involve parents in implementation of childcare-based health promotion interventions have yielded limited success, suggesting a need for different implementation strategies. This study evaluated the efficacy of an enhanced implementation strategy to increase parent engagement with Healthy Me, Healthy We. This quasi-experimental study included childcare centers from the second of two waves of a cluster-randomized trial. The standard approach (giving parents intervention materials, prompting participation at home, inviting participation with classroom events) was delivered in 2016–2017 (29 centers, 116 providers, and 199 parents). The enhanced approach (standard plus seeking feedback, identifying and addressing barriers to parent participation) was delivered in 2017–2018 (13 centers, 57 providers, and 114 parents). Parent engagement was evaluated at two levels. For the center-level, structured interview questions with providers throughout the intervention were systematically scored. For the parent-level, parents completed surveys following the intervention. Differences in parent engagement were evaluated using linear regression (center-level) and mixed effects (parent-level) models. Statistical significance was set at p < 0.025 for two primary outcomes. There was no difference in parent engagement between approaches at the center-level, β = −1.45 (95% confidence interval, −4.76 to 1.87), p = 0.38l. However, the enhanced approach had higher parent-level scores, β = 3.60, (95% confidence interval, 1.49 to 5.75), p < 0.001. In the enhanced approach group, providers consistently reported greater satisfaction with the intervention than parents (p < 0.001), yet their fidelity of implementing the enhanced approach was low (less than 20%). Results show promise that parent engagement with childcare-based health promotion innovations can positively respond to appropriately designed and executed implementation strategies, but strategies need to be feasible and acceptable for all stakeholders.

Selection of strategy for reverse logistics implementation

Purpose Reverse logistics has attracted many industries due to product recalls, enormous waste generation, competitive reasons, vast opportunity in the waste management market, and to get the maximum value out of waste recovery. Selection of the right implementation strategy is vital for reverse logistics to function efficiently. Therefore, this research aims to evaluate the criteria for selecting reverse logistics strategy and help to choose the preferred strategy for its implementation. Design/methodology/approach Three reverse logistics implementation strategies, namely, in-house, joint venture and outsourcing, are proposed. A novel hybrid fuzzy analytical hierarchy process (F-AHP) and fuzzy measurement of alternatives and ranking according to COmpromise Solution (F-MARCOS) based framework is developed to fulfil the research objective. A survey is performed on Indian manufacturing industry to demonstrate the applicability of the proposed framework. Findings The result shows that government policy and regulations, reverse logistics risks and reduced emission have prime importance for a manufacturing industry which needs to implement reverse logistics into its supply chain. Outsourcing is the preferred reverse logistics strategy followed by joint venture and in-house that a manufacturing firm in India can implement. Research limitations/implications The research results are based on the responses of the survey received. This research considers various industry sectors to test the applicability of the framework. However, for actual implementation, this survey must first be limited to a particular industry as the results will apply to that industrial sector only. Practical implications This developed framework simplifies the procedure of selecting the strategy when the industry needs to implement reverse logistics. For industries working with a smaller set of criteria, this framework is a powerful and dynamic approach for reducing and choosing the most pertinent one that helps accomplish their objectives of reverse logistics implementation strategy selection. Originality/value Based on the literature and current applicability of reverse logistics, this research proposes three models to implement reverse logistics in Indian industries. A novel hybrid F-AHP and F-MARCOS based framework is developed to handle the selection of suitable reverse logistics strategy.

Development of a Multicomponent Implementation Strategy to Reduce Upper Gastrointestinal Bleeding Risk in Patients Using Warfarin and Antiplatelet Therapy, and Protocol for a Pragmatic Multilevel Randomized Factorial Pilot Implementation Trial

BackgroundConcomitant use of anticoagulant and antiplatelet medications increases the risk of upper gastrointestinal (GI) bleeding. Two underused evidence-based practices (EBPs) can reduce the risk: de-prescribe unnecessary antiplatelet therapy or initiate a proton pump inhibitor. We describe 1) the development of a multicomponent intervention to increase use of these EBPs in patients treated with warfarin and followed by an anticoagulation monitoring service (AMS) and 2) the design of a pilot pragmatic implementation trial.MethodsA participatory planning group iteratively used Implementation Mapping and the Multiphase Optimization Strategy to develop implementation strategies and plan the trial. Informed by qualitative interviews with patients and clinicians, we drew on several implementation science theories, as well as self-determination theory, to design interventions. For patients, we developed an activation guide to help patients discuss the EBPs with their clinicians. For clinicians, we developed two electronic health record (EHR)-based interventions: (1) Clinician notification (CN) consists of a templated message that identifies a patient as high risk, summarizes the EBPs, and links to a guidance statement on appropriate use of antiplatelet therapy. (2) Clinician notification with nurse facilitation (CN+NF) consists of a similar notification message but includes additional measures by nursing staff to support appropriate and timely decision-making: The nurse performs a chart review to identify any history of vascular disease, embeds indication-specific guidance on antiplatelet therapy in the message, and offers to assist with medication order entry and patient education. We will conduct a pilot factorial cluster- and individual-level randomized controlled trial with a primary objective of evaluating feasibility. Twelve clinicians will be randomized to receive either CN or CN+NF for all their patients managed by the AMS while 50 patients will be individually randomized to receive either the activation guide or usual care. We will explore implementation outcomes using patient and clinician interviews along with EHR review.DiscussionThis pilot study will prepare us to conduct a larger optimization study to identify the most potent and resource conscious multicomponent implementation strategy to help AMSs increase use of best practices for upper GI bleeding risk reduction.Trial RegistrationClinicalTrials.gov, NCT05085405, Registered 19 October 2021 – Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT05085405