An embedded multiple case study: using CFIR to map clinical food security screening constructs for the development of primary care practice guidelines

Background Food insecurity (FI), the limited access to healthy food to live an active and healthy life, is a social determinant of health linked to poor dietary health and difficulty with disease management in the United States (U.S.). Healthcare experts support the adoption of validated screening tools within primary care practice to identify and connect FI patients to healthy and affordable food resources. Yet, a lack of standard practices limits uptake. The purpose of this study was to understand program processes and outcomes of primary care focused FI screening initiatives that may guide wide-scale program implementation. Methods This was an embedded multiple case study of two primary care-focused initiatives implemented in two diverse health systems in Chicago and Suburban Cook County that routinely screened patients for FI and referred them to onsite food assistance programs. The Consolidated Framework for Implementation Research and an iterative process were used to collect/analyze qualitative data through semi-structured interviews with N = 19 healthcare staff. Intended program activities, outcomes, actors, implementation barriers/facilitators and overarching implementation themes were identified as a part of a cross-case analysis. Results Programs outcomes included: the number of patients screened, identified as FI and that participated in the onsite food assistance program. Study participants reported limited internal resources as implementation barriers for program activities. The implementation climate that leveraged the strength of community collaborations and aligned internal, implementation climate were critical facilitators that contributed to the flexibility of program activities that were tailored to fill gaps in resources and meet patient and clinician needs. Conclusion Highly adaptable programs and the healthcare context enhanced implementation feasibility across settings. These characteristics can support program uptake in other settings, but should be used with caution to preserve program fidelity. A foundational model for the development and testing of standard clinical practice was the product of this study.

Fermatean Fuzzy DEMATEL and MMDE Algorithm for Modelling the Barriers of Implementing Education 4.0: Insights from the Philippines

Technological transitions in the education sector of developing economies are faced with a range of barriers, involving resource scarcity, socio-cultural concerns, and issues related to management and policy. The popularity of Industry 4.0 has prompted Education 4.0 (EDUC4), an approach to learning that involves transformation using advanced technologies. While a recent work reported a comprehensive list of barriers to EDUC4 implementation, particularly in developing economies, further analysis to identify those priority barriers remains a gap. Thus, this work addresses this gap by introducing a novel methodological extension of the decision-making trial and evaluation laboratory (DEMATEL) method following the integration of Fermatean fuzzy sets (FFS). The FFS, compared to other fuzzy environments, could capture higher levels of uncertainties that are associated when eliciting judgments necessary for the DEMATEL. Such integration is aided by the maximum mean de-entropy (MMDE) algorithm, which analytically determines the threshold value crucial for constructing the prominence-relation map of the DEMATEL. Following its application in evaluating the implementation of EDUC4 in Philippine universities, the critical barriers are the lack of training resources, costs, insufficiency of available technologies, skills gap of human resources, knowledge gap, and the complexity of the learning platforms. Among this set, barriers related to cost and lack of training resources are deemed the most prominent ones. The statistical test on the impact of addressing the two prominent barriers shows that addressing the barrier related to costs yields statistically more favorable results regarding the mitigation of other EDUC4 implementation barriers. Although these insights may contain idiosyncrasies, they can serve as starting points of discussion in other relevant developing economies. These methodological and practical contributions advance the development of analytical tools under uncertainty that can handle pressing problems such as the EDUC4 implementation.

Implementation of Therapeutic Virtual Reality Into Psychiatric Care: Clinicians' and Service Managers' Perspectives

Objectives: Virtual reality (VR) has emerged as a highly promising tool for assessing and treating a range of mental illnesses. However, little is known about the perspectives of key stakeholders in mental healthcare, whose support will be critical for its successful implementation into routine clinical practise. This study aimed to explore the perspectives of staff working in the private mental health sector around the use of therapeutic VR, including potential implementation barriers and facilitators.Methods: Semi-structured qualitative interviews were conducted with cross-disciplinary clinicians (n = 14) and service managers (n = 5), aged 28–70 years working in a major private mental health hospital in Victoria, Australia. Transcripts were analysed using general inductive coding to allow themes to naturally emerge.Results: Three major themes were identified: clinical factors (four subthemes), organisational factors (five subthemes), and professional factors (three subthemes). The themes encompassed enabling factors and potential barriers that need to be addressed for successful implementation of VR. Clinical factors highlighted the influence of knowledge or perceptions about appropriate clinical applications, therapeutic efficacy, safety and ethical concerns, and patient engagement. Organisational factors emphasised the importance of service contexts, including having a strong business case, stakeholder planning, recruitment of local opinion leaders to champion change, and an understanding of resourcing challenges. Professional factors highlighted the need for education and training for staff, and the influence of staff attitudes towards technology and perceived usability of VR.Conclusions: In addition to enabling factors, potential implementation barriers of therapeutic VR were identified, including resourcing constraints, safety and ethical concerns, negative staff attitudes towards technology and VR system limitations. Future dissemination should focus on addressing knowledge and skills gaps and attitudinal barriers through development of clinical guidelines, training programs, and implementation resources (e.g., adoption decision tools, consultation opportunities).

Planning for Implementation Success of an Electronic Cross-Facility Health Record for Pediatric Palliative Care Using the Consolidated Framework for Implementation Research (CFIR)

Pediatric palliative care (PPC) patients require years of care across professions and sectors. Sharing treatment-related information and communicating among different PPC professionals is critical to ensure good quality of care. In Germany, this communication is mostly paper-based and prone to errors. Therefore, an electronic cross-facility health record (ECHR) was participatorily designed with users, wherein information can be shared and PPC professionals can communicate with each other. As this form of electronic health record differs from existing models in Germany, there is a need for successful implementation to ensure a positive impact. Therefore, the facilitators and barriers to the implementation of ECHR in PPC were examined. Using the consolidated framework for implementation research (CFIR), transcripts of 32 interviews, 3 focus groups, and 20 think-aloud studies with PPC professionals were analyzed. CFIR indicated that the ECHR-design was viewed positively by users and can be a facilitator for implementation. Barriers exist, mainly due to the fact that the implementation is not planned, the use of the ECHR involves effort, costs are not covered, and all users must be motivated to use the ECHR for functionality. CFIR helps uncover the crux of the issues that need to be considered when planning ECHR implementation to improve care in PPC.

Mobile Health Platform to Augment Integrated Behavioral Health Care: Pilot in a Large Health System (Preprint)

BACKGROUND Digital and mobile technologies have potential to improve the delivery and scale of integrated care models. OBJECTIVE We aimed to assess acceptability and feasibility, preliminary clinical outcomes, and implementation barriers of a mobile health platform used to augment an existing integrated behavioral health program. METHODS The mobile platform was used by three behavioral health care managers responsible for coordinating disease management in six primary care practices. 89 of 245 individuals (36%) who were referred by their PCP for behavioral health services consented to app-augmented behavioral health care. The mobile health platform functions included chat communication, monthly depression self-report assessments, and psychoeducational content. RESULTS The clinical improvement rate in our sample was 72% although follow-up assessments were only available for 49% of participants. At least one action in the mobile app was completed by 87% of participants (n=78; median=7; IQR=12, 0-130). Behavioral health care managers cited increased documentation burden and language as barriers to use. CONCLUSIONS Our pilot of mobile technology in collaborative care highlights important implementation barriers. Future research should systematically evaluate the implementation of digital and mobile health technology in collaborative care.

ISM-MICMAC approach for analysis of project-based learning barriers

Purpose This paper aims to identify and model the key barriers to implementation of project-based learning (PjBL) in higher educational institution. Design/methodology/approach Using the interpretive structural modelling (ISM) technique, the study has developed a hierarchical-based model, depicting the mutual relationships amongst the key barriers to implementation of PjBL. Additionally, the paper has performed Matrice d’ Impacts Croises Multiplication Appliqué an Classement (MICMAC) analysis to categorize the barriers in terms of their driving and dependence power. Findings The study has identified the key barriers to implementation of PjBL and presented an integrated model using ISM. Higher educational institutions need to pay attention to diagnose and overcome these hindrances for effective implementation of PjBL in their programmes. Research limitations/implications The study adopts a systematic way to model the relevant barriers to implementation of PjBL. The ISM-based model would help higher education institutions to prioritize the issues as the barriers are hierarchically structured. As the input to model development is based on the experts’ opinions, it may be biased, influencing the final output of the structural model. Originality/value The presentation of PjBL implementation barriers in the form of an ISM-based model is a new effort. The model would be useful to understand the barriers and overcome these for the successful implementation of PjBL in higher educational institutions.

The bioeconomy paradigm as a factor stimulating companies innovation in SMEs sector

Purpose of the study: This study intended to do an assessment of the bioeconomy paradigm importance for companies’ innovation in the SMEs sector. Methodology: The research material was collected on the basis of desk research method using professional literature, including book publications, scientific articles, presentations, reports, as well as various legal acts and press sources in paper and electronic form. Case studies of selected companies were prepared on the basis of the European Commission report. Main Findings: The concept of knowledge-based bioeconomy has become an important factor determining the innovation of enterprises. In the face of global eco-threats, companies that implement strategies in areas convergent with the new development paradigm are increasingly using innovative biotechnologies in their manufacturing processes or replacing non-renewable production resources with biodegradable bio-materials. In the process of changes, an important role is played by small and medium-sized enterprises (SMEs), whose activities are to fill the gap between scientific research and the implementation of innovation, especially in such areas as food, agriculture and fisheries, and biotechnology. Therefore, despite numerous implementation barriers, this sector has gained a new source of competitive advantages thanks to the bioeconomy. Applications of this study: The presented material may become a source of knowledge for entrepreneurs interested in developing activities in the area of bioeconomy and for institutions focused on creating innovation support programs for the SMEs sector. The originality of this study: In the literature the bioeconomy is considered mainly as the sustainable production of renewable resources and the possibility of their transformation into food, feed, bio-based products or bioenergy. The new development paradigm should therefore be considered as a valuable source of competitive advantages for enterprises. This study documented its importance as a factor stimulating the innovation activity of small and medium-sized enterprises. This phenomenon is particularly important from the point of view of the Polish SMEs sector, whose innovations are most often of an imitative nature.

Mixed-methods Process Evaluation of a Residence-based SARS-CoV-2 Testing Participation Pilot on a UK University Campus during the COVID-19 Pandemic

BackgroundRegular testing for SARS Coronavirus-2 (SARS-CoV-2) is an important strategy for controlling virus outbreaks on university campuses during the COVID-19 pandemic but testing participation rates can be low. The Residence-Based Testing Participation Pilot (RB-TPP) was a novel intervention implemented at two student residences on a large UK university campus over four weeks. The aim of the pilot was to increase the frequency of asymptomatic SARS-CoV-2 saliva testing onsite. This process evaluation aimed to determine whether RB-TPP was implemented as planned and identify implementation barriers and facilitators.MethodsA mixed-methods process evaluation was conducted alongside the RB-TPP. Evaluation participants were students (opting in, or out of RB-TPP) and staff with a role in service provision or student support. Monitoring data were collected from the intervention delivery team and meeting records. Data were collected from students via online survey (n=152) and seven focus groups (n=30), and from staff via individual interviews (n=13). Quantitative data were analysed descriptively and qualitative data thematically. Barriers and facilitators to implementation were mapped to the ‘Capability, Opportunity, Motivation–Behaviour’ (COM-B) behaviour change framework.Results464 students opted to participate in RB-TPP (98% of students living onsite). RB-TPP was implemented broadly as planned but was terminated early due to concerns relating to national escalation of the COVID-19 Delta variant. Most students (97.9%) perceived the relaxing of social distancing regulations within residences positively. The majority engaged in asymptomatic testing (88%); 46% (52% of testers) were fully compliant with pre-determined testing frequency. Implementation was facilitated by convenience and efficiency of testing, reduction in the risk of self-isolation and opportunities for students to socialise. Main barriers to implementation were mixed-messages about the rules, ambivalent attitudes, and lack of adherence to COVID-19 protective measures in the minority.ConclusionsThis process evaluation identifies factors that help or hinder the success of university residence-based outbreak prevention and management strategies. RB-TPP led to increased rates of COVID-19 testing participation among students in university residences. Perceived normalisation of university life significantly enhanced student mental wellbeing. The complexity and challenge generated by multiple lines of communication and rapid adaptions to a changing pandemic context was evident.Trial registration numberUKAS 307727-02-01; Pre-results. ClinicalTrials.gov Identifier: NCT05045989; post-results (first posted, 16/09/21).Ethical ApprovalFMHS 96-0920