Taking Care of Friends: The Implementation Evaluation of a Peer-Focused School Program Using First Aid to Reduce Adolescent Risk-Taking and Injury

Injury is a leading cause of adolescent deaths, with risk-taking associated with a sizeable proportion of injuries and many of those risks undertaken in the presence of peers or with peers’ knowledge. Novel ways to promote safety are required and using the peer-relationship may be an important mechanism for prevention. This study reports on the implementation evaluation of the Skills for Preventing Injury in Youth (SPIY) program. SPIY is a high-school program designed to reduce injury by encouraging peers to look out for one another and prevent risk-taking, complemented by developing peer helping and first aid skills as well as school connectedness. 152 students and 12 teachers who delivered SPIY participated in separate 30 min focus groups and reported on students’ understanding of peer protective behaviour and the program implementation (adherence, dose, quality of program delivery, and participant responsiveness). Students reported on many approaches to protecting friends and both students and teachers reported they found the program interesting, interactive, and able to be delivered. Peer protection messages were relevant and acceptable to teachers and students in a risk-taking harm reduction program to reduce adolescent injury.

Caregiver Intervention Implementation Fidelity: An Empirical Investigation of a Multidimensional Model

The extant literature on implementation fidelity has found mixed evidence for empirically establishing the dimensionality of implementation fidelity. The current study aims to add to this growing body of literature by examining implementation fidelity in a book-reading intervention for young children’s caregivers. Caregivers ( n = 291) implemented Sit Together and Read 2 (STAR 2) with their preschool-age children. These data indicated that implementation fidelity was determined to be a four-dimensional construct including adherence/dose, quality of delivery, participant responsiveness, and program differentiation. The main findings of this work are twofold: (a) implementation fidelity is a more complex construct than some previous descriptions, and (b) early childhood education research should aim to report on all aspects of implementation fidelity.

Implementation Fidelity In A Multifaceted Program To Foster Rational Antibiotics Use In Primary Care: An Observational Study

BackgroundThe ARena study (Sustainable Reduction of Antimicrobial Resistance in German Ambulatory Care) is a three-arm, cluster randomized trial to evaluate a multifaceted implementation program in a German primary care setting. In the context of a prospective process evaluation conducted alongside ARena, this study aimed to document and explore fidelity of the implementation program.MethodsThis observational study is based on data generated in a three-wave survey of 312 participating physicians in the ARena program and attendance documentation. Measures concerned persistence of participation in the ARena program and adherence to intervention components (thematic quality circles, e-learning, basic expenditure reimbursements, additional bonus payments and a computerized decision support system). Participants’ views on five domains of the implementation were also measured. Binary logistic and linear regression analyses were used to explore which views on the implementation were associated with participants’ adherence to quality circles and use of additional bonus compensation. ResultsThe analysis of fidelity showed overall high persistence of participation in the intervention components across the three intervention arms (90,1%; 97,9%; 92,9%). 96.4% of planned quality circles were delivered to study participants and, across waves, 30.4% to 93% of practices participated; 56.1% of physicians attended the maximum of four quality circles. 84% of the practices (n=158) with a minimum of one index patient received a performance-based additional bonus payment at least once. In total, bonus compensation was triggered for 51.8% of affected patients. Participation rate for e-learning (a prerequisite for reimbursement of project-related expenditure) covered 90.8% of practices across all intervention arms, with the highest rate in arm II (96.5%). Uptake of expenditure reimbursement was heterogeneous across study arms, with a mean rate of 86.5% (89.1% in arm I, 96.4% in arm II and 74.1% in arm III). Participants’ views regarding participant responsiveness (OR = 2.298) 95% CI [1.598, 3.305] and Context (OR = 2.146) 95% CI [1.135, 4.055] affected additional bonus payment. Participants’ views on participant responsiveness (Beta = 0.718) 95% CI [0.479, 0.957], Context (Beta = 0.323) 95% CI [0.055, 0.590] and Culture of shared decision-making (Beta = -0.334) 95% CI [-0.614, -0.053] affected quality circle attendance.ConclusionThis study showed an overall high fidelity to the implementation program. Participants’ views on the implementation were associated with degree of intervention fidelity. Trial registration: ISRCTN, ISRCTN58150046

Participant Characteristics Contributed to Variable Responsiveness to Personalized Healthy Food Incentives—A Secondary Analysis of a Randomized Crossover Trial

Objectives The recently completed Smart Cart Study, designed to promote healthier food purchases, found that personalized healthy food incentives modestly improved mean grocery purchase quality, with considerable variation in participant responsiveness. The present study explored participant characteristics associated with variable responsiveness to this healthy food incentives intervention. Methods A secondary analysis examined the Smart Cart Study, where participants received personalized weekly coupons during in the intervention and occasional generic coupons during the control period (n = 209). The outcome variable was 3-month changes in Grocery Purchase Quality Index (GPQI), a validated score calculated from purchasing data that compares the % spending relative to recommended spending to reflect the dietary quality of grocery purchases, in the intervention minus control periods. Potential exposure variables were selected a priori based on a literature review included age, sex, race/ethnicity, education, income, general health status, food literacy, food neophobia, nutritional self-efficacy and eating perception. Multivariable linear regressions evaluated characteristics that predict changes in GPQI. Stepwise model selection guided variable retention with specification of pr = 0.2. Analyses were conducted in Stata 16.1. Results Participants were predominately female (89.5%), Non-Hispanic white (94.1%), higher income (50.3% ≥$100K/year), higher education (48.4% >bachelor's degree), with a mean age of 55.3. In the final model, changes in % spending on couponed foods (β = 15.58, P < 0.001) and food neophobia (β = −1.77, P = 0.047) predicted changes in GPQI, while other predictors were not significant. The final model explained 13% of the variation in GPQI changes. Conclusions Greater % spending on couponed foods was associated with higher GPQI while food neophobia was associated with lower GPQI. Given that food neophobia may prevent participants from increasing their spending on new couponed healthy foods, future personalized couponing interventions should explore strategies to address food neophobia, potentially through free samples of new foods or providing coupons for familiar healthy foods, especially in diverse populations. Funding Sources The Smart Cart Study was funded by the Foundation for Food and Agricultural Research.

A retrospective quantitative implementation evaluation of Safer Opioid Prescribing, a Canadian continuing education program

BackgroundContinuing health professions education (CHPE) is an important policy intervention for the opioid epidemic. Besides effectiveness or impact, health policy implementation should be studied to understand how an intervention was delivered within complex environments. Implementation outcomes can be used to help interpret CHPE effects and impacts, help answer questions of “how” and “why” programs work, and inform transferability. We evaluated Safer Opioid Prescribing (SOP), a national CHPE program, using implementation outcomes of reach, dose, fidelity, and participant responsiveness.MethodsWe conducted a retrospective quantitative implementation evaluation of the 2014–2017 cohorts of SOP. To measure reach and dose, we examined participation and completion data. We used Ontario physician demographic data, including regulatory status with respect to controlled substances, to examine relevant trends. To measure fidelity and participant responsiveness, we analyzed participant-provided evaluations of bias, active learning, and relevance to practice. We used descriptive statistics and measures of association for both continuous and categorical variables. We used logistic regression to determine predictors of workshop participation and analysis of covariance to examine variation in satisfaction across different-sized sessions.ResultsReach: In total, there were 472 unique participants, 84.0% of whom were family physicians. Among Ontario physician participants, 90.0% were family physicians with characteristics representative of province-wide demographics. Dose: Webinar completion rate was 86.2% with no differences in completion based on rurality, gender, or controlled substance prescribing status with medical regulatory authorities. Fidelity and participant responsiveness: Nearly all participants rated the three webinars and workshop as balanced, and each element of SOP was also rated as highly relevant to clinical practice.ConclusionsThis evaluation demonstrates that Safer Opioid Prescribing was implemented as intended. Over a short period and without any external funding, the program reached more than 1% of the Ontario physician workforce. This suggests that the program may be a good model for using virtual CHPE to reach a critical mass of prescribers. This study represents a methodological advance of adapting evaluation methods from health policy and complex interventions for continuing health professions education. Future studies will assess effectiveness and impact on opioid prescribing and utilization within evaluation models of complex interventions.

Implementation of highly challenging balance training for Parkinson’s disease in clinical practice: a process evaluation

Background Process evaluations provide contextual insight into the way in which interventions are delivered. This information is essential when designing strategies to implement programs into wider clinical practice. We performed a process evaluation of the HiBalance effectiveness trial investigating the effects of a 10-week of highly challenging and progressive balance training for mild-moderate Parkinson’s disease (PD). Study aims were to investigate i) the quality and quantity of intervention delivery and ii) barriers and facilitators for implementation. Methods Process outcomes included; Fidelity; Dose (delivered and received) Recruitment and Reach. Investigation of barriers and facilitators was guided by the Consolidated Framework for Implementation Research. Program delivery was assessed across four neurological rehabilitation sites during a two-year period. Data collection was mixed-methods in nature and quantitative and qualitative data were merged during the analysis phase. Results Thirteen program trainers delivered the intervention to 12 separate groups during 119 training sessions. Trainer fidelity to program core components was very high in 104 (87%) of the sessions. Participant responsiveness to the core components was generally high, although adherence to the home exercise program was low (50%). No significant context-specific differences were observed across sites in terms of fidelity, dose delivered/ received or participant characteristics, despite varying recruitment methods. Facilitators to program delivery were; PD-specificity, high training frequency and professional autonomy. Perceived barriers included; cognitive impairment, absent reactional balance among participants, as well a heterogeneous group in relation to balance capacity. Conclusion These findings provide corroborating evidence for outcome evaluation results and valuable information for the further adaptation and implementation of this program. Important lessons can also be learned for researchers and clinicians planning to implement challenging exercise training programs for people with mild-moderate PD. Trial registration ClinicalTrials.gov, NCT02727478, registered 30 march, 2016 − Retrospectively registered.

A process evaluation of the improving wisely intervention: a peer-to-peer data intervention to reduce overuse in surgery

Background The Improving Wisely intervention is a peer-to-peer audit and feedback intervention to reduce overuse of Mohs Micrographic Surgery (MMS). The objective of this study was to conduct a process evaluation to evaluate Mohs surgeons’ perceptions of the implementation quality and perceived impact of the Improving Wisely intervention. Methods Surgeons in the Improving Wisely intervention arm, comprised of members of the American College of Mohs Surgeons (ACMS) who co-led the intervention, were invited to complete surveys and key informant interviews. Participants described perceptions of implementation quality (evaluated via dose, quality of implementation, reach and participant responsiveness), perceived impact of the Improving Wisely intervention (evaluated on a 1–5 Likert and qualitatively), and barriers and facilitators to changing surgeons’ clinical practice patterns to reduce Mohs overuse. Results Seven hundred thirty-seven surgeons participated in the survey. 89% were supportive of the intervention. Participants agreed that the intervention would improve patient care and reduce the annual costs of Mohs surgery. Thirty surgeons participated in key informant interviews. 93% were interested in receiving additional data reports in the future. Participants recommended the reports be disseminated annually, that the reports be expanded to include appropriateness data, and that the intervention be extended to non ACMS members. Six themes identifying factors impacting potential MMS overuse were identified. Conclusions Participants were strongly supportive of the intervention. We present the template used to design and implement the Improving Wisely intervention and provide suggestions for specialty societies interested in leading similar quality improvement interventions among their members.

Implementation of Highly Challenging Balance Training for Parkinson’s disease in Clinical Practice: A Process Evaluation

Background: Process evaluations provide contextual insight into the way in which interventions are delivered. This information is essential when designing strategies to implement programs into wider clinical practice. We performed a process evaluation of the HiBalance effectiveness trial investigating the effects of a 10-week of highly challenging and progressive balance training for mild-moderate Parkinson’s disease (PD). Study aims were to investigate i) the quality and quantity of intervention delivery and ii) barriers and facilitators for implementation. Methods: Process outcomes included; Fidelity; Dose (delivered and received) Recruitment and Reach. Investigation of barriers and facilitators was guided by the Consolidated Framework for Implementation Research. Program delivery was assessed across four neurological rehabilitation sites during a two-year period. Data collection was mixed-methods in nature and quantitative and qualitative data were merged during the analysis phase. Results : Thirteen program trainers delivered the intervention to 12 separate groups during 119 training sessions. Trainer fidelity to program core components was very high in 104 (87%) of the sessions. Participant responsiveness to the core components was generally high, although adherence to the home exercise program was low (50%). No significant context-specific differences were observed across sites in terms of fidelity, dose delivered/ received or participant characteristics, despite varying recruitment methods. Facilitators to program delivery were; PD-specificity, high training frequency and professional autonomy. Perceived barriers included; cognitive impairment, absent reactional balance among participants, as well a heterogeneous group in relation to balance capacity. Conclusion: These findings provide corroborating evidence for outcome evaluation results and valuable information for the further adaptation and implementation of this program. Important lessons can also be learned for researchers and clinicians planning to implement challenging exercise training programs for people with mild-moderate PD. Trial registration: ClinicalTrials.gov, NCT02727478, registered 30 march 2016 − Retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT02727478

Designing a 3D Printed Prosthetic to Meet Task-Specific Needs: A Case Study

The purpose of this case study is to explore the ease of utilizing task-specific design in computer-aided, open-source 3D printed design software. Two participants were recruited and assessed using subjective and objective measures to guide the prosthetic designs. Hand measurements were obtained and entered into computer software to create computer-aided design drawings of the digit prosthetics. Field notes were taken throughout this process by the interdisciplinary team and analyzed to address the ease of utilizing this technology. Objective assessments showed that both participants experienced decreased expansion, grip, and prehension strength of their affected hands. Semi-structured interviews with the participants identified several meaningful tasks that a prosthetic device could improve function in and offered valuable guidance in the development of the prosthetic designs. Analysis of the field notes allowed for the identification of six domains within the research questions. Those domains include appropriate assessment utilization, time management, participant responsiveness, clinical reasoning, common language, and available resources. The successful collaboration of occupational therapy (OT) and engineering disciplines resulted in customized 3D printed finger prosthetic designs to meet participants' specified tasks.

Implementation fidelity of nutritional counselling, Iron and Folic Acid supplementation guidelines and associated challenges in rural Uasin Gishu County Kenya

BackgroundImplementation fidelity which is defined as the degree to which programmes are implemented as intended is one of the factors that affect programme outcome, thus requiring careful examination. This study aims to acquire insight into the degree to which nutritional counselling and Iron and Folic Acid supplementation (IFAs) policy guidelines during pregnancy have been implemented as intended and the challenges to implementation fidelity.MethodsData were collected in rural Uasin Gishu County in the western part of Kenya through document analysis, questionnaires among intervention recipients (n=188) and semi-structured interviews with programme implementers (n=6). Data collection and analysis were guided by an implementation fidelity framework. We specifically evaluated adherence to intervention design (content, frequency, duration and coverage), exposure or dosage, quality of delivery and participant responsiveness.ResultsCoverage of nutritional counselling and IFAs policy is widespread. However, partial provision was reported in all the intervention components. Only 10% accessed intervention within the first trimester as recommended by policy guidelines, only 28% reported receiving nutritional counselling, only 18% and 15% of the respondents received 90 or more iron and folic acid pills respectively during their entire pregnancy period, and 66% completed taking the IFAs pills that were issued to them. Late initial bookings to antenatal care, drug stock shortage, staff shortage and long queues, confusing dosage instructions, side effects of the pills and issuing of many pills at one go, were established to be the main challenges to effective implementation fidelity. Anticipated health consequences and emphasis by the health officer to comply with instructions were established to be motivations for adherence to nutritional counselling and IFAs guidelines.ConclusionsImplementation fidelity of nutritional counselling and IFAs policy in Kenya is generally weak. There is need for approaches to enhance early access to interventions, enhance stock availability, provide mitigation measures for the side effects, as well as intensify nutritional counselling to promote the consumption of micronutrient-rich food sources available in the local environment to substitute for the shortage of nutritional supplements and low compliance to IFAs.