Implementation Science : IS最新文献

{"title":"A systematic review of evidence-based practice implementation in drug and alcohol settings: applying the consolidated framework for implementation research framework.","authors":"Eva Louie, Emma L Barrett, Andrew Baillie, Paul Haber, Kirsten C Morley","doi":"10.1186/s13012-021-01090-7","DOIUrl":"10.1186/s13012-021-01090-7","url":null,"abstract":"<p><strong>Background: </strong>There is a paucity of translational research programmes to improve implementation of evidence-based care in drug and alcohol settings. This systematic review aimed to provide a synthesis and evaluation of the effectiveness of implementation programmes of treatment for patients with drug and alcohol problems using the Consolidated Framework for Implementation Research (CFIR).</p><p><strong>Methods: </strong>A comprehensive systematic review was conducted using five online databases (from inception onwards). Eligible studies included clinical trials and observational studies evaluating strategies used to implement evidence-based psychosocial treatments for alcohol and substance use disorders. Extracted data were qualitatively synthesised for common themes according to the CFIR. Primary outcomes included the implementation, service system or clinical practice. Risk of bias of individual studies was appraised using appropriate tools. A protocol was registered with (PROSPERO) (CRD42019123812) and published previously (Louie et al. Systematic 9:2020).</p><p><strong>Results: </strong>Of the 2965 references identified, twenty studies were included in this review. Implementation research has employed a wide range of strategies to train clinicians in a few key evidence-based approaches to treatment. Implementation strategies were informed by a range of theories, with only two studies using an implementation framework (Baer et al. J Substance Abuse Treatment 37:191-202, 2009) used Context-Tailored Training and Helseth et al. J Substance Abuse Treatment 95:26-34, 2018) used the CFIR). Thirty of the 36 subdomains of the CFIR were evaluated by included studies, but the majority were concerned with the Characteristics of Individuals domain (75%), with less than half measuring Intervention Characteristics (45%) and Inner Setting constructs (25%), and only one study measuring the Outer Setting and Process domains. The most common primary outcome was the effectiveness of implementation strategies on treatment fidelity. Although several studies found clinician characteristics influenced the implementation outcome (40%) and many obtained clinical outcomes (40%), only five studies measured service system outcomes and only four studies evaluated the implementation.</p><p><strong>Conclusions: </strong>While research has begun to accumulate in domains such as Characteristics of Individuals and Intervention Characteristics (e.g. education, beliefs and attitudes and organisational openness to new techniques), this review has identified significant gaps in the remaining CFIR domains including organisational factors, external forces and factors related to the process of the implementation itself. Findings of the review highlight important areas for future research and the utility of applying comprehensive implementation frameworks.</p>","PeriodicalId":417097,"journal":{"name":"Implementation Science : IS","volume":" ","pages":"22"},"PeriodicalIF":0.0,"publicationDate":"2021-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7931583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25430173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unpacking the intention to action gap: a qualitative study understanding how physicians engage with audit and feedback.","authors":"Laura Desveaux,&nbsp;Noah Michael Ivers,&nbsp;Kim Devotta,&nbsp;Noor Ramji,&nbsp;Karen Weyman,&nbsp;Tara Kiran","doi":"10.1186/s13012-021-01088-1","DOIUrl":"https://doi.org/10.1186/s13012-021-01088-1","url":null,"abstract":"<p><strong>Background: </strong>Audit and feedback (A&F) often successfully enhances health professionals' intentions to improve quality of care but does not consistently lead to practice changes. Recipients often cite data credibility and limited resources as barriers impeding their ability to act upon A&F, suggesting the intention-to-action gap manifests while recipients are interacting with their data. While attention has been paid to the role feedback and contextual variables play in contributing to (or impeding) success, we lack a nuanced understanding of how healthcare professionals interact with and process clinical performance data.</p><p><strong>Methods: </strong>We used qualitative, semi-structured interviews guided by Normalization Process Theory (NPT). Questions explored the role of data in quality improvement, experiences with the A&F report, perceptions of the data, and interpretations and reflections. Interviews were audio-recorded and transcribed verbatim. Data were analyzed using a combination of inductive and deductive strategies using reflexive thematic analysis informed by a constructivist paradigm.</p><p><strong>Results: </strong>Healthcare professional characteristics (individual quality improvement capabilities and beliefs about data) seem to influence engagement with A&F to a greater degree than feedback variables (i.e., delivered by peers) and observed contextual factors (i.e., strong quality improvement culture). Most participants lacked the capabilities to interpret practice-level data in an actionable way despite a motivation to engage meaningfully. Reasons for the intention-to-action gap included challenges interpreting longitudinal data, appreciating the nuances of common data sources, understanding how aggregate data provides insights into individualized care, and identifying practice-level actions to improve quality. These factors limited effective cognitive participation and collective action, as outlined in NPT.</p><p><strong>Conclusions: </strong>A well-designed A&F intervention is necessary but not sufficient to inform practice changes. A&F initiatives must include co-interventions to address recipient characteristics (i.e., beliefs and capabilities) and context to optimize impact. Effective strategies to overcome the intention-to-action gap may include modelling how to use A&F to inform practice change, providing opportunities for social interaction relating to the A&F, and circulating examples of effective actions taken in response to A&F. More broadly, undergraduate medical education and post-graduate training must ensure physicians are equipped with QI capabilities, with an emphasis on the skills required to interpret and act on practice-level data.</p>","PeriodicalId":417097,"journal":{"name":"Implementation Science : IS","volume":" ","pages":"19"},"PeriodicalIF":7.2,"publicationDate":"2021-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s13012-021-01088-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25381566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the implementation of evidence-informed policies and practices from a policy perspective: a critical interpretive synthesis.","authors":"Heather L Bullock,&nbsp;John N Lavis,&nbsp;Michael G Wilson,&nbsp;Gillian Mulvale,&nbsp;Ashleigh Miatello","doi":"10.1186/s13012-021-01082-7","DOIUrl":"https://doi.org/10.1186/s13012-021-01082-7","url":null,"abstract":"<p><strong>Background: </strong>The fields of implementation science and knowledge translation have evolved somewhat independently from the field of policy implementation research, despite calls for better integration. As a result, implementation theory and empirical work do not often reflect the implementation experience from a policy lens nor benefit from the scholarship in all three fields. This means policymakers, researchers, and practitioners may find it challenging to draw from theory that adequately reflects their implementation efforts.</p><p><strong>Methods: </strong>We developed an integrated theoretical framework of the implementation process from a policy perspective by combining findings from these fields using the critical interpretive synthesis method. We began with the compass question: How is policy currently described in implementation theory and processes and what aspects of policy are important for implementation success? We then searched 12 databases as well as gray literature and supplemented these documents with other sources to fill conceptual gaps. Using a grounded and interpretive approach to analysis, we built the framework constructs, drawing largely from the theoretical literature and then tested and refined the framework using empirical literature.</p><p><strong>Results: </strong>A total of 11,434 documents were retrieved and assessed for eligibility and 35 additional documents were identified through other sources. Eighty-six unique documents were ultimately included in the analysis. Our findings indicate that policy is described as (1) the context, (2) a focusing lens, (3) the innovation itself, (4) a lever of influence, (5) an enabler/facilitator or barrier, or (6) an outcome. Policy actors were also identified as important participants or leaders of implementation. Our analysis led to the development of a two-part conceptual framework, including process and determinant components.</p><p><strong>Conclusions: </strong>This framework begins to bridge the divide between disciplines and provides a new perspective about implementation processes at the systems level. It offers researchers, policymakers, and implementers a new way of thinking about implementation that better integrates policy considerations and can be used for planning or evaluating implementation efforts.</p>","PeriodicalId":417097,"journal":{"name":"Implementation Science : IS","volume":" ","pages":"18"},"PeriodicalIF":7.2,"publicationDate":"2021-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s13012-021-01082-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25370749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A micro costing analysis of the development of a primary care intervention to improve the uptake of diabetic retinopathy screening.","authors":"Susan Ahern,&nbsp;Fiona Riordan,&nbsp;Aileen Murphy,&nbsp;John Browne,&nbsp;Patricia M Kearney,&nbsp;Susan M Smith,&nbsp;Sheena M McHugh","doi":"10.1186/s13012-021-01085-4","DOIUrl":"https://doi.org/10.1186/s13012-021-01085-4","url":null,"abstract":"<p><strong>Background: </strong>The application of economic analysis within implementation science is still developing and the cost of intervention development, which differs markedly from the costs of initial implementation and maintenance, is often overlooked. Our aim was to retrospectively cost the development of a multifaceted intervention in primary care to improve attendance at diabetic retinopathy screening.</p><p><strong>Methods: </strong>A retrospective micro costing of developing the intervention from the research funder perspective was conducted. It was based on a systematic intervention development process involving analysis of existing audit data and interviews with patients and healthcare professionals (HCPs), conducting consensus meetings with patients and HCPs, and using these data together with a rapid review of the effectiveness of interventions, to inform the final intervention. Both direct (non-personnel, e.g. travel, stationary, room hire) and indirect (personnel) costs were included. Data sources included researcher time logs, payroll data, salary scales, an online financial management system, invoices and purchase orders. Personnel involved in the intervention development were consulted to determine the activities they conducted and the duration of their involvement. Sensitivity and scenario analyses were conducted to estimate uncertainty around parameters and scope.</p><p><strong>Results: </strong>The total cost of intervention development (July 2014-January 2019) was €40,485 of which 78% were indirect (personnel) costs (€31,451). In total, personnel contributed 1368 h to intervention development. Highest cost activities were the patient interviews, and consensus process, contributing 23% and 34% of the total cost. Varying estimated time spent on intervention development activities by + 10% increased total intervention development cost by 6% to €42,982.</p><p><strong>Conclusions: </strong>Our results highlight that intervention development requires a significant amount of human capital input, combining research experience, patient and public experience, and expert knowledge in relevant fields. The time committed to intervention development is critical but has a significant opportunity cost. With limited resources for research on developing and implementing interventions, capturing intervention development costs and incorporating them as part of assessment of cost-effective interventions, could inform research priority and resource allocation decisions.</p>","PeriodicalId":417097,"journal":{"name":"Implementation Science : IS","volume":" ","pages":"17"},"PeriodicalIF":7.2,"publicationDate":"2021-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s13012-021-01085-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25354922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of clinical practice changes in the PICU: a qualitative study using and refining the iPARIHS framework.","authors":"Katherine M Steffen,&nbsp;Laura M Holdsworth,&nbsp;Mackenzie A Ford,&nbsp;Grace M Lee,&nbsp;Steven M Asch,&nbsp;Enola K Proctor","doi":"10.1186/s13012-021-01080-9","DOIUrl":"https://doi.org/10.1186/s13012-021-01080-9","url":null,"abstract":"<p><strong>Background: </strong>Like in many settings, implementation of evidence-based practices often fall short in pediatric intensive care units (PICU). Very few prior studies have applied implementation science frameworks to understand how best to improve practices in this unique environment. We used the relatively new integrated Promoting Action on Research Implementation in Health Services (iPARIHS) framework to assess practice improvement in the PICU and to explore the utility of the framework itself for that purpose.</p><p><strong>Methods: </strong>We used the iPARIHS framework to guide development of a semi-structured interview tool to examine barriers, facilitators, and the process of change in the PICU. A framework approach to qualitative analysis, developed around iPARIHS constructs and subconstructs, helped identify patterns and themes in provider interviews. We assessed the utility of iPARIHS to inform PICU practice change.</p><p><strong>Results: </strong>Fifty multi-professional providers working in 8 U.S. PICUs completed interviews. iPARIHS constructs shaped the development of a process model for change that consisted of phases that include planning, a decision to adopt change, implementation and facilitation, and sustainability; the PICU environment shaped each phase. Large, complex multi-professional teams, and high-stakes work at near-capacity impaired receptivity to change. While the unit leaders made decisions to pursue change, providers' willingness to accept change was based on the evidence for the change, and provider's experiences, beliefs, and capacity to integrate change into a demanding workflow. Limited analytic structures and resources frustrated attempts to monitor changes' impacts. Variable provider engagement, time allocated to work on changes, and limited collaboration impacted facilitation. iPARIHS constructs were useful in exploring implementation; however, we identified inter-relation of subconstructs, unique concepts not captured by the framework, and a need for subconstructs to further describe facilitation.</p><p><strong>Conclusions: </strong>The PICU environment significantly shaped the implementation. The described process model for implementation may be useful to guide efforts to integrate changes and select implementation strategies. iPARIHS was adequate to identify barriers and facilitators of change; however, further elaboration of subconstructs for facilitation would be helpful to operationalize the framework.</p><p><strong>Trial registration: </strong>Not applicable, as no health care intervention was performed.</p>","PeriodicalId":417097,"journal":{"name":"Implementation Science : IS","volume":" ","pages":"15"},"PeriodicalIF":7.2,"publicationDate":"2021-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s13012-021-01080-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38871218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incentivizing appropriate malaria case management in the private sector: a study protocol for two linked cluster randomized controlled trials to evaluate provider- and client-focused interventions in western Kenya and Lagos, Nigeria.","authors":"Aaron M Woolsey,&nbsp;Ryan A Simmons,&nbsp;Meley Woldeghebriel,&nbsp;Yunji Zhou,&nbsp;Oluwatosin Ogunsola,&nbsp;Sarah Laing,&nbsp;Tayo Olaleye,&nbsp;Joseph Kipkoech,&nbsp;Bomar Mendez Rojas,&nbsp;Indrani Saran,&nbsp;Mercy Odhiambo,&nbsp;Josephine Malinga,&nbsp;George Ambani,&nbsp;Emmah Kimachas,&nbsp;Chizoba Fashanu,&nbsp;Owens Wiwa,&nbsp;Diana Menya,&nbsp;Jeremiah Laktabai,&nbsp;Theodoor Visser,&nbsp;Elizabeth L Turner,&nbsp;Wendy Prudhomme O'Meara","doi":"10.1186/s13012-020-01077-w","DOIUrl":"https://doi.org/10.1186/s13012-020-01077-w","url":null,"abstract":"<p><strong>Background: </strong>A large proportion of artemisinin-combination therapy (ACT) anti-malarial medicines is consumed by individuals that do not have malaria. The over-consumption of ACTs is largely driven by retail sales in high malaria-endemic countries to clients who have not received a confirmatory diagnosis. This study aims to target ACT sales to clients receiving a confirmatory diagnosis using malaria rapid diagnostic tests (mRDTs) at retail outlets in Kenya and Nigeria.</p><p><strong>Methods: </strong>This study comprises two linked four-arm 2 × 2 factorial cluster randomized controlled trials focused on malaria diagnostic testing and conditional ACT subsidies with the goal to evaluate provider-directed and client-directed interventions. The linked trials will be conducted at two contrasting study sites: a rural region around Webuye in western Kenya and the urban center of Lagos, Nigeria. Clusters are 41 and 48 participating retail outlets in Kenya and Nigeria, respectively. Clients seeking care at participating outlets across all arms will be given the option of paying for a mRDT-at a study-recommended price-to be conducted at the outlet. In the provider-directed intervention arm, the outlet owner receives a small monetary incentive to perform the mRDT. In the client-directed intervention arm, the client receives a free ACT if they purchase an mRDT and receive a positive test result. Finally, the fourth study arm combines both the provider- and client-directed interventions. The diagnosis and treatment choices made during each transaction will be captured using a mobile phone app. Study outcomes will be collected through exit interviews with clients, who sought care for febrile illness, at each of the enrolled retail outlets.</p><p><strong>Results: </strong>The primary outcome measure is the proportion of all ACTs that are sold to malaria test-positive clients in each study arm. For all secondary outcomes, we will evaluate the degree to which the interventions affect purchasing behavior among people seeking care for a febrile illness at the retail outlet.</p><p><strong>Conclusions: </strong>If our study demonstrates that malaria case management can be improved in the retail sector, it could reduce overconsumption of ACTs and enhance targeting of publicly funded treatment reimbursements, lowering the economic barrier to appropriate diagnosis and treatment for patients with malaria.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT04428307 , registered June 9, 2020, and NCT04428385 , registered June 9, 2020.</p>","PeriodicalId":417097,"journal":{"name":"Implementation Science : IS","volume":" ","pages":"14"},"PeriodicalIF":7.2,"publicationDate":"2021-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s13012-020-01077-w","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38840743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of using children's mental health research in policymaking: variation by type of research use and phase of policy process.","authors":"Jonathan Purtle,&nbsp;Katherine L Nelson,&nbsp;Sarah Mc Cue Horwitz,&nbsp;Mary M McKay,&nbsp;Kimberly E Hoagwood","doi":"10.1186/s13012-021-01081-8","DOIUrl":"https://doi.org/10.1186/s13012-021-01081-8","url":null,"abstract":"<p><strong>Background: </strong>Research use in policymaking is multi-faceted and has been the focus of extensive study. However, virtually no quantitative studies have examined whether the determinants of research use vary according to the type of research use or phase of policy process. Understanding such variation is important for selecting the targets of implementation strategies that aim to increase the frequency of research use in policymaking.</p><p><strong>Methods: </strong>A web-based survey of US state agency officials involved with children's mental health policymaking was conducted between December 2019 and February 2020 (n = 224, response rate = 33.7%, 49 states responding (98%), median respondents per state = 4). The dependent variables were composite scores of the frequency of using children's mental health research in general, specific types of research use (i.e., conceptual, instrumental, tactical, imposed), and during different phases of the policy process (i.e., agenda setting, policy development, policy implementation). The independent variables were four composite scores of determinants of research use: agency leadership for research use, agency barriers to research use, research use skills, and dissemination barriers (e.g., lack of actionable messages/recommendations in research summaries, lack of interaction/collaboration with researchers). Separate multiple linear regression models estimated associations between determinant and frequency of research use scores.</p><p><strong>Results: </strong>Determinants of research use varied significantly by type of research use and phase of policy process. For example, agency leadership for research use was the only determinant significantly associated with imposed research use (β = 0.31, p < 0.001). Skills for research use were the only determinant associated with tactical research use (β = 0.17, p = 0.03) and were only associated with research use in the agenda-setting phase (β = 0.16, p = 0.04). Dissemination barriers were the most universal determinants of research use, as they were significantly and inversely associated with frequency of conceptual (β = -0.21, p = 0.01) and instrumental (β = -0.22, p = 0.01) research use and during all three phases of policy process.</p><p><strong>Conclusions: </strong>Decisions about the determinants to target with policy-focused implementation strategies-and the strategies that are selected to affect these targets-should reflect the specific types of research use that these strategies aim to influence.</p>","PeriodicalId":417097,"journal":{"name":"Implementation Science : IS","volume":" ","pages":"13"},"PeriodicalIF":7.2,"publicationDate":"2021-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s13012-021-01081-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38836762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: Coincidence analysis: a new method for causal inference in implementation science.","authors":"Rebecca Garr Whitaker,&nbsp;Nina Sperber,&nbsp;Michael Baumgartner,&nbsp;Alrik Thiem,&nbsp;Deborah Cragun,&nbsp;Laura Damschroder,&nbsp;Edward J Miech,&nbsp;Alecia Slade,&nbsp;Sarah Birken","doi":"10.1186/s13012-020-01079-8","DOIUrl":"https://doi.org/10.1186/s13012-020-01079-8","url":null,"abstract":"","PeriodicalId":417097,"journal":{"name":"Implementation Science : IS","volume":" ","pages":"11"},"PeriodicalIF":7.2,"publicationDate":"2021-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7802317/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38811918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Context-acceptability theories: example of family planning interventions in five African countries.","authors":"Jayne Webster,&nbsp;Shari Krishnaratne,&nbsp;Jenna Hoyt,&nbsp;Shiferaw Dechasa Demissie,&nbsp;Nathaly Spilotros,&nbsp;Justine Landegger,&nbsp;Misozi Kambanje,&nbsp;Shannon Pryor,&nbsp;Easterlina Moseti,&nbsp;Seth Marcus,&nbsp;Marius Gnintoungbe,&nbsp;Dora Curry,&nbsp;Jessie K Hamon","doi":"10.1186/s13012-020-01074-z","DOIUrl":"https://doi.org/10.1186/s13012-020-01074-z","url":null,"abstract":"<p><strong>Background: </strong>Family planning (FP) can lengthen birth intervals and potentially reduce the risk of foetal death, low birthweight, prematurity, and being small for gestational age. Effective FP is most easily achieved through access to and acceptability of modern contraceptive methods (MCMs). This study aimed to identify mechanisms of acceptability and the contexts in which they are triggered and to generate theories to improve the selection and implementation of effective interventions by studying an intervention integrating FP with childhood immunisation services.</p><p><strong>Methods: </strong>Qualitative interpretative synthesis of findings from realist evaluations of FP interventions in five African countries was guided by an analytical framework. Empirical mechanisms of acceptability were identified from semi-structured interviews and focus group discussions with key stakeholders (N = 253). The context in which these mechanisms were triggered was also defined. Empirical mechanisms of acceptability were matched to constructs of a theoretical framework of acceptability. Context-acceptability theories (CATs) were developed, which summarised constructs of acceptability triggered for specific actors in specified contexts. Examples of interventions that may be used to trigger acceptability for these actors were described.</p><p><strong>Results: </strong>Seven CATs were developed for contexts with strong beliefs in religious values and with powerful religious leaders, a traditional desire for large families, stigmatisation of MCM use, male partners who are non-accepting of FP, and rumours or experiences of MCM side effects. Acceptability mechanisms included alignment with values and beliefs without requiring compromise, actors' certainty about their ability to avoid harm and make the intervention work, and understanding the intervention and how it works. Additionally, acceptability by one group of actors was found to alter the context, triggering acceptability mechanisms amongst others.</p><p><strong>Conclusions: </strong>This study demonstrated the value of embedding realist approaches within implementation research. CATs are transferable theories that answer the question: given the context, what construct of acceptability does an intervention need to trigger, or more simply, what intervention do we need to apply here to achieve our outcomes? CATs facilitate transfer of interventions across geographies within defined contexts.</p>","PeriodicalId":417097,"journal":{"name":"Implementation Science : IS","volume":" ","pages":"12"},"PeriodicalIF":7.2,"publicationDate":"2021-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s13012-020-01074-z","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38811859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Economic evaluation of a web-based menu planning intervention to improve childcare service adherence with dietary guidelines.","authors":"Penny Reeves,&nbsp;Kim Edmunds,&nbsp;Zoe Szewczyk,&nbsp;Alice Grady,&nbsp;Sze Lin Yoong,&nbsp;Luke Wolfenden,&nbsp;Rebecca Wyse,&nbsp;Meghan Finch,&nbsp;Fiona Stacey,&nbsp;John Wiggers,&nbsp;Andrew Searles","doi":"10.1186/s13012-020-01068-x","DOIUrl":"https://doi.org/10.1186/s13012-020-01068-x","url":null,"abstract":"<p><strong>Background: </strong>Despite the known benefits of healthy eating in childhood, few Australian childcare services provide food that is consistent with dietary guidelines. The effectiveness of a web-based menu planning intervention to increase childcare service provision of healthy foods and decrease provision of discretionary foods in long day-care services in Australia was assessed in a randomised controlled trial. Here we consider the costs, consequences, cost-effectiveness and budget impact of the intervention using data collected within the trial.</p><p><strong>Methods: </strong>The prospective trial-based economic evaluation involved 54 childcare services across New South Wales (NSW), Australia. Services were randomised to a 12-month intervention or usual care. The intervention involved access to a web-based menu planning and decision support tool and online resources. Effectiveness measures included mean number of food groups, overall menu and individual food group compliance with dietary guidelines, and mean servings of food groups at 12 months. Costs (reported in $AUD, 2017/18) were evaluated from both health sector and societal perspectives. The direct cost to support uptake of the intervention was calculated, as were costs to each childcare service. The incremental cost of the intervention was calculated as the net difference in the cost to undertake menu planning and review plus the direct cost of the intervention. Incremental cost-effectiveness ratios (ICERs) including uncertainty intervals were estimated for differences in costs and effects between intervention and control groups. A relative value index was calculated to determine overall value for money.</p><p><strong>Results: </strong>Over the 12 months of the trial, we calculated a difference in cost between usual practice and intervention groups of - $482 (95% UI - $859, - $56). While the measured increase in menu and food group compliance within the trial did not reach statistical significance, there were significant improvements in mean servings of fruit and discretionary food, represented in the cost-consequence analysis. The calculated relative value index of 1.1 suggests that the intervention returns acceptable value for money for the outcomes generated.</p><p><strong>Conclusion: </strong>Compared to usual practice, web-based programmes may offer an efficient and sustainable alternative for childcare services to improve the provision of healthy foods to children in their care.</p><p><strong>Trial registration: </strong>Australian New Zealand Clinical Trials Registry ACTRN12616000974404.</p>","PeriodicalId":417097,"journal":{"name":"Implementation Science : IS","volume":" ","pages":"1"},"PeriodicalIF":7.2,"publicationDate":"2021-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s13012-020-01068-x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39129507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}