Jbi Evidence Implementation最新文献

{"title":"Understanding improvements in self-efficacy and engagement with the Long-term care Information system For Evidence (LIFE) workshop in Japan.","authors":"Tomoko Ohura, Takehiko Doi, Takeru Oka, Fumio Sakimoto, Soichiro Matsuda, Mayumi Nishimura, Hiroyuki Shimada","doi":"10.1097/XEB.0000000000000593","DOIUrl":"https://doi.org/10.1097/XEB.0000000000000593","url":null,"abstract":"<p><strong>Introduction: </strong>LIFE is a Japanese digital database introduced by the Ministry of Health, Labour and Welfare to promote evidence-based care for older adults. Training sessions to promote the dissemination of the Long-term care Information system For Evidence (LIFE) commenced in 2021 in Japan. However, participants' subsequent understanding of the system and their self-efficacy in using it remained unclear.</p><p><strong>Aim: </strong>This study aimed to clarify the participants' understanding and self-efficacy regarding LIFE on the day of training and 3 months after the training.</p><p><strong>Methods: </strong>A \"LIFE Workshop (Basic)\" was held in 2024 in Japan in the cities of Hakata, Sapporo, and Sendai. An online survey was administered to participants directly after the workshop, on the same day of the training session, and again, 3 months later. The survey included 12 items to gauge the participants' (and by extension, their work colleagues') understanding in self-efficacy and engagement with LIFE. An analysis was conducted of 42 matched data using a paired t-test, with the effect size calculated using Hedges' g.</p><p><strong>Results: </strong>Three months after training, participants' understanding of the LIFE outline improved significantly (from 5.12 (2.43) to 6.19 (1.71), p  < .001, Hedges' g = -0.471, 95% confidence interval [CI] [-0.736 to -0.206]). Significant improvements were observed in the following areas: performing the tests and measurements used in LIFE; interpreting and using the tests and measurements; planning and submitting LIFE data; and using the system within the organization. From the respondents' perspective, no significant improvement was found in their colleagues' understanding, practices, or use of the system.</p><p><strong>Conclusions: </strong>When introducing new initiatives to existing services, support must be provided for the organizational structure and the personnel who will take on leadership roles.</p>","PeriodicalId":48473,"journal":{"name":"Jbi Evidence Implementation","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pelvic floor muscle exercises in preventing urinary incontinence among mothers after delivery in a maternity ward: a best practice implementation project.","authors":"Isabel Xin Wei Tan, Leta Wei Ling Loh, Sarah Beevee Binte Abdul Jabbar, Tiffany Mei Ling Woo, Mien Li Goh","doi":"10.1097/XEB.0000000000000590","DOIUrl":"https://doi.org/10.1097/XEB.0000000000000590","url":null,"abstract":"<p><strong>Introduction: </strong>Pelvic floor muscles can undergo significant trauma and physical changes during childbirth. This may result in urine leaking involuntarily in postnatal mothers after normal vaginal delivery. Pelvic floor muscle exercises (PFME) have been found to be beneficial in preventing urinary incontinence after delivery.</p><p><strong>Objectives: </strong>This project aimed to prevent and reduce urinary incontinence among postnatal mothers who received PFME education prior to discharge. This was achieved through the implementation of best practice recommendations.</p><p><strong>Methods: </strong>This project was guided by the JBI Evidence Implementation Framework which comprises a baseline audit, analysis of barriers, tailored strategies, and follow-up audit to assess impact and sustainability. The maternity ward midwives and nurses were trained how to educate the participants about PFME. Urinary incontinence symptoms were evaluated using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form. Two follow-up audits were conducted to measure changes in compliance with best practices.</p><p><strong>Results: </strong>The percentage of mothers who received training on PFME was 53.3% at baseline, 50% at follow-up audit 1, and 60% at follow-up audit 2. The percentage of mothers who received a physical copy of the patient information leaflet increased from 80% at baseline to 90% in follow-up audit 1, and 96.7% in follow-up audit 2. In addition, mothers who performed PFME after discharge reported fewer urine incontinence symptoms.</p><p><strong>Conclusions: </strong>The project results showed that urinary incontinence had decreased among postnatal mothers who had practiced PFME. Sustainability plans involve regular audits, educating new nurses, and nursing leadership support for an evidence-based culture.</p><p><strong>Spanish abstract: </strong>http://links.lww.com/IJEBH/A569.</p>","PeriodicalId":48473,"journal":{"name":"Jbi Evidence Implementation","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving nutritional education for villagers at a health center in Gotvand, Iran: a best practice implementation project.","authors":"Amin Talebpour, Elham Pirabbasi, Seyedeh Narjes Marashi, Mohammad Zakaria Pezeshki, Maryam Asadi","doi":"10.1097/XEB.0000000000000567","DOIUrl":"https://doi.org/10.1097/XEB.0000000000000567","url":null,"abstract":"<p><strong>Introduction: </strong>Individuals living in rural areas and low-income communities are at an increased risk of nutrient-poor diets and associated metabolic disorders, including obesity, cardiovascular disease, and type 2 diabetes.</p><p><strong>Aim: </strong>This study aimed to enhance the nutritional education process, identify barriers and facilitators to improving compliance, and develop strategies to address areas of non-compliance for villagers in Gotvand, Iran.</p><p><strong>Methods: </strong>In accordance with the JBI Evidence Implementation Framework, this clinical audit study was conducted in 2023 at a health center in Gotvand, Iran. Forty adult villagers referred to the health center took part in a baseline audit to evaluate compliance with recommended practices. After 1 month, a follow-up audit was conducted, during which 20 villagers were randomly selected and their data analyzed. Data collection methods included direct observation and interviews.</p><p><strong>Results: </strong>The baseline results indicated that face-to-face interviews or experiential learning approaches had the highest compliance rate (70%), followed by other strategies in addition to nutrition education (60%). Training aimed to increase nutritional knowledge recorded a compliance rate of 55%, while self-monitoring to facilitate nutrition education by individuals had the lowest rate at 33%. After the 1-month follow-up, compliance rates improved significantly, revealing audit scores of 100% for Criteria 1-3, and 94.4% for Criterion 4.</p><p><strong>Conclusions: </strong>The findings suggest that employing local educators, using educational packages (including illustrated pamphlets), and conducting face-to-face sessions are effective strategies for delivering nutritional education in rural areas, taking into account local community knowledge, language differences, and cultural context.</p><p><strong>Spanish abstract: </strong>http://links.lww.com/IJEBH/A517.</p>","PeriodicalId":48473,"journal":{"name":"Jbi Evidence Implementation","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving patient safety and satisfaction in the peri-operative setting of a general private hospital in Iran; interventions for nursing staff: a best practice implementation project.","authors":"Behrouz Amini, Shahram Dabiri Oskoei, Maryam Soleimanpour, Mahdieh Esmaeilnezhad, Bahram Jafarinodeh, Azam Badrgholi Tabrizi, Sakineh Hajebrahimi, Fariba Pashazadeh, Neda Kabiri, Amin Talebpour","doi":"10.1097/XEB.0000000000000598","DOIUrl":"https://doi.org/10.1097/XEB.0000000000000598","url":null,"abstract":"<p><strong>Introduction: </strong>Compliance with surgical safety checklists remains a concern worldwide and is responsible for more than half of in-hospital complications.</p><p><strong>Objective: </strong>The aim of this implementation project was to assess and promote compliance with evidence-based practices regarding custom surgical safety checklists and safe staffing levels in a general private hospital in Iran.</p><p><strong>Methods: </strong>This evidence implementation project was conducted in the peri-operative setting of a general private hospital in Tabriz, Iran. The project adhered to the JBI Evidence Implementation Framework and used the JBI Practical Application of Clinical Evidence System (PACES) and the Getting Research into Practice (GRiP) audit and feedback strategy to develop three audit criteria for the baseline and two follow-up audits.</p><p><strong>Results: </strong>The baseline and follow-up audits revealed that compliance for Criterion 1 (customization of checklists for specialized surgical procedures) decreased from 79% at baseline to 68% at the first follow-up audit but improved to 90% at the second follow-up audit. The compliance rate for Criterion 2 (demand-based staffing level in the peri-operative area) improved from 55% at baseline to 93% at the first follow-up and 100% at the second follow-up. Lastly, the compliance rate for Criterion 3 (staff competence in the peri-operative area) increased from 75% to 100% at both follow-ups 1 and 2.</p><p><strong>Conclusions: </strong>The implementation of educational and policy-related strategies led to improved compliance across all audit criteria. However, future audit cycles and implementation strategies are needed to sustain improvements.</p><p><strong>Spanish abstract: </strong>http://links.lww.com/IJEBH/A576.</p>","PeriodicalId":48473,"journal":{"name":"Jbi Evidence Implementation","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient hand hygiene in a residential aged care facility: a best practice implementation project.","authors":"Jannette Silvania, Michelle Palokas, Linda Upchurch","doi":"10.1097/XEB.0000000000000591","DOIUrl":"10.1097/XEB.0000000000000591","url":null,"abstract":"<p><strong>Introduction: </strong>Hand hygiene for both health care workers and patients is an important measure to prevent health care-associated infections in residential aged care facilities. Studies on health care workers' and patients' perceptions and behaviors have indicated that despite understanding its importance, patient hand hygiene is not a deliberate practice.</p><p><strong>Objective: </strong>This project aimed to promote evidence-based practices regarding patient hand hygiene in a residential aged care facility.</p><p><strong>Methods: </strong>Guided by the JBI Evidence Implementation Framework, six best practices were used as audit criteria. Baseline audits were conducted through observations, staff surveys, and electronic health record reviews. Barriers to best practices were identified and strategies were implemented to address those barriers. Follow-up audits were conducted and compared to baseline results.</p><p><strong>Results: </strong>The baseline results showed 64% compliance with the six best practice recommendations. Barriers included health care workers' lack of knowledge of the multimodal approach to patient hand hygiene, limited hand hygiene products, patients' inability to use products independently, and missing or inaccurate education documentation in the health record. Strategies to improve compliance included education for health care workers, increasing the availability and usability of hygiene products, and standardizing patient hand hygiene documentation in the electronic health record. Post-implementation audits showed a 12% increase in compliance, which rose to 76%.</p><p><strong>Conclusions: </strong>Through education initiatives, increased product accessibility, and standardized documentation, this evidence implementation project successfully improved adherence to best practices for patient hand hygiene in a residential aged care facility. Sustained efforts, including integration into staff orientation and competency programs, will be critical to maintaining these gains.</p><p><strong>Spanish abstract: </strong>http://links.lww.com/IJEBH/A567.</p>","PeriodicalId":48473,"journal":{"name":"Jbi Evidence Implementation","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147785749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improvement of pain management in burn patients: a best practice implementation project.","authors":"Kavous Shahsavarinia, Sajjad Ahmadi, Nooshin Milanchian, Fatemeh Abbasi, Farzad Rahmani, Behjat Derakhti, Sakineh Hajebrahimi, Hanieh Salehi-Pourmehr","doi":"10.1097/XEB.0000000000000571","DOIUrl":"https://doi.org/10.1097/XEB.0000000000000571","url":null,"abstract":"<p><strong>Introduction: </strong>Effective pain management is crucial for burn patients in emergency departments due to the complex nature of burn pain.</p><p><strong>Objective: </strong>This project aimed to assess and improve compliance with best practices in burn pain management in the emergency department of a hospital in Iran.</p><p><strong>Methods: </strong>This project used the JBI Evidence Implementation Framework. We conducted baseline and follow-up audits over 3 months to identify barriers to compliance with best practices, implement targeted interventions, and re-evaluate practice.</p><p><strong>Results: </strong>Following the implementation of intervention strategies, the follow-up audit revealed significant improvements across all six criteria over a 3-month period. We observed increased compliance for individualized pain management plans (87.80% to 95.12%), appropriate pharmacological agent selection (95.12% to 100%), and multimodal pain management (80.49% to 92.68%). Furthermore, adherence to tailored opioid therapy significantly improved (60.98% to 85.37%), as did the practice of using fewer opioid types for effective pain management (48.78% to 80.49%). Patient education regarding pain medications also notably increased (68.29% to 90.24%). Barriers included lack of staff awareness concerning opioid administration and general best practices. These were addressed through standardized evidence-based training, educational workshops, and a simplified documentation checklist in Farsi.</p><p><strong>Conclusion: </strong>This project achieved substantial advancements in burn pain management practices, highlighting the success of individualized, evidence-based strategies. These positive outcomes underscore the need for continued education, rigorous protocol adherence, and active patient engagement to sustain and enhance the quality of care for this vulnerable patient population.</p><p><strong>Spanish abstract: </strong>http://links.lww.com/IJEBH/A522.</p>","PeriodicalId":48473,"journal":{"name":"Jbi Evidence Implementation","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevention and management of pre-operative thirst in patients undergoing elective surgery: a best practice implementation project.","authors":"Minzhi He, Zhiqian Wang, Ningning Zhou, Yanli Zhu, Mengdan Zhou, Song Xu","doi":"10.1097/XEB.0000000000000588","DOIUrl":"10.1097/XEB.0000000000000588","url":null,"abstract":"<p><strong>Introduction: </strong>Peri-operative thirst is the second most common source of distress among surgical patients, yet its clinical management remains suboptimal and unstructured.</p><p><strong>Objectives: </strong>This evidence implementation project aimed to improve the prevention and management of pre-operative thirst in patients undergoing elective sequential gynecological surgery at a public tertiary hospital in Hangzhou, China.</p><p><strong>Methods: </strong>This project employed a before-and-after study design guided by the JBI Evidence Implementation Framework, utilizing the JBI Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRiP) tool. A baseline audit was conducted using 21 evidence-based audit criteria to assess compliance with best practices. Barriers to compliance were identified, and targeted strategies were implemented. Three follow-up audits were conducted to evaluate compliance improvement and strategy sustainability at 3, 6, and 9 months post implementation.</p><p><strong>Results: </strong>The baseline audit revealed an overall compliance rate of 5.29%. Following the implementation of targeted strategies, three sequential follow-up audits demonstrated progressive and sustained improvement: overall compliance increased to 40.65%, 76.19%, and 92.19% at 3, 6, and 9 months, respectively. In the final follow-up audit, 16 of the 21 criteria (76.2%) achieved full compliance (100%).</p><p><strong>Conclusion: </strong>This project improved surgical nurses' management of pre-operative thirst and promoted hospital-wide, evidence-based practice. The evidence-based recommendations reduced the gap between current and best practices, thereby enhancing both the quality of care and patient satisfaction. Future practice should embed the new protocols into routine workflows and address the specific challenges in pre-operative fasting for sequential surgery patients.</p><p><strong>Spanish abstract: </strong>http://links.lww.com/IJEBH/A553.</p>","PeriodicalId":48473,"journal":{"name":"Jbi Evidence Implementation","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147785952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of immune-related dermatologic toxicities in cancer patients receiving PD-1/PD-L1 blockade: a best practice implementation project.","authors":"Lanfang Zhang, Zhijun Li, Shaoyan Huang, Peijuan Chen, Ling He, Mengya Du, Yang Lu, Jing Cai, Yanni Wu","doi":"10.1097/XEB.0000000000000584","DOIUrl":"10.1097/XEB.0000000000000584","url":null,"abstract":"<p><strong>Introduction: </strong>Immune checkpoint inhibitors (ICIs) have been widely used as an important approach to treat tumors. However, about 30% patients receiving ICIs develop immune-related dermatologic toxicities (IDTs), which may lead to treatment interruption and poor prognosis.</p><p><strong>Objectives: </strong>This evidence implementation project was carried out in the Department of Radiation Oncology at Nanfang Hospital in Guangzhou, China and aimed to improve the management of IDTs in cancer patients treated with PD-1/PD-L1 inhibitors.</p><p><strong>Methods: </strong>The project used the JBI Evidence Implementation Framework, which is based on an audit and feedback process. Criteria for audits were derived from JBI Best Practice Evidence Summaries. The baseline audit was used to identify gaps in compliance with best practices and barriers and facilitators of implementation. After the implementation of change strategies, a follow-up audit was conducted to measure changes in compliance.</p><p><strong>Results: </strong>Gaps between evidence and practice were noted for six of the criteria, and five barriers to implementation were identified. The follow-up audit revealed that compliance with audit criteria 1-5, 7, and 8 reached 100%, while criterion 6 partially improved from 36.7% to 50%.</p><p><strong>Conclusions: </strong>The results indicate that this project improved compliance with evidence-based practices for the management of IDTs by standardizing clinical practices and improving the quality of nursing management.</p><p><strong>Spanish abstract: </strong>http://links.lww.com/IJEBH/A550.</p>","PeriodicalId":48473,"journal":{"name":"Jbi Evidence Implementation","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147785746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An integrated, multidisciplinary, early identification, and triage program for university students at risk of anxiety and depression: a best practice implementation project.","authors":"Sarah J Templeton, Andrea L Canada","doi":"10.1097/XEB.0000000000000498","DOIUrl":"10.1097/XEB.0000000000000498","url":null,"abstract":"<p><strong>Introduction: </strong>Rising mental health issues among university students in the United States may significantly affect their academic progress, contributing to a variety of negative outcomes, ranging from poor academic performance to forced attrition.</p><p><strong>Objective: </strong>This study evaluated the implementation of an evidence-based practice (EBP) interdisciplinary approach to universal proactive mental health screening and triage at a university student health center (SHC).</p><p><strong>Methods: </strong>Using the Knowledge to Action framework, a comprehensive program was developed to identify and triage university undergraduate students at risk of mental health conditions, to address a gap between current practice and emerging EBP. Potential barriers to implementation were identified and strategies were developed to improve the translation of knowledge to practice. A retroactive chart audit was used to evaluate the effectiveness of practice improvements.</p><p><strong>Results: </strong>EBP interventions were implemented to proactively identify and triage mental health concerns in students, with positive results. Provider compliance with assessment and referral was 100%. Further studies are needed to assess long-term effectiveness.</p><p><strong>Conclusion: </strong>Our results confirm the usefulness of a comprehensive, proactive mental health program for detecting and triaging undergraduate students at risk of anxiety and/or depression. This interdisciplinary approach has the potential to address mental health issues among college students in a timely fashion and to best steward limited campus resources.</p><p><strong>Spanish abstract: </strong>http://links.lww.com/IJEBH/A327.</p>","PeriodicalId":48473,"journal":{"name":"Jbi Evidence Implementation","volume":" ","pages":"236-245"},"PeriodicalIF":1.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing theory-driven and intuition-based approaches to inform implementation strategies in practice: an exploratory two-arm cluster-randomized head-to-head implementation trial.","authors":"Julia Steinberg, Priscilla Chan, Sarsha Yap, April Morrow, Gabriella Tiernan, Yoon-Jung Kang, Emily He, Elizabeth Kennedy, Jasmine Jansen, Rhiannon Edge, Deborah Debono, Bonny Parkinson, Sam Egger, Michael David, Skye McKay, Desiree Hilton, Lucien Sankey, Amy Pearn, Rohan Rahman, Rebecca Venchiarutti, Cassandra Nichols, Sascha Karunaratne, Daniel Steffens, Natasha Egoroff, Natalie J Lott, Leanna Titterton, Alexander Engel, Anthony J Gill, Annabel Goodwin, Marion Harris, James G Kench, Nicholas Pachter, Peter Pockney, Abiramy Ragunathan, Courtney Smyth, Michael Solomon, James Wei Tatt Toh, Marina Wallace, Karen Canfell, Finlay Macrae, Kathy Tucker, Emily Hogden, Natalie Taylor","doi":"10.1097/XEB.0000000000000557","DOIUrl":"10.1097/XEB.0000000000000557","url":null,"abstract":"<p><strong>Introduction: </strong>To explicitly assess the impact of theory in implementation strategies, it is essential to isolate theoretical components while controlling other variables.</p><p><strong>Aim: </strong>This exploratory two-arm cluster-randomized implementation trial compared theory-driven versus intuition-based approaches to the development of strategies to improve risk-appropriate tumor testing and referral to genetics services for Lynch syndrome (LS), a hereditary cancer predisposition condition.</p><p><strong>Methods: </strong>Seven major Australian hospitals received an identical, seven-step implementation approach, with the only difference being either the use of theory-driven or intuition-based implementation strategy development, which was randomly assigned (theory n = 4; intuition n = 3). The theory-driven approach was guided by the Theoretical Domains Framework (step 4) and matched Behavior Change Techniques (step 5), with all other steps identical between both trial arms. The primary outcome was the rate of risk-appropriate LS tumor testing and referral within 2 months of colorectal cancer (CRC) resection, using data from January 1, 2017 to September 30, 2021 (n = 3,321 patients). Secondary outcomes included the proportion of risk-appropriate patients with a genetic referral.</p><p><strong>Results: </strong>The theory-driven arm showed a modest but non-significant improvement in the primary outcome of risk-appropriate LS pathway completion (adjusted risk ratio [aRR]=1.22, 95% CI: 0.92- 1.61, p  = 0.1713); however, this was driven by one large hospital, with null effect when excluding that hospital (aRR = 1.00, 95% CI: 0.86-1.18, p  = 0.9639) and heterogeneous results across different hospitals. For patients with high LS risk tumor test results, the theory-driven arm showed a significantly lower proportion without a genetics referral (secondary outcome: aRR = 0.50, 95% CI: 0.41-0.61, p  < 0.0001).</p><p><strong>Conclusion: </strong>Theory-driven implementation led to stronger improvements in a secondary outcome. Primary outcome evidence was inconclusive. While theory-driven approaches led to some improvements in a secondary outcome, there was no conclusive difference in the primary outcome. A published process evaluation reports on the contextual factors influencing results at each site, as well as theoretical alignment of intuitive strategies and their proposed mechanisms of action. This trial design offers a template for isolating and evaluating the contribution of theory to implementation strategies.</p><p><strong>Trial registration: </strong>Australian New Zealand Clinical Trials Registry, ACTRN12618001072202. Registered June 27, 2018 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375348&isReview=true.</p><p><strong>Spanish abstract: </strong>http://links.lww.com/IJEBH/A491.</p>","PeriodicalId":48473,"journal":{"name":"Jbi Evidence Implementation","volume":" ","pages":"372-387"},"PeriodicalIF":1.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147285879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}