Translational Behavioral Medicine最新文献

{"title":"Adaptations to a statewide walking program: Use of iterative feedback cycles between research and delivery systems improves fit for over 10 years.","authors":"Mary C Frazier, Laura E Balis, Shannon D Armbruster, Paul A Estabrooks, Samantha M Harden","doi":"10.1093/tbm/ibad052","DOIUrl":"10.1093/tbm/ibad052","url":null,"abstract":"<p><p>FitEx is an 8-week, group-based physical activity and fruit and vegetable consumption program co-created and implemented with the Cooperative Extension System. Effectiveness and delivery personnel perceptions of the program are promising; however, ongoing adaptations are required to continuously meet shifting needs of both researchers and delivery systems. We applied the APDER iterative cycles of implementation over 15 years to understand dynamic and ongoing adaptations as well as implications for FitEx sustainability. Each year, an IRPP between delivery (FitEx deliverers) and research (FitEx developers) systems shared feedback on program core elements and strategies for adaptation through regular team meetings, emails, and evaluations. While the core elements (delivering to groups, goal setting, feedback, and self-monitoring) of FitEx remained consistent, changes were made to address logistical factors, emergent research questions, and technological advancements. For example, program deliverers suggested decreasing training time and making program content available on demand rather than through traditional in-person training. Using APDER with a long-standing IRPP allowed the delivery system to provide feedback to program developers to co-create ongoing adaptations and data-driven decisions. Future work in response to shifting needs includes Fitbit integration and technological updates to the usability of the FitEx platform. Our aim is to report the 15+ years of applying the Assess, Plan, Do, Evaluate, Report (APDER) process with an integrated research-practice partnership (IRPP) for co-creation of ongoing adaptations of FitEx and to share methods for capturing relevant data for decision-making to integrate health promotion programs in community settings.</p>","PeriodicalId":48679,"journal":{"name":"Translational Behavioral Medicine","volume":" ","pages":"45-53"},"PeriodicalIF":3.6,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10782918/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10539125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A preliminary randomized trial of reinforcement contingencies to improve compliance with ecological momentary assessment.","authors":"Julie C Gass, Sarah Tonkin, Eugene Maguin, Craig R Colder, Martin C Mahoney, Stephen T Tiffany, Larry W Hawk","doi":"10.1093/tbm/ibad066","DOIUrl":"10.1093/tbm/ibad066","url":null,"abstract":"<p><p>Ecological Momentary Assessment (EMA) methods are increasingly used by translational scientists to study real-world behavior and experience. The ability to draw meaningful conclusions from EMA research depends upon participant compliance with assessment completion. Most EMA studies provide financial compensation for compliance, but little empirical evidence addresses the impact of reinforcement parameters on the level of compliance. The purpose of this study-within-a-trial was to determine the effects of varying the amount and frequency of reinforcement on EMA compliance in a clinical sample of individuals seeking treatment for cigarette smoking. In the parent clinical trial, participants were asked to complete 9 weeks of EMA (1 daily Morning Assessment and 4 daily Random Assessments). Following a 5-week Standard Payment phase for EMA compliance, 61 individuals seeking treatment for cigarette smoking enrolled in the larger clinical trial were randomized to receive Standard ($1 per assessment, paid biweekly), Frequent ($1 per assessment, paid 3 times per week), or Large ($2 per assessment, paid biweekly) payments for EMA compliance during a 4-week Payment Manipulation Phase. Overall, receiving Frequent or Large payments did not improve EMA compliance compared to Standard payments, Ps > .30. Varying frequency and amount of remuneration for EMA compliance did not generally improve compliance in an ongoing clinical trial, raising further questions about the importance of reinforcement parameters in promoting EMA compliance.</p>","PeriodicalId":48679,"journal":{"name":"Translational Behavioral Medicine","volume":" ","pages":"60-65"},"PeriodicalIF":3.6,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10782908/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71414816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Budget impact analysis for implementation decision making, planning, and financing.","authors":"Natalie Riva Smith, Douglas E Levy","doi":"10.1093/tbm/ibad059","DOIUrl":"10.1093/tbm/ibad059","url":null,"abstract":"<p><p>Shelley et al. (in Accelerating integration of tobacco use treatment in the context of lung cancer screening: relevance and application of implementation science to achieving policy and practice. Transl Behav Med 2022;12:1076-1083) laid out how implementation science frameworks and methods can advance the delivery of tobacco use treatment services during lung cancer screening services, which until recently was mandated by the Centers for Medicare and Medicaid Services. Their discussion provides an important overview of the full process of implementation and highlights the vast number of decisions that must be made when planning for implementation of an evidence-based practice such as tobacco use treatment: what specific tobacco use treatment services to deliver, when to deliver those services within the lung cancer screening process, and what implementation strategies to use. The costs of implementation play a major role in decision making and are a key implementation determinant discussed in major implementation frameworks. When making decisions about what and how to implement, budget impact analyses (BIAs) can play an important role in informing decision making by helping practitioners understand the overall affordability of a given implementation effort. BIAs can also inform the development of financing strategies to support the ongoing sustainment of tobacco use treatment service provision. More attention is needed by the research community to produce high-quality, user-friendly, and flexible BIAs to inform implementation decision making in health system and community settings. The application of BIA can help ensure that the considerable time and effort spent to develop and evaluate evidence-based programs has the best chance to inform implementation practice.</p>","PeriodicalId":48679,"journal":{"name":"Translational Behavioral Medicine","volume":" ","pages":"54-59"},"PeriodicalIF":3.6,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11491932/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41161150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chatbot-interfaced and cognitive-affective barrier-driven messages to improve colposcopy adherence after abnormal Pap test results in underserved urban women: A feasibility pilot study.","authors":"Kuang-Yi Wen, Sandra Dayaratna, Rachel Slamon, Clara Granda-Cameron, Erin K Tagai, Racquel E Kohler, Shawna V Hudson, Suzanne M Miller","doi":"10.1093/tbm/ibad064","DOIUrl":"10.1093/tbm/ibad064","url":null,"abstract":"<p><p>Challenges in ensuring adherence to colposcopy and follow-up recommendations, particularly within underserved communities, hinder the delivery of appropriate care. Informed by our established evidence-based program, we sought to assess the feasibility and acceptability of a novel cognitive-affective intervention delivered through a Chatbot interface, aimed to enhance colposcopy adherence within an urban inner-city population. We developed the evidence-based intervention, CervixChat, to address comprehension of colposcopy's purpose, human papillomavirus (HPV) understanding, cancer-related fatalistic beliefs, procedural concerns, and disease progression, offered in both English and Spanish. Females aged 21-65, with colposcopy appointments at an urban OBGYN clinic, were invited to participate. Enrolled patients experienced real-time counseling messages tailored via a Chatbot-driven barriers assessment, dispatched via text one week before their scheduled colposcopy. Cognitive-affective measures were assessed at baseline and through a 1-month follow-up. Participants also engaged in a brief post-intervention satisfaction survey and interview to capture their acceptance and feedback on the intervention. The primary endpoints encompassed study adherence (CervixChat response rate and follow-up survey rate) and self-evaluated intervention acceptability, with predefined feasibility benchmarks of at least 70% adherence and 80% satisfaction. Among 48 eligible women scheduled for colposcopies, 27 (56.3%) agreed, consented, and completed baseline assessments. Participants had an average age of 34 years, with 14 (52%) identifying as non-Hispanic White. Of these, 21 (77.8%) engaged with the CervixChat intervention via mobile phones. Impressively, 26 participants (96.3%) attended their diagnostic colposcopy within the specified timeframe. Moreover, 22 (81.5%) completed the follow-up survey and a brief interview. Barriers assessment revealed notable encodings in the Affect and Values/Goals domains, highlighting concerns and understanding around HPV, as well as its impact on body image and sexual matters. Persistent and relatively high intrusive thoughts and lowered risk perceptions regarding cervical cancer were reported over time, unaffected by the intervention. Post-intervention evaluations documented high satisfaction and perceived usefulness, with recommendations for incorporating additional practical and educational content. Our findings underscore the robust satisfaction and practicality of the CervixChat intervention among a diverse underserved population. Moving forward, our next step involves evaluating the intervention's efficacy through a Sequential Multiple Assignment Randomized Trial (SMART) design. Enhanced by personalized health coaching, we aim to further bolster women's risk perception, address intrusive thoughts, and streamline resources to effectively improve colposcopy screening attendance.</p>","PeriodicalId":48679,"journal":{"name":"Translational Behavioral Medicine","volume":" ","pages":"1-12"},"PeriodicalIF":3.6,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10782901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138446626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The potential for graphical abstracts to enhance science communication.","authors":"Rebecca A Krukowski, Carly M Goldstein","doi":"10.1093/tbm/ibad069","DOIUrl":"10.1093/tbm/ibad069","url":null,"abstract":"<p><p>Science communication, including formats such as podcasts, news interviews, or graphical abstracts, can contribute to the acceleration of translational research by improving knowledge transfer to patient, policymaker, and practitioner communities. In particular, graphical abstracts, which are optional for articles published in Translational Behavioral Medicine as well as many other journals, are created by authors of scientific articles or by editorial staff to visually present a study's design, findings, and implications, to improve comprehension among non-academic audiences. The use of graphical abstracts in scientific journals has increased in the past 10-15 years; however, most scientists are not trained in how to develop them, which presents a challenge for creating graphical abstracts that engage the public. In this article, the authors describe graphical abstracts and offer suggestions for their construction based on the extant literature. Specifically, graphical abstracts should use a solid background, employ an easily readable font, combine visuals with words, convey only the essential study design information and 1-3 \"take-home\" points, have a clear organizational structure, contain restrained and accessible use of color, use single-color icons, communicate ways to access the full-text article, and include the contact information for the lead author. Authors should obtain feedback on graphical abstract drafts prior to dissemination. There is emerging research on the benefits of graphical abstracts in terms of impact and engagement; however, it will be essential for future research to determine how to optimize the design of graphical abstracts, in order to engage patient, policymaker, and practitioner communities in improving behavioral health.</p>","PeriodicalId":48679,"journal":{"name":"Translational Behavioral Medicine","volume":" ","pages":"891-895"},"PeriodicalIF":3.6,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10724116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134650193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using intervention mapping to design and implement a multicomponent intervention to improve antibiotic and NSAID prescribing.","authors":"Thomas J Reese, Amanda S Mixon, Michael E Matheny, Christina N Flatt, Melissa Rubenstein, Jin H Han, Jesse Wrenn, Chloe Dagostino, Kemberlee Bonnet, Shilo Anders, David Schlundt, Michael J Ward","doi":"10.1093/tbm/ibad063","DOIUrl":"10.1093/tbm/ibad063","url":null,"abstract":"<p><p>Successfully changing prescribing behavior to reduce inappropriate antibiotic and nonsteroidal anti-inflammatory drug (NSAID) prescriptions often requires combining components into a multicomponent intervention. However, multicomponent interventions often fail because of development and implementation complexity. To increase the likelihood of successfully changing prescribing behavior, we applied a systematic process to design and implement a multicomponent intervention. We used Intervention Mapping to create a roadmap for a multicomponent intervention in unscheduled outpatient care settings in the Veterans Health Administration. Intervention Mapping is a systematic process consisting of six steps that we grouped into three phases: (i) understand behavioral determinants and barriers to implementation, (ii) develop the intervention, and (iii) define evaluation plan and implementation strategies. A targeted literature review, combined with 25 prescriber and 25 stakeholder interviews, helped identify key behavioral determinants to inappropriate prescribing (e.g. perceived social pressure from patients to prescribe). We targeted three desired prescriber behaviors: (i) review guideline-concordant prescribing and patient outcomes, (ii) manage diagnostic and treatment uncertainty, and (iii) educate patients and caregivers. The intervention consisted of components for academic detailing, prescribing feedback, and alternative prescription order sets. Implementation strategies consisted of preparing clinical champions, conducting readiness assessments, and incentivizing use of the intervention. We chose a mixed-method study design with a commonly used evaluation framework to assess effectiveness and implementation outcomes in a subsequent trial. This study furthers knowledge about causes of inappropriate antibiotic and NSAID prescribing and demonstrates how theoretical, empirical, and practical information can be systematically applied to develop a multicomponent intervention to help address these causes.</p>","PeriodicalId":48679,"journal":{"name":"Translational Behavioral Medicine","volume":" ","pages":"928-943"},"PeriodicalIF":3.6,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49683844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient perspectives on a proposed pharmacy-based colorectal cancer screening program.","authors":"Renée M Ferrari, Dana L Atkins, Mary Wangen, Catherine L Rohweder, Austin R Waters, Sara Correa, Jennifer Richmond, Dillon van Rensburg, Annika Ittes, Olufeyisayo Odebunmi, Rachel B Issaka, Rachel Ceballos, Parth D Shah, Stephanie B Wheeler, Alison T Brenner","doi":"10.1093/tbm/ibad057","DOIUrl":"10.1093/tbm/ibad057","url":null,"abstract":"<p><p>Colorectal cancer (CRC) is a common and preventable cancer. CRC screening is underutilized, particularly within medically underserved communities. Most interventions aimed at increasing CRC screening are delivered through primary care clinics. Pharmacies are more accessible than traditional primary care settings and may be ideally suited for delivering CRC screening and increasing access. Fecal immunochemical test is an at-home, stool-based CRC screening test that could be distributed through pharmacies. The purpose of our study was to assess patient perspectives on receiving fecal immunochemical test-based CRC screening through pharmacies. We conducted semi-structured interviews with participants residing in North Carolina and Washington. Interviews explored acceptability and intervention design preferences for a pharmacy-based CRC screening program. The interview guide was informed by Andersen's Healthcare Utilization Model and the Theoretical Domains Framework. Interviews were conducted at the University of North Carolina at Chapel Hill and Fred Hutchinson Cancer Research Center, audio-recorded, and transcribed. Patients perceived a pharmacy-based CRC screening program to be highly acceptable, citing factors such as ease of pharmacy access and avoiding co-pays for an office visit. Some concerns about privacy and coordination with patients' primary care provider tempered acceptability. Trust and positive relationships with providers and pharmacists as well as seamless care across the CRC screening continuum also were viewed as important. Patients viewed pharmacy-based CRC screening as an acceptable option for CRC screening. To improve programmatic success, it will be important to ensure privacy, determine how communication between the pharmacy and the patient's provider will take place, and establish closed-loop care, particularly for patients with abnormal results.</p>","PeriodicalId":48679,"journal":{"name":"Translational Behavioral Medicine","volume":" ","pages":"909-918"},"PeriodicalIF":3.6,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10724111/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41156024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring contextual factors impacting the implementation of and engagement with a digital platform supporting psychosis recovery: A brief report.","authors":"Lydia Sequeira, Iman Kassam, Jessica D'Arcey, Wenjia Zhou, Sana Junaid, Sherry Luo, Navi Boparai, Leah Tackaberry-Giddens, Sean Kidd","doi":"10.1093/tbm/ibad070","DOIUrl":"10.1093/tbm/ibad070","url":null,"abstract":"<p><p>Individuals with schizophrenia often demonstrate poor engagement in treatment and challenges with illness self-management. App4independence (A4i) is a digital health platform that was developed with the purpose of addressing the aforementioned challenges. While digital interventions can support patient care, there is a paucity of research on implementing such interventions in clinical settings. To describe the contextual factors that impacted the implementation of and engagement with A4i across three different clinical implementation sites, a descriptive approach, guided by implementation science frameworks, was employed to understand how people, culture, process, and technology impacted the implementation of A4i. Descriptive statistics were used to present user engagement data across each site implementation. Additionally, the lessons learned from each implementation were described narratively. Overall, 53 patients were onboarded to A4i in Context 1, 8 in Context 2, and 65 within Context 3, with retention rates over 90 days of 100%, 100%, and 96%, respectively. The adoption, engagement, and sustained use of the A4i platform varied across each implementation site and were affected by implementation strategies within the sociotechnical domains of people, culture, process, and technology. Despite differences in implementation processes, engagement with A4i remained consistently high. Customized educational materials, digital navigators, and technical support served as facilitators in the adoption of A4i.</p>","PeriodicalId":48679,"journal":{"name":"Translational Behavioral Medicine","volume":" ","pages":"896-902"},"PeriodicalIF":3.6,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10724108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71487670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Receipt, uptake, and satisfaction with tailored DVD and patient navigation interventions to promote cancer screening among rural women.","authors":"Susan M Rawl, Ryan Baltic, Patrick O Monahan, Timothy E Stump, Madison Hyer, Alysha C Ennis, Jean Walunis, Katherine Renick, Karen Hinshaw, Electra D Paskett, Victoria L Champion, Mira L Katz","doi":"10.1093/tbm/ibad054","DOIUrl":"10.1093/tbm/ibad054","url":null,"abstract":"<p><p>Process evaluation is essential to understanding and interpreting the results of randomized trials testing the effects of behavioral interventions. A process evaluation was conducted as part of a comparative effectiveness trial testing a mailed, tailored interactive digital video disc (DVD) with and without telephone-based patient navigation (PN) to promote breast, cervical and colorectal cancer screening among rural women who were not up-to-date (UTD) for at least one screening test. Data on receipt, uptake, and satisfaction with the interventions were collected via telephone interviews from 542 participants who received the tailored interactive DVD (n = 266) or the DVD plus telephone-based PN (n = 276). All participants reported receiving the DVD and 93.0% viewed it. The most viewed sections of the DVD were about colorectal, followed by breast, then cervical cancer screening. Most participants agreed the DVD was easy to understand, helpful, provided trustworthy information, and gave information needed to make a decision about screening. Most women in the DVD+PN group, 98.2% (n = 268), reported talking with the navigator. The most frequently discussed cancer screenings were colorectal (86.8%) and breast (71.3%); 57.5% discussed cervical cancer screening. The average combined length of PN encounters was 22.2 minutes with 21.7 additional minutes spent on coordinating activities. Barriers were similar across screening tests with the common ones related to the provider/health care system, lack of knowledge, forgetfulness/too much bother, and personal issues. This evaluation provided information about the implementation and delivery of behavioral interventions as well as challenges encountered that may impact trial results.</p>","PeriodicalId":48679,"journal":{"name":"Translational Behavioral Medicine","volume":" ","pages":"879-890"},"PeriodicalIF":3.6,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10724168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10243525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using the matrixed multiple case study methodology to understand site differences in the outcomes of a Hybrid Type 1 trial of a peer-led healthy lifestyle intervention for people with serious mental illness.","authors":"Daniela Tuda, Lauren Bochicchio, Ana Stefancic, Mark Hawes, Jun-Hong Chen, Byron J Powell, Leopoldo J Cabassa","doi":"10.1093/tbm/ibad060","DOIUrl":"10.1093/tbm/ibad060","url":null,"abstract":"<p><p>Site differences in implementation trial outcomes are common but often not examined. In a Hybrid Type 1 trial examining the effectiveness-implementation of a peer-led group life-style balance (PGLB) intervention for people with serious mental illness (SMI) in three supportive housing agencies, we found that PGLB recipients' physical health outcomes differed by study sites. The matrixed multiple case study methodology was used to explore how implementation outcomes and changes in context of usual care (UC) services contributed to these site differences. Two implementation outcomes (i.e. PGLB fidelity ratings and intervention recipients' acceptability of PGLB and UC) and changes in healthcare services integration at the study sites were examined. ANOVAs were used to examine site differences in fidelity ratings and client satisfaction. Directed content analysis was used to analyze leadership interviews to identify changes in the context of UC services. Site 3 showed a trend approaching significance (P = .05) towards higher fidelity ratings. High levels of satisfaction with PGLB were reported at all sites. Significant differences in PGLB recipients' satisfaction with UC were found, with Site 3 reporting the lowest levels of satisfaction. Agency leaders reported an increase in prioritizing client's health throughout the trial with sites differing in how these priorities were put into action. Differences in PGLB recipients' satisfaction with UC, and changes in healthcare service integration seemed to have contributed to the site differences in our trial. The matrixed multiple case study methodology is a useful approach to identify implementation outcomes contributing to the heterogeneity of multisite implementation trial results.</p>","PeriodicalId":48679,"journal":{"name":"Translational Behavioral Medicine","volume":" ","pages":"919-927"},"PeriodicalIF":3.6,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10724107/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41240022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}