Implementation Science最新文献

{"title":"Nudging implementation of low tidal volume ventilation: a stepped wedge, cluster randomized trial.","authors":"Meeta Prasad Kerlin, Michael O Harhay, Fan Li, Dylan S Small, Yingying Lu, Wei Wang, Barry D Fuchs, Mark E Mikkelsen, Teresa Tran, Aerielle Belk, Jasmine A Silvestri, Tamar Klaiman, Stefania Scott, Elizabeth Levy, Michael W Sjoding, Rachel Kohn, Karsten J Roberts, Rinad S Beidas, Scott D Halpern","doi":"10.1186/s13012-026-01500-8","DOIUrl":"https://doi.org/10.1186/s13012-026-01500-8","url":null,"abstract":"<p><strong>Background: </strong>\"Nudges\" embedded in the electronic health record (EHR) facilitate desired decisions while preserving autonomy and may provide a scalable strategy to overcome the common implementation barrier of lack of knowledge about a best practice. We sought to test whether EHR-based nudges targeting two intensive care unit (ICU) clinician groups would safely increase evidence-based use of low tidal volume ventilation.</p><p><strong>Methods: </strong>We performed a stepped-wedge, cluster randomized, hybrid type 3 effectiveness-implementation trial in 12 ICUs from February 2021 to May 2023 to test three nudges targeting clinicians responsible for order entry and respiratory therapists responsible for operationalizing orders and documentation. A default ventilation order auto-populated a low tidal volume setting; an accountable justification order required a free-text justification to order high tidal volume; and an accountable justification flowsheet required a free-text justification to document delivery of high tidal volume. ICUs were randomly assigned to launch one of the two order nudges on a pre-specified date, followed by the flowsheet nudge six months thereafter. The primary outcome was fidelity to low tidal volume ventilation, defined as percentage of time during the first 72 h of ventilation with low tidal volumes. For additional contextual inquiry, we conducted qualitative interviews with ICU clinicians regarding their perspectives on low tidal volume ventilation and study nudges.</p><p><strong>Results: </strong>The primary analysis included 4412 patients. Unadjusted median fidelity to low tidal volume ventilation was 45.7%. Using multivariable mixed effects regression, marginal estimates of fidelity to low tidal volume ventilation ranged from 47.1% to 57.8% across study groups, with no significant differences after Holm adjustment for multiple comparisons. ICUs experienced variable changes with nudges in fidelity to low tidal volume ventilation. Clinician interviews revealed potential explanations for this variability, including the possibility of differential effects by experience level of clinicians and culture of interprofessional collaboration, and influence of the COVID-19 pandemic on familiarity with and use of low tidal volume ventilation.</p><p><strong>Conclusions: </strong>EHR-based default and accountable justification nudges did not increase utilization of low tidal volume ventilation in a broad population of mechanically ventilated patients; however, nudge effectiveness varied by ICU.</p><p><strong>Trial registration: </strong>Clinicaltrials.gov, NCT04663802. Registered 10 December 2020, https://clinicaltrials.gov/study/NCT04663802.</p>","PeriodicalId":54995,"journal":{"name":"Implementation Science","volume":" ","pages":""},"PeriodicalIF":13.4,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Too deductive too soon? Toward an inductive renewal of implementation science.","authors":"Per Nilsen, Roman Kislov, Sarah A Birken, Brian S Mittman","doi":"10.1186/s13012-026-01504-4","DOIUrl":"https://doi.org/10.1186/s13012-026-01504-4","url":null,"abstract":"<p><strong>Background: </strong>Over the past two decades, implementation science has developed a strong conceptual foundation through the proliferation and widespread use of theories, models, and frameworks (TMFs). These have provided coherence, shared vocabulary, and methodological discipline across a rapidly expanding field. However, this success has also produced an unintended consequence: increasing reliance on deductive modes of inquiry, in which a limited set of established TMFs are repeatedly applied as analytic templates across diverse empirical contexts. This tendency toward early deductivism risks constraining theoretical development, reducing sensitivity to heterogeneity, complexity, and temporality inherent in implementation, and reinforcing methodological circularity.</p><p><strong>Toward an inductive renewal of implementation science: </strong>In this conceptual paper, we argue for an inductive renewal of implementation science that rebalances deduction with stronger inductive and abductive forms of reasoning. Rather than abandoning established TMFs, we propose reframing them as evolving heuristics - resources for structuring inquiry that remain open to refinement, extension, and selective reconfiguration through empirical engagement. We clarify the complementary roles of induction, abduction, and deduction in theory development, emphasizing abductive iteration as a mechanism for translating empirical discovery into cumulative conceptual advancement. We outline strategies for advancing this agenda across three interdependent levels. At the study level, this involves treating TMFs as provisional heuristics, re-embracing qualitative discovery, and using abductive reasoning to refine theory through engagement with unexpected findings. At the field level, shared infrastructures for synthesis and longitudinal learning are needed to support cumulative, context-sensitive theorizing and to account for the temporal dynamics of implementation. Institutionally, journals and funders must recalibrate incentives to value theory development, adaptation, and transparency alongside theory application. Drawing on examples from research on knowledge brokering and implementation scale-up, we show how theoretically informative contributions emerge when empirical surprises, temporal dynamics, and analytic tensions are used to interrogate and refine existing TMFs rather than being absorbed into pre-specified categories.</p><p><strong>Conclusion: </strong>A mature implementation science must move beyond asking which TMF best fits a study, toward examining how empirical phenomena challenge, extend, and reshape theory. Sustaining this balance is essential for theoretical coherence and continued conceptual innovation.</p>","PeriodicalId":54995,"journal":{"name":"Implementation Science","volume":"21 1","pages":""},"PeriodicalIF":13.4,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141323/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the implementation of integrated knowledge translation in a multi-country research consortium in Sub-Saharan Africa - a mixed methods comparative case study.","authors":"Kerstin Sell, Eva Rehfuess, Esther Bayiga-Zziwa, Jimmy Osuret, Lisa Pfadenhauer","doi":"10.1186/s13012-026-01494-3","DOIUrl":"https://doi.org/10.1186/s13012-026-01494-3","url":null,"abstract":"<p><strong>Background: </strong>Integrated knowledge translation (IKT) is an approach facilitating collaboration between researchers and decision-makers towards evidence-informed decision-making. Increasingly evaluated in various contexts, less is known about the implementation process of IKT, including in low- and middle-income countries. The Collaboration for Evidence-based Healthcare and Public Health in Africa (CEBHA+) developed, implemented and evaluated an IKT approach across five countries. Here, we examined how the IKT approach was implemented in the African-German multi-country research consortium, investigating project-level context; implementation process, strategy, and outcomes; and exploring intervention core components.</p><p><strong>Methods: </strong>This process evaluation used a mixed-methods comparative case study design. Following a previously published protocol, the main authors of this paper surveyed and interviewed African CEBHA+ researchers and their partners from policy and practice in 2020/2021 and 2022/2023 and identified relevant IKT-related documents. We drew on our programme theory and implementation science frameworks to undertake qualitative content analysis of interview data and documents. Data was analysed within sites, integrated with descriptively analysed quantitative survey data, and subsequently compared across sites.</p><p><strong>Results: </strong>We enrolled 36 researchers and 19 decision-makers and analysed 92 IKT-related documents. IKT was implemented at the five sites in Ethiopia, Malawi, Rwanda, South Africa, and Uganda. In our cross-site analysis of fidelity and adaptability of IKT, we identified three core components of the IKT approach: (i) continuous tailored engagement between researchers and decision-makers, (ii) researchers' commitment to research impact, and (iii) linking to existing KT routines. The context analysis revealed that IKT implementation was facilitated by local KT structures, pre-existing knowledge translation routines and relationships with decision-makers, senior leadership motivation, and funder support including a dedicated budget for IKT activities. Feasibility of IKT implementation was reduced by administrative challenges, overall project complexity, and conflicting priorities.</p><p><strong>Conclusion: </strong>This research leveraged a unique opportunity to study a systematic IKT approach implemented across sites in five African countries in the context of a large international research consortium. The findings can inform IKT design and implementation in other multi-site and multi-country projects. Particularly, the identified core components can guide adaptation and refinement of IKT in contextually diverse settings, including low- and middle- income countries.</p>","PeriodicalId":54995,"journal":{"name":"Implementation Science","volume":" ","pages":""},"PeriodicalIF":13.4,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147823563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AI Methods for Implementation Science (AIM-IS): developing a framework, toolkit, and reporting standard for the responsible use of AI in implementation practice and research.","authors":"Guillaume Fontaine, Susan Michie, Rinad S Beidas, Elvin Geng, Christine Fahim, Byron J Powell, Vivian Welch, James Thomas, Jeffery Chan, Samira Abbasgholizadeh-Rahimi, France Légaré, Janna Hastings, Sylvie D Lambert, Justin Presseau, Sharon E Straus, Ruopeng An, Ashrita Saran, Natalie Taylor","doi":"10.1186/s13012-026-01503-5","DOIUrl":"https://doi.org/10.1186/s13012-026-01503-5","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence (AI), including machine learning, natural language processing, and large language models, may support implementation practice and research in tasks such as evidence synthesis, determinant assessment, strategy selection, monitoring, adaptation, and theory development. However, these applications of AI do not form a single, uniform category. They span a continuum from practice-facing applications that support local implementation work to research- and methods-facing applications that support evidence generation and synthesis. The guidance on how to classify, evaluate, and report these uses of AI remains limited. The AI Methods for Implementation Science (AIM-IS) program aims to develop, validate, and maintain a suite of products to guide the responsible use of AI across implementation practice, implementation research, and bridging use cases.</p><p><strong>Methods: </strong>AIM-IS is a multi-phase, multi-method methodological development program. The unit of analysis is the AI-for-implementation use case: a specific AI capability supporting a defined implementation practice or research task within a workflow, decision point, and governance context. Phase 1 is a living scoping review mapping published AI use cases in implementation science, including how they are evaluated and what risks they raise. Phase 2 is a qualitative interview study with implementation researchers, practitioners, AI experts, community members, and data infrastructure and governance experts to refine use cases and identify feasibility constraints, outcome priorities, and reporting needs. Phase 3 will integrate findings from Phases 1 and 2 to develop the draft AIM-IS products, including a framework, a taxonomy of use cases, guardrails for responsible use, a practical guide, outcome domains, and reporting items. Phase 4 will use an eDelphi process and consensus meeting to refine and finalize these products. Phase 5 will conduct usability testing to improve clarity and ease of use, resulting in the finalized AIM-IS products. AIM-IS is informed by implementation science, sociotechnical systems, equity, and responsible AI frameworks, and includes a living-update approach to support ongoing refinement.</p><p><strong>Discussion: </strong>The AIM-IS program will deliver a suite of products, including a framework, toolkit and reporting standard, to support the specification, governance, evaluation, and reporting of AI in implementation science. Together, these products aim to strengthen transparency, comparability, accountability, and attention to equity in how AI is used by implementation practitioners and researchers over time.</p><p><strong>Registration: </strong>Open Science Framework, March 15, 2026: https://doi.org/10.17605/OSF.IO/BX35K.</p>","PeriodicalId":54995,"journal":{"name":"Implementation Science","volume":" ","pages":""},"PeriodicalIF":13.4,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147678672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Targeted social and behavior change communication (SBCC) in a high adolescent pregnancy setting of Bangladesh: a cluster-randomized study protocol engaging key family members.","authors":"Seohyun Lee, Gohtbyeol Kim, SeYeon Kim, Narae Kim, Jihye Kim, Jieun Kim, Mohammad Sarwar Basher, Md Atikur Rahman, Syeda Jamila Siddika, Jahanara Hridita, Golam Fakhruddin, Sharmin Sultana Urmi, Uzzal Kumar Roy, Golam Mothabbir","doi":"10.1186/s13012-026-01502-6","DOIUrl":"https://doi.org/10.1186/s13012-026-01502-6","url":null,"abstract":"<p><strong>Background: </strong>Maternal health service utilization remains low in Bangladesh, while maternal health outcomes are poor and adolescent pregnancy rates are high. In this context, targeted social and behavior change communication (SBCC) can be an effective approach. This targeted SBCC research was participatorily designed in collaboration with Bangladesh local partners and was funded as part of the 2023-27 KOICA Strategic Partnership Program (SPP)- Strengthening Maternal and Neonatal Health System in Rangpur, Bangladesh (No. 2023-0515). The study was informed by implementation and behavior change theories, engaging key family members in the intervention.</p><p><strong>Methods: </strong>A hybrid effectiveness-implementation type II cluster-randomized study was designed to measure key maternal health service utilization outcomes as well as implementation outcomes. A total of 750 participants classified into four targeted groups-1) adolescent pregnant women, 2) adult pregnant women, 3) husbands and 4) mothers-in-law, will be invited to participate in group-based interactive community courtyard sessions. These 5-month curriculum targeted SBCC sessions cover maternal and newborn health topics such as antenatal care (ANC), safe delivery, postnatal care (PNC), and neonatal care. The primary outcomes include four or more ANC visits, facility delivery, Postnatal Care (PNC) and neonatal care within 48 h after delivery. Secondary outcomes are perceptions on early marriage, maternal health-seeking behaviors, family support, decision making, and satisfaction with the information gained from the targeted SBCC sessions. To assess the effectiveness, baseline and endline surveys, along with endline focus group discussions (FGDs) will be conducted before and after the 5-month curriculum. Additionally, implementation outcomes such as adoption, penetration, acceptability, coverage, feasibility, fidelity, and sustainability will be measured.</p><p><strong>Discussion: </strong>This study engages key decision-makers such as pregnant women, their husbands, and mothers-in-law, to enhance maternal health service utilization. As Bangladesh is a patriarchal society, men within households are often the primary decision-makers regarding marriage and reproductive matters. Moreover, the child marriage and adolescent pregnancy rates remain high, contributing to persistently elevated maternal and neonatal mortality. By applying implementation science frameworks and behavior change theories, this study aims to generate evidence to inform future scale-up efforts in similar contexts.</p><p><strong>Trial registration: </strong>The protocol was registered with ISRCTN registry under registration ISRCTN12515877.</p>","PeriodicalId":54995,"journal":{"name":"Implementation Science","volume":" ","pages":""},"PeriodicalIF":13.4,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147678686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Employing Peer Outreach and Whole Health in Recovery (EMPOWER) for homeless-experienced veterans: protocol for a hybrid type 3 implementation trial.","authors":"Daniel M Blonigen, Justeen Hyde, Jennifer Smith, Samantha TorresTower, Tanya Podchiyska, Thomas J Taylor, Rebecca A Raciborski, Sharmily G Roy, Amanda M Midboe","doi":"10.1186/s13012-026-01499-y","DOIUrl":"https://doi.org/10.1186/s13012-026-01499-y","url":null,"abstract":"<p><strong>Background: </strong>Homelessness is a national crisis in the United States, particularly in the veteran population. Due to multiple chronic conditions, homeless individuals have elevated risk for acute care service use. Engagement in primary and specialty care can mitigate this risk. Interventions grounded in evidence-based practices of peer support, patient-centered care, and whole health are effective for increasing service engagement. However, implementation of such interventions with high-acuity patients often requires multi-component strategies that are intensive and costly. This protocol paper describes a hybrid type 3 effectiveness-implementation trial of Employing Peer Outreach and Whole Health in Recovery (EMPOWER) with high-need, homeless-experienced veterans in permanent supportive housing and will evaluate the impact and cost of high-intensity (vs. low-intensity) implementation strategies on outcomes.</p><p><strong>Methods: </strong>(Aim 1) At 7 sites in the Veterans Health Administration (VA), a mixed methods pre-implementation evaluation will identify determinants and their potential impact on uptake of EMPOWER and inform modifications to the intervention and implementation strategies as needed. (Aim 2) A staircase cluster randomized design will evaluate the rollout of the implementation strategies, beginning with Audit and Feedback (low-intensity) and then switching to Implementation Facilitation (high-intensity) after 6 months. Implementation Facilitation is hypothesized to have a greater impact on the reach, effectiveness, adoption, implementation (fidelity), and maintenance of EMPOWER. (Aim 3) A budget impact analysis will estimate the average cost of implementing EMPOWER at future sites and comparative costs for implementing the low- and high-intensity strategies.</p><p><strong>Discussion: </strong>This project will provide information on the relative impacts and relative costs of strategies aimed at implementing a peer-led, patient-centered, whole health intervention for homeless-experienced veterans in permanent supportive housing. The findings will provide guidance to VA and other healthcare systems that serve the aging population of homeless-experienced veterans.</p><p><strong>Trial registration: </strong>Clinicaltrials.gov (NCT07309224).</p>","PeriodicalId":54995,"journal":{"name":"Implementation Science","volume":" ","pages":""},"PeriodicalIF":13.4,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147640913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation impact in the age of complexity: walking the tightrope between scientific rigour and real‑world pragmatism - Proceedings of the 2025 European Implementation Event.","authors":"","doi":"10.1186/s13012-026-01486-3","DOIUrl":"10.1186/s13012-026-01486-3","url":null,"abstract":"","PeriodicalId":54995,"journal":{"name":"Implementation Science","volume":"21 Suppl 1","pages":""},"PeriodicalIF":13.4,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13034602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147576745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Study protocol for coaching and leadership in autism support settings: a cluster randomized controlled hybrid type 2 effectiveness-implementation trial.","authors":"Jill Locke, Nathaniel J Williams, Aksheya Sridhar, Wendy Shih, Christine Espeland, Daina Tagavi, Karen Bearss","doi":"10.1186/s13012-026-01497-0","DOIUrl":"10.1186/s13012-026-01497-0","url":null,"abstract":"<p><strong>Background: </strong>The increased prevalence of autism spectrum disorder creates a sense of urgency to improve outcomes for this population in publicly funded education systems, the primary setting in which autistic children receive behavioral health services in the United States. Important barriers to progress include a lack of feasible clinical interventions that address autistic children's externalizing behaviors in schools and major challenges sustaining fidelity to newly implemented programs over time. This trial addresses these gaps by (1) testing the clinical effectiveness of the Research Units on Behavioral Interventions in Educational Settings (RUBIES) program relative to educator psychoeducation on externalizing behaviors of autistic children in public elementary schools, and (2) testing the effects of adding a leadership-focused organizational implementation strategy, Helping Educational Leaders Mobilize Evidence (HELM), to educator coaching in RUBIES on RUBIES sustainment.</p><p><strong>Methods: </strong>In a cluster-randomized, hybrid type 2 effectiveness-implementation trial, schools will be randomized to one of 3 arms: 1) educator coaching in RUBIES and school participation in HELM; 2) educator coaching in RUBIES only; or 3) a control condition incorporating an active clinical comparator, educator psychoeducation. We will enroll 42 schools and 126 educators yoked to 126 elementary-aged autistic children. Depending on arm, educators will complete study instruments up to six times: 1) Spring semester prior to the year of school and student enrollment (implementation baseline; arms 1-2); 2) Fall semester Year 1 (clinical baseline; arms 1-3); 3) 16 weeks (arms 1-3); 4) 24 weeks (arms 1-3); 5) 52 weeks (arms 1-2); and 6) 76 weeks (arms 1-2). The primary clinical outcome compares arms 1 & 2 vs. 3 on change in autistic children's externalizing behavior from clinical baseline to 24 weeks. The primary implementation outcome compares arms 1 vs. 2 on RUBIES sustainment, operationalized as educators' average RUBIES fidelity at 52 and 76 weeks.</p><p><strong>Discussion: </strong>Generating evidence for the clinical effectiveness of RUBIES addresses a significant gap in educator-delivered interventions to minimize highly prevalent externalizing behaviors among autistic children in public schools. Simultaneously, testing the effectiveness of HELM on sustainment of RUBIES will inform future efforts to successfully implement and sustain new innovations for autistic youth in public schools.</p><p><strong>Name of the registry: </strong>Clinical Trials.</p><p><strong>Trial registration: </strong>NCT07276750. Date of registration 12/10/25. URL of trial registry record https://clinicaltrials.gov/study/NCT07276750?cond=Autism&intr=RUBIES&rank=1 .</p>","PeriodicalId":54995,"journal":{"name":"Implementation Science","volume":" ","pages":""},"PeriodicalIF":13.4,"publicationDate":"2026-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151114/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147576729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Monitoring systems for public health program and policy implementation in community settings: features and suggested actions from a scoping review.","authors":"Alison Zucca, Cassandra Lane, William Pascoe, Belinda Peden, Carly Gardner, Adam Shoesmith, Angela Smith, Edward Riley-Gibson, Andrew Milat, Tanja Kuchenmüller, Davi Mamblona Marques Romao, Luke Wolfenden, Nicole Nathan","doi":"10.1186/s13012-026-01491-6","DOIUrl":"https://doi.org/10.1186/s13012-026-01491-6","url":null,"abstract":"<p><strong>Background: </strong>Monitoring systems are important for evaluating key outcome measures, identifying opportunities for improvement, and informing public health investment. While disease surveillance systems are highly developed and widely used, monitoring systems for the implementation of public health programs and policies in community settings are less established. To address this gap, this review aimed to: 1) describe the scope of the literature on implementation monitoring systems and their operational features; and 2) synthesise this literature to produce features and suggested actions for system design.</p><p><strong>Methods: </strong>A systematic search of five databases and grey literature sources was conducted to identify systems, frameworks, or guidance for monitoring the implementation of public health programs or policies in community settings. Studies focused on clinical healthcare, or disease surveillance were excluded. Two authors independently screened titles, abstracts, and full texts for eligibility. Included documents were then categorised by 'Case' (one or more documents exploring the same monitoring system, framework, or topic). For Research Aim 1, characteristic data for each Case were extracted and narratively summarised. For Research Aim 2, Best Fit Framework Synthesis was employed using an a priori framework informed by disease surveillance models. Full text of included documents were coded, and the framework iteratively modified, to develop a new framework with key features and suggested actions relevant to implementation monitoring systems in community settings.</p><p><strong>Results: </strong>Ninety-seven documents were identified, describing 75 distinct real-world implementation monitoring Cases. Aim 1: Most Cases were intended for use in high-income countries (64%) and focused on monitoring programs (81%) rather than policy. The most common topic areas related to nutrition (36%) and reproductive, HIV, and sexual health (28%). Primary responsibility for monitoring systems was most often held by national-level agencies (43%). Aim 2: Synthesis led to 13 key features of monitoring systems, with corresponding suggested actions across five broad Action Areas: 1) planning and preparation; 2) data collection activities; 3) system appraisal; 4) partner engagement, and 5) system revision.</p><p><strong>Conclusions: </strong>Findings emphasise that monitoring systems require attention across multiple Action Areas, including planning and resourcing, data collection, partner engagement, and system improvements (through both proactive appraisals and real-time response). This manuscript offers a foundational framework to guide policymakers and practitioners in monitoring the implementation of community-based public health policy or programs.</p>","PeriodicalId":54995,"journal":{"name":"Implementation Science","volume":" ","pages":""},"PeriodicalIF":13.4,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147522768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing two strategies to support the implementation of evidence-based practices for substance use disorders in VA's permanent supportive housing program: a protocol for a type 3 hybrid cluster-randomized controlled trial.","authors":"Sonya Gabrielian, Evelyn T Chang, Emily B H Treichler, Jenny Barnard, Richard E Nelson, Michelle S Wong, Nicholas J Jackson, Erin P Finley","doi":"10.1186/s13012-026-01498-z","DOIUrl":"10.1186/s13012-026-01498-z","url":null,"abstract":"<p><strong>Background: </strong>Homeless-experienced Veterans (HEVs) have higher rates of substance use disorders (SUDs) than housed Veterans, which impairs their ability to retain housing. The Department of Housing and Urban Development-VA Supportive Housing (HUD-VASH) initiative, which provides subsidized permanent housing and supportive services, contributed to the 50% reduction in Veteran homelessness over the past decade. However, ~ 40% of Veterans exit HUD-VASH within two years, often due to untreated SUDs. We will use two strategies to support the implementation of Medications for Addiction Treatment (MAT) and Cognitive Behavioral Therapy for Substance Use Disorders (CBT-SUD) in 12 HUD-VASH sites; conduct an evaluation of this implementation effort; and generate an implementation playbook to support continued spread of MAT and CBT-SUD in HUD-VASH.</p><p><strong>Methods: </strong>We will use Replicating Effective Programs (REP) to implement MAT and CBT-SUD at 12 sites over 18 months. After 9 months of REP alone, half (n = 6) of these sites will also receive Consumer Engagement (CE) for 9 months, activating HEVs to adopt these practices via peer coaching. We will conduct a type 3 hybrid cluster-randomized trial to compare the impacts of REP versus REP + CE. Randomization will occur at two levels: implementation start date (3 cohorts) and the implementation strategy (REP versus REP + CE). We will use stratified block randomization to balance site size among sites receiving each strategy across cohorts. We will use mixed methods to assess the impacts of REP versus REP + CE on implementation outcomes (reach [primary outcome], adoption, and sustainment); Veteran outcomes (primarily housing); provider and Veteran experiences; and costs and budget impacts. We hypothesize that REP + CE will have higher implementation costs than REP but result in improved MAT and CBT-SUD implementation and Veteran outcomes, leading to a business case for REP + CE.</p><p><strong>Discussion: </strong>Implementing MAT and CBT-SUD within HUD-VASH can improve HEVs' housing and health. By identifying effective strategies to support the implementation of these practices, we aim to inform other implementation efforts of behavioral health practices in homeless service settings.</p><p><strong>Trial registration: </strong>This project was registered with ClincialTrials.gov as \"Coordinated Access for Addiction Recovery and Equity in VA Supportive Housing.\" Trial registration NCT07141394, registered 8/26/2025 ( https://clinicaltrials.gov/study/NCT07141394?term=CARE-VASH&rank=1 ).</p>","PeriodicalId":54995,"journal":{"name":"Implementation Science","volume":" ","pages":""},"PeriodicalIF":13.4,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13137684/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147516868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}