Implementation research and practice最新文献

{"title":"A randomized controlled trial testing supervision strategies in community mental health.","authors":"Shannon Dorsey, Rashed AlRasheed, Suzanne Eu Kerns, Rosemary D Meza, Noah Triplett, Esther Deblinger, Nathaniel Jungbluth, Lucy Berliner, Lavangi Naithani, Michael D Pullmann","doi":"10.1177/26334895251330523","DOIUrl":"10.1177/26334895251330523","url":null,"abstract":"<p><strong>Background: </strong>Clinicians need supports beyond training to deliver evidence-based treatments with fidelity. Workplace-based clinical supervision often is a commonly provided support in community mental health, yet too few studies have empirically examined supervision and its impact on clinician fidelity and treatment delivery.</p><p><strong>Method: </strong>Building on a Washington State-funded evidence-based treatment initiative (CBT+), we conducted a randomized controlled trial (RCT), testing two supervision conditions delivered by workplace-based supervisors (supervisors employed by community mental health organizations). The RCT followed a supervision-as-usual (SAU) phase for comparison. The treatment of focus was trauma-focused cognitive behavioral therapy (TF-CBT). Clinicians (<i>N</i> = 238) from 25 organizations participated in the study across the SAU baseline and RCT phases. In the RCT phase, clinicians were randomized to either symptom and fidelity monitoring (SFM) or SFM and behavioral rehearsal (SFM + BR). For BR, clinicians engaged in a short role play of an upcoming treatment element. Supervisors delivered both conditions, with regular study monitoring for drift. Clinicians audiorecorded therapy sessions with enrolled clients, and masked coders coded a subset of recordings for adherence to TF-CBT. One hundred and thirty-three clinicians had recorded TF-CBT session data for 258 youth. We examined six adherence outcomes, including potential moderators.</p><p><strong>Results: </strong>Results of generalized estimating equations indicated that there were no real differences on adherence outcomes for experimental conditions (SFM, SFM + BR) compared to SAU. Adherence scores in the baseline SAU phase and the RCT conditions were high. Only one interaction was significant.</p><p><strong>Conclusions: </strong>Contrary to our hypotheses, we did not see improvements in adherence with the RCT conditions. However, nonsignificant findings seem best explained by clinicians' acceptable/high adherence in SAU. This study was conducted within the context of a long-standing, state-funded EBT initiative, in which clinicians and their supervisors receive training and support, and in which participating community mental health organizations have adopted and supported TF-CBT.</p><p><strong>Clinicaltrialsgov id: </strong>NCT01800266.</p>","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"6 ","pages":"26334895251330523"},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Organizational readiness for change: A systematic review of the healthcare literature.","authors":"Laura Caci, Emanuela Nyantakyi, Kathrin Blum, Ashlesha Sonpar, Marie-Therese Schultes, Bianca Albers, Lauren Clack","doi":"10.1177/26334895251334536","DOIUrl":"10.1177/26334895251334536","url":null,"abstract":"<p><strong>Background: </strong>Organizational readiness for change (ORC), referring to psychological and behavioral preparedness of organizational members for implementation, is often cited in healthcare implementation research. However, evidence about whether and under which conditions ORC is relevant for positive implementation results remains ambiguous, with past studies building on various theories and assessing ORC with different measures. To strengthen the ORC knowledge base, we therefore identified factors investigated in the empirical literature alongside ORC, or as mediators and/or moderators of ORC and implementation.</p><p><strong>Method: </strong>We conducted a systematic review of experimental, observational, and hybrid studies in physical, mental, and public health care that included a quantitative assessment of ORC and at least one other factor (e.g., ORC correlate, predictor, moderator, or mediator). Studies were identified searching five online databases and bibliographies of included studies, employing dual abstract and full text screening. The study synthesis was guided by the Consolidated Framework for Implementation Research integrated with the Theory of ORC. Study quality was appraised using the Mixed Methods Appraisal Tool.</p><p><strong>Results: </strong>Of 2,907 identified studies, 47 met inclusion criteria, investigating a broad range of factors alongside ORC, particularly contextual factors related to individuals and the innovation. Various ORC measures, both home-grown or theory-informed, were used, confirming a lack of conceptual clarity surrounding ORC. In most studies, ORC was measured only once.</p><p><strong>Conclusions: </strong>This systematic review highlights the broad range of factors investigated in relation to ORC, suggesting that such investigation may enhance interpretation of implementation results. However, the observed diversity in ORC conceptualization and measurement supports previous calls for clearer conceptual definitions of ORC. Future efforts should integrate team-level perspectives, recognizing ORC as both an individual and team attribute. Prioritizing the use of rigorous, repeated ORC measures in longitudinal implementation research is essential for advancing the collective ORC knowledge base.</p>","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"6 ","pages":"26334895251334536"},"PeriodicalIF":0.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12084713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating professionals' adaptations before and after a decision support intervention \"the Adaptation and Fidelity Tool\" (A-FiT)-A longitudinal within-person intervention design.","authors":"Johanna Zetterlund, Henna Hasson, Ulrica von Thiele Schwarz, Margit Neher, Emmie Wahlström","doi":"10.1177/26334895251334552","DOIUrl":"https://doi.org/10.1177/26334895251334552","url":null,"abstract":"<p><strong>Background: </strong>Implementing evidence-based interventions (EBIs) in practice requires balancing fidelity and adaptation to suit new contexts. Careful considerations are needed to maintain the core elements for effectiveness while ensuring fit with new contexts. The Adaptation and Fidelity Tool (A-FiT) intervention addresses this challenge by providing support for professionals using EBIs in the sustainment phase of implementation. This study evaluates the A-FiT intervention and examines how professionals delivering an EBI manage fidelity and adaptation during the sustainment phase of implementation, before and after the intervention. Method Short, structured interviews were repeatedly conducted with 14 professionals delivering an EBI (<i>n</i> = 127). Data was analyzed using deductive content analysis focusing on adaptation types, planning, intentionality, and fidelity consistency. The adaptations were counted and compared before versus after the A-FiT intervention using a chi²-test.</p><p><strong>Results: </strong>The professionals made about the same number of adaptations before and after the A-FiT intervention. However, after the intervention, significant changes in the type and intentionality of the adaptations were observed. Changes in type consisted of fewer \"removing,\" \"substituting,\" and \"integrating another framework\" adaptations and more \"loosening structure\" and \"departing from the intervention\" adaptations. Regarding intentionality, fewer planned adaptations with the intention of improving the EBI effects were made, while adaptations made for practical reasons, both planned and unplanned, increased after the A-FiT intervention. No statistical change was found regarding fidelity consistency.</p><p><strong>Conclusions: </strong>The findings indicate increased awareness about fidelity and adaptation among the group leaders, resulting in fewer planned adaptations to enhance program effects and more practical adaptations to address context challenges. The A-FiT intervention appears to help professionals in their management of fidelity and adaptations when delivering EBIs. The study underscores the importance of understanding adaptations in their context, purpose, and impact (intended and unintended) on the outcome/value.</p>","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"6 ","pages":"26334895251334552"},"PeriodicalIF":0.0,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12033404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of a novel pain coach educator program in a safety-net emergency department.","authors":"Jennifer H LeLaurin, Magda Montague, Megan E Curtis, Ramzi G Salloum, Sophia Sheikh, Phyllis L Hendry","doi":"10.1177/26334895251330511","DOIUrl":"10.1177/26334895251330511","url":null,"abstract":"<p><strong>Introduction: </strong>The ongoing opioid epidemic and rising number of patients with chronic pain highlight the need for alternative and integrative pain management approaches as a strategy to reduce opioid use and misuse. Evidence-based nonpharmacologic pain management strategies are available; however, they remain underutilized due to barriers including time limitations, cost, and lack of training. To address these barriers, we implemented a pain coach educator pilot program and nonpharmacologic patient toolkit in the emergency department of a large safety-net hospital. This paper describes the implementation process and preliminary evaluation of the first year of the program.</p><p><strong>Method: </strong>We implemented a multimodal pain coach educator program that included education on pain neuroscience and over-the-counter analgesic options, demonstration of integrative techniques, and dissemination of nonpharmacologic toolkits for home use in January 2021. Implementation strategies included changing the electronic health record infrastructure, developing stakeholder interrelationships, and ongoing education and training. We used the RE-AIM framework to guide evaluation of the first year of program implementation using data from the electronic health record, program records, and patient-reported outcomes.</p><p><strong>Results: </strong>In the first year of program implementation, 550 pain coach educator sessions were conducted. Upon session completion, 61% of patients felt the program was helpful, 39% were unsure at the time, and none reported session was not helpful. Clinician feedback was overwhelmingly positive. Program cost per patient was $344.35. Adaptations to intervention and implementation strategies included modifications of session delivery timing to accommodate clinical workflows, additions to program content to align with patient characteristics, and changes to patient identification strategies in response to the COVID-19 pandemic.</p><p><strong>Conclusions: </strong>Our pain coach educator program provides a model for implementing nonpharmacologic pain management opioid alternatives which can be scaled and adapted for other settings. This work demonstrates the importance of intervention and implementation strategy adaptations to enhance program reach and effectiveness.</p>","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"6 ","pages":"26334895251330511"},"PeriodicalIF":0.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11970099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation strategies for school-based universal prevention: A qualitative pilot study of Enhanced and standard Replicating Effective Programs.","authors":"Andria B Eisman, Christine Koffkey, Judy Fridline, Christina Harvey, Rebecca E Hasson, Lawrence A Palinkas, Amy M Kilbourne","doi":"10.1177/26334895251330520","DOIUrl":"10.1177/26334895251330520","url":null,"abstract":"<p><strong>Background: </strong>School-based universal prevention programs, like the Michigan Model for Health™ (MMH), hold promise for enhancing youth behavioral health but often face implementation challenges due to insufficiently addressing priority student issues. Previous research identified trauma-sensitive content as a student need in the MMH. Enhanced Replicating Effective Programs (REP), a multicomponent implementation strategy, is well suited to support program providers in addressing priority health issues among youth.</p><p><strong>Method: </strong>This pilot cluster-randomized controlled trial compared Enhanced REP (tailored curriculum, training, and implementation facilitation with trauma-sensitive content) to standard REP (standard curriculum, initial training, as-needed technical assistance) across eight high schools serving low-income students. Through semistructured interviews at three time points, we assessed teacher perceptions of feasibility, acceptability, and appropriateness related to REP core and enhanced components.</p><p><strong>Results: </strong>Teachers generally found Enhanced REP to deliver MMH satisfactory and suitable. However, the school environment, notably administrative support, influenced feasibility compared to standard REP. Enhanced REP teachers reported benefits in meeting student needs that were not seen in the standard REP group. The standard REP data helped to understand the comparative value of the enhanced strategy during a time of notable upheaval and mental health challenges due to the COVID-19 pandemic.</p><p><strong>Conclusions: </strong>While some schools may succeed with less intensive strategies (REP), many may require more intensive approaches for effective implementation. Enhanced REP shows promise in tailoring curriculum delivery and providing additional support to meet student needs, but its success may hinge on organizational support, especially from leadership. Future research should investigate the addition of organizational-level strategies, such as leadership training, to optimize implementation and explore the comparative effectiveness of Enhanced versus standard REP.</p>","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"6 ","pages":"26334895251330520"},"PeriodicalIF":0.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11960151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143766069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of implementation science frameworks to inform the adaptation process of an evidence-based eating disorder prevention program for high-risk perinatal individuals.","authors":"Rachel Vanderkruik, Emily C Woodworth, Caroline M Frisch, Stacey Nelson, Madison M Dunk, Marlene P Freeman, Lee S Cohen, Eric Stice, Stephen J Bartels","doi":"10.1177/26334895251319811","DOIUrl":"https://doi.org/10.1177/26334895251319811","url":null,"abstract":"<p><strong>Background: </strong>The perinatal period is a high-risk time for body dissatisfaction and disordered eating. Evidence-based interventions for disordered eating have not been adapted to address the needs of this population. We describe the process of adapting the Body Project, an evidence-based eating disorder (ED) prevention program, for pregnant individuals with histories of disordered eating behaviors.</p><p><strong>Method: </strong>Our approach is informed by ADAPT, a framework offering guidance for adapting interventions to new contexts, to modify the Body Project for pregnant individuals. Following initial adaptations informed by a needs assessment and stakeholder input, we conducted a pilot trial with individuals who have lived experience relative to our target population (i.e., previously pregnant individuals with ED history, <i>n</i> = 10). Participants provided feedback on the intervention through surveys and a focus group assessing perceptions of the intervention and barriers and facilitators to its implementation as guided by the Consolidated Framework for Implementation Research (CFIR).</p><p><strong>Results: </strong>Eighty percent of enrolled participants attended five or more sessions (out of six). Across sessions, average satisfaction ratings were 9.28 (1 = <i>poor</i> to 10 = <i>excellent</i>). Most participants (89%) reported improvements in body satisfaction. Approximately 33% reported reductions in disordered eating with the remainder reporting no change due to healthy eating behaviors at baseline. Themes from the focus group are reported aligning with CFIR domains and all final modifications are summarized and reported aligning with the Framework for Reporting Adaptation and Modifications-Enhanced.</p><p><strong>Conclusions: </strong>Applying implementation science frameworks to structure our process for making and summarizing planned adaptations, we adapted an empirically supported ED prevention program for pregnant individuals with histories of an ED. We made adaptation decisions based on participant feedback while weighing intervention fidelity and scalability. We will formally test the adapted intervention in a subsequent pilot randomized controlled trial versus a time- and dose-matched educational control.</p>","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"6 ","pages":"26334895251319811"},"PeriodicalIF":0.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Usability of a cross-system housing stability program for juvenile courts: A multimethod study of probation counselor perspectives.","authors":"Asia S Bishop, Sarah C Walker, Ella B Baumgarten, Kristin Vick, Taquesha Dean","doi":"10.1177/26334895251319814","DOIUrl":"10.1177/26334895251319814","url":null,"abstract":"<p><strong>Background: </strong>Youth in contact with the juvenile legal system experience disproportionate rates of homelessness. While system contact is a critical intervening point, juvenile courts do not typically offer housing services. One solution is to refer youth to evidence-based, community-based services to meet housing-related needs, but a myriad of individual and organizational factors often impede court staff from making such referrals. Housing Stability for Youth in Courts (HSYNC) is a novel, cross-system service linkage model for court-involved youth facing housing instability. HSYNC was developed using codesign as a strategy to improve usability and incorporated evidence on juvenile court linkage strategies effective at increasing service referrals and improving outcomes.</p><p><strong>Method: </strong>The current study utilized a multimethod approach to evaluate the usability of HSYNC from the perspective of juvenile probation counselors (JPCs) as one group of end-users. As part of the pilot implementation study, survey (<i>N</i> = 15) and semi-structured interview (<i>N </i>= 20) data were obtained from JPCs from four juvenile courts in one northwestern state.</p><p><strong>Results: </strong>Survey results indicated good usability for HSYNC (mean implementation strategy usability scale score of 80). Themes from the interviews complemented survey findings, pointing to HSYNC as a value-added program that integrated well with existing probation practices. The housing navigator's approach was highlighted as a strong facilitator of program usability. Themes also provided greater insight into implementation barriers (i.e., individual and contextual factors) and areas for improvement (e.g., eligibility screening process).</p><p><strong>Conclusions: </strong>Drivers of program usability and implications for program improvement to address identified implementation challenges to ensure the HSYNC model is effective and sustainable long-term are discussed.</p>","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"6 ","pages":"26334895251319814"},"PeriodicalIF":0.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11843703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sustainment and adaptation of systems navigation and psychosocial counseling across HIV testing clinics in Vietnam: A qualitative assessment.","authors":"Sophia M Bartels, Minh X Nguyen, Trang T Nguyen, Adams L Sibley, Hong Linh T Dang, Ha T T Nong, Ngan T K Nguyen, Ha V Tran, Teerada Sripaipan, Byron J Powell, Clare Barrington, Luz M Reyes, Carl A Latkin, Le Minh Giang, Huong T T Phan, William C Miller, Vivian F Go","doi":"10.1177/26334895251319812","DOIUrl":"10.1177/26334895251319812","url":null,"abstract":"<p><strong>Background: </strong>Few evidence-based interventions have been successfully scaled up and sustained long-term. Within an implementation trial testing strategies for scale-up of the Systems Navigation and Psychosocial Counseling (SNaP) intervention for people who inject drugs (PWID) with HIV across HIV testing clinics in Vietnam, we sought to assess if the implementation of SNaP was sustained after study support ended and to identify factors, including adaptations, that affected SNaP sustainment.</p><p><strong>Method: </strong>Across all 42 SNaP clinics, we surveyed clinic staff at 6-10 months post-study completion to assess SNaP sustainment. We purposively selected six high and six low-sustaining clinics and conducted 31 in-depth interviews with clinic staff (<i>n</i> = 23) and clinic directors (<i>n</i> = 8). Interviews were coded and analyzed using thematic analysis informed by the Integrated Sustainability Framework. Matrices were used to compare themes across high and low-sustaining clinics.</p><p><strong>Results: </strong>1/12 clinics sustained all of SNaP's core components, 2/12 would continue to sustain SNaP if they had new PWID patients, and the remainder did not fully sustain SNaP but continued conducting a modified version, including shorter or fewer SNaP sessions, tailoring SNaP to participants' specific needs, and conducting SNaP-style counseling for all clients. Facilitators of sustainment included leadership directives to clinic staff around SNaP sustainment, clinicians' belief in SNaP's effectiveness, and SNaP's perceived fit with clinic activities and mission. Major barriers to SNaP sustainment included lack of funding for PWID outreach activities, time, staff, training continuity, and systemic challenges with getting PWID into care, such as poverty and lack of transportation.</p><p><strong>Conclusions: </strong>We identified the challenge of sustaining the SNaP intervention long-term, the ubiquity of intervention adaptations, and multi-level barriers and facilitators to intervention sustainment. These findings demonstrate the need for sustainment strategies and could inform trials of strategies to improve the longevity of effective HIV interventions for populations that are disproportionately affected by this epidemic.</p>","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"6 ","pages":"26334895251319812"},"PeriodicalIF":0.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11837132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers to dental providers' use of a clinical decision support tool for pain management following tooth extractions.","authors":"Shannon Gwin Mitchell, Jan Gryczynski, Donald C Worley, Stephen E Asche, Anjali R Truitt, D Brad Rindal","doi":"10.1177/26334895251319810","DOIUrl":"10.1177/26334895251319810","url":null,"abstract":"<p><strong>Background: </strong>De-implementing non-effective or even harmful practices in healthcare is sometimes necessary, as has been the case with opioid prescribing in dentistry over the past decade. One approach to practice transformation is to deploy clinical decision support (CDS) tools. This qualitative study examined barriers to CDS use as part of a cluster randomized trial that aimed to decrease opioid prescribing for pain management following tooth extractions across a large dental practice.</p><p><strong>Method: </strong>Twenty dental providers who took part in the larger randomized trial were purposively selected to complete a semi-structured qualitative interview. Participants represented a broad range in terms of years of practice, dental specialization, and CDS use patterns. Interviews were conducted via Zoom, audio recorded, transcribed, and analyzed using a content analysis approach in ATLAS.ti following participation in the cluster randomized trial.</p><p><strong>Results: </strong>Reasons for not using the CDS fell generally into two broad categories: unintentional (i.e., forgetting to use the CDS) and intentional. Providers who forgot to use the CDS after training and implementation either were not sure where to look for the alert on the screen or did not remember to look for it because its use was never incorporated into their workflow. Reasons for deciding not to use the CDS included feeling that it slowed down their workflow, thinking that the information it provided would not be useful, and not trusting the functionality of the system.</p><p><strong>Conclusions: </strong>There were numerous, interdependent human, organizational, and technological factors that influenced the intentionally and unintentionally low CDS use rates observed in the study. Findings highlight issues to be aware of and address in future implementation efforts that utilize CDS.</p><p><strong>Trial registration: </strong>Clinicaltrials.gov NCT03584789.</p>","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"6 ","pages":"26334895251319810"},"PeriodicalIF":0.0,"publicationDate":"2025-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11808763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Not getting better but not getting worse: A cluster randomized controlled pilot trial of a leadership implementation strategy.","authors":"Jill Locke, Catherine M Corbin, Roger Goosey, Vaughan K Collins, Mark G Ehrhart, Kurt Hatch, Christine Espeland, Aaron R Lyon","doi":"10.1177/26334895241312405","DOIUrl":"10.1177/26334895241312405","url":null,"abstract":"<p><strong>Background: </strong>Implementation of evidence-based practices (EBPs) in schools is fraught with challenges. Even when EBPs are initiated, deterioration of implementation efforts often hinders their long-term success. School leadership behaviors can influence teachers' EBP implementation. Our study tested an implementation strategy called Helping Educational Leaders Mobilize Evidence (HELM), adapted from the Leadership and Organizational Change for Implementation strategy, to enhance EBP implementation through improvements in school leadership teams' implementation leadership and climate to buffer against the deterioration of implementation efforts. This study explores the impact of HELM on theorized mechanisms of change (i.e., implementation leadership, climate), educator-level factors (i.e., implementation citizenship), and implementation outcomes (i.e., fidelity, initiative stability).</p><p><strong>Method: </strong>One school district and 10 schools in Washington participated. Five of the schools were randomized to receive the HELM strategy and the remaining five schools received an alternative leadership training as an implementation attention control. Teachers at every school (<i>n</i> = 341) received training for an EBP called Positive Greetings at the Door that has been previously demonstrated to reduce student behavior problems. Principals and Assistant Principals (<i>n</i> = 18) received the HELM strategy or alternative leadership training. Three district Administrators also participated in HELM as part of the Organizational Strategy Development meetings.</p><p><strong>Results: </strong>HELM significantly slowed the average decline of implementation leadership (perseverant leadership and communication), three dimensions of implementation climate (recognition, rewards, and existing supports) and total implementation climate, and one dimension of implementation citizenship (keeping informed). No significant effects were found with regard to implementation outcomes (i.e., fidelity, initiative stability).</p><p><strong>Conclusions: </strong>HELM shows promise in buffering the deterioration of EBP implementation efforts in schools. HELM positively influenced implementation leadership and climate, which are the hypothesized mechanisms for promoting successful long-term implementation efforts. An appropriately powered trial is needed to determine the efficacy of HELM in the future.Name of the registry: clinicaltrials.govTrial registration number: NCT06340074Date of registration: March 29, 2024. Retrospectively registeredURL of trial registry record: https://clinicaltrials.gov/study/NCT06340074?intr=helm&rank=.</p>","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"6 ","pages":"26334895241312405"},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11775992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}