Implementation research and practice最新文献

{"title":"Intervention Activities and Implementation Strategies for School-Based Health Promotion: Identifying Core Functions and Forms to Facilitate Scale-up of an Effective Intervention.","authors":"Julia Dabravolskaj, Jodi Kalubi, Julia Moore, Boshra A Mandour, Camila Honorato, Paul J Veugelers, Katerina Maximova","doi":"10.1177/26334895251385936","DOIUrl":"10.1177/26334895251385936","url":null,"abstract":"<p><p><b>Background:</b> School-based health promotion is a key public health strategy to reduce disease burden and health inequalities. School-based interventions with local evidence of effectiveness need to be scaled up to maximize their benefits. A Project Promoting healthy Living for Everyone in Schools (APPLE Schools) is a health promoting school (HPS) intervention that targets schools in disadvantaged settings and has been shown to be effective in promoting children's healthy lifestyle behaviors and reducing health inequalities. To support its scale-up, we aimed to identify core functions (basic purposes driving intervention's effectiveness) and forms (specific content and delivery strategies implemented to achieve core functions). <b>Method:</b> We extracted 5,301 action items from 191 annual action plans written between 2011 and 2021 in 70 APPLE Schools. We followed an implementation science approach and used supervised machine learning algorithms to classify 2,683 unique action items into intervention activities and implementation strategies. Core functions were drawn from theoretical frameworks; forms were identified through thematic analysis. <b>Results:</b> We identified 55 forms and mapped them to 17 core functions of intervention activities and implementation strategies. The most common core functions of intervention activities were enablement (96%), modeling (66%), and education (54%); the most common core functions of implementation strategies were relational and organizational support context (86%), partnerships and networking (84%), student participation (78%), and professional development and learning (73%). The remaining core functions were identified in <50% of the schools. Forms included a broad range of activities, with a greater variety of those that addressed the most common core functions. <b>Conclusions:</b> We created matrices of core functions and forms of intervention activities and implementation strategies to inform the successful scale-up of APPLE Schools, an effective and cost-effective HPS intervention. These matrices can be used as a guide to improving existing HPS interventions and scaling them up to new settings.</p>","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"6 ","pages":"26334895251385936"},"PeriodicalIF":2.6,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12511711/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145282074","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":"Unraveling the \"black box\" of school tobacco policy implementation: A mixed-methods study at Danish vocational schools informed by Normalization Process Theory.","authors":"Anneke Vang Hjort, Charlotte Demant Klinker, Mirte A G Kuipers, Charlotta Pisinger, Tine Tjørnhøj-Thomsen","doi":"10.1177/26334895251377658","DOIUrl":"10.1177/26334895251377658","url":null,"abstract":"<p><strong>Background: </strong>Smoke-free policies are often poorly implemented in schools. The Smoke-Free Vocational Schools intervention aimed to support the routine implementation of a comprehensive school tobacco policy at Danish vocational schools and took place across seven schools. This study aimed to assess and understand the mechanisms-that is, reasoning and behavior change-that shaped if and how policy implementation outcomes occurred.</p><p><strong>Method: </strong>We applied a convergent mixed-methods design informed by Normalization Process Theory (NPT). The quantitative strand employed a repeated cross-sectional design, assessing implementation mechanisms-Coherence, Cognitive Participation, Collective Action, Reflexive Monitoring-and implementation outcomes at two time points: 5+ months post-policy (T1) and 14+ months post-policy (T2). Additional mechanisms-Change Commitment and Change Efficacy-were surveyed among subsamples who completed questionnaires pre-policy (T0) and at the follow-ups (i.e., T0-T1 and T0-T2). The qualitative strand involved interviews and focus groups with 40 participants to explore the mechanisms and their connections to intervention activities. Integration of qualitative and quantitative findings was achieved through joint displays.</p><p><strong>Results: </strong>Quantitative analyses included responses from <i>N</i> = 419 participants at T1, <i>N</i> = 452 at T2, <i>N</i> = 209 at T0-T1, and <i>N</i> = 182 at T0-T2. All implementation mechanisms were significantly and consistently associated with the total implementation outcomes score. Coherence encompassed the perceived meaningfulness of the policy, for example, believing the policy was a school responsibility. Cognitive Participation was related to policy legitimacy, for example, enforcement legitimacy beliefs. Collective Action involved practical implementation efforts, for example, enforcement and communication strategies. Reflexive Monitoring encompassed perceived policy impacts, for example, reduced smoking visibility. Change Commitment and Change Efficacy were found to be closely interrelated with the other mechanisms. Moreover, qualitative analysis revealed plausible connections between intervention activities and mechanisms.</p><p><strong>Conclusions: </strong>This study identified critical mechanisms for implementing school tobacco policies and demonstrated how specific intervention activities can activate these mechanisms, offering guidance for future research and practice development.</p>","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"6 ","pages":"26334895251377658"},"PeriodicalIF":2.6,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12511714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145282095","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":"Testing Three Alternate Methods to Direct Observation in Measuring Use of Discrete Youth Cognitive Behavioral Techniques: A Secondary Analysis.","authors":"Simone H Schriger, Steven C Marcus, Emily M Becker-Haimes, Shannon Dorsey, David S Mandell, Bryce D McLeod, Sonja K Schoenwald, Rinad S Beidas","doi":"10.1177/26334895251369899","DOIUrl":"10.1177/26334895251369899","url":null,"abstract":"<p><strong>Background: </strong>Cognitive behavioral therapy (CBT), an umbrella term for therapeutic techniques guided by cognitive behavioral theory, is an evidence-based approach for many psychiatric conditions in youth. A stronger dose of CBT delivery is thought to improve youth clinical outcomes. While a critical indicator of care quality, measuring the use of CBT techniques feasibly and affordably is challenging. Certain CBT techniques (e.g., more concrete and observable) may be easier to measure than others using low-cost methods, such as clinician self-report; however, this has not been studied.</p><p><strong>Method: </strong>To assess the concordance of three methods of measuring CBT technique use with direct observation (DO), clinicians from 27 community agencies (<i>n</i> = 126; <i>M</i> _age = 37.7 years, <i>SD</i> = 12.8; 76% female) were randomized 1:1:1 to a self-report, chart-stimulated recall (CSR; semistructured interviews with the chart available), or behavioral rehearsal (BR; simulated role-plays) condition. In previous work using a global score aggregating 12 CBT techniques, only BR produced scores that did not differ from DO. This secondary analysis examined the concordance of these alternate methods with DO for each discrete CBT technique, testing for differential concordance across cognitive techniques (e.g., cognitive education) compared to behavioral techniques (e.g., behavioral activation).</p><p><strong>Results: </strong>Results of three-level mixed effects regression models indicated that BR scores did not differ significantly from DO for any techniques, and for nine techniques, neither did CSR (all <i>p</i>s > .05). Contrastingly, self-report scores differed from DO for all but one technique, with greater concordance for behavioral than cognitive techniques (<i>z</i> = -3.29, <i>p</i> <i><</i> .001).</p><p><strong>Conclusions: </strong>Unlike previous findings using an aggregate score, we found that both BR and CSR did not differ significantly from DO for most techniques tested. These findings have implications within implementation research and usual care settings; they support multiple viable measurement methods that are less resource-intensive than DO.</p>","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"6 ","pages":"26334895251369899"},"PeriodicalIF":2.6,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12444060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145115096","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":"How Are Qualitative Methods Used in Implementation Science Research? Results From a Systematic Scoping Review.","authors":"Ashley Hagaman, Elizabeth C Rhodes, Carlin F Aloe, Rachel Hennein, Mary L Peng, Maryann Deyling, Michael Georgescu, Kate Nyhan, Anna Schwartz, Kristal Zhou, Marina Katague, Emilie Egger, Donna Spiegelman","doi":"10.1177/26334895251367470","DOIUrl":"10.1177/26334895251367470","url":null,"abstract":"<p><strong>Background: </strong>Qualitative methods are essential for providing an in-depth understanding of \"why\" and \"how\" evidence-based interventions are successfully implemented-a key area of implementation science (IS) research. A systematic synthesis of the applications of qualitative methods is critical for understanding how qualitative methods have been used to date and identifying areas of innovation and optimization. This scoping review explores which qualitative data collection and analytic methods are used in IS research, what and how frameworks and theories are leveraged using qualitative methods, and which implementation issues are explored with qualitative implementation research.</p><p><strong>Method: </strong>We conducted a systematic scoping review of articles in MEDLINE and Embase using qualitative methods in IS health research. We systematically extracted information including study design, data collection method(s), analytic method(s), implementation outcomes, and other domains.</p><p><strong>Results: </strong>Our search yielded a final dataset of 867 articles from 76 countries. Qualitative study designs were predominantly single elicitation (67.7%) and longitudinal (20.3%). In-depth interviews were the most common data collection method (84.3%), followed by focus group discussions (FGDs) (34.5%), and nearly 25% used both. Sample sizes were, on average, 40 in-depth interviews (range: 1-1,131) and nine FGDs (range: 1-46). The most common analytic approaches were thematic analysis (45.3%) and content analysis (18.5%) with substantial variation in analytic conceptualization. Nearly one-quarter (23.2%) of articles used one or more TMF to conceptualize the study, and less than half (40.9%) of articles used a TMF to guide both data collection and analysis.</p><p><strong>Conclusions: </strong>We highlight variation in how qualitative methods were used, as well as detailed examples of data collection and analysis descriptions. By reviewing how qualitative methods have been used in well-described and innovative ways, and identifying important gaps, we highlight opportunities for strengthening their use to optimize IS research.</p><p><strong>Registration: </strong>The protocol can be found 10.11124/JBIES-20-00120.</p>","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"6 ","pages":"26334895251367470"},"PeriodicalIF":2.6,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12394868/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981179","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":"Measurement-based care implementation by K-12 public school clinicians: A mixed-methods proof of concept study.","authors":"Elizabeth H Connors, Sophia Selino, Daniel Almirall, Nicolina Fusco, Jacob K Tebes","doi":"10.1177/26334895251363416","DOIUrl":"10.1177/26334895251363416","url":null,"abstract":"<p><strong>Background: </strong>This study assessed the feasibility and acceptability of a multilevel, multi-component implementation strategy for measurement-based care (MBC) called Feedback and Outcomes for Clinically Useful Student Services (FOCUSS). FOCUSS includes six components selected in our prior work with a national sample of school mental health stakeholders. This is among the first demonstrations of MBC with school-employed clinicians. We explored proof of concept by observing MBC adoption rates achieved by the end of the school year and other related implementation outcome data.</p><p><strong>Method: </strong>A mixed-method, single-arm pilot study was conducted during one academic year with 10 school-employed mental health clinicians in two K-12 public school districts in Connecticut. Clinician adoption was assessed by monthly fidelity monitoring of measures clinicians entered in the feedback system. Clinician self-reported practices, attitudes, feasibility, acceptability, and appropriateness of using MBC with K-12 students was assessed by pre-training, 3-, 6-, and 9-month surveys. School year-end qualitative interviews explored clinician implementation experiences using MBC and FOCUSS implementation supports to inform future changes to FOCUSS in a district-wide trial.</p><p><strong>Results: </strong>Clinicians were asked to implement MBC with five students; 60% of the clinicians achieved or exceeded this target, and MBC was adopted with 65 students. Other implementation outcomes were comparable to related studies. Qualitative feedback indicated that MBC is clinically valuable in schools by providing consistency and structure to sessions, is compatible with school mental health, and well regarded by students and parents. FOCUSS implementation supports were regarded as helpful, and individual performance feedback emails appeared to be a necessary component of FOCUSS to boost post-training implementation.</p><p><strong>Conclusion: </strong>This is among the first studies of MBC implementation with school-employed mental health professionals in the United States. Results demonstrate proof of concept for MBC implementation with school social workers, psychologists and counselors and support subsequent district-wide use of FOCUSS to install MBC in schools.</p>","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"6 ","pages":"26334895251363416"},"PeriodicalIF":2.6,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12344241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144850026","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 Intervention Fidelity and Adaptation Within Context: A Mixed-Methods Study of Implementation Practice Within Public Early Intervention Systems.","authors":"Katherine Pickard, Nailah Islam, Aubyn Stahmer, Radley Christopher Sheldrick, Scott Gillespie, Jennifer Singh, Lawrence Scahill","doi":"10.1177/26334895251343648","DOIUrl":"10.1177/26334895251343648","url":null,"abstract":"<p><strong>Background: </strong>The science of intervention adaptation is rapidly expanding, yet there has been limited research evaluating how context affects intervention fidelity and adaptation. The current study sought to address this gap by closely characterizing the delivery of an autism evidence-based practice (EBP), Project ImPACT, within an Early Intervention (EI) system to understand how context shaped both intervention adaptation and providers' coaching fidelity.</p><p><strong>Method: </strong>Twenty-one EI providers were trained in Project ImPACT. Following training, providers submitted videos of each of their Project ImPACT sessions, which were scored for Project ImPACT coaching fidelity, Project ImPACT adaptation, and the presence and quantity of supplemental therapeutic content. After each session, EI providers also completed a brief survey about how they delivered Project ImPACT and adaptations they made.</p><p><strong>Results: </strong>Mixed methods data from 100 sessions demonstrated that how providers reported delivering Project ImPACT was misaligned from adaptations that were observed within the same session. Overall, providers' Project ImPACT fidelity was variable and driven by the integration of other content areas within the confines of relatively short therapy sessions. EI providers adapted Project ImPACT in approximately half of their sessions and spent about 17% of their recorded session time covering other therapeutic content. Spending a greater percentage of session time integrating other content areas was significantly associated with dropping core Project ImPACT coaching activities and having lower Project ImPACT fidelity within that same session.</p><p><strong>Conclusion: </strong>The current study highlights the critical role of context in shaping providers' Project ImPACT coaching fidelity. Fidelity outcomes in this study were consistent with other EI implementation trials and raise questions about fidelity benchmarks and normative delivery within community settings. Findings also highlight the need for holistic fidelity tools and training models that support the delivery of core intervention functions in relationship to child-, family-, and system-level factors.</p>","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"6 ","pages":"26334895251343648"},"PeriodicalIF":2.6,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12322350/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790894","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":"Re-Implementation of Parent-Child Interaction Therapy (PCIT) in the Community: Findings From a Pilot Randomized Controlled Trial.","authors":"Melanie J Woodfield, Sarah Fortune, Tania Cargo, Sally Merry, Sarah E Hetrick","doi":"10.1177/26334895251363418","DOIUrl":"10.1177/26334895251363418","url":null,"abstract":"<p><strong>Background: </strong>This study explored the feasibility, acceptability, and Māori cultural responsivity of study methods and components of an intervention to support clinicians to resume implementation of Parent-Child Interaction Therapy (PCIT), an evidence-based treatment for disruptive behavior in young children.</p><p><strong>Method: </strong>This pragmatic, parallel-arm, randomized, controlled pilot trial ran for a 6-month period and included PCIT-trained clinicians who were not delivering, or only rarely using PCIT in their work. Re-implementation strategies were systematically developed and theory-driven and included a mobile co-worker, a portable time-out space, audio-visual equipment, weekly consultation groups, and 2-day targeted PCIT refresher training.</p><p><strong>Results: </strong>Pre-specified progression criteria included enrolling 20 clinicians, a maximum of 20% attrition, and a monthly survey response rate of at least 80%. Fourteen clinicians enrolled in the trial, there was no attrition, and an 89.8% average survey response rate was achieved. Secondary outcomes included clinician ratings of the usefulness and acceptability of intervention components. The time-out cubicle was considered relatively less useful and acceptable, while the refresher training and manuals were preferred. Study methods and intervention components were considered acceptable by the small proportion of Māori participants. Clinician self-reported Capability, Opportunity, and Motivation to implement PCIT fluctuated monthly across both groups. Pre-/post-changes in each domain within the Theoretical Domains Framework generally showed similar improvement from baseline to follow-up in both groups. There was no observable difference in PCIT adoption in either group.</p><p><strong>Conclusion: </strong>To the best of our knowledge, this is the first study to pragmatically attempt to re-implement a parent training intervention in a community setting, several years after clinicians' initial training in the approach (here, an average of 5.36 years). Low attrition and high survey response rates highlighted the feasibility of the data collection methodology. Important opportunities to improve the design of an adequately powered definitive trial are highlighted to minimize future resource waste.</p>","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"6 ","pages":"26334895251363418"},"PeriodicalIF":2.6,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12304612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144746297","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 and facilitators of inpatients and healthcare professionals prior to the implementation of a Multidisciplinary Lifestyle-Focused Approach in the Treatment of Inpatients With Mental Illness (MULTI+): The MULTI+ Study II.","authors":"Myrthe M E van Schothorst, Natascha M den Bleijker, Peter N van Harten, Nanne K De Vries, Jeroen Deenik","doi":"10.1177/26334895251351663","DOIUrl":"10.1177/26334895251351663","url":null,"abstract":"<p><strong>Background: </strong>Despite the efficacy of lifestyle interventions for the physical and mental health of people with mental illness, there is little change in clinical care. Understanding barriers and facilitators of implementation can help interpret intervention effectiveness and aid implementation. This cross-sectional study identifies barriers and facilitators before implementing a multidisciplinary lifestyle approach in the treatment of inpatients with mental illness (MULTI+). Additionally, we analyze associations between barriers and facilitators, and recipients' health and demographic characteristics.</p><p><strong>Method: </strong>This study used baseline data from an open cohort stepped wedge cluster randomized trial. The Measurement Instrument for Determinants of Innovations was used to investigate barriers and facilitators associated with the innovation (MULTI+), user (recipients and deliverers), and organization. Data was collected through semi-structured interviews for recipients and an online survey for deliverers. We explored associations between barriers and facilitators, and recipients' health and demographic characteristics through multiple regression models.</p><p><strong>Results: </strong>We included 134 recipients and 125 deliverers. Perceived barriers to implementing MULTI+ included complexity, incomplete information, and incompatibility with current treatment. Recipients and deliverers reported personal barriers, including a lack of personal benefits, potential drawbacks, and insufficient knowledge. Facilitators such as the recognized importance of lifestyle-focused care, social support, and organizational commitment could enhance implementation. Being hospitalized for more than a year was negatively associated with determinants such as compatibility, patient relevance, and satisfaction (range between <i>β</i> = -.25 and <i>β</i> = -.45). Regression models indicated few other associations. Suggestions to address barriers were made.</p><p><strong>Conclusions: </strong>This study is one of the first to analyze barriers and facilitators before the large-scale implementation of a multicomponent lifestyle-focused approach in mental healthcare. Recipients and deliverers experience barriers and facilitators across all domains. Addressing these factors through patient-level tailoring, structured training, the use of champions, and sustained organizational support may enhance implementation and sustainability.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov registration. Identifier: NCT04922749. Retrospectively registered 3rd of June 2021.</p>","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"6 ","pages":"26334895251351663"},"PeriodicalIF":0.0,"publicationDate":"2025-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12235223/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144593063","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 implementation preparedness for suicide screening and referral in a Nepali emergency department: A mixed-methods study.","authors":"Anmol P Shrestha, Roshana Shrestha, Ajay Risal, Renu Shakya, Kripa Sigdel, Riya Bajracharya, Pratiksha Paudel, Divya Gumudavelly, Emilie Egger, Sophia Zhuang, Lakshmi Vijayakumar, Ashley Hagaman","doi":"10.1177/26334895251343644","DOIUrl":"10.1177/26334895251343644","url":null,"abstract":"<p><strong>Background: </strong>Most research on appropriate, feasible, and effective suicide screening has excluded research conducted in non-Western and low-income settings. This study explores preparedness and co-designing a suicide screening and referral intervention in a Nepali emergency department (ED) using the Consolidated Framework for Implementation Research (CFIR).</p><p><strong>Method: </strong>To assess implementation readiness and context, we conducted eight key informant interviews and four focus-group discussions with clinical staff along with 3 months of embedded ethnography. We also assessed clinical staff (<i>n</i> = 26) knowledge, attitudes, current practices, confidence, and institutional priorities surrounding implementing suicide screening using structured questionnaires. Qualitative analysis used CFIR to assess feasibility, acceptability, and necessary implementation strategies for a suicide screening intervention within the context of this resource-strained ED. We report descriptive statistics of quantitative findings using a convergent analytic mixed-methods approach.</p><p><strong>Results: </strong>Qualitatively, clinicians expressed hopelessness and reservations surrounding ED programs to prevent suicide given important system and social barriers. Additionally, they doubted their ability to meaningfully overcome broader structural issues in their patients' lives (e.g., poverty and family tension) that they believed more directly determined suicidal behavior and thwarted help seeking. They discussed practical and emotional motivators for doing suicide prevention work, which highlighted departmental leadership and deep teamwork that motivated action despite wider societal myths that suicide cannot easily be prevented. Quantitative assessments largely supported these findings, indicating shared beliefs that suicide prevention was important and supported by leadership. However, providers frequently endorsed suicide myths and noted barriers including difficult interdepartmental collaboration, limited confidence in suicide prevention communication and suicide screening.</p><p><strong>Conclusions: </strong>In under-resourced settings, staff must contend with competing responsibilities and complex structural causes of suicide and barriers to treatment. These can impede implementation of suicide screening interventions and must be integrated into the co-design of implementation strategy selection and deployment.</p><p><strong>Trial registration: </strong>NCT06094959 clinicaltrials.gov.</p>","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"6 ","pages":"26334895251343644"},"PeriodicalIF":0.0,"publicationDate":"2025-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12235230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144593064","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":"Supporting integration of substance use interventions in HIV service organizations: Assessing the fit of 10 strategies for AIDS Education and Training Centers to use.","authors":"Sheila V Patel, Sarah Philbrick, Michael Bradshaw, Heather J Gotham, Hannah K Knudsen, Tom Donohoe, Stephen Tueller, Bryan R Garner","doi":"10.1177/26334895251343647","DOIUrl":"10.1177/26334895251343647","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;People with HIV are more likely than the general population to have a substance use disorder (SUD), which can impact the HIV care continuum. HIV service organizations (HSOs) can implement SUD interventions but may need assistance from support systems like the AIDS Education and Training Center (AETC) network. We assess the fit of strategies AETCs may use to help HSOs integrate SUD interventions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method: &lt;/strong&gt;We invited 74 of 91 AETCs (81.3%) to participate. Using a real-time Delphi approach, 64 AETCs (86.5% of those invited) rated the (a) importance of, (b) feasibility of, (c) readiness to offer, (d) scalability of, (e) pressure to offer, and (f) current need for 10 strategies their AETC could use to help HSOs integrate SUD interventions. Items were examined via confirmatory factor analyses. Responses were summed to create the Setting-Strategy Fit index score. We conducted pairwise t-tests to examine differences in scores between strategies, plotted the mean importance ratings for each strategy against the mean ratings for other criteria to review the strategies' relative viability, and conducted bivariate and multiple regression analyses to examine correlates of the scores.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The items of the Setting-Strategy Fit index showed good internal consistency and model fit. Generally, strategies were considered somewhat important but AETCs felt very little pressure to offer them. Two strategies (disseminating information, providing access to asynchronous training) exceeded the \"important\" threshold. One strategy (disseminating information) was considered viable for also having high feasibility. Overall, AETCs were only somewhat ready to provide the strategies, which were perceived as only somewhat feasible or currently needed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Although AETCs recognized the importance of several strategies for helping HSOs integrate SUD interventions, their responses resulted in only one having good fit. These findings can guide efforts to further prepare AETCs to support HSOs and to end the HIV epidemic.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Plain language summary: &lt;/strong&gt;&lt;b&gt;&lt;i&gt;Strategies AIDS Education and Training Centers Could Use to Help HIV Service Organizations Implement Substance Use Interventions.&lt;/i&gt;&lt;/b&gt; &lt;b&gt;Why was the study done?:&lt;/b&gt; Having a substance use disorder (SUD) can complicate care for people with HIV by reducing their engagement in services. HIV service organizations (HSOs) serve people with HIV but not all of them offer services to address SUD. We assessed the fit of different strategies that AIDS Education and Training Centers (AETCs), which provide technical assistance to HSOs, could use to help HSOs implement SUD interventions.&lt;b&gt;What did the researchers do?:&lt;/b&gt; We engaged 74 AETC representatives nationally to rate 10 strategies. They were asked about (a) the importance of the strategies, (b) the feasibility of offering them, (c) their readiness to off","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"6 ","pages":"26334895251343647"},"PeriodicalIF":0.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12179455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478135","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}