Implementation research and practice最新文献

{"title":"Stakeholder perspectives on digital behavioral health applications targeting adolescent depression and suicidality: Policymaker, provider, and community insights.","authors":"Ana Radovic,&nbsp;Afton Kirk-Johnson,&nbsp;Morgan Coren,&nbsp;Brandie George-Milford,&nbsp;David Kolko","doi":"10.1177/26334895221120796","DOIUrl":"https://doi.org/10.1177/26334895221120796","url":null,"abstract":"<p><strong>Background: </strong>With adolescent depression and suicidality increasing, technology-based interventions may help address mental health needs. The Enhancing Treatment and Utilization for Depression and Emergent Suicidality (ETUDES) Center supports development of technology interventions to help primary care providers target these problems. To successfully develop and integrate such interventions into primary care, iterative engagement of stakeholders is necessary. This paper outlines our stakeholder engagement process, a qualitative analysis of feedback and outcomes, and how feedback was incorporated to develop Center interventions.</p><p><strong>Methods: </strong>Stakeholder panels represented key end-users of ETUDES Center interventions (adolescents, young adults, parents, and healthcare providers) and their advocates at the organizational/policy level. Meetings were held throughout intervention development and at annual retreats. Detailed meeting notes were collected and summarized by the stakeholder engagement team in real time, after which action items were generated and reviewed by the full research team. Using a content analysis approach, all stakeholder feedback summaries were coded using a prespecified codebook organized by recurring topics. Codes were organized under the Consolidated Framework for Implementation Research (CFIR). Anonymous stakeholder feedback surveys assessed relevance of topics, meeting effectiveness, and stakeholder involvement.</p><p><strong>Results: </strong>Stakeholder meetings provided feedback on topics such as representation, language, access to care, and stigma. Relevant feedback and recommendations were incorporated into subsequent iterations of the interventions and their implementation. Mean stakeholder ratings of meeting proceedings on a 0-3 Likert scale ranged from 1.70 (<i>SD</i>  =  0.10) for participation to 2.43 (<i>SD</i>  =  0.08) for effectiveness in addressing meeting agenda.</p><p><strong>Conclusions: </strong>The iterative engagement approach yielded practical feedback from stakeholders about ETUDES Center interventions. The team organized feedback to identify barriers and facilitators to using Center interventions and to generate action items, which were transposed onto components of an implementation strategy, supplemented by the CFIR-ERIC Implementation Strategy Matching Tool. Stakeholder feedback will direct the future development of an integrated intervention and guide further stakeholder engagement in developing technologies for adolescent mental health.<b>Plain Language Summary:</b> Depression and suicide in teens have been on the rise for the past several years. Primary care may be an ideal place to address these concerns because most teens have a primary care provider (PCP) who can offer a confidential place for both teens and their caregivers. Our Center develops technology-based interventions to help PCPs address teen depression and suicidality. Multiple barriers may hinde","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"3 ","pages":"26334895221120796"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2f/52/10.1177_26334895221120796.PMC9924270.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9393578","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 integrating tobacco cessation treatment in cancer care: A qualitative study.","authors":"Jennifer H LeLaurin, Ryan P Theis, Jesse Dallery, Natalie L Silver, Merry-Jennifer Markham, Stephanie A Staras, Chengguo Xing, Elizabeth A Shenkman, Graham W Warren, Ramzi G Salloum","doi":"10.1177/26334895221112153","DOIUrl":"10.1177/26334895221112153","url":null,"abstract":"<p><strong>Purpose: </strong>The objective of this study was to determine how to optimize implementation of tobacco cessation treatment interventions in cancer care by (1) investigating the feasibility and acceptability of a multi-level approach to tobacco cessation treatment intervention, (2) identifying barriers and facilitators to implementation, and (3) eliciting additional strategies to improve implementation of the intervention.</p><p><strong>Methods: </strong>We conducted qualitative interviews with oncologists (<i>n</i> = 15) from one large academic health center in the Southeastern United States. We asked about their knowledge, attitudes, and current practices regarding tobacco use screening and treatment. We also asked about two proposed strategies to support implementation of tobacco cessation treatment: (1) developing a registry of tobacco users in collaboration with the state-run tobacco cessation program, and (2) providing on-site tobacco cessation counseling from trained professionals.</p><p><strong>Results: </strong>Oncologists saw addressing tobacco use as valuable; however, they felt restricted from consistently addressing tobacco use by multi-level barriers such as workload, electronic health record (EHR) design, patient anxiety, and low self-efficacy for treating tobacco dependence. Oncologists responded positively to on-site treatment and felt this strategy would increase treatment accessibility and enhance engagement. Reaction to developing a registry of tobacco users was mixed, with concerns regarding lack of oncologist involvement and patient privacy expressed. Other suggested strategies for supporting implementation of tobacco cessation treatment included reducing referral complexity, establishing financial or quality incentives for oncologists, and leveraging existing EHR tools to facilitate integration of cessation interventions into clinic workflows.</p><p><strong>Conclusion: </strong>We identified several challenges to implementing tobacco use treatment in cancer care; however, we considered strategies to overcome these barriers that were viewed as feasible and acceptable. Our work highlights the importance of engaging stakeholders in implementation efforts. Future work should explore the impact of the implementation strategies identified in this study.</p>","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"3 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/98/9a/10.1177_26334895221112153.PMC9924274.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9336985","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":"Examining health care champions: a mixed-methods study exploring self and peer perspectives of champions.","authors":"Emily R George,&nbsp;Lora L Sabin,&nbsp;Patricia A Elliott,&nbsp;James A Wolff,&nbsp;Mikala C Osani,&nbsp;Jorma McSwiggan Hong,&nbsp;William R Berry","doi":"10.1177/26334895221077880","DOIUrl":"https://doi.org/10.1177/26334895221077880","url":null,"abstract":"<p><strong>Background: </strong>Champions are widely recognized as playing a key role in the successful implementation of evidence-based interventions within the health care sector; however, little is known about which characteristics and skills enable them to play that role. Furthermore, previous studies have measured only individual champions' responses to personal attributes without incorporating input from other observers. A mixed-methods study was conducted to identify, analyze, and group the behaviors and characteristics of champions who have successfully promoted the adoption of new initiatives within the health care delivery system, taking into consideration self and peer perspectives.</p><p><strong>Methods: </strong>Using a mixed-methods, cross-sectional triangulation design with a convergence model, quantitative data were collected and analyzed from health care champions (n = 30) and their colleagues (n = 58) from 11 countries using a survey. Every champion and a subset of colleagues (n = 14) also participated in in-depth interviews. Descriptive statistics were used to explore the relationship between champion and colleague responses to survey items; chi-squared tests and Kruskal-Wallis tests were used to compare the differences. Thematic content analysis of qualitative data was used to explore champion-like behaviors and features. Characteristics of champions were categorized using the Transformational Leadership Theory framework.</p><p><strong>Results: </strong>Champions exhibited characteristics that facilitated trust and encouraged motivation among their colleagues to adopt innovations, such as being intrinsically motivated, persistent, enthusiastic, and highly effective communicators. Champions were described by their colleagues as empathetic, curious, physically present, approachable, and often soliciting feedback from others. Although there was a high degree of agreement between champion and colleague survey responses, champions were more likely to underrate their skills and abilities to instigate change compared to their colleagues.</p><p><strong>Conclusion: </strong>Both champions and colleagues described key champion-like characteristics, but champions often downplayed the characteristics and behaviors that make champions uniquely effective at facilitating the adoption of evidence-based interventions.</p><p><strong>Plan language abstract: </strong>Health care champions are people who promote the adoption of new initiatives to improve the quality of patient care among their colleagues within health care settings. Champions are often viewed by organizational leaders and researchers as critical for the successful implementation of new ideas; however, little is known about what specific skills or characteristics make them effective at promoting the adoption of new ideas among their colleagues. Most studies on champions' behaviors have only included the perspectives of champions, and not perspectives from others within the organiza","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"3 ","pages":"26334895221077880"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/59/86/10.1177_26334895221077880.PMC9924235.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9388973","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 factors associated with community therapists' self-efficacy in EBP delivery: The interplay between sustainment leadership, sustainment climate, and psychological safety.","authors":"Y Vivian Byeon,&nbsp;Anna S Lau,&nbsp;Teresa Lind,&nbsp;Alison B Hamilton,&nbsp;Lauren Brookman-Frazee","doi":"10.1177/26334895221110263","DOIUrl":"https://doi.org/10.1177/26334895221110263","url":null,"abstract":"<p><strong>Background: </strong>Inner context organizational factors proximally shape therapist experiences with evidence-based practice (EBP) implementation and may influence therapist self-efficacy, which has been linked to sustained use of EBPs in community mental health settings. Research has primarily focused on constructs such as implementation leadership and climate. However, the effects of such factors may depend upon other inner context dimensions, such as psychological safety. Psychologically safe environments are conducive to taking risks, speaking up about problems, and requesting feedback and may promote therapist self-efficacy during implementation. This study examines whether organizational sustainment leadership and sustainment climate relate to therapist EBP self-efficacy only under conditions of psychological safety.</p><p><strong>Methods: </strong>Data were collected from 410 clinicians in 85 programs during the sustainment phase of a system-driven implementation of multiple EBPs in children's mental health services. Therapists reported on their organization's sustainment leadership, sustainment climate, psychological safety, and their own self-efficacy in delivering specific EBPs. Multilevel regression analyses were conducted to account for nested data structure.</p><p><strong>Results: </strong>Among program-level variables, sustainment leadership and psychological safety both significantly predicted therapist self-efficacy. However, there were no significant interactions between program-level sustainment climate and psychological safety. Exploratory post-hoc analyses revealed a significant interaction between program-level sustainment leadership and therapist-level perceptions of psychological safety such that that the conditional effect of psychological safety on EBP self-efficacy was significant at high levels of sustainment leadership, but not at low or average levels.</p><p><strong>Conclusion: </strong>We noted independent links between sustainment leadership, organizational psychological safety and therapists feelings of confidence and mastery with EBPs. Therapists' individual perceptions of psychological safety were linked to self-efficacy only in programs with high sustainment leadership. Thus, sustainment leadership and psychological safety may both represent implementation intervention targets, but it may not be critical to assess for perceptions of psychological safety before deploying organizational leadership strategies.<b>Plain language abstract</b> Therapist self-efficacy is a therapist's belief that they are capable, knowledgeable, and skilled enough to deliver evidence-based practices (EBPs), and is thought to promote improved clinical and implementation outcomes, such as therapists' sustained use of EBPs. Conditions within community mental health organizations may influence therapists' sense of EBP self-efficacy. Leaders' support and expectations for EBP implementation, and collective staff perceptions about ","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"3 ","pages":"26334895221110263"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9978605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9393062","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":"Augmenting systems-level implementation of patient-reported outcomes for depression care through the use of structured analysis and design technique.","authors":"Elizabeth J Austin,&nbsp;Joseph A Heim,&nbsp;Savitha Sangameswaran,&nbsp;Courtney Segal,&nbsp;Denise Chang,&nbsp;Danielle C Lavallee","doi":"10.1177/26334895221137927","DOIUrl":"https://doi.org/10.1177/26334895221137927","url":null,"abstract":"<p><strong>Background: </strong>Health systems increasingly need to implement complex practice changes such as the routine capture of patient-reported outcome (PRO) measures. Yet, health systems have met challenges when trying to bring practice change to scale across systems at large. While implementation science can guide the evaluation of implementation determinants, teams first need tools to systematically understand and compare workflow activities across practice sites. Structured analysis and design technique (SADT), a system engineering method of workflow modeling, may offer an opportunity to enhance the scalability of implementation evaluation for complex practice change like PROs.</p><p><strong>Method: </strong>We utilized SADT to identify the core workflow activities needed to implement PROs across diverse settings and goals for use, establishing a generalizable PRO workflow diagram. We then used the PRO workflow diagram to guide implementation monitoring and evaluation for a 1-year pilot implementation of the electronic Patient Health Questionnaire-9 (ePHQ). The pilot occurred across multiple clinical settings and for two clinical use cases: depression screening and depression management.</p><p><strong>Results: </strong>SADT identified five activities central to the use of PROs in clinical care: deploying PRO measures, collecting PRO data, tracking PRO completion, reviewing PRO results, and documenting PRO data for future use. During the 1-year pilot, 8,596 patients received the ePHQ for depression screening via the patient portal, of which 1,719 (21%) submitted the ePHQ; 367 patients received the ePHQ for depression management, of which 174 (47%) submitted the ePHQ. We present three case examples of how the SADT PRO workflow diagram augmented implementation monitoring, tailoring, and evaluation activities.</p><p><strong>Conclusions: </strong>Use of a generalizable PRO workflow diagram aided the ability to systematically assess barriers and facilitators to fidelity and identify needed adaptations. The use of SADT offers an opportunity to align systems science and implementation science approaches, augmenting the capacity for health systems to advance system-level implementation.</p><p><strong>Plain language summary: </strong>Health systems increasingly need to implement complex practice changes such as the routine capture of patient-reported outcome (PRO) measures. Yet these system-level changes can be challenging to manage given the variability in practice sites and implementation context across the system at large. We utilized a systems engineering method-structured analysis and design technique-to develop a generalizable diagram of PRO workflow that captures five common workflow activities: deploying PRO measures, collecting PRO data, tracking PRO completion, reviewing PRO results, and documenting PRO data for future use. Next, we used the PRO workflow diagram to guide our implementation of PROs for depression care in multiple clinic","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"3 ","pages":"26334895221137927"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ab/06/10.1177_26334895221137927.PMC9924240.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9393570","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":"Improving the feasibility of fidelity measurement for community-based quality assurance: Partial- versus full-session observations of supervisor adherence and competence.","authors":"Jason E Chapman,&nbsp;Zoe M Alley,&nbsp;Sonja K Schoenwald","doi":"10.1177/26334895221135263","DOIUrl":"https://doi.org/10.1177/26334895221135263","url":null,"abstract":"<p><strong>Background: </strong>Clinical supervision is a common quality assurance method for supporting the implementation and sustainment of evidence-based interventions (EBIs) in community mental health settings. However, assessing and supporting supervisor fidelity requires efficient and effective measurement methods. This study evaluated two observational coding approaches that are potentially more efficient than coding full sessions: a randomly selected 15-min segment and the first case discussion of the session.</p><p><strong>Method: </strong>Data were leveraged from a randomized trial of an Audit and Feedback (A&F) intervention for supervisor Adherence and Competence. Supervisors (<i>N</i> = 57) recorded and uploaded weekly group supervision sessions for 7 months, with one session observationally coded each month (<i>N</i> = 374). Of the coded sessions, one was randomly selected for each supervisor, and a random 15-min segment was coded. Additionally, the first case discussion was coded for the full sample of sessions.</p><p><strong>Results: </strong>Across all models (and controlling for the proportion of the session covered by the partial observation), Adherence and Competence scores from partial observations were positively and significantly associated with scores from full sessions. In all cases, partial observations were most accurate when the level of Adherence and Competence was moderate. At lower levels, partial observations were underestimates, and at higher levels, they were overestimates.</p><p><strong>Conclusions: </strong>The results suggest that efficient observational measurement can be achieved while retaining a general level of measurement effectiveness. Practically, first-case discussions are easier to implement, whereas 15-min segments have fewer potential threats to validity. Evaluation of resource requirements is needed, along with determining whether A&F effects are retained if feedback is based on partial observations. Nevertheless, more efficient observational coding could increase the feasibility of routine fidelity monitoring and quality assurance strategies, including A&F, which ultimately could support the implementation and sustainment of effective supervision practices and EBIs in community practice settings.<b>Plain Language Summary:</b> When delivering evidence-based mental health interventions in community-based practice settings, a common quality assurance method is clinical supervision. To support supervisors, assessment methods are needed, and those methods need to be both efficient and effective. Ideally, supervision sessions would be recorded, and trained coders would rate the supervisor's use of specific strategies. In most settings, though, this requires too many resources. The present study evaluated a more efficient approach. The data came from an existing randomized trial of an Audit and Feedback intervention for enhancing supervisor Adherence and Competence. This included 57 supervisors and 374 ","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"3 ","pages":"26334895221135263"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b0/97/10.1177_26334895221135263.PMC9924246.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9393571","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":"Implementing mental health interventions within a national nurse home visiting program: A mixed-methods evaluation.","authors":"Jennifer Leeman,&nbsp;Alasia Ledford,&nbsp;Sharon Sprinkle,&nbsp;Mariarosa Gasbarro,&nbsp;Michael Knudtson,&nbsp;Elisabeth Bernhardt,&nbsp;Paula Zeanah,&nbsp;Georgette McMichael,&nbsp;Allison Mosqueda,&nbsp;Linda Beeber","doi":"10.1177/26334895221128795","DOIUrl":"https://doi.org/10.1177/26334895221128795","url":null,"abstract":"<p><strong>Background: </strong>Up to half of low-income mothers experience symptoms of depression and anxiety that affect their well-being and increase their children's risk for behavioral and emotional problems. To address this problem, an engaged research/practice planning team designed the Mental Health Innovation (MHI), a multicomponent implementation strategy that integrates evidence-based mental health interventions within the national Nurse-Family Partnership (NFP). The MHI includes four implementation strategies: online training modules, clinical resources, team meeting modules, and virtual consultation.</p><p><strong>Methods: </strong>A convergent, mixed methods observational design was applied to evaluate implementation outcomes, guided by the RE-AIM framework. We operationalized Reach as the number and demographics of women enrolled in NFP agencies exposed to MHI strategies. Adoption was operationalized as the number and proportion of nurses and supervisors who used MHI implementation strategies. For implementation, we assessed multilevel stakeholders' perceptions of strategy acceptability and feasibility. Data were pulled from NFP's national data management systems and collected through focus groups and surveys. Quantitative data were analyzed using counts and summary statistics. Qualitative themes were generated through content analysis.</p><p><strong>Results: </strong>The MHI reached agencies serving 51,534 low-income mothers (31.2% African American and 30.0% Latina). Adoption rates varied across implementation strategies. Between 60% and 76% of NFP nurses (<i>N</i> = 2,100) completed each online module. Between 27% and 51% of nurse supervisors (<i>n</i> = 125) reported using each team meeting module. Of 110 teams invited to participate in virtual consultation, 40.9% (<i>n</i> = 45) participated. Mothers served by agencies participating in virtual consultation differed significantly from those who did not, with lower percentages of African American and Latina. Qualitative themes suggest that MHI strategies were generally viewed as acceptable; perceptions of feasibility varied across strategies.</p><p><strong>Conclusions: </strong>This study identified both strengths and opportunities for improvement. Further evaluation is needed to assess the MHI's effectiveness in improving mothers' mental health.</p>","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"3 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/41/00/10.1177_26334895221128795.PMC9762775.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10763187","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":"Mechanisms of implementation: An appraisal of causal pathways presented at the 5th biennial Society for Implementation Research Collaboration (SIRC) conference.","authors":"Sarah F Vejnoska,&nbsp;Kayne Mettert,&nbsp;Cara C Lewis","doi":"10.1177/26334895221086271","DOIUrl":"https://doi.org/10.1177/26334895221086271","url":null,"abstract":"<p><p><b>Background</b> Implementation mechanisms are defined as processes or events through which implementation strategies operate to affect one or more implementation outcomes. Understanding the mechanisms through which implementation strategies work is critical to understanding how and why implementation efforts are successful, and to matching, tailoring, and optimizing implementation strategies. This study examined the content of abstracts included in the program for the 2019 Society for Implementation Research Collaboration (SIRC) conference to characterize the presence of data related to implementation strategy mechanisms and their larger causal pathways. <b>Methods</b> Trained coders reviewed all 205 accepted abstracts and extracted information regarding discrete implementation strategies, determinants of implementation, implementation mechanisms, service outcomes, and implementation outcomes. Theoretical articles were omitted from further analyses due to their inability to offer data related to implementation mechanisms. <b>Results</b> Of the 151 empirical studies included, only 11 (7.28%) reported studying mechanisms. Mechanisms were examined in projects utilizing 14 different implementation strategies. We were able to construct implementation causal pathways for just two implementation strategies, \"assess for readiness and identify determinants,\" representing information pulled from four different abstracts, and \"create a learning collaborative,\" with data pulled from just one abstract. <b>Conclusions</b> These findings indicate that, at least based on SIRC conference abstracts, the empirical investigation of implementation mechanisms remains understudied, highlighting the need for focused research on the study of mechanisms. <b>Plain Language Summary</b> Understanding the mechanisms through which implementation strategies work is critical to understanding how and why implementation efforts are successful. The study of implementation mechanisms may be used to optimize implementation strategy decisions. Investigations to date have not established causal pathways linking implementation strategies, mechanisms, barriers, and outcomes. This study examined abstracts included in the program for the 2019 Society for Implementation Research Collaboration (SIRC) conference. Trained coders reviewed all 205 accepted abstracts and extracted information to characterize the presence of data related to implementation strategy causal pathways. A minority of abstracts reported studying mechanisms. We were able to construct implementation causal pathways for just two implementation strategies, representing information pulled from five different abstracts all together. This highlights the need for focused research on the study of mechanisms.</p>","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"3 ","pages":"26334895221086271"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/07/b3/10.1177_26334895221086271.PMC9924245.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9388967","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":"Developing and applying synergistic multilevel implementation strategies to promote reach of an evidence-based parenting intervention in primary care.","authors":"Samantha Schilling,&nbsp;Luisa Bigal,&nbsp;Byron J Powell","doi":"10.1177/26334895221091219","DOIUrl":"https://doi.org/10.1177/26334895221091219","url":null,"abstract":"Background: This practical implementation report describes a primary care-based group parenting intervention—Child–Adult Relationship Enhancement in Primary Care (PriCARE)—and the approach taken to understand and strengthen the referral process for PriCARE within a pediatric primary care clinic through the deployment of synergistic implementation strategies to promote physician referrals. PriCARE has evidence of effectiveness for reducing child behavior problems, harsh and permissive parenting, and parent stress from three randomized controlled trials (RCTs). The integration of evidence-based parenting interventions into pediatric primary care is a promising means for widespread dissemination. Yet, even when integrated into this setting, the true reach will depend on parents knowing about and attending the intervention. A key factor in this process is the endorsement of and referral to the intervention by the child's pediatrician. Therefore, identifying strategies to improve physician referrals to parenting interventions embedded in primary care is worthy of investigation. Method: Through lessons learned from the RCTs and key informant interviews with stakeholders, we identified barriers and facilitators to physician referrals of eligible parent–child dyads to PriCARE. Based on this data, we selected and implemented five strategies to increase the PriCARE referral rate. We outline the selection process, the postulated synergistic interactions, and the results of these efforts. Conclusions: The following five discrete strategies were implemented: physician reminders, direct advertising to patients, incentives/public recognition, interpersonal patient narratives, and audit and feedback. These discrete strategies were synergistically combined to create a multifaceted approach to improve physician referrals. Following implementation, referrals increased from 13% to 55%. Continued development, application, and evaluation of implementation strategies to promote the uptake of evidence-based parenting interventions into general use in the primary care setting are discussed. Plain Language Summary There is strong evidence that parenting interventions are effective at improving child behavioral health outcomes when delivered in coordination with pediatric primary care. However, there is a lack of focus on the implementation, including the screening and referral process, of parenting interventions in the primary care setting. This is contributing to the delay in the scale-up of parenting interventions and to achieving public health impact. To address this gap, we identified barriers and facilitators to physician screening and referrals to a primary care-based parenting intervention, and selected and piloted five synergistic strategies to improve this critical process. This effort successfully increased physician referrals of eligible patients to the intervention from 13% to 55%. This demonstration project may help advance the implementation of evidence-base","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"3 ","pages":"26334895221091219"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9924241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9388971","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":"Construct validity of the school-implementation climate scale.","authors":"Andrew J Thayer,&nbsp;Clayton R Cook,&nbsp;Chayna Davis,&nbsp;Eric C Brown,&nbsp;Jill Locke,&nbsp;Mark G Ehrhart,&nbsp;Gregory A Aarons,&nbsp;Elissa Picozzi,&nbsp;Aaron R Lyon","doi":"10.1177/26334895221116065","DOIUrl":"https://doi.org/10.1177/26334895221116065","url":null,"abstract":"<p><strong>Background: </strong>Implementation climate is an organizational construct theorized to facilitate the adoption and delivery of evidence-based practices. Within schools, teachers often are tasked with implementing universal prevention programs. Therefore, they are ideal informants when assessing school implementation climate for initial and continuous implementation improvement efforts. The purpose of this study was to examine the construct validity (i.e., factor structure and convergent/divergent validity) of a school-adapted measure of strategic implementation climate called the School Implementation Climate Scale (SICS).</p><p><strong>Methods: </strong>Confirmatory factor analyses of SICS data, collected from 441 teachers in 52 schools, were used to compare uncorrelated and correlated first-order factor models and a second-order hierarchical model. Correlations with other school measures were examined to assess SICS convergent and divergent validities.</p><p><strong>Results: </strong>Results demonstrated acceptable internal consistency for each SICS subscale (<i>α</i>s > 0.80 for all subscales) and construct validity of the hypothesized factor structure of the SICS with three new scales. The hierarchical second-order factor structure with eight first-order factors was found to best model the SICS data. Correlations with other school measures were in the expected direction and magnitude.</p><p><strong>Conclusions: </strong>Results from this study provide psychometric evidence that supports the use of the SICS to inform the implementation research and practice in schools.</p><p><strong>Plain language summary: </strong>Schools are busy trying to implement various universal programs and systems to help support kids in their growth. Beginning and sustaining these efforts is quite challenging, and there is need for tools and ideas to help those implementation efforts. One concept is implementation climate, which is broadly the school staff's perception of the implementation support for a given practice. However, no measure currently exists to help schools assess their implementation climate. The goal of our study was to adapt a measure of implementation climate used in other settings to the school environment. We used feedback from educational experts to make changes and used various analyses to determine if the newly adapted measure was psychometrically sound. Findings suggest the new measure is usable to guide implementation efforts in schools.</p>","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"3 ","pages":"26334895221116065"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/00/b3/10.1177_26334895221116065.PMC9924285.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9393572","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}