Implementation research and practice最新文献

{"title":"Implementing a \"Naloxone Hub With Many Spokes\" Model in Kentucky: Partner Agency Perspectives on Implementation Strategies.","authors":"Hannah K Knudsen, Michael Goetz, Shaquita Andrews-Higgins, Sandra Back-Haddix, Olivia A Davis, Patricia R Freeman, Douglas R Oyler, Sharon L Walsh","doi":"10.1177/26334895261438500","DOIUrl":"10.1177/26334895261438500","url":null,"abstract":"<p><strong>Background: </strong>Overdose education and naloxone distribution (OEND) is a vitally important evidence-based practice for addressing the ongoing opioid epidemic. During the HEALing Communities Study in Kentucky, OEND was dramatically scaled up in eight counties using a \"hub with many spokes\" model and multifaceted implementation strategies. This aim of this manuscript is to describe qualitative perspectives of partner organizations regarding the utility of the implementation strategies used to expand OEND.</p><p><strong>Method: </strong>Twenty small-group and 24 individual qualitative interviews were conducted with staff from 44 agencies that implemented OEND through partnerships with the study team. Interviews were conducted 6-8 months after the study's Communities That HEAL intervention had ended, allowing participants the ability to reflect on their experiences. Inductive coding in NVivo 12 and thematic analysis were used to identify themes regarding agencies' perspectives regarding the implementation strategies deployed during the study.</p><p><strong>Results: </strong>In describing implementation strategies that supported their efforts to implement OEND, interview participants largely focused on strategies that provided resources, such as shipments of no-cost naloxone and overdose education tools. Flexibility in how the requisite overdose education was delivered allowed agencies to identify an educational approach that fit their workflow and addressed OEND recipients' needs. Participants also viewed implementation facilitation and technical assistance provided by study staff as helpful in facilitating the implementation process.</p><p><strong>Conclusions: </strong>These qualitative data highlight the importance of multifaceted implementation strategies in the process of scaling up EBPs in communities. Future efforts should continue to explore how implementation strategies can be optimized to meet the needs of diverse types of organizations seeking to implement OEND and other evidence-based practices that can mitigate the harms of the opioid epidemic.</p>","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"7 ","pages":"26334895261438500"},"PeriodicalIF":2.2,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13039641/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147610875","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":"Identifying Community-Sourced Implementation Strategies for Delivering a Task-Shared Mental Health Intervention for Fathers in Kenya.","authors":"Ali Giusto, Florence Jaguga, Michaela Greenlee, Noah Triplett, Wilter Rono, Hani Rukh-E-Qamar, Mercy Korir, Dan Aburi, Milton Wainberg","doi":"10.1177/26334895261417238","DOIUrl":"10.1177/26334895261417238","url":null,"abstract":"<p><strong>Background: </strong>To design accessible interventions, understanding how best to implement them in context is essential. Strategies that reflect community perspectives may be most relevant and impactful. This study aimed to identify and specify community-sourced implementation strategies for delivering a mental health and alcohol use intervention for fathers in Kenya and to map them to the Expert Recommendations for Implementing Change (ERIC) taxonomy.</p><p><strong>Method: </strong>In Eldoret, Kenya, focus groups (seven groups; 31 participants) and key informant interviews (<i>n = </i>18) were conducted with hospital leaders, policymakers, mental health providers, community leaders, fathers, lay providers, patients, and men currently experiencing mental health and alcohol use challenges. Data were analyzed using the framework method to generate high-level codes, followed by a second phase to extract, specify, and review implementation strategies.</p><p><strong>Results: </strong>Community members identified lay providers recruited from the community as a promising delivery approach, with professional providers contributing to linkage to care and support for more acute needs. Engagement of community leaders and leveraging existing infrastructure were seen as key to enhancing implementation and reach, particularly among men. Multiple delivery settings (e.g., church, hospital, school) were considered acceptable depending on patient preference. A total of 25 unique community-sourced strategies were identified: three directly matched ERIC strategies, 19 were adapted, and two were unique to the community context.</p><p><strong>Conclusions: </strong>This study identified locally grounded implementation strategies to guide early-stage intervention delivery for fathers in Kenya. Findings contribute to the growing body of implementation science in non-Western contexts and highlight a participatory approach for identifying and specifying strategies relevant to local systems and populations.</p>","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"7 ","pages":"26334895261417238"},"PeriodicalIF":2.2,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13009579/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517149","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":"Perinatal and Substance Use Care in North Carolina Jails: A Qualitative Organizational Context Ideal-Type Analysis.","authors":"Paige M Anderson, Jamie Jackson, Zakiya Stewart, Isabelle Falk, Armani Anderson, Essence Hairston, Andrea K Knittel","doi":"10.1177/26334895261426558","DOIUrl":"10.1177/26334895261426558","url":null,"abstract":"<p><strong>Introduction: </strong>Around 55,000 pregnant individuals enter US jails annually, with over one-third having a substance use disorder (SUD), putting them at risk of perinatal morbidity and mortality. Yet, uptake of perinatal/SUD care best-practices into jails is slow, impacted by many organizational factors. This study explores the organizational contexts that shape decision-making structures and policy development regarding perinatal/SUD care in North Carolina (NC) jails.</p><p><strong>Method: </strong>We conducted semi-structured interviews with employees at 26 NC jails in 2023. Interview transcripts were de-identified and analyzed using ideal-type analysis methodology. Two team members created organizational context summaries, proposed ideal-types (i.e., categories based on shared characteristics), and categorized each interviewed jail. A third team member performed a credibility check, and discrepancies were resolved through team consensus.</p><p><strong>Results: </strong>We constructed three jail ideal-types based on organizational capacity to implement new care policies, identify medical care alternatives to incarceration through community and judiciary connections, and foster collaborative decision making between custody and medical staff regarding perinatal/SUD care. Proactive and Collaborative jails (n = 6) had recently implemented evidence-based programs and/or policies, facilitated referrals to alternatives to incarceration, and collaborated across roles in perinatal/SUD care innovation. Responsive and Coordinated jails (n = 15) had more limited perinatal/SUD implementation experience, fewer connections for alternatives to incarceration, and less management collaboration. Traditional jails (n = 5) had not implemented new programs and/or policies, did not identify local alternatives to incarceration, and maintained centralized and siloed decision-making structures.</p><p><strong>Conclusions: </strong>These typologies provide a conceptual framework for understanding leadership structures and care innovation in NC jails regarding perinatal/SUD care. This framework can be applied to collaborative initiatives with jails to help develop context-specific implementation teams and strategies for integrating perinatal/SUD best-practices. Understanding these organizational contexts is crucial for developing tailored approaches that support jails in their uptake and delivery of perinatal/SUD evidence-based practice to ultimately improve perinatal outcomes.</p>","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"7 ","pages":"26334895261426558"},"PeriodicalIF":2.2,"publicationDate":"2026-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12929843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147312612","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 Interrelationships Between Implementation Outcomes in the Context of Traumatic Brain Injury Screening in Behavioral Health Treatment.","authors":"Kathryn A Hyzak, Alicia C Bunger, Jennifer A Bogner, Alan K Davis","doi":"10.1177/26334895261417230","DOIUrl":"10.1177/26334895261417230","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injury (TBI) is common among individuals seeking treatment for substance use disorders in behavioral healthcare settings, but evidence-based TBI screening methods are underutilized. We investigated provider perceptions of the acceptability, feasibility, and appropriateness of TBI screening, and whether these perceptions influenced the relationships between screening intentions and behaviors. Understanding how these implementation outcomes are interrelated can help clarify the temporal sequencing of implementation processes and lead to more precise and cost-effective dissemination and implementation (D&I) strategies.</p><p><strong>Method: </strong>In Phase 1 of this explanatory sequential mixed methods study, 215 behavioral healthcare providers completed an electronic survey assessing their intentions to screen for TBI using the Ohio State University TBI Identification Method (OSU TBI-ID). After 1-month, a second survey assessed the number of screens conducted, and perceptions of the acceptability, feasibility, and appropriateness of the OSU TBI-ID. Binary logistic regressions were used to examine whether acceptability, feasibility, and appropriateness moderated the relationship between screening intentions and behaviors. In Phase 2, 20 providers participated in an interview to contextualize the quantitative results. Qualitative data were analyzed thematically and integrated with the quantitative results.</p><p><strong>Results: </strong>The mean acceptability, feasibility, and appropriateness scores were 4.12, 4.02, and 3.69, respectively. Acceptability (<i>OR</i> = 0.80, <i>p</i> = .29), feasibility (<i>OR</i> = 0.93, <i>p</i> = .88), and appropriateness (<i>OR</i> = 0.97, <i>p</i> = .65) of TBI screening did not moderate the relationship between intentions and behaviors. Providers endorsed the OSU TBI-ID as easy to use and integrate into practice, relevant to clients, and helpful in guiding referrals and treatment decision-making.</p><p><strong>Conclusions: </strong>Positive perceptions of an intervention are important but insufficient for shaping the transition from intentions to behavior. This study begins to disentangle interrelationships between early-phase implementation outcomes, which can help guide more precise D&I strategy development to enhance implementation efficiency and effectiveness.</p>","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"7 ","pages":"26334895261417230"},"PeriodicalIF":2.6,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12855753/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146109000","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":"Using the Framework for Reporting Adaptations and Modifications to Evidence-Based Implementation Strategies (FRAME-IS) to Document Modifications to a Multilevel Deimplementation Strategy Aimed at Reducing Opioid Prescribing for Chronic Pain.","authors":"Rose Hennessy Garza, Nora Jacobson, Andrew Cohen, Jillian Landeck, Nicholas Schumacher, Rachel Lundwall, Andrew Quanbeck","doi":"10.1177/26334895251407338","DOIUrl":"10.1177/26334895251407338","url":null,"abstract":"<p><strong>Background: </strong>Strategies to implement evidence-based practices often require modifications. A systematic approach to documenting these changes was not widely adopted until the Framework for Reporting Adaptations and Modifications to Evidence-Based Implementation Strategies (FRAME-IS) emerged in 2021, enabling researchers to characterize both proactive and reactive implementation changes. While publications demonstrating the FRAME-IS's application are emerging, few have reflected on the use of the tool itself. The National Institutes of Health-funded Deidentified Opioid Initiative R01 trial, testing strategies to implement the Centers for Disease Control and Prevention guidelines on opioid prescribing, offered a timely chance to assess the FRAME-IS's utility in a multisite, hybrid type-3 trial.</p><p><strong>Method: </strong>An interdisciplinary team of researchers, clinicians, and implementers documented modifications using the FRAME-IS across four implementation strategies that comprise an implementation package called systems consultation: (1) audit and feedback, (2) educational meetings, (3) practice facilitation, and (4) prescriber peer consulting. Modifications were needed due to COVID-19, the rise in telemedicine, changes in opioid prescribing, and healthcare system variations.</p><p><strong>Results: </strong>The Deidentified Opioid Initiative was implemented in 32 clinics within two Midwestern healthcare systems using a sequential, multiple-assignment randomized trial. The implementation team completed the FRAME-IS's seven modules for each strategy's modifications and reflected on the process of using the tool, strengths, and limitations.</p><p><strong>Conclusions: </strong>The team found the FRAME-IS is practical, comprehensive, and user-friendly. It effectively documents modifications and fosters reflection, raising critical questions about implementation. Challenges included role blurring (i.e., researcher/implementer/coordinator), capturing the complexity of cascading modifications (i.e., how one modification leads to another), and a lack of reporting options to capture modifications in a clustered, multisite trial (i.e., clinical staff nested in clinics nested in healthcare systems). Considerations and recommendations from this case study can enhance the FRAME-IS, guide other scholars in its use, and improve the research community's ability to measure the dynamic evolution of implementation strategies systematically. Future research should explore how documented modifications impact implementation outcomes.</p>","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"7 ","pages":"26334895251407338"},"PeriodicalIF":2.6,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12775363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145936649","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":"Using Incentivization as a Strategy to Improve Implementation of a Motivational Interviewing Brief Intervention for Substance Use Disorders in HIV Settings: Results of a 26-Site Parallel Groups Cluster-Randomized Type-3 Hybrid Trial.","authors":"Bryan R Garner, Stephen J Tueller, Michael Bradshaw, Kathryn J Speck, Derek D Satre, Carla Rash, Tom Donohoe, Jackie Mungo, Sarah Philbrick, Richa Ruwala, Mathew R Roosa, Mark Zehner, James H Ford","doi":"10.1177/26334895251389475","DOIUrl":"10.1177/26334895251389475","url":null,"abstract":"<p><strong>Background: </strong>To help improve the implementation of evidence-based substance use disorder (SUD) treatment in practice settings, the United States funds a support system called the Addiction Technology Transfer Center (ATTC) network. Prior implementation research in HIV care found the team-focused Implementation and Sustainment Facilitation (ISF) strategy as an effective addition to the ATTC's staff-focused training, feedback, and consultation (TFC) strategy. Using the ISF + TFC strategy as the control, this type-3 hybrid trial tested the effectiveness of adding a staff-focused incentivization (INC) strategy (ISF + TFC + INC vs. ISF + TFC). Staff-focused incentivization was selected because prior implementation research found it to be highly effective and cost-effective for improving SUD treatment implementation.</p><p><strong>Methods: </strong>Twenty-six HIV service organizations (HSOs), their staff participants (<i>N = </i>87), and their client participants (<i>N = </i>341) were cluster-randomized to either the ISF + TFC control condition or ISF + TFC + INC experimental condition. The INC strategy rewarded/reinforced motivational interviewing brief intervention (MIBI) implementation (US$10 per MIBI delivered) and MIBI implementation at or above a pre-defined level of quality (US$10 per demonstration). In addition to these outcomes, past 4-week changes/reductions in client participant's days of primary substance use and anxiety symptoms were examined.</p><p><strong>Results: </strong>The addition of the INC strategy had a large and significant (<i>p</i> < .05) effect on the number of MIBIs implemented (<i>d</i> = 1.30) and reduction in anxiety (<i>d</i> <i>=</i> -1.54). There was no significant impact on days of substance use.</p><p><strong>Conclusions: </strong>The addition a staff-focused INC strategy improved implementation of an evidence-based brief intervention for adults with comorbid HIV and SUD, and also reduced anxiety. To help improve the integration of evidence-based SUD services in HSOs across the United States, use of the ISF + TFC + INC strategy by the ATTC network and/or the AIDS Education and Training Center (AETC) network is recommended.</p>","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"6 ","pages":"26334895251389475"},"PeriodicalIF":2.6,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12681604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145710211","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":"Exploring Factors Across Levels Impacting Educators' Selection of Evidence-Based Practices for Autistic Students.","authors":"Maria L Hugh, Olivia G Michael, Mahima M Joshi, Alyssa M Hernandez, Jill J Locke","doi":"10.1177/26334895251389976","DOIUrl":"10.1177/26334895251389976","url":null,"abstract":"<p><p><b>Introduction:</b> Front-line implementers report that selecting an evidence-based practice is the most challenging aspect of supporting Autistic students, which may contribute to the long-standing implementation gap. There is a need to understand educators' (special education teachers', general education teachers', and paraeducators') decision-making and determinants of their evidence-based practice (EBP) selection. <b>Method:</b> This study aimed to identify educators' decision-making factors, focusing on (a) information sources and (b) factors within the student, intervention, educator, and classroom levels. Eighty-one educators (general education teachers, special education teachers, and paraeducators) participated in semistructured interviews regarding their EBP selection for a specific student they served in inclusive classrooms. <b>Results:</b> General and special education teachers cited EBP sources from their teacher preparation and colleagues with autism expertise, while paraeducators relied on existing classroom practices and guidance from other educators. EBP decision-making frequently revolved around student and intervention characteristics, focusing less on educator, environment, and resource determinants. Educators made individualized EBP decisions for each student, selecting EBPs that served all students. They also shared that their decision-making was most supported through collaboration, despite limited opportunity. <b>Conclusion:</b> The study provides insights into key team members' EBP selection for Autistic students to aid in the development of implementation supports.</p>","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"6 ","pages":"26334895251389976"},"PeriodicalIF":2.6,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12639238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145590157","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":"Cascading Training Model to Promote Screening, Brief Intervention, and Referral to Treatment Across South Africa: Rollout in an HIV Service Organization.","authors":"Kira DiClemente-Bosco, Caroline Kuo, Goodman Sibeko, Shaheema Allie, Timothy Souza, Tim Janssen, Warren Cornelius, Ayanda Mkhize, Andrew Scheibe, Anje Pretorius, Tricia Sterling, Sara J Becker","doi":"10.1177/26334895251389461","DOIUrl":"10.1177/26334895251389461","url":null,"abstract":"<p><strong>Background: </strong>In South Africa, rates of HIV and alcohol use are among the highest globally, with a detrimental synergistic relationship. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based, cost-effective approach to identifying people at risk of alcohol-related problems to deliver early intervention. We developed and deployed a cascading train-the-trainer model to promote SBIRT implementation in a large nongovernmental organization offering HIV services across South Africa.</p><p><strong>Method: </strong>Between 2021 and 2022, we completed preparatory activities including designing scalable training resources prior to rolling out the train-the-trainer model across two South African provinces. We conducted a comprehensive assessment of outcomes at the trainer- (knowledge, fidelity), provider- (attitudes, confidence, perceived implementation potential, adoption), and client-encounter (reach) levels over approximately one year.</p><p><strong>Results: </strong>We trained 12 novice trainers who then trained 206 providers to implement SBIRT. Trainer SBIRT knowledge increased pre- to posttraining, and fidelity of training delivery was high (99.0% of elements covered across sessions). Provider attitudes, confidence, and perceived implementation potential increased over time, and 64% of providers adopted SBIRT. Reach of the model varied by component, with 41,793 clients screened by trained providers. Of those screening positive for risky alcohol use, 86% received brief intervention (BI) and 53% received referral to treatment (RT). Additionally, 15,353 clients who did not screen as having risky alcohol use received BI and 1,122 received RT.</p><p><strong>Conclusion: </strong>Results indicated that the cascading training model was delivered with high fidelity, associated with improvements in all provider outcomes, and reached high numbers of clients for the screening component of the model. Rates of BI and RT delivery were moderate to high, though data suggested over-application of these elements with some clients, highlighting the tension between reach and fidelity. Lessons learned will inform future scale-out of this model in HIV service settings in low- and middle-income countries.</p>","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"6 ","pages":"26334895251389461"},"PeriodicalIF":2.6,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12576171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145433130","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":"Real-World Implementation and Impact of Digital CBT for Insomnia on Healthcare Utilization: A Propensity-Matched Controlled Study.","authors":"Christopher B Miller, Danielle Bradley, Ian Wood, David Willens, Anupama Nair, Benjamin Brennan, Shane Bole, Laila Poisson, Shana Hall, Greig Thomson, Mika Hirata, David A Kalmbach, Christopher L Drake","doi":"10.1177/26334895251386306","DOIUrl":"10.1177/26334895251386306","url":null,"abstract":"<p><p><b>Background:</b> Chronic insomnia disorder affects 10-15% of adults, causing significant individual and societal burden. Despite Cognitive Behavioral Therapy for Insomnia (CBT-I) being the recommended first-line, sleep medications remain more common due to limited access to trained providers. Digital CBT-I offers a scalable solution, but evidence of its real-world impact in U.S. clinical settings is lacking. <b>Method:</b> This study evaluates real-world implementation and impact of digital CBT-I in U.S. clinical settings, using Normalization Process Theory (NPT) to guide integration at Henry Ford Health, Detroit, Michigan. Implementation success was assessed through order rates, patient sign-ups and workflow acceptability. We assess the effect on healthcare utilization through a propensity-matched observational treatment-control design. <b>Results:</b> Implementation was successful, with 1,162 patients offered digital CBT-I. From this cohort, we analyzed a sample of 340 patients with sufficient chart data and established care (120 days) who utilized digital CBT-I, comparing them to 340 matched standard care controls. Patients who used digital CBT-I had a 64% reduction in the odds of any medication fill during the postwindow period (<i>p</i> < .001) and were 53% less likely to fill insomnia medication prescriptions compared with the preperiod (<i>p</i> = .013). Controls did not have any significant reductions in medication fill rates. Time-varied analysis showed digital CBT-I patients had transiently higher outpatient visit odds at 30-60 days, followed by sustained reductions of 28% (120-150 days) and 31% (150-180 days). After covariate adjustment, early differences were nonsignificant while later reductions remained significant. <b>Conclusions:</b> NPT facilitated integration of digital CBT-I into existing workflows, allowing immediate access while minimizing disruption to routine practice. Provider training sessions and reminders effectively promoted suitable patient uptake. Digital CBT-I was associated with reduced medication fills pre-to-post with an initial rise and then sustained reduction in outpatient service utilization patterns over time. A key limitation is the use of individuals who declined digital CBT-I as comparators, which may introduce selection bias. Generalizability may be limited as the study was conducted within a single healthcare system. <b>Trial Registration:</b> Not applicable-the assignment of the medical intervention to patients was not at the discretion of the investigators.</p>","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"6 ","pages":"26334895251386306"},"PeriodicalIF":2.6,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12576209/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145433109","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":"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}