Implementation science communications最新文献

{"title":"Physician-suggested strategies for deimplementing low-value care in Swedish primary care: a qualitative analysis across system levels.","authors":"Hanna Augustsson Öfverström, Sara Ingvarsson, Emma Hedberg Rundgren, Marta Roczniewska, Henna Hasson, Per Nilsen, Ulrica von Thiele Schwarz","doi":"10.1186/s43058-026-00947-6","DOIUrl":"10.1186/s43058-026-00947-6","url":null,"abstract":"<p><strong>Background: </strong>Low-value care (LVC) remains a persistent problem in primary healthcare. While various implementation strategies have been proposed and tested for deimplementation, there is limited knowledge about whether there are strategies uniquely suited to deimplementation. Furthermore, there is limited knowledge about system-level responsibilities for deimplementation. Given that implementation strategies are recommended to be tailored to the specific contextual factors surrounding LVC practices, involving primary care physicians in identifying contextually appropriate strategies holds promise. This study aimed to explore the strategies that primary care physicians suggest could facilitate the deimplementation of LVC and map them to the system levels responsible for initiating and deploying these strategies.</p><p><strong>Methods: </strong>This qualitative study was based on responses to an open-ended survey question asking physicians to suggest strategies that could facilitate the deimplementation of LVC practices within primary healthcare in Sweden. A national sample of 441 primary care physicians responded. Responses were analyzed via deductive content analysis categorized by the Expert Recommendations for Implementing Change (ERIC) compilation. Responses that could not be categorized via ERIC were analyzed inductively. The identified strategies were then mapped to the system levels (individual, group, leader, organization and overarching system) responsible for deploying these strategies.</p><p><strong>Results: </strong>Strategies were identified across all nine original ERIC domains, representing 39 (53%) of the original ERIC strategies, and later additions for deimplementation. Additionally, a set of strategies categorized under a new domain, develop better evidence, was identified. Most strategies were suitable for deployment at the organizational (31 strategies) and overarching (31 strategies) levels. Sixteen strategies were best suited for the group level, thirteen for the leadership level, and two for the individual level.</p><p><strong>Conclusion: </strong>Primary care physicians proposed strategies across all nine ERIC domains, with additional strategies beyond those previously described, including develop better evidence. From the physicians' perspective, deimplementation cannot rely solely on individuals but requires coordinated action across the organizational and system levels. Broader structural, policy, and cultural changes would support physicians and ensure that responsibility for deimplementation is shared across the healthcare system.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13094004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719165","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":"Development of blueprint materials that strengthen and embed the infection control link nurse role in hospitals - an action research study.","authors":"Mireille Dekker, Christiaan Vis, Femke van Nassau, Per Nilsen, Rosa van Mansfeld, Irene P Jongerden","doi":"10.1186/s43058-026-00942-x","DOIUrl":"https://doi.org/10.1186/s43058-026-00942-x","url":null,"abstract":"<p><strong>Background: </strong>In hospitals, infection control link nurses (ICLNs) serve as a bridge between their peers and the infection prevention team, driving infection prevention measures through motivation, practical guidance, and knowledge sharing. The success of the ICLN role varies depending on how well it is supported and integrated into hospital structures. In this study, we co-created materials for infection control practitioners (ICPs), incorporating activities to support ICLNs with strategies to strengthen and embed the ICLN role in hospitals. We aimed to develop materials to support and implement the role, and evaluated how cocreation contributed to its normalization in participating hospitals.</p><p><strong>Methods: </strong>We used an action research approach with co-creation as a general guiding principle. Stakeholders and end-users from ten participating hospitals collaboratively developed blueprint materials, including a role description, training resources and strategies for hospital-wide integration of the ICLN role. ICPs tested these materials in their respective hospitals. To explore their experiences with both the application of materials and the collaborative process, focus group interviews were conducted. Normalization Process Theory (NPT) was used as a framework to guide the analyses and the collaborative process itself.</p><p><strong>Results: </strong>Participants agreed upon the materials, but the extend to which their content became normalized in daily practice varied. In the interviews, ICPs mentioned that adoption and application of the materials depended on the implementation phase of the ICLN role. The collaborative process increased their confidence and intention to actively support ICLNs. It also helped them reflect on how to position the role within the organization, prompting them to consider various actions to embed the role structurally. Blueprint materials were considered helpful and provided practical strategies and hands-on activities and could be tailored to the local context.</p><p><strong>Conclusions: </strong>The collaborative process resulted in three practical, adaptable blueprint materials. The process helped ICPs reassess their own role in implementing the ICLN role, refine their training strategies, and strengthen their support for ICLNs at the ward level. Signs of normalization of the ICLN role varied across hospitals, influenced by both the stage of implementation and how ICPs interpreted and enacted their own role.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Difference-making factors in implementing a quality improvement program for sleep apnea in stroke/TIA patients.","authors":"Nicholas A Rattray, Edward J Miech, Dawn M Bravata, K Maya Story, Laura J Myers, Brian B Koo, Laura Burrone, Ali Sexson, Stanley E Taylor, Anthony J Perkins, Joanne Daggy, Jason J Sico","doi":"10.1186/s43058-026-00944-9","DOIUrl":"10.1186/s43058-026-00944-9","url":null,"abstract":"<p><strong>Background: </strong>Effective prevention of ischemic stroke and transient ischemic attack (TIA) involves timely, guideline-concordant risk factor management. Obstructive sleep apnea (OSA), a significant but underdiagnosed cerebrovascular risk factor, affects approximately 70% of stroke and TIA patients. Untreated OSA is linked to impaired post-stroke recovery, recurrent vascular events, and increased mortality. Despite guideline recommendations to consider early post-stroke/TIA OSA screening, few patients receive sleep studies. This study explores the implementation of a multidisciplinary quality improvement intervention for OSA management at six Department of Veterans Affairs medical centers between 2021 and 2024, focusing on contextual factors influencing implementation success.</p><p><strong>Methods: </strong>This mixed-methods study used data from the Addressing Sleep Apnea Post-Stroke/TIA (ASAP) stepped-wedge cluster-randomized clinical trial (NCT04322162). We conducted qualitative analyses of provider interviews and quantitative assessments via configurational comparative methods (CCMs) to identify difference-making conditions for successful implementation. The Group Organization (GO) score, a facility-level measure indicating team cohesion and activation in diagnosing and treating OSA among patients with acute cerebrovascular events, served as the primary implementation outcome.</p><p><strong>Results: </strong>Successful implementation, defined by a GO score of ≥ 6, was achieved at four of the six facilities. Four conditions were sufficient by themselves for implementation success: implementation of sleep test ordering, monitoring sleep testing processes, post-discharge care coordination, and positive influence of champions during implementation.</p><p><strong>Conclusions: </strong>This study highlights the interplay between local context and novel clinical practices in successful program implementation of an acute sleep service. Four difference-makers perfectly distinguished between sites with and without implementation success. These findings provide actionable insights for tailoring and timing implementation strategies to improve adoption.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT04322162.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strengthening community-based doula and clinician partnerships through implementation and dissemination science approaches: a mixed-methods pilot study.","authors":"Jessica Olson, Amber Chavez, Erica Marion, Katherine Quinn, Geraud Blanks, Maureen Post, Toni Whitaker, Juan Pablo Garnham, Camila Vallejo, Camille Johnson, Xavier Johnson, Dalvery Blackwell, Joni Williams, Anna Palatnik","doi":"10.1186/s43058-026-00948-5","DOIUrl":"https://doi.org/10.1186/s43058-026-00948-5","url":null,"abstract":"<p><strong>Background: </strong>Collaboration between community-based doulas and clinical care teams improves birth outcomes, yet partnerships are hindered by operational, communication, and role clarity challenges. Evidence is lacking on scalable, low-burden strategies to strengthen these relationships outside of formal intervention settings.</p><p><strong>Methods: </strong>Rapid deductive content analysis of focus groups and interviews with 12 perinatal clinicians and 11 community-based doulas was conducted. Findings informed a five-minute video vignette illustrating the role of community-based doulas and their hopes for partnerships with clinical care teams. The vignette was screened in two settings: with community-based participants (n = 72), and with clinical healthcare professionals (n = 21).</p><p><strong>Results: </strong>In the first screening, 94% of participants indicated that the vignette honored doula voices either \"completely\" or \"mostly\" (n = 72). Participants reported that the vignette centered authentic voices and presented clear, relatable narratives. In the second screening (n = 21), the 13-item Interprofessional Collaboration Scale (ICS) assessed perceived interprofessional collaboration across three subscales (Communication, Accommodation, and Isolation). Mean total ICS scores increased from 2.63 to 2.90 (t(20) = 3.27, p = .004, Cohen's dz = 0.71). Communication and Accommodation subscales also improved significantly (Communication: 2.70 to 3.09, p < .001, dz = 0.87; Accommodation: 2.75 to 3.08, p = .010, dz = 0.62).</p><p><strong>Conclusions: </strong>Combining rapid qualitative analysis with vignette-based dissemination is a feasible approach to improve partnerships outside of intervention settings. The vignette's strongest influence was on perceptions and willingness to collaborate. This approach represents a scalable, low-burden strategy that may be adapted across interprofessional collaborations.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating narrative medicine into laboratory quality improvement: a sustainable model for reducing coagulation specimen rejections.","authors":"Yumei Huang, Zhaoxia Chen, Qinglin Liu, Hongyu Deng, Yonghong Hu","doi":"10.1186/s43058-026-00937-8","DOIUrl":"https://doi.org/10.1186/s43058-026-00937-8","url":null,"abstract":"<p><strong>Background: </strong>Pre-analytical errors, particularly specimen rejections due to insufficient volume, represent a persistent challenge in coagulation testing, especially in oncology settings where patients often have compromised vascular access. Conventional quality improvement (QI) approaches frequently focus narrowly on procedural compliance and may inadvertently reinforce a punitive, blame-oriented culture between laboratory and nursing teams, thereby undermining systemic problem-solving. This study evaluated whether integrating narrative medicine principles into QI could reduce rejection rates while fostering a just culture grounded in empathy, shared accountability, and patient-centered learning.</p><p><strong>Methods: </strong>A longitudinal QI study using iterative Plan-Do-Study-Act (PDSA) cycles was conducted at a large tertiary oncology hospital (Jan 2019-Nov 2025). Root-cause analysis identified a \"culture of blame\" as core drivers. A narrative medicine curriculum utilizing \"parallel charts\" to foster empathy and mutual understanding was implemented. Monthly coagulation specimen rejection rates were analyzed across three phases using non-parametric statistics and staff behavioral changes were monitored.</p><p><strong>Results: </strong>Rejection rates decreased by 98.6%, from a median of 1.862% (baseline) to 0.026% (optimization phase; p < 0.001). This reduction remained stable during a major staff rotation, indicating the resilience of this system. Qualitative feedback indicated that narrative reflection rebuilt trust and created a \"just culture\" focused on patient safety rather than individual blame.</p><p><strong>Conclusions: </strong>Embedding narrative medicine in laboratory QI is a rigorous, evidence-informed strategy. By shifting the focus from technical compliance to human-centered understanding, healthcare systems may better bridge the gap between the laboratory and the clinic, and potentially achieve breakthroughs in patient safety.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing palliative care in intensive care units: assessing processes using the normalisation process theory NoMAD instrument.","authors":"Stephanie A Meddick-Dyson, Tracy Finch, Jason W Boland, Mark Pearson, Andy Bradshaw, Fliss E M Murtagh","doi":"10.1186/s43058-026-00945-8","DOIUrl":"https://doi.org/10.1186/s43058-026-00945-8","url":null,"abstract":"<p><strong>Background: </strong>The importance of palliative care for Intensive Care Unit (ICU) patients/families is known. Little is known about implementing this care in practice, and how to support healthcare professionals in this implementation. This study uses survey methodology informed by Normalisation Process Theory to assess implementation processes for providing palliative care in the ICU.</p><p><strong>Methods: </strong>A descriptive cross-sectional survey was conducted with UK healthcare professionals involved in providing or organising palliative care in the ICU. Implementation processes were assessed using the validated 23-item Normalisation MeAsure Development (NoMAD) instrument. Absolute (n) and relative frequencies, median and interquartile ranges were reported. Mann-Whitney U Test assessed differences between specialist palliative care and ICU respondents. One open-ended item captured free-text responses, analysed using NPT-guided framework analysis.</p><p><strong>Results: </strong>From 153 completed surveys, 69% of respondents were ICU professionals, 31% were specialist palliative care professionals. There was no statistically significant difference between responses from ICU and specialist palliative care professionals. Likert responses showed that respondents felt familiar with palliative care in the ICU and felt it was part of their normal work. Positive tendency was found toward implementation of palliative care in the ICU with coherence (sense-making work), cognitive participation (relational work) and reflexive monitoring (appraisal work). Rating of collective action (operational work) showed a more neutral tendency, highlighting this as a potential target for improvement. Free-text responses were categorised into themes within Normalisation Process Theory constructs: Coherence-recognising and stratifying need, and nuances within palliative care in the ICU; Cognitive participation-interdisciplinary interfaces and building capacity; Collective action-procedures for provision, pressures on provision, and perceived capability; Reflexive monitoring-perceived value.</p><p><strong>Conclusion: </strong>This novel study uses NPT to assess professional processes relating to implementation of palliative care in the ICU. Findings suggest important perceived implementation gaps may lie within operational work such as tailoring utilisation of existing resources, ensuring leadership support, and building skill sets. Dedicated qualitative research is needed to explain how these issues operate in context and to examine potential patient- and family-related influences.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the sustainability of a three-year community-based intergenerational project in Hong Kong: a longitudinal mixed methods study from the perspective of service providers.","authors":"Eliza Lai-Yi Wong, Dorothy Yingxuan Wang, Nelson Chun-Yiu Yeung, Phoenix Kit-Han Mo, Per Nilsen, Carol Ka-Po Wong, Samuel Yeung-Shan Wong, Eng-Kiong Yeoh","doi":"10.1186/s43058-026-00920-3","DOIUrl":"https://doi.org/10.1186/s43058-026-00920-3","url":null,"abstract":"<p><strong>Background and objectives: </strong>Intergenerational programmes improve older adults' cognitive, emotional, social, and health outcomes. However, their long-term sustainability remains unclear, which is important for ongoing effectiveness. This study aimed to evaluate the sustainability of a three-year community-based intergenerational project and the underlying facilitators and barriers from service providers' perspectives.</p><p><strong>Research design and methods: </strong>A longitudinal, mixed-methods approach was applied. The Program Sustainability Assessment Tool (PSAT), consisting of eight domains, was used to assess the project's sustainability capacity, which is the ability of a programme to maintain its operations, benefits and impacts over time. Barriers and facilitators in PSAT domains were determined by the mean value of each domain. Semi-structured interviews were further administered to identify implementation determinants. A total of 28 managerial and front-line staff responsible for the programme were recruited from three local non-profit organisations. They completed baseline and three rounds PSAT survey and three focus-group interviews across the three-year project. Descriptive statistics and content analysis were conducted for quantitative and qualitative data, respectively.</p><p><strong>Results: </strong>The total sustainability scores during the three-year implementation of the programme were 5.16 ± 0.65 in baseline, 5.66 ± 0.54 in Year 1, 5.62 ± 0.67 in Year 2, and 5.18 ± 0.48 in Year 3. Domains as consistent facilitators across the three-year implementation were organisational capacity and programme evaluation, while domains as consistent barriers were partnerships and strategic planning. Environmental support, funding stability, programme adaptation, and communications were found as mixed impacts during three years of implementation.</p><p><strong>Discussion and implications: </strong>Service providers perceived the overall sustainability of the community-based intergenerational programme as acceptable. Fluctuations in sustainability reflected the life cycle of the programme. Factors affecting the long-term implementation are common practical issues for community-based programme and need to be addressed, especially in the aspects of funding stability, partnerships, and strategic planning, as well as those specific to intergenerational relationship and communication.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A mixed methods evaluation of mechanisms for facilitation in pediatric primary care.","authors":"Jennifer M Boggs, Nathaniel Williams, Claire R Waller, Mallika Pandey, Christina Johnson, Brian K Ahmedani, Celeste Pappas, Katy Bedjeti, Melissa Maye, Courtney Benjamin Wolk, Alison M Buttenheim, Kristin A Linn, Leslie Wright, Matthew F Daley, Dylan S Small, Rinad S Beidas","doi":"10.1186/s43058-026-00941-y","DOIUrl":"https://doi.org/10.1186/s43058-026-00941-y","url":null,"abstract":"<p><strong>Background: </strong>Understanding how implementation strategies work is vitally important for the deployment of evidence-based practices (EPBs) in healthcare settings. Specifically, mechanistic inquiry provides information on specific targets (e.g., buy-in, saliency) that must be engaged for a strategy to be successful. We used mixed-methods to investigate mechanisms of facilitation as part of a trial to implement S.A.F.E. Firearm, a brief evidence-based practice which includes firearm storage counseling and offering free cable locks in pediatric primary care during well-child visits.</p><p><strong>Methods: </strong>We used a mixed-methods approach to ascertain mechanisms. Quantitative analyses determined whether clinic-level adaptive reserve (e.g., mechanism) mediated the impact of facilitation (e.g., strategy) on reach (e.g., primary outcome). Adaptive reserve, evaluated via clinician survey, refers to a clinic's ability to broadly make and sustain change and includes multiple components (i.e., relationship infrastructure, facilitative leadership, sensemaking, teamwork, work environment, and culture of learning). Importantly, adaptive reserve is not the specific capacity to implement a given EBP. Second, qualitative interviews guided by the updated Consolidated Framework for Implementation Research, and analyzed using deductive and inductive approaches, were conducted with pediatric clinicians, clinic change agents, and health system leaders to ascertain other mechanisms. Mixed methods integration occurred at completion of both activities.</p><p><strong>Results: </strong>Quantitative analyses indicated that adaptive reserve did not mediate the effect of facilitation on reach. Qualitative findings illustrated other potential mechanisms of facilitation including: increasing buy-in and saliency to help overcome initial inertia and to support application of training principles in practice; strong collaborative relationships between facilitators and clinics to improve accountability; in-person visits or electronic communications that serve as reminders; reinforcing the why and how of the intervention (sensemaking); and fostering team collaboration to troubleshoot logistical barriers.</p><p><strong>Discussion: </strong>While prior studies have found that adaptive reserve was related to facilitation, our mediation analysis did not support this hypothesis. Contextual factors may offer potential explanations, particularly a lower-intensity facilitation in this context commensurate with a smaller practice change (e.g., a brief program intended to take < 1 min), but further study is needed. Our qualitative results offer a potentially new mechanistic model of facilitation to be investigated in future studies.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of implementation strategies for the National Emergency Airway Registry for Pediatric Emergency Medicine (NEAR4PEM) pre-intubation checklist: a prospective, pre-implementation planning study.","authors":"Robyn Wing, Ariana M Albanese, Monica M Prieto, Emily Greenwald, Ilana Harwayne-Gidansky, Joshua Nagler, Michael P Goldman, Joshua Ray Tanzer, Kelsey Miller, Natalie Napolitano, Akira Nishisaki","doi":"10.1186/s43058-026-00935-w","DOIUrl":"10.1186/s43058-026-00935-w","url":null,"abstract":"<p><strong>Background: </strong>The National Emergency Airway Registry for Pediatric Emergency Medicine (NEAR4PEM) pre-intubation checklist was rigorously developed and usability-tested for pediatric emergency departments (PEDs), but effective integration into routine PED practice has not been systematically planned. We undertook a structured implementation planning process to identify site-level barriers and develop a context-responsive implementation plan to support checklist adoption.</p><p><strong>Methods: </strong>To develop strategies to support adoption, a disciplinarily-diverse team of PED clinicians performed a five-step stakeholder-informed barrier prioritization and strategy-matching process. In Step 1, focus groups and surveys were employed to identify barriers and facilitators to checklist implementation. In Step 2, barriers were ranked on feasibility to address and potential impact if addressed in order to identify which determinants to prioritize in strategy selection. In Step 3, implementation strategies were selected to address prioritized barriers via virtual facilitated sessions. In Step 4, these strategies were ranked for feasibility and impact by Advisory Board (AB) members to guide decision making around which to include in the final implementation plan. In step 5, the AB detailed the prioritized implementation strategies in an implementation plan.</p><p><strong>Results: </strong>Sixteen unique barriers were identified, 6 of which were prioritized. 24 strategies were generated, 19 of which were prioritized and included in our implementation plan. Prioritized strategies addressed key barriers like staff turnover and competing job responsibilities, utilizing approaches like folding the checklist into provider training, and creating a network of airway champions to promote the checklist's implementation.</p><p><strong>Conclusions: </strong>In addition to generating a list of strategies to support this effort, this study serves as a proof of concept that a participatory and somewhat resource-intensive process can successfully be executed in a complex emergency setting. By linking prioritized barriers to operationalized implementation strategies, it offers a practical framework for translating determinant assessment into actionable implementation plans for low-frequency, high-risk workflows. Future work will evaluate implementation and patient outcomes during checklist rollout.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adapting the HealthMpowerment (HMP) mobile application for youth living with or at risk of HIV in Africa using the ADAPT-ITT model.","authors":"Julia Brasileiro, Kathryn E Muessig, Taylor Lascko, Nadia A Sam-Agudu, Aimee Rochelle, Megan E Mansfield, Akipu Ehoche, Sylvia Adebajo, Lisa B Hightow-Weidman, Manhattan E Charurat, Elizabeth Shoyemi, Cassidy W Claassen, Gift Trapence, Joshua Kimani, Ojore Godday Aghedo, Olawole Ayorinde, Kennedy Sambambi, Gift Ndalumbira, Richard Gichuki, Marie-Claude C Lavoie","doi":"10.1186/s43058-026-00913-2","DOIUrl":"10.1186/s43058-026-00913-2","url":null,"abstract":"<p><strong>Background: </strong>Adaptation plays a critical role in implementation science (IS) by optimizing the fit of evidence-based interventions (EBIs) to local contexts and populations. Adaptation is especially relevant in digital health, where technologies, user preferences, and needs evolve rapidly. Yet, methodological approaches to guide and document adaptation processes are seldom included. Grounded in an IS framework, we describe a multi-phase process and results for the adaptation of a digital health intervention (DHI) for HIV prevention and treatment for sexual and gender minority (SGM) youth in Malawi, Kenya, Nigeria, and Zambia.</p><p><strong>Methods: </strong>Guided by the Assessment, Decision, Administration, Production, Topical Experts, Integration, Training, and Testing (ADAPT-ITT) model, we adapted the EBI HealthMpowerment (HMP) DHI for SGM youth. We conducted eight focus group discussions with SGM youth (N = 80) living with or at risk for HIV and four with other key experts (N = 29) to inform app adaptations. Rapid qualitative analyses were conducted, and the findings were summarized using the Mobile App Rating Scale. Subsequently, we conducted beta testing with 40 SGM youth to assess the app's usability with the validated System Usability Scale. The data were collected from June 2024 to April 2025.</p><p><strong>Results: </strong>Most HMP adaptations were within two domains of the Mobile App Rating Scale: Engagement and Information Quality. Engagement adaptations focused on increasing support and reducing provider response times through the app, along with added gamification. Information Quality adaptations focused on expanding resources (e.g., mental health, economic strengthening) and ensuring that healthcare referrals made via the app were to SGM-competent providers. Functionality enhancements included adding content in local languages and integrating WhatsApp. Data safety was prioritized and addressed by creating an emergency lockout code. For Subjective Quality, participants perceived the app favorably for its support for medication adherence. Results from the beta testing indicated a score of 70.0, indicating above-average usability. Modifications were made to the ADAPT-ITT model to embed consultations with key experts throughout the different phases.</p><p><strong>Conclusions: </strong>The HMP app was collaboratively and iteratively adapted with SGM youth and key partners. This methodological approach enhances HMP's functionality, quality, and safety, increasing the likelihood of success in future trials and scale-up.</p><p><strong>Trial registration: </strong>NCT06350682. Registered on February 20, 2024. https://reporter.nih.gov/project-details/11373152.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}