Implementation science communications最新文献

{"title":"Planning for scale: analysis of adaptations and contextual factors influencing scale-up of the QUALI-DEC intervention to optimize caesarean section use.","authors":"Soha El-Halabi, Claudia Hanson, Alexandre Dumont, Amanda Cleeve, Helle Mölsted Alvesson, Charles Kaboré, Guillermo Carroli, Pisake Lumbiganon, Quoc Nhu Hung Mac, Ana Pilar Betran, Kristi Sidney Annerstedt, Meghan A Bohren, Karen Zamboni","doi":"10.1186/s43058-025-00737-6","DOIUrl":"10.1186/s43058-025-00737-6","url":null,"abstract":"<p><strong>Background: </strong>Researchers are encouraged to plan for scale through purposeful and guided assessment of scalability of an intervention. This study analysed factors potentially influencing scale-up and synthesised early adaptations of the QUALI-DEC intervention aiming to improve the appropriate use of caesarean section. The intervention consists of opinion leader engagement, audit and feedback for caesarean section, a tool to help women make an informed decision on the mode of birth, and labour companionship.</p><p><strong>Methods: </strong>We conducted a framework analysis, which was guided by the scalability assessment framework by Zamboni et al., a 34-item checklist with a three-point scale. We used data from the formative research including a document review, hospital readiness assessment and qualitative interviews conducted between March 2019 and May 2020 in 32 facilities across Argentina, Burkina Faso, Thailand, and Viet Nam. Data were deductively coded based on the four dimensions of the scalability framework. Our findings were validated with implementing partners across countries.</p><p><strong>Results: </strong>We identified the perceived relevance of the intervention by women and providers and the presence of relevant key clinical guidelines as factors that may ease scalability of QUALI-DEC. Labour companionship and the decision-analysis tool were perceived as harder to scale-up and requiring additional changes to existing healthcare structures. Most of the study facilities reported high workload and time constraints as implementation barriers. Thailand was the only country with a national policy to reduce unnecessary caesarean sections. Legal disputes were common and followed a structured process in Thailand and Argentina, which may support preference of caesarean section due to fear of litigation. Early adaptations included development, revision and translation of educational material, monetary compensation of opinion leaders and reaching consensus on clinical guidelines to be used across hospitals, most of which are deemed conducive to scale up.</p><p><strong>Conclusions: </strong>Planning for scale-up is a key feature of the QUALI-DEC intervention. Scale-up may not be guaranteed at this point of the intervention since effectiveness and cost-effectiveness are not demonstrated yet. However, the investment in studying scale-up opportunities is a core contribution to implementation research. This exercise informed implementation and scale-up strategies of the QUALI-DEC intervention.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"6 1","pages":"61"},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093684/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121598","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 implementation research logic model to examine high-intensity resistance rehabilitation implementation in skilled nursing facilities: a mixed methods multi-site case study.","authors":"Lauren A Hinrichs-Kinney, Danielle Derlein, Mattie E Pontiff, Daniel Malone, Jodi Summers Holtrop, Jennifer E Stevens-Lapsley","doi":"10.1186/s43058-025-00747-4","DOIUrl":"10.1186/s43058-025-00747-4","url":null,"abstract":"<p><strong>Background: </strong>Implementing evidence-based rehabilitation in skilled nursing facilities (SNFs) is essential for enhancing physical function outcomes and mitigating risk of adverse events. Best implementation approaches in this complex setting are unknown. This study uses the Implementation Research Logic Model (IRLM) to retrospectively examine the implementation of high-intensity resistance rehabilitation (HIR) in SNFs, aiming to elucidate contextual factors and pathways that could enhance future HIR implementation endeavors.</p><p><strong>Methods: </strong>We conducted a convergent, mixed-methods multi-site case study (n = 8 sites). A standardized implementation strategy was employed, allowing sites to adapt this approach. HIR use was measured using the Provider Report of Sustainment Scale (PRESS). Contextual factors were identified using the Practical Robust Implementation and Sustainability Model (PRISM) through study-specific questionnaires and validated measures (Inner Setting Scale, Provider Perspective of Team Effectiveness, Evidence Based Practice Attitudes Scale, Perceived Characteristics of Intervention Scale, Self-Defined Burnout Measure, and Utrecht Engagement Scale), and analyzed descriptively. Interviews and focus groups with leadership and clinicians revealed contextual factors and strategies influencing implementation. Heat maps visualized site patterns, while an IRLM proposed provisional implementation pathways.</p><p><strong>Results: </strong>PRESS scores ranged from 3.75 (0.17) to 2.33 (0.67), indicating all sites implemented HIR to at least a \"moderate extent\". Higher-implementing sites demonstrated full-team ability to adapt HIR to diverse patients. Differentiating contextual factors between higher and lower implementing sites included clinician perspectives, site infrastructure, and satisfaction with leadership. Higher-implementing sites employed a higher volume of site-initiated implementation strategies, notably having a champion and patient engagement. Pathways that appeared to contribute to higher implementation extent included: 1) overcoming inertia of current practice through HIR salience, 2) overcoming clinician concerns of patient compatibility through affirmative experiences, 3) addressing clinician perspective of complexity with session planning, and 4) optimizing patient rehabilitation mindset through encouraging environments.</p><p><strong>Conclusion: </strong>Improving physical function in older adults necessitates adoption of evidence-based rehabilitation like HIR. Implementation strategies that target infrastructure, including leadership support and communication channels, inertia of current practice, and clinician perspectives of HIR complexity and patient compatibility may facilitate implementation. Identifying a champion and providing guidance for effective patient engagement appear to be key.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"6 1","pages":"62"},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121625","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":"The role of organizational characteristics in intervention sustainment: findings from a quantitative analysis in 42 HIV testing clinics in Vietnam.","authors":"Sophia M Bartels, Minh X Nguyen, Trang T Nguyen, Ha V Tran, Teerada Sripaipan, Ngan T K Nguyen, Van Anh T Cao, Van Anh T Tran, Byron J Powell, Clare Barrington, Luz M Reyes, Le Minh Giang, Huong T T Phan, William C Miller, Vivian F Go","doi":"10.1186/s43058-025-00745-6","DOIUrl":"10.1186/s43058-025-00745-6","url":null,"abstract":"<p><strong>Background: </strong>Evidence-based intervention (EBI) sustainment is one of public health's largest translational research problems. Fewer than half of public health EBIs are sustained long-term, and sustainment challenges are even more pressing in low and middle-income countries (LMICs). Organizational characteristics, including organizations' inner structures, culture, and climate, may play a key role in EBI sustainment. However, little quantitative research has examined these relationships, particularly in LMICs.</p><p><strong>Methods: </strong>In this observational study, we assessed the association between baseline organizational characteristics and EBI sustainment within a cluster randomized implementation trial in Vietnam testing strategies to scale-up Systems Navigation and Psychosocial Counseling (SNaP) for people who inject drugs (PWID) living with HIV across 42 HIV testing clinics. From the Exploration, Preparation, Implementation, and Sustainment (EPIS) Framework, five baseline organizational characteristics were selected for investigation: 1) organizational readiness for implementing change; 2) implementation leadership; 3) implementation climate; 4) percent PWID; and 5) staff workload. Six to ten months post-study completion, clinic staff and leadership completed a survey that included the Provider Report of Sustainment Scale (PRESS), a measure of EBI sustainment across a clinic. We conducted clinic-level simple and multiple linear regression analyses to evaluate the association between organizational characteristics and sustainment.</p><p><strong>Results: </strong>218 participants (94% completion rate) completed the PRESS survey. All implementation scales had good individual-level internal consistency reliability. Clinics with high organizational readiness to change at baseline had significantly greater SNaP sustainment than clinics with low organizational readiness to change (ß = 1.91, p = 0.015). None of the other organizational characteristics were associated with sustainment, controlling for study arm.</p><p><strong>Conclusions: </strong>We identified the importance of organizational readiness for SNaP sustainment in Vietnam. This study adds to the evidence base around the relationship between organizational characteristics and HIV intervention sustainment and could inform the development of future sustainment strategies. We also identified several areas for organizational characteristic and sustainment measure advancement, including the need for pragmatic sustainment measures that also capture EBI adaptation. This research demonstrates that assessing clinics' organizational readiness pre-implementation and providing tailored support to those with low readiness scores could improve HIV intervention sustainment for key populations.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"6 1","pages":"60"},"PeriodicalIF":0.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144087049","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":"The Consolidated Approach to Intervention Adaptation (CLARION): Developing and undertaking an empirically and theoretically driven intervention adaptation.","authors":"Lydia Ould Brahim, Sylvie D Lambert, Nancy Feeley, Jane McCusker, Dan Bilsker, Mark J Yaffe, Rosetta Antonacci, Stephanie Robins, John William Kayser, Christine Genest, Haida Paraskevopoulos, Jessica Blair, Andrea Laizner","doi":"10.1186/s43058-025-00731-y","DOIUrl":"10.1186/s43058-025-00731-y","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Intervention adaptation, the deliberate modification of the design or delivery of interventions to a new context, is more resource efficient than de novo development. However, adaptation must be approached methodically, as some modifications, such as those to the core components, may compromise the intervention's initial efficacy. While adaptation frameworks have been published, none have been identified as more likely to result in successful adaptations. Further, frameworks lack the step-by-step details needed for operationalization. Therefore, the goal of this paper is to share our experience in addressing these methodological limitations in intervention adaptation. The objectives were to describe: 1) our development of a step-by-step, theoretically and empirically driven approach to intervention adaptation labelled the ConsoLidated AppRoach to Intervention adaptatiON (CLARION), 2) the application of CLARION in adapting a depression self-management intervention, 3) the facilitators and challenges encountered when using CLARION.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The development of CLARION was informed by the Medical Research Council guidance, the Method for Program Adaptation through Community Engagement (M-PACE), and a published scoping review identifying the key steps in existing adaptation frameworks. M-PACE was selected for its patient-oriented research principles, its application to a similar complex intervention, and for offering some of the specificity needed for execution. However, the scoping review indicated that M-PACE lacked three critical steps: selecting a candidate intervention, understanding its core components, and pre-testing the adapted intervention. These were added to form CLARION, which was structured in two stages: the first involves selecting an intervention, identifying core components, and deciding on modifications; the second stage solicits interest stakeholder feedback to assess the acceptability of the preliminary adapted intervention (pre-test).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Once CLARION was developed, it was put into action to adapt a depression self-management intervention. CLARION demonstrated several strengths: 1) clearly articulating core components before deciding on modifications, 2) mobilizing a diverse steering committee of experts, including patient partners and developers of the original intervention, which balanced input and efficiency, and 3) establishing committee decision-making rules prior to adjudication (specific criteria and 75% supermajority). Key challenges included defining the types of modifications requiring committee input, determining the extent of the committee's involvement, and prioritizing the presence of all committee members at meetings to avoid difficulties integrating incongruent feedback.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The development of CLARION contributes to best practices for intervention adaptation by identifying step-by-step guidance as wel","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"6 1","pages":"59"},"PeriodicalIF":0.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082546","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":"Impact of a stakeholder selected implementation strategy package - fast tracking, provider re-training, and co-location - on PrEP implementation for pregnant women in antenatal care clinics in western Kenya.","authors":"Joseph Sila, Anjuli Dawn Wagner, Felix Abuna, Julia C Dettinger, Ben Odhiambo, Nancy Ngumbau, George Oketch, Enock Sifuna, Laurén Gómez, Sarah Hicks, Bryan J Weiner, Grace John-Stewart, John Kinuthia","doi":"10.1186/s43058-025-00746-5","DOIUrl":"https://doi.org/10.1186/s43058-025-00746-5","url":null,"abstract":"<p><strong>Background: </strong>Pre-exposure prophylaxis (PrEP) is recommended for HIV prevention in pregnant and postpartum women at substantial ongoing risk for HIV. In resource-limited settings, there exist gaps in the integration of PrEP into antenatal care.</p><p><strong>Methods: </strong>We conducted a difference-in-differences analytic approach (3 months pre- and 3 months post) between January 2022 and July 2022 in 8 facilities (4 intervention and 4 comparison) in western Kenya. During the 6-month period, we tested a combination of 2 stakeholder selected implementation strategies - retraining health providers and fast tracking PrEP clients- to improve PrEP delivery. All study facilities dispensed PrEP in the Maternal and Child health clinics (MCH). We evaluated absolute changes in: PrEP penetration, PrEP fidelity, client PrEP knowledge, client satisfaction, and client waiting and service times as outcomes specified a priori while PrEP offer and HIV testing were outcomes specified post hoc. We measured acceptability and appropriateness by providers of the implementation strategies using AIM and IAM respectively.</p><p><strong>Results: </strong>We observed statistically significant improvements in PrEP penetration and PrEP offer (p < 0.05) and non-significant improvements in fidelity. PrEP penetration increased 6 percent points (p = 0.002), PrEP offer increased nearly 6 percentage points (p = 0.002), and PrEP fidelity increased 4 percentage points (p = 0.202) in intervention vs comparison facilities. Client PrEP knowledge increased 0.45 out of 7 total points (p < 0.001) and PrEP screening increased 13 percentage points (p = 0.001). We observed no significant changes in service time (0.13-min increase; p = 0.249), waiting time (0.03-min decrease; p = 0.796), or client satisfaction (0.04/24 total point decrease; p = 0.849) in intervention vs comparison facilities. HIV testing did not significantly change (7 percentage point decrease, p = 0.305). The implementation strategy bundle was deemed appropriate and acceptable by the providers (appropriateness: 18.5/20; acceptability: 18.5/20). Overall, the implementation strategy bundle was associated with larger increases in implementation outcomes among women receiving a visit other than their first ANC visit, as well as among sites without stockouts of HIV test kits.</p><p><strong>Conclusions: </strong>A stakeholder-selected implementation strategy bundle that included retraining healthcare workers, fast tracking PrEP clients to reduce waiting time, and PrEP dispensing in MCH improved several implementation outcomes without significantly affecting waiting time or reducing service time.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"6 1","pages":"58"},"PeriodicalIF":0.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057788","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":"Relationships between internal facilitation processes and implementation outcomes among hospitals participating in a quality improvement collaborative to reduce cesarean births: a mixed-methods embedded case study.","authors":"Jennifer A Callaghan-Koru, Rachel Blankstein Breman, Bonnie DiPietro, Loren Henderson, Geoffrey Curran","doi":"10.1186/s43058-025-00735-8","DOIUrl":"https://doi.org/10.1186/s43058-025-00735-8","url":null,"abstract":"<p><strong>Background: </strong>Quality improvement collaboratives (QICs) are a common strategy for implementing evidence-based practices; however, there is often variable performance between participating organizations. Few studies of QICs assess the internal facilitation (IF) processes engaged in by participating organizations, which may be key to understanding and enhancing the effectiveness of QICs as an implementation strategy. We examined IF processes among hospitals participating in Maryland's perinatal QIC to implement national guidelines for reducing primary cesarean births.</p><p><strong>Methods: </strong>This study followed a mixed-methods embedded case study design. We conducted qualitative interviews with internal implementation leaders at 21 QIC-participating hospitals using a guide informed by the iPARIHS and CFIR frameworks. Two investigators independently coded transcripts in Dedoose using a modified CFIR codebook including seven IF process codes adapted from published categorizations. The investigators also independently applied the CFIR rating system to rate each IF process as a barrier (-2, -1), facilitator (+ 1, + 2), neutral (0), or mixed (X), for each hospital. Final ratings were established through consensus discussions. Average ratings were calculated by hospital and process and charted alongside implementation outcomes from secondary data sources for identification of patterns.</p><p><strong>Results: </strong>Hospital leaders engaged in a variety of activities within each IF process. The average hospital rating across IF processes ranged from -1.1 to + 1.5. The IF process with the highest average rating was project management (average: 1.0; SD: 0.9), the lowest was planning (average: 0.5; SD: 1.0) and the most variable was providing individual support and accountability (average: 0.5; SD: 1.2). Negative ratings resulted from hospital teams not engaging in an IF process or the activities of hospital teams being insufficient to overcome related contextual barriers. Average IF process ratings were significantly higher among hospitals that implemented more than the median number of practice changes. Multiple contextual determinants influenced each IF process; work infrastructure and relational connections were the most frequent influences across IF processes.</p><p><strong>Conclusions: </strong>IF processes played an important role in determining implementation success at hospitals participating in a perinatal QIC. Monitoring and strengthening IF processes at participating organizations may enhance the effectiveness of QICs as an implementation strategy.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"6 1","pages":"57"},"PeriodicalIF":0.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060298/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047916","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":"Advancing implementation of single session interventions in schools: a protocol for a qualitative study.","authors":"Katherine A Cohen, Eric Bruns, Aaron Lyon, Tali Raviv, Sara Becker, Jessica L Schleider","doi":"10.1186/s43058-025-00742-9","DOIUrl":"https://doi.org/10.1186/s43058-025-00742-9","url":null,"abstract":"<p><strong>Background: </strong>Schools are one of the most common settings in which youth seek mental health services, yet existing school-based mental health interventions are often difficult to implement due to time, cost, and staffing limitations. Digital, self-administered Single Session Interventions (SSIs) are evidence-based supports that are intentionally structured to deliver a clinically-meaningful dosage of evidence-based content within one session. Although multiple studies have demonstrated the clinical effectiveness of school-based SSIs, there have been no systemic efforts to understand how SSIs can be practically implemented in schools. The goal of this project is to partner with students, parents, and school staff to identify factors that impact the implementation of SSIs and understand how SSIs can be sustainably integrated as mental health supports into school mental health infrastructure.</p><p><strong>Methods: </strong>We will conduct focus groups (five groups, total n = 35-45) among community members (i.e., students, parents/caregivers, teachers, school administrators, and school mental health providers) to assess perceived facilitators and barriers to the effective implementation of evidence-based SSIs in schools (Aim 1). We will then work in partnership with community members (n = 10-15) to co-design multi-level implementation strategies (i.e., student-directed, staff-directed, system-directed) for increasing uptake and promoting sustainability of school-based SSIs (Aim 2). We will use inductive coding to thematically analyze qualitative data from group sessions. This study is being conducted within the Lake Washington School District in the Seattle, Washington region.</p><p><strong>Discussion: </strong>The proposed project will be the first to investigate facilitators and barriers to real-world implementation of SSIs in schools and strategies to improve implementation. Future studies may test the effectiveness of the generated implementation strategies on outcomes such as SSI uptake over time.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"6 1","pages":"54"},"PeriodicalIF":0.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12057033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055433","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":"Leveraging inter-organizational networks to scale up a sepsis recovery program: results from an application of the Making Optimal Decisions for Intervention Flexibility during Implementation (MODIFI) method.","authors":"Cheyenne R Wagi, Marc A Kowalkowski, Stephanie P Taylor, Aliza Randazzo, Asha Ganesan, Amit Khanal, Sarah A Birken","doi":"10.1186/s43058-025-00743-8","DOIUrl":"https://doi.org/10.1186/s43058-025-00743-8","url":null,"abstract":"<p><strong>Background: </strong>Nearly two million adults in the United States are hospitalized with sepsis yearly, with survivors facing complications that result in high rates of hospital readmission and mortality after discharge. We demonstrated improved outcomes following discharge among sepsis survivors who participated in the Sepsis Transition And Recovery (STAR) program; however, important differences among hospitals require STAR's adaptation to facilitate its implementation and ensure its effectiveness in new settings.</p><p><strong>Purpose: </strong>The purpose of this study was to adapt STAR to hospitals with diverse characteristics.</p><p><strong>Methods: </strong>We used the Making Optimal Decisions for Intervention Flexibility during Implementation (MODIFI) approach. We identified STAR core functions (i.e., effectiveness-driving features) using semi-structured key informant interviews (n = 7). We identified adaptations using semi-structured interviews with clinicians and leaders with expertise and oversight of resources related to transitions of care after sepsis hospitalization (n = 7) from four hospitals that systematically differed from the hospitals in which we originally found STAR to be effective.</p><p><strong>Results: </strong>Network theory, which proposes that performance improves with more efficient flow of information within and across hospitals, underlays STAR's eleven core functions. Adaptation included specific points-of-contact, communication preferences, and methods for achieving buy-in. We used proposed adaptations to tailor STAR protocols to each hospital.</p><p><strong>Conclusions: </strong>We used MODIFI, a state-of-the-science method, to adapt a program that was effective in promoting transition and recovery in sepsis survivors to facilitate its scale-up to diverse hospitals. Future studies will assess STAR's implementation and effectiveness in diverse hospitals.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"6 1","pages":"56"},"PeriodicalIF":0.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054708","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":"Multi-sector determinants of implementation and sustainment for non-specialist treatment of depression and post-traumatic stress disorder in Kenya: a concept mapping study.","authors":"Erika L Crable, Susan M Meffert, Ryan G Kenneally, Linnet Ongeri, David Bukusi, Rachel L Burger, Grace Rota, Ammon Otieno, Raymond Rotai, Muthoni Mathai, Gregory A Aarons","doi":"10.1186/s43058-025-00744-7","DOIUrl":"https://doi.org/10.1186/s43058-025-00744-7","url":null,"abstract":"<p><strong>Background: </strong>The global shortage of trained mental health workers disproportionately impacts mental health care access in low- and middle-income countries. In Kenya, effective strategies are needed to scale-up the workforce to meet the demand for depression and post-traumatic stress disorder treatment. Task-shifting - delegating specific tasks to non-specialist workers - is one workforce expansion approach. However, non-specialist workers remain underutilized in Kenya due to a paucity of research on how to scale-up and sustain such service models.</p><p><strong>Methods: </strong>Purposive sampling was used to recruit experts from policy, healthcare practice, research, and mental health advocacy roles in Kenya (N = 30). Participants completed concept mapping activities to explore factors likely to facilitate or hinder a collaborative Ministry of Health-researcher training of the mental health non-specialist workforce. Participants brainstormed 71 statements describing determinants and implementation strategies, sorted and rated the importance and changeability of each. Multidimensional scaling and hierarchical cluster analysis quantified relationships between statements. The Exploration, Preparation, Implementation, and Sustainment (EPIS) framework guided cluster interpretation activities.</p><p><strong>Results: </strong>Twelve determinant clusters were identified: 1) Current workforce characteristics, 2) Exploration considerations, 3) Preparation considerations, 4) Sustainment considerations, 5) Inner context implementation processes and tools, 6) Local capacity and partnerships, 7) Financing for community health teams, 8) Outer context resource allocation/policy into action, 9) Workforce characteristics to enhance during implementation, 10) Workforce implementation strategies, 11) Cross-level workforce strategies, and 12) Training and education recommendations. Cluster 8 was rated the most important and changeable.</p><p><strong>Conclusion: </strong>Concept mapping offers a rapid, community-engaged approach for identifying determinants and implementation strategies to address workforce shortages. Organizing results by EPIS phases can help prioritize strategy deployment to achieve implementation goals. Scale-up and sustainment of the non-specialist workforce in Kenya requires formal partnerships between the Ministry of Health and community health worker teams to distribute financial resources and collaboratively standardize training curriculum.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"6 1","pages":"55"},"PeriodicalIF":0.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12056999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047644","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":"Integrating behavioral health care into a low-barrier HIV clinic using the Collaborative Care Model: a mixed methods evaluation of patient care cascade outcomes and determinants.","authors":"Scott Halliday, Lydia A Chwastiak, Kaitlin Zinsli, Ramona Emerson, Teagan Wood, Meena S Ramchandani, Kenneth Sherr, Judith I Tsui, Bradley H Wagenaar, Deepa Rao, Julia C Dombrowski","doi":"10.1186/s43058-025-00738-5","DOIUrl":"https://doi.org/10.1186/s43058-025-00738-5","url":null,"abstract":"<p><strong>Background: </strong>Low-barrier HIV care is an evidence-based intervention to improve HIV outcomes among those who have complex barriers to care, but the walk-in model poses challenges to integrating behavioral health services. We evaluated the acceptability and feasibility of a Collaborative Care Model (CoCM) for treatment of depression and opioid use disorder in a low-barrier clinic.</p><p><strong>Methods: </strong>In a sequential explanatory mixed methods pilot study, we accessed data from patient records to generate a care cascade for the number of patients enrolled in the first six months of the program and conducted individual interviews with patients and staff to interpret the care cascade findings.</p><p><strong>Results: </strong>Among 175 patients who visited the clinic, 36% were screened for, 24% were referred to, 15% completed an intake for, and 9% engaged in CoCM. The interviews revealed that screening was limited by a lack of clarity among staff about services offered in CoCM, staff forgetting the screening process, and limited time during patent visits. Referrals were limited by low buy-in among staff and patient complexity. Intakes were limited by time and space constraints in the care setting and competing acute patient needs. The care manager's ability to embody the clinic's culture facilitated engagement among patients who completed intakes.</p><p><strong>Conclusions: </strong>Staff perceived CoCM to be acceptable and feasible to implement, but only in the context of multiple barriers to implementation and challenges to systematic screening and measurement-based care.</p><p><strong>Trial registration: </strong>Not applicable.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"6 1","pages":"53"},"PeriodicalIF":0.0,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053849/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057304","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}