Implementation science communications最新文献

{"title":"Implementation strategies for evidence-based management of type 2 diabetes at primary healthcare facilities in low- and middle-income countries and related barriers and facilitators: a scoping review.","authors":"Asima Khan, Izhan Ali Khan, Khalid Rehman, Gerardo Zavala Gomez, Imogen Featherstone, Kamran Siddiqi, Saima Afaq","doi":"10.1186/s43058-026-00998-9","DOIUrl":"10.1186/s43058-026-00998-9","url":null,"abstract":"<p><strong>Background: </strong>Type 2 Diabetes prevalence is rapidly increasing in low- and middle-income countries (LMICs), where constrained health budgets and inequitable resource distribution limit access to quality care. Primary healthcare is central to addressing these challenges; however, the implementation of evidence-based diabetes care remains inconsistent. This scoping review mapped implementation strategies for integrating diabetes care into primary healthcare settings in LMICs and identified associated barriers and facilitators influencing implementation.</p><p><strong>Methods: </strong>This review focuses on type 2 diabetes, given its predominance and relevance to primary healthcare delivery in LMICs, and followed the Joanna Briggs Institute methodology for scoping reviews and was reported in accordance with PRISMA-ScR guidelines. The search strategy was peer-reviewed using the PRESS checklist. Eight electronic databases were searched for studies published between January 1996 and November 2024. Eligible studies were conducted in LMICs, as defined by the World Bank, and described the implementation, adaptation, or evaluation of evidence-based Type 2 diabetes care in primary healthcare settings. Two reviewers independently screened titles, abstracts, and full texts. Implementation strategies were mapped to the Expert Recommendations for Implementing Change (ERIC) taxonomy, while reported barriers and facilitators were coded using the Consolidated Framework for Implementation Research (CFIR).</p><p><strong>Results: </strong>Ninety-two articles describing 85 studies across 27 LMICs were included. Implementation strategies most frequently clustered within Engage Consumers, Change Infrastructure, and Use Evaluative and Iterative Strategies, whereas Adapt and Tailor to Context and Utilise Financial Strategies were less often explicitly reported. Forty-three studies reported clinical outcomes only, 11 reported implementation outcomes only, and 31 reported both. Studies more frequently reported improvements in clinical and/or implementation outcomes that combined multiple strategies, particularly provider training and decision support alongside patient or family engagement and pragmatic system redesign. Co-occurrence analyses indicated that Train and Educate Stakeholders was frequently paired with Engage Consumers, supported by supervision, feedback mechanisms, and infrastructure strengthening. CFIR mapping suggested that workflow integration, leadership engagement, regular supervision, and reliable medicine and diagnostic supplies were commonly associated with improved adoption and fidelity, while connectivity challenges, stock-outs, and high workload disrupted implementation and limited scale-up. Reporting of adoption, fidelity, and acceptability remained uneven, and financial strategies were poorly described despite their relevance to sustainability.</p><p><strong>Conclusion: </strong>In LMIC primary healthcare settings, diabetes care i","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13508276/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148267178","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":"Evaluation of a co-designed community-based physical activity program with immigrant South Asian older women: an intersectional RE-AIM/PRISM analysis of acceptability and feasibility.","authors":"Jordana Salma, Alesia Au, Sadaf Murad-Kassam, Sepali Guruge, Vestine Mukanoheli, Hongmei Tong, Stephanie A Chamberlain, Bukola Salami, Higinio Fernández-Sánchez, Shelby Yamamoto, Rija Kamran, Huda Temuri, Allyson Jones","doi":"10.1186/s43058-026-00999-8","DOIUrl":"10.1186/s43058-026-00999-8","url":null,"abstract":"<p><strong>Aims: </strong>To use the RE-AIM/PRISM Framework to evaluate a co-designed community-based physical activity program for immigrant South Asian older (ISAO) women.</p><p><strong>Design: </strong>A qualitative-driven community based participatory research study that draws on intersectionality theory.</p><p><strong>Methods: </strong>The STRONG Program 'Seniors Thriving, Reaching Out, and Growing' is an eight-week hybrid intervention, combining virtual health education with in-person exercise sessions, that was co-designed with ISAO women in Edmonton, Canada. Data sources were participant observations, post-intervention interviews and conversation circles, facilitator debriefs and meeting minutes. Reflexive thematic analysis was used to examine RE-AIM/PRISM dimensions and intersectional influences shaping program acceptability and feasibility.</p><p><strong>Results: </strong>Thirty-four ISAO women participated in the study. Reach was facilitated by relational safety, community champions, and family support. Perceived effectiveness was reflected in acceptance and satisfaction via high attendance (82%) and participant-reported improvements in physical function and social connectedness. Adoption and implementation were shaped by an intergenerational contract in which family members provided essential digital and transportation support, while South Asian facilitators bridged clinical expertise with holistic, strength-based care. Maintenance was challenged by structural inequities; however, organizational partnerships fostered continuity of program success.</p><p><strong>Conclusion: </strong>The STRONG program demonstrates that health promotion for ISAO women is acceptable and feasible when grounded in relational safety and family support. Long-term sustainability requires moving beyond individual-level interventions to address structural barriers related to transportation equity, digital literacy, and the integration of clinical expertise within community-based organizations.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13651044/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148267040","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":"Correction: Mathematical modeling to assess health and economic impact of cardiovascular interventions and implementation strategies among people living with HIV: SAIA HTN.","authors":"Akash Malhotra, Ana Olga Mocumbi, Maria Joana Coutinho, Maxinel Jeremias Filipe Chidácua, Amido Charama, Onei A Uetela, Carmen Hazim, Isaias Ramiro, Kenneth Sherr, Sarah Gimbel, David Watkins","doi":"10.1186/s43058-026-01016-8","DOIUrl":"10.1186/s43058-026-01016-8","url":null,"abstract":"","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"7 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13267383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148260611","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":"Correction: Characterizing, protocolizing, and scaling up local adjunctive interventions and implementation strategies to enhance the reach of HIV-prevention and mental health/substance use treatments: a study protocol.","authors":"Audrey Harkness, Maeleigh Tidd, Susanne Doblecki-Lewis, Jahn Jaramillo, Guillermo Prado, Ruth Soto Malave, Omar Martinez, Nequiel Reyes, Carlos E Rodriguez-Diaz, Souhail Malavé Rivera, Steven Safren, Justin D Smith, Radhika Sundararajan, Nicole Altenberg, Daniel Feaster, Jorge Limia, Rana Saber, Eric W Schrimshaw, Edda Santiago-Rodriguez","doi":"10.1186/s43058-026-01015-9","DOIUrl":"10.1186/s43058-026-01015-9","url":null,"abstract":"","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"7 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13267518/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148260637","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 preparation in implementation for rural healthcare innovation: a multi method evaluation of a virtual medical officer model of inpatient care in Australia.","authors":"Carol Joy Reid, Catherine Church, Viv Jeffery, Ka Chun Tse, Andrew Freeman, Christopher Sia, Raymond Wen, Jacquie Phillips, Mark Ashcroft","doi":"10.1186/s43058-026-00991-2","DOIUrl":"10.1186/s43058-026-00991-2","url":null,"abstract":"<p><strong>Background: </strong>Preparation factors in implementation are critical for success but remain relatively unexplored in rural healthcare. This evaluative study investigated the introduction of a virtual medical officer model in three acute wards of a rural health service in Victoria, Australia. The paper describes the innovation and identifies important features of preparation in implementation.</p><p><strong>Methods: </strong>The evaluation was process-outcome orientated, undertaken from December 2022 to June 2023; deemed the innovation's pilot phase. Multi-method data collection involved a review of documents pertaining to the model, an electronic survey specific to nurses at two time points (preparation and implementation), and semi-structured interviews targeting two groups; Group one, health system stakeholders (nurses, doctors, managers and virtual medical officers) and Group two, patients. Implementation frameworks informed the evaluation design, data collection and analysis.</p><p><strong>Results: </strong>The document review emphasised the important preparation factors undertaken as an interdependent platform for subsequent implementation stages, for example having a clear understanding of determinants such as the rural context, the problem and need. Interview findings (n = 77), involving Group one (n = 39); and Group two (n = 38), were categorised into three overarching themes; Facilitators of the telemedicine model, Barriers to the telemedicine model, and Sustaining telemedicine innovation gains for the future of rural healthcare. Critical preparation factors identified were the relational culture of collaboration and partnership during innovation design negotiation, and the importance of organisational and individual leadership. Implementation factors highlighted the effectiveness of the project management approach, and responsive adaptation, such as active feedback loops leading to model adjustment to increase acute ward routine efficiency. Sustainment factors were predicted to be impeded or aided by preparation actions.</p><p><strong>Conclusions: </strong>The role of preparation in implementation requires clearer articulation with its features included in implementation plans. It is an active process which can influence any stage and eventual sustainability. Our description of facilitators and barriers, and contextual determinants, as contributors to implementation success, would aid decision makers when designing, introducing and adapting rural healthcare innovations. This study has policy implications for the development of rural medical workforce strategies and the planning of a rural digital healthcare strategy.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148240813","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":"District health management teams as champions for implementing the WHO LIVE LIFE suicide-prevention framework in Rural Uganda: a pre-implementation qualitative study.","authors":"Edith K Wakida, Herbert E Ainamani, Samuel Maling, Zohray M Talib, Suzie Boyadzhyan, Celestino Obua, Godfrey Z Rukundo","doi":"10.1186/s43058-026-01004-y","DOIUrl":"10.1186/s43058-026-01004-y","url":null,"abstract":"<p><strong>Background: </strong>Suicide is a major public-health challenge globally and in Uganda, where criminalization, stigma, and weak surveillance hinder prevention. The WHO LIVE LIFE framework offers evidence-based strategies, but there is limited experience implementing it at the district level in low-resource settings. Guided by the i-PARIHS framework, the \"WHO LIVE LIFE with District Health Management Team as Champions for Suicide Prevention across the Lifespan in Rural Uganda (WLLDC-SP)\" initiative positions District Health Management Team (DHMT) members as implementation champions. This study explored perceptions of the proposed champion strategy, operationalization pathways, facilitation needs, and contextual influences on adoption.</p><p><strong>Methods: </strong>We conducted a pre-implementation exploratory descriptive qualitative study in a rural district in southwestern Uganda. Criterion-based purposive sampling identified nine participants from the DHMT and community-based partner organizations. In September 2025, semi-structured interviews were conducted in English using an i-PARIHS-informed guide. Participants received a brief overview of the WHO LIVE LIFE framework before discussing anticipated fit and readiness. Interviews were audio-recorded, transcribed verbatim, and analyzed using a framework-guided matrix approach with deductive coding to i-PARIHS constructs and inductive refinement of sub-themes within each domain.</p><p><strong>Results: </strong>Four implementation domains emerged. First, participants viewed the DHMT as a credible and motivated champion platform because of its mandate for planning, supervision, and district coordination. Second, they identified opportunities to operationalize LIVE LIFE through existing systems, including Village Health Teams, schools, faith-based organizations, media, routine health education, supervision structures, and district reporting processes. Third, participants emphasized that implementation success would require facilitation through training, practical tools, mentorship, transport, airtime, and integration into district plans and budgets. Fourth, participants identified contextual threats, including stigma, criminalization, weak surveillance, limited mental-health staffing, competing priorities, and resource constraints. Means restriction was viewed as important but requiring adaptation because of widespread pesticide access.</p><p><strong>Conclusions: </strong>District leaders and partners demonstrated high motivational readiness and perceived system fit for implementing the WHO LIVE LIFE framework through a DHMT-champion approach. Realizing this potential will require facilitation, logistical support, and policy alignment. Although conducted in one district, these findings may inform other decentralized health systems seeking to embed suicide prevention through district leadership structures.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491912/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148240780","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":"Sustaining values-driven innovation in primary healthcare: a protocol for identifying implementation strategies for long-term impact (longitudinal participatory study).","authors":"Nicky Van Broeck, Birgitte Schoenmakers, Pauline Boeckxstaens, Patricia De Vriendt, Dominique Van de Velde, Sibyl Anthierens","doi":"10.1186/s43058-026-01003-z","DOIUrl":"10.1186/s43058-026-01003-z","url":null,"abstract":"<p><strong>Background: </strong>Responding to system pressures, fragmentation, and growing project fatigue in primary care, this study examines how values-driven innovations (VDIs) can be successfully embedded and sustained by (1) defining what constitutes a values-driven innovation, (2) identifying strategies and mechanisms that support long-term implementation, and (3) co-developing evidence-based sustainability indicators with stakeholders. By integrating four complementary theoretical frameworks and examining the full lifecycle from conceptualization to long-term sustainment, it generates actionable insights to strengthen enduring, values-based transformation in primary care.</p><p><strong>Methods and analysis: </strong>This study uses a longitudinal, theory-informed, multi-stakeholder design. Over three years, we follow selected VDIs from conceptualization through long-term sustainment, using multiple data sources and repeated timepoints to capture dynamic implementation processes. An integrated conceptual framework: combining realist evaluation, the Dynamic Sustainability Framework, Consolidated Framework for Implementation Research, and Normalization Process Theory, guides all phases. The three-phase design includes: (1) defining VDI and mapping the innovation landscape; (2) conducting longitudinal case studies using document analysis, serial interviews, and questionnaires; and (3) co-creating an actionable sustainability model and monitoring indicators with stakeholders. Continuous reflexive practice, triangulation, and participatory engagement ensure rigor and relevance.</p><p><strong>Discussion: </strong>Despite the analytical complexity of using multiple frameworks, this integration provides a comprehensive understanding of sustainability and contextual adaptation in primary care.</p><p><strong>Ethics and dissemination: </strong>The study protocol was approved by the Ethics Committee of the University of Antwerp (reference number 2025-7124).</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148240736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating two implementation approaches to support a nationally mandated caregiver skills training in veterans affairs: a type III hybrid implementation-effectiveness randomized controlled trial.","authors":"Courtney H Van Houtven, Kasey Decosimo, Cynthia J Coffman, Swetha Kota, Connor Drake, Nina R Sperber, Jaime M Hughes, Leah L Zullig, Matthew Tucker, Amy Webster, Emily Franzosa, Amanda Blok, Trisha Chadduck, Leah Christensen, Brystana G Kaufman, Megan Shepherd-Banigan, Kelli D Allen, Susan Nicole Hastings","doi":"10.1186/s43058-026-00960-9","DOIUrl":"10.1186/s43058-026-00960-9","url":null,"abstract":"<p><strong>Background: </strong>Few caregiver support interventions have been scaled nationally; thus, gaps remain regarding the optimal level of support needed to successfully adopt caregiver trainings in diverse clinical contexts. We evaluated the effectiveness of two implementation support approaches on implementation outcomes for a family caregiver training (Caregivers FIRST) in partnership with the Veterans Health Administration Caregiver Support Program (CSP).</p><p><strong>Methods: </strong>In a hybrid type III effectiveness-implementation trial, we enrolled 25 non-adopter sites six months following the national mandate Caregivers FIRST to compare two different implementation support approaches (foundational support or foundational support with the addition of group external facilitation (enhanced support)). Co-primary site-level penetration outcomes at 12-months were 1) percentage of caregivers attending ≥ 1 class among those with any caregiver referral or enrolled in CSP and 2) number of classes delivered. Secondary outcomes were fidelity and adoption. Fidelity was proportion of expected classes delivered of those promised; adoption was delivering at least one round of classes to 5 or more caregivers. Secondary analysis examined outcomes at six and 18-months separately. We fit generalized linear models to examine differences in outcomes between arms. Survey, interview, and administrative data were used to contextualize findings and assess implementation support costs.</p><p><strong>Results: </strong>Twelve sites were randomized to foundational support and 13 to enhanced support. At 12-months, the estimated mean percentage of qualifying caregivers attending ≥ 1 class was 8.3% and mean number of classes offered was 9.4 for enhanced support and in foundational support were 6.1% and 5.4, respectively. No differences were found by arm at 12-months in mean percentage of caregivers attending a class (mean difference = 2.2%; 95% CI -1.8%,6.1%; p = 0.26) or mean number of classes offered (rate ratio = 1.7; 95% CI 0.9,3.4; p = 0.11). Neither fidelity nor adoption were different by arm at 12-months, and similar patterns were found at additional timepoints. The added cost of delivering enhanced support per site was $3,678 over a one-year period (median foundational =$14,985 vs. enhanced =$18,663).</p><p><strong>Conclusions: </strong>Foundational support allowed most sites (75% foundational, 100% enhanced) to successfully adopt by 18 months. While not reaching a priori benchmarks in magnitude, observed means of implementation outcomes at enhanced support sites were higher at 12 months.</p><p><strong>Trial registration: </strong>This study was registered on April 8, 2022 at ClinicalTrials.gov (identifier NCT05319535). https://clinicaltrials.gov/ct2/show/NCT05319535 .</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13508206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148229654","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":"Outcomes of a penicillin allergy de-labelling implementation intervention in a UK hospital: a prospective, single centre, type 2 hybrid effectiveness-implementation study evaluated using mixed methods.","authors":"Neil Powell, Daniel Hearsey, Robert West, Mathew Upton, Bridie Kent, Sarah Tonkin-Crine, Jonathan Sandoe","doi":"10.1186/s43058-026-01008-8","DOIUrl":"10.1186/s43058-026-01008-8","url":null,"abstract":"<p><strong>Background: </strong>Non-allergy specialist healthcare workers removing low-risk penicillin allergy (penA) records, enabling patients to receive penicillin antibiotics, is safe but not common practice. We developed a behavioural change implementation intervention to support non-allergist healthcare workers to remove incorrect penA records from adult inpatients (penicillin allergy de-labelling; PADL). This study aimed to evaluate the effectiveness of the implementation intervention strategy and its impact on delabelling and antibiotic prescribing.</p><p><strong>Methods: </strong>The implementation intervention was launched 10^th June 2024. This prospective, single centre, type 2 hybrid effectiveness-implementation study was evaluated using mixed methods: process evaluation, qualitative and quantitative study designs. The proportion of patients delabelled was measured. Antibiotics were grouped into the three WHO AWaRe categories with differences in antibiotic use between the de-labelled and non-de-labelled measured. Pearson chi-squared tests, Welch's t-tests or Wilcoxon matched-pairs signed-rank tests were used.</p><p><strong>Results: </strong>Between 10^th June and 13^th December 2024, the mean number of penicillin allergy records removed from the inpatient electronic prescribing system increased from 18.2/month pre-intervention to 42.7/month post intervention. Of 186 patients de-labelled with full data capture, the majority 126 (67.7%) were de-labelled by the antimicrobial pharmacists and the remainder by ward doctors or ward pharmacists across 21 clinical specialties. Antibiotic exposure, when grouped by WHO AwARe category, was not significantly different between de-labelled and not de-labelled groups. Of 138 patients with a penA record in their primary care records, there was evidence of communication with the GP to amend the primary care penA record for 94 (68.1%) patients of which 42 (44.7%) were actioned by GP surgeries. The PADL intervention was accepted by most patients, who considered hospital a safe place to be tested. Awareness of the PADL intervention was generally high across all healthcare workers. The PADL process was acceptable to all interviewed healthcare workers and aligned with staff roles and hospital processes but competing priorities were commonly cited as a barrier.</p><p><strong>Conclusions: </strong>The PADL implementation intervention successfully increased non-specialist workforce PADL of low-risk patients. There is opportunity to further optimise PADL but competing priorities are a challenge. We found non-statistically significant impact of PADL on antibiotic use.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488184/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148229665","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":"A qualitative study of the reimplementation of a standardised paediatric early warning system pilot in England.","authors":"Stephanie Stockwell, Sarah Ball, Damian Roland, Graham Martin, Jennifer Newbould","doi":"10.1186/s43058-026-01013-x","DOIUrl":"10.1186/s43058-026-01013-x","url":null,"abstract":"<p><strong>Background: </strong>Efforts to improve healthcare quality and safety and optimise resource use are increasingly focused on deimplementation-the reduction or cessation of existing practice. Reimplementation, a common form of deimplementation, involving the reintroduction of an existing intervention with some degree of modification, is under-researched, particularly in the context of standardising clinical tools. Recent initiatives, such as the national rollout of a standardised paediatric early warning system (PEWS) in England, highlight the need to understand the processes and challenges of substitution, especially from nursing and paediatric perspectives.</p><p><strong>Methods: </strong>This qualitative study employed a comparative case study design across four diverse hospital sites. Data collection (June 2023-November 2024) included semi-structured interviews with staff (n = 29), site-specific workshops and a final stakeholder workshop. Thematic analysis, informed by the Theoretical Domains Framework, was used to analyse interview and workshop data, with cross-case comparisons to identify influences on the reimplementation of PEWS.</p><p><strong>Results: </strong>Buy-in and firm commitment (purchase) was identified as a central influence on the reimplementation effort and was in turn influenced by factors falling into four key categories: product and process (characteristics of, familiarity with and confidence using the system being reimplemented - connected to specific training needs and gaps); people (the people involved in or providing support for reimplementation - having strong leadership across roles and seniority, ward champions and peer support); purpose and promise (belief in the value of the reimplementation); and practice (practical and contextual influences on reimplementation efforts - staffing pressures, removal of the previous system, and acknowledgement that the change would require an initial adjustment period).</p><p><strong>Conclusions: </strong>The considerations identified in this study provide a simple '5P' framework to help understand and support reimplementation, which maps to and is grounded in existing theory. Those considering reimplementation efforts should consider (1) the people, (2) the product and process, (3) the purpose and promise, and (4) the practical influences when reimplementing systems or initiatives. These factors greatly influence (5) purchase - buy-in and commitment - and, we suggest, ultimate success. This will be important in the wider roll-out of a national PEWS as well as other standardisation efforts in the NHS.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13483595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148229551","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}