Implementation science communications最新文献

{"title":"From CXR to ultrasound: a multi-framework approach to advancing De-implementation in acute care.","authors":"Enyo A Ablordeppey, Byron J Powell, Tiffany E Rosenzweig, Rebecca X Lengnick-Hall, Aimee S James, Richard T Griffey, Elvin X Geng","doi":"10.1186/s43058-026-00963-6","DOIUrl":"10.1186/s43058-026-00963-6","url":null,"abstract":"<p><p>Efforts such as Choosing Wisely have raised awareness about low-value care, yet entrenched practices persist, particularly in acute care settings where clinician behavior is shaped by workflow defaults, training norms, and institutional policies. Routine chest radiography (CXR) after central venous catheter (CVC) placement continues despite strong evidence supporting point-of-care ultrasound (POCUS) as a safe and efficient alternative. We applied a multi-framework, theory-informed approach to diagnose behavioral drivers sustaining CXR use and to design targeted de-implementation strategies.</p><p><strong>Methods: </strong>We conducted focus groups and interviews with emergency and critical care clinicians within a single integrated academic health system. Transcripts were deductively coded using the Consolidated Framework for Implementation Research (CFIR) and mapped to the COM-B model (capability, opportunity, motivation). A causal map was developed to represent behavioral drivers. Using the Behaviour Change Wheel (BCW), we selected aligned intervention functions and specified mechanisms of action using the Behavior Change Technique Taxonomy (BCTT). Strategies were organized within an Implementation Research Logic Model (IRLM).</p><p><strong>Results: </strong>Three interrelated themes emerged: (1) variable self-efficacy for POCUS confirmation (capability), (2) entrenched organizational norms and workflow defaults favoring CXR (opportunity), and (3) behavioral inertia reinforced by habit and perceived safety (motivation). These determinants informed seven candidate strategies, including competency-based ultrasound training, audit and feedback with peer comparison, policy supported clinical algorithms, workflow redesign, peer champions, and structured adaptation cycles. Fourteen behavior change techniques were specified to clarify mechanisms of action. The IRLM linked determinants, strategies, mechanisms, and anticipated outcomes, providing a transparent pathway from qualitative diagnosis to strategy specification.</p><p><strong>Conclusion: </strong>Integrating CFIR, COM-B, BCW, and BCTT enabled systematic translation of contextual and behavioral insights into mechanism-based de-implementation strategies. This structured approach enhances transparency in strategy specification and offers a replicable roadmap for reducing low-value care in complex clinical environments. Future work will pilot and evaluate these strategies to support broader de-implementation efforts.</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/PMC13492023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148229603","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 roads towards fidelity: a mixed-method study of mechanisms of a multifaceted implementation strategy to improve implementation of a guideline for the prevention of mental Ill-health at the workplace in a school setting.","authors":"Andreas Rödlund, Rebecca Lengnick-Hall, Anna Toropova, Byron J Powell, Liselotte Schäfer Elinder, Christina Björklund, Lydia Kwak","doi":"10.1186/s43058-026-01010-0","DOIUrl":"10.1186/s43058-026-01010-0","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Many implementation studies focus on assessing the effectiveness of implementation strategies without investigating the mechanisms explaining their effects. This study investigates the specific mechanisms through which a multifaceted implementation strategy is hypothesized to improve guideline fidelity. This is done by tracing the specific mechanisms through which each discrete strategy achieved proximal outcomes that precede guideline fidelity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Process tracing with comparative case studies was used to analyze qualitative data from a subsample of 16 implementers participating in a cluster-randomized controlled trial exploring the mechanisms by which a multifaceted strategy affects fidelity to a guideline for prevention of mental problems in schools. The study involved four steps: (1) Organizing a traceable process theory of change; (2) Gathering data to validate, modify, or expand the theory; (3) Coding data through qualitative content analysis; and (4) Causal analysis to articulate the theory's mechanisms, including temporal order and key contextual conditions that explain success or failure. The unit of analysis was implementers who were members of the schools' implementation teams, with each implementer representing a case.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The analyses illuminated distinct pathways that explain how each of the five discrete strategies led to implementation success. (1) Organizing Implementation Teams enabled participation in implementation activities, as principals created an environment with dedicated resources, enabling social influences; (2) Educational meetings influenced the decision to implement the guideline through the educators' who promoted knowledge acquisition among the implementers and shaped their beliefs about the implementation; (3) Ongoing Training influenced the intention for implementation and enactment of activities through educators' engaged processes around ongoing acquisition and refinement of skills, which gradually built belief in implementation capability; (4) Small Cyclical Tests of Change influenced behavioral regulation as the workshops engaged repeated engagement in goal setting, action planning, reflection, and adjustment; (5) Facilitation supported implementers' goal setting and prioritization by creating an environmental context, enabling implementers' social influence through receiving social support from facilitators. Unsuccessful pathways for each strategy were also identified and explained.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study traced the specific sequences of actions and interactions through which five discrete implementation strategies contributed to guideline implementation. The findings illustrate how the mechanisms of the multifaceted strategy can be successfully engaged and why they may fail under certain conditions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Trial registration: &lt;/strong&gt;The trial was registered the 9th of August 2021 at Clin","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/PMC13261927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148228966","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":"Knowledge mobilization planning guides: a pragmatic synthesis and content analysis.","authors":"Marco Zaccagnini, Chris McCutcheon, Marina Angel, Kelly J Mrklas, Ian D Graham","doi":"10.1186/s43058-026-00996-x","DOIUrl":"10.1186/s43058-026-00996-x","url":null,"abstract":"<p><strong>Background: </strong>Knowledge mobilization (KMb) aims to bridge the gap between research evidence and real-world application. While researchers, practitioners, and policymakers are increasingly expected to engage in KMb, many lack formal training and rely on publicly available guides. Despite their widespread use, little is known about the quality, evidence base, or development processes of these resources. This study examined the availability, content, and construction of online KMb guides relevant to health disciplines.</p><p><strong>Methods: </strong>We conducted a pragmatic synthesis simulating how individuals typically search for KMb resources, using Google Plain to identify freely accessible, English-language guides offering concrete planning steps. Inclusion was based on relevance to health-related audiences, such as researchers, clinicians, managers, and policymakers. Two reviewers screened the first 50 results per search string, with calibration exercises to ensure consistency. Data were extracted using a piloted tool and analyzed through conventional content analysis to identify themes and guide characteristics.</p><p><strong>Findings: </strong>The search was conducted in two time periods (pre-2019 and 2019-2025), yielding 52 eligible guides, of which 42 were available for full extraction. Most guides originated from Canada (69%) and used \"knowledge translation\" as the primary term (43%). Only a third cited evidence to support their guidance (33%) or effectiveness of strategies (24%), and none included a process for future updates. Most guides clearly outlined planning steps (91%) and were visually accessible (88%). Common steps included selecting a KMb method (93%), identifying the audience (86%), and evaluating the process (81%). Few addressed plan sustainability (19%).</p><p><strong>Discussion: </strong>This review found significant variability in the quality, transparency, and theoretical grounding of publicly available KMb guides. Many lacked clear development methods, cited evidence, or plans for updates, limiting their credibility and long-term usefulness. Only a minority referenced KMb theories or provided evidence to support their recommendations. We developed a meta-guide and reflective questions to support the creation and evaluation of more transparent and evidence-informed KMb resources.</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/PMC13483500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148229618","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":"De-implementation of low-value care: contrasting theories, models, and frameworks to generate methodological guidance.","authors":"Sophie Sergerie-Richard, Guillaume Fontaine, Marie-Hélène Goulet","doi":"10.1186/s43058-026-01007-9","DOIUrl":"10.1186/s43058-026-01007-9","url":null,"abstract":"<p><strong>Background: </strong>Low-value care remains pervasive across healthcare systems and consumes scarce resources while exposing patients to avoidable harms. De-implementation, the purposeful process of reducing, restricting, replacing, or discontinuing low-value practices, has gained momentum, yet the field still lacks clear methodological guidance grounded in theory. De-implementation is often treated as \"reverse implementation\", despite accumulating evidence that stopping practices can activate distinct mechanisms and constraints.</p><p><strong>Main body: </strong>In this paper, we synthesize and contrast theories, process models, and frameworks relevant to de-implementation of low-value care to generate actionable methodological guidance. Drawing on a theory-informed narrative review and constant-comparative synthesis, we identify where de-implementation converges with implementation (e.g., staged processes; multilevel determinants; use of established determinant, strategy, and outcome frameworks) and where it diverges in ways that matter for design and evaluation. Across sources, three recurring lenses structure these divergences: (i) the psychology of stopping (habit disruption, loss aversion, cognitive biases, professional identity threats), (ii) multi-level constraints and politics (incentives, regulation, professional norms, stakeholder interests), and (iii) the nature of the low-value practice and endpoint (reduction vs. restriction vs. elimination; replacement vs. disenchantment discontinuance). We translate these contrasts into ten streamlined methodological recommendations that specify what investigators should state and report in practice, including configuration (stand-alone vs. embedded/paired), low-value classification, explicit determinant-to-strategy-to-mechanism logic, inclusion of patient experience and unintended consequences, and dual-trajectory evaluation when substitution is involved.</p><p><strong>Conclusion: </strong>De-implementation is not simply implementation in reverse. Methodological rigor in de-implementation research requires explicitly specifying configuration and endpoint, aligning strategies with stopping-specific mechanisms and multilevel constraints, and evaluating beyond utilization to include mechanisms, patient experience, equity-relevant impacts, and unintended consequences. This paper provides a practical, theory-grounded set of recommendations to strengthen the design, evaluation, and reporting of future de-implementation studies.</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/PMC13488570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148229500","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 implementation of the HEARTS model for management of hypertension and diabetes in Guatemala: protocol for a prospective observational hybrid type 3 study.","authors":"David Flood, Irmgardt Alicia María Wellmann Castellanos, Luis Fernando Ayala, Scott Tschida, Anita N Chary, Rocío Donis, Ana Irina Argeli Alvarez Nufio, Amy M Kilbourne, David Watkins, Mark D Huffman, John D Rice, Peter Rohloff, Manuel Ramírez-Zea","doi":"10.1186/s43058-026-00993-0","DOIUrl":"10.1186/s43058-026-00993-0","url":null,"abstract":"<p><strong>Background: </strong>The HEARTS model (Healthy-lifestyle counseling, Evidence-based treatment protocols, Access to essential medicines and technologies, Risk-based management, Team-based care, and Systems for monitoring) is recommended by the World Health Organization and the Pan American Health Organization to improve primary care management of hypertension, diabetes, and other cardiovascular disease risk factors in national health systems. The objective of this study is to evaluate HEARTS implementation in the Ministry of Health primary care system in Guatemala, where a scale-up project covering approximately 10% of the country began in 2024.</p><p><strong>Methods: </strong>This is a prospective, observational evaluation using a hybrid type 3 effectiveness-implementation design with three sequential periods: pre-implementation, implementation, and maintenance. The six HEARTS-aligned multilevel implementation strategies are: (1) training and supportive supervision for health workers, (2) standardized treatment protocols, (3) strengthening availability of medications and diagnostics, (4) task sharing with non-physician health workers, (5) quality monitoring systems, and (6) patient engagement and community outreach. The evaluation is guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. Co-primary outcomes are hypertension and diabetes treatment rates (Reach), estimated from MOH administrative data using a difference-in-differences approach comparing intervention districts with non-HEARTS comparator districts. Additional quantitative outcomes include treatment intensity and retention (Reach), disease control (Effectiveness), district-level uptake (Adoption), strategy-specific fidelity (Implementation), and sustainment of outcomes after external support concludes (Maintenance). To explain variation in quantitative outcomes, semi-structured interviews will be conducted with MOH staff, government officials, international advisors, and civil society stakeholders using an explanatory sequential mixed methods design. The study will include a cost-effectiveness analysis and budget impact analysis to inform policy decisions on scale-up and sustainability.</p><p><strong>Discussion: </strong>This study will provide evidence on HEARTS implementation in Guatemala. Findings will inform decisions about national scale-up and contribute to the global evidence base on implementation of hypertension and diabetes management in primary care health systems.</p><p><strong>Study registration: </strong>This study is registered on the Open Science Framework ( https://osf.io/easm9 ).</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/PMC13540874/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148229620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation climate and readiness for the THRIVE intervention in school settings: a mixed methods study.","authors":"Sinko Wang, Hayley Quinones, Lisa Miller, Joan Luby, Patricia L Kohl","doi":"10.1186/s43058-026-01006-w","DOIUrl":"10.1186/s43058-026-01006-w","url":null,"abstract":"<p><strong>Background: </strong>Schools are increasingly recognized as critical settings for delivering mental health interventions. The successful implementation of school-based programs like THRIVE, a parent-child intervention, is likely influenced by the organizational context and the school's readiness for change. This mixed methods study, part of a Type 2 hybrid implementation-effectiveness RCT, aimed to explore baseline contextual factors that may influence the implementation of THRIVE in school settings.</p><p><strong>Methods: </strong>Using a convergent mixed methods design, we investigated the climate of schools implementing THRIVE. Twenty-five interventionists were recruited from six school districts. Quantitative data were collected using the School Implementation Climate Scale (SICS) and Organizational Readiness for Change (ORC). Individual qualitative interviews guided by the Consolidated Framework for Implementation Research (CFIR) were also conducted. Schools were classified as resource-rich or resource-constrained using the Social Vulnerability Index. Descriptive and bivariate statistics were performed. Deductive thematic analysis was conducted. Results were integrated through a joint display table to identify convergences and divergences.</p><p><strong>Results: </strong>The overall SICS score averaged 3.27 (SD = 0.66) and the overall ORC score averaged 3.79 (SD = 0.42), suggesting moderately positive school implementation climate and readiness. On average, participating schools demonstrated a strong focus on evidence-based practice (EBP) and high availability of training and resources for EBP, while providing limited incentives for EBP use (M = 2.09, SD = 0.93). They also presented a collaborative and supportive working environment with shared values but insufficient communication (M = 3.36, SD = 0.73). Qualitative findings are mostly consistent with quantitative results. Most interventionists (n = 24) believed THRIVE aligns with school values and family needs and remained optimistic despite barriers such as time commitment and negative perceptions. Compared to resource-rich schools (n = 11), resource-constrained schools (n = 14) placed less emphasis on EBP (t(23) = 2.37, p < .05) and had fewer facilitators (n = 5), but perceived greater benefits in implementing THRIVE (n = 14).</p><p><strong>Conclusions: </strong>This study found a moderately positive implementation climate and organizational readiness for change in schools adopting the THRIVE intervention. However, limited incentives, communication challenges, and resource constraints may hinder successful implementation. The divergence between strong support for EBPs and the lack of resources suggests that implementation strategies must be tailored and flexible to promote buy-in and address structural barriers.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT06139874. Registered on November 27, 2023.</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/PMC13488226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148229667","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":"Cultural adaptation and psychometric assessment of acceptability, appropriateness, and feasibility measures for family planning interventions among midwives and nurses in Ghana.","authors":"Ernest Maya, Chris Guure, Franklin N Glozah, Sarita Sonalkar, Arden McAllister, Roseline Doe, James Kiarie, Mary Eluned Gaffield","doi":"10.1186/s43058-026-01001-1","DOIUrl":"10.1186/s43058-026-01001-1","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Implementation research relies on accurate measurement of early implementation outcomes such as acceptability, appropriateness, and feasibility. However, instruments developed in high income settings may demonstrate limited cross-cultural validity when applied in different health systems. In postpartum family planning, differences in counselling routines, workload, and service organisation mean that unadapted measures can overlook important aspects of provider experience. This study aimed to culturally adapt and psychometrically evaluate the Acceptability of Intervention Measure, the Intervention Appropriateness Measure, and the Feasibility of Intervention Measure when applied to postpartum family planning counselling and use of the World Health Organization Medical Eligibility Criteria mobile application among midwives and family planning nurses in Ghana.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A sequential exploratory mixed methods design was employed. Three focus group discussions with 18 midwives and family planning nurses were conducted to culturally adapt the original measures developed by Weiner and colleagues. Insights from the qualitative phase informed revisions to the survey instrument. The adapted tool was subsequently administered to 150 midwives who had used the Medical Eligibility Criteria mobile application during one-on-one postpartum family planning counselling. Psychometric evaluation included assessment of internal consistency reliability, exploratory and confirmatory factor analysis, predictive validity, and tests of convergent and discriminant validity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The adapted implementation outcome measures demonstrated strong internal consistency, with Cronbach alpha coefficients ranging from 0.82 to 0.93 across the three constructs for both the counselling intervention and the mobile application. Confirmatory factor analysis indicated acceptable model fit following minor modifications, providing supportive evidence for the proposed factor structure of the acceptability, appropriateness, and feasibility constructs. Predictive validity was demonstrated through significant associations between implementation outcome scores and providers' preferences regarding counselling practices and use of digital tools. Although the expanded adapted scales showed high reliability, only the abridged versions consisting of four acceptability items and three items each for appropriateness and feasibility demonstrated full convergent and discriminant validity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Culturally adapted versions of the Acceptability of Intervention Measure, Intervention Appropriateness Measure, and Feasibility of Intervention Measure can be applied with acceptable reliability to evaluate postpartum family planning interventions among midwives and family planning nurses in Ghana. The findings suggest that the abridged versions of these measures retain stronger construct validity than expand","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491745/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148221024","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":"Barriers and bottlenecks to implementation of WHO recommendations for prevention, detection, and treatment of postpartum hemorrhage: a mixed-methods triangulation study.","authors":"Caitlin R Williams, Sara Rushwan, Kristie-Marie Mammoliti, A Metin Gülmezoglu, Lester Chinery, Arri Coomarasamy, Fernando Althabe, Mariana Widmer, Allisyn Moran, Uzma Syed, Olufemi T Oladapo, Ioannis Gallos","doi":"10.1186/s43058-026-00912-3","DOIUrl":"10.1186/s43058-026-00912-3","url":null,"abstract":"<p><strong>Background: </strong>The World Health Organization develops evidence-based recommendations for postpartum hemorrhage (PPH) prevention, detection, and treatment. However, persistently high PPH-related mortality suggests recommendations are poorly implemented, especially in low-resource settings. This study aimed to identify implementation bottlenecks to inform action.</p><p><strong>Methods: </strong>Drawing on public policy, implementation science, and health behavior, we constructed a multi-level framework to identify bottlenecks affecting recommendation uptake. This informed the development of a survey assessing which bottlenecks affected specific WHO recommendations. Surveys were completed by global stakeholders and by health care workers in three high-burden countries. We also analyzed direct observations of clinical practice from those countries to see how bottlenecks affected practice. An a priori interpretive threshold of 75% was selected to indicate a bottleneck was not a severe impediment to implementation.</p><p><strong>Results: </strong>Surveys from 102 global stakeholders and 246 health care workers, as well as 2039 direct observations of clinical practice revealed variation in adherence to WHO recommendations, with some through-lines. Oxytocin for PPH prevention and treatment was perceived to have national policy support (> 75% for inclusion in national guidelines and Essential Medicines Lists, regulatory approval, and support from national champions) but other uterotonics were not. Tranexamic acid for PPH treatment was found to be underutilized, likely due to compounding bottlenecks. Respondents reported extensive bottlenecks to refractory PPH interventions (< 75% across nearly all bottlenecks). The most substantial bottlenecks were availability/procurement of medicines and devices, affordability and quality of medicines and devices, presence of job aids, and availability of qualified staff. Observed practice generally aligned with stakeholder perceptions.</p><p><strong>Conclusions: </strong>National policy bottlenecks strongly mediated implementation in clinical practice. Policy change addressing gaps in commodity procurement and availability of trained clinicians is critical. Efforts addressing only one part of the implementation ecosystem are unlikely to drive transformative change.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13483687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148220953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing a primary-tertiary shared care model for enhancing cascade testing for familial hypercholesterolaemia: an effectiveness-implementation hybrid type III pre-post study.","authors":"Mitchell Sarkies, Madeline Calder, David Sullivan, Shubha Srinivasan, Catherine Spinks, Emile Belramoul, Ronald J Trent, Claire Trumble, Charlotte Hespe, Stephen C H Li, Luke Elias, Brendan Goodger, Karen Birkenhead","doi":"10.1186/s43058-026-00988-x","DOIUrl":"10.1186/s43058-026-00988-x","url":null,"abstract":"<p><strong>Background: </strong>Familial hypercholesterolaemia (FH) is a common but underdiagnosed genetic condition that leads to high low-density lipoprotein cholesterol and premature cardiovascular disease. Cascade genetic testing remains underutilised as a screening approach. Implementation strategies can increase the diffusion of innovations such as genetic medicine into non-genetic specialty settings more rapidly through dissemination networks. This study aimed to evaluate the success of a multifaceted implementation strategy to increase cascade testing for relatives of a person diagnosed with FH using a primary-tertiary shared care model.</p><p><strong>Methods: </strong>A multisite effectiveness-implementation hybrid type III pre-post study was conducted between 2022 and 2024 to compare the implementation of a new shared care model for FH cascade testing in NSW, Australia. During the control period, cascade testing of relatives was offered to FH index cases by a genetic counsellor at the lipid clinic. In the implementation strategy period, FH index cases were offered a cascade testing expression of interest form to provide to their relatives. Relatives were contacted by a genetic counsellor and provided with a pre- and post-cascade testing package, which was also provided to their general practitioner.</p><p><strong>Results: </strong>A total of n = 25 index and n = 6 cascade cases were included in the control period and n = 81 index and n = 56 cascade cases in the implementation period. The number of cascade genetic tests per index case increased significantly from 0.24 in the control period to 0.52 in the implementation strategy period (incident rate ratio = 4.62; 95% CI: 0.39, 8.84; p = 0.032). Among relatives tested, there was no difference in the proportion with a confirmed FH gene change per index case (IRR = 2.15; 95% CI: 0.65, 7.01; p = 0.207). There was no difference in the proportion of index cases with at least one cascade test (OR = 1.49; 95% CI: 0.53, 4.19; p = 0.442).</p><p><strong>Conclusions: </strong>Implementation of our model increased FH cascade testing compared to previous standard care. These findings suggest a greater role for cascade testing in primary care settings. This opens new opportunities for integrating genetic screening into routine general practice, particularly for autosomal dominant conditions such as FH.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148195317","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":"Provider comments reveal barriers to EHR nudge effectiveness: process evaluation of a null deprescribing trial.","authors":"Ratnalekha V N Viswanadham, Hayley M Belli, Tiffany Rose Martinez, Christina Wong, Saul B Blecker, Andrea B Troxel, Devin M Mann","doi":"10.1186/s43058-026-00983-2","DOIUrl":"10.1186/s43058-026-00983-2","url":null,"abstract":"<p><strong>Background: </strong>De-implementation-reducing low-value or harmful care-is critical but difficult in clinical practice. Clinical decision support (CDS) \"nudges\" in electronic health records (EHRs) aim to promote guideline-concordant deprescribing, but effects are inconsistent. In a pragmatic randomized controlled trial across a large health system, we tested a suite of EHR-based CDS nudges to support Choosing Wisely-aligned deprescribing of glycemic medications in older adults with type 2 diabetes. Although a prior pilot showed modest improvement in guideline concordance (5.1%), the full trial found no significant changes in prescribing; this process evaluation examines clinicians' comments on alerts to explain why.</p><p><strong>Methods: </strong>We conducted a mixed-methods process evaluation of comments within EHR-based alerts from a null-result RCT that promoted Choosing Wisely deprescribing for older adults with type 2 diabetes. Among 66,634 alerts firing across EHR encounters (December 2016-July 2023), providers commented on 764 (1.2%). Two researchers independently coded comments using reflexive thematic analysis, identifying four themes (three negative). Exploratory logistic and multinomial regressions examined predictors of commenting, valence, and themes among acknowledged firings, adjusting for patient, provider, and encounter factors.</p><p><strong>Results: </strong>Thematic analysis of comments revealed three barriers to deprescribing: (1) disagreement with Choosing Wisely guidelines (308 comments, e.g., perceived low overtreatment risk); (2) workflow misalignment (203 comments, e.g., wrong provider responsibility); and (3) patient preferences (69 comments). Logistic regression showed multiple concurrent OPAs reduced action odds by 31.6% (OR 0.684, 95% CI 0.560-0.835); comments were 2.57 times more likely to be negative than positive (OR 2.565, 95% CI 1.637-4.018). Disparities in engagement were found, with female providers, patients, and socially vulnerable individuals less likely to comment.</p><p><strong>Conclusion: </strong>This process evaluation demonstrates scalable real-time feedback for clinical decision support refinement in de-implementation, with regressions identifying context-specific predictors. Provider disagreement, alert firings misaligned to workflows, and patient resistance hinder effectiveness. Future work should refine clinical decision support design to address complexity, enhance guideline explainability to build provider concordance, align with provider roles and workflows, and include patient-centered approaches.</p><p><strong>Trial registration: </strong>The NYU School of Medicine Institutional Review Board (i17-01308) approved the trial, which has the clinicaltrials.gov ID NCT04181307 (https://clinicaltrials.gov/study/NCT04181307), with a first record date of November 26, 2019.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13464996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148195278","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}