Implementation science communications最新文献

{"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}

{"title":"Effect of implementing an evidence-based clinical practice intra-hospital transport guideline for hospitalized children: a type III hybrid implementation-effectiveness study.","authors":"Yang Li, Yuxia Yang, Jing Hu, Wenchao Wang, Yun Jin, Weijie Shen, Yanhong Zhang, Yingfeng Zhou, Ye Cheng, Jos M Latour, Ying Gu","doi":"10.1186/s43058-026-00962-7","DOIUrl":"10.1186/s43058-026-00962-7","url":null,"abstract":"<p><strong>Background: </strong>Intra-hospital transfers (IHT) of hospitalized children are unavoidable practices often performed with emergency patients and postoperative patients. Standardizing IHT processes to minimize adverse events might improve children's outcomes. We developed an evidence-based clinical practice IHT guideline for hospitalized children. The aim of this study was to evaluate the implementation process and the effectiveness of the implementation of this guideline on patient outcomes, healthcare professionals' knowledge and behavior, and hospital organizational context.</p><p><strong>Methods: </strong>A type III hybrid effectiveness-implementation design was adopted, using a pre-post intervention trial (January-December 2024). Data of patient demographics, transport-related outcomes, and healthcare providers' knowledge and compliance were collected. We used the RE-AIM framework to assess effectiveness across four dimensions: Reach, Effectiveness, Adoption, and Implementation. Totally, 110 healthcare professionals conducted 213 IHTs of eligible children (109 children in the pre-intervention group and 104 in post-intervention group).</p><p><strong>Results: </strong>The Reach outcomes demonstrated that participation among hospitalized children (n = 312) was suboptimal at 33% (104/312). No differences were observed between the pre- and post-intervention group regarding gender, disease distribution, or pediatric early warning scores. The implementation showed favorable outcomes in the dimensions Effectiveness, Adoption, and Implementation. Healthcare professionals engagement was 95%, with 86% (19/22) of the implementation strategies successfully completed. Healthcare professionals' knowledge in the pre-intervention group (n = 109) improved from median 40 (IQR 28;52) to median 76 (IQR 64;84) in the post-intervention group (n = 104; p < 0.001). Clinically, the new guideline reduced adverse events (12 vs 4; p = 0.047), reduced the median minutes of bedside handover time from 5 (IQR 3;7) to 4 (IQR 3;5; p < 0.001), and improved handover information completeness from median score of 5 (IQR 4;6) to 20 (IQR 12;23, p < 0.001). The total transport time increased from 14 to 19 minutes in the post-intervention group (p < 0.05), while no significant changes were observed in handover interruptions or post-transfer vital sign stability (p > 0.05).</p><p><strong>Conclusion: </strong>The RE-AIM-based evaluation confirmed that the implementation strategies effectively enhanced healthcare professionals' knowledge and compliance while reducing adverse events and optimizing handover efficiency. However, the limited patient participation rate and increased transport duration highlight areas requiring further refinement to maximize the guideline's impact.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov, NCT06512805. Registered 27 June 2024.</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/PMC13508307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148195326","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":"Assessing PRISM context domains and RE-AIM outcomes: data from use of the iterative PRISM webtool.","authors":"Russell E Glasgow, Bryan S Ford, Jun Ying, Carlos Rodriguez, Borsika A Rabin, Katy E Trinkley","doi":"10.1186/s43058-026-00982-3","DOIUrl":"10.1186/s43058-026-00982-3","url":null,"abstract":"<p><strong>Background: </strong>Use of an implementation science (IS) theory, model, or framework (TMF) is one of the hallmarks of a well-executed IS study. Although TMFs are frequently used in IS studies, the TMFs themselves are seldom evaluated. Understanding the relationships between the constructs within an IS TMF and their effect on the implementation and effectiveness outcomes can help to refine the TMF, advance IS and assist implementers.</p><p><strong>Methods: </strong>We evaluated several hypotheses pertinent to the context domains and Reach, Effectiveness Adoption, Implementation, and Maintenance (RE-AIM) outcomes from the Practical, Robust Implementation and Sustainability Framework (PRISM). Data for these evaluations emerged from the use of the Iterative PRISM (iPRISM) webtool, which includes 21 assessment questions that operationalize PRISM context and outcomes constructs. We tested 11 'a priori' hypotheses including relationships within and between different framework constructs and considered whether some of the webtool's assessment questions could be refined or changed to make the assessment more pragmatic and helpful.</p><p><strong>Results: </strong>A total of 348 clinical, community, and public health respondents completed the iPRISM survey using the publicly available webtool. They reported on projects from a wide variety of clinical, community, and public health settings; in English and Spanish; and in different project phases. Seven of the 11 hypotheses were fully or partially supported (e.g. that ratings for Maintenance would be lower than other RE-AIM outcomes). One exception was that the hypothesis that the correlation between Reach and Effectiveness would be the lowest among RE-AIM outcomes was not supported. As hypothesized, scores on the equity items on the various RE-AIM dimensions (e.g. Reach) were consistently lower than general ratings for that dimension. Fewer of the hypotheses about the PRISM context items were supported, possibly due to there being only one item per contextual domain.</p><p><strong>Conclusions: </strong>The webtool questions provide a standardized way to operationalize PRISM constructs and initial norms for different items. Future research, including qualitative evaluation, is needed to replicate, explore, and understand the complex relationships found within RE-AIM outcomes, within PRISM context domains, and between PRISM context ratings and RE-AIM outcomes.</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/PMC13465186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148195312","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":"Community health worker implementation of transdiagnostic evidence-based treatment in Spanish: protocol for refinement, implementation, and a feasibility pilot RCT.","authors":"Erika L Gustafson, Naomi Quezada, Kellyn N Blaisdell, Gabriella Bobadilla, Colleen Stiles-Shields, Kelly McCabe, Stacy Ignoffo, Anubhav Kidambi, Greg Staszko, Beatriz Medina, Dale L Smith, Miya Barnett, Emily E Anderson, Yamilé Molina, Laura Murray, Sara J Becker, Niranjan S Karnik","doi":"10.1186/s43058-026-00980-5","DOIUrl":"10.1186/s43058-026-00980-5","url":null,"abstract":"<p><strong>Background: </strong>Latine people in the U.S. face unequal access to mental healthcare, particularly families and parents with limited English proficiency. Community health workers (CHWs) are well-positioned to increase access to care if integrated into mental health services. The Common Elements Treatment Approach (CETA) is a transdiagnostic evidence-based treatment (EBT) designed to be delivered by lay providers with little to no prior mental health training (i.e., CHWs). CHWs have demonstrated effectiveness in delivering CETA and other EBTs globally; however, there is limited evidence to guide domestic implementation of these models. This study aims to evaluate the implementation of CHW-delivered CETA with Spanish-speaking Latine parents to establish initial feasibility and proof of concept prior to expanding the study of CHW EBT models across other populations and settings.</p><p><strong>Methods: </strong>This protocol outlines a three phase study. Phase 1 involves collaboration with key partners to refine CETA fit for the local context using the ADAPT-ITT model, an implementation framework for EBT refinement. Phase 2 will use mixed methods to assess multilevel contextual determinants during the CETA training period, which includes initial CHW implementation with clients, and using key partner feedback for implementation planning. Phase 3 involves conducting a randomized feasibility pilot of CHW-delivered CETA in Spanish with Latine parents who will be randomized to receive CETA immediately or after a 5-month delay. Key outcomes will include administrative data (i.e., patient attendance and retention over the course of the intervention), patient-report data (i.e., implementation questionnaire, validated mental health symptom measures pre-, during-, and post-intervention), provider-report data (i.e., fidelity, implementation questionnaire), and qualitative interviews to evaluate feasibility, acceptability, and preliminary effectiveness of CHW-delivered CETA.</p><p><strong>Discussion: </strong>This study stands to have a significant public health impact by advancing an innovative mental health model, i.e., CHW-delivered EBTs, that has great potential for expanding mental health service access for marginalized families who are underserved in traditional models of care. This project begins with one population (Spanish-speaking Latine parents) to establish initial feasibility and proof of concept prior to expanding the study of these models to other diverse populations and settings.</p><p><strong>Trial registration: </strong>Prospectively registered on February 4, 2026, at ClinicalTrials.gov no. NCT07390630.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13474750/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148165896","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":"Pre-implementation factors for Active Music Engagement (AME): barriers and facilitators to integrating an evidence-based dyadic intervention into pediatric oncology care.","authors":"Kristin M Story, Elizabeth Harman, Kristin Stegenga, Jelena Golubovic, Sheri L Robb","doi":"10.1186/s43058-026-00979-y","DOIUrl":"10.1186/s43058-026-00979-y","url":null,"abstract":"<p><strong>Background: </strong>Pediatric cancer treatment is a difficult and distressing experience that often results in sustained, interrelated distress in young children and parents, and traumatic stress symptoms for some parents. Few evidence-based interventions address this dyadic distress. Active Music Engagement (AME) is a manualized, evidence-based music play intervention that significantly reduces distress in child/parent dyads and mitigates traumatic stress and improves well-being among highly distressed parents and those experiencing sociodemographic risk. Successfully integrating AME into standard care requires a systematic understanding of implementation factors. This study aimed to identify site-specific barriers and facilitators that influenced successful AME delivery during a recently completed randomized controlled trial, leveraging multidisciplinary team insights to inform the selection of implementation strategies needed to successfully integrate AME into standard care.</p><p><strong>Methods: </strong>Semi-structured interviews (n = 10) were conducted with study personnel responsible for coordination and delivery of AME in a previous multisite randomized controlled trial; this included Advanced Practice Nurses and Board-Certified Music Therapists from our three participating sites. Interview questions were informed by the Consolidated Framework for Implementation Research. Data were analyzed using Rapid Qualitative Analysis and reported following the Planning for and Assessing Rigor in Rapid Qualitative Analysis framework.</p><p><strong>Results: </strong>Findings highlighted that AME was strongly supported by staff with direct exposure to the intervention. Key barriers were primarily structural, including limited clinic space, competing demands in the outpatient setting, and limited awareness of the music therapy role among executive leadership. Key facilitators included the intervention's strong theoretical structure, the perceived high compatibility of AME principles with inpatient care needs, and the value of peer support/collaboration among music therapists. Participants recommended aligning AME delivery with existing inpatient infrastructure, enhancing referral and prioritization systems to manage demand, and refining therapist training to prioritize core theoretical constructs over manualized content.</p><p><strong>Conclusion: </strong>Future research and implementation efforts should focus on integrating AME into routine inpatient pediatric care, where service structure and patient/parent needs compatibility are highest. Strategies should include broader engagement with hospital leadership and parents, a clear plan for staffing/resource allocation, modified intervention training that supports flexible delivery, and the development of structured decision-support tools for targeted patient referral.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13466145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148159357","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":"Champions and early adopters in an implementation-effectiveness study of shared decision making: implications for interpersonal strategies.","authors":"Jennifer L Ridgeway, Megan E Branda, Shubhangi Bagewadi, Victor Montori, Hugh Jackson, Vivek Nautiyal, Ashlee Dagoberg, Yvonne L Gomez, Hooman Gharai, Charanjit S Khurana, Kelly Louks, Derek L Gravholt, Victor M Montori","doi":"10.1186/s43058-026-00977-0","DOIUrl":"10.1186/s43058-026-00977-0","url":null,"abstract":"<p><strong>Background: </strong>Although recommended, shared decision making (SDM) is not widely adopted for primary prevention of cardiovascular (CV) disease. Champions may influence peer adoption if they are enthusiastic and skilled. We describe adoption of an SDM conversation aid for CV risk reduction (CV Prevention Choice) by champions and early adopters in a pragmatic implementation trial and consider their influence on uptake in clinics.</p><p><strong>Methods: </strong>We embedded the SDM tool in the electronic health record in three U.S. health care systems. Eight of their 15 affiliated clinics deployed a champion implementation strategy. Adopters used the SDM tool in ≥ 2 routine clinical encounters. Superusers had ≥ 20 encounters. Penetration was the proportion of adopters among eligible clinicians. Adoption and penetration were assessed in the usual care (early adoption), active implementation, and maintenance implementation phases. Thematic analysis methods were used to analyze qualitative data from individual interviews and periodic reflections.</p><p><strong>Results: </strong>Between May 2021 and January 2025, 37 interviews with clinicians and other staff and 65 periodic reflections were completed. Among 176 clinicians, 55% (n = 97) used CV Prevention Choice at least once and 42% (n = 76) adopted it. Champions and other opinion leaders gave presentations and demonstrated their practice, but targeted individual persuasion and group dialogue were less common, especially when champions appreciated peers' preferences. Champions used the tool more frequently (median = 93, IQR 53-150) than non-champions (median = 16, IQR 4-50), although only 4 of the top 20 users were champions. Clinics with champions had higher penetration rates (50% vs 29%) and lower rates of one-time tool use than clinics without champions (17% vs 33%).</p><p><strong>Conclusion: </strong>Champions, superusers, and other opinions leaders may influence peer adoption of clinical innovations by sharing their experience, but group discourse may be needed to build the case for uptake of innovations. Superusers may be impactful in clinics without formal champions.</p><p><strong>Trial registration: </strong>The protocol described herein was registered with ClinicalTrials.gov on 22 June 2020 (No. NCT04450914).</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13430797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148102380","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":"Challenges in measuring acceptability, appropriateness, and feasibility: a case study in the pediatric intensive care unit.","authors":"Amanda O'Halloran, Robert M Sutton, Meghan Lane-Fall","doi":"10.1186/s43058-026-00967-2","DOIUrl":"10.1186/s43058-026-00967-2","url":null,"abstract":"<p><strong>Background: </strong>Rigorous development and evaluation of implementation outcome measures is needed to advance the field of implementation science. The Acceptability of Intervention Measure (AIM), Feasibility of Intervention Measure (FIM), and the Intervention Appropriateness Measure (IAM) are commonly used, psychometrically validated measures. The objective of the current analysis was to analyze use of the AIM, FIM, and IAM in a single-center pediatric intensive care (PICU) unit study.</p><p><strong>Methods: </strong>This was a secondary analysis of a mixed-methods interventional study. The initial project studied development of a novel cardiac arrest ventilation rate metronome to improve adherence to guideline-recommended ventilation rates during CPR; study components included contextual inquiry, participatory intervention design, and simulation usability testing. Using a purposive sampling strategy for pre-implementation contextual inquiry, eligible participants included multidisciplinary PICU clinicians. The pre-implementation questionnaire asked about current cardiac arrest ventilation practices and perceived acceptability, appropriateness, and feasibility of our proposed intervention (AIM, FIM, and IAM). Five-point scale Likert data were summarized using descriptive statistics (medians and interquartile ranges). A score of > 3 was considered favorable.</p><p><strong>Results: </strong>Of 133 started instances of the pre-implementation survey, 107 were completed (80.5%). The response rate was 30.6% (107/350). Respondents included 34 nurses (31.8%), 18 respiratory therapists (16.8%), and 55 ordering providers (physicians and nurse practitioners; 51.4%). Most respondents (79/107; 73.8%) had previously participated in > 10 PICU cardiac arrests. Appropriateness, acceptability, and feasibility of the ventilation metronome were favorable (appropriateness median: 4 [IQR 4,5]; acceptability median: 4 [IQR 3,5]; feasibility median: 4 [IQR 4,4.5]). For each AIM, IAM, and FIM statement, ≥24.3% of all responses were the highest value on the 5-point scale. Of the 19.5% of survey instances with only partial responses, all but one (26/27; 96.3%) were stopped at the AIM, IAM, FIM matrix of statements.</p><p><strong>Conclusions: </strong>In this single-center PICU study utilizing the previously validated Acceptability of Intervention Measure, Feasibility of Intervention Measure, and Intervention Appropriateness Measure, there were several challenges associated with the use of these scales, including (1) survey responses that were terminated at the portion of the questionnaire presenting the AIM, IAM, and FIM and (2) ceiling effect.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13471310/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148058801","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":"Anticipating implementation: A mixed methods study of future prescribing determinants within an ongoing trial of clinical effectiveness.","authors":"Jennifer Kononowech, Allison Ranusch, Anne E Sales","doi":"10.1186/s43058-026-00969-0","DOIUrl":"10.1186/s43058-026-00969-0","url":null,"abstract":"<p><strong>Background: </strong>The Department of Veterans Affairs Cooperative Studies Program (CSP) added implementation science teams to select trials to accelerate the uptake of research evidence into practice. CSP study #2008, \"Pentoxifylline in Diabetic Kidney Disease\", evaluates whether adding pentoxifylline to usual care reduces the incidence of end-stage renal disease and mortality in patients with diabetic kidney disease. This implementation science sub-study aims to develop a VA-wide implementation plan by identifying key implementation outcomes, identifying and interviewing key stakeholders, and identifying critical barriers and facilitators to implementing findings.</p><p><strong>Methods: </strong>Using an exploratory sequential mixed methods approach in this hybrid type 1 design, we conducted semi-structured interviews with nephrologists, primary care physicians, and pharmacists from ten VA facilities that were enrolling Veterans in the CSP 2008 clinical trial. The interviews were analyzed using the Tailored Implementation in Chronic Disease (TICD) framework. Findings informed a web-based survey distributed to nephrologists, primary care physicians, and pharmacists from 15 additional participating facilities.</p><p><strong>Results: </strong>Interviews identified five facilitators: 1) providers are willing to prescribe an older medication; 2) providers are not concerned about the side effects of pentoxifylline; 3) providers believe that pentoxifylline is inexpensive; 4) providers report widespread comfort with off-label prescribing; and 5) providers state they would be comfortable prescribing pentoxifylline if colleagues they trust recommend it. Survey data confirmed that providers are not concerned with prescribing an older medication, but there were mixed responses about off-label prescribing. Barriers included: 1) concerns about possible drug interactions; 2) providers self-identified as late adopters; 3) concerns about polypharmacy; 4) prescribers prefer newer drugs; and 5) providers want ample evidence that pentoxifylline works for this indication. Survey data confirmed all the identified barriers except for providers identifying as late adopters.</p><p><strong>Conclusions: </strong>Interview data provided early evidence of facilitators that may support pentoxifylline adoption if the trial shows positive results. Survey data reinforced and broadened these insights across a larger clinician sample. Together, these findings will guide development of targeted implementation strategies to support effective and timely dissemination of trial findings across the VA health system.</p><p><strong>Trial registration: </strong>The CSP 2008 study ClinicalTrials.gov ID is NCT03625648.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13455494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148058759","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}