Implementation science communications最新文献

{"title":"Specifying behavioural and strategy components of de-implementation efforts targeting low-value prescribing practices in secondary health care.","authors":"Jennifer Dunsmore, Eilidh Duncan, Sara MacLennan, James N'Dow, Steven MacLennan","doi":"10.1186/s43058-024-00624-6","DOIUrl":"10.1186/s43058-024-00624-6","url":null,"abstract":"<p><strong>Background: </strong>/Aims De-implementation, including the removal or reduction of unnecessary or inappropriate prescribing, is crucial to ensure patients receive appropriate evidence-based health care. The utilization of de-implementation efforts is contingent on the quality of strategy reporting. To further understand effective ways to de-implement medical practices, specification of behavioural targets and components of de-implementation strategies are required. This paper aims to critically analyse how well the behavioural targets and strategy components, in studies that focused on de-implementing unnecessary or inappropriate prescribing in secondary healthcare settings, were reported.</p><p><strong>Methods: </strong>A supplementary analysis of studies included in a recently published review of de-implementation studies was conducted. Article text was coded verbatim to two established specification frameworks. Behavioural components were coded deductively to the five elements of the Action, Actor, Context, Target, Time (AACTT) framework. Strategy components were mapped to the nine elements of the Proctor's 'measuring implementation strategies' framework.</p><p><strong>Results: </strong>The behavioural components of low-value prescribing, as coded to the AACTT framework, were generally specified well. However, the Actor and Time components were often vague or not well reported. Specification of strategy components, as coded to the Proctor framework, were less well reported. Proctor's Actor, Action target: specifying targets, Dose and Justification elements were not well reported or varied in the amount of detail offered. We also offer suggestions of additional specifications to make, such as the 'interactions' participants have with a strategy.</p><p><strong>Conclusion: </strong>Specification of behavioural targets and components of de-implementation strategies for prescribing practices can be accommodated by the AACTT and Proctor frameworks when used in conjunction. These essential details are required to understand, replicate and successfully de-implement unnecessary or inappropriate prescribing. In general, standardisation in the reporting quality of these components is required to replicate any de-implementation efforts.</p><p><strong>Trial registration: </strong>Not registered.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"5 1","pages":"88"},"PeriodicalIF":0.0,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11304722/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141903815","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: Implementing evidence-based practices to improve primary care for high-risk patients: study protocol for the VA high-RIsk VETerans (RIVET) type III effectiveness-implementation trial.","authors":"Elvira E Jimenez, Ann-Marie Rosland, Susan E Stockdale, Ashok Reddy, Michelle S Wong, Natasha Torrence, Alexis Huynh, Evelyn T Chang","doi":"10.1186/s43058-024-00623-7","DOIUrl":"10.1186/s43058-024-00623-7","url":null,"abstract":"","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"5 1","pages":"86"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11295385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876887","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":"Understanding barriers and facilitators to integrated HIV and hypertension care in South Africa.","authors":"Leslie C M Johnson, Suha H Khan, Mohammed K Ali, Karla I Galaviz, Fatima Waseem, Claudia E Ordóñez, Mark J Siedner, Athini Nyatela, Vincent C Marconi, Samanta T Lalla-Edward","doi":"10.1186/s43058-024-00625-5","DOIUrl":"10.1186/s43058-024-00625-5","url":null,"abstract":"<p><strong>Background: </strong>The burden of hypertension among people with HIV is high, particularly in low-and middle-income countries, yet gaps in hypertension screening and care in these settings persist. This study aimed to identify facilitators of and barriers to hypertension screening, treatment, and management among people with HIV in primary care clinics in Johannesburg, South Africa. Additionally, different stakeholder groups were included to identify discordant perceptions.</p><p><strong>Methods: </strong>Using a cross-sectional study design, data were collected via interviews (n = 53) with people with HIV and hypertension and clinic managers and focus group discussions (n = 9) with clinic staff. A qualitative framework analysis approach guided by COM-B and the Theoretical Domains Framework were used to identify and compare determinants of hypertension care across stakeholder groups.</p><p><strong>Results: </strong>Data from clinic staff and managers generated three themes characterizing facilitators of and barriers to the adoption and implementation of hypertension screening and treatment: 1) clinics have limited structural and operational capacity to support the implementation of integrated care models, 2) education and training on chronic care guidelines is inconsistent and often lacking across clinics, and 3) clinicians have the goal of enhancing chronic care within their clinics but first need to advocate for health system characteristics that will sustainably support integrated care. Patient data generated three themes characterizing existing facilitators of and barriers to clinic attendance and chronic disease self-management: 1) the threat of hypertension-related morbidity and mortality as a motivator for lifestyle change, 2) the emotional toll of clinic's logistical, staff, and resource challenges, and 3) hypertension self-management as a patchwork of informational and support sources. The main barriers to hypertension screening, treatment, and management were related to environmental resources and context (i.e., lack of enabling resources and siloed flow of clinic operations) and patients' knowledge and emotions (i.e., lack of awareness about hypertension risk, fear, and frustration). Clinical actors and patients differed in perceived need to prioritize HIV versus hypertension care.</p><p><strong>Conclusions: </strong>The convergence of multi-stakeholder data highlight key areas for improvement, where tailored implementation strategies targeting motivations of clinic staff and capacity of patients may address challenges to hypertension screening, treatment, and management recognized across groups.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"5 1","pages":"87"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11295645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876888","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":"Learning Health System to rapidly improve the implementation of a school physical activity policy.","authors":"Cassandra Lane, Nicole Nathan, John Wiggers, Alix Hall, Adam Shoesmith, Adrian Bauman, Daniel Groombridge, Rachel Sutherland, Luke Wolfenden","doi":"10.1186/s43058-024-00619-3","DOIUrl":"10.1186/s43058-024-00619-3","url":null,"abstract":"<p><strong>Background: </strong>Learning Health Systems (LHS) - characterised by cycles of evidence generation and application - are increasingly recognised for their potential to improve public health interventions and optimise health impacts; however there is little evidence of their application in the context of public health practice. Here, we describe how an Australian public health unit applied a LHS approach to successfully improve a model of support for implementation of a school-based physical activity policy.</p><p><strong>Methods: </strong>This body of work was undertaken in the context of a strong research-practice partnership. Core LHS capabilities included: i) partnerships and stakeholder engagement; ii) workforce development and learning health communities; iii) multi-disciplinary scientific expertise; iv) practice data collection and management system; v) evidence surveillance and synthesis; and vi) governance and organisational processes of decision making. Three cycles of data generation and application were used. Within each cycle, randomised controlled trials conducted in NSW primary schools were used to generate data on the support model's effectiveness for improving schools' implementation of a government physical activity policy, its delivery costs, and process measures such as adoption and acceptability. Each type of data were analysed independently, synthesised, and then presented to a multi-disciplinary team of researchers and practitioners, in consult with stakeholders, leading to collaborative decisions for incremental improvements to the support model.</p><p><strong>Results: </strong>Cycle 1 tested the first version of the support model (composed of five implementation strategies targeting identified barriers of policy implementation) and showed the model's feasibility and efficacy for improving schools' policy implementation. Data-informed changes were made to enhance impact, including the addition of three implementation strategies to address outstanding barriers. Cycle 2 (now, testing a package of eight implementation strategies) established the model's effectiveness and cost-effectiveness for improving school's policy implementation. Data-informed changes were made to reduce delivery costs, specifically adapting the costliest strategies to reduce in-person contact from external support personnel. Cycle 3 showed that the adaptations minimised the relative cost of delivery without adversely impacting on the effect.</p><p><strong>Conclusions: </strong>Through this process, we identified an effective, cost-effective, acceptable and scalable policy implementation support model for service delivery. This provides important information to inform or support LHS approaches for other agencies seeking to optimise the health impact of evidence-based interventions.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"5 1","pages":"85"},"PeriodicalIF":0.0,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11292924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141861846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of the Technical Assistance Engagement Scale: a modified Delphi study.","authors":"Victoria C Scott, Jasmine Temple, Zara Jillani","doi":"10.1186/s43058-024-00618-4","DOIUrl":"10.1186/s43058-024-00618-4","url":null,"abstract":"<p><strong>Background: </strong>Technical assistance (TA) is a tailored approach to capacity building that is commonly used to support implementation of evidence-based interventions. Despite its widespread applications, measurement tools for assessing critical components of TA are scant. In particular, the field lacks an expert-informed measure for examining relationship quality between TA providers and recipients. TA relationships are central to TA and significantly associated with program implementation outcomes. The current study seeks to address the gap in TA measurement tools by providing a scale for assessing TA relationships.</p><p><strong>Methods: </strong>We utilized a modified Delphi approach involving two rounds of Delphi surveys and a panel discussion with TA experts to garner feedback and consensus on the domains and items that compose the TA Engagement Scale.</p><p><strong>Results: </strong>TA experts represented various U.S. organizations and TA roles (e.g., provider, recipient, researcher) with 25 respondents in the first survey and 26 respondents in the second survey. The modified Delphi process resulted in a scale composed of six domains and 22 items relevant and important to TA relationships between providers and recipients.</p><p><strong>Conclusion: </strong>The TA Engagement Scale is a formative evaluation tool intended to offer TA providers the ability to identify strengths and areas for growth in the provider-recipient relationship and to communicate about ongoing needs. As a standard measurement tool, it lends a step toward more systematic collection of TA data, the ability to generate a more coherent body of TA evidence, and enables comparisons of TA relationships across settings.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"5 1","pages":"84"},"PeriodicalIF":0.0,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11288084/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141794188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using the consolidated framework for implementation research to identify church leaders' perspectives on contextual determinants of community-based colorectal cancer screening for Black Kentuckians.","authors":"Aaron J Kruse-Diehr, Derek Cegelka, Carlee Combs, Rose Wood, Elizabeth Holtsclaw, Jerod L Stapleton, Lovoria B Williams","doi":"10.1186/s43058-024-00621-9","DOIUrl":"10.1186/s43058-024-00621-9","url":null,"abstract":"<p><strong>Background: </strong>Black Kentuckians experience more deleterious colorectal cancer (CRC) outcomes than their White counterparts, a disparity that could be reduced by increased screening in Black communities. Previous research has shown that Black Kentuckians may not be equitably informed of different CRC screening options by health care providers, making community-based screening a potentially effective option among this disparate population. We used the Consolidated Framework for Implementation Research (CFIR) to identify church leaders' perspectives of contextual factors that might influence community-based screening and explore the feasibility of using church-based screening outreach.</p><p><strong>Methods: </strong>Six participants were selected, based on leadership roles and interest in CRC screening, from five established Louisville-area church partners that had previously participated in community health initiatives. Data were collected, both virtually and in-person, in Summer 2021 using semi-structured interview guides developed with guidance from the CFIR Guide that focused on domains most relevant to community-based interventions. Data were transcribed verbatim, coded by two independent researchers, and member checked for accuracy.</p><p><strong>Results: </strong>Data were aligned primarily with six CFIR constructs: key stakeholders, champions, opinion leaders, tension for change, compatibility, and culture. Participants noted a strong tension for change in their community due to perceptions of inadequacy with clinical approaches to CRC screening. Additionally, they stressed the importance of identifying individuals both within the church who could champion CRC screening and help implement program activities, as well as those outside the church who could collaborate with other local organizations to increase participant reach. Finally, participants agreed that faith-based CRC screening aligned with church culture and would also likely be compatible with overall community values.</p><p><strong>Conclusions: </strong>Overall, our church partners strongly endorsed the need for, and importance of, community-based CRC screening. Given a history of successful implementation of health promotion programs within our partner churches, it is highly likely that a CRC screening intervention would also be effective. Findings from this study will be used to identify implementation strategies that might positively impact a future faith-based CRC screening intervention, as well as CFIR constructs that are most positively associated with CRC screening completion.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"5 1","pages":"83"},"PeriodicalIF":0.0,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11271043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141763068","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":"What works in implementing shared medical appointments for patients with diabetes in primary care to enhance reach: a qualitative comparative analysis from the Invested in Diabetes study.","authors":"Jodi Summers Holtrop, Dennis Gurfinkel, Andrea Nederveld, Julia Reedy, Claude Rubinson, Bethany Matthews Kwan","doi":"10.1186/s43058-024-00608-6","DOIUrl":"10.1186/s43058-024-00608-6","url":null,"abstract":"<p><strong>Background: </strong>Diabetes is a serious public health problem affecting 37.3 million Americans. Diabetes shared medical appointments (SMAs) are an effective strategy for providing diabetes self-management support and education in primary care. However, practices delivering SMAs experience implementation challenges. This analysis examined conditions associated with successful practice implementation of diabetes SMAs in the context of participation in a pragmatic trial.</p><p><strong>Methods: </strong>Mixed methods study using qualitative and quantitative data collected from interviews, observations, surveys, and practice-reported data, guided by the practical, robust implementation and sustainability model (PRISM). Data were analyzed using qualitative comparative analysis (QCA). Successful implementation was defined as meeting patient recruitment targets (Reach) during the study period. Participants were clinicians and staff members from 22 primary care practices in Colorado and Missouri, USA.</p><p><strong>Results: </strong>The first necessary condition identified from the QCA was the presence of additional resources for patients with diabetes in the practice. Within practices that had these additional resources, we found that a sufficiency condition was the presence of an effective key person to make things happen with the SMAs. A second QCA was conducted to determine conditions underlying the presence of the effective key person (often performing functions of an implementation champion), which revealed factors including low or managed employee turnover, a strong baseline practice culture, and previous experience delivering SMAs.</p><p><strong>Conclusions: </strong>Identification of key factors necessary and sufficient for implementation of new care processes is important to enhance patient access to evidence-based interventions. This study suggests that practice features and resources have important implications for implementation of diabetes SMAs. There may be opportunities to support practices with SMA implementation by enabling the presence of skilled implementation champions.</p><p><strong>Trial registration: </strong>Registered at clinicaltrials.gov under trial ID NCT03590041, registered on July 18, 2018.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"5 1","pages":"82"},"PeriodicalIF":0.0,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11267890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141763033","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 fidelity of intravenous ferric carboxymaltose administration for iron deficiency anaemia in pregnancy: a mixed-methods study nested in a clinical trial in Nigeria.","authors":"Opeyemi R Akinajo, Kristi Sidney Annerstedt, Aduragbemi Banke-Thomas, Chisom Obi-Jeff, Nadia A Sam-Agudu, Ochuwa A Babah, Mobolanle R Balogun, Lenka Beňová, Bosede Bukola Afolabi","doi":"10.1186/s43058-024-00609-5","DOIUrl":"10.1186/s43058-024-00609-5","url":null,"abstract":"<p><strong>Background: </strong>Iron deficiency anaemia is common among pregnant women in Nigeria. The standard treatment is oral iron therapy, which can be sub-optimal due to side effects. Intravenous ferric carboxymaltose (FCM) is an evidenced-based alternative treatment with a more favourable side effect profile requiring administration according to a standardized protocol. In this study, we assessed the fidelity of administering a single dose of FCM according to protocol and identified factors influencing implementation fidelity.</p><p><strong>Methods: </strong>We used a mixed-method approach with a sequential explanatory design nested in a clinical trial across 11 facilities in Lagos and Kano States, Nigeria. Guided by a conceptual framework of implementation fidelity, we quantitatively assessed adherence to protocol by directly observing every alternate FCM administration, using an intervention procedure checklist, and compared median adherence by facility and state. Qualitative fidelity assessment was conducted via in-depth interviews with 14 skilled health personnel (SHP) from nine purposively selected health facilities, using a semi-structured interview guide. We analyzed quantitative data using descriptive and inferential statistics in Stata and used thematic analysis to analyze the transcribed interviews in NVivo.</p><p><strong>Results: </strong>A total of 254 FCM administrations were observed across the 11 study sites, with the majority in secondary (63%), followed by primary healthcare facilities (PHCs) (30%). Overall, adherence to FCM administration as per protocol was moderate (63%) and varied depending on facility level. The lowest level of adherence was observed in PHCs (36%). Median, adherence level showed significant differences by facility level (p = 0.001) but not by state (p = 0.889). Teamwork and availability of protocols are facilitation strategies that contributed to high fidelity. However, institutional/ logistical barriers are contextual factors that influenced the varied fidelity levels observed in some facilities.</p><p><strong>Conclusions: </strong>Collaborative teams and access to operating protocols resulted in high fidelity in some facilities. However, in some PHCs, fidelity to FCM was low due to contextual factors and intervention complexities, thereby influencing the quality of delivery. In Nigeria, scale-up of FCM will require attention to staff strength, teamwork and availability of administration protocols, in order to optimize its impact on anaemia in pregnancy.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"5 1","pages":"81"},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11264421/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141753527","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":"Quantitative outcomes of a type 2 single arm hybrid effectiveness implementation pilot study for hypertension-HIV integration in Botswana.","authors":"Thato Moshomo, Tendani Gaolathe, Mareko Ramotsababa, Onkabetse Julia Molefe-Baikai, Edwin Mogaetsho, Evelyn Dintwa, Pooja Gala, Ponego Ponatshego, Laura M Bogart, Nabila Youssouf, Khumo Seipone, Amelia E Van Pelt, Kara Bennett, Shabbar Jaffar, Maliha Ilias, Veronica Tonwe, Kathleen Wirth Hurwitz, Kago Kebotsamang, Karen Steger-May, Lisa R Hirschhorn, Mosepele Mosepele","doi":"10.1186/s43058-024-00620-w","DOIUrl":"10.1186/s43058-024-00620-w","url":null,"abstract":"<p><strong>Background: </strong>Successful HIV treatment programs have turned HIV into a chronic condition, but noncommunicable diseases such as hypertension jeopardize this progress. Hypertension control rates among people with HIV (PWH) are low owing to gaps in patient awareness, diagnosis, effective treatment, and management of both conditions at separate clinic visits. Integrated management, such as in our study, InterCARE, can enhance HIV-hypertension integration and blood pressure (BP) control.</p><p><strong>Methods: </strong>Our pilot study was conducted in two Botswana HIV clinics between October 2021 and November 2022. Based on our formative work, we adopted three main strategies; Health worker training on HTN/cardiovascular disease (CVD) management, adaptation of HIV Electronic Health Record (EHR) for HTN/CVD care, and use of treatment partners to support PWH with hypertension for implementation. We employed the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework to assess implementation effectiveness and outcomes for BP control at baseline, 6 and 12 months. HIV viral load (VL) suppression was also measured to assess impact of integration on HIV care.</p><p><strong>Results: </strong>We enrolled 290 participants; 35 (12.1%) were lost to follow-up, leaving 255 (87.9%) at 12-months. Median age was 54 years (IQR 46-62), and 77.2% were females. Our interventions significantly improved BP control to < 140/90 mmHg (or < 130/80 mmHg if diagnosis of diabetes or chronic kidney disease), from 137/290 participants, 47.2% at baseline to 206/290 participants, 71.0%, at 12 months (p < 0.001). Among targeted providers, 94.7% received training, with an associated significant increase in counseling on exercise, diet, and medication (all p < 0.001) but EHR use for BP medication prescribing and cardiovascular risk factor evaluation showed no adoption. In the intention-to-treat analysis, HIV VL suppression at 12 months decreased (85.5% vs 93.8%, p = 0.002) due to loss to follow-up but the per protocol analysis showed no difference in VL suppression between baseline and 12 months (97.3% vs 93.3%, p = 0.060).</p><p><strong>Conclusion: </strong>The InterCARE pilot study demonstrated that low-cost practical support measures involving the integration of HIV and hypertension/CVD management could lead to improvements in BP control. These results support the need for a large implementation and effectiveness trial.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT05414526. Registered 18th May 2022.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"5 1","pages":"80"},"PeriodicalIF":0.0,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11264446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141749915","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":"Feasibility of an implementation strategy for preventing falls in homecare services.","authors":"Siv Linnerud, Linda Aimée Hartford Kvæl, Maria Bjerk, Kristin Taraldsen, Dawn A Skelton, Therese Brovold","doi":"10.1186/s43058-024-00615-7","DOIUrl":"10.1186/s43058-024-00615-7","url":null,"abstract":"<p><strong>Background: </strong>Falls among older adults represent a major health hazard across the world. In 2022, the World Falls Guidelines was published, summarising research evidence and expert recommendations on how to prevent falls, but we need more knowledge on how the evidence can be successfully implemented into routine practice. In this study we used an implementation strategy co-created by healthcare providers, older adults who had fallen and researchers, to facilitate uptake of fall prevention recommendations. This current study aimed to evaluate the feasibility of this co-created implementation strategy in homecare services and provide information on the intervention and measurements for a full-scale cluster-randomized trial.</p><p><strong>Methods: </strong>This study was a single-armed feasibility study with an embedded mixed-method approach completed in two city districts of Oslo, Norway, over a period of ten weeks. The co-created implementation strategy consists of a package for implementing national recommendations for preventing falls, empowering leaders to facilitate implementation, establish implementation teams, competence improvement and implementation support. City districts established implementation teams who were responsible for the implementation. Feasibility was assessed both qualitatively and quantitatively, using focus group interviews with implementation team members and individual interviews with leaders and staff members and the Feasibility of Intervention Measure (FIM). Qualitative data were analysed using thematic analysis and the Normalisation Process Theory.</p><p><strong>Results: </strong>Qualitative data were collected from 19 participants: 12 implementation team members, 2 leaders and 5 staff members. 8 of the implementation team members responded to FIM. The analysis revealed four themes: 1) Fostering consensus through tailored implementation and discussions on fall prevention, 2) The importance of multi-level and interdisciplinary collaboration in fall prevention implementation, 3) Minimizing perceived time usage through utilization of existing areas for implementation activities, and 4) Reflective monitoring demonstrates the importance of facilitation and structure in the implementation strategy. For FIM, there were a high level of agreement related to how implementable, possible, doable, and easy to use the implementation strategy was.</p><p><strong>Conclusions: </strong>Overall, we found the implementation strategy to be feasible to enhance uptake of fall prevention recommendations in the Norwegian homecare services. To succeed with the implementation, a dedicated implementation team should receive support through the implementation process, they should choose small implementation activities to enhance fall prevention competence and managers should possess implementation knowledge.</p><p><strong>Trial registration: </strong>The trial is registered in the Open Science Registry: https://doi.org/10.17605","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"5 1","pages":"79"},"PeriodicalIF":0.0,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11264773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141728396","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}