Implementation science communications最新文献

{"title":"The champion paradox: the dual effects of implementation champions on the sustainment of evidence-based practices.","authors":"Hannah Stark, Jane Page","doi":"10.1186/s43058-026-00959-2","DOIUrl":"10.1186/s43058-026-00959-2","url":null,"abstract":"<p><strong>Background: </strong>Champions are individuals who demonstrate strong commitment to promoting sustained implementation efforts through their expertise, enthusiasm, and influence, and are known to enable the implementation of evidence-based educational programs. However, existing research has predominantly examined champion effectiveness during implementation and early sustainment phases, with limited attention to their role in long-term program or innovation sustainment. This study investigated how champions influence organisational capacity for sustained program implementation over extended timeframes.</p><p><strong>Methods: </strong>A multiple case study design examined champion dynamics across three Australian organisations sustaining implementation of the Abecedarian Approach Australia (3a) for 10 or more years. Semi-structured interviews were conducted with 25 participants, including senior leaders, program managers, educational leaders, and practitioners. Thematic analysis informed by critical realist epistemology identified mechanisms through which champions influenced long-term sustainability.</p><p><strong>Results: </strong>Cross-case analysis suggested the presence of what we term a 'champion paradox': the factors that make champions effective in driving implementation may simultaneously create systemic vulnerabilities that can threaten long-term program sustainability. Across these cases, the paradox appeared to operate through three interconnected mechanisms: (1) knowledge concentration, where expertise accumulates in individuals rather than organisational systems; (2) dependency creation, where organisations become reliant on champions for quality assurance, problem-solving, and program continuity; and (3) system capacity prevention, where champion effectiveness conceals organisational need for systematic capacity building. These mechanisms were interpreted as forming a self-reinforcing cycle that may strengthen champion dependency while inhibiting organisational independent capacity.</p><p><strong>Conclusions: </strong>The champion paradox framework invites reconsideration of widespread assumptions that individual champions inherently strengthen organisational implementation capacity. Findings suggest potential value of a shift from champion-dependent to more system-dependent implementation models, with implications for champion selection and development, organisational design, sustainability assessment, and policy frameworks. Implementation strategies may be strengthened by positioning champions as transitional resources focused on building collective organisational capacity rather than as permanent drivers of program quality.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13352853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943932","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 attitudes and organizational support for cervical cancer screening implementation across PEPFAR-supported HIV clinics in Kenya.","authors":"Ludivine Brunissen, Nazha M Diwan, Erica L Kocher, Kara Suvada, Andrew Nagy Adly, Mary Nderitu, Judith Lukorito, Janet Maingi, Sameh R Sakr, Rose Kosgei, Michael H Chung, Leslie Johnson","doi":"10.1186/s43058-026-00958-3","DOIUrl":"10.1186/s43058-026-00958-3","url":null,"abstract":"<p><strong>Background: </strong>Cervical cancer (CC) is the leading cause of cancer-related mortality in sub-Saharan Africa (SSA), disproportionally affecting women living with HIV. Integration of CC screening and treatment of precancerous lesions into established HIV care systems supported by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) has resulted in screening of millions of women and treatment of tens of thousands of precancerous lesions. Despite these gains, research has largely focused on patient-level barriers to screening, with limited attention to provider attitudes, organizational climate, and leadership support within PEPFAR-supported HIV clinics.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted with 46 clinic staff at seven affiliated faith-based HIV clinics overseen by the Coptic Hope Center for Infectious Diseases in Nairobi County, Kenya. The Coptic Hope Center is funded by PEPFAR through the Centers for Disease Control and Prevention (CDC). Clinic staff completed three validated implementation science instruments: the Evidence-Based Practice Attitude Scale (EBPAS-36), the Implementation Climate Scale (ICS), and the Implementation Leadership Scale (ILS). Total and subscale scores were computed, and Mann-Whitney U tests were conducted to examine associations between staff and clinic characteristics and total scores.</p><p><strong>Results: </strong>Clinic staff reported moderate overall EBPAS-36 scores, median (M) = 3.06 on a 0-4 scale, reflecting positive attitudes towards CC screening implementation. The highest ratings were observed for Feedback, Fit, Openness, and Appeal subscales, indicating both the appeal of current screening methods and openness to novel approaches. ICS (M = 2.36) and ILS (M = 3.62 for staff; 2.71 for supervisors) scores indicated moderate to strong organizational and leadership support, though lower scores on Rewards and Selection for EBP subscales suggest limited institutional incentives. No significant differences were observed by clinic type, staff role and years in position.</p><p><strong>Conclusions: </strong>Staff attitudes, leadership engagement, and organizational climate were broadly supportive of CC screening implementation across PEPFAR-supported clinics in Nairobi, Kenya. As countries in SSA seek to sustain the gains achieved through integrated HIV and CC prevention programs and adapt to evolving donor funding landscapes, preserving positive provider environments is essential to effective service delivery and keeping countries on the path toward CC elimination.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13383382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147936063","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 the utility of an abbreviated Consolidated Framework for Implementation Research (CFIR) for rapid qualitative analysis: a suicide prevention program case study.","authors":"Ariel M Domlyn, Jessica Dodge, Paul N Pfeiffer, Claire H Robinson, Lacey Evans, Laura J Damschroder, Madison A Stewart, Brittani Garlick, Jeremy B Sussman, Andrea L Nevedal","doi":"10.1186/s43058-026-00956-5","DOIUrl":"10.1186/s43058-026-00956-5","url":null,"abstract":"<p><strong>Background: </strong>The Consolidated Framework for Implementation Research (CFIR) is widely used and comprehensive. Yet the number of constructs can overwhelm users and slow qualitative analysis. The Pragmatic Context Assessment Tool (pCAT), an abbreviated CFIR-derived instrument with 14 items, may offer a streamlined approach for rapid qualitative analysis. However, the adequacy of this abbreviated tool for capturing key implementation determinants across different contexts remains unexplored.</p><p><strong>Methods: </strong>This study assessed whether the pCAT-derived CFIR constructs adequately capture implementation determinants, using a suicide prevention program case study. Semi-structured interviews (n = 16) were conducted across four VA medical centers with frontline mental health providers about the Suicide Prevention 2.0 Clinical Telehealth program (SP 2.0). Using methodological triangulation, we compared rapid directed content analysis using the 14 pCAT-derived constructs versus the full CFIR. The team summarized each interview using a note template that was organized by site. First, we reviewed the interview notes and used an inductive approach to identify barriers and facilitators (determinants). Determinants were copied into a matrix. Second, we conducted deductive coding of the determinants using the abbreviated pCAT construct list. Third, we expanded coding to the full CFIR when determinants did not fit the limited pCAT set. We used a consensus-based process to identify anticipated determinants and finalize the coding.</p><p><strong>Results: </strong>Of the 14 initial pCAT constructs, 11 were identified in the SP 2.0 dataset, with six representing major cross-site determinants. However, 12 additional constructs from the full CFIR were needed to comprehensively capture all barriers and facilitators, resulting in 23 total relevant constructs. Three pCAT constructs were not identified as relevant determinants. Major facilitators included Innovation Relative Advantage, Communications, Compatibility, and Innovation Deliverer Motivation. Key barriers encompassed Structural Characteristics (work infrastructure), Innovation Deliverer Capability, Reflecting & Evaluating, and Innovation Design. Most added constructs (8 of 12) belonged to the updated CFIR's Individual Roles and Characteristics domain.</p><p><strong>Conclusion: </strong>The pCAT provides a useful starting point for rapid CFIR analysis when contexts are similar to its original development, capturing most relevant constructs while requiring significantly less analytical resources. However, the abbreviated approach provides incomplete assessment compared to full CFIR analysis. We recommend using pCAT for rapid implementation practice assessments when timely, high level results are prioritized over comprehensiveness but utilizing full CFIR when thorough determinant evaluation is paramount for research purposes.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13352689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147936033","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 unnecessary antibiotic use for upper respiratory tract infections in ambulatory HIV care in Mozambique: a two-arm parallel cluster-randomized controlled hybrid type II trial.","authors":"Candido Faiela, Troy D Moon, Mohsin Sidat, Esperança Sevene","doi":"10.1186/s43058-026-00957-4","DOIUrl":"10.1186/s43058-026-00957-4","url":null,"abstract":"<p><strong>Background: </strong>Antibiotics are commonly overused to treat upper respiratory tract infections (URTIs) in HIV-infected adults in primary healthcare settings, even though viruses cause most URTIs. Therefore, a de-implementation of unnecessary antibiotic prescribing for URTIs was implemented in these settings. Thus, this study aimed to evaluate a strategy to de-implement unnecessary antibiotic prescriptions among ambulatory HIV-infected adults with acute URTI symptoms using the reach-effectiveness-adoption-implementation-maintenance (RE-AIM) framework.</p><p><strong>Methods: </strong>We conducted a three-phase (pre-implementation, adaptation-implementation, and post-implementation), hybrid type II effectiveness-implementation study utilizing a two-arm, parallel cluster-randomized controlled trial design involving HIV-infected adults recruited from six primary healthcare facilities (intervention 1^o de Maio, Bagamoyo, and Matola-2, whilst Alto Maé, Hulene, and Ndlavela as control) in Mozambique. Quantitative data were collected from June to September 2024, while qualitative data were collected from October to December 2024. The intervention included a clinical decision support algorithm (CDSA), training and supervision of clinicians, and prescription audits. The intervention was evaluated using four dimensions of the RE-AIM framework: reach, effectiveness, adoption, and implementation. We used Pearson's chi-square test and relative risk to assess the effect of the intervention.</p><p><strong>Results: </strong>Among 387 HIV-infected adults approached, 379 (97.9%) were successfully recruited, with 182 (48%) in the intervention and 197 (52%) in the control group. Among the recruited patients, the mean age was 44 ± 12.3 years, and 286 (75.5%) were female. The intervention resulted in 33.2% fewer antibiotics prescribed compared to controls (RR = 0.41; 95% CI: 0.31-0.55). The antibiotic prescribing rate was 23.1% in the intervention and 56.3% in the control group. All three intervention sites (100%) and all clinicians (100%) demonstrated a commitment to de-implementing antibiotics. The implementation protocol was delivered as planned. Almost all participants (n = 21) in focus group discussions (FGD) were either satisfied or very satisfied with the intervention. They reported the effectiveness of the CDSA and the change in attitudes and antibiotic prescribing practices.</p><p><strong>Conclusions: </strong>Based on the RE-AIM evaluation, the implementation of the planned intervention was successful as it effectively promoted de-implementation and reduced unnecessary antibiotics for URTIs. The strategy employed in this study should be evaluated in other areas to determine if the same findings are observed elsewhere.</p><p><strong>Trial registration: </strong>ISRCTN, ISRCTN88272350. Registered 16 May 2024, https://www.isrctn.com/ISRCTN88272350 .</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13371453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147864849","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":"Managing urinary incontinence: evaluating the role of practice facilitators in enhancing quality improvement and digital integration in primary care.","authors":"Nipher Malika, Shona Olalere Oluwatola, Gabriela Alvarado, Sangeeta Ahluwalia","doi":"10.1186/s43058-026-00936-9","DOIUrl":"10.1186/s43058-026-00936-9","url":null,"abstract":"<p><strong>Background: </strong>Practice facilitation is an established strategy for advancing quality improvement in primary care, particularly in chronic disease management. However, knowledge gaps remain regarding its long-term impact, integration of digital tools (e.g., telehealth), and barriers encountered during implementation. This study aimed to address these gaps by evaluating the Agency for Healthcare Research and Quality (AHRQ)-funded Managing Urinary Incontinence (MUI) Initiative, which supported five US institutions in implementing evidence-based, nonsurgical treatments for urinary incontinence (UI) in women.</p><p><strong>Methods: </strong>Over a two-year period, we conducted virtual semi-structured interviews and focus groups with 15 practice facilitators from each grantee institution, all of whom worked with a total of 270 practices. Discussions explored their evolving roles, implementation processes, challenges encountered, and strategies for supporting UI care. Data were audio-recorded, transcribed, and subjected to thematic analysis in Dedoose, using a team-developed codebook with dual independent coders.</p><p><strong>Results: </strong>Five major themes emerged: (1) practice facilitator role conceptualization varied across settings and evolved over time; (2) facilitators were central to supporting process improvements with tailored resources; (3) technology integration, such as telehealth and electronic health records (EHRs), was increasingly leveraged but unevenly adopted; (4) substantial barriers included navigating institutional bureaucracy and securing physician champions amidst competing demands; and (5) facilitators implemented strategies for sustaining practice change beyond the funded intervention. Despite successes, facilitators struggled with limitations of time, resources, and systemic constraints.</p><p><strong>Conclusions: </strong>The findings provide actionable insights into the facilitation process for implementing evidence-based UI care, highlighting the importance of adaptive facilitator roles, technology use, and strategies for overcoming barriers and sustaining improvements. This research contributes to practical approaches for implementation in primary care settings.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13335138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846755","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 to the World Health Organization package of essential non-communicable disease interventions (PEN) during scale-up in Nepal's primary healthcare system: a mixed methods study.","authors":"Felix Teufel, Chandani Singh Nakarmi, Sushmita Mali, Soniya Shrestha, Yunika Acharya, Bikram Poudel, Anupama Bishwokarma, Alina Bharati, Asmita Adhikari, Aarati Dhakal, Binuka Kulung Rai, Sangita Manandhar, Surakshya Kc, Dinesh Timalsena, Phanindra Prasad Baral, Meghnath Dhimal, Sashi Silwal, Sanju Bhattarai, Donna Spiegelman, Elizabeth C Rhodes, Archana Shrestha","doi":"10.1186/s43058-026-00922-1","DOIUrl":"10.1186/s43058-026-00922-1","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The World Health Organization package of essential non-communicable disease interventions (PEN) comprises evidence-based interventions for primary healthcare systems in low- and middle-income countries (LMICs). Implementation fidelity, defined as the degree to which an intervention is delivered as intended, is crucial for intervention effectiveness. Yet, across LMICs, evidence on fidelity to PEN is scarce and mostly limited to pilot studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We evaluated fidelity to PEN during national scale-up in Nepal using a convergent parallel mixed methods study design based on the Conceptual Framework for Implementation Fidelity. Data were collected in 2021 from 105 randomly selected primary healthcare facilities across all seven provinces of Nepal. Using direct observation of 172 non-communicable disease (NCD) patient visits, we quantified health service providers' adherence to PEN protocol 1 (hypertension and diabetes management) and protocol 2 (lifestyle counselling). We calculated overall fidelity scores and examined their potential determinants in multivariable regression models using generalized estimating equations. Moreover, we conducted semi-structured interviews with 47 providers and 33 NCD patients to elicit their views on factors affecting fidelity. We analyzed verbatim interview transcripts using thematic analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;PEN-trained health service providers managing hypertension and diabetes patients (protocol 1) mainly focused on asking about medication (76% of patient visits), measuring blood pressure (82%), and adjusting medication (85%). Blood glucose was measured in 28% of eligible patient contacts. Other care steps, including cardiovascular risk estimation, were mostly skipped. Lifestyle counselling for NCD patients (protocol 2) most frequently entailed salt restriction advice (41%) and instructions on medications (62%) and follow-up appointments (69%). Overall fidelity scores for protocols 1 and 2 were 20.8 and 22.1 out of 100, respectively. In multivariable regressions, prior PEN training was associated with 25% (95%-CI: 1-54%; p = 0.04) and 32% (95%-CI: -4-80%; p = 0.08) higher fidelity scores for protocols 1 and 2, respectively. Qualitative data suggested that providers and patients were generally engaged by the intervention, though various factors impede fidelity, including negative user experiences and limited availability of medical supplies. Strategies to improve fidelity to PEN that participants suggested were intervention manuals, supervision and monitoring visits, brief refresher trainings, and community outreach programs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Implementation fidelity to PEN during scale-up in Nepal was often limited to a few diagnostic and therapeutic actions. Next to enhancing user experience, ensuring a reliable supply of diagnostic equipment and medicines will likely be crucial to sustainably improve NCD care. Fidelity as","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13317323/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847138","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":"Large language models for deductive qualitative content analysis in dementia-focused embedded pragmatic clinical trials: A comparative methodological study.","authors":"Jeffrey Turner, Spencer Phillips Hey, Zachary G Baker, Vincent Mor, Jennifer L Sullivan","doi":"10.1186/s43058-026-00953-8","DOIUrl":"10.1186/s43058-026-00953-8","url":null,"abstract":"<p><strong>Introduction: </strong>Thematic coding helps researchers characterize intervention implementation in embedded pragmatic clinical trials (ePCTs), particularly interventions for older adults with dementia and care partners. However, manual coding is time-consuming, requiring multiple researchers. Because implementation science relies on systematic identification of determinants, barriers, and facilitators, advances in Artificial Intelligence (AI), specifically large language models (LLMs), may automate this process meaningfully by accelerating implementation evaluations within ePCTs. We developed and tested an automated algorithm using Chat GPT-4o and Chat GPT-4o-mini to achieve human-level performance coding interview transcripts.</p><p><strong>Methods: </strong>We created a Python-based system that uses LLMs to process and code semi-structured interview transcripts about implementation challenges in translating dementia interventions into healthcare systems. The system matches excerpts to an existing codebook. Multiple iterations, including expert review, were used to refine accuracy and efficiency.</p><p><strong>Results: </strong>The LLM consistently coded more excerpts than humans. In the third iteration (V3), the LLM captured 61.7% of human-coded excerpts, with matching rates reaching as high as 72.6% for individual transcripts. Matching was higher for descriptive codes, 63.7%, than interpretive codes, 57.7%. The LLM identified 206 correct coded excerpts that human coders missed. In the fourth iteration (V4), GPT-4o outperformed GPT-4o-mini: descriptive code matching reached 89% (e.g. \"Site Characteristics\"), compared to 69% for GPT-4o-mini with the R1+R2 85% threshold. GPT-4o showed a weak, but positive correlation (r = 0.230) between transcript word count and matching agreement, while 4o-mini showed a moderate, but negative correlation (r = -0.452). The LLM workflow yielded a 97% reduction in time and a 99% reduction in cost per transcript.</p><p><strong>Conclusion: </strong>This study compared an LLM-powered workflow with human coding for thematic analysis. The LLM aligned strongly with human coders. While error rates necessitate human oversight, time and cost reduction, and ability to identify missed excerpts make it a potentially reliable supplementary tool. Although ePCTs and implementation science share complementary goals, they differ in focus, this flexible approach enhances efficiency and scalability, with acceptable accuracy. It streamlines the qualitative research workflow from outlining to the analysis of implementation processes in real-world settings and may accelerate existing implementation approaches while minimizing implementation resources.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13352772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846591","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 and proof-of-concept of a complex intervention to support appropriate imaging for musculoskeletal pain: the Betti programme.","authors":"Nicole Lindner, Kristina Buch, Konrad Hierasimowicz, Reinhard Loose, Michael Walz, Karl-Friedrich Schüttler, Veronika van der Wardt, Annika Viniol","doi":"10.1186/s43058-026-00949-4","DOIUrl":"10.1186/s43058-026-00949-4","url":null,"abstract":"<p><strong>Background: </strong>Inappropriate diagnostic imaging for musculoskeletal pain is common and causes patient harm and unnecessary costs. Existing interventions frequently target single conditions and stakeholders and show limited integration into routine consultations. This study aimed to develop and test a complex intervention to de-implement low-value care by supporting appropriate imaging decisions for musculoskeletal pain in primary care.</p><p><strong>Methods: </strong>We developed Betti (\"Better Imaging\") following the Medical Research Council framework (MRC) for complex interventions. The development was both theory- and evidence-based and included: specification and iterative refinement of a programme theory (logic model); a comprehensive literature review; qualitative interviews with patients; structured expert feedback; and a proof-of-concept test with general practitioners and patients. The Behaviour-Change-Wheel informed intervention components. We addressed early implementation considerations throughout the development process.</p><p><strong>Results: </strong>Findings from the literature review revealed a wide range of intervention approaches and components. Overall effectiveness was mixed. Reductions in imaging were reported more frequently in multicomponent interventions that included both physician-facing components and patient-facing materials. Qualitative interviews with people with musculoskeletal pain highlighted that expectations of primary care consultations are highly individual and shaped by context (e.g., prior experiences). Expert feedback emphasised communication and reassurance to support imaging decisions. Informed by these findings, we developed Betti, multicomponent intervention comprising: (1) a multimedia training module for general practitioners, (2) a clinical decision support system based on guideline recommendations across musculoskeletal pain, and (3) multimedia patient information materials. In the proof-of-concept test, patients and general practitioners perceived Betti as well structured and supportive. However, implementation challenges emerged: patients were not directed to the materials, indicating that Betti was not integrated into the consultation as intended. These findings led us to refine the programme theory, explicitly positioning consultation-integrated delivery and physician-mediated handover explicitly as essential for our program theory.</p><p><strong>Conclusions: </strong>Betti is a theory- and evidence-based, stakeholder-developed intervention. Early findings show high acceptability but underscore consultation-integrated delivery as critical. The study adds transferable implementation insights for de-implementing low-value imaging by specifying mechanisms, determinants, and strategy choices beyond tool use, informing further refinement and future feasibility and effectiveness-implementation evaluation.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"7 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847005","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":"Strengthening implementation of syringe services programs in Florida: insights from a statewide survey and social network analysis.","authors":"Marina Plesons, Shelby Meaders, Britt DeVries, Megan E Murphy, Tim Santamour, Hansel E Tookes, Tyler S Bartholomew","doi":"10.1186/s43058-026-00955-6","DOIUrl":"10.1186/s43058-026-00955-6","url":null,"abstract":"<p><strong>Background: </strong>Syringe services programs (SSPs) are an evidence-based intervention for preventing infectious diseases and reducing the risk of overdose. Florida passed legislation that authorizes the implementation of SSPs (via the Infectious Disease Elimination Act; IDEA) in 2019. However, little is known about how organizational contexts and interorganizational networks shape adoption, implementation, and sustainment of this intervention.</p><p><strong>Methods: </strong>We conducted a cross-sectional, statewide survey of organizations engaged in implementing SSPs and related services between March and May 2025, using a community-based participatory research approach with the Florida Harm Reduction Collective. The survey assessed SSP implementation, barriers and facilitators, implementation climate, organizational sustainability, and interorganizational networks. Data were analyzed using descriptive statistics, t-tests for group comparisons, and social network analysis to examine relational structures and organizational centrality.</p><p><strong>Results: </strong>A total of 29 organizations representing 18 counties responded to the survey. Eight counties reported operating a sanctioned SSP, while none of the remaining counties had ordinances or champions supporting SSP adoption. Stigma and political resistance, lack of funding, and restrictive laws and policies were cited as major barriers to SSP implementation. There was an overall weak implementation climate for SSPs (mean = 1.4 on a 0-4 scale), though it was significantly stronger in counties with operational SSPs (1.8 vs. 1.1, p = 0.01). Organizations reported relatively strong organizational sustainability (mean = 5.6 on a 1-7 scale), with high ratings for program adaptation and lower scores for funding stability. Social network analysis revealed that the Florida Harm Reduction Collective served as the most central and influential node connecting diverse organizations statewide.</p><p><strong>Conclusions: </strong>Our findings highlight both structural barriers (e.g., funding, stigma, restrictive policies) and organizational strengths (e.g., adaptability, network connectivity) in Florida's harm reduction landscape. Addressing policy barriers, expanding and stabilizing funding availability, and leveraging statewide networks will be critical for strengthening implementation of SSPs in Florida and expanding equitable access to harm reduction services for people who use drugs.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13288805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846920","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":"Clinically relevant contextual factors for enrolling patients in a pain intervention across multiple health care centers.","authors":"Lindsay A Ballengee, Trevor A Lentz, Devon Check, Leah L Zullig, Susan N Hastings, Rebecca North, Heather A King, Chanee Lynch, Steven Z George","doi":"10.1186/s43058-026-00943-w","DOIUrl":"10.1186/s43058-026-00943-w","url":null,"abstract":"<p><strong>Background: </strong>Low back pain (LBP) negatively impacts public health and places a significant burden on healthcare systems. Non-pharmacologic interventions are recommended as first-line treatments for LBP, yet their uptake remains low due to implementation challenges. This study examined clinically relevant contextual factors that influenced implementation of two care pathways for LBP.</p><p><strong>Methods: </strong>We applied the Basel Approach for Contextual Analysis (BANANA) to examine 10 contextual factors across 17 sites implementing two low back pain care pathways: a sequenced care pathway integrating physical therapy with psychologically informed treatment via telehealth, and a navigator pathway facilitating access to non-pharmacologic pain treatments. A parallel mixed-methods design (QUAN + qual) evaluated contextual influences on enrollment. Quantitative analysis used a clustered Cox proportional hazards model with robust variance to assess time to minimum enrollment. Qualitative interviews with 12 high- and low-referring providers, guided by the Consolidated Framework for Implementation Research, explored organizational context, implementation conditions, and pathway impact.</p><p><strong>Clinicaltrials: </strong>gov ID: NCT04411420.</p><p><strong>Results: </strong>Sites in both pathways reached enrollment targets in a similar timeframe (~16 months), though navigator sites showed less variability and enrolled their first patient faster (17.2 vs. 47.5 days). In the clustered survival analysis, urban community-based outpatient clinics demonstrated faster time to minimum enrollment (HR = 3.07, 95% CI 1.31-7.18) compared with medical centers for both pathways. The number (HR = 1.50, 95% CI 1.39-1.63) and years of experience (HR = 1.06 per year, 95% CI 1.02-1.10) of physical therapists in the sequenced care pathway were associated with faster time to minimal enrollment but navigator pathway-related factors were not associated with enrollment speed. Qualitative themes included provider comfort with referring, perceived benefits of holistic care, the role of leadership support, and importance of patient feedback. Barriers identified included communication gaps, site-level variability, and logistical challenges for specific populations.</p><p><strong>Conclusions: </strong>This analysis highlights the role of contextual factors in shaping enrollment within embedded care pathways for LBP. Tailoring implementation strategies to local contexts, care pathway characteristics, strengthening provider engagement, and enhancing feedback mechanisms may improve the reach and scalability of non-pharmacologic interventions in real-world healthcare settings.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13288567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847081","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}