Implementation science communications最新文献

{"title":"Clinic practitioner and support staff perspectives on implementation strategies to increase patient referrals to diabetes self-management education and support services.","authors":"Aaron J Kruse-Diehr, Borsika A Rabin, Jessica Elliott, Vance Drakeford, Laura Wright, Brent McKune, Russell E Glasgow, Key C Douthitt, James W Keck, Mary E Lacy","doi":"10.1186/s43058-026-00978-z","DOIUrl":"10.1186/s43058-026-00978-z","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of diabetes in Appalachian Kentucky is among the highest in the United States. Diabetes self-management education and support (DSMES) is a cost-effective, evidence-based intervention that improves patient outcomes yet is underutilized due to multilevel barriers. Throughout 2023-2024, we implemented a 9-month learning collaborative with two regional healthcare systems to increase DSMES referrals and documented their clinical strategies. At study conclusion, we assessed clinical perceptions of each strategy's feasibility, acceptability, appropriateness, as well as likelihood of sustainment of the clinical DSMES referral program.</p><p><strong>Methods: </strong>After 6 months of participation and at study conclusion, participants (N = 13) described timing and intended outcomes for activities, which were then mapped to relevant Expert Recommendations for Implementing Change (ERIC) domains. Intended outcomes were coded to Practical, Robust Implementation and Sustainability Model (PRISM) contextual factors and implementation outcomes, and refinements to implementation strategies were documented iteratively throughout the study. At study end, participants (n = 9) individually assessed each strategy's acceptability, appropriateness, and feasibility, as well as its potential for sustainment. Assessments used 5-point unidimensional Likert scales that were summed and averaged, with higher numbers indicating greater favorability.</p><p><strong>Results: </strong>To help facilitate DSMES referrals, clinic learning collaborative participants most frequently employed implementation strategies within the ERIC stakeholder interrelationshipsand supporting clinicians domains. Specific activities included creating a new electronic health record referral system, utilizing morning huddles to identify eligible patients, and creating patient face sheets for providers to review during visits. Strategies were refined minimally, primarily to increase provider and staff participation and patient and provider acceptability of activities. Across all strategies, mean scores for acceptability, appropriateness, and feasibility were mostly high, as was the overall likelihood of sustainment.</p><p><strong>Conclusions: </strong>The process of developing and refining implementation strategies to fit context was associated with positive clinical perceptions of acceptability, appropriateness, feasibility, and sustainability. Systematically documenting strategies along with their intended outcome targets throughout an intervention can help contextualize the dynamic nature of implementation and inform future scale-up.</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/PMC13455143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148058735","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":"Updating the critical steps of the quality implementation framework: an umbrella review of reviews.","authors":"Kathrine Hald, Anne Gulbech Ording, Martin Jorsal, Julie Midtgaard, Louise A Ellis, Samantha Spanos, Lisa Pagano, Georgia Fisher, Abraham Wandersman, Jeffrey Braithwaite, Søren Paaske Johnsen","doi":"10.1186/s43058-026-00954-7","DOIUrl":"10.1186/s43058-026-00954-7","url":null,"abstract":"<p><strong>Background: </strong>The Quality Implementation Framework (QIF) is a widely used process model in implementation science (IS). Since its publication in 2012, the field of IS has expanded considerably, yet QIF has never undergone formal revision. Given recent advances and the complexity in implementation research and practice, this study examines whether QIF continues to capture the full scope of implementation quality and its challenges.</p><p><strong>Methods: </strong>An umbrella review of reviews was conducted on literature published between 2012 and 2025. Eligible articles reported on the development, application, or update of implementation frameworks within healthcare or social science. Data were deductively mapped to the four phases and 14 steps of the original QIF and inductively mapped to identify knowledge not included in the original framework.</p><p><strong>Results: </strong>A total of 15 reviews met the inclusion criteria. Most aligned with the core structure of QIF, supporting its continued relevance. However, several reviews highlighted the need to add a pre-implementation phase focusing on evidence appraisal, and a post-implementation phase addressing sustainability. Four cross-cutting domains (service user, intervention deliverer, context, and technology) were identified as critical factors throughout the implementation process.</p><p><strong>Conclusions: </strong>An updated version of QIF is proposed, building on the original framework while introducing two new phases and four cross-cutting domains. This expanded model reflects recent developments in the literature and provides more comprehensive guidance to support implementation across complex real-world settings; it has important implications for implementation research and implementation practice.</p><p><strong>Registration: </strong>PROSPERO registration number: CRD42023475994.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13242111/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148045019","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":"Application of Innovation Tournament methodology to inform de-implementation strategies: lessons learned in addressing mammography overscreening in older women.","authors":"Rachel C Shelton, Parisa Tehranifar, Savannah P Alexander, Emmy Burroughs, Anita G Karr, Nathalie Moise","doi":"10.1186/s43058-026-00950-x","DOIUrl":"10.1186/s43058-026-00950-x","url":null,"abstract":"<p><strong>Background: </strong>De-implementation is a critical, understudied area within implementation science, particularly de-implementation strategy development. Aligned with most national guidelines, de-implementation of routine mammography screening among older women (without considering patient preferences, health, life expectancy), is a compelling area for advancing de-implementation science. While previously applied for implementation, this research seeks to advance understanding of Innovation Tournaments (InTs) as a participatory methodology to inform de-implementation strategy development.</p><p><strong>Methods: </strong>Building on formative qualitative research and informed by User-Centered Design (UCD), we conducted an InT to generate, confirm, and refine de-implementation strategies among purposively selected providers and administrators across two healthcare systems in New York City. InT development began 07/2021 and launched 11/2022-05/2023. A key challenge in co-creating, launching, and maintaining the InT was difficulty communicating about de-implementation, especially given differences in opinion about guidelines across provider specialties. To address this complexity, we collaborated with experts in InTs, shared decision-making, healthcare informatics, communication, creative content development, and UCD. Based on input during the UCD process and to facilitate engagement across participants with varying opinions, we expanded the InT to assess ideas and opinions about mammography guidelines for older women and appropriateness of de-implementation, in addition to assessing de-implementation strategy ideas. We conducted descriptive analyses of InT forum engagement data and content analysis of forum posts/comments.</p><p><strong>Results: </strong>Of 47 participants who entered the InT website, 36 engaged in the forum (voted, commented, or posted). Participants voted 256 times on posted ideas/opinions/strategies and comments, submitted 71 comments, and posted 13 new ideas/opinions/strategies. Most participants engaged in the forum during their initial visit to the InT, with limited engagement over time. Content analysis of posts/comments identified de-implementation strategy categories largely aligned with the ERIC taxonomy (e.g., patient education, provider training/reminders), though system-level strategies specific to de-implementation emerged.</p><p><strong>Conclusions: </strong>Findings advance de-implementation methods by indicating importance of formative qualitative research and UCD to inform InT development and engagement (particularly if stakeholders disagree on de-implementation appropriateness). Unique considerations include: how best to seed InT content; challenges in generating new strategies that meaningfully expand upon formative qualitative research findings; and time and resources needed to develop, elicit and sustain stakeholder engagement over time.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13411346/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148044994","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":"Application of a typology for sustainment of Public health interventions using real-world case studies.","authors":"Karen Lee, Alix Hall, Adrian Bauman, Luke Wolfenden, Melanie Crane, Nicole Nathan","doi":"10.1186/s43058-026-00961-8","DOIUrl":"10.1186/s43058-026-00961-8","url":null,"abstract":"<p><strong>Background: </strong>The sustainment of effective, scaled-up public health interventions is key to ensuring that resources are not wasted and opportunities to improve population health maintained. An initial typology of practical approaches to sustain interventions were developed, however it is unknown how frequently these approaches are applied in the real world. This study aimed to explore how scaled-up obesity preventions interventions have addressed sustainment and whether their sustainment approaches could be classified into the sustainment typologies.</p><p><strong>Methods: </strong>Building on previously published study that identified 90 obesity prevention interventions scaled up to at least city-wide level, we extracted relevant information from each of the interventions pertinent to their development, funding, delivery, magnitude of scale and length of sustainment. Interventions were further coded into one of two sustainment typologies, that is self-sustainment and supported sustainment. Descriptive statistics were used to describe the characteristics of the intervention and their sustainment approach.</p><p><strong>Results: </strong>From the dataset of 90 interventions, a quarter of the interventions were identified as using the 'self-sustainment' approach, with the remaining three quarters of interventions coded as 'supported sustainment'. Self-sustaining interventions were mostly delivered and funded by private or community organisations while supported sustainment interventions were government organisations. Over a third of the supported sustainment interventions had been found to be scaled up without prior research.</p><p><strong>Conclusions: </strong>This hypothesis generating study revealed the presence of self-sustained and externally supported approaches to sustainment with some differences. Self-sustaining interventions were found to employ a commercialisation strategy to facilitate their sustainment and were delivered at larger magnitudes of scale. In contrast, supported interventions were mostly developed and delivered by government organisations and delivered at smaller magnitudes of scale. Our results suggests that government developed and delivered interventions tend to remain dependent on ongoing government support, rather than evolving into self-sustaining models. It is also concerning that governments may be supporting the sustainment of interventions where their evidence base is questionable. Importantly, future research needs to explore the characteristics of programs that are sustained and identify the most effective strategies for supported sustainment.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13403398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148038367","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":"Comparative effectiveness of non-reflective and reflective strategies to favor de-implementation of low-value prescribing for the primary prevention of cardiovascular disease in primary care: the DE-imFAR cluster randomized implementation trial.","authors":"Alvaro Sanchez, Jose I Pijoan, Rita Sainz de Rozas, Itxasne Lekue, Ricardo San Vicente, Jose Antonio Quindimil, Rafael Rotaeche, Arritxu Etxeberria, Carmela Mozo, Monica Martinez-Cengotitabengoa, Monica Monge, Cristina Gómez-Ramírez, Lourdes Vivanco, Vanesa Martin, Nerea Merino-Inda, Marta Llarena, Marta Gonzalez Saenz de Tejada, Arturo Garcia-Alvarez","doi":"10.1186/s43058-026-00968-1","DOIUrl":"10.1186/s43058-026-00968-1","url":null,"abstract":"<p><strong>Background: </strong>The DE-imFAR study aims to compare the effectiveness of several de-implementation strategies targeting clinicians' decision-making processes to reduce potentially inappropriate prescribing (PIP) of statins for cardiovascular disease (CVD) primary prevention.</p><p><strong>Methods: </strong>A partially randomized, cluster implementation trial with an active comparator group, involving family physicians (FPs) with non-zero incidence rates of PIP of statins in 2021, was conducted in 13 integrated healthcare organizations (IHOs) in the Basque Health Service. All eligible FPs (n = 621) were exposed to (1) a non-reflective decision assistance (DA) strategy based on reminders. FPs from two IHOs were randomized to additionally receive one of two increasingly intensive reflective strategies: (2) a knowledge dissemination decision information (DI) strategy (n = 59), or (3) a DI strategy plus audit and feedback (A&F) self-reflective decision (SRD) strategy (n = 59). The main outcome was the change from baseline to 12 months after deployment in the likelihood of receiving new PIP of statins and advice on lifestyle modifications, estimated with generalized mixed effects models, in 45- to 74-year-old low cardiovascular risk patients with elevated cholesterol levels but no diagnosed CVD.</p><p><strong>Results: </strong>After FPs' exposure to the corresponding strategies, rates of statin PIP decreased significantly in all groups (p < 0.001). Concerning study's main observational comparisons between strategies, though the reduction obtained by the DI and SRD strategies were 33% (adjusted OR: 0.77; 95% CI: 0.58-1.01) and 6% (aOR: 0.94; 95% CI: 0.73-1.23) higher compared to the change from the DA, estimated differences did not reach statistical significance (p = 0.07). When comparing the two reflective strategies together (DI + SRD) with the non-reflective (DA), a significant difference (p = 0.038) was observed, being the odds of receiving PIP of statins 19% lower (aOR: 0.81; 95% CI: 0.66-0.99). In the experimental comparison between reflective strategies (SRD vs. DI), providing A&F to FPs showed no additional effect (p = 0.30).</p><p><strong>Conclusions: </strong>De-implementation strategies that targeted clinical decision-making were effective in reducing PIP of statins for CVD primary prevention. Strategies that targeted reflective thinking and increased awareness of low-value prescribing showed a trend toward greater effectiveness.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier NCT04022850. Registered 17 July 2019.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13383474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148007610","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":"Construct validity, reliability and measurement invariance of the intervention usability scale - insights from two psychological interventions in primary health care.","authors":"Kasperi Mikkonen, Markus S Hannukkala, Jari Lahti, Samuli I Saarni, Suoma E Saarni","doi":"10.1186/s43058-026-00951-w","DOIUrl":"10.1186/s43058-026-00951-w","url":null,"abstract":"<p><strong>Background: </strong>Usability has been proposed as a critical factor influencing the implementation of psychological interventions in routine practice. The Intervention Usability Scale (IUS) has previously been adapted from the System Usability Scale to assess the perceived usability of psychological interventions. However, the construct validity, reliability and theoretical consistency of the IUS remain unclear. This study evaluates the psychometric properties of the Finnish version of the IUS in two cognitive-behavioral therapy-based interventions delivered in primary healthcare.</p><p><strong>Methods: </strong>A translated Finnish version of the IUS was administered to healthcare professionals trained in either low-intensity guided self-help (n = 921) or high-intensity face-to-face cognitive-behavioral therapy programs (n = 455). Exploratory and confirmatory factor analyses were conducted to examine the underlying structure of the IUS. Configural, metric and scalar invariance was assessed across multiple demographic subgroups. Reliability was assessed using McDonald's Omega.</p><p><strong>Results: </strong>Exploratory analyses suggested a three-factor structure, contradicting previous findings supporting a unidimensional or two-factor models. Confirmatory factor analysis in the guided self-help dataset showed moderate model fit after treating identified issues with correlated residuals and item cross-loadings. Measurement invariance was established across all assessed demographic characteristics. However, the identified factor structure did not replicate in the face-to-face cognitive-behavioral therapy dataset, raising concerns about the generalizability of the measure across different interventions. Reliability estimates were acceptable in the guided self-help dataset but weaker in the face-to-face cognitive-behavioral therapy dataset.</p><p><strong>Conclusions: </strong>The findings suggest that the IUS does not robustly measure usability as previously proposed. The measure's factor structure varies across different interventions, and its alignment with theoretical models of usability is unclear. These results question the applicability of the IUS for assessing usability in psychological interventions. If usability is to be measured in this context, a domain-specific approach may be necessary. A roadmap for further measure development is outlined. Until further validation is conducted, the use of the IUS for assessing psychological interventions to guide intervention implementation is not recommended.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13383391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148007628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cultural adaptation of compensatory cognitive training for Nigerian mental health services: a participatory approach balancing fidelity and contextual fit.","authors":"Olabisi E Oladipo, Abiodun O Adewuya, Bolanle A Ola, Adeniran Okewole, Ayantunde Ayankola, Arit Esangbedo, Azizat Lebimoyo","doi":"10.1186/s43058-026-00965-4","DOIUrl":"10.1186/s43058-026-00965-4","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Cognitive impairment substantially constrains functional recovery in psychosis, persisting despite adequate symptom control. Although Compensatory Cognitive Training (CCT) demonstrates efficacy in high-income contexts, its direct transfer to resource-constrained settings encounters multiple barriers: linguistic complexity, cultural distance, extended session requirements, and specialist workforce dependencies. This study documents a systematic cultural adaptation process through which CCT was reconfigured for Nigerian mental health services whilst preserving core therapeutic mechanisms.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A ten-day participatory workshop convened 28 multistakeholder participants (clinicians, researchers, service users, implementation scientists, designers, and language specialists) organised into four interlinked committees. The adaptation drew upon layered theoretical frameworks, including the Ecological Validity Framework, Framework for Reporting Adaptations and Modifications-Enhanced, and principles balancing fidelity against contextual responsiveness. Modified Delphi procedures (80% consensus threshold) governed decisions according to hierarchical criteria: preserve cognitive principles, enhance accessibility, ensure feasibility. Post-adaptation assessment employed a five-domain fidelity matrix examining core model preservation, content validity, structural integrity, cultural fit, and implementation feasibility. Independent stakeholder validation involved both service users (n = 10) and mental health providers (n = 13) who had not participated in the adaptation process.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The adapted twelve-session Nigerian CCT manuals retained all five cognitive domains and compensatory philosophy whilst incorporating extensive modifications: linguistic simplification with strategic Nigerian Pidgin integration, contextually grounded examples reflecting Nigerian daily life, session condensation (90-120 min to 60 min), complete visual redesign, and comprehensive task-shifting supports. Fidelity assessment suggested strong preservation of essential intervention features (overall M = 4.76/5.0). Stakeholder validation yielded exceptional ratings for language clarity (M = 4.9/5.0), cultural relevance (M = 4.9/5.0), and acceptability (M = 4.8/5.0). All service users expressed willingness to participate; 92% of providers endorsed sixty-minute session deliverability. Implementation barriers appeared predominantly structural, concerning space (54%) and staffing (46%), rather than content-related.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Theory-informed participatory adaptation appears capable of preserving intervention fidelity whilst enhancing both cultural appropriateness and implementation feasibility. The adapted CCT-Nigeria materials demonstrate content readiness for pilot implementation, though successful scale-up will likely require health system strengthening that addresses infrastructure, ","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13383451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147990077","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":"Study protocol for the: HIV enhanced access testing in emergency department program using a systems analysis and improvement approach (HEATED-SAIA) cluster randomized trial.","authors":"Adam R Aluisio, Gideon Loevinsohn, Elwyn Chondo, Arthur Nderitu, Mercy Bruba, Ahmed Adam, Janette Baird, Omar Galárraga, Marta Wilson-Barthes, Malabika Sarker, Kishorchandra Mandaliya, John Kinuthia, Rose Bosire, Benjamin Wachira, Zachary Gross, Peter Cherutich, George Wanje, R Scott McClelland, McKenna C Eastment","doi":"10.1186/s43058-026-00964-5","DOIUrl":"10.1186/s43058-026-00964-5","url":null,"abstract":"<p><strong>Background: </strong>In Kenya, incident and undiagnosed HIV infections are concentrated among populations who are inadequately reached by existing HIV services. These difficult-to-reach populations include men, adolescents and young adults, people who engage in sex work, and people who use substances, populations which also frequently access unscheduled emergency care. Though Kenya's guidelines recommend evaluation of HIV testing and prevention services (HTS) needs during outpatient emergency encounters, emergency departments have not been well leveraged for HIV testing and prevention programming.</p><p><strong>Methods: </strong>This cluster randomized trial will evaluate the Systems Analysis and Improvement Approach (SAIA) as an implementation strategy to improve HIV screening, testing, and linkage to treatment and prevention from emergency care settings in the three counties in the Coast region of Kenya. SAIA is a multicomponent strategy for continuous care enhancement that empowers frontline healthcare personnel to improve services in their clinical settings. Ten public facilities will be cluster-randomized in a 1:1 ratio, with half exposed to the SAIA implementation strategy and the other half following usual procedures. The trial will be evaluated across Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) domains through quantitative systems-level data, qualitative insights from key stakeholders, and micro-costing data. Analyses will utilize Poisson regression and mixed-effect models to compare inter-arm HIV testing and prevention services (HTS) cascade outcomes. Framework matrix and coincidence analyses will be used to understand determinants of program success. Cost-effectiveness of the SAIA strategy will be assessed using incremental cost-effectiveness ratios and scale-up modeling.</p><p><strong>Discussion: </strong>Emergency care interactions represent an underutilized opportunity to deliver evidence-based HIV testing and prevention services to difficult-to-reach populations. This trial will robustly assess the potential of the SAIA implementation strategy to improve and expand HTS from emergency care settings, and generate key data relevant to program effectiveness, feasibility and scalability in the Kenya context to inform public health programming.</p><p><strong>Trial registration: </strong>This study is registered with ClinicalTrials.gov (NCT06747221). Registration date: December 18, 2024.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13214408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The 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}