Annice Brown, Sharon M. Kelly, Tracy Agee, Jeffrey Hsu, Nicholas Schweizer, Geetanjali Chander, Larry W. Chang, Sheree Schwartz & Oluwaseun Falade-Nwulia
University of Washington affiliated authors are displayed in bold.
Published: June 2025
Catherine M. Corbin, Mark G. Ehrhart, Eric C. Brown, Jill Locke, Clayton R. Cook, Gregory A. Aarons & Aaron R. Lyon
University of Washington affiliated authors are displayed in bold.
Published: May 2025
Employee behaviors that strategically support implementation (i.e., implementation citizenship behavior [ICB]) theoretically promote the adoption and high-fidelity use of evidence-based practices (EBPs). ICB (e.g., helping colleagues overcome implementation barriers) may vary across contexts, including schools where children are most likely to access and receive mental and behavioral health services. Pragmatic measures are needed to advance nascent research on school-based ICB and inform how these behaviors can be used to support successful implementation. The current study expanded the Implementation Citizenship Behavior Scale (ICBS) to create and validate the School Implementation Citizenship Behavior Scale (SICBS) in a sample of elementary school teachers implementing evidence-based prevention programs to support children’s mental and behavioral health.
Based on subject matter expert feedback, items were refined from the original ICBS and items for two new subscales (taking initiative, advocacy) were created for the SICBS. A sample of 441 public school teachers from 52 elementary schools in the Midwest and Western United States of America completed a survey that included the SICBS and additional measures to assess convergent and divergent validity. SICBS was refined and validated via examination of item characteristics curves to reduce items and develop a pragmatic instrument, confirmatory factor analyses to evaluate the hypothesized measurement structure, and assessment of convergent and divergent validity.
The original two ICBS subscales (helping others, keeping informed) were retained, and two new three-item subscales resulted from item reduction analyses (taking initiative, advocacy). The hypothesized second-order factor model was generally well fit to the data (CFI = .99, TLI = .99, RMSEA = .09), all first- (λs = .85-.96) and second-order factor loadings (λs = .93-.95) were high. All SICBS subscales demonstrated acceptable reliability (αs = .88-.92). Convergent validity was evidenced by moderate correlations with organizational citizenship behavior items (rs = .42-.49). Divergent validity was demonstrated by weak correlations with teachers’ beliefs about teaching (rs = .31-.38) and null correlations with most school demographics.
Results support the structural, convergent, and divergent validity of the 12-item, 4-factor SICBS. The SICBS provides a deeper understanding of individual implementer actions that may serve as implementation mechanisms or outcomes.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
K. M. Sileo, R. K. Wanyenze, A. Anecho, R. L. Luttinen, K. Weston, B. Mukasa, S. C. Mukama, S. H. Vermund, S. L. Dworkin, J. F. Dovidio, B. S. Taylor & T. S. Kershaw
University of Washington affiliated authors are displayed in bold.
Published: May 2025
Health workers play a critical role in providing gender-sensitive HIV care. However, without adequate training, they may inadvertently reinforce negative gender norms that hinder engagement in care. To improve ART services in sub-Saharan Africa, effective implementation strategies, including trainings, are essential.
This study evaluated the feasibility and acceptability of a novel 4-session, gender-sensitivity training for HIV health and lay workers in rural and peri-urban Uganda. We conducted a pilot quasi-experimental controlled trial in 2022–23, utilizing data from three sources: process data from 144 providers and 238 clients, qualitative post-intervention focus groups and interviews with 53 training attendees, and stakeholder interviews with 12 community leaders and facilitators. We employed thematic analysis guided by the Consolidated Framework for Implementation Research (CFIR).
The training was highly rated by attendees via brief post-session surveys, with 99% of sessions deemed satisfactory. Qualitative feedback indicated that the sessions were perceived as appropriate for addressing providers’ gaps in delivering gender-sensitive care and as beneficial for participants. High feasibility was evidenced by 100% of intervention steps delivered (fidelity checklists), 86% attendance (attendance logs), and 98.6% and 94.8% recruitment of eligible providers and clients (study records), respectively. Through qualitative exit focus groups, factors that positively affected acceptability and feasibility included tactics to gain support from supervisors, the use of experienced facilitators and active learning approaches, and the consideration of the health system context in delivery (e.g., cadre mix, location). Suggested improvements encompassed addressing interpersonal and structural barriers to client-centered care, incorporating community sensitization, streamlining content, and enhancing mentorship follow-ups. Stakeholders recognized the training’s alignment with national health priorities and emphasized the need for clarity regarding its integration with existing training curricula and ongoing stakeholder engagement.
This study underscores the acceptability and feasibility of a gender-sensitivity training program for HIV providers; further evaluation of the program is warranted. Identified factors influencing implementation can inform enhancements to gender-focused training initiatives to improve the quality of HIV services and enhance client engagement and health outcomes.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Nok Chhun, Dorothy I. Mangale, Kawango Agot, Winnie A. Owade, Julie Kadima, Jacinta Badia, James K. Kibugi, Pamela K. Kohler, Grace John-Stewart & Kristin Beima-Sofie
University of Washington affiliated authors are displayed in bold.
Published: May 2025
Differentiation of HIV services, a client-centered strategy, may improve care outcomes among adolescents and youth living with HIV (AYLHIV). Understanding health provider perceptions of barriers and facilitators that influence implementation can optimize adoption and sustainment of health systems interventions.
The Data-informed Stepped Care (DiSC) study was a cluster randomized controlled trial of a stepped care intervention in 24 HIV care facilities in Kenya. At each visit, providers used an assessment tool to allocate AYLHIV to services according to level of need. Stable clients were allocated to differentiated service delivery (DSD) with less frequent visits. Intensified services, including behavioral counseling, were provided for those with greater likelihood of loss to follow-up, mental health issues, or viral non-suppression. We conducted focus group discussions (FGDs) with providers across 12 intervention sites between January-February 2023. FGDs used a semi-structured interview guide, grounded in the Consolidated Framework for Implementation Research, which were audio-recorded and transcribed. Transcripts were analyzed using a team-based rapid turnaround approach to characterize key determinants influencing adoption, reach, and fidelity.
Providers were enthusiastic about, and quick to adopt, the DiSC intervention. They found the DiSC tool easy to use and felt it provided a relative advantage by improving service delivery efficiency and prioritizing time with higher need AYLHIV. Providers noted the importance of tool flexibility to align with changing national guidelines. They expressed concerns about compatibility with existing workflows at facilities exclusively using electronic medical record (EMR) systems, suggesting EMR integration will be needed for intervention sustainment. AYLHIV eligible for DSD benefited from clinic visit intervals that aligned with the school calendar, which posed a challenge for reaching AYLHIV in more intensive steps. Provider collective efficacy was important in consistent implementation of DiSC and was facilitated by continuous quality improvement meetings, access to knowledge and information, and perceived intervention effectiveness. Supportive leadership was an important driver of implementation success, through availing space for mental health counseling sessions and time for client-provider interactions outside standard operating hours.
Consideration of alignment with national policy, integration into clinic workflows, school schedules, and leadership engagement, will be important for sustained use of differentiated care interventions.
ClinicalTrials.gov, NCT05007717. Registration date: July 13, 2021.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Joseph Sila, Anjuli Dawn Wagner, Felix Abuna, Julia C Dettinger, Ben Odhiambo, Nancy Ngumbau, George Oketch, Enock Sifuna, Laurén Gómez, Sarah Hicks, Bryan J. Weiner, Grace John-Stewart & John Kinuthia
University of Washington affiliated authors are displayed in bold.
Published: May 2025
Pre-exposure prophylaxis (PrEP) is recommended for HIV prevention in pregnant and postpartum women at substantial ongoing risk for HIV. In resource-limited settings, there exist gaps in the integration of PrEP into antenatal care.
We conducted a difference-in-differences analytic approach (3 months pre- and 3 months post) between January 2022 and July 2022 in 8 facilities (4 intervention and 4 comparison) in western Kenya. During the 6-month period, we tested a combination of 2 stakeholder selected implementation strategies – retraining health providers and fast tracking PrEP clients– to improve PrEP delivery. All study facilities dispensed PrEP in the Maternal and Child health clinics (MCH). We evaluated absolute changes in: PrEP penetration, PrEP fidelity, client PrEP knowledge, client satisfaction, and client waiting and service times as outcomes specified a priori while PrEP offer and HIV testing were outcomes specified post hoc. We measured acceptability and appropriateness by providers of the implementation strategies using AIM and IAM respectively.
We observed statistically significant improvements in PrEP penetration and PrEP offer (p < 0.05) and non-significant improvements in fidelity. PrEP penetration increased 6 percent points (p = 0.002), PrEP offer increased nearly 6 percentage points (p = 0.002), and PrEP fidelity increased 4 percentage points (p = 0.202) in intervention vs comparison facilities. Client PrEP knowledge increased 0.45 out of 7 total points (p < 0.001) and PrEP screening increased 13 percentage points (p = 0.001). We observed no significant changes in service time (0.13-min increase; p = 0.249), waiting time (0.03-min decrease; p = 0.796), or client satisfaction (0.04/24 total point decrease; p = 0.849) in intervention vs comparison facilities. HIV testing did not significantly change (7 percentage point decrease, p = 0.305). The implementation strategy bundle was deemed appropriate and acceptable by the providers (appropriateness: 18.5/20; acceptability: 18.5/20). Overall, the implementation strategy bundle was associated with larger increases in implementation outcomes among women receiving a visit other than their first ANC visit, as well as among sites without stockouts of HIV test kits.
A stakeholder-selected implementation strategy bundle that included retraining healthcare workers, fast tracking PrEP clients to reduce waiting time, and PrEP dispensing in MCH improved several implementation outcomes without significantly affecting waiting time or reducing service time.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Scott Halliday, Lydia A. Chwastiak, Kaitlin Zinsli, Ramona Emerson, Teagan Wood, Meena S. Ramchandani, Kenneth Sherr, Judith I. Tsui, Bradley H. Wagenaar, Deepa Rao, & Julia C. Dombrowski
University of Washington affiliated authors are displayed in bold.
Published: May 2025
Low-barrier HIV care is an evidence-based intervention to improve HIV outcomes among those who have complex barriers to care, but the walk-in model poses challenges to integrating behavioral health services. We evaluated the acceptability and feasibility of a Collaborative Care Model (CoCM) for treatment of depression and opioid use disorder in a low-barrier clinic.
In a sequential explanatory mixed methods pilot study, we accessed data from patient records to generate a care cascade for the number of patients enrolled in the first six months of the program and conducted individual interviews with patients and staff to interpret the care cascade findings.
Among 175 patients who visited the clinic, 36% were screened for, 24% were referred to, 15% completed an intake for, and 9% engaged in CoCM. The interviews revealed that screening was limited by a lack of clarity among staff about services offered in CoCM, staff forgetting the screening process, and limited time during patent visits. Referrals were limited by low buy-in among staff and patient complexity. Intakes were limited by time and space constraints in the care setting and competing acute patient needs. The care manager’s ability to embody the clinic’s culture facilitated engagement among patients who completed intakes.
Staff perceived CoCM to be acceptable and feasible to implement, but only in the context of multiple barriers to implementation and challenges to systematic screening and measurement-based care.
Not applicable.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Mercy Owuor, Beatrice Wamuti, David A Katz, Wenjia Liu, Harison Lagat, Edward Kariithi, Brienna Naughton, Hanley Kingston, Mary Mugambi, Rose Bosire, Sarah Masyuko, Carey Farquhar, and Bryan J Weiner
University of Washington affiliated authors are displayed in bold.
Published: March 2025
This study explores factors affecting community-level demand for assisted partner services (APS) and HIV testing services (HTS) in western Kenya.
This is a multilevel qualitative analysis conducted as part of the APS Scale-up Study, a hybrid type 2 implementation-effectiveness study of APS integrated within routine HTS. For this analysis, in-depth phone interviews assessed demand for APS and factors influencing decisions to participate in APS.
Participants were recruited from eight healthcare facilities and (for APS stakeholders) from affiliated healthcare institutions in western Kenya (Kisumu and Homabay). Interviews were conducted by phone in 2019 and 2020.
67 participants were interviewed: 14 APS providers, 16 female index clients, 17 male sexual partners and 20 community members. Participants were recruited using criteria-based purposive sampling to represent different types of facilities and to include indexes who named different numbers of partners and stakeholders representing all Kenyan healthcare system levels.
Collectively, participants perceived that demand and uptake of APS could be impacted by multiple stigmas related to HIV, sexual behaviours and identities; long clinical wait times; certain gender norms and expectations; and fear of relationship dissolution, loss of financial support and intimate partner violence. However, different stakeholder groups generally focused on different factors; women focused more on gender dynamics and family roles; male sexual partners on stigma and structural barriers; HTS providers focused on HIV testing accessibility; and community-level stakeholders focused on low community awareness of APS.
Stigma reduction, awareness about APS, creation of male entry points at the facility level and provision of social support mechanisms have the potential to increase demand for APS.
Data are available upon reasonable request. The datasets generated and/or analysed during the current study are not publicly available because some interview transcripts may contain sensitive individual information; however, they can be made available from the corresponding author on reasonable request.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Rachel A Pozzar, James A Tulsky, Donna L Berry, Jeidy Batista, Paige Barwick, Charlotta J Lindvall, Patricia C Dykes, Michael Manni, Ursula A Matulonis, Nadine J McCleary, and Alexi A Wright
University of Washington affiliated authors are displayed in bold.
Published: March 2025
People with advanced ovarian cancer and their caregivers report unmet supportive care needs. We developed a Collaborative Agenda-Setting Intervention (CASI) to elicit patients’ and caregivers’ needs through the patient portal before a clinic visit and to communicate these needs to clinicians using the electronic health record.
We aimed to assess the usability and acceptability of the CASI and identify barriers to and facilitators of its implementation.
We recruited English- and Spanish-speaking patients, caregivers, and clinicians from the gynecologic oncology program at a comprehensive cancer center. Participants used the CASI prototype and then completed individual cognitive interviews and surveys. We assessed usability with the System Usability Scale (scores range 0‐100, scores ≥70 indicate acceptable usability) and acceptability with the Acceptability of Intervention Measure and Intervention Appropriateness Measure (scores for both measures range from 1 to 5, higher scores indicate greater acceptability). Interviews were audio recorded, transcribed, and analyzed using directed content analysis. Domains and constructs from the Consolidated Framework for Implementation Research comprised the initial codebook. We analyzed survey data using descriptive statistics and compared usability and acceptability scores across patients, caregivers, and clinicians using analyses of variance.
We enrolled 15 participants (5 patients, 5 caregivers, and 5 clinicians). The mean System Usability Scale score was 72 (SD 16). The mean Acceptability of Intervention Measure and Intervention Appropriateness Measure scores were 3.9 (SD 1.0) and 4.1 (SD 0.8), respectively. Participants viewed the CASI content and format positively overall. Several participants appreciated the CASI’s integration into the clinical workflow and its potential to increase attention to psychosocial concerns. Suggestions to refine the CASI included removing redundant items, simplifying item language, and adding options to request a conversation or opt out of supportive care referrals. Key barriers to implementing the CASI include its complexity and limited resources available to address patients’ and caregivers’ needs.
The CASI is usable and acceptable to patients with advanced ovarian cancer, caregivers, and clinicians. We identified several barriers to and facilitators of implementing the CASI. In future research, we will apply these insights to a pilot randomized controlled trial to assess the feasibility of comparing the CASI to usual care in a parallel group-randomized efficacy trial.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Kathryn A. Hansen, Erin Blakeney, and Cynthia J. Price
University of Washington affiliated authors are displayed in bold.
Published: February 2025
As regulation of opioid prescribing evolves, primary care and pain clinics are shifting to provide non-pharmacological and interdisciplinary chronic pain care. An under-utilized but growing area of health care for chronic pain is complementary and integrative health (CIH). However, there is limited availability of CIH approaches within the health care system. Mindful Awareness in Body-Oriented Therapy (MABT) is an evidence-based mind-body therapy, with a manualized protocol, that focuses on developing interoceptive sensibility for improved self-awareness and nervous system regulation. Prior MABT research shows MABT improves self-report and physiological indicators of interoception as well as mental and physical symptoms of distress.
This pilot single-group study used a hybrid implementation-effectiveness design and mixed methods to study implementation strategies and outcomes for bringing MABT into an integrative chronic pain clinic. Administrative data, staff surveys, and focus groups were used to understand the implementation process and outcomes (see Additional files 2, 3, and 4). Descriptive statistics were used to analyze survey and administrative data. A content analysis approach was used to analyze qualitative data from focus groups.
7 staff surveys were administered over the 24-month study period and showed high acceptability and appropriateness that increased over time. Adoption, feasibility, and sustainability were also high. Clinicians made 70 referrals to MABT, 56 patients scheduled a session, 41 patients completed at least one session, and 71% of these completed the protocol. Focus groups identified MABT as a therapy that filled a gap in services, particularly for patients with a lack of body awareness and high emotion dysregulation.
Implementation of MABT was highly successful in an integrative health clinic focused on chronic pain treatment.
NCT05289024 Registered March 11, 2022
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Raslina Shrestha, Kajal Mehta, Aldina Mesic, Dinasha Dahanayake, Manish Yadav, Shankar Rai, Kiran Nakarmi, Pariwesh Bista, Tam Pham, and Barclay T. Stewart
University of Washington affiliated authors are displayed in bold.
Published: February 2025