Authors:
Judy Leong, Sou Hyun Jang, Sonia K. Bishop, Emily V. R. Brown, Eun Jeong Lee, Linda K. Ko
University of Washington affiliated authors are displayed in bold.
Subscription Required for Full Text Access
Published: June 2020
Keywords: CFIR
Use of the Consolidated Framework for Implementation Research (CFIR) to Characterize Healthcare Workers’ Perspectives on Financial Incentives to Increase Pediatric HIV Testing
Authors:
Dana Atkins, Anjuli D. Wagner, Junyi Zhang, Irene N. Njuguna, Jillian Neary, Vincent O. Omondi, Verlinda A. Otieno, Kenneth Ondeng'e, Dalton C. Wamalwa, Grace John-Stewart, Jennifer A. Slyker, and Kristin Beima-Sofie
University of Washington affiliated authors are displayed in bold.
Subscription Required for Full Text Access
Published: May 2020
Read the full text in the subscription access journal JAIDS
✪ Evaluating and optimizing the consolidated framework for implementation research (CFIR) for use in low- and middle-income countries: a systematic review
Authors:
Arianna Rubin Means, Christopher G. Kemp, Marie-Claire Gwayi-Chore, Sarah Gimbel, Caroline Soi, Kenneth Sherr, Bradley H. Wagenaar, Judith N. Wasserheit, & Bryan J. Weiner
University of Washington affiliated authors are displayed in bold.
✪ Open Access
Published: March 2020
Read the full text in the open access journal Implementation Science
Abstract:
Background
The Consolidated Framework for Implementation Research (CFIR) is a determinants framework that may require adaptation or contextualization to fit the needs of implementation scientists in low- and middle-income countries (LMICs). The purpose of this review is to characterize how the CFIR has been applied in LMIC contexts, to evaluate the utility of specific constructs to global implementation science research, and to identify opportunities to refine the CFIR to optimize utility in LMIC settings.
Methods
A systematic literature review was performed to evaluate the use of the CFIR in LMICs. Citation searches were conducted in Medline, CINAHL, PsycINFO, CINAHL, SCOPUS, and Web of Science. Data abstraction included study location, study design, phase of implementation, manner of implementation (ex., data analysis), domains and constructs used, and justifications for use, among other variables. A standardized questionnaire was sent to the corresponding authors of included studies to determine which CFIR domains and constructs authors found to be compatible with use in LMICs and to solicit feedback regarding ways in which CFIR performance could be improved for use in LMICs.
Results
Our database search yielded 504 articles, of which 34 met final inclusion criteria. The studies took place across 21 countries and focused on 18 different health topics. The studies primarily used qualitative study designs (68%). Over half (59%) of the studies applied the CFIR at study endline, primarily to guide data analysis or to contextualize study findings. Nineteen (59%) of the contacted authors participated in the survey. Authors unanimously identified culture and engaging as compatible with use in global implementation research. Only two constructs, patient needs and resources and individual stages of change were commonly identified as incompatible with use. Author feedback centered on team level influences on implementation, as well as systems characteristics, such as health system architecture. We propose a “Characteristics of Systems” domain and eleven novel constructs be added to the CFIR to increase its compatibility for use in LMICs.
Conclusions
These additions provide global implementation science practitioners opportunities to account for systems-level determinants operating independently of the implementing organization. Newly proposed constructs require further reliability and validity assessments.
Trial registration
PROSPERO, CRD42018095762
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
✪ Systems analysis and improvement approach to optimize the hypertension diagnosis and care cascade for PLHIV individuals (SAIA-HTN): A hybrid type III cluster randomized trial
Authors:
Sarah Gimbel, Ana Olga Mocumbi, Kristjana Ásbjörnsdóttir, Joana Coutinho, Leonel Andela, Bonifacio Cebola, Heidi Craine, Jonny Crocker, Leecreesha Hicks, Sarah Holte, Rodrigues Hossieke, Edgar Itai, Carol Levin, Nelia Manaca, Filipe Murgorgo, Miguel Nhumba, James Pfeiffer, Isaias Ramiro, Keshet Ronen, Nona Sotoodehnia, Onei Uetela, Anjuli Wagner, Bryan J. Weiner, & Kenneth Sherr
University of Washington affiliated authors are displayed in bold.
✪ Open Access
Published: March 2020
Read the full text in the open access journal Implementation Science
Abstract:
Background
Across sub-Saharan Africa, evidence-based clinical guidelines to screen and manage hypertension exist; however, country level application is low due to lack of service readiness, uneven health worker motivation, weak accountability of health worker performance, and poor integration of hypertension screening and management with chronic care services. The systems analysis and improvement approach (SAIA) is an evidence-based implementation strategy that combines systems engineering tools into a five-step, facility-level package to improve understanding of gaps (cascade analysis), guide identification and prioritization of low-cost workflow modifications (process mapping), and iteratively test and redesign these modifications (continuous quality improvement). As hypertension screening and management are integrated into chronic care services in sub-Saharan Africa, an opportunity exists to test whether SAIA interventions shown to be effective in improving efficiency and coverage of HIV services can be effective when applied to the non-communicable disease services that leverage the same platform. We hypothesize that SAIA-hypertension (SAIA-HTN) will be effective as an adaptable, scalable model for broad implementation.
Methods
We will deploy a hybrid type III cluster randomized trial to evaluate the impact of SAIA-HTN on hypertension management in eight intervention and eight control facilities in central Mozambique. Effectiveness outcomes include hypertension cascade flow measures (screening, diagnosis, management, control), as well as hypertension and HIV clinical outcomes among people living with HIV. Cost-effectiveness will be estimated as the incremental costs per additional patient passing through the hypertension cascade steps and the cost per additional disability-adjusted life year averted, from the payer perspective (Ministry of Health). SAIA-HTN implementation fidelity will be measured, and the Consolidated Framework for Implementation Research will guide qualitative evaluation of the implementation process in high- and low-performing facilities to identify determinants of intervention success and failure, and define core and adaptable components of the SAIA-HTN intervention. The Organizational Readiness for Implementing Change scale will measure facility-level readiness for adopting SAIA-HTN.
Discussion
SAIA packages user-friendly systems engineering tools to guide decision-making by front-line health workers to identify low-cost, contextually appropriate chronic care improvement strategies. By integrating SAIA into routine hypertension screening and management structures, this pragmatic trial is designed to test a model for national scale-up.
Trial registration
Registered 09/13/2019; NCT04088656).
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
ImPlementation REsearCh to DEvelop Interventions for People Living with HIV (the PRECluDE consortium): Combatting chronic disease comorbidities in HIV populations through implementation research
Authors:
Joyonna Carrie Gamble-George, Christopher T. Longenecker, Allison R. Webel, David H. Au, Arleen F. Brown, Hayden Bosworth, Kristina Crothers, William E. Cunningham, Kevin A. Fiscella, Alison B. Hamilton, Christian D. Helfrich, Joseph A. Ladapo, Amneris Luque, Jonathan N. Tobin, Gail E. Wyatt, Implementation Research to Develop Interventions for People Living with HIV (PRECluDE) Consortium
University of Washington affiliated authors are displayed in bold.
Subscription Required for Full Text Access
Published: March 2020
Read the full text in the subscription access journal Progress in Cardiovascular Diseases
✪ Responding to the challenge of Adolescent Perinatal Depression (RAPiD): Protocol for a cluster randomized hybrid trial of psychosocial intervention in primary maternal care
Authors:
Oye Gureje, Lola Kola, Bibilola D. Oladeji, Jibril Abdulmalik, Olatunde Ayinde, Phyllis Zelkowitz & Ian Bennett
University of Washington affiliated authors are displayed in bold.
✪ Open Access
Published: February 2020
Read the full text in the open access journal Trials
Abstract:
Background
Adolescent pregnancy is a pressing public health issue globally, and particularly in low and middle-income countries. Depression occurring in the perinatal period is common among women and more so among adolescent mothers. Effective treatments for the condition have been demonstrated in adults but the needs of adolescents are often unique, making such treatments unlikely to meet those needs.
Method/study design
A hybrid effectiveness–implementation research study is described in which a cluster randomized trial design is used to explore the effectiveness as well as the utility in routine practice of an intervention package specifically designed for adolescents with perinatal depression. Consenting pregnant adolescents (aged less than 20 years) who are newly registered for antenatal care are enrolled into the trial if their fetal gestational age is less than 36 weeks and they score 12 or more on the Edinburgh Postnatal Depression Scale (EPDS). The intervention package consists of structured sessions of behavior activation, problem-solving treatment, and parenting skills training, and is delivered by primary maternal health care providers, complemented by support provided by a “neighborhood mother” identified by the adolescent.
Mothers in the control arm receive care as usual. The trial is conducted in clinics where the maternal providers are trained to deliver routine depression care with the use of the WHO Mental Health Gap Action Programme, intervention guide. Assessments are undertaken by trained blinded assessors at baseline, at childbirth, and at 3 and 6 months postpartum. The primary outcome, assessed at 6 months, is the level of maternal depression (measured with the EPDS). The secondary outcome is parenting skills (assessed with the Home Observation Measurement of the Environment, Infant–Toddler version), while tertiary outcomes include measures of disability, quality of life, mother–child bonding, as well as infants’ nutritional and growth indices.
Discussion
This, to the best of our knowledge, will be the first fully-powered trial of an intervention package specifically designed to address the unique needs of adolescents with perinatal depression.
Trial registration
ISRCTN16775958. Registered on 30 April 2019.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
✪ Study protocol for evaluating Six Building Blocks for opioid management implementation in primary care practices
Authors:
Sarah J. Shoemaker-Hunt, Leigh Evans, Holly Swan, Olivia Bacon, Brooke Ike, Laura-Mae Baldwin, & Michael L. Parchman
University of Washington affiliated authors are displayed in bold.
✪ Open Access
Published: February 2020
Read the full text in the open access journal Implementation Science Communications
Abstract:
Background
The Six Building Blocks for improving opioid management (6BBs) is a program for improving the management of patients in primary care practices who are on long-term opioid therapy for chronic pain. The 6BBs include building leadership and consensus; aligning policies, patient agreements, and workflows; tracking and monitoring patient care; conducting planned, patient-centered visits; tailoring care for complex patients; and measuring success. The Agency for Healthcare Research and Quality funded the development of a 6BBs implementation guide: a step-by-step approach for independently implementing the 6BBs in a practice. This mixed-method study seeks to assess practices’ use of the implementation guide to implement the 6BBs and the effectiveness of 6BBs implementation on opioid management processes of care among practices using the implementation guide.
Methods
Data collection is guided by the Consolidated Framework for Implementation Research, Proctor’s taxonomy of implementation outcomes, and the Centers for Disease Control and Prevention’s Guideline for Prescribing Opioids for Chronic Pain. A diverse group of health care organizations with primary care clinics across the USA will participate in the study over 15 months. Qualitative data collection will include semi-structured interviews with stakeholders at each organization at two time points, notes from routine check-in calls, and document review. These data will be used to understand practices’ motivation for participation, history with opioid management efforts, barriers and facilitators to implementation, and implementation progress. Quantitative data collection will consist of a provider and staff survey, an implementation milestones assessment, and quarterly opioid prescribing quality measures. These data will supplement our understanding of implementation progress and will allow us to assess changes over time in providers’ opioid prescribing practices, prescribing self-efficacy, challenges to providing guideline-driven care, and practices’ opioid prescribing quality measures. Qualitative data will be coded and analyzed for emergent themes. Quantitative data will be analyzed using descriptive statistics and clustered multivariate regression.
Discussion
This study contributes to the knowledge of the implementation and effectiveness of a team-based approach to opioid management in primary care practices. Information gleaned from this study can be used to inform efforts to curtail opioid prescribing and assist primary care practices considering implementing the 6BBs.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
✪ First-year implementation of mailed FIT colorectal cancer screening programs in two Medicaid/Medicare health insurance plans: qualitative learnings from health plan quality improvement staff and leaders
Authors:
Laura-Mae Baldwin, Jennifer L. Schneider, Malaika Schwartz, Jennifer S. Rivelli, Beverly B. Green, Amanda F. Petrik & Gloria D. Coronado
University of Washington affiliated authors are displayed in bold.
✪ Open Access
Published: February 2020
Read the full text in the open access journal BMC Health Services Research
Abstract:
Background
Colorectal cancer screening rates remain low, especially among certain racial and ethnic groups and the uninsured and Medicaid insured. Clinics and health care systems have adopted population-based mailed fecal immunochemical testing (FIT) programs to increase screening, and now health insurance plans are beginning to implement mailed FIT programs. We report on challenges to and successes of mailed FIT programs during their first year of implementation in two health plans serving Medicaid and dual eligible Medicaid/Medicare enrollees.
Methods
This qualitative descriptive study gathered data through in-depth interviews with staff and leaders at each health plan (n = 10). The Consolidated Framework for Implementation Research, field notes from program planning meetings between the research team and the health plans, and internal research team debriefs informed interview guide development. Qualitative research staff used Atlas.ti to code the health plan interviews and develop summary themes through an iterative content analysis approach.
Results
We identified first-year implementation challenges in five thematic areas: 1) program design, 2) vendor experience, 3) engagement/communication, 4) reaction/satisfaction of stakeholders, and 5) processing/returning of mailed kits. Commonly experienced challenges by both health plans related to the time-consuming nature of the programs to set up, and complexities and delays in working with vendors. We found implementation successes in the same five thematic areas as well as four additional areas of: 1) leadership support, 2) compatibility with the health plan, 3) broader impacts, and 4) collaboration with researchers. Commonly experienced successes included the ability to adapt the mailed FIT program to the individual health plan culture and needs, and the synchronicity between the programs and their organizational missions and goals.
Conclusions
Both health plans successfully adapted mailed FIT programs to their own culture and resources and used their strong quality management resources to maximize success in overcoming the time demands of setting up the program and working with their vendors. Mailed FIT programs administered by health plans, especially those serving Medicaid- and dual eligible Medicaid/Medicare-insured populations, may be an important resource to support closing gaps in colorectal cancer screening among traditionally underserved populations.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
✪ Research translation for military and veteran health: research, practice, policy
Authors:
Jeffrey P. Haibach, Katherine D. Hoerster, Lindsey Dorflinger, Lisa M. McAndrew, Daniel G. Cassidy, David E. Goodrich, Jill E. Bormann, Julie Lowery, Steven M. Asch, Susan D. Raffa, Tannaz Moin, Alan L. Peterson, Michael G. Goldstein, Tracy Neal-Walden, Gerald W. Talcott, Christopher L. Hunter, & Sara J. Knight
University of Washington affiliated authors are displayed in bold.
✪ Open Access
Published: February 2020
Read the full text in the journal Translational Behavioral Medicine
Validation of a counseling guide for adherence to antiretroviral therapy using implementation science
Authors:
Flor Yesenia Musayón-Oblitas, Cesar Paul Cárcamo, Sarah Gimbel, Juan Ignacio Echevarria Zarate, and Ana Beatriz Graña Espinoza
University of Washington affiliated authors are displayed in bold.
✪ Open Access
Published: February 2020
Read the full text in the open access journal Revista Latino-Americana de Enfermagem
Abstract:
Objective:
To determine the contents that must be included in the usual counseling to improve the adherence to antiretroviral therapy (ART) of HIV patients, according to their different levels of alcohol consumption, and to determine the validity of the Counseling Guide in improving the adherence to ART in patients who consume alcohol using Implementation Science.
Method:
This is an observational study with formative and validation phases. The formative phase defined the content, approach and structure of the counseling. Validation included focus groups with patients and nurses, trial process by an expert and a pilot test. The criteria evaluated based on Implementation Science were: intervention source, evidence strength and quality, relative advantage, and complexity. The following criteria were also evaluated: usefulness, practicality, acceptability, sustainability, effectiveness; content consistency and congruence; procedural compliance and difficulties, and time spent in counseling.
Results:
The strength of evidence of the counseling is High-IIA, with strong level of recommendation and presenting usefulness, practicality, acceptability, sustainability and effectiveness. Eight in 11 experts argued that the Guide is clear, consistent and congruent. Initial counseling takes around 24 minutes; and follow-up counseling, 21. The instruments of the Guide present reliability levels between good and high (0.65 ≥ alpha ≤ 0.92).
Conclusion:
The Counseling Guide is valid to improve the adherence to antiretroviral therapy in patients who consume alcohol.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**