Patricia Mae G. Santos, Sierra Silverwood, Gita Suneja, Eric C. Ford, Nikhil G. Thaker, Jamie S. Ostroff, Bryan J. Weiner, and Erin F. Gillespie
University of Washington affiliated authors are displayed in bold.
Published: December 2024
Bryan J Weiner, Rosemary D Meza, Predrag Klasnja, Rebecca Lengnick-Hall, Gretchen J Buchanan, Aaron R Lyon, Kayne D Mettert, Marcella H Boynton, Byron J Powell, and Cara C Lewis
University of Washington affiliated authors are displayed in bold.
Published: September 2024
Opinion leadership, educational outreach visiting, and innovation championing are commonly used strategies to address barriers to implementing innovations and evidence-based practices in healthcare settings. Despite voluminous research, ambiguities persist in how these strategies work and under what conditions they work well, work poorly, or work at all. The current paper develops middle-range theories to address this gap.
Conceptual articles, systematic reviews, and empirical studies informed the development of causal pathway diagrams (CPDs). CPDs are visualization tools for depicting and theorizing about the causal process through which strategies operate, including the mechanisms they activate, the barriers they address, and the proximal and distal outcomes they produce. CPDs also clarify the contextual conditions (i.e., preconditions and moderators) that influence whether, and to what extent, the strategy's causal process unfolds successfully. Expert panels of implementation scientists and health professionals rated the plausibility of these preliminary CPDs and offered comments and suggestions on them.
Theoretically, opinion leadership addresses potential adopters' uncertainty about likely consequences of innovation use (determinant) by promoting positive attitude formation about the innovation (mechanism), which results in an adoption decision (proximal outcome), which leads to innovation use (intermediate outcome). As this causal process repeats, penetration, or spread of innovation use, occurs (distal outcome). Educational outreach visiting addresses knowledge barriers, attitudinal barriers, and behavioral barriers (determinants) by promoting critical thinking and reflection about evidence and practice (mechanism), which results in behavioral intention (proximal outcome), behavior change (intermediate outcome), and fidelity, or guideline adherence (distal outcome). Innovation championing addresses organizational inertia, indifference, and resistance (determinants) by promoting buy-in to the vision, fostering a positive implementation climate, and increasing collective efficacy (mechanisms), which leads to participation in implementation activities (proximal outcome), initial use of the innovation with increasing skill (intermediate outcome) and, ultimately, greater penetration and fidelity (distal outcomes). Experts found the preliminary CPDs plausible or highly plausible and suggested additional mechanisms, moderators, and preconditions, which were used to amend the initial CPD.
The middle-range theories depicted in the CPDs furnish testable propositions for implementation research and offer guidance for selecting, designing, and evaluating these social influence implementation strategies in both research studies and practice settings.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Predrag Klasnja, Rosemary D. Meza, Michael D. Pullmann, Kayne D. Mettert, Rene Hawkes, Lorella Palazzo, Bryan J. Weiner, and Cara C. Lewis
University of Washington affiliated authors are displayed in bold.
Published: April 2024
Implementation strategies are theorized to work well when carefully matched to implementation determinants and when factors—preconditions, moderators, etc.—that influence strategy effectiveness are prospectively identified and addressed. Existing methods for strategy selection are either imprecise or require significant technical expertise and resources, undermining their utility. This article outlines refinements to causal pathway diagrams (CPDs), a method for articulating the causal process through which implementation strategies work and offers illustrations of their use.
CPDs are a visualization tool to represent an implementation strategy, its mechanism(s) (i.e., the processes through which a strategy is thought to operate), determinants it is intended to address, factors that may impede or facilitate its effectiveness, and the series of outcomes that should be expected if the strategy is operating as intended. We offer principles for constructing CPDs and describe their key functions.
Applications of the CPD method by study teams from two National Institute of Health-funded Implementation Science Centers and a research grant are presented. These include the use of CPDs to (a) match implementation strategies to determinants, (b) understand the conditions under which an implementation strategy works, and (c) develop causal theories of implementation strategies.
CPDs offer a novel method for implementers to select, understand, and improve the effectiveness of implementation strategies. They make explicit theoretical assumptions about strategy operation while supporting practical planning. Early applications have led to method refinements and guidance for the field.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Meredith Kimball & Bradley Wagenaar
University of Washington affiliated authors are displayed in bold.
Published: September 2021
Junyi Zhang, Dana L. Atkins, Anjuli D. Wagner, Irene N. Njuguna, Jillian Neary, Vincent O. Omondi, Verlinda A. Otieno, Winnie O. Atieno, Merceline Odhiambo, Dalton C. Wamalwa, Grace John-Stewart, Jennifer A. Slyker, Bryan J. Weiner, & Kristin Beima-Sofie
University of Washington affiliated authors are displayed in bold.
Published: June 2021
Nagham J. Ailabouni, Emily Reeve, Christian D. Helfrich, Sarah N. Hilmer, & Bradley H. Wagenaar
University of Washington affiliated authors are displayed in bold.
Published: June 2021
Aaron R. Lyon, Michael D. Pullmann, Shannon Dorsey, Carol Levin, Larissa M. Gaias, Stephanie K. Brewer, Madeline Larson, Catherine M. Corbin, Chayna Davis, Ian Muse, Mahima Joshi, Rosemary Reyes, Nathaniel J. Jungbluth, Rachel Barrett, David Hong, Michael D. Gomez & Clayton R. Cook
University of Washington affiliated authors are displayed in bold.
Published: January 2021
More than two-thirds of youth experience trauma during childhood, and up to 1 in 5 of these youth develops posttraumatic stress symptoms that significantly impair their functioning. Although trauma-focused cognitive behavior therapy (TF-CBT) has a strong evidence base, it is rarely adopted, delivered with adequate fidelity, or evaluated in the most common setting where youth access mental health services—schools. Given that individual behavior change is ultimately required for successful implementation, even when organizational factors are firmly in place, focusing on individual-level processes represents a potentially parsimonious approach. Beliefs and Attitudes for Successful Implementation in Schools (BASIS) is a pragmatic, motivationally focused multifaceted strategy that augments training and consultation and is designed to target precise mechanisms of behavior change to produce enhanced implementation and youth clinical outcomes. This study protocol describes a hybrid type 2 effectiveness-implementation trial designed to concurrently evaluate the main effects, mediators, and moderators of both the BASIS implementation strategy on implementation outcomes and TF-CBT on youth mental health outcomes.
Using a cluster randomized controlled design, this trial will assign school-based mental health (SMH) clinicians and schools to one of three study arms: (a) enhanced treatment-as-usual (TAU), (b) attention control plus TF-CBT, or (c) BASIS+TF-CBT. With a proposed sample of 120 SMH clinicians who will each recruit 4–6 youth with a history of trauma (480 children), this project will gather data across 12 different time points to address two project aims. Aim 1 will evaluate, relative to an enhanced TAU condition, the effects of TF-CBT on identified mechanisms of change, youth mental health outcomes, and intervention costs and cost-effectiveness. Aim 2 will compare the effects of BASIS against an attention control plus TF-CBT condition on theoretical mechanisms of clinician behavior change and implementation outcomes, as well as examine costs and cost-effectiveness.
This study will generate critical knowledge about the effectiveness and cost-effectiveness of BASIS—a pragmatic, theory-driven, and generalizable implementation strategy designed to enhance motivation—to increase the yield of evidence-based practice training and consultation, as well as the effectiveness of TF-CBT in a novel service setting.
ClinicalTrials.gov registration number NCT04451161. Registered on June 30, 2020.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Deborah J. Bowen, Catharine Wang, Allison M. Cole, Barbara M. Norquist, Sarah Knerr, Beth Devine, Brian Shirts, Kevin Cain, Heather M. Harris, Helen G. Haile, Elizabeth M. Swisher
University of Washington affiliated authors are displayed in bold.
Published: December 2020
Andrea K. Graham, Emily G. Lattie, Byron J. Powell, Aaron R. Lyon, Justin D. Smith, Stephen M. Schueller, Nicole A. Stadnick, C. Hendricks Brown, & David C. Mohr
University of Washington affiliated authors are displayed in bold.
Published: November 2020
Madeline Larson, Clayton R. Cook, Stephanie K. Brewer, Michael D. Pullmann, Corinne Hamlin, James L. Merle, Mylien Duong, Larissa Gaias, Margaret Sullivan, Nicole Morrell, Tara Kulkarni, Mollie Weeks, & Aaron R. Lyon
University of Washington affiliated authors are displayed in bold.
Published: November 2020