Interview Archives - Implementation Science at UW

✪ Identifying Community-Sourced Implementation Strategies for Delivering a Task-Shared Mental Health Intervention for Fathers in Kenya

Abstract:

Background

To design accessible interventions, understanding how best to implement them in context is essential. Strategies that reflect community perspectives may be most relevant and impactful. This study aimed to identify and specify community-sourced implementation strategies for delivering a mental health and alcohol use intervention for fathers in Kenya and to map them to the Expert Recommendations for Implementing Change (ERIC) taxonomy.

Method

In Eldoret, Kenya, focus groups (seven groups; 31 participants) and key informant interviews (n = 18) were conducted with hospital leaders, policymakers, mental health providers, community leaders, fathers, lay providers, patients, and men currently experiencing mental health and alcohol use challenges. Data were analyzed using the framework method to generate high-level codes, followed by a second phase to extract, specify, and review implementation strategies.

Results

Community members identified lay providers recruited from the community as a promising delivery approach, with professional providers contributing to linkage to care and support for more acute needs. Engagement of community leaders and leveraging existing infrastructure were seen as key to enhancing implementation and reach, particularly among men. Multiple delivery settings (e.g., church, hospital, school) were considered acceptable depending on patient preference. A total of 25 unique community-sourced strategies were identified: three directly matched ERIC strategies, 19 were adapted, and two were unique to the community context.

Conclusions

This study identified locally grounded implementation strategies to guide early-stage intervention delivery for fathers in Kenya. Findings contribute to the growing body of implementation science in non-Western contexts and highlight a participatory approach for identifying and specifying strategies relevant to local systems and populations.

Plain Language Summary

This study explored how to deliver mental health and alcohol use treatment to Kenyan fathers based on community and father input. Key strategies included using local helpers, familiar spaces, and engaging leaders. Findings emphasize co-design and context-based delivery to make interventions more accessible, relevant, and ready for testing.

^{**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**}

✪ Perceptions and practices of long-acting injectable antipsychotic administration in community pharmacies within Washington state: A qualitative implementation science study

Abstract:

Background

Use of long-acting injectable antipsychotics (LAIAs) for schizophrenia are associated with improved medication adherence and reduce relapse and hospitalizations compared to oral antipsychotics; however, despite these advantages LAIAs remain underutilized. Community pharmacies could improve access and reduce logistical barriers to LAIA administration; however, relatively few deliver this service, and we do not yet fully understand why.

Objective

To assess the contextual fit of administering LAIAs in community pharmacies, identify determinants influencing implementation, and inform implementation strategies to optimize and increase LAIA delivery across Washington State.

Methods

Key informant interviews were conducted with community pharmacy staff in Washington State using a hybrid deductive–inductive qualitative approach to explore determinants and compatibility of LAIA administration. Interviews were conducted using a semi-structured guide informed by Proctor's Implementation Outcomes Framework. Using rapid analysis, transcripts were summarized in a structured matrix and coded into a priori domains. Barriers and facilitators were inductively categorized and then deductively-mapped to the Consolidated Framework for Implementation Research domains; recommendations were identified to inform future implementation strategies.

Results

Ten interviews were conducted with 9 community pharmacists and one pharmacy technician. Current practices varied across participants administering LAIAs in community pharmacies. Reimbursement and payment for LAIA administration emerged as the top barrier. Appointment-based models were seen as facilitators by improving predictability for staffing and medication inventory. Participants recommended streamlining reimbursement and turnkey toolkits for training, care coordination, and communication between prescribers.

Conclusion

For community pharmacies within Washington State, payment models and reimbursement present a critical barrier to LAIA administration. Optimizing billing processes, improving funding and contracting mechanisms, and engaging payers may expand LAIA services. These represent both outer-setting and inner-setting factors, meaning that optimizing LAIA administration in community pharmacies will require system-level, multistakeholder involvement and research.

^{**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**}

Implementing Payer Partnerships for Patient Care Programs within Clinically Integrated Networks of Community Pharmacies: A Qualitative Study

✪ Testing Three Alternate Methods to Direct Observation in Measuring Use of Discrete Youth Cognitive Behavioral Techniques: A Secondary Analysis

Abstract:

Background

Cognitive behavioral therapy (CBT), an umbrella term for therapeutic techniques guided by cognitive behavioral theory, is an evidence-based approach for many psychiatric conditions in youth. A stronger dose of CBT delivery is thought to improve youth clinical outcomes. While a critical indicator of care quality, measuring the use of CBT techniques feasibly and affordably is challenging. Certain CBT techniques (e.g., more concrete and observable) may be easier to measure than others using low-cost methods, such as clinician self-report; however, this has not been studied.

Method

To assess the concordance of three methods of measuring CBT technique use with direct observation (DO), clinicians from 27 community agencies (n = 126; Mage = 37.7 years, SD = 12.8; 76% female) were randomized 1:1:1 to a self-report, chart-stimulated recall (CSR; semistructured interviews with the chart available), or behavioral rehearsal (BR; simulated role-plays) condition. In previous work using a global score aggregating 12 CBT techniques, only BR produced scores that did not differ from DO. This secondary analysis examined the concordance of these alternate methods with DO for each discrete CBT technique, testing for differential concordance across cognitive techniques (e.g., cognitive education) compared to behavioral techniques (e.g., behavioral activation).

Results

Results of three-level mixed effects regression models indicated that BR scores did not differ significantly from DO for any techniques, and for nine techniques, neither did CSR (all ps > .05). Contrastingly, self-report scores differed from DO for all but one technique, with greater concordance for behavioral than cognitive techniques (z = −3.29, p < .001).

Conclusions

Unlike previous findings using an aggregate score, we found that both BR and CSR did not differ significantly from DO for most techniques tested. These findings have implications within implementation research and usual care settings; they support multiple viable measurement methods that are less resource-intensive than DO.

^{**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**}

✪ High acceptability, feasibility and sustainability of a direct-to-pharmacy differentiated PrEP delivery model in public health HIV clinics in Kenya: perspectives of PrEP clients and healthcare providers

Abstract:

Introduction

High client opportunity costs and a burdened healthcare system limit oral pre-exposure prophylaxis (PrEP) delivery in Kenyan public HIV clinics. We conducted a qualitative study among PrEP clients and providers to understand the acceptability, feasibility and willingness to implement a client-centred, differentiated direct-to-pharmacy (DTP) PrEP refill visits intervention aimed at improving the efficiency of PrEP implementation in real-world clinics.

Methods

From March 2021 to March 2022, we conducted in-depth interviews with clients and healthcare providers participating in an individual facility pharmacy-based PrEP delivery model for PrEP refills among clients in the continuation phase at two public HIV clinics in central Kenya. The core components of the DTP model included directed-to-PrEP pharmacy refill visits conducted by facility pharmacy staff and client HIV self-testing (HIVST) while waiting for services at the pharmacy. We used semi-structured interview guides informed by the Consolidated Framework for Implementation Research (CFIR). We analysed data using thematic content analysis and organised findings by CFIR constructs.

Results

We interviewed 20 PrEP clients and 20 healthcare providers. PrEP clients included 15 females and had a median age of 39 years (interquartile range [IQR]: 33–48). Providers included 13 females, had a median age of 32 years (IQR: 30–41), and included 10 HIV counsellors, 5 pharmacy and 3 clinical providers. Both providers and clients reported high satisfaction with DTP PrEP refill visits derived from improved clinic flow and quality of service. Among clients, shorter waiting times and less movement between multiple clinic rooms reduced delays, improved privacy and reduced stigma associated with visiting HIV clinics. Furthermore, shorter waiting times and infrequent clinic visits reduced loss of working hours and income among clients, motivating PrEP continuation. Providers reported improved clinic flow, reduced work burden among non-pharmacy providers, improved knowledge and ease of implementing DTP refill visits. However, providers expressed concerns about the potential loss of roles among HIV counsellors and the shifting of workload burden to pharmacy providers.

Conclusions

Differentiated DTP refill visits with HIVST were highly acceptable and feasible among PrEP clients and providers. Context-specific modifications and scale-up of the intervention could improve the efficiency of PrEP delivery within public HIV clinics in Kenya and similar settings.

^{**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**}

✪ “When he is around, I’ll take the PrEP, but when he is not, I will not take PrEP”: key influences on PrEP use decisions among women attending family planning clinics in Kenya

Abstract:

Background

Women of childbearing age in sub-Saharan Africa (SSA) face a disproportionately high risk of HIV acquisition. Although oral PrEP has been universally scaled up for individuals at significant risk of HIV, its uptake and sustained use remain suboptimal. Understanding PrEP use decisions offers insights into context-specific barriers and facilitators to its utilization.

Methods

From September to November 2023, we conducted a qualitative study nested in a larger prospective, open-label clinical trial (FP-Plus). We conducted in-depth interviews (IDIs) with younger women (ages 15–24) and older women (ages ≥25) who declined, delayed, discontinued, or restarted PrEP during the study. IDIs were conducted at two FP clinics by trained Kenyan social scientists and were audio recorded, translated, and transcribed. We analyzed data using inductive and deductive thematic analysis through the lens of the theory of planned behavior (TPB) to explore experiences, beliefs, and rationale among women who made various PrEP decisions.

Results

We interviewed 64 women, including 40 younger women and 24 older women, all of whom declined, delayed, discontinued, or restarted PrEP (n = 16 women/category). The median age of these women was 24 years (IQR, 23–30). The majority of participants (86%, 55/64) were using family planning methods, primarily injectables (42%, 23/64). PrEP discontinuation or restart was primarily influenced by changes in HIV risk dynamics. Agency and perceived HIV risk were pivotal factors in PrEP use decisions, shaping participants’ ability to practice effective prevention adherence (TPB: perceived behavioral control). Women who declined PrEP cited a lack of autonomy, partner influence, and insufficient information (TPB: social and subjective norms). Low self-efficacy influenced decisions to delay or decline PrEP (TPB: behavioral beliefs and attitudes). In addition, challenges with PrEP pill size, taste, and texture were perceived as barriers to swallowing pills among all groups of women. Participants expressed a preference for alternative PrEP formulations, such as injectable PrEP, due to perceived ease of use, privacy, and potential to support adherence.

Conclusions

PrEP discontinuation and restart cycles largely reflected changes in HIV risk. Women who decline or delay PrEP may benefit from personalized support to improve their autonomy, recognizing that HIV risk persists during periods of PrEP delay.

^{**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**}

✪ When evidence is not enough: A qualitative exploration of healthcare workers’ perspectives on expansion of two-way texting (2wT) for post- circumcision follow-up in South Africa

Abstract:

As per South African national guidelines, in-person follow-up visits after voluntary medical male circumcision (VMMC) are required but may be unnecessary. Two-way texting (2wT), an mHealth platform, engages clients in post-operative care and triages those with complications to in-person review. 2wT was found to be safe, effective, and efficient. In South Africa, to understand provider perspectives on 2wT and potential for expansion, 20 key informant interviews were conducted with management, clinicians, data officials and support staff involved in 2wT scale-up. Interviews were analyzed using rapid qualitative methods and informed by two implementation science frameworks: the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework and the Pragmatic, Robust, Implementation and Sustainability Model (PRISM). Participants shared mixed and multi-faceted feedback, including that 2wT improves monitoring and evaluation of clients and clinical outcomes while also reducing follow-up visits. Challenges included duplicative routine and 2wT reporting systems and perceptions that 2wT increased workload. To improve the likelihood of successful 2wT scale-up in routine VMMC settings, participants suggested: further 2wT sensitization to ensure clinician and support staff buy-in; a dedicated clinician or nurse to manage telehealth clients; improved dashboards to better visualize 2wT client data; mobilizing 2wT champions at facilities to garner support for 2wT as routine care; and updating VMMC guidelines to support VMMC telehealth. As attendance at follow-up visits may not be as high as reported, implementing 2wT may require more effort but also brings added benefits of client verification and documented follow-up. The transition from research to routine practice is challenging, but use of RE-AIM and PRISM indicate that it is not impossible. As VMMC funding is decreasing, more effort to share the evidence base for 2wT as a safe, cost-effective, high-quality approach for VMMC follow-up is needed to encourage widespread uptake and adoption.

Author summary

South Africa has a high prevalence of HIV, and voluntary medical male circumcision is a prevention method recommended by the World Health Organization. Two-way texting (2wT) is a digital health intervention that allows males to receive educational messages after circumcision about healing and send messages directly to a provider via SMS or WhatsApp. This system detects as many complications as routine follow-up care, though is more efficient. As we scale up to new locations in South Africa, we wanted to ensure the approach is well-adapted for health workers. Through 20 interviews with health workers, we found that it saves clients in-person visits and helps with data collection. However, more effort is needed to introduce the intervention to clinicians, including providing better training and appointing champions to help motivate clinicians. Funding for HIV and VMMC programs is decreasing, so it is important to find tools such as digital health to reduce the burden on facilities while maintaining quality client care.

^{**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**}

Developing and implementing a process improvement intervention to expand evidence-based psychotherapy in the Department of Defense

Authors:

Jeffrey Cook, Melissa Mistretta, Carmen P. McLean, Jeffrey Mann, Erin Frick, Alan L. Peterson, Stacey Young-McCaughan, Elisa V. Borah, Katherine Anne Comtois, Katherine A. Dondanville, Allison M. Conforte, Jeremy Jinkerson, Zachary K. Jones
81st Medical Group, Keesler Air Force Base, Biloxi, Mississippi, United States
Hana J. Kim, Jared S. Link, Debra Nofziger, Erik N. Ringdahl, John Waggoner, Craig Woodworth, Craig S. Rosen, & David S. Riggs

^{University of Washington affiliated authors are displayed in bold.}

Subscription Required for Full Text Access

Published: April 2025

Read the full text in the subscription access journal Psychological Services

✪ Development of a method for qualitative data integration to advance implementation science within research consortia

Abstract:

Background

Methods of integrating qualitative data across diverse studies and within multi-site research consortia are less developed than those for integrating quantitative data. The development ofsuchmethods is essential to support the data exchange needed for cross-study qualitative inquiry and given the increasing emphasis on data sharing and open science. We describe methods for qualitative data integration within the National Cancer Institute’s Improving the Management of symPtoms During And following Cancer Treatment (IMPACT) Consortium funded by the Cancer MoonshotSM. Data collection and analysis were guided by the Consolidated Framework for Implementation Research (CFIR). Our case study highlights potential solutions for unique challenges faced when integrating qualitative data across multiple settings in a research consortium.

Methods

The IMPACT consortium is comprised of three research centers (RCs) each conducting pragmatic trials examining the effectiveness of routine symptom management on patient-centered outcomes. After reaching consensus on use of CFIR as the common implementation determinant framework, RCs developed a semi-structured interview guide and tailored it to features of their healthcare setting and symptom management interventions. RCs conducted interviews/focus groups with healthcare system partners to examine contextual factors impacting implementation. RCs exchanged 1–2 transcripts (n = 5 total) for purposes of pilot testing the methodology.

Results

Given the heterogeneity of study settings and contexts, it was challenging to simultaneously assign codes at both domain and construct levels and the process was resource intensive. Recommendations include employing a common framework for data collection and analyses from the outset, coding at domain level first and then incorporating construct codes, and centralizing processes via a coordinating center (or similar entity) and combining coded transcripts using qualitative software. We also generated an iteratively refined codebook that employed the CFIR schema and incorporated CFIR 2.0 to provide detailed guidance for coders conducting cross-study qualitative inquiry.

Conclusions

Limited guidance exists on how to support qualitative data integration, data exchange, and sharing across multiple studies. This paper describes a systematic method for employing an implementation determinant framework-guided approach to foster data integration. This methodology can be adopted by other research consortia to support qualitative data integration, cross-site qualitative inquiry, and generate improved understanding of evidence-based intervention implementation.

Contributions to the literature

Few standard practices exist for integrating qualitative data across different studies to conduct cross-study qualitative inquiry. Developing data integration procedures is critical to generating insights about practice improvement across settings and achieving goals of open science.
This report describes a method for integrating qualitative data using the Consolidated Framework for Implementation Research illustrated within the context of NCI’s Improving the Management of symPtoms During And following Cancer Treatment (IMPACT) Consortium.
The method describedcan be applied within research consortia and across multi-site studies to support qualitative data integration, thereby producing valuable insights to improve implementation of evidence-based interventions.

^{**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**}

Authors:

✪ Open Access

Read the full text in the open access journal Implementation Research and Practice

Abstract:

Background

Method

Results

Conclusions

Plain Language Summary

Authors:

✪ Open Access

Read the full text in the open access journal Journal of the American Pharmacy Association

Abstract:

Background

Objective

Methods

Results

Conclusion

Authors:

Subscription Required for Full Text Access

Read the full text in the subscription access journal Journal of the American Pharmacy Association

Authors:

✪ Open Access

Read the full text in the open access journal Implementation Research and Practice

Abstract:

Background

Method

Results

Conclusions

Authors:

✪ Open Access

Read the full text in the open access journal Journal of the International AIDS Society

Abstract:

Introduction

Methods

Results

Conclusions

Authors:

✪ Open Access

Read the full text in the open access journal Frontiers in Medicine

Abstract:

Background

Methods

Results

Conclusions

Authors:

✪ Open Access

Read the full text in the open access journal PLOS Digital Health

Abstract:

Author summary

Authors:

Subscription Required for Full Text Access

Read the full text in the subscription access journal Psychological Services

Authors:

✪ Open Access

Read the full text in the open access journal Implementation Science Communications

Abstract:

Background

Methods

Results

Conclusions

Contributions to the literature

Authors:

Subscription Required for Full Text Access

Read the full text in the subscription access journal Genetics in Medicine