Open Access Archives - Page 3 of 35 - Implementation Science at UW

✪ Exploring Factors Across Levels Impacting Educators’ Selection of Evidence-Based Practices for Autistic Students

Abstract:

Introduction

Front-line implementers report that selecting an evidence-based practice is the most challenging aspect of supporting Autistic students, which may contribute to the long-standing implementation gap. There is a need to understand educators’ (special education teachers’, general education teachers’, and paraeducators’) decision-making and determinants of their evidence-based practice (EBP) selection.

Method

This study aimed to identify educators’ decision-making factors, focusing on (a) information sources and (b) factors within the student, intervention, educator, and classroom levels. Eighty-one educators (general education teachers, special education teachers, and paraeducators) participated in semistructured interviews regarding their EBP selection for a specific student they served in inclusive classrooms.

Results

General and special education teachers cited EBP sources from their teacher preparation and colleagues with autism expertise, while paraeducators relied on existing classroom practices and guidance from other educators. EBP decision-making frequently revolved around student and intervention characteristics, focusing less on educator, environment, and resource determinants. Educators made individualized EBP decisions for each student, selecting EBPs that served all students. They also shared that their decision-making was most supported through collaboration, despite limited opportunity.

Conclusion

The study provides insights into key team members’ EBP selection for Autistic students to aid in the development of implementation supports.

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

✪ Increasing access without compromising quality: optimizing telemedicine care in pediatric rheumatology

Abstract:

Juvenile idiopathic arthritis (JIA) is a chronic immune-mediated condition affecting approximately 1 in 1,000 children in the United States. Without appropriate treatment, JIA can lead to permanent disability, chronic pain, and impaired quality of life. Targeted treatment strategies have enabled some patients to achieve sustained inactive disease and improved outcomes. However, the ongoing workforce shortage of pediatric rheumatologists poses a barrier to accessing effective care for many patients and families. Telemedicine is a potential solution to improving access to care for patients who travel significant distances to obtain pediatric rheumatology healthcare. During the COVID-19 pandemic, telemedicine saw rapid adoption with exponential uptake in use during unprecedented circumstances and resulted in inconsistent implementation of this emerging healthcare modality. While virtual visits offer many benefits, they often fail in gathering critical data elements required for measuring and tracking health outcomes, engaging in data-driven shared decision making, population health management and secondary research. In response to these challenges, the Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN) Digital Health Workgroup conducted a needs assessment among its members to identify opportunities and barriers for optimizing telemedicine visits for patients with JIA. Based on this assessment, potential interventions and instructional materials were developed and compiled into a “change package” to assist rheumatology teams in planning, implementing and evaluating improvements to telemedicine visits at their centers. This change package is publicly available on the PR-COIN website for adoption and use (https://www.pr-coin.org/center-tools-resources). Continuous evaluation and adaptation of these tools are essential as telemedicine practices continue to evolve.

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

✪ Strategies to improve healthcare team communication structure and quality in resource-variable childhood cancer hospitals (TeamTalk): a study protocol

Abstract:

Background

Healthcare team communication is essential to high-quality childhood cancer care, especially during high-acuity events such as clinical deterioration and in resource-variable settings, where supportive interventions to resolve deterioration are less available. Communication quality has traditionally been understudied in these settings, and there is a notable lack of communication interventions that are appropriate and feasible in settings across resource levels. We propose addressing this challenge in this study protocol, which will co-develop and pilot a multi-level intervention to improve communication and outcomes for children receiving cancer treatment.

Methods/design

This study leverages systems and implementation science methodologies to evaluate and improve communication quality in the care of hospitalized children with cancer. We will use a newly developed reliable and multilingual measure of communication quality during clinical deterioration (CritCom). In this study, we will: 1) evaluate the relationship between healthcare team communication structures (using social network analysis) and quality (using CritCom) in the care of children with cancer, with a specific focus on the impact of hierarchy and modifiable communication determinants. We will then: 2) co-develop a multilevel intervention to address challenges in communication quality across variably resourced settings, using semi-structured interviews among clinicians working in these settings and intervention mapping with a global expert panel. Finally, we will 3) test the feasibility, acceptability, appropriateness, and preliminary efficacy of this novel intervention using a cluster-randomized wait list control pilot trial in eight resource-variable hospitals providing childhood cancer care with poor team communication quality.

Discussion

This project identifies modifiable determinants of communication before co-developing and testing interventions with clinicians. When completed, this study will produce an evidence-informed, multilevel intervention to improve healthcare team communication during clinical deterioration, advancing the science of team communication during cancer care, and ultimately improving survival for children with cancer.

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

✪ Assessing ‘connective tissue’ in public-private partnerships: a stakeholder survey on multisectoral collaboration in global health

Abstract:

Background

Public-private partnerships have the potential to advance solutions to complex dilemmas such as the prevention and control of noncommunicable diseases. Knowledge creation, trust, and social capital among partners – encapsulated in the term “connective tissue” – are key considerations for the cohesion and sustainability of multisectoral collaborative efforts in global health.

Methods

A survey was conducted with 23 stakeholders of projects in four countries supported by Access Accelerated, a collective of biopharmaceutical and life sciences companies. The survey elicited perspectives on the factors that strengthen collaboration and develop knowledge creation, trust, and social capital within the multisectoral partner network.

Results

Survey respondents related how connective tissue was cultivated through implementation of multiple projects with shared goals. Identified barriers to effective collaboration included resource constraints, while facilitators included shared objectives and overlapping activities. Qualitative responses provide deeper understanding of how multisectoral collaboration contributed to the sustainability of the Access Accelerated initiative.

Conclusion

Measurement of connective tissue enhances understanding of project performance by addressing dynamic and previously overlooked outcomes of multisectoral collaboration. Multisectoral health initiatives can incorporate implementation science methods into measurement approaches to strengthen connective tissue among partners and stakeholders.

^{**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**}

✪ “Though there are some challenges, we try our best to follow the guidelines”: a qualitative study exploring determinants of providing guideline-adherent care to hospitalized children in Kenya

Abstract:

Background

Clinical treatment guidelines are designed to improve quality of care by offering clear recommendations for health workers; however, across many settings, implementing guidelines is a challenge. For over 20 years, comprehensive World Health Organization guidelines for care of hospitalized children have provided guidance for treating the primary causes of childhood death. These recommendations were adapted in Kenya and codified in the Basic Paediatric Protocol; however, adherence to these evidence-based interventions remains suboptimal.

Methods

This qualitative study identified the barriers and facilitators of providing guideline-adherent care to children admitted to two hospitals in Kenya. The semi-structured question guide was informed by the Theoretical Domains Framework (TDF). Three focus group discussions and 16 in-depth interviews were conducted with 35 health workers. Participants were nurses, doctors, clinical officers, or nutritionists (including in-charges and clinical supervisors). Interviews were audio recorded and transcribed. Transcripts were coded using a TDF-based codebook, validated, and analyzed for themes.

Results

TDF domains with the greatest influence on the thematic findings were environmental context and resources, social influences, beliefs about consequences, and beliefs about capabilities. Health workers were knowledgeable about guidelines and felt strongly that adherence to them was beneficial; however, they also faced barriers implementing them. Challenges related to the environmental context were pervasive, including shortages of staff and supplies. Participants praised the simplicity of guidelines but also noted that simplified diagnostic criteria don’t align with complex patient presentations. While guidelines empowered some nurses to make clinical decisions, respondents reported that strict professional roles sometimes delayed diagnosis and treatment. Further, health workers reported some deviations were intentional (ex. when guidelines were not aligned to their beliefs) and other times they were unintentional (ex. when complex patient presentations make guideline adherence difficult).

Conclusions

Knowledge of guidelines and motivation to use them were not major determinants in this analysis. Rather, human and material resource shortages presented the greatest barrier to guideline adherence in this setting. Improving guidelines by involving health workers in participatory development of guidelines would improve both clarity and feasibility. Health workers are well-versed in guideline recommendations, so educational strategies should focus on knowledge gaps or changes in the latest version of guidelines.

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

✪ Editorial: Using the RE-AIM framework and other implementation theories, models, and frameworks to guide the implementation and evaluation of rural health innovations

✪ Environmental sustainability, an essential outcome for implementation scientists to improve health

Abstract:

While there is evidence of humans' harmful impact on the environment, translating such evidence into changes is challenging. Implementation science can facilitate a shift from a reactive to proactive approach in tackling environmental sustainability. This article aims to spur further discussion among implementation scientists to incorporate environmental sustainability within their research, while also offering concepts relevant to environmental science researchers seeking to apply implementation science principles.

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

✪ Predictors of skill trajectories in the implementation of cognitive behavioral therapy

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**}

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

Abstract:

Background

Method

Results

Conclusions

^{**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 Science Research and Practice

Abstract:

Introduction

Method

Results

Conclusion

Authors:

✪ Open Access

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

Abstract:

Authors:

✪ Open Access

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

Abstract:

Background

Methods/design

Discussion

Authors:

✪ Open Access

Read the full text in the open access journal Global Health

Abstract:

Background

Methods

Results

Conclusion

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:

✪ Open Access

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

Abstract:

Background

Methods

Results

Conclusions

Authors:

✪ Open Access

Read the full text in the open access journal Frontiers in Health Services

Authors:

✪ Open Access

Read the full text in the open access journal Frontiers in Health Services

Abstract:

Authors:

✪ Open Access

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

Abstract:

Background

Method

Results

Conclusions

Authors:

✪ Open Access

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

Abstract:

Background

Method

Results

Conclusions