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Implementation Science at UW

Keywords: Qualitative Research

✪ Hypothetical acceptability of hospital-based post-mortem pediatric minimally invasive tissue sampling in Malawi: The role of complex social relationships

Authors:

Sarah Lawrence, Dave Namusanya, Andrew Hamuza, Cornelius Huwa, Dennis Chasweka, Maureen Kelley, Sassy Molyneux, Wieger Voskuijl, Donna M. Denno, & Nicola Desmond

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: February 2021

Read the full text in the open access journal PLOS ONE

Abstract:

Background

Child mortality rates remain unacceptably high in low-resource settings. Cause of death (CoD) is often unknown. Minimally invasive tissue sampling (MITS)–using biopsy needles to obtain post-mortem samples–for histopathological and microbiologic investigation is increasingly being promoted to improve child and adult CoD attribution. “MITS in Malawi” is a sub-study of the Childhood Acute Illness & Nutrition (CHAIN) Network, which aims to identify biological and socioeconomic mortality risk factors among young children hospitalized for acute illness or undernutrition. MITS in Malawi employs standard MITS and a novel post-mortem endoscopic intestinal sampling approach to better understand CoD among children with acute illness and/or malnutrition who die during hospitalization.

Aim

To understand factors that may impact MITS acceptability and inform introduction of the procedure to ascertain CoD among children with acute illness or malnutrition who die during hospitalization in Malawi.

Methods

We conducted eight focus group discussions with key hospital staff and community members (religious leaders and parents of children under 5) to explore attitudes towards MITS and inform consent processes prior to commencing the MITS in Malawi study. We used thematic content analysis drawing on a conceptual framework developed from emergent themes and MITS acceptability literature.

Results

Feelings of power over decision-making within the hospital and household, trust in health systems, and open and respectful health worker communication with parents were important dimensions of MITS acceptability. Other facilitating factors included the potential for MITS to add CoD information to aid sense-making of death and contribute to medical knowledge and new interventions. Potential barriers to acceptability included fears of organ and blood harvesting, disfigurement to the body, and disruption to transportation and burial plans.

Conclusion

Social relationships and power dynamics within healthcare systems and households are a critical component of MITS acceptability, especially given the sensitivity of death and autopsy.

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

Implementing Goals-of-Care Conversations: Lessons From High- and Low-Performing Sites From a VA National Initiative

Authors:

Cati Brown-Johnson, Marie C Haverfield, Karleen F Giannitrapani, Natalie Lo, Jill S Lowery, Mary Beth Foglia, Anne M Walling, David B Bekelman, Scott T Shreve, Lisa Soleymani Lehmann, Karl A Lorenz

University of Washington affiliated authors are displayed in bold.

Subscription Required for Full Text Access

Published: February 2020

Read the full text in the subscription access Journal of Pain and Symptom Management

✪ Unintended uses, meanings, and consequences: HIV self-testing among female sex workers in urban Uganda

Authors:

Shannon A. McMahon, Daniel Kibuuka Musoke, Jonas Wachinger, Aidah Nakitende, Jocelyn Amongin, Esther Nanyiri, Anne-Marie Turcotte-Tremblay, Catherine E. Oldenburg, Till Barnighausen, & Katrina F. Ortblad

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: November 2020

Read the full text in the (partially) open access journal AIDS Care

Abstract:

Female sex workers (FSWs) are at increased risk of HIV and face significant barriers to clinic-based HIV testing, including provider stigma and privacy constraints. HIV self-testing (HIVST) has been proven to significantly increase HIV testing among FSWs. Less is known, however, about how FSWs make meaning of oral-fluid HIV self-tests, and the unintended ways they use and understand this novel technology. From October 2016 to March 2017, we conducted 61 in-depth interviews with FSWs (n = 31) in Kampala, Uganda. Eligible participants were: female, ≥18 years, exchanged sex for money or goods, and had not recently tested for HIV. We used inductive coding to identify emerging themes and re-arranged these into an adapted framework. Unintended desirable ways FSWs described self-testing included as a means to test others, to bolster their reputation as a health-conscious sex worker, and to avoid bearing witness to suffering at health facilities. Unintended undesirable meanings ascribed to self-testing included misunderstandings about how HIV is transmitted (via saliva versus blood) and whether self-tests also test for other infections. HIVST can increase FSWs’ knowledge of their own HIV status and that of their sexual partners, but messaging and intervention design must address misunderstandings and misuses of self-testing.

Trial registration:

ClinicalTrials.gov identifier: NCT02846402

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

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

Two Medicaid health plans’ models and motivations for improving colorectal cancer screening rates

Authors:

Jennifer K Coury, Jennifer L Schneider, Beverly B Green, Laura-Mae Baldwin, Amanda F Petrik, Jennifer S Rivelli, Malaika R Schwartz, & Gloria D Coronado

University of Washington affiliated authors are displayed in bold.

Subscription Required for Full Text Access

Published: February 2020

Read the full text in the subscription access journal Translational Behavioral Medicine

✪ Factors Influencing Primary Care Providers’ Unneeded Lumbar Spine MRI Orders for Acute, Uncomplicated Low-Back Pain: a Qualitative Study

Authors:

Andrea L. Nevedal, Eleanor T. Lewis, Justina Wu, Josephine Jacobs, Jeffrey G. Jarvik, Roger Chou, & Paul G. Barnett

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: December 2019

Read the full text, open access in the subscription Journal of General Internal Medicine

Abstract:

Background

Clinical practice guidelines suggest that magnetic resonance imaging of the lumbar spine (LS-MRI) is unneeded during the first 6 weeks of acute, uncomplicated low-back pain. Unneeded LS-MRIs do not improve patient outcomes, lead to unnecessary surgeries and procedures, and cost the US healthcare system about $300 million dollars per year. However, why primary care providers (PCPs) order unneeded LS-MRI for acute, uncomplicated low-back pain is poorly understood.

Objective

To characterize and explain the factors contributing to PCPs ordering unneeded LS-MRI for acute, uncomplicated low-back pain.

Design

Qualitative study using semi-structured interviews.

Participants

Veterans Affairs PCPs identified from administrative data as having high or low rates of guideline-concordant LS-MRI ordering in 2016.

Approach

Providers were interviewed about their use of LS-MRI for acute, uncomplicated low-back pain and factors contributing to their decision-making. Directed content analysis of transcripts was conducted to identify and compare environmental-, patient-, and provider-level factors contributing to unneeded LS-MRI.

Key Results

Fifty-five PCPs participated (8.6% response rate). Both low (n = 33) and high (n = 22) guideline-concordant providers reported that LS-MRIs were required for specialty care referrals, but they differed in how other environmental factors (stringency of radiology utilization review, management of patient travel burden, and time constraints) contributed to LS-MRI ordering patterns. Low- and high-guideline-concordant providers reported similar patient factors (beliefs in value of imaging and pressure on providers). However, provider groups differed in how provider-level factors (guideline familiarity and agreement, the extent to which they acquiesced to patients, and belief in the value of LS-MRI) contributed to LS-MRI ordering patterns.

Conclusions

Results describe how diverse environmental, patient, and provider factors contribute to unneeded LS-MRI for acute, uncomplicated low-back pain. Prior research using a single intervention to reduce unneeded LS-MRI has been ineffective. Results suggest that multifaceted de-implementation strategies may be required to reduce unneeded LS-MRI.

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

Understanding the Organizational Implementation Context of Schools: A Qualitative Study of School District Administrators, Principals, and Teachers

Authors:

Jill Locke, Kristine Lee, Clayton R. Cook, Lindsay Frederick, Cheryl Vázquez-Colón, Mark G. Ehrhart, Gregory A. Aarons, Chayna Davis, & Aaron R. Lyon

University of Washington affiliated authors are displayed in bold.

Published: November 2019

Subscription Required for Full Text Access
Read the full text in the subscription access journal School Mental Health