UW Articles Archive - Page 10 of 60 - Implementation Science at UW

✪ Usability, Acceptability, and Barriers to Implementation of a Collaborative Agenda-Setting Intervention (CASI) to Promote Person-Centered Ovarian Cancer Care: Development Study

Abstract:

Background

People with advanced ovarian cancer and their caregivers report unmet supportive care needs. We developed a Collaborative Agenda-Setting Intervention (CASI) to elicit patients’ and caregivers’ needs through the patient portal before a clinic visit and to communicate these needs to clinicians using the electronic health record.

Objective

We aimed to assess the usability and acceptability of the CASI and identify barriers to and facilitators of its implementation.

Methods

We recruited English- and Spanish-speaking patients, caregivers, and clinicians from the gynecologic oncology program at a comprehensive cancer center. Participants used the CASI prototype and then completed individual cognitive interviews and surveys. We assessed usability with the System Usability Scale (scores range 0‐100, scores ≥70 indicate acceptable usability) and acceptability with the Acceptability of Intervention Measure and Intervention Appropriateness Measure (scores for both measures range from 1 to 5, higher scores indicate greater acceptability). Interviews were audio recorded, transcribed, and analyzed using directed content analysis. Domains and constructs from the Consolidated Framework for Implementation Research comprised the initial codebook. We analyzed survey data using descriptive statistics and compared usability and acceptability scores across patients, caregivers, and clinicians using analyses of variance.

Results

We enrolled 15 participants (5 patients, 5 caregivers, and 5 clinicians). The mean System Usability Scale score was 72 (SD 16). The mean Acceptability of Intervention Measure and Intervention Appropriateness Measure scores were 3.9 (SD 1.0) and 4.1 (SD 0.8), respectively. Participants viewed the CASI content and format positively overall. Several participants appreciated the CASI’s integration into the clinical workflow and its potential to increase attention to psychosocial concerns. Suggestions to refine the CASI included removing redundant items, simplifying item language, and adding options to request a conversation or opt out of supportive care referrals. Key barriers to implementing the CASI include its complexity and limited resources available to address patients’ and caregivers’ needs.

Conclusions

The CASI is usable and acceptable to patients with advanced ovarian cancer, caregivers, and clinicians. We identified several barriers to and facilitators of implementing the CASI. In future research, we will apply these insights to a pilot randomized controlled trial to assess the feasibility of comparing the CASI to usual care in a parallel group-randomized efficacy trial.

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

How to integrate and leverage digital health modalities for health promotion in early childhood education: Opportunities to improve intervention access and engagement

✪ A framework for designing hybrid effectiveness-implementation trials for digital health interventions

Abstract:

This article proposes methods for designing randomized controlled trials studying the implementation and effectiveness of digital interventions, meaning websites or applications ("apps") that patients use in healthcare. Deploying digital interventions for behavioral health differs from implementing traditional interventions such as medications or human-delivered therapy. Prior trial design guidance has ignored the existence of international governmental evidence standards, has paid insufficient attention to implementation reporting guidelines, and has not described methods for empirically testing the approach for organizing the delivery of digital interventions.

This framework for designing hybrid effectiveness-implementation trials of digital behavioral health interventions helps researchers articulate research questions that matter to decision-makers and meaningfully contribute to implementation. The framework outlines three phases: 1) frame effectiveness and implementation questions in terms of the digital intervention components, types of clinical support for the digital intervention, and specific strategies for implementing the digital intervention; 2) define and delineate actors, activities, action targets, dose, temporality, and outcomes to maximize inference and reproducibility; and 3) specify trial design features used for hybrid classification.

We illustrate the utility of this framework with two effectiveness-implementation studies of digital interventions for substance use. This framework can help researchers decide on appropriate methodology and help decision-makers apply findings.

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

✪ 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**}

Perspectives on Implementing a Communication Facilitator Intervention From a Critical Care Setting

✪ Usability of a cross-system housing stability program for juvenile courts: A multimethod study of probation counselor perspectives

Abstract:

Background

Youth in contact with the juvenile legal system experience disproportionate rates of homelessness. While system contact is a critical intervening point, juvenile courts do not typically offer housing services. One solution is to refer youth to evidence-based, community-based services to meet housing-related needs, but a myriad of individual and organizational factors often impede court staff from making such referrals. Housing Stability for Youth in Courts (HSYNC) is a novel, cross-system service linkage model for court-involved youth facing housing instability. HSYNC was developed using codesign as a strategy to improve usability and incorporated evidence on juvenile court linkage strategies effective at increasing service referrals and improving outcomes.

Method

The current study utilized a multimethod approach to evaluate the usability of HSYNC from the perspective of juvenile probation counselors (JPCs) as one group of end-users. As part of the pilot implementation study, survey (N = 15) and semi-structured interview (N = 20) data were obtained from JPCs from four juvenile courts in one northwestern state.

Results

Survey results indicated good usability for HSYNC (mean implementation strategy usability scale score of 80). Themes from the interviews complemented survey findings, pointing to HSYNC as a value-added program that integrated well with existing probation practices. The housing navigator's approach was highlighted as a strong facilitator of program usability. Themes also provided greater insight into implementation barriers (i.e., individual and contextual factors) and areas for improvement (e.g., eligibility screening process).

Conclusions

Drivers of program usability and implications for program improvement to address identified implementation challenges to ensure the HSYNC model is effective and sustainable long-term are discussed.

Plain Language Summary

A study examining the key factors impacting successful implementation of a novel housing stability program to address homelessness risk for court-involved youth and their families.
Court-involved youth experience disproportionate rates of homelessness, yet housing services are not traditionally offered by juvenile courts. Court staff, such as probation staff, can refer youth to community-based services to meet their housing needs. Unfortunately, many factors complicate whether these referrals are made, including staff feeling overburdened by other work obligations and uncertainty about whether referring youth to community services fits within their job responsibilities. In this study, we surveyed and interviewed probation staff who were responsible for implementing a new referral-based housing stability program—Housing Stability for Youth in Courts (HSYNC)—to understand whether the program addressed previously identified barriers to referral-making. A unique feature of HSYNC is that there is a dedicated housing navigator, who works as a “linkage specialist” to support probation staff in making referrals while working directly with youth and families to access housing-related services in the community. Our findings suggest that, from the perspective of probation staff, HSYNC is considered to be a user-friendly program that is well-aligned with existing court practices. The housing navigator and their unique approach to working with probation staff, youth, and families was perceived as the strongest facilitator of implementation success; meanwhile, screening for program eligibility was the biggest barrier, pointing to the need for improvement before HSYNC is widely implemented. The persistent intersection of youth housing instability and court involvement calls for better coordination between juvenile courts and community agencies providing housing-related services. From the probation perspective, HSYNC offers a viable solution to meeting youths’ housing needs without creating additional workload burden for court staff.

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

✪ Outcome preferences in fidelity-adaptation scenarios across evidence-based parenting programs: A discrete choice experiment

Abstract:

Background

Implementing evidence-based parenting programs often involves navigating fidelity-adaptation decisions. While research has explored various aspects of this dilemma, little is known about how practitioners’ outcome preferences influence their decisions in real-world scenarios.

Methods

This study employed a discrete choice experiment (DCE) to investigate the relative importance of five outcomes (Relationship Quality, Satisfaction, Workload Strain, Value Conflict, and Reach) in fidelity-adaptation decisions among 209 practitioners delivering evidence-based parenting programs in Sweden. The DCE presented 25 choice sets across five contextual scenarios, analyzed using Bayesian hierarchical logistic regression.

Results

All five outcomes significantly influenced practitioners’ choices, with Relationship Quality emerging as the most impactful (log-odds: 4.56, 95% CI [4.16, 4.91]). Satisfaction and minimizing Value Conflict showed similar importance (log odds: 2.45 and -2.40, respectively), while Workload Strain and Reach had slightly less impact (log odds: -2.10 and 1.96, respectively).

Conclusions

This study offers a novel perspective on the role of outcome preference in navigating fidelity-adaptation decisions. The strong preference for improving parent-child relationships aligns with core parenting program goals, while consideration of other outcomes reflects practitioners’ holistic approach to implementation. These findings can inform the design of interventions and implementation strategies that balance effectiveness with real-world constraints, potentially enhancing parenting programs’ adoption, sustainability, and impact.

Contributions to the literature

This study pioneers the application of discrete choice experiments in exploring fidelity-adaptation decisions.
Quantifying practitioners’ outcome preferences provides empirical evidence of complex trade-offs in implementing evidence-based parenting programs.
The study’s results provide actionable insights for program developers, policymakers, and implementation scientists on designing interventions that resonate with practitioners’ priorities while maintaining program effectiveness.
This research bridges theoretical frameworks and real-world decision-making, advancing our understanding of how various factors influence intervention delivery in practice.

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

The difference-making role of staff support in implementing nurse care management for opioid use disorder treatment: A configurational analysis

Authors:

Theresa E Matson, Amy K Lee, Edward J Miech, Paige D Wartko, Rebecca C Phillps, Mary Shea, Andrea Altschuler, Aimee N C Campbell, Colleen T Labelle, Julia H Arnsten, Jordan M Braciszewski, Joseph E Glass, Viviana E Horigian, Mark T Murphy, Mohammad Zare-Mehrjerdi, and Katharine A Bradley

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

Subscription Required for Full Text Access

Published: February 2025

Read the full text in the subscription access Journal of Substance Use and Addiction Treatment

✪ Health Care Professional Adherence to Breast Cancer Management Guidelines in Nigeria

Authors:

Anya Romanoff, Olalekan Olasehinde, Kathleen Lynch, Sharif Folorunso, Oluwatosin Omoyiola, Betiku Omolade, Adeleye Omisore, Chukwuma Eze Okereke, Olayide Agodirin, Abubakar Bala Muhammad, Nuhu Ali, Omorodion Irowa, Nneka Sunday Nweke, Uchechukwu Emmanuel Nwokwu, Adewale Aderounmu, Funmilola Wuraola, Hannah L Kalvin, Rivka Kahn, Grace Fitzgerald, Cristina Olcese, Alexia Iasonos, Victoria L Mango, Jamie S Ostroff, Rachel Vreeman, Benjamin O Anderson, T Peter Kingha, and Olusegun Isaac Alatise

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

✪ Open Access

Published: February 2025

Read the full text in the open access journal JAMA Network Open

Abstract:

Importance

In Nigeria, 80% of breast cancer is diagnosed at an advanced stage, when clinical management is complex and necessitates multidisciplinary collaboration. The Nigerian Federal Ministry of Health promotes multidisciplinary tumor board (MDT) discussions and endorses the National Comprehensive Cancer Network Harmonized Guidelines for Sub-Saharan Africa (Harmonized Guidelines) to standardize breast cancer care, but the extent of their clinical utilization is not well understood.

Objective

To identify barriers to and facilitators of the standardization of breast cancer care in Nigeria as reflected by awareness and consultation of resource-adapted guidelines.

Design, Setting, and Participants

For this survey study, health care professionals (HCPs) involved in breast cancer care in Nigeria were recruited electronically through medical societies and snowball sampling from November 1, 2023, to January 31, 2024.

Exposure

Breast cancer care guidelines.

Main Outcomes and Measures

Current breast cancer guideline awareness, adherence among specialties, and multidisciplinary management in Nigeria were evaluated. A multinational, multidisciplinary team developed and distributed an HCP questionnaire. Cochran-Armitage trend tests and logistic regression assessed associations with guideline awareness and use.

Results

A total of 277 HCPs (median [IQR] age, 42 [38-48] years; 211 of 275 [77%] male), including 124 surgeons (45%), 59 radiologists (21%), 49 clinical oncologists (18%), and 45 pathologists (16%), responded to the survey. Of 274 HCPs, 253 (92%) believed that breast cancer guidelines contribute to better patient outcomes, and 100 of 195 (51%) routinely consulted guidelines. Of 273 HCPs, 103 (38%) had regular engagement in breast cancer MDT discussions. Only 93 of 277 HCPs (34%) were aware of resource-adapted Harmonized Guidelines; both guideline awareness and consultation increased with the frequency of MDT participation. Completing a cancer-related fellowship (OR, 14.56; 95% CI, 6.24-40.00; P < .001), clinical oncology specialization (OR vs surgery, 0.20 [95% CI, 0.09-0.42]; OR vs pathology, 0.05 [95% CI, 0.02-0.14]; OR vs radiology, 0.02 [95% CI, 0.01-0.06]; P < .001), devoting more time to breast health care delivery (OR, 1.04; 95% CI, 1.02-1.05; P < .001), and regular MDT engagement (OR for weekly vs none, 5.13; 95% CI, 1.69-17.35; P = .04) were associated with consulting guidelines regularly on univariable analysis. To improve guideline adherence, 230 of 277 HCPs (83%) reported needing regular MDT discussions.

Conclusions and Relevance

In this survey of HCPs across Nigeria, half reported routinely consulting guidelines and only one-third were aware of the Harmonized Guidelines, which are resource adapted and endorsed by the Nigerian Federal Ministry of Health. Approximately one-third of HCPs reported engaging in regular breast cancer MDT discussions; guideline awareness and consultation increased as frequency of MDT participation increased. Opportunities for disseminating knowledge, such as MDT discussions and fellowship training, are essential to standardize breast cancer care delivery in Nigeria.

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

Treating seizures faster: The quality improvement in time to treat status epilepticus (QuITT-SE) multicenter randomized stepped wedge clinical trial protocol

Authors:

✪ Open Access

Read the full text in the open access journal JMIR Cancer

Abstract:

Background

Objective

Methods

Results

Conclusions

Authors:

Subscription Required for Full Text Access

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

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✪ Open Access

Read the full text open access in the journal Annals of Epidemiology

Abstract:

Authors:

✪ Open Access

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

Abstract:

Background

Methods

Results

Conclusions

Contributions to the literature

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

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✪ 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 Implementation Science

Abstract:

Background

Methods

Results

Conclusions

Contributions to the literature

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Subscription Required for Full Text Access

Read the full text in the subscription access Journal of Substance Use and Addiction Treatment

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✪ Open Access

Read the full text in the open access journal JAMA Network Open

Abstract:

Importance

Objective

Design, Setting, and Participants

Exposure

Main Outcomes and Measures

Results

Conclusions and Relevance

Authors:

Subscription Required for Full Text Access

Read the full text in the subscription access journal Contemporary Clinical Trials