UW Articles Archive - Page 11 of 60 - Implementation Science at UW

✪ Implementation Outcomes From a Pilot Study of Mindful Awareness in Body-Oriented Therapy (MABT) as a Chronic Pain Treatment Modality in an Integrative Health Clinic

Abstract:

Background

As regulation of opioid prescribing evolves, primary care and pain clinics are shifting to provide non-pharmacological and interdisciplinary chronic pain care. An under-utilized but growing area of health care for chronic pain is complementary and integrative health (CIH). However, there is limited availability of CIH approaches within the health care system. Mindful Awareness in Body-Oriented Therapy (MABT) is an evidence-based mind-body therapy, with a manualized protocol, that focuses on developing interoceptive sensibility for improved self-awareness and nervous system regulation. Prior MABT research shows MABT improves self-report and physiological indicators of interoception as well as mental and physical symptoms of distress.

Methods

This pilot single-group study used a hybrid implementation-effectiveness design and mixed methods to study implementation strategies and outcomes for bringing MABT into an integrative chronic pain clinic. Administrative data, staff surveys, and focus groups were used to understand the implementation process and outcomes (see Additional files 2, 3, and 4). Descriptive statistics were used to analyze survey and administrative data. A content analysis approach was used to analyze qualitative data from focus groups.

Results

7 staff surveys were administered over the 24-month study period and showed high acceptability and appropriateness that increased over time. Adoption, feasibility, and sustainability were also high. Clinicians made 70 referrals to MABT, 56 patients scheduled a session, 41 patients completed at least one session, and 71% of these completed the protocol. Focus groups identified MABT as a therapy that filled a gap in services, particularly for patients with a lack of body awareness and high emotion dysregulation.

Conclusion

Implementation of MABT was highly successful in an integrative health clinic focused on chronic pain treatment.

ClinicalTrials.gov registration

NCT05289024 Registered March 11, 2022

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

Feasibility of Using Patient Navigation to Improve Identification of Hereditary Cancer Syndromes in Newly Diagnosed Colorectal Cancer Patients

✪ How integrated knowledge translation worked to reduce federal policy barriers to the implementation of medication abortion in Canada: a realist evaluation

Abstract:

Background

Initial Canadian federal regulations for the abortion pill, mifepristone, had the potential to impede safe and equitable access to this medication. To catalyze evidence-based regulatory change, we engaged health policy, health system, and health services decision makers, and health professional organizations in integrated knowledge translation (iKT), a research approach that engages the users of research as equal partners.

Methods

We conducted a realist evaluation of what iKT strategies worked, for whom, and in what context to impact federal mifepristone regulations. We constructed initial program theories (if–then statements about how iKT worked). We tested the initial program theories using interviews with researchers and knowledge partners and triangulated with analysis of research programme documents. We configured the evidence in relation to the initial program theories, and refined program theories into causal explanatory configurations.

Results

We analyzed 38 interviews with researchers, health professional leaders, advocacy group leaders, and administrative government policy makers, as well as 49 program documents. Our results indicated that researcher partnerships with stakeholders had a meaningful impact on the removal of restrictions. We found key components of the causal explanatory configurations included: researcher motivation to move evidence into action, trusted reputations as credible sources of evidence, strategic partnerships, understanding of health policy processes, and researcher roles as a trusted convenor between key groups and decision makers.

Conclusions

Our study identifies several practical and transferable approaches to impactful iKT. The findings may be of relevance to researchers focused on public health topics subject to stigma.

Contributions to the literature

The effect of integrated knowledge translation (iKT) on public health policy is ambiguous, especially for issues that may be stigmatized, like abortion.
To bridge this knowledge gap, we evaluated the iKT used to support Canadian federal drug regulatory decisions to remove restrictions for the medication abortion pill, mifepristone.
Our realist evaluation identified several practical and transferable approaches to impactful iKT in complex policy systems that comprise an ‘iKT mindset’.
Key approaches for researchers include acting on motivations to move evidence into policy, building trusted reputations as credible sources of evidence, understanding and targeting policy levers, acting as a source of strategic evidence, and acting as a trusted convenor between key groups and decision makers.
Our use of realist methodology contributes to theoretical and empirical understandings of iKT with policy makers and has relevance for other stigmatized topics including opioid safe supply, vaccination, and climate change.

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

Pilot Testing a Digital Transdiagnostic Mental Health Intervention for Use Among Immigrant and Refugee Youth in the USA: A Mixed Methods Evaluation of Clinical and Implementation Outcomes

Barriers and facilitators to implementing enteral resuscitation for major burn injuries: Reflections from Nepalese care providers

✪ Human-Centered Design of an mHealth Tool for Optimizing HIV Index Testing in Wartime Ukraine: Formative Research Case Study

Abstract:

Background

Assisted partner services (APSs; sometimes called index testing) are now being brought to scale as a high-yield HIV testing strategy in many nations. However, the success of APSs is often hampered by low levels of partner elicitation. The Computer-Assisted Self-Interview (CASI)–Plus study sought to develop and test a mobile health (mHealth) tool to increase the elicitation of sexual and needle-sharing partners among persons with newly diagnosed HIV. CASI-Plus provides client-facing information on APS methods and uses a standardized, self-guided questionnaire with nonjudgmental language for clients to list partners who would benefit from HIV testing. The tool also enables health care workers (HCWs) to see summarized data to facilitate partner tracking.

Objective

The formative research phase of the CASI-Plus study aimed to gather client and HCW input on the design of the CASI-Plus tool to ensure its acceptability, feasibility, and usability.

Methods

This study gathered input to prioritize features and tested the usability of CASI-Plus with HCWs and clients receiving HIV services in public health clinics in wartime Ukraine. The CASI-Plus study’s formative phase, carried out from May 2023 to July 2024, adapted human-centered design (HCD) methods grounded in principles of empathy, iteration, and creative ideation. The study involved 3 steps: formative HCD, including in-depth individual interviews with clients, such as men who have sex with men and people who inject drugs, and internet-based design workshops with HCWs from rural and urban HIV clinics in Chernihiv and Dnipro; software platform assessment and heuristic evaluation, including assessment of open-source mHealth platforms against CASI-Plus requirements, prototype development, and testing of the REDCap (Research Electronic Data Capture) prototype based on usability heuristics; and usability walk-throughs, including simulated cases with HCWs and clients.

Results:

The formative phase of the CASI-Plus study included in-depth individual interviews with 10 clients and 3 workshops with 22 HCWs. This study demonstrated how simplified HCD methods, adapted to the wartime context, gathered rich input on prioritized features and tool design. The CASI-Plus design reflected features that are both culturally sensitive and in alignment with the constraints of Ukraine’s wartime setting. Prioritized features included information about the benefits of HIV index testing; a nonjudgmental, self-guided questionnaire to report partners; client stories; and bright images to accompany the text. Two-way SMS text messaging between clients and HCWs was deemed impractical based on risks of privacy breaches, national patient privacy regulations, and HCW workload./p>

Conclusions

It was feasible to conduct HCD research in Ukraine in a wartime setting. The CASI-Plus mHealth tool was acceptable to both HCWs and clients. The next step for this research is a randomized clinical trial of the effect of the REDCap-based CASI-Plus tool on the number of partners named and the rate of partners completing HIV testing.

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

✪ Development of learning health system competency items related to health and healthcare equity and justice for rehabilitation researchers

Authors:

Pamela M. Dunlap, Kathleen M. Poploski, Catherine A. Anderson, Thiru M. Annaswamy, Melissa A. Clark, Peter C. Coyle, Natalie F. Douglas, Ann Marie Flores, Janet K. Freburger, Brian J. Hafner, Kenneth J. Harwood, Jeanne M. Hoffman, Adam R. Kinney, Linda Resnik, Kristin Ressel, Margarite J. Whitten, and Christine M. McDonough

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

✪ Open Access

Published: January 2025

Read the full text in the open access journal Learning Health Systems

Abstract:

Introduction

In 2021, the Learning Health Systems Rehabilitation Research Network (LeaRRn) developed and administered a needs assessment survey, based on the Agency on Healthcare Research and Quality's (AHRQ's) original seven domains of learning health systems (LHS) researcher core competencies, to identify knowledge and interest in LHS research competencies among rehabilitation researchers. In 2022, the AHRQ added a new health and healthcare equity and justice (HE) domain to the existing seven domains for LHS researcher core competencies.

Methods

LeaRRn utilized methods similar to those employed in the development of their original needs assessment survey to generate and refine competency items for the HE domain. In this report, we describe the methods used to develop these HE competency items.

Results & Conclusions

Other training programs and LHS researchers may use the competency items developed for this needs assessment survey to identify training opportunities in the HE domain.

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

✪ Not getting better but not getting worse: A cluster randomized controlled pilot trial of a leadership implementation strategy

Abstract:

Background

Implementation of evidence-based practices (EBPs) in schools is fraught with challenges. Even when EBPs are initiated, deterioration of implementation efforts often hinders their long-term success. School leadership behaviors can influence teachers’ EBP implementation. Our study tested an implementation strategy called Helping Educational Leaders Mobilize Evidence (HELM), adapted from the Leadership and Organizational Change for Implementation strategy, to enhance EBP implementation through improvements in school leadership teams’ implementation leadership and climate to buffer against the deterioration of implementation efforts. This study explores the impact of HELM on theorized mechanisms of change (i.e., implementation leadership, climate), educator-level factors (i.e., implementation citizenship), and implementation outcomes (i.e., fidelity, initiative stability).

Method

One school district and 10 schools in Washington participated. Five of the schools were randomized to receive the HELM strategy and the remaining five schools received an alternative leadership training as an implementation attention control. Teachers at every school (n = 341) received training for an EBP called Positive Greetings at the Door that has been previously demonstrated to reduce student behavior problems. Principals and Assistant Principals (n = 18) received the HELM strategy or alternative leadership training. Three district Administrators also participated in HELM as part of the Organizational Strategy Development meetings.

Results

HELM significantly slowed the average decline of implementation leadership (perseverant leadership and communication), three dimensions of implementation climate (recognition, rewards, and existing supports) and total implementation climate, and one dimension of implementation citizenship (keeping informed). No significant effects were found with regard to implementation outcomes (i.e., fidelity, initiative stability).

Conclusions

HELM shows promise in buffering the deterioration of EBP implementation efforts in schools. HELM positively influenced implementation leadership and climate, which are the hypothesized mechanisms for promoting successful long-term implementation efforts. An appropriately powered trial is needed to determine the efficacy of HELM in the future.

Trial Registration Information

Name of the registry: clinicaltrials.gov
Trial registration number: NCT06340074
Date of registration: March 29, 2024. Retrospectively registered
URL of trial registry record: https://clinicaltrials.gov/study/NCT06340074?intr=helm&rank=

Plain Language Summary

Using practices that have been proven to work in research to support youth social, emotional, and behavioral well-being in schools is hard. Efforts to use these practices decrease across the school year. School leadership behaviors can influence educators’ use of these practices. Our study tested an implementation strategy or support designed to help educators use a research-backed practice called Helping Educational Leaders Mobilize Evidence (HELM). HELM was adapted from the Leadership and Organizational Change for Implementation (LOCI) strategy, to enhance school leadership teams’ specific leadership behaviors to protect against the decline in implementation effort. This study explores the impact of HELM on outcomes related to practice use. One school district and 10 schools in western Washington State participated. Five of the schools received the HELM strategy and the remaining five schools received an alternative leadership training. Teachers at every school (n = 341) received training in a practice called Positive Greetings at the Door (PGD) that has been shown to reduce student behavior problems. Principals and Assistant Principals (n = 18) received the HELM strategy or alternative leadership training. Three district administrators also participated in HELM. HELM unexpectedly slowed the average decline of implementation leadership (perseverant leadership and communication), three dimensions of implementation climate (recognition, rewards, and existing supports), total implementation climate, and one dimension of implementation citizenship (keeping informed). No significant effects were found with regard to use of the practice. The HELM strategy shows promise in slowing the deterioration of practice in schools and positively influenced implementation leadership behaviors.

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

✪ Harnessing Human-Centered Design for Evidence-Based Psychosocial Interventions and Implementation Strategies in Community Settings: Protocol for Redesign to Improve Usability, Engagement, and Appropriateness

Authors:

Aaron R Lyon, Sean A Munson, Michael D Pullmann, Brittany Mosser, Tricia Aung , John Fortney, Alex Dopp, Katie P Osterhage, Helen G Haile, Kathryn E Bruzios, Brittany E Blanchard, Ryan Allred, Macey R Fuller, Patrick J Raue, Ian Bennett, Jill Locke, Karen Bearss, Denise Walker, Elizabeth Connors, Eric J Bruns, Jenna Van Draanen, Doyanne Darnell, Patricia A Areán

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

✪ Open Access

Published: January 2025

Read the full text in the open access journal JMIR Research Protocols

Abstract:

Background

Although substantial progress has been made in establishing evidence-based psychosocial clinical interventions and implementation strategies for mental health, translating research into practice—particularly in more accessible, community settings—has been slow.

Objective

This protocol outlines the renewal of the National Institute of Mental Health–funded University of Washington Advanced Laboratories for Accelerating the Reach and Impact of Treatments for Youth and Adults with Mental Illness Center, which draws from human-centered design (HCD) and implementation science to improve clinical interventions and implementation strategies. The Center’s second round of funding (2023-2028) focuses on using the Discover, Design and Build, and Test (DDBT) framework to address 3 priority clinical intervention and implementation strategy mechanisms (ie, usability, engagement, and appropriateness), which we identified as challenges to implementation and scalability during the first iteration of the center. Local redesign teams work collaboratively and share decision-making to carry out DDBT.

Methods

All 4 core studies received institutional review board approval by June 2024, and each pilot project will pursue institutional review board approval when awarded. We will provide research infrastructure to 1 large effectiveness study and 3 exploratory pilot studies as part of the center grant. At least 4 additional small pilot studies will be solicited and funded by the center. All studies will explore the use of DDBT for clinical interventions and implementation strategies to identify modification targets to improve usability, engagement, and appropriateness in accessible nonspecialty settings (Discover phase); develop redesign solutions with local teams to address modification targets (Design and Build phase); and determine if redesign improves usability, engagement, and appropriateness (Test phase), as well as implementation outcomes. Center staff will collaborate with local redesign teams to develop and test clinical interventions and implementation strategies for community settings. We will collaborate with teams to use methods and centerwide measures that facilitate cross-project analysis of the effects of DDBT-driven redesign on outcomes of interest.

Results

As of January 2025, three of the 4 core studies are underway. We will generate additional evidence on the robustness of DDBT and whether combining HCD and implementation science is an asset for improving clinical interventions and implementation strategies.

Conclusions

During the first round of the center, we established that DDBT is a useful approach to systematically identify and address chronic challenges of implementing clinical interventions and implementation strategies. In this subsequent grant, we expect to increase evidence of DDBT’s impact on clinical interventions and implementation strategies by expanding a list of common challenges that could benefit from modification, a list of exemplary solutions to address these challenges, and guidance on using the DDBT framework. These resources will contribute to broader discourse on how to enhance implementation of clinical interventions and implementation strategies that integrate HCD and implementation science.

International Registered Report Identifier (IRRID)

PRR1-10.2196/65446

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

✪ Looking under the hood of a hybrid two-way texting intervention to improve early retention on antiretroviral therapy in Malawi: an implementation fidelity evaluation

Abstract:

Background

While key to interpreting findings and assessing generalizability, implementation fidelity is underreported in mobile health (mHealth) literature. We evaluated implementation fidelity of an opt-in, hybrid, two-way texting (2wT) intervention previously demonstrated to improve 12-month retention on antiretroviral therapy (ART) among people living with HIV (PLHIV) in a quasi-experimental study in Lilongwe, Malawi.

Methods

Short message service (SMS) data and ART refill visit records were used to evaluate adherence to 2wT content, frequency and duration through the lens of the Conceptual Framework for Implementation Fidelity. Message delivery and 2wT participant interactions were considered across four core 2wT components: 1) weekly motivational SMS messages; 2) proactive SMS appointment reminders; 3) SMS reminders after missed appointments; and 4) interactive messaging with 2wT staff about transfers and appointment rescheduling. Using mixed-effects logistic regression models adjusted for participant demographics, we examined the effect of core 2wT component fidelity on a) on-time appointment attendance and b) timely return to care after a missed appointment, presenting adjusted odds ratios (aORs) and 95% confidence intervals (CIs).

Results

The 468 2wT participants had a median of 52 study weeks (interquartile range [IQR] 34 – 52) with 6 ART appointments (IQR 4—7) of which 2 (IQR 1 – 3) were missed. On average, participants received a motivation message for 75% (IQR 56%—83%) of enrolled weeks, a reminder before 83% (IQR 67%—100%) of appointments, and after 67% (IQR 0%—100%) of missed appointments. Participants reported 9 transfers and rescheduled 46 appointments through 2wT prompts; 196 appointments were changed via unprompted interaction. Participants with 10% higher expected motivation message delivery were more likely to attend clinic appointments on time (aOR: 1.08; 95%CI: 1.01 – 1.16, p = 0.03). Receiving and responding to an appointment reminder in any way were also associated with increased on-time appointment attendance (aOR: 1.35; 95%CI: 1.03 – 1.79, p = 0.03 and aOR: 1.47, 95%CI: 1.16 – 1.87, p = 0.001, respectively). No associations were found for 2wT messages and timely return to care following a missed appointment.

Conclusion

Greater 2wT implementation fidelity was associated with improved care outcomes. Although implementation fidelity monitoring of mHealth interventions is complex, it should be integrated into study design.

Contributions to the literature

Despite the recognized importance of implementation fidelity in digital health research, few studies evaluate and transparently report the extent to which mHealth interventions were implemented as intended.
This study presents a framework-based evaluation of the implementation fidelity of a two-way texting intervention for HIV retention in a routine care setting in Malawi. Findings demonstrate how fidelity assessment not only facilitates replication of findings and generalizability assessment, but uncovers implementation challenges and generates hypotheses about intervention mechanisms of action.
The benefits and complexity of implementation fidelity evaluation underscore the need to consider fidelity early and integrate monitoring mechanisms into study design.

^{**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 Integrative Medicine & Health

Abstract:

Background

Methods

Results

Conclusion

ClinicalTrials.gov registration

Authors:

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

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✪ Open Access

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

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Conclusions

Contributions to the literature

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Read the full text in the subscription access Journal of Technology in Behavioral Science

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Read the full text in the subscription access journal Burns

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✪ Open Access

Read the full text in the open access journal JMIR Formative Research

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Background

Objective

Methods

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Conclusions

Authors:

✪ Open Access

Read the full text in the open access journal Learning Health Systems

Abstract:

Introduction

Methods

Results & Conclusions

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✪ Open Access

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

Abstract:

Background

Method

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Trial Registration Information

Plain Language Summary

Authors:

✪ Open Access

Read the full text in the open access journal JMIR Research Protocols

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Background

Objective

Methods

Results

Conclusions

International Registered Report Identifier (IRRID)

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✪ Open Access

Read the full text in the open access journal Implementation Science

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Background

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