UW Articles Archive - Page 48 of 60 - Implementation Science at UW

✪ Lay Counselor Perspectives of Providing a Child-Focused Mental Health Intervention for Children: Task-Shifting in the Education and Health Sectors in Kenya

Abstract:

The global mental health treatment gap has increasingly been addressed using task-shifting; however, very little research has focused on lay counselors’ perspectives on the acceptability, feasibility, and appropriateness of mental health interventions in specific government-supported sectors that might scale up and sustain mental health care for children and adolescents. In western Kenya, these sectors include Education and Health.

Data come from a large hybrid effectiveness-implementation study examining implementation practices and policies in either or both sectors that support successful implementation of a child-focused intervention, Trauma-focused Cognitive Behavioral Therapy (TF-CBT), for children and adolescents who had experienced parental death. We examined lay counselors’ self-report of acceptability, feasibility, and appropriateness of TF-CBT. Lay counselors were teachers (n = 30) from the Education sector and Community Health Volunteers (CHVs; n = 30) from the Health sector, who were part of Sequence 1 of a large stepped-wedge, cluster randomized trial.

Lay counselor self-report surveys included reflective and formative measurement of acceptability, feasibility, and appropriateness administered after lay counselors in both sectors had experience delivering the locally-adapted, group-based TF-CBT intervention. Descriptive statistics (means, standard deviations) were used to understand counselors’ perspectives stratified by sector.

Both teachers and CHVs endorsed high acceptability, feasibility, and appropriateness of TF-CBT, with lay counselors’ responses on items from the formative measures providing some insight into specific aspects of acceptability, feasibility, and appropriateness that may be important to consider when planning for implementation support.

These early findings suggest that both sectors may hold promise for task-shifting of mental health care for children and adolescents but also underline the importance of considering the multiple facets of these three implementation outcomes as well as lay counselor context (Education vs. Health).

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

Cascade Analysis: An Adaptable Implementation Strategy Across HIV and Non-HIV Delivery Platforms

Anjuli D. Wagner, Sarah Gimbel, Kristjana H. Ásbjörnsdóttir, Peter Cherutich, Joana Coutinho, Jonny Crocker, Emiliae Cruz, Fatima Cuembelo, Vasco Cumbe, McKenna Eastment, Jennifer Einberg, Florencia Floriano, Douglas Gaitho, Brandon L. Guthrie, Grace John-Stewart, Alex H. Kral, Barrot H. Lambdin, Shan Liu, Martin Bcom Maina, Nelia Manaca, Mika Matsuzaki, Loris Mattox, Nancy Mburu, R. Scott McClelland, Mark A. Micek, Ana Olga Mocumbi, Albertoe Muanido, Ruth Nduati, Irene N. Njuguna, Geoffrey Oluoch, Laura B. Oyiengo, Keshet Ronen, Caroline Soi, Bradley H. Wagenaar, George Wanje, Lynn D. Wenger, and Kenneth Sherr

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

Published: December 2019

Read the full text in the subscription access JAIDS: Journal of Acquired Immune Deficiency Syndromes

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

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**}

✪ UW Research Presented at D&I 2019

What makes an enabling context for mental health delivery? Differential implementation practices for task-shared delivery across education and health sectors in western Kenya

Prerna Martin, MPH¹, Kathryn Whetten, PhD, MPH², Christine Gray, PhD, MPH², Rosemary Meza, MS¹, Caroline Soi, PhD, Msc. MD¹, Cyrilla Amanya, MS³, Augustine Wasonga, MBA, MA³ and Shannon Dorsey, PhD⁴.

4:30 PM - 4:45 PM
Crystal Gateway Marriott - Salon J

Also presenting at the Best of D & I Poster Session Friday, December 6, 2019 from 9:45 AM - 11:15 AM in Salon F/G/H

Strategically employing patient navigation to reduce colorectal cancer screening disparities

Chair: Peggy Hannon, PhD MPH, Health Services, University of Washington, Seattle, WA
Discussant: Amy DeGroff, PhD, MPH, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA

4:30 PM - 6:00 PM
Crystal Gateway Marriott - Rosslyn

Patient navigators and their activities in the colorectal cancer control program (CRCCP): A national survey

Wendy Barrington, PhD, MPH¹, Thuy Vu, MPH², Amy DeGroff, PhD, MPH³, Stephanie Melillo, MPH⁴, Allison Cole, MD, MPH⁵, Cam Escoffery, PhD⁶, Natoshia Askelson, MPH, PhD⁷, Laura Seegmiller, MPH⁸, Sarah Koopman Gonzalez, PhD⁹ and Peggy Hannon, PhD MPH².

4:30 PM - 4:45 PM
Crystal Gateway Marriott - Rosslyn

Implementing and adapting a promising patient navigation intervention to increase colonsocopy completion

Allison Cole, MD, MPH¹, Thuy Vu, MPH², Marlana Kohn, MPH², Gloria Coronado, PhD³, Amy DeGroff, PhD, MPH⁴, Dara Schlueter, MPH⁵ and Peggy Hannon, PhD MPH².

4:45 PM - 5:00 PM
Crystal Gateway Marriott - Rosslyn

Implementation of interprofessional bedside rounding models with hospitalized patients: A scoping review of quantitative and qualitative evidence

Erin Blakeney, PhD, RN¹, Frances Chu, RN², Andrew White, MD³, Danielle Lavallee, PharmD, PhD¹, Elizabeth (Ibby) Tanner, PhD, RN⁴, Nicole Summerside, MHA⁵, Kyla Woodward, RN², Deborah Dang⁶ and Dr. Bryan Weiner, PhD⁷.

6:15 PM - 7:45 PM
Crystal Gateway Marriott - Arlington Ballroom

Implementing pharmacist-led medication interventions in outpatient oncology: A systematic review of barriers, facilitators, and costs

Dr. Cara McDermott, Ph.D, PharmD¹, J. Randall Curtis, MD, MPH¹, Ruth Engelberg, PhD¹, Cossette Woo, MSW¹ and Dr. Bryan Weiner, PhD².

6:15 PM - 7:45 PM
Crystal Gateway Marriott - Arlington Ballroom

Unique patient identification: Feasibility and acceptability of an iris recognition biometric system in routine HIV services in Kenya

Anne Njoroge¹, Matthew Dunbar², Peter Cherutich³, David Bukusi¹ and Carey Farquhar².

6:15 PM - 7:45 PM
Crystal Gateway Marriott - Arlington Ballroom

Assessing adaptations to Medicaid/ Medicare health-plan-initiated mailed FIT outreach programs

Gloria Coronado, PhD¹, Jennifer Schneider, MS¹, Malaika Schwarz, MPH², Beverly Green, MD, MPH³ and Laura-Mae Baldwin, MD, MPH⁴.

6:15 PM - 7:45 PM
Crystal Gateway Marriott - Arlington Ballroom

Implementing a public health intervention to close statin gaps in diabetes care: Feasibility and protocol adherence in community pharmacy

Jennifer Bacci, PharmD, MPH, BCACP¹, Jenny Kim, PharmD², Tara Pfund, PharmD³, Kayla Hensley, PharmD² and Peggy Odegard, BSPharm, PharmD, CDE¹

6:15 PM - 7:45 PM
Crystal Gateway Marriott - Arlington Ballroom

Understanding early implementation of pre-exposure prophylaxis for HIV prevention in public health facilities in Uganda using the consolidated framework for implementation research

Katrina Ortblad, ScD, MPH¹, Charles Brown, MS², Timothy Muwonge, MBChB², Caitlin Scoville, MPH¹, Diego Izizinga, MS², Sylvia Namanda, MS², Florence Nambi, MS², Lylianne Nakabugo, MS², Andrew Mujugira, MBChB, PhD² and Renee Heffron, PhD, MPH¹.

6:15 PM - 7:45 PM
Crystal Gateway Marriott - Arlington Ballroom

Thursday, December 5, 2019

Patterns of early implementation process in primary care clinics adopting collaborative care for perinatal depression

Tess Grover¹, Mindy Vredevoogd¹, Ian Bennett, MD PhD¹, Lisa Saldana, PhD², Rachel Gold, PhD, MPH³, Amritha Bhat, MD¹, Holle Schaper, MS⁴ and Enola Proctor, PhD⁵.