6th UK and Ireland Implementation Science Research Conference 2023
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Authors: Noura Bawab, Joanna C. Moullin, Olivier Bugnon, Clémence Perraudin
Presented by: Noura Bawab
Biography: Noura Bawab is a pharmacist and doctoral student at the Centre for Primary Care and Public Health (Unisanté) in Lausanne, Switzerland. After completing her master thesis on the development and testing of a serious game with final year pharmacy students in Switzerland and Belgium, she graduated from the Université Libre de Bruxelles. She then started her PhD thesis in 2015 while working in community pharmacy. Her research, funded by the Swiss Federal Office of Public Health, focuses on the implementation of pharmaceutical services in community pharmacies. Her current research project aims to implement an interprofessional support program for chronic patients in a primary care setting in French-speaking Switzerland, with a special focus on patients with diabetes. This project will be the result of her thesis to be presented in September 2020.
Background: The Swiss federal government promoted the evaluation of an inter-professional patient support model, including regular motivational interviews (patient-pharmacist), medication adherence and patient-reported outcomes monitoring and interactions with physicians. The aim of this 15-month study was to evaluate the implementation process of a programme tailored to patients with type 2 diabetes, taking at least one oral antidiabetic treatment.
Materials and methods: This is a prospective, multi-centric, observational, cohort study using a hybrid implementation-effectiveness design and the Framework for the Implementation of Services in Pharmacy (FISpH) [1]. Outcomes were assessed at each stage of the implementation process using both quantitative and qualitative methods. A set of implementation measures reported on the process (number of pharmacies going through the stages), outcomes (e.g. reach, fidelity) and impact (influencing factors and implementation strategies).
Results: Two-hundred-twelve patients were included to benefit from the support programme in 27 pharmacies. The mean inclusion rate per pharmacy was 8 patients (SD 6, range: 1-29). We observed a step-by-step implementation process: 1) internal organisation: teaching and coaching of the pharmacy team, identification of eligible patients, 2) preparation of inter-professional collaboration: information and local networking with physicians; and 3) relationship building with patients. Main influencing factors were pharmacists’ skills in motivational interviewing, support from pharmacy owners, pre-existing local inter-professional networks and profitability of the programme.
Figure 1. Indicators of progress of the implementation process
Conclusions: This evaluation provided evidence regarding the implementation capacity and acceptability of the programme by pharmacy teams, patients with diabetes and physicians: a promising start for inter-professional chronic care services.
Authors: Mark Pearson, Daniele Carrieri, Karen Mattick, Chrysanthi Papoutsi, Simon Briscoe, Geoff Wong, Mark Jackson
Presented by: Mark Pearson
Biography: Mark is a social scientist focusing on knowledge mobilisation and implementation issues in health and social services. His research focuses on how social, psychological and organisational factors interact and impact on how knowledge is used in practice. Using theory-driven methods, Mark conducts research that informs both the development of interventions (the implementation and impact theories that underpin the ways in which complex interventions are proposed to work) and the evaluation of interventions (refining understanding of implementation mechanisms that are transferable across fields of practice). He is Mark is Lead for Implementation Science at the Wolfson Palliative Care Research Centre (Hull York Medical School) and a member of the National Institute for Health Research’s Health Services & Delivery Research (HSDR) Funding Committee.
Background: The impact of the work environment on the mental health of doctors is internationally recognised. However, research syntheses on interventions that provide support, advice and/or treatment to sick doctors have not fully taken account of intervention complexity and heterogeneity, the multiple dimensions of the issue, nor the challenges of implementing strategies to address mental ill-health in doctors. We: 1) conducted a realist review of interventions to improve doctors’ and medical students’ mental ill-health, engaging throughout with a diverse group of stakeholders; 2) developed recommendations to support tailoring, implementation, monitoring and evaluation of these strategies.
Method: Realist review, conducted and reported consistent with RAMESES standards. Research and policy sources identified through bibliographic database searches, purposive searches, and stakeholder engagement. Extracted data analysed using a realist lens to identify explanatory context-mechanism-outcome configurations (CMOcs) of mental ill-health in doctors and medical students.
Results: 179 sources were included, 45% of which were from the USA and 74% of which were published in 2009 or later. The synthesis produced 19 CMOcs (processes, relationality, balance, and implementation) explaining how mental ill-health develops in the workplace and how strategies can be implemented to reduce mental ill-health. Trust was identified as highly important in explaining the interplay between implementation strategy, intervention development, and the broader workplace context.
Conclusion: Interventions to improve doctors’ and medical students’ mental ill-health should take account of the complexity of the issue and its implementation by operating at multiple levels and engaging diverse stakeholders. Refining existing complex interventions, informed by the CMOcs in this review, is likely to be more efficient and ultimately more effective than developing new interventions. This review has demonstrated the importance of Realist review in critically synthesising diverse evidence about complex health service issues so that implementable multi-level strategies can be developed.
Acknowledgements: This project is funded by the by the National Institute for Health Research (NIHR) HS&DR (project number 16/53/12) and supported by the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. Systematic review registration PROSPERO CRD42017069870
Authors: Alita Rushton, Kai Elmas, Dr Jack Bell
Presented by: Jack Bell
Biography: Dr Bell is an advanced dietitian, a conjoint Principal Research Fellow with University of Queensland and Metro North Hospital Health Service, and a current Medical Research Futures Fund TRIP Fellow. As an implementation scientist Jack currently works with teams across Queensland and Canada to implement systematised, interdisciplinary malnutrition care in hospitals. In diverse representational roles, Dr Bell advocates for embedding audit and patient reported measures to inform values based healthcare improvements.
Background: Traditional malnutrition models of care apply individualised, dietitian administered nutrition care. Shifting to systematised and/or interdisciplinary alternatives is an important step towards improved service efficiencies, effectiveness, and patient reported experience measures. This study consequently applied a nominal group technique approach with experts in field to identify and prioritise low-value nutrition care practices for de-implementation.
Method: Workshops using the nominal group technique were undertaken at eight hospitals across Queensland, Australia administered by a single experienced clinician/implementation expert. Purposively sampled dietitians and nutrition assistants were asked the question “What highly individualised malnutrition care activities do you think we could replace with systematised, interdisciplinary malnutrition care?”. Each participant was provided opportunity to individually list and present responses, discuss them as a group, and then vote for the highest priorities; each participant was allowed five votes.
Results: Nine workshops were conducted across eight sites. Dietitians (51) and assistants (12) identified 101 dietetics actions to replace with systematised, interdisciplinary alternatives. These were spread across screening (n=5), assessment (n=31), diagnosis (n=2), intervention (n=45), and monitoring and evaluation (n=18) domains of the nutrition care process. Actions that received the highest number of nominal group technique votes were: comprehensive dietitian assessments for low risk referrals (n=50); dietetics follow-up reviews where unlikely to add substantial benefit (n=32); individualised inpatient educations by dietitian where specialised education or counselling were considered low-value (n=28); individualised food and fluid support for patients who do not require specialised dietitian care (n=22); and assistants undertaking malnutrition screening (n=19).
Conclusion: Findings highlight the nominal group technique as a useful approach to prioritising embedded, low-value clinical care activities for de-implementation. The individual and group elements of the framework supported establishment of consensus amongst practicing clinicians and policy makers. These findings are currently supporting practice and policy value-based healthcare reform across Queensland hospitals.
Authors: Agnes Binagwaho, Miriam F Frisch, Jovial Thomas Ntawukuriryayo, Dieudonné Nkurunziza, Kelechi Udoh, Amy VanderZanden, Laura Drown, Lisa R Hirschhorn
Presented by: Agnes Binagwaho
Biography: Professor Agnes Binagwaho,MD,M(Ped),PhD is a Rwandan pediatrician and the Vice Chancellor of the University of Global Health Equity. She worked for 20 years in the public health sector in Rwanda, serving in high-level government positions from 2002-2016 as the Executive Secretary of Rwanda’s National AIDS Control Commission, then as Permanent Secretary of the Ministry of Health, and then for five years as Minister of Health. She is currently the Senior Advisor to the Director General of the World Health Organization, a Senior Lecturer in the Department of Global Health and Social Medicine at Harvard Medical School, an Adjunct Clinical Professor of Pediatrics at Dartmouth’s Geisel School of Medicine, a Professor of Pediatrics at the University of Global Health Equity, a member of US National Academy of Medicine and a fellow of the African Academy of Sciences. Her current research interests center around implementation science and health equity.
Background: Despite health-system evidence-based interventions (EBIs) known to reduce amenable under-5 childhood mortality (U5M), countries struggle to effectively bridge the implementation gap. We applied implementation research (IR) to understand how six countries (Rwanda, Senegal, Ethiopia, Bangladesh, Nepal, Peru) implemented EBIs to contribute to successfully dropping U5M.
Method: We developed an IR framework building on the Exploration, Preparation, Implementation, Sustainment Framework and Consolidated Framework for Implementation Research to include adaptation (EPIAS) and capture contextual factors at the global, national, health system, and individual levels.[1,2] We used mixed methodology to analyze EBI implementation and successes and challenges.
Results: These countries took a five-step implementation approach, reflecting EPIAS, to implement the EBIs, recognizing contextual factors needing to be addressed or influencing implementation strategies. Exploration: Understand and research the problem and possible solutions; identify multisectoral stakeholders; identify possible implementation strategies. Preparation for implementation: Choose EBIs or implementation strategies that fit national contexts, priorities, and identified gaps; identify contextual factors to be addressed or influencing strategies; develop evidence-based guidelines for implementation; plan for monitoring and evaluation. Initiate implementation: Disseminate national protocols; train personnel and stakeholders; implement interventions and accountability frameworks; monitor implementation; follow research and new guidelines to identify new EBIs or strategies. Adaptation: Use monitoring data and stakeholder engagement to determine gaps in fidelity, reach, acceptability, and effectiveness; make evidence-based adaptations; continue monitoring to assess impact; identify new resources needed. Sustainment: Ensure longer-term funding; cultivate a culture of evaluation and implementation of needed changes; integrate training and capacity-building. These countries’ success in U5M reduction also included broader initiatives to reduce disease burden (ex. sanitation) and improve child and family resilience (ex. economic development, female empowerment).
Conclusion: These findings provide lessons for other countries to better adapt and implement health-system delivered EBIs to accelerate U5M reduction and achieve equity.
Authors: Mike Hurley, Sally Irwin, Jo Erwin, Fay Sibley, Amber Gibney, Andrea Carter
Presented by: Mike Hurley
Biography: Mike Hurley qualified as a physiotherapist at Kings’ College Hospital in 1985. After completing his PhD at University College London he was Lecturer, Reader and Professor at Kings’ College London between 1990-2010. In 2010 he became Research Lead in the School of Rehabilitation Sciences at St George’s University of London, and in 2013 was appointed Clinical Director for the Musculoskeletal Programme of the Health Innovation Network.
Professor Hurley has been a Clinical Advisor to Arthritis Research UK (2002-2008), Chair of Chartered Society of Physiotherapy’s Research and Clinical Effectiveness (2001-2004), has contributed to several national working groups, clinical guideline committee and conferences. He has authored more than 80 papers.
A major part of his work was the development of ESCAPE-pain – a rehabilitation programme to help people with knee, hip and back pain that is now being delivered in nearly 300 clinical and community venues across the UK.
Background: NICE recommend people with knee, hip and/or back pain receive self-management and lifestyle advice, emphasising the importance of physical activity and maintaining healthy weight. Unfortunately, delivering NICE advice to the millions of people requiring help is prevented by limitations in time, facilities and expertise. Moreover, using healthcare facilities and professionals medicalises a problem most people see as a natural part of living and ageing. Joint Pain Advice (JPA) can deliver NICE advice in a variety of health and community settings, using a range healthcare and non-healthcare professionals (1,2). Here we extend JPA delivery into workplace settings using local health champions.
Method: In workplaces, 2-3 people were trained to deliver JPA. This involved an initial assessment of participant’s pain (using VAS), musculoskeletal health and function (MSK-HQ), activity level (number of days/week active for >30mins). Participants were taught simple self-management strategies, encouraged to adopt healthier lifestyle using motivational interviewing, goal-setting action/coping planning and personalised care plans constructed. Participants were reviewed 3 times over 6-months, baseline outcomes reassessed, progress highlighted, health messages reinforced and plans and care plans revised if necessary. Results presented as mean change (95% CI)
Results: Twelve large public organisations or small/medium private enterprises delivered JPA to 417 people. Participants attendance was 75%, suggesting they found JPA acceptable, valued advice tailored to their individual needs and experienced tangible benefits. Overall the MSK-HQ improved by 8 points (CI 6.6 to 9.2), pain 1 (-1.33 to -0.88), activity for >30mins by 1.5 (1.1 to 1.8), self-reported physical function by 1.5 (1.1 to 1.8).
Conclusion: Delivering NICE advice for management of chronic joint pain through JPA in workplace settings using local health champions is practicable, beneficial and valued. This can avoid medicalising the problem and “prevent turning people into patients”. JPA could benefit small medium or large employers across the UK.
Acknowledgements: This work was funded by the Department of Work and Pensions Work and Health Unit Challenge Fund Trial Registration Not applicable Consent to publish Not applicable References 1. Hurley M V., Semple A, Sibley F, Walker A. Evaluation of a health trainer–led service for people with knee, hip and back pain. Perspectives in Public Health [Internet]. 2019;139(6):308–15. Available from: https://doi.org/10.1177/1757913919833721 2. Innovation Network Joint Pain Advice (JAP) information https://healthinnovationnetwork.com/projects/joint-pain-advisor-exploring-a-new-model-of-care-for-chronic-joint-pain/Health
Authors: Seward N, Hanlon C, Colbourn T, Murdoch J, Prince M, Venkatapuram S, Sevdalis N
Presented by: Nadine Seward
Biography: Nadine Seward is a Lecturer in Global Implementation, based within the Centre for Implementation Science. Nadine holds a BSC (Hons Life Science) from Queen’s University in Canada, an MSC (Epidemiology) from LSHTM and a PhD (Epidemiology) from UCL.
Prior to starting at KCL in August 2018, Nadine worked at LSHTM on community trials aimed at improving maternal and newborn health outcomes as well as trials trying to better educational outcomes. Her interests were focused on using causal mediation analyses and other techniques to evaluate the “how and why” behind the effectiveness of different complex interventions. Before LSHTM, Nadine worked at UCL, Institute of Global Health on community trials that involved women’s groups using participatory learning and action, to improve maternal and newborn health outcomes.
Nadine is currently working with the NIHR Global Health Research Unit on Health System Strengthening in Sub-Saharan Africa (ASSET) to improve the quality of integrated primary health care, surgical and maternal and newborn care. As a Lecturer in Global Implementation Science, Nadine is interested in brining interventions that are known to be effective, to scale through the application of appropriate models, frameworks and theories. Nadine will be working with the different ASSET partners and across the different care platforms to use implementation science methodology to evaluate practical ways to improve the quality and coverage of care.
Nadine is also interested in developing implementation science methodologies as well as applying and adapting causal inference techniques to evaluate the effectiveness of different implementation programmes in low- and- middle- income countries.
Background: The call for universal health coverage within low-and middle-income countries, requires the implementation and scale-up of interventions that are known to be effective.1 Achieving universal health coverage requires robust implementation research (IR) that evaluates the influence of context on the effectiveness of interventions to deliver evidence-based care.(1) However, where IR uses a randomised controlled trial (RCT) to test the effectiveness of interventions to deliver care that is known to be effective, clinical equipoise may no longer be relevant.(2)
IR is fundamentally about evaluating the influence of context on the effectiveness of interventions to deliver evidence-based care. (3) However, the process of conceptualising whether there is sufficient evidence about context to generalise findings from previous research to a new setting is rarely reported, leaving uncertainty as to whether an RCT is justified. This raises important ethical concerns surrounding participants in the control arm of an RCT being exposed to unnecessary harms associated with denying individuals access to care that is known or can be expected to be effective, in the local context.(2)
Proposed methods to address ethical concerns: To address this ethical concern, we propose a complementary approach to clinical equipoise for IR, known as “contextual equipoise.” We further propose that IR that uses an RCT needs to clearly articulate the grounds for contextual equipoise. However, the process of understanding contextual equipoise raises ontological and epistemological challenges for assessing the certainty of evidence. We discuss these challenges and argue that a guiding principle should be uncertainty amongst key stakeholders, as to the influence of context on the delivery evidence-based care.
Conclusions: To guide researchers, we describe how theory-driven methods can be applied to help understand if contextual equipoise is justified. We hope our approach helps researchers to better understand and ensure the ethical principle of beneficence is upheld in the real-world contexts of IR in low-resource settings.
Authors: Elena Pallari
Presented by: Elena Pallari
Biography: Elena Pallari is currently a Research Methodologist at the Department of Clinical Trials and Methodology at University College London. She has also been serving as a Research Scientist (Consultant) for the International Institute of Compassionate during the Covid-19 pandemic period in Cyprus providing proposals on the set-up of a clinical-trial platform on the island and plans for the reconfiguration of healthcare services. Her current research activities include the evaluation of research impact, clinical guidelines, health-policy and quality of care improvement, with a publication portfolio of over 30 peer-review publications, book chapters and over 20 international conferences. She is affiliated with the Centre for Implementation Science at King’s College London. She is currently co-leading the Knowledge translation work package for the burden-eu COST Action CA18218: https://www.burden-eu.net/network/core-group with focus on the estimation of the burden of covid-19 across Europe and its implications on the social, research and dimension.
Background: The translation of scientific findings in healthcare is notoriously slow, except for a few ground-breaking innovations, healthcare interventions and recently the global response to the public health emergency posed by the novel coronavirus (Covid-19).
Method: In this study, I evaluated the government plans of the Republic of Cyprus in response to the Covid-19 outbreak. I applied the Promoting Action on Research Implementation in Health Services (PARiHS) framework to guide this assessment. I used data provided by the Department of Medical and Public Health Services of the Ministry of Health, the Press and Information Office and publicly available data to assess the healthcare capacity to the pandemic response through the PARiHS framework.
Results: The initiative of the government of the Republic of Cyprus has been responsive and reactive but not proactive, following the robust and vigorous prototype set by the Chinese government. As soon as the first two Covid-19-positive cases were diagnosed on the island, the appropriate services were activated, and a thorough contact-tracing lead (Figure 1). This was the turning point for the government to initiate immediate measures to slow the spread within the community.
Conclusions: As the hub of Covid-19 shifted from China to Italy, with Europe becoming the epicentre of the disease, so did the evidence and sharing of best practices in dealing with the pandemic. The PARiHS framework was a useful model to map the spontaneous practice-based implementation plans of the Cypriot government to protect the health of an island with a population of under a million residents.
Authors: Soukup T, Hull L, Healey A, Bakolis I, Kariyawasam D, Brooks A, Heller A, Amiel S, Sevdalis N, People with Diabetes Group
Presented by: Tayana Soukup
Biography: Tayana Soukup, PhD, is a research scientist at the Centre for Implementation Science of King’s College London, UK. A psychologist by training, she has worked extensively with multidisciplinary health care teams for a number of years, has obtained PhD in clinical medicine research, and has published numerous papers in the field. Her research interests include implementation and improvement science, communication and decision-making, and team science. Her expertise is in research design, mixed methods (quant and quali), and applied health research that includes a range of stakeholders and spans a range of conditions, including cancer, diabetes, mental health, speech impediments, dementia, stroke, and neurodevelopmental conditions.
Background: Through the lens of an effectiveness-implementation hybrid type 2 study (NCT02940873) we describe how such multidimensional methodology can help form stakeholder-centred interventions, care and practice. We also reflect on methodological challenges and opportunities with stakeholder-engaged hybrids in the effort to help advance the emerging field of these designs in health care research.
Method: The case study tested two psychoeducational programmes in diabetes. It consisted of effectiveness testing accompanied by the implementation assessments while shaped by the stakeholder inputs – these have been parallel yet mutually interacting formative processes. The key intervention stakeholders for the hybrid were identified through the stakeholder snowballing technique. The engagement with the identified stakeholders was structured based on the principles reported in the literature, i.e., clear goals for engagement and regular communication channels for continuous partnership building. In total 17 study meetings were conducted with overall 28 intervention stakeholders, including, individuals with lived experience (n=6), and healthcare professionals (n=22).
Results: The stakeholder input has enabled relevant, feasible, and appropriate implementation outcomes, validated surveys, interview questions, participant groups, and measurement time-points to be identified. We also identified key challenges and opportunities of working within such complex research landscape, thus contributing to the scientific understanding of stakeholder-engaged hybrid methods for evaluating and implementing complex interventions within health care. These were as follows: (1) data richness, (2) wide range of participant groups, and (3) pre- and post-intervention assessments.
Conclusion: Stakeholder-led methodology and engagement is critical to ensuring relevance and feasibility of the study design across different hospital settings and countries helping overcome challenges. Such design involves systematic study planning and organisation based on the principles for stakeholder engagement reported in the literature, and a thoughtful assessment of outcomes utilising mixed methods across multi-participant groups and sources.
Authors: Hossai Gul, Dr Janet Long, Dr Stephanie Best, Prof. Frances Rapport, Prof. Jeffrey Braithwaite
Presented by: Hossai Gul
Biography: Hossai has worked within the Australian health and medical sector for over 10 years in health services, biomedical research, and health system and implementation science research. Hossai has a Bachelor of Advanced Science, an Honours by thesis in cancer drug discovery, a Master of Research by thesis in bioinformatic analysis, and currently completing a PhD in Implementation Science. For the last 3 years, Hossai has led the research for the design and implementation of 3 new models of care to implement genomic medicine as routine care within the largest health system in Australia. Hossai is passionate about embedding implementation science and health services research within projects that are conducted within and by the health system to maximise research impact on health services and build research capacity within clinical and managerial teams.
Background: There is a clinical implementation gap in patient care between what is applied and what we know works best. Changing this within a complex system is challenging. Studying change from outside the system is even harder. This study aimed to develop an anchoring framework seeking to bring implementation research and implementation practice together for the benefit of translating new science into quality care at the coalface of change.
Methods:
Phase 1: Examination of existing literature to understand how researchers outside healthcare approached wicked problems such as poverty, domestic violence, AIDS prevention. Methodological and epistemological aspects of approaches were noted and compared to implementation science models, frameworks, and theories to assess the methodological and epistemological grounding.
Phase 2: Development of a new framework for undertaking implementation research in parallel with implementation practice to understand changes in complex adaptive systems. Phase 3: Deployed the newly developed framework across 3 projects focused on the design and implementation of genomic service delivery models.
Results: The new framework – Systems-informed Participatory Action Implementation Research (SPAIR) – combines Systems science, Participatory Action Research (PAR), and Implementation science models, frameworks, and theories (Figure 1). Preliminary results using the SPAIR approach: 1) flexible to deploy using implementation frameworks, 2) direct, real-time positive impact on implementation efforts, 3) builds implementation science skills and capacity within organisations, and 4) directly promotes implementation science and practice. Figure 1: SPAIR framework.
Conclusion: SPAIR can be deployed as the underlying template for leading implementation research and practice within complex adaptive systems.
Authors: Shalini Ahuja*, Nathan Peiffer-Smadja, Kimberly Peven, Michelle White, Andrew Leather, Sanjeev Singh, Marc Mendelson, Alison Holmes, Gabriel Birgand, and Nick Sevdalis*, ASPIRES study co-investigators
Presented by: Shalini Ahuja
Biography: Shalini is an implementation science researcher and a physiotherapist by training. She has a PhD in public mental health research from King’s College London and a master’s in health management, planning and policy from University of Leeds, UK.
Her research work includes design and implementation of behaviour change interventions addressing various public health challenges including chronic malnutrition, mental health treatment gap, Antimicrobial Resistance, infection-prevention and control, all in the context of low and middle income countries mainly India, Nepal, Ghana, South Africa and Ethiopia.
Background: Surgical site infection (SSI) prevention is a major issue, particularly in the era of antimicrobial resistance. Reducing SSI rates will require, among other priorities, optimisation of antibiotic usage which may be enhanced by feedback1. Within the area of surgery, it remains unclear how feedback can best be used to reduce SSIs and improve antibiotic usage. Therefore, this study aims to understand how data from surveillance and audit are utilised in routine surgical practice.
Method: A systematic scoping review was conducted. Two electronic health-oriented databases and the bibliographies of relevant articles were searched. We included studies that assessed the use of feedback as a strategy either in the prevention and management of SSI and/or in the use of antibiotics perioperatively. The results of included studies were synthesised using a narrative synthesis approach underpinning thematic analysis principles. Implementation strategies were grouped into 73 discrete strategies as suggested by the ERIC implementation science research group2. The quality of the individual studies was assessed using Integrated Quality Criteria for Systematic Review of Multiple Study Designs.
Results: We identified 21 studies: 17 focused on SSI outcomes and 8 described antibiotic usage in surgery in relation to SSI. These 21 studies described several interventions, mostly multimodal with feedback as a component. Among studies reporting antibiotic usage in surgery most (71%,) discussed compliance with surgical antibiotic prophylaxis. Fifty-five percent of the studies on SSI outcomes reported significant reduction in infection rates. Feedback was often provided in written format (62%), either individualised (38%) or in group (48%). In 65% of the studies, between one and five of 73 ERIC implementation strategies were used while only one study reported using more than 15 implementation strategies.
Conclusion: Our study summarises the efficacy of auditing and surveillance outputs by analysing implementation strategies and highlights the need for feedback to all levels of health care professionals involved in perioperative care of surgical patients.
Authors: Jackie Dwane, Dr. Sean Redmond, Eoin O’Meara Daly, Caitlin Lewis
Presented by: Jackie Dwane
Biography: Jackie joined the Research into Evidence Policy, Programme and Practice (REPPP) team in University of Limerick in 2019. Her role on the Action Research Project involves working with Garda (Police) Youth Diversion Projects (GYDP) to identify and disseminate best practice in working with young people at risk. Jackie graduated from University College Cork (UCC) (BA Hons) in 1998 and completed her MSocSc in Youth and Community Work in UCC in 2001. For twelve years Jackie worked in the Limerick and Clare Education and Training Board as a Youth Officer where her role included trialling a new framework with youth projects involved in a reform process with the Department of Children and Youth Affairs. Jackie’s previous career history includes working as Coordinator of a GYDP in Limerick city, as a youth worker and as a residential care worker with young people in secure care settings. Jackie is an experienced trainer and facilitator of Restorative Practice.
Background: There are 105 youth diversion projects across Ireland targeting young people in trouble with the law. It is estimated that 60 percent of professionals’ time spent in these projects relates to building professional relationships with young people. This relationship effort accounts for approximately €8 million taxpayer’s investment each year. The objective of the relationship is to motivate young people towards pro-social trajectories. However, the practice is largely uncodified or sufficiently described in terms of highlighting and incentivising approaches which are informed by the available evidence.
Method: An Action Research Project (ARP) on behalf of the Department of Justice and Equality is underway to identify the most potent mechanisms within the best relationships. The study involves 16 projects. Initially a Systematic Evidence Review of high quality youth programmes examined underlying relationship ‘mechanisms’. The project then involved academics and practitioners co-designing new evidence informed guidance on relationship-building to improve the effectiveness of everyday practice. An implementation study will complement a realist evaluation of the ARP. The researchers are routinely collecting data through a series of reflective conversations with practitioners over several months to track the experiences of each project implementing the new guidance, time stamped to document key internal and external events. Focused workshops with the wider teams will further interrogate this experience. The researchers are using the Proctor implementation outcomes framework (Proctor et al. 2011) to shape their analysis of the data collected from across the 16 projects.
Results: The implementation study charts the projects’ experience of co-design and transforming guidance into practice. Projects have responded to phase one of the co-design process with enthusiasm and we can report initial ‘buy-in’ and motivation is high.
Conclusion: This presentation will outline the implementation study so far in terms of the methodological design, interim implementation findings, next steps and our reflections on a complex co-design process. Acknowledgements This study is presented on behalf of Research Evidence into Policy, Programme and Practice (REPPP). The Action Research Project is funded and supported by the Department of Justice and Equality. Special thank you goes to the participating Garda Youth Diversion Projects and the Department of Justice and Equality.
References: Proctor, E., Silmere, H., Raghavan, R. et al. Outcomes for Implementation Research: Conceptual Distinctions, Measurement Challenges, and Research Agenda. Adm Policy Ment Health 38, 65–76 (2011).
Authors: Julia E. Moore and Sobia Khan
Presented by: Julia Moore
Biography: Dr. Julia E. Moore is the Senior Director for the Center for Implementation. Dr. Moore has a PhD from Penn State in Human Development, where she was trained as an implementation scientist, researching the best ways to implement evidence-based programs. She has worked on over 100 implementation projects. Dr. Moore is known internationally for her ability to communicate complex implementation science concepts in a clear and practical ways. Dr. Moore developed the online mini-course, Inspiring Change: creating impact with evidence-based implementation, which has been completed by over 4000 professionals from around the world. She is an invited keynote speaker at implementation and healthcare conferences and events. Dr. Moore is most passionate about supporting professionals how to use implementation science; she has delivered dozens workshops to thousands of participants.
Background: While the field of implementation science has advanced in recent years, this has coincided with a growing divide between the science and practice of implementation. One strategy to bridge this gap is training implementation practitioners to apply implementation science to their initiatives in a thoughtful and proactive way. Effective implementation capacity building should be based on core competencies – the knowledge, skills, attitudes, and behaviours needed to apply implementation science. There is a growing body of literature on core competencies for implementation scientists, but the same progress has not been made for core competencies for implementation practitioners. Building applied implementation science capacity at the practitioner level can foster better implementation and overall improved population-level impacts; therefore, understanding the core competencies for applying implementation science at the front line is paramount. The goal of this project was to extrapolate and synthesize core competencies for implementation practitioners.
Method: We scanned the published and grey literature to identify core competencies for implementation practice. Six documents outlining (or including components of) core competencies for implementation practice were retrieved. Two analysts reviewed each document using a content analysis approach. Competencies relevant to implementation practice were extracted into an abstraction form and consolidated into a list of common competencies. The refined list of competencies was then grouped thematically into overarching implementation “activities” (e.g., understanding the problem, facilitating implementation).
Results: We identified 37 core competencies which we categorized into 10 implementation activities: Inspiring Stakeholders and Developing Relationships; Building Implementation Teams; Understanding the Problem; Using Evidence to Inform all Aspects of KT; Assessing the Context; Facilitating Implementation; Evaluation; Planning for Sustainability; Brokering Knowledge; and Disseminating Evidence. Additionally, we identified 5 values or guiding principles for implementation practice, which emerged from the document review.
Conclusion: The competencies can be used as a guide to prioritize capacity building efforts. Acknowledgements Support and funding from Health Canada for this project.
Authors: Dennis H. Li, Nanette Benbow, J. D. Smith, Juan Villamar, Brennan Keiser, Melissa Mongrella, Thomas Remble, Brian Mustanski
Presented by: Dennis H. Li
Biography: Dennis H. Li (he/him) is an assistant professor in the Department of Psychiatry and Behavioral Sciences and the Institute for Sexual and Gender Minority Health and Wellbeing (ISGMH) at Northwestern University. He holds an MPH and PhD from The University of Texas Health Science Center at Houston School of Public Health. His research centers on the development and implementation of technology-enabled sexual health promotion programs for young people, particularly sexual and gender minority youth. A primary focus is on accelerating the scale-out of eHealth evidence-based HIV prevention interventions into public health practice in order to improve reach to marginalized populations. He is a co-investigator on two national (US) implementation–effectiveness hybrid trials of web-based HIV interventions. He also leads the online community of practice for the Implementation Science Coordination, Consultation, and Collaboration Initiative (ISC3I), the research coordination and technical assistance center for the USA’s Ending the HIV Epidemic plan.
Background: The first year of the USA’s Ending the HIV Epidemic (EHE) strategy funded 65 planning projects in 46 high-priority jurisdictions to begin studying implementation of evidence-based HIV interventions in local healthcare and public health systems. To maximize the value of implementation science (IS) in these projects, we established the Implementation Science Coordination, Consultation, and Collaboration Initiative (ISC3I) with two goals: (1) support high-quality IS through expert technical assistance and (2) create opportunities to develop generalizable knowledge from local knowledge through cross-project information sharing, measure harmonization, and data synthesis. This presentation describes the first year of this innovative approach to coordinating HIV implementation research nationally.
Methods: To launch ISC3I, we invited project leads, their primary implementation partners, and federal health agencies to a two-day summit that focused on applying IS concepts to HIV contexts, facilitated researchers and partners’ co-development of an implementation research logic model, and fostered cross-project dialogue. We created an online community of practice (COP) as a clearinghouse for IS resources and ISC3I training and collaboration activities (e.g., webinars, expert coaching, videoconference discussions). We also established infrastructure to collect data from the projects, which we are using to inform coordinated IS measures and constructs to put forth for recommended use across future EHE-related projects.
Results: Because most project leads had limited prior IS training or experience, and most projects are in the formative stage, ongoing coordination challenges include differentiating interventions from implementation strategies and identifying appropriate implementation outcomes. However, many teams have engaged with ISC3I activities and reported them to be helpful. Additional lessons learned will be discussed.
Conclusions: ISC3I represents an unprecedented opportunity to expand IS capacity and develop generalizable knowledge for HIV prevention and treatment in the US. We aim to further codify our measure harmonization efforts as we move into the next year of EHE.
Authors: Dr Logan Manikam, Shereen Allaham, Dr Michelle Heys, Dr Clare Llewellyn, Dr Neha Batura, Prof Andrew Hayward, Yasmin Bou Karim, Jenny Gilmour, Kelley Webb-Martin, Carol Irish, Chanel Edwards, Prof Monica Lakhanpaul
Presented by: Shereen Al Laham
Biography: Shereen Al Laham holds Doctor of Pharmacy degree and Master of Public Health in Management and Leadership from the University of Sheffield. She has previous experience working in clinical settings and with Local authorities. She is particularly interested in epidemiological studies, and the analysis of health data to strengthen the healthcare system and its influences on policies. Currently working at the University College London (UCL) as part of the Research team on NIHR funded Nurture Early for Optimal Nutrition (NEON) Project (intervention development & Pilot Randomised Controlled Trial), that aims to optimise feeding, care and dental hygiene practices in South Asian children <2 in East London, using participatory learning and action (PLA) cycles facilitated by a multi-lingual community facilitator. She also works on other research projects at Aceso Global Health Consultants Limited and Public Health England.
Background: The first 1,000 days of a child’s life are an important period for growth and cognitive development. Exposures during pregnancy and infancy may alter lifetime risk of overall development and dental health1. The Participatory Learning and Action (PLA) is a low-cost bottom-up approach that mobilises communities to identify, prioritise, implement, and evaluate their needs and solutions through culturally-sensitive group discussions2. Recognising PLA has been successful in LMICs and the importance of community engagement, the NEON study aimed at improving infant feeding, care, and dental hygiene practices of South Asians (SA) in two deprived East London boroughs (Tower Hamlets & Newham) by reverse innovating the WHO-recommended PLA approach from LMICs.
Method: Our approach was developed through a series of workshops with community and local stakeholders facilitated by experts in PLA. Adaptation is supported by multilingual community facilitators (CFs) and the local health and social care systems. We are currently co-developing the PLA intervention toolkit consisted of; (i) PLA group facilitator manual, (ii) picture cards, (iii) healthy food recipes & (iv) community asset map by undertaking monthly development meetings with SA CFs (n=10) and refinement workshops with a larger audience of SA residents (n=50). Initially done face-to-face, we are now utilising blended-approach of online meetings due to COVID-19.
Results: The PLA approach was highly acceptable to participants. However, the feasibility of undertaking 12-session PLA cycle was questioned. We have since adapted the model to shorter cycles (7&6 session). Strong community ownership presented with CFs engaged in developing culturally-tailored PLA intervention content including a digitally shareable asset map consisting of local resources and services.
Conclusion: NEON is an exemplar of how to adapt tailored culturally-sensitive community-based intervention from LMICs to urban high-income setting. The PLA is an acceptable and feasible approach to address public health issues in marginalised poorly-resourced and ethnically-diverse community.
Authors: Paulina Daw, Dr Jet Veldhuijzen van Zanten, Alexander Harrison, Dr Hasnain Dalal, Prof Rod S Taylor, Prof Patrick J Doherty, Dr Sinead TJ McDonagh, Prof Colin J Greaves
Presented by: Paulina Daw
Biography: I have been involved in delivering and running mental health services for over a decade. Working as a senior clinician and managing teams of healthcare professionals gave me an insight into many complexities of providing quality healthcare. In 2018 I completed an MSc at Queen Mary University of London in Transcultural Mental Healthcare – my final project involved conducting a systematic review looking at service user involvement in personality disorder services. In recent years, I became interested in healthcare research and in particular the research-to-practice gap. In 2019 I started a PhD investigating the implementation of a home-based cardiac rehabilitation programme. I work closely with intervention developers and early adopters at four sites in England and Northern Ireland to investigate the process of implementation and make recommendations for further rollout. Post PhD I am hoping that my clinical and academic experience will allow me to continue contributing towards closing the translational gap.
Background: Low uptake of cardiac rehabilitation (CR) is a global problem, particularly for heart failure patients (HFPs), who are often older and more frail than other cardiac patients. Offering alternative forms of CR (e.g. home-based programmes) might improve uptake. This is especially relevant in the current COVID-19 pandemic where HFPs are asked to self-isolate. Rehabilitation Enablement in Chronic Heart Failure (REACH-HF) is a home- and evidence-based CR programme for HFPs. The effectiveness of REACH-HF has been established in two clinical trials.[1,2] Subsequently, four NHS Beacon Sites are delivering REACH-HF to 200 patients in England and Northern Ireland.
Methods: A multi-method study, conducted in five phases (two completed and three ongoing), to evaluate the implementation of REACH-HF. The Normalisation Process Theory will be used as a framework to inform data collection/analysis.[3] 1. A systematic review identified professional and system-level factors affecting the delivery of CR for HFPs. 2. Qualitative in-depth interviews and focus groups with key healthcare professionals (HCPs). Thematic analysis of qualitative data informed a pragmatic REACH-HF implementation manual for HCPs. 3. Participatory action research: feedback from key stakeholders will lead to refinement of the implementation manual. This will be further piloted in an implementation study in Scotland. 4. Implementation fidelity will be assessed by coding audio recordings of treatments using the existing REACH-HF fidelity checklist. Scores will be compared to fidelity achieved in the clinical trial. 5. Audit: pre-post treatment outcomes will be analysed using data from the National Audit of Cardiac Rehabilitation. Real-world patient outcomes will be compared to outcomes achieved in the clinical trial.
Results: Summary data will be presented from the systematic review and qualitative elements of the study, along with a discussion of the planned synthesis of data from all five phases using meta-ethnography.[4]
Conclusion: When completed, this study will identify ways to improve the CR provision for HFPs.
Acknowledgements: REACH-HF Beacon Sites Steering Group References 1. Dalal H., Taylor R., Jolly K., et al. The effects and costs of home-based rehabilitation for heart failure with reduced ejection fraction: The REACH-HF multicentre randomized controlled trial. Eur J Prev Cardiol. 2018;27:3. 2. Lang C., Smith K., Wingham J., et al. A randomised controlled trial of a facilitated home-based rehabilitation intervention in patients with heart failure with preserved ejection fraction and their caregivers: the REACH-HFpEF Pilot Study. BMJ Open. 2018;8:4. 3. May C., Mair F., Finch T., et al. Development of a theory of implementation and integration: Normalization Process Theory. Implement. Sci. 2009;4:29 (2009) 4. Noblit G., Hare R. Meta-ethnography: synthesizing qualitative studies. Volume 11. California: Sage Publications;1988.
Authors: Michelle C White, Andrew JM Leather, Nick Sevdalis, Andy Healey
Presented by: Dr Michelle C White
Biography: Dr White is a part-time PhD student at the Centre for Global Health and Health Partnerships at King’s College London and an Anaesthetist at Great Ormond Street Hospital, London. From 2012-2017 Dr White worked for an international charity Mercy Ships in sub-Saharan African, collaborating with Ministries of Health, Hospital Directors and local healthcare workers to improve the access and quality of surgical and anaesthesia care. Her PhD continues this work, focussing specifically on the World Health Organisation Surgical Safety Checklist. The checklist reduces surgical complications and save lives, which is why it is used every day in the NHS, but can it be implemented at scale at a national level in sub-Saharan Africa countries; and if so, how much does it cost and is it worth the effort compared with other health and non-health inventions as part of the Sustainable Development Goal era?
Background: Limited resources in Low and Middle-Income Countries (LMICs) mean health interventions must compete against other projects for political priority. Policy-makers make decisions using subjective and objective criteria.1 The World Health Organisation (WHO) Surgical Safety Checklist reduces surgical mortality and morbidity2 but its economic impact is unknown. We undertook a return-on-investment (ROI) analysis of checklist scale-up in Benin, Cameroon and Madagascar.
Methods: The ROI analysis used two approaches: cost-effectiveness analysis (CEA) and benefit-cost analysis, (BCA). We estimated the years of life lost (YLL) due to post-operative mortality that would be averted through checklist use, and then using total project costs we estimated incremental cost-effectiveness ratios (ICER) for each country. We estimated benefit-cost ratios (BCR) using the value of a statistical life-year approach. All monetary values are expressed in US$ using World Bank purchasing power parity and discounted at 4%. Results The ICERs are $31, $138 and $118 per YLL averted, and the BCRs are 62, 29 and 9 for Benin, Cameroon and Madagascar respectively. The BCRs mean that for every $1 USD spent, the potential return is $9-62. Following WHO criteria3, checklist scale up is ‘very cost-effective’; using more stringent criteria, it ranks among the most cost-effective interventions in LMICs (see Table 1).4
Conclusion: Checklist scale-up is very cost-effective and gives a good ROI. This research offers policy-makers evidence to help make checklist implementation a national priority. Our methodology offers a ‘blueprint’ for including implementation costs in health economic evaluations of other safety and quality improvement interventions.
References 1. Shiffman J, Smith S Generation of political priority for global health initiatives: a framework and case study of maternal mortality Lancet 2007: 370; 1370-1379 2. Bergs J, Hellings J, Cleemput I, et al. Systematic review and meta-analysis of the effect of the World Health Organization surgical safety checklist on postoperative complications Br J Surg 2014: 101; 150-158 3. WHO-CHOICE: CHoosing Interventions that are Cost–Effective, Geneva, World Health Organisation, 1998. 4. Horton S, Gelband H, Jamison D, et al. Ranking 93 health interventions for low- and middle-income countries by cost-effectiveness PloS one 2017: 12; e0182951 Table 1 Incremental cost effectiveness ratios (ICER) and benefit-cost ratios (BCR) of health and non-health interventions – see uploaded file
Authors: Michael Sykes*, Richard Thomson, Niina Kolehmainen, Louise Allan, Tracy Finch, and the co-design group
Presented by: Michael Skyes
Biography: I am a nurse with experience of leading improvements across health sectors in NHS England and Scotland, including leading national improvement work. My research interest is in implementing enhancements to existing quality improvement interventions. I am an NIHR Doctoral Research Fellow leading a study to describe and enhance the effectiveness of audit and feedback.
Background: Patients with dementia do not always get best care [1]. Hospitals use audit and feedback to improve dementia care. Audit and feedback is variably effective at improving care [2]. There have been calls to test potential enhancements to national audit [3]. Both evidence and theory describe practices that might affect the effectiveness of audit and feedback [2,4]. We aimed to describe the content and delivery of the national audit of dementia, identify potential enhancements and develop a strategy to implement the enhancements.
Method: We purposively sampled six hospitals, semi-structured interview participants (n=32), observations (n=36) and documentary analysis (n=39). We used framework analysis. Interim analysis was iteratively presented to stakeholders during co-design workshops (n=9; 18 hours) for challenge and to integrate findings, until a stable description was developed. The co-design group specified potential enhancements (3 workshops; 6 hours). Further co-design workshops (n=2; 4 hours) used the normalisation process theory toolkit [5] to identify mechanisms affecting implementation. This analysis informed a specified [6] implementation strategy.
Results: Hospital actions were not informed by a robust analysis of performance, were selected from a narrow range of implementation strategies [7] and were not presented in a way to gain organisational commitment [8]. We co-designed a training intervention to hospital dementia leads and clinical governance leads that aims to improve the development and agreement of hospital-level actions. The intervention trains the leads to present information which supports governance committee sense-making in relation to implementation capability (by targeting low baseline, analysing barriers and linking barriers to actions) and change commitment (by addressing trust and credibility, linking to priorities, presenting comparators and considering existing work) [2,3,7,8].
Conclusion: Training clinical leads to analyse performance, investigate barriers, select strategies and present specific information designed to gain organisational commitment may enhance the effectiveness of the national audit of dementia.
Authors: S. Hogervorst, M.C. Adriaanse, H.E. Brandt, M. Vervloet, L. van Dijk, J.G. Hugtenburg
Presented by: Stijn Hogervorst
Biography: Stijn Hogervorst is a PhD student at the department of Health Sciences at the VU University, Amsterdam. He has a background in Public Administration and Health Sciences. From 2017-2019 he was the main researcher in the support for diabetes project. Currently, he is working as a researcher in the Dutch Make-It consortium. This is a group of Dutch experts on medication adherence funded by The Netherlands Organisation for Health Research and Development (ZonMw). They strive to combine their knowledge to stimulate sustainable implementation of medication adherence interventions in the Dutch primary care.
Background: Despite the existence of many effective adherence interventions, they are rarely used in routine care. This gap between research and practice calls for more emphasis on the implementation of adherence interventions. This pilot project aims to implement an existing adherence intervention (HOUVAST 2.0) in the Dutch primary care.
Method: A qualitative process evaluation was conducted as part of a medication adherence pilot project (HOUVAST 2.0). Data were collected through a focus group and four interviews with ten allied GP and pharmacy staff members. Interviews and focus groups were semi-structured using topic lists based on the RE-AIM implementation framework. Interviews were audiotaped and transcribed verbatim. Atlas.ti 8.0 software was used for coding and structuring of themes. A thematic analysis of the data was performed.
Results: Main themes that emerged were ‘Training and preparation’, ‘Appreciation for the intervention’ ‘Technical barriers to implementation‘ and ‘social barriers to implementation’.
The intervention HOUVAST 2.0 proved engaging for clinicians that used the intervention, but also proved difficult to implement. The main barriers were a suboptimal selection process based on pharmacy refill data, a difficult target population, nurse practitioners’ difficulties addressing adherence with patients and the project did not align with goals of GPs.
Conclusion: Implementation of the HOUVAST 2.0 intervention in the Dutch primary care proved challenging. A good established collaboration between GPs and pharmacies, better ICT applications for selecting patients and a training more aimed towards practical communication techniques are important improvements needed for further implementation.
Authors: Jennifer Shuldiner, Nida Shah, Ann Marie Corrado, Paul C. Nathan, Noah Ivers
Presented by: Jennifer Shuldiner
Biography: Dr. Jennifer Shuldiner is a Post Doctoral Fellow at Women’s College Hospital Institute For Health Systems Solutions & Virtual Care (WIHV). Her work uses a multi-method approach to health service research aimed at improving patient outcomes and experience. She has worked on a diverse portfolio of projects in the health sector, including infectious disease, dementia, nursing homes, transitions in care, indicators to assess health system performance, and cancer screening. Most recently, her Ph.D. thesis at the Dalla Lana School of Public Health at the University of Toronto used mixed-methods to explored decision making and responses related to receiving uncertain genetic results. Jennifer is passionate about the co-production of research to facilitate the development and implementation of effective, and patient and provider-centred innovation.
Background: Survivors of childhood cancer require lifelong risk-tailored care to mitigate the risk of morbidity or premature mortality as a result of their prior cancer treatment (“late effects”). Despite evidence that surveillance focused on early detection of late effects improves health and reduces mortality, most adult survivors of childhood cancer do not complete recommended surveillance tests. We sought to elucidate the barriers and enablers to accessing evidence-based, high-yield surveillance tests among childhood cancer survivors.
Method:This qualitative study involved one-on-one semi-structured interviews with adult survivors of childhood cancer (N=22). Participants were registered at the largest provincial cancer survivor program in Ontario, Canada, and eligible for the surveillance tests of interest but had not attended the clinic in over five years. We framed the interview guide and content analysis using the Theoretical Domains Framework, a tool specifically developed for implementation research to identify influences on desired behaviour.
Results: Key barriers to completing recommended surveillance tests included a lack of knowledge regarding late effects, physical distance from specialised survivor services, and a lack of advice from family physicians. These barriers impacted the intention of survivors to obtain recommended surveillance tests or visit a speciliazed survivor clinic. Conversely, survivors discussed how they would not be deterred from getting a test if a physician recommended it, and those who had a health professional who referred survivors for tests were committed to obtaining them.
Conclusion: Childhood cancer survivors prioritized their health and valued surveillance testing for late effects as a means to prevent illness. Poor awareness about the recommendations among survivors and their physicians must be addressed as a first step to implementation of guidelines. These findings will inform the planning and implementation of a centralized system to identify high-risk survivors and provide them and their physicians with personalized information about recommended surveillance.
Authors: Susan Calnan, Caragh Flannery, Sheena McHugh
Presented by: Susan Calnan
Biography: Dr Susan Calnan is a post-doctoral researcher at the School of Public Health in University College Cork (UCC). She is currently working on a number of Health Research Board (HRB) funded projects within the School, involving research in implementation science and knowledge translation. Susan completed her PhD in 2019 in the area of alcohol research, including evaluation of an alcohol prevention programme for college students. Prior to this, she worked for 10 years in research publishing and has also worked as a freelance health journalist. Susan also holds a Masters of Social Science in Social Policy. Her research interests include implementation science, knowledge translation, policy analysis, ageing and alcohol-related research.
Background: Falls are considered one of the most serious and common threats to older people’s ability to maintain their independence. In Ireland, a new integrated falls prevention pathway for older people was introduced in 2015, including multidisciplinary falls risk assessment clinics in primary care. The aim of this study is to identify the factors that influenced the acceptability, appropriateness and feasibility of implementation among those delivering the clinics.
Methods: Methods involved one-to-one interviews with healthcare professionals (physiotherapists, occupational therapists and nurses) delivering falls risk assessment clinics across five implementation sites. Interviews were conducted prior to implementation and six months after implementation had commenced, in 2016 and 2017. Data were analysed deductively and inductively using a combination of the Consolidated Framework for Implementation Research (CFIR) and Proctor’s implementation outcomes taxonomy.
Results: The study identifies particular aspects of the implementation, as defined by CFIR, that influenced its acceptability, appropriateness and feasibility. Intervention characteristics, such as the relative advantages perceived and low complexity of the assessment clinics, positively influenced its perceived acceptability among service providers. Both outer setting (patient need for falls services) and inner setting (networks and communications) factors influenced its perceived appropriateness. Readiness for implementation, in particular the lack of available resources, strongly influenced the perceived feasibility of the service.
Conclusion: This study highlights the complex interplay between implementation outcomes. While an intervention may be deemed acceptable by service providers, for example, its perceived feasibility may be negatively impacted by practical constraints of the implementation setting. Results from this study will be used to improve future implementation of this complex health intervention and to inform the implementation of other falls prevention services for older people internationally.
Authors: Emma Smith , Emma Belton
Presented by: Emma Smith
Biography: Emma Smith is a Senior Evaluation Officer currently working for the NSPCC Evidence team. Emma has worked in research and evaluation for the past 13 years. After graduating from Kingston University with a BSC Psychology and Master of Philosophy, Emma worked for a small voluntary organisation Young Voice conducting research with children and young people on a range of topics, such as dating violence and bullying. She has worked for the NSPCC Evidence Department since 2009. Recently, she has been leading on evaluations of NSPCC models that have been ‘scaled up’; where services have been supported by the NSPCC to adopt its evidence-based models. This has included the scale up of the Graded Care Profile 2, a tool to support practitioners’ assessments of neglect, and Domestic Abuse Recovering Together (DART), a service which supports mothers and children following domestic abuse.
Background: As part of the NSPCC 2016-2021 strategy, the charity scaled up a number of its evidence-based programmes in order that more children could potentially benefit. This included Domestic Abuse Recovering Together (DART), a programme designed to support mothers and children through their recovery from domestic abuse. DART is currently implemented in 28 UK sites, including local authorities and voluntary organisations.
Following an implementation evaluation, an outcomes evaluation was conducted to see whether or not non-NSPCC services, supported by the NSPCC to deliver DART, could achieve similar outcomes for service users as evidenced by the evaluation of the original service.
Method: A quasi experimental design involved an intervention group (comprised of families from six scale up sites), a no intervention group (Families from three NSPCC sites waiting to attend DART) and evaluation data from the original NSPCC DART services. The same standardised measures were completed by all sites at two time points.
Results: Independent samples t tests revealed significant improvements in all outcomes measured pre and post DART for scale up sites: Mothers had significantly greater self-esteem, an improved relationship with their child and their child had fewer emotional and behavioural difficulties. These improvements were significantly greater than the no-intervention group, but very similar to the original DART groups run by the NSPCC.
Conclusion: The results suggested that external organisations were equally as successful as the NSPCC at implementing DART, with very similar positive outcomes for families.
