Co-design of an implementation plan for a digital holistic assessment and decision support framework for people with dementia in care homes

P2

PRESENter

Juliet Gillam

presenter biography

Juliet is an ESRC PhD training fellow at the Cicely Saunders Institute at King’s College London. She also works as a research assistant on the EMBED-Care programme which stands for ‘EMpowering Better End of life Dementia-Care’. Her research is focusing on implementation of an eHealth intervention to support assessment and decision making for residents with dementia in care homes.

background

Positive findings around the use of eHealth to support dementia care in care homes are unfortunately insufficient to ensure its adoption in routine practice. A key strategy to promote uptake of eHealth is to co-design the intervention and implementation plan with users and relevant stakeholders. The aim of this study was to develop a plan with people with dementia, family carers and health and social care professionals to implement an eHealth intervention in care homes.

MEthod

An iterative co-design method was applied through a series of workshops which focused on co-developing implementation strategies, in response to identified determinants of implementation. Participants included family carers of people with dementia and practitioners with direct experience of working in care homes. A deductive thematic analytic approach was taken, guided by the constructs of the Normalisation Process Theory (NPT). Where data did not align, an inductive approach was taken.

results

Implementation strategies which promoted the constructs of the NPT were selected. To target ‘coherence’, strategies focused on developing materials to promote the value of the eHealth intervention. ‘Cognitive participation’ was targeted through strategies which aim to maximise engagement with the intervention, including identifying champions and engaging care home managers. To promote ‘collective action’, strategies centered around maximising compatibility between routine practice and the intervention, and providing sufficient training and built-in user prompts. Strategies around ongoing adjustment and evaluation of the plan targeted ‘Reflexive monitoring’.

Conclusion

Implementing eHealth into such a complex system is a multifaceted process involving multiple stakeholders. Collaborating with stakeholders provided unique insight and perspective which can only be gained through lived-experience, and allowed us to co-develop a credible implementation plan with real world relevance. The theoretically informed strategies target the constructs of the NPT; mechanisms previously demonstrated to shape implementation process and outcomes. The plan is now ready for feasibility testing in care homes.

Implementation and dissemination of home and community-based interventions for informal caregivers of people living with dementia: a systematic scoping review

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PRESENter

Eden Meng Zhu

presenter biography

My name is Eden Zhu, and I am a current PhD researcher at Erasmus University Rotterdam School of Health Policy and Management in the department of Health Service Management and Organization. My PhD research focuses on the implementation and delivery of supportive interventions for informal caregivers of people living with dementia at home. Prior to my PhD, I obtained a Master of Public Administration degree from Tsinghua University (China) and a Bachelor of Science in Global Health and Social Medicine from King’s College London (UK). I have previous experience working and studying in the UK, Switzerland, China and the Netherlands, and I am interested in opportunities to bridge international research and knowledge exchange in the field of global health, dementia care and implementation science.

background

Informal caregivers of people with dementia (PwD) living at home are often the primary source of care, and, in their role, they often experience loss of quality of life. Implementation science knowledge is needed to optimize the real-world outcomes of evidence-based interventions (EBIs) for informal caregivers. This scoping review is the first to systematically synthesize the literature that reports implementation strategies employed to deliver home- and community-based EBIs for informal caregivers of PwD, implementation outcomes, and the barriers and facilitators to implementation in the research context.

MEthod

Embase, MEDLINE, Web of Science and Cochrane Library were searched from inception to March 2021; included studies focused on “implementation science”, “home- and community-based interventions” and “informal caregivers of people with dementia”. Titles and abstracts were screened using ASReview (an AI-based tool) and data extraction was guided by the ERIC taxonomy [1], the Implementation Outcome Framework [2], and the Consolidated Framework for Implementation Science Research [3]; each framework was used to examine a unique element of implementation.

results

67 studies were included in the review. Multi-component (26.9%) and eHealth (22.3%) interventions were the most commonly found in included studies, and 31.34% of included studies were guided by an implementation science framework. Train and educate stakeholders and provide interactive assistance clusters had the most commonly employed implementation strategies, and acceptability (65.67%), appropriateness (70.14%) and penetration (58.21%) were the most frequently reported implementation outcomes. Design quality and packaging (intervention component suitability) and cosmopolitanism (partnerships) constructs, and patient’s needs and resources and available resources (infrastructure) constructs, contained the most frequently reported barriers and facilitators to implementation, respectively.

Conclusion

A co-creation approach to implementing eHealth applications in care organizations: lessons learned from multiple cases.

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PRESENter

Saskia Robben

presenter biography

Saskia Robben is working in the research group Digital Life as researcher and project manager in the field of care and (new) technology. She is also affiliated with the research group Responsible AI. One of her main research interests is on the development of new analytical methods for measuring health parameters with sensors. She also worked on the development of innovative interfaces to show data to different stakeholders. As teacher she is currently involved in applied artificial intelligence programs.

background

The uptake of eHealth technology in care organizations is low, considering the large supply of available eHealth applications. This study follows the implementation attempts of 18 European eHealth products (of several SME) in two health-care organizations to study the challenges during implementation, particularly in relation to acceptance, integration and scaling.
Experiences of health-care professionals were the primary focus of this study. This study is based on existing practical implementation guidelines [1], the five-phase model [2] and a co-creation approach.

MEthod

Three different sources were used to study implementation: 1) Four focus group sessions with health-care professionals, eHealth product developers, and policy makers within health-care organizations. 2) Informal and formal meetings of product evaluations. 3) Regular project meetings in a co-creation setting between all stakeholders to facilitate interaction.

results

The result is a roadmap that provides guidelines and specific tips and tricks to both caregivers and developers to aid them in the implementation process. The roadmap added a “design and development” phase to the existing implementation model to emphasize the importance of co-creation for the implementation process. In addition to the implementation roadmap, an eHealth product catalog (both in a paper and digital version) and a guide to support the realization of business plans for SME have been developed.

Conclusion

The main conclusion of this study is the importance of engaging all the important stakeholders and to understand each other’s goals and needs. In addition, the co-creation approach was highly valued by the different stakeholders. Future work comprises studying the positive effects of this approach on improved eHealth applications, increased acceptance, and a smoother implementation process in care organizations.
[1] https://publicaties.zonmw.nl/maak-zelfeen-implementatieplan/
[2] Wensing MJP, Grol RPTM. Implementatie: Effectieve verbetering van de patiëntenzorg: Bohn
Stafleu van Loghum; 2017.

The Implementation and Evaluation of a Child Weight E-Learning Toolkit (HealthyWEY) for Maternity, Health Visiting and Children’s Centre Workforces

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PRESENter

James Harrison

presenter biography

James completed a BSc and MSc in Sport and Exercise Psychology at Liverpool John Moores University and is a current PhD researcher investigating the effects of ball heading on neurocognitive function within recreational football players. Prior to this, James worked as a Research Officer at John Moores University and was responsible for overseeing the implementation and evaluation of the Healthy Weight in Early Years (HealthyWEY) toolkit in collaboration with the Office for Health Improvement and Disparities. The resource brings together child weight-related information into a single e-learning package with the aim of providing a universal and collaborative approach to promoting healthy weight in the early years. This project allowed James to apply his passion for using research to guide the development of evidence-based interventions that have the potential to improve public health.

background

With childhood obesity rates reaching epidemic levels, the absence of standardised training pathways has created inconsistencies in the pre-school weight management practices of health care professionals in England [1]. These inconsistencies, together with the barriers to addressing pre-school child weight [2] have highlighted the need for appropriate training focused on increasing the skills, knowledge and confidence of frontline practitioners. To address this, Healthy Weight in Early Years (HealthyWEY) is an e-learning resource that was co-developed through a collaborative PhD between Liverpool John Moores University and Blackburn with Darwen Council [3]. The aim of this feasibility study was to assess the preliminary effectiveness of the toolkit for upskilling early years professionals to support healthy weight-related behaviours during infancy and early childhood.

MEthod

Drawing on MRC process evaluation guidance, a mixed-methods approach was used to assess the toolkit’s impact on the perceived barriers to addressing pre-school child weight and the approaches, attitudes and motivations of frontline practitioners via an online questionnaire. Focus groups were used to explore the acceptability of the e-learning among participating workforces as well as the barriers and facilitators to implementation. Analysis of the study’s quantitative data was conducted through SPSS. Focus groups took place online via Microsoft Teams and were coded using thematic analysis.

results

The study’s quantitative data showed significant reductions in the perceived barriers to addressing pre-school weight, significant increases in the autonomy, competence and relatedness of participants, and a significant increase in autonomous motivation for prioritising pre-school child weight management (p<.001). There was no change in participants’ approaches to managing pre-school weight from pre- to post-intervention (p>.05). Analysis of the focus group data provided support for the acceptability of the toolkit with participants acknowledging the impact of the e-learning on their weight management practices, whilst also perceiving a change in the culture of pre-school weight management. The flexibility that the e-learning provided and the opportunities for collaborative learning during drop-in sessions were identified as facilitators to implementation, while participants highlighted time, a lack of capacity and staff absences as the primary barriers to implementation.

Conclusion

The project’s findings provide preliminary evidence of the HealthyWEY toolkit’s effectiveness for upskilling multi-agency professionals to support healthy weight-related behaviours during infancy and early childhood.

References
[1] Bradbury, D., Porcellato, L., Timpson, H., Turner, G., Goodhew, S., Young, R., & Watson, P.M. (2019). Multiple stakeholder views of pre-school child weight management practices: a mixed-methods study. Health Education Journal, 78(7), 798-811.
[2] Bradbury, D., Chisholm, A., Watson, P.M., Bundy, C., Bradbury, N., & Birtwistle, S. (2018). Barriers and facilitators to health care professionals discussing child weight with parents: A meta-synthesis of qualitative studies. British Journal of Health Psychology, 23(3), 701-722.
[3] Bradbury, D. (2020). Promoting healthy weight in pre-school children in Blackburn with Darwen: development and feasibility assessment of a pre-school weight-related training tool for multi-agency professionals. Thesis submitted to Liverpool John Moores University for the degree of Doctor of Philosophy (PhD) in the School of Sport and Exercise Science.

Implementing patient-centered information tool to increase awareness and utilization of weight-loss surgery among obese Black men in the US

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PRESENter

Ekaterina Noyes

presenter biography

Dr. Katia Noyes is Professor and Director of the Division of Health Services Policy & Practice in the School of Public Health & Health Professions, as well as Director of the Surgical Outcomes and Research (UB SOAR) Center in the Department of Surgery (Jacobs School of Medicine and Biomedical Sciences) at the University at Buffalo (UB), USA. She is also the Director of Team Science for UB’s Clinical and Translational Science Institute. She has a broad background in health services research with expertise in health outcomes and quality of care assessment, large administrative data analytics, comparative effectiveness, and economic evaluations in healthcare, as well as mixed methods and implementation research. In the 20+ years of her academic career, she has specialized in the development and evaluation of cross-disciplinary healthcare programs and interventions. Her research explores barriers to care for patients with complex chronic diseases and underserved populations.

background

One size fits all implementation approach often results in implementation failure in marginalized communities. Obesity is one of the leading causes of preventable death in developed countries. Minority patients bear a disproportionate burden of obesity but are less likely to receive surgical obesity treatment compared to Whites. Evidence indicates that primary care providers (PCPs) rarely able to engage minority male patients in discussion about weight management. The aim of this study is to identify culturally acceptable implementation strategies to disseminate accurate information about surgical weight management in minority men, to help men recognize their weight problem and its consequences, activate them to seek solutions, educate them about the safety and benefits of MBS, to help them locate a high-quality bariatric provider and receive insurance authorization.

MEthod

The study is conducted in partnership with our community advisory committee (CAC) consisting of stakeholders involved in care, services and decision-making for minority populations. Based on the input from the CAC, we design an educational tool using multiple iterative process obtaining feedback from community stakeholders. We pilot the tool among Black men (n=30) for final feedback and modify the tool to ensure cultural competency, effectiveness and acceptability of the end product. CAC and men are also asked about perceived effectiveness of different implementation strategies (e.g., a cartoon played by Black TV and radio stations vs in Black barber shops).

results

Our study identified lack of role models for successful surgical weight loss as the most important barriers to Black men’s unwillingness to consider MBS. Black men expressed a strong preference for autonomy when making important health decisions and favored autonomy-preserving approaches to decision making.

Conclusion

New timely and effective strategies are needed to disseminate accurate information about surgical obesity management using patient-centered approaches as well as settings and social connections that patients trust.

Integrating mental and physical healthcare: Evaluating the implementation of two novel interventions, Physical Health Clinic and Consultant Connect, in a UK mental health NHS Trust

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PRESENter

Theo Boardman-Pretty & George Gillett

presenter biography

Theo Boardman-Pretty

I am in my third year of Core Psychiatry Training at South London & Maudsley NHS Trust (SLaM), and am currently working in the National & Specialist OCD, BDD & Related Disorders service for children and young people. I have an interest in addressing the physical health burden of those with mental health problems, and I am currently also working on projects regarding the monitoring of SSRI side effects and the assessment and management of gender-based violence in users of psychiatric services. I have a keen interest in teaching and have led multiple educational projects at SLaM / King’s College London School of Medicine.

Dr George Gillett

Dr Gillett junior doctor at South London and Maudsley NHS Foundation Trust and Academic Clinical Fellow affiliated with King’s College London. His research interests include precision psychiatry and the use of digital technologies in mental health. He has previously held a Digital Fellowship in Healthcare, funded by the Topol Programme, Health Education England.

Dr Gillett also has a keen interest in public engagement. He has written for a number of media publications on topics related to healthcare and served as a member of the Royal College of Psychiatrists’ Public Engagement Editorial Board.

Twitter: @george_gillett

background

People with severe mental illnesses have poorer physical health and a reduced life expectancy compared to the general population. Two novel interventions, Consultant Connect (CC) and a Physical Health Clinic (PHC), were introduced in June 2020 at South London and Maudsley NHS Foundation Trust (SLaM) to improve integration between mental and physical healthcare systems and patient outcomes.

CC is an App that enables direct telephone access to specialist Consultants in local, acute hospitals for brief advice and guidance. All clinicians working at SLaM have access. The PHC is available to 12 adult mental health wards across SLaM. Referrers can request advice for various physical health complaints. A Consultant Physician responds by e-mail, telephone, or in person.

We report an ongoing prospective evaluation of the implementation and service impacts of the two interventions.

MEthod

Implementation of both interventions is being assessed by uptake data, validated measures of acceptability, appropriateness and feasibility and qualitative data collected via semi-structured interviews with users, using co-designed topic guides. A sample of users (n=10) will be interviewed per intervention. The ERIC implementation strategies framework will guide the assessment of implementation strategies for both interventions.

results

From June 2020 to-date, CC has been used >1800 times; there have been >450 user downloads/registrations; >60 specialist services have been contacted. The PHC has received >80 referrals; from 35 referrers (32 medical / 3 nursing); from 12/12 inpatient wards included in the pilot. The above data are being mapped against the ERIC strategies to determine which strategies yielded higher uptake. Qualitative data collection is ongoing. We will update on our findings so far.

Conclusion

Integration of mental and physical health services is one potential approach to reduce the mortality gap in people with SMI. Our results can inform future service developments by providing insights into clinical and implementation effectiveness.

Development of the Implementation Science Research Project Appraisal Criteria (ImpResPAC) tool

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PRESENter

Chloe Sweetnam

presenter biography

Chloe Sweetnam has a background in healthcare quality improvement. She received her MSc. in implementation and improvement science at King’s College London, before joining Icahn School of Medicine at Mount Sinai, Department of Neurology where she manages and evaluates the implementation of digital health programs and collaborative care models. Chloe’s research interests include implementation research methodological quality and health information technology implementation.

background

The need for quantitative criteria to appraise the quality of implementation research has recently been highlighted to improve methodological rigor. The Implementation Science Research development (ImpRes) tool and supplementary guide provide methodological guidance and recommendations on how to design high-quality implementation research. Here we report the development of the Implementation Science Research Project Appraisal Criteria (ImpResPAC) tool, a quantitative appraisal tool, developed based on the structure and content of ImpRes, to evaluate the conceptual and methodological quality of implementation research.

MEthod

This study employed a two-stage, prospective mixed-methods design. In stage 1, the 10 domains of the ImpRes tool, guidance and recommendations contained in the supplementary guide and within the literature, were mapped to ImpResPAC. In stage 2, an international multi-disciplinary expert group, recruited through purposive sampling, informed the refinement of ImpResPAC, including content, scoring system and user instructions. We also calculated descriptive characteristics for each domain.

results

Stage 1:
We developed an initial version of ImpResPAC containing 55 items, indicating high-quality implementation research across 10 domains. ImpResPAC tool users assign a global score from 1-5 to each domain, indicating the quality of an implementation project.
Stage 2:
69 experts, from 8 countries, reviewed and provided feedback, including modifications and suggestions for improvement, on one or more ImpResPAC domains. Across 10 ImpResPAC domains, 50-75% of experts believe that the initial ImpResPAC domain items represented and reflected high-quality conceptual and methodological elements of implementation research. We are currently modifying ImpResPAC based on the extensive expert feedback we have received.

Conclusion

We have developed a quantitative appraisal tool, ImpResPAC, to allow implementation research stakeholders, primarily grant reviewers and educators, to undertake a comprehensive and transparent appraisal of the quality of implementation research. The next step of this research is to evaluate the psychometric properties of ImpResPAC.

An evaluation of physical healthcare within Adult Community Mental Health Teams at South London and Maudsley NHS Foundation Trust (SLaM)

P18

PRESENter

Gracie Tredget

presenter biography

Gracie Tredget is a Clinical Research Assistant based at South London and Maudsley NHS Foundation Trust (SLaM) working within the Mind and Body Programme at King’s Health Partners. Alongside colleagues at King’s College London, Gracie and others contribute to a body of work focused on Integrating Mental and Physical Healthcare Systems (IMPHS) at SLaM. Gracie has a background of experience working on service improvement projects, and previously worked on the development team for the Community Mental Health Transformation at Oxleas NHS Foundation Trust in Bromley prior to joining SLaM.

background

People living with serious mental illnesses (SMI), such as Schizophrenia, are more likely to die prematurely (as much as 15-20 years earlier) from preventable physical health problems than the average population (John et al., 2018). Despite this, little is known about how mental health staff perceive their role in providing physical healthcare, nor how these attitudes may impact upon patient care. We report a prospective pragmatic evaluation to explore perceptions, attitudes, and experiences of staff, patients, and carers, regarding physical healthcare within South London and Maudsley (SLaM) Adult Community Mental Health Teams (CMHTs). We aim to identify common barriers or facilitators that impact on clinical practice and patient experience and use insights to develop recommendations to improve future routine practice regarding physical healthcare.

MEthod

This is a prospective service evaluation in SLaM CMHTs using qualitative methodology. The evaluation involves semi-structured interviews (n=23), focus groups (n=27) and observations (n=6) with staff, patients, and carers. We aim to recruit 64 participants (40 clinical staff, 12 patients and 12 carers). The evaluation will focus on three areas: 1) attitudes, perceptions, and experiences, 2) physical health infrastructure (e.g., screening tools, equipment, patient data), and 3) knowledge, skills, and training. Framework analysis will be used to analyse and synthesise data collected across the data set. Findings will be reviewed via feedback workshops with participating staff to co-develop recommendations for SLaM.

results

The data collection is ongoing. At the time of the conference, we will report on the evaluation methodology and share early findings.

Conclusion

This evaluation will provide insights into how staff in CMHTs deal with physical health and the main barriers and facilitators for staff, patients, and carers. We will use this to provide recommendations that can better support future routine physical health provision within community mental health services.

Tailoring strategies to support the implementation of Dose Adjustment For Normal Eating (DAFNE), a structured patient education programme for people with Type 1 diabetes

P19

PRESENter

Fiona Riordan

presenter biography

Dr Fiona Riordan is a Senior Postdoctoral Researcher in the School of Public Health, UCC. Her research interests include implementation science, quality improvement, integrated care, and chronic disease management in primary care. Currently Fiona works on the CUSTOMISE project, which aims to explore the process and impact of tailoring strategies to implement evidence-based interventions. In 2021 she has been working on the LINK project, to understand the implementation of a local befriending service during the COVID-19 pandemic, including how it links in with community healthcare services. Fiona has a PhD in Health Services Research, and a Masters in Public Health.

background

Evidence-based patient education programmes like DAFNE, which is prioritised for national implementation in Ireland, are recommended as part of diabetes management. However, little is known about current DAFNE implementation and how best to support delivery. Tailoring typically involves determinant identification, prioritisation, and selection of strategies, but how best to combine evidence, theory and stakeholder perspectives during prioritisation and selection is unclear[1,2]. To address this gap, we are 1) working with Irish DAFNE centres to tailor strategies, 2) evaluating the tailoring process, including how clinical stakeholders use evidence and guidance.

MEthod

To identify potential determinants, we (a) undertook a rapid review of structured diabetes education programmes and coded to CFIR (b) are analysing data from 91 Irish and UK DAFNE centres). DAFNE teams will complete a survey on their site characteristics (implementation culture, climate, readiness) before taking part in three group sessions to identify and prioritise determinants and select strategies. First, participants prioritise determinants and select strategies based on their own assumptions, needs and preferences. Then they will consider guidance (including feasibility of addressing a determinant, importance, ubiquity, chronicity, and criticality), determinant-strategy alignment of strategies, and evidence of strategy effectiveness. Participants’ experiences of the tailoring process will be evaluated via research logs, non-participant observation, surveys, and post-tailoring interviews.

results

During 2019-2021 91 centres delivered 1257 courses (2 to 74 courses across centres) and 6749 people attended; 9.5% dropped out. Determinants identified included: lack of available resources (e.g., staff schedules), access to knowledge and information (e.g., staff preparation) and networking and communication (e.g., staff experience working with one another). For the next stage, we have invited 18 sites to participate in the tailoring process

Conclusion

This study will advance our current understanding of tailoring, including clinical stakeholder decision-making during the process, and what is feasible and sustainable for them in practice

Characterising processes and outcomes of tailoring implementation strategies in healthcare: a protocol for a scoping review

P20

PRESENter

Fiona Riordan

presenter biography

Dr Fiona Riordan is a Senior Postdoctoral Researcher in the School of Public Health, UCC. Her research interests include implementation science, quality improvement, integrated care, and chronic disease management in primary care. Currently, Fiona works on the CUSTOMISE project, which aims to explore the process and impact of tailoring strategies to implement evidence-based interventions. In 2021 she has been working on the LINK project, to understand the implementation of a local befriending service during the COVID-19 pandemic, including how it links in with community healthcare services. Fiona has a PhD in Health Services Research and a Masters in Public Health.

background

Tailoring strategies to target the salient barriers to and enablers of implementation is considered a critical step in supporting successful delivery of evidence based interventions in healthcare. Theory, evidence, and stakeholder engagement are considered key ingredients in the process however, these ingredients can be combined in different ways [1,2]. There is no consensus on the definition of tailoring or single method for tailoring strategies to optimize impact, ensure transparency, and facilitate replication. The purpose of this scoping review is to describe how tailoring has been undertaken within healthcare, to answer questions about how it has been conceptualised, described, and conducted in practice, and to identify research gaps.

MEthod

The review is being conducted in accordance with best practice guidelines[3] and the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for scoping reviews (PRISMA-ScR) will be used to guide the reporting. Searches have been conducted of MEDLINE, Embase, Web of Science, Scopus, from 2005 to present. Reference lists of included articles will be searched. Grey literature will be searched on Google Scholar. Screening and data extraction is being conducted by four members of the research team. Any discrepancies will be resolved through discussion. Initial analysis will be quantitative involving a descriptive numerical summary of the characteristics of the studies and the tailoring process. Qualitative content analysis aligned to the research questions will also be conducted, and data managed using NVivo where applicable. This scoping review is pre-registered with the Open Science Framework.

results

In total, 5936 articles have been identified through database searches. Pilot screening of title and abstracts is underway.

Conclusion

The findings will serve as a resource for implementation researchers and practitioners to guide future research in this field and facilitate systematic, transparent, and replicable development of tailored implementation strategies.

Experts consensus on multilevel implementation hypotheses to promote the uptake of youth care guidelines: a Delphi study

P21

PRESENter

Evelien Dubbeldeman

presenter biography

Having trained as a master’s in Health Sciences and Human Movement Sciences at the VU University Amsterdam in the Netherlands, Evelien is currently undertaking a PhD at the Leiden University Medical Center. The focus of her PhD concerns the prevention of psychosocial problems within youth care. She has an interest in the implementation processes and uses several methods in her research. Currently, in addition to her PhD trajectory, she is involved in a research project on the (cost-)effectiveness of Social Prescribing, where she performs a systematic review to identify key characteristics of Social Prescribing interventions.

background

The implementation of evidence-based youth care guidelines remains a complex process. Several frameworks to aid the identification and specification of implementation determinants and effective strategies have been developed [1-4]. However, how specific determinants are influenced by specific strategies is not yet clear. There is a need for clarity on which active ingredients of strategies, called Behavior Change Techniques (BCTs) [5], elicit behavior change, and in turn, implementation outcomes. With this knowledge, we are able to formulated detailed, evidence-based implementation hypotheses. We aimed to identify 1) relevant determinants to the implementation of youth care guidelines and 2) feasible and effective implementation hypotheses to address these determinants.

MEthod

A four-round online Delphi study was conducted. In the first round, experts rated determinants on their relevance. In the second, implementation hypotheses were formulated by connecting BCTs and implementation strategies to determinants. In round three, experts reconsidered and finalized their hypotheses based on an anonymous overview of hypotheses formulated by all experts including their substantiations. Finally, experts were asked to rate the implementation hypotheses on potential effectiveness and feasibility.

results

Fourteen experts completed the first, second, and third round and twelve the final round. Promotion of guideline use, Mandatory education, Presence of an implementation leader, Poor management support, Knowledge regarding use of the guideline, and Lack of communication skills were reported as most relevant. For each determinant, an overview is provided of the implementation hypotheses most often considered as effective and feasible.

Conclusion

Determinants related to knowledge, skills, and engagement of professionals and management were found to be relevant for the implementation of youth care guidelines.. This study provides a set of hypotheses that could facilitate organizations, policy makers, and professionals to guide the implementation process of youth care guidelines to, ultimately, improve implementation outcomes. Their effectiveness in practice remains to be assessed.

Implementation strategies for an Australian school-based mental health prevention program: A realist evaluation

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PRESENter

Rachel Baffsky

presenter biography

Rachel is a PhD Candidate at the University of New South Wales, Australia. Her PhD is focused on the co-design and trial of strategies to improve the implementation of evidence-based mental health prevention program, the PAX Good Behaviour Game, in New South Wales primary schools. It is funded by a scholarship from the Wellbeing Health & Youth Centre of Research Excellence in Adolescent Health funded by the NHMRC (APP1134894).

Since 2018, she has worked as a Research Assistant applying implementation science and mixed methods research to optimise school-based programs targeting the health and wellbeing of young people who experience disadvantage.

Rachel is also involved in a number of research projects on interpersonal violence. She worked with practitioners and survivors in the domestic and family violence (DFV) sector to co-design a trauma-informed, long-term recovery service for women with lived experience of DFV, recently funded by the Australian government.

background

The United Nations has issued a call to action for schools to deliver evidence-based prevention programs to address the growing burden of mental health, but implementation has failed in real-world settings. There is a need for implementation scientists to develop and trial strategies to address this translational problem.

MEthod

In this qualitative study, we used realist interviews and focus group discussions with educational staff (N=29) and performed a realist evaluation of a multicomponent implementation strategy called PAX Plus, designed to enhance the adoption of international evidence-based mental health prevention program, PAX Good Behaviour Game, in New South Wales primary schools.

results

The PAX Plus strategies consistently reported to improve implementation outcomes were having a recognition system for positive reinforcement, leadership support through monthly meetings, training, and distributing support resources. Strategies that did not appear to work but could potentially be reformatted were monitoring progress using self-report methods, distributing e-newsletters with practical tips and having an online peer learning network.

Conclusion

Internationally, school-based practitioners can use findings from this study to develop/adapt their own strategies to improve the implementation outcomes of mental health prevention programs which will improve effectiveness outcomes. Improving the effectiveness of mental health prevention programs is a priority to address Sustainable Development Goal 3.4, to reduce premature death from non-communicable diseases by one third by 2030. This study also highlights to other implementation scientists how realist evaluations can be pragmatically used to improve knowledge translation of evidence-based programs in schools.

Learning outcome: We recommend school-based practitioners use recognition systems, training, leadership support and streamlined resources to increase the likelihood a mental health prevention program will be adopted and sustained in schools.

Specifying and reporting implementation strategies used in the implementation of matrix support in mental health care in a medium-sized Brazilian city

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PRESENter

Carlos Alberto dos Santos Treichel

presenter biography

Having trained as a bachelor’s and master’s in Nursing at the Federal University of Pelotas, Treichel recently completed his Ph.D. in Public Health at the State University of Campinas, where he develops activities as a Post-Doctoral Researcher. Currently, in addition to integrating the Latin American Network of the Global Implementation Society, he studies the implementation of public mental health policies in Brazil and carries out the adaptation of methodological resources to improve the quality of Implementation Research in the Brazilian context.

background

Corresponding to a collaborative care proposal, for approximately 10 years matrix support has been consolidated as the Brazilian response to the need to integrate mental health services and primary care [1]. Although studies on its effectiveness are on the rise, to the best of our knowledge, studies focused on the strategies used for its implementation still missing. Thus, our objective was to specify and report the strategies used to implement matrix support in a medium-sized municipality.

MEthod

Following the conclusion of a 3-year implementation process, core research team members identified the implementation strategies that supported intervention delivery using the established taxonomy of implementation strategies proposed by the ERIC compilation [2]. The actors, actions, action targets, temporality, dose, and implementation outcomes were specified using the implementation strategies reporting guideline proposed by Proctor et al. (2013) [3].

results

We identified 24 discrete implementation strategies that were used to implement the matrix support. Most strategies fell within the categories of Develop Stakeholder Interrelationships, Train and Educate Stakeholders, and Use Evaluative and Iterative Strategies. Actors included members of the research team, managers and workers of local health services, and members of partner universities. Strategies were used multiple times during the preparation and implementation phases. Action targets were most often characteristics of the inner setting, characteristics of individuals, and the implementation process. Strategies predominantly targeted the implementation outcomes of acceptability, adoption, appropriateness, and fidelity.

Conclusion

We believe that our study provides evidence that will allow other teams to envision strategies that can be contemplated in undertaking efforts to implement matrix support in the context of mental health care in the future.

Implementing telemedicine at scale in Denmark: Barriers and facilitators at the political-administrative level of the implementation process

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PRESENter

Stina Bollerup

presenter biography

Stina Bollerup is a PhD student at the Department of Public Health at Aarhus University and DEFACTUM – Public Health & Health Services Research at the Central Denmark Region. She holds a Master of Political Science from Aarhus University. Her PhD project focuses on large-scale implementation through the investigation of the national implementation process of a telehealth intervention targeting patients with Chronic Obstructive Pulmonary Disease (COPD). In the project, she studies the implementation process on multiple levels. Her research interests are implementation- and organisation studies in healthcare, focusing on complex interventions and technology.

background

Implementing technologies on a large scale is a continuous challenge in healthcare systems. This challenge also applies to telemedicine, where implementation to practice and scale-up has proven difficult. The political-administrative system plays a vital role in the implementation process of technologies. However, this level of the implementation process remains understudied. To address this gap, this study will explore the political-administrative level of the national implementation process of TeleCOPD in Denmark – a home-monitoring telehealth intervention targeting patients with Chronic Obstructive Pulmonary Disease (COPD). Denmark is a pioneer country in regards to the implementation of telemedicine on a national scale. This provides a unique chance to study the large-scale implementation of telemedicine.

MEthod

An in-depth qualitative case study of the implementation process at the political-administrative level is undertaken. Data consists of semi-structured interviews with key implementation stakeholders at a national, regional, and municipality level. Furthermore, project descriptions and policy documents are analysed to discover how the intervention is implemented across settings. Data is analysed following thematic analysis.

results

The study is ongoing. However, early analysis of the collected material suggests:
• Key translation processes occur before implementation in practice. Investigating implementation on a political-administrative level provides valuable insights into the adaption and translation of telehealth to local contexts. Room for local adaption and translation can facilitate implementation.

• National scale-up is a time-consuming and complex process. Implementation on a national scale fosters knowledge sharing across settings but may also slow down the implementation process due to added complexity.

• Timeliness is crucial for successful implementation. Continuous delays in the implementation process impact the project’s credibility and motivation among stakeholders.

• Collaborative project management across sectors on a political-administrative level may facilitate implementation.

Conclusion

The results of this study will generate valuable knowledge about large-scale implementation of telemedicine and give insights into the role of the political-administrative level in the implementation process.

Evaluating the implementation of Tommy’s Clinical Decision Tool, a device for reducing inequity in maternity care.

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PRESENter

Jenny Carter

presenter biography

Jenny Carter has worked in maternal health research since 2003, supporting and leading high-quality trials and clinical studies. Most recently focusing on preterm birth and the award-winning St Thomas’ Preterm Surveillance Clinic, she established a novel patient and public involvement group and is a founder member of the UK Preterm Clinical Network. She led development of, and continues to manage, the Preterm Clinical Network Database (www.medscinet.net/ukpcn), capturing clinical data on women at risk of preterm birth for use in local audit and collaborative cohort studies. Her PhD work, which focused on risk assessment in threatened preterm labour and development of the QUiPP app, was supported by an NIHR Clinical Doctoral Research Fellowship and resulted in a KCL Outstanding PhD Thesis Prize. Since completing her PhD she was supported by an NIHR postdoctoral Development and Skills Enhancement Award, and is currently Research Fellow for the Tommy’s National Centre for Maternity Improvement.

background

Poor perinatal outcomes are more common in those living in areas of social deprivation and from ethnic minority groups. Causes of this disparity may be complex, but appear to include variation in care, as stillbirth and preterm birth rates vary between hospitals, even after adjustment for maternal characteristics. To address this variation in care, Tommy’s National Centre for Maternity Improvement developed the Tommy’s Clinical Decision Tool. This web-based tool assesses risk of preterm birth and placental dysfunction, which can lead to stillbirth, much more accurately than current methods, and recommends best evidenced-based care pathways in a format accessible to both women and healthcare professionals (HCPs). This study is evaluating implementation of the Tool in five early-adopter sites, to inform wider scale-up.

MEthod

Tommy’s Tool development, including determination of risk parameters and care pathways, involved maternity service users and HCPs in equal partnership. This study is evaluating: maternity service user and provider experience; barriers and facilitators to implementation; reach (whether particular groups are excluded and why), fidelity (degree to which the intervention is delivered as intended), and unintended consequences. Data is gathered through interviews, focus groups, questionnaires and through the Tool itself. The NASSS framework (Non-adoption or Abandonment of technology by individuals and difficulties achieving Scale-up, Spread and Sustainability)[1] is informing implementation and data analysis.

results

Findings to date have informed ongoing developments of the Tool and implementation strategy, including those aimed at addressing digital and social exclusion (e.g. one-to-one support, language translation, animations). Other notable findings include: need for persistent, high-level local leadership, local champions, flexibility in training.

Conclusion

Tommy’s Tool has the potential to make providing “the right care at the right time” easier, personalising risk-assessment and care according to best evidence. Findings will inform implementation in scaling up in other settings.

Implementing brief and low-intensity psychological interventions for children and young people: A rapid realist review

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PRESENter

Anna Roach

presenter biography

I am a first year PhD student at UCL Great Ormond Street Institute of Child Health. My project is focused on implementing and evaluating mental health drop-in centres at paediatric hospitals. I am interested in brief and low-intensity psychological interventions for children and families with chronic illnesses who are concerned about their mental health. In the first year of my PhD I have been conducting a systematic review exploring the barriers and facilitators to implementing similar psychological interventions for children and young people and look forward to using these findings as we open our drop-in mental health centres at other hospitals across the UK.

background

Despite research demonstrating that brief and low intensity psychological interventions are beneficial for children and young people with emotional, behavioural or mental health difficulties, there remains a significant implementation gap, leaving many children awaiting treatment. Innovative approaches are needed to develop, disseminate and implement appropriate psychological interventions.

MEthod

We conducted a rapid realist review to understand the barriers and facilitators to implementing brief or low-intensity psychological interventions in children and young people (PROSPERO protocol: CRD42022307367). We searched PsycInfo, EMBASE and Medline from inception to March 2022. Papers included in the review identified methods, factors and/or processes for the adoption, implementation or sustainability of brief and/or low intensity psychological interventions for children and young people (5-25 years) with emotional, behavioural or mental health difficulties. A systematic approach to data extraction using Normalisation Process Theory (NPT) highlighted key barriers and facilitators.

results

9 papers, including 10 interventions with over 500 participants, met eligibility criteria. A variety of brief and/or low intensity psychological interventions were delivered across different settings by a range of individuals and common mechanisms were identified that promoted or impeded implementation. . Barriers included: 1) organisational demands such as cost, capacity and time restraints 2) poor training and communication and 3) mental health stigma. Facilitators to implementation were 1) the availability of an implementation strategy, 2) interventions that are easily explained to children and families and 3) detailed training and continued communication.

Conclusion

Our rapid realist review identified mechanisms and factors that need to be considered to optimise the implementation of brief and low-intensity interventions for children and young people with emotional, behavioural or mental health needs. Our findings can inform future implementation studies. Future research could consider creating a toolkit to help monitor and evaluate uptake into routine practice.

Pragmatic and formative evaluation of the pilot implementation of UCLPartners’ Proactive Care Frameworks across multiple primary care sites in England

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PRESENter

Alexandra Ziemann

presenter biography

Dr Alexandra Ziemann is a Senior Research Fellow at the Centre for Healthcare Innovation Research, City University of London. She has a background in public health, health services research, and implementation science. Her research focuses on improving the spread of innovations across health and social care systems.

Alexandra’s current work investigates implementation and spread approaches applied by Academic Health Science Networks across England, the influence of external contextual factors on the implementation of innovations, and the adaptation of innovations that spread from high to low- and middle-income countries.

Before joining City, Alexandra worked at the Centre for Implementation Science, King’s College London and the National Institute for Health Research (NIHR) Collaboration of Leadership in Applied Health Research and Care (CLAHRC) South London. Alexandra is a board member of the European Implementation Collaborative and an Honorary Board Member of the UK Implementation Society.

background

The Academic Health Science Network (AHSN) UCLPartners developed the Proactive Care Frameworks (PCF) to support people with long term conditions during the pandemic and support the primary care system with post-pandemic recovery. PCF consists of patient risk stratification/prioritisation, optimising workforce capacity and utilising digital resources to support self-management, remote support, and personalisation of care. In 2021, we evaluated the pilot implementation of PCF in six regions to derive insights informing ongoing implementation and spread efforts.

MEthod

The six-month pragmatic evaluation applied a mixed-method comparative case study approach. Guided by a Theory of Change, co-developed with implementation stakeholders, we assessed the impact of PCF implementation on care and work processes, workforce and patient/carer experience, health inequalities, and the implementation process. We analysed quantitative data from a survey among AHSNs and qualitative data from 41 implementation stakeholder interviews at AHSNs, local authorities, and general practices, and observations of nine Communities of Practice.

results

Risk stratification supported clinicians to be more efficient and prioritise their work, freeing up time for higher skilled clinicians to see more complex patients. Staff reported an improved fit between patient needs and practice workforce, and increased patient knowledge, motivation and self-management skills. Critical learning included the need for realistic timeframes for implementation, dedicated implementation support, and sufficient engagement with both strategic leads and staff on the ground to allow for local adaptation and building ownership.

Conclusion

Rapid and pragmatic evaluation of early real-world implementation provided valuable formative insights to improve ongoing implementation. It also offered the opportunity to generate initial evidence about the potential impact of an innovation lacking an established traditional evidence base. Further rapid evaluation cycles should be conducted to gather direct patient/carer feedback, clinical and cost-effectiveness outcomes information, and identify core form and functions of PCF to improve local adaptation and spread.

Implementing guideline-based care in people with knee osteoarthritis -Development and evaluation of a patient education and self-management booklet in Tamil

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PRESENter

Malarvizhi D

presenter biography

Malarvizhi completed her undergraduate & postgraduate degree in Physiotherapy from the Tamil Nadu Dr. M.G.R. Medical University, Chennai, Tamil Nadu. She has more than two decades of academic and clinical experience. She is currently doing her PhD at the SRM Institute of Science and Technology, Kanchipuram, India. Her PhD investigates the effect of lifestyle modifications in overweight school children. She is interested in collaborative research and knowledge exchange in implementing evidence-based physiotherapy interventions in clinical practice.

background

Background
Knee osteoarthritis (KOA) is a common joint disease leading to chronic pain, disability and reduced quality of life.
KOA is managed by pharmacological and conservative interventions before surgery is considered.
Patient education and self-management are core components of conservative care.
We developed a KOA patient resource for Tamil speaking people in Tamil Nadu, a southern state in India (population 77 million).
This study explored the feasibility and acceptability of using the booklet in physiotherapy practice.

MEthod

Methods
The booklet was based on available research evidence and a needs assessment with patient representatives and physiotherapists.
It covered clinical aspects of KOA and self-management strategies, exercise illustrations and frequently asked questions by patients.
Participants: Adults with KOA, carers, and physiotherapists at the SRM Medical College Hospital and Research Centre provided input and feedback in telephone or face-to-face sessions.

results

Results
21 adults with KOA (4 males; 17 females; average age 59 years)
14 carers (7 males; 7 females; average age 50.3 years), 15 physiotherapists
(7 males; 8 females; average 18 years work experience) participated.
Participants found the booklet easily readable, useful and acceptable.
The booklet was regarded as easy to implement in daily practice.
A few changes were recommended: simplify text; reorganize exercises easy to difficult levels; include WHO Body Mass Index criteria for Asians.
The booklet was refined and proofread by a patient representative to produce the final version.

Conclusion

Conclusion
The KOA booklet is to be widely disseminated in digital & printed formats.
The booklet can improve patient-therapist communication and easily integrated into routine physiotherapy plans.
The next stage is to evaluate the clinical impact of patient education with a personalized exercise programme in people with KOA.

Exploration of barriers and facilitators to the implementation of ventilator bundle: a descriptive qualitative study with health care professionals, Nepal

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PRESENter

Dejina Thapa

presenter biography

Dejina Thapa is a registered nurse with over 7 years of clinical and academic experience working in different health care settings in Nepal. Nepal. Since 2020, Dejina has been persuing a PhD at Nethersole School of Nursing, The Chinese University of Hong Kong. She is currently working in a project which is focused improving the adherence to ventilator bundle in multisite Nepalese health care settings. She has also involved in various research project and also involved in funded research projects in simulation training for the nurses.
Her expertise and research interests fall within the areas of implementation science, critical care unit and patient safety.

background

Low- and middle-income countries, like Nepal, have greater rates of ventilator-associated pneumonia than high-income countries. Effective implementation of ventilator bundle is crucial to reduce the occurrence of ventilator-associated pneumonia. So far, no comprehensive assessment of barriers to sustained, successful implementation of hospitals interventions has been conducted in Nepalese healthcare settings. The main aim of the study is to identify the perceived barriers and facilitators of health care professionals to the implementation of the ventilator bundle in a tertiary care centre.

MEthod

This qualitative study used the semi-structured virtual interview, enrolled twenty-one participants; nurses (n=18) and doctors (n=3) were selected by purposive sampling. The study setting was a general ICU and medical ICU at a tertiary academic hospital. All the interview data were transcribed, coded, using thematic analysis, and analysed using the NVivo software.

results

Provider-related factors, organisational, environmental, and patient factors were the major identified barriers that could affect the implementation of the ventilator bundle. The major barriers were a high rate of nursing turnover, imbalanced nurse-to-patient ratio, heavy workload, time spent on training new employees, lack of knowledge and skills, especially in novice nurses, and lack of motivation and reward. The key facilitators were timely educational training and workshops, ensuring the availability of strong leadership and champions, and providing adequate support at the organisational level.

Conclusion

The findings of this qualitative study revealed that organisational support is critical to the effective implementation of the guidelines. Building on these facilitators and addressing and measuring these barriers may aid in improving the acceptability and sustainability of the ventilator bundle especially among the nurses.

Beyond input-output: Applying dynamic systems theory to the complexity of implementing mental health interventions in non-western cultures

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PRESENter

Adele Pacini

presenter biography

Adele Pacini is a clinical-academic with a background in clinical psychology and mindfulness based approaches. She has a particular interest in adaptation of mental health interventions in LMICs, and hold academic affiliations with the Open University and UCL.

background

Global dissemination of western mental health interventions across widely diverse cultures leaves a potentially large implementation gap for non-Caucasian people1. Central to the uptake of mental health interventions are the extent to which they align with the cultural and personal values of local cultures, organisations, staff, individuals and their families which are key contextual factors influencing implementation science.

MEthod

We explore the potential of integrating components of the Pragmatic Robust Implementation and Sustainability Model (PRISM)2 within a dynamic system of cultural adaptation3. We model the complementary and contradictory perspectives on cultural concepts of distress and healing, highlighting how successful implementation depends on navigating the ‘best fit’ between these concepts and evidence based psychological techniques

results

Figure 1 shows the resulting model for the implementation of culturally adapted psychological interventions. We model the dynamic nature of the overlap between an individual’s coping mechanisms, their family’s, alongside organizational capacity to implement interventions and existing cultural and evidence based practices to support mental health.

Conclusion

Integrating components of PRISM within a dynamic system model of cultural adaptation allows us to represent the uncertainty and unpredictability of adapting mental health interventions more accurately in non-western cultures. Importantly, it also models the tension between self, other and organizational values, which may be particularly critical in collectivist cultures, or across generations in countries experiencing rapid development. Our case example suggests how we might navigate these uncertainties and complexities through a lens of ‘best fit’ rather than input-output.

References:
1. Rose D, Kalathil J. Power, privilege and knowledge: the untenable promise of co-production in mental “health”. Frontiers in Sociology. 2019:57.
2. Feldstein AC, Glasgow RE. A practical, robust implementation and sustainability model (PRISM) for integrating research findings into practice. The Joint Commission Journal on Quality and Patient Safety. 2008 Apr 1;34(4):228-43.
3.Braithwaite J, Churruca K, Long JC, Ellis LA, Herkes J. When complexity science meets implementation science: a theoretical and empirical analysis of systems change. BMC medicine. 2018 Dec;16(1):1-4.

Development and implementation of educational prescribing resources to mental health pharmacists to improve the physical health of people with severe mental illness

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PRESENter

Annabel Lane

presenter biography

Principal pharmacist for the Ladywell Unit within the South London and Maudsley NHS Foundation Trust.

background

People with serious mental illnesses (SMI) live on average 15-20 years less than the general population, partly due to physical health comorbidities. Improving the physical health knowledge of mental health pharmacists could assist in reducing the mortality gap in people with SMI. We describe the development and implementation of educational materials for mental health pharmacists at a large UK mental health trust.

MEthod

Physical health training needs were identified using a survey with pharmacists. We implemented (1) monthly, educational webinars covering different physical health topics, and (2) specific physical health guidelines, circulated to all mental health trust pharmacists. Questionnaires and interviews were undertaken with pharmacists to evaluate impact and implementation.

results

106 individual staff attended the webinars. Common themes from the questionnaire (n=15) and interviews (n=8) were that the webinars were ‘good-refreshers’, concise and provided appropriate level, pharmacy specific information. Common barriers for webinar attendance were high workload and other work commitments. 50% of the interviewed pharmacists were not aware of the guidelines and only two pharmacists had read them. The implementation evaluation further revealed that the co-design approach with pharmacists enabled interprofessional relationships (ie acute and mental health pharmacists) and tailoring of educational content. Trust-wide pharmacy leadership buy-in and administrative support also boosted implementation.

Conclusion

These barriers reflect the challenges of developing interventions in a pressurised hospital setting. To overcome these barriers, co-designing with expert pharmacists is key. Regular meetings, establishing role clarity and accountability, building a relationship with the acute hospital pharmacy team, and dedicated funding enabled this.
Continual education for clinicians is key to ensuring service users experience the best available care including physical healthcare expertise. To sustain the interventions, dedicated administrative and leadership resource is required to establish accountability and responsibility. We also identified the need to publicise implementations and improve access to resources.

“Mindfulness for parents who care” or ”Mindfulness for parent carers?” Re-framing a mindfulness course to align with parent carers’ identity as a parent before a carer increases uptake: A formative evaluation

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PRESENter

Adele Pacini

presenter biography

Adele Pacini is a registered mindfulness teacher and chartered clinical psychologist specialising in older adult mental healthcare. She has a particular interest in the mental health needs of both carers and former carers. She holds academic affiliations with UCL and the Open University.

background

Parent carers of children with special educational needs have an increased risk of mental and physical ill-health [1,2]. It remains problematic to engage parent carers in wellbeing support [3], with many parents not perceiving themselves as ‘carers’ [4]. Following low uptake to our Mindfulness for Parent Carers (MPC) group we carried out a formative evaluation and utilised ecological theory aligned with public health goals as outlined by Atkins et al [5]. We examined whether expressions of interest (EOI), and applications to, the MPC group were increased by aligning the promotion of the group with parent carer’s identity and through settings that support that identity.

MEthod

For intake one, the course was promoted as ‘Mindfulness for Parent Carers’ via email, poster and telephone contacts to local carer charities, NHS services, and the voluntary action mailing list (a reach of 1,300 individuals). For intake two the course was promoted as ‘Mindfulness for Parents who Care’ via local workplace settings (18) and primary and secondary schools (397 including 15 special needs schools).

results

For the EOI questionnaire, fourteen people completed the EOI questionnaire for intake one, and seventeen people for intake two. The difference was not significant (X2(1) = 0.29 p = 0.59). For full applications, intake one had one application; intake two had six applications. There were significantly more applications made in intake two than intake one X2 (1) = 3.57, p = 0.05.

Conclusion

Aligning intervention promotional material with both parent carer’s primary identity (ie a parent first), and setting (ie schools/workplace) resulted in a significantly greater number of applications to the MPC group. However, numbers were low across both intakes, and thus more work is needed to understand how to work with parent carers and offer support how and when they need it.

References
1. Emerson, E. Mothers of children and adolescents with intellectual disability: social and economic situation, mental health status, and the self-assessed social and psychological impact of the child’s difficulties. J Intellect Disabil Res 2003;47:385–99. Available from doi:10.1046/j.1365-2788.2003.00498.x
2. Lee, M.H., Park, C., Matthews, A.K., et al. Differences in physical health, and health behaviors between family caregivers of children with and without disabilities. Disabil Health J 2017;10:565–70. Available from doi:10.1016/j.dhjo.2017.03.007
3. Moriarty, J., Manthorpe J., Cornes, M. Reaching out or missing out: approaches to outreach with family carers in social care organisations” Health Soc Care Community 23(1) 2015; 42-50. Available from doi: 10.1111/hsc.12119

4. O’Connor, D.L. Self-identifying as a caregiver: Exploring the positioning process. Journal of Aging Studies, 21(2) 2007, 165-174. Available from doi.org/10.1016/j.jaging.2006.06.002

5. Atkins, M.S. Rusch, D., Mehta, T.G., Lakind, D. Future Directions for Dissemination and Implementation Science: Aligning Ecological Theory and Public Health to Close the Research to Practice Gap. J Clin Child Adolesc Psychol, 45(2) 2016, 215-226. Available from doi:10.1080/15374416.2015.1050724

Implementation of home practice support strategies for older adults attending an online mindfulness based cognitive therapy course: An adaptive intervention protocol

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PRESENter

Adele Pacini

presenter biography

Adele Pacini is a registered mindfulness teacher and chartered clinical psychologist specialising in older adult mental healthcare. She holds academic affiliations with UCL and the Open University.

background

Mindfulness based cognitive therapy (MBCT) is a NICE recommended treatment for recurrent depression. Daily home practice is an essential part of MBCT to promote clinical change, but is inconsistently completed our course participants. Using self-report data from an online MBCT course for older adults we describe a formative evaluation to develop an adaptive intervention protocol with the aim of improving home practice compliance.

MEthod

Participants (n = 55) attended an online MBCT course and were issued with audio files from which to practice daily between sessions. Weekly questionnaires were completed where participants recorded frequency of practice (x ̅ = 3.68, SD = 1.69 days) and what impacted on their ability to complete daily practice. Focus groups were held after each course (four in total) and thematic analysis identified successful strategies alongside challenges faced with home practice.

results

The behaviour change wheel (BCW) was used to map out participant’s experiences of home practice. Figure 1 shows the resultant framework, with quotes from participants illustrating key themes from the focus groups. The strategies to be used in the second arm of our adaptive intervention are shown in the ‘intervention functions’ column.

Conclusion

The BCW provided a good fit for mapping participant’s experiences of home practice. Quantitative and qualitative data on home practice from the second arm of the adaptive intervention will be used to evaluate the feasibility and acceptability of proposed strategies.

2 Young Lives: Mentoring scheme for pregnant adolescent girls in Sierra Leone

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PRESENter

Cristina Fernandez Turienzo

presenter biography

Cristina is a postdoctoral research fellow at the Department of Women and Children’s Health (Faculty of Life Sciences and Medicine, King’s College London) with more than 15 years of clinical and research experience in a wide range of international settings. She has experience in clinical research of tropical and infectious diseases, complex interventions in maternal health, clinical trials and mixed methods implementation research.

background

Sierra Leone (SL) has one of the highest maternal mortality rates in the world. Adolescent girls are particularly vulnerable, many times belong to disadvantaged communities usually driven by poverty, lack of education & employment opportunities. In 2015, a household survey conducted in Easter Freetown showed an adolescent maternal mortality of 1 in 102, and a following qualitative study found important contributing factors such as a) vulnerability to adolescent pregnancy: not living with birth family, sex for water/grades/school fees, criminal justice system, availability & accessibility of contraception and abortion; and b) vulnerability to death when pregnant: neglect, abandonment; being cared for by a non-parental adult, delayed care seeking, obstetric risks (i.e. bleeding, eclampsia, infections), socio-economic factors. Cross-cutting :Gendered social norms for sexual behaviour.

In 2017, 2YoungLives (2YLs) was developed as an upstream solution to maternal/perinatal mortality for adolescent girls and their babies. Pregnant girls are supported by mentors to: attend antenatal care and deliver at facilities; re-establish family connections’ have practical advice about childbirth, parenting, health-seeking behaviour, contraception; run small business; and re-engage with school or start vocational learning. After a small-scale pilot across 4 districts over 4 years, 2YLs has mentored over 200 girls with no maternal deaths and 8% perinatal loss. Girls report close loving relationships with their mentors, and a sense of agency and wellbeing from the educational and socio-economic elements of the scheme.

MEthod

As part of the NIHR CRIBS group that started in 2021, we are carrying out a hybrid type 2, pilot cluster RCT in 12 areas (both rural + urban) to assess the feasibility of 2YLs in new communities and inform procedures for a larger scale up programme. A mixed methods process evaluation will explore context, implementation (i.e. acceptability, fidelity, adoption, sustainability), mechanisms, & experiences of care, health & wellbeing.

results

We believe 2YLs directly addresses some key government priorities (e.g., Radical Inclusion policy, National Strategy for the reduction of adolescent pregnancy and child marriage) with a community-run, sustainable intervention which complements statutory services such as free maternity care and free secondary education. Pilot data confirms it has potential to save lives and promote wellbeing of adolescent girls and babies in Sierra Leone.

Conclusion

KCL and the University of Sierra Leone, with support from in country collaborators, have partnered to build maternal health implementation and evaluation research and expertise where it is needed most. We believe close partnership and planning will promote uptake & success, strengthen institutional capacity & create a platform for advancement in health projects and services, across all cadres of maternal health provider.

Limiting and facilitating contextual factors impacting efforts to address gender norms underpinning female child marriage: a comparative case study of the implementation of the national strategy to end child marriage in Nigeria (2016-2021) and the national plan of action to end child marriage (2018-2030) in Bangladesh

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PRESENter

Kelechi Udoh

presenter biography

Kelechi Udoh is currently a Doctor of Health student, at the University of Bath, UK, where he is studying child sexual abuse assessment and treatment in Nigeria. He also works in international development research across sub-Saharan Africa and South Asia, on a range of topics including public health (sexual and reproductive health; humanitarian health; health systems strengthening; infectious diseases; nutrition; water, sanitation, and hygiene; reproductive, maternal, newborn and child health); child protection; youth development; livelihoods; conflict and peace building; resilience; and education.

background

Elimination of Female Child Marriage (FCM) remains a global health priority because FCM is associated with adverse health outcomes like teenage pregnancy and corresponding higher risks of puerperal endometritis, eclampsia, and systemic infections [1]. In 2016, the National Strategy to End Child Marriage in Nigeria (NSECMN) was introduced while in 2018, the National Plan of Action to End Child Marriage (NPAECM) was launched in Bangladesh, to amongst other priorities, address gender norms which evidence suggests remains the most potent and important factor underpinning FCM in both countries. Gender norms impact FCM by influencing whether (and to what extent) societies ascribe value to female children based on their ability to reproduce and provide care, compared to accomplishment of other life goals [2,3,4]. Despite these efforts, by 2021, the FCM rates in Nigeria and Bangladesh remained persistently high at 44% and 66%, respectively, which provided impetus for an analysis which would inform future endeavors to address the problem, in both countries [5,6].

MEthod

Guided by the Consolidated Framework for Implementation Research (CFIR), this study analysed the contextual factors impacting NSECMN and NPAECM’s efforts at addressing gender norms underpinning FCM, using a document analysis method [7].

results

Nigeria and Bangladesh’s spending on social programs (including for the implementation of both policies) was low during the reference period at approximately 2% of GDP, between 2016 and 2019, in Nigeria, and at approximately 2.5% of GDP, between 2018 and 2019, in Bangladesh [8,9]. As such, financial and human resource support from international donors and non-governmental organisations ensured implementation feasibility [10,11]. While in both countries, the policies were backed by legislation, weak implementation remained a challenge [12,13]. This challenge was exacerbated by Nigeria and Bangladesh’s multilateral legal systems which prevented the government from restricting FCM conducted under Islamic or customary laws [12,13]. Furthermore, in both countries, poverty fostered the norm of dowry payment, which promoted FCM [14,15].

Conclusion

Both countries need to increase national spending on FCM policy implementation, to reduce overreliance on international actors. They also need to introduce legislation that mandates adherence to civil law and adopt a holistic approach that ensures FCM policies are implemented in coordination with poverty alleviation programs.

Result of a feasibility hybrid II randomised controlled trial of volunteer ‘Health Champions’ supporting people with serious mental illness manage their physical health

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PRESENter

Julie Williams

presenter biography

Julie is a post doctoral researcher and Occupational Therapist based in the Centre for Implementation Science at King’s College London. She is currently working on the Integrating Mental and Physical Healthcare Systems projects which is aiming to improve the physical health of people using mental health services by developing new interventions and services and providing support to implement them successfully. She is the PI for the Health Champions study.

background

People with severe mental illness (SMI) such as schizophrenia are more likely to have physical health comorbidities than the general population. Interventions are needed to address this. Volunteers can bring a different and valued experience to supporting people with SMI. We report on a feasibility hybrid trial of an intervention called ‘Health Champions’ in which volunteers are trained to support individuals with their physical health.

MEthod

The study is a feasibility randomised Hybrid II trial. Health Champions provided weekly one to one support for up to nine months.
Our primary effectiveness outcome is physical health related quality of life and we also collected data on other related clinical and social outcomes. We collected data on clinical effectiveness at baseline and at the end of the intervention. We are conducting interviews with Health Champions and participants at the end of the intervention to understand their experience of the intervention and to evaluate the implementation challenges and collecting standardised Implementation Science measures. We are collecting data on the costs of the intervention as part of the economic evaluation.

results

The intervention started during COVID and has been delivered both online and face-to face depending on the precautions at the time. To-date, we have recruited 48 participants, with 27 in the intervention arm and 21 in the control arm. We are still collecting data and will give an update on the results so far.

Conclusion

We will use the data collected to understand whether the Health Champions intervention is implementable, what the implementation challenges are, whether clinical and implementation outcomes can be collected and indicate any differences between trial arms, and whether the intervention is cost effective. We will use these results to decide on whether to undertake a larger trial and/or to recommend the intervention as part of routine care.

What interventions should we implement in England’s mental-health services? The Mental-Health Implementation Network’s (MHIN) mixed-methods approach to rapid prioritisation.

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PRESENter

Shalini Ahuja

presenter biography

Shalini Ahuja is a health services researcher and physiotherapist who is working as a Senior Research Fellow in the Centre for Implementation Science at the Health Services Population Research Department, King’s College London.
She is interested in using implementation research methods to explore the confluence of evidence-based interventions and how they are delivered throughout health and care systems, in order to support evidence-based policies that can effectively improve global health.

Currently, she works for the NIHR ARC National Priorities Programme on Mental Health including children and young people’s mental health (https://www.arc-sl.nihr.ac.uk/research-and-implementation/our-research-areas/mental-health-implementation-network). She works towards catalysing and evaluating the co-produced implementation of high impact, evidence-based mental health interventions, at key stages of the life course, supra-regionally within the National Health Services.

Prior to this, Ahuja was working with NIHR Health Protection Research Unit at Imperial College London for ASPIRES project. Here, she supported the development and evaluation of context specific behavioural, structural and technological interventions aiming at optimising antibiotic usage across the surgical pathway in England, India, Rwanda and South Africa.
Ahuja also worked for Public Health Foundation of India (PHFI) in Emerging Mental Health Systems in Low and Middle Income countries (EMERALD) and Programme for Improving Mental Health Care (PRIME) projects. Here, she worked towards integrating mental health at primary levels by strengthening mental health information systems.
She holds an PhD in Health Services Research from King’s College London and a master’s degree in Health Management, Planning and Policy from University of Leeds.

background

Setting mental health priorities can assist researchers and funders in enabling improvement in and expansion of mental health services. In the context of a national mental health implementation programme, this study aims to provide a list of mental health priorities for England, as well as a collection of adaptable evidence-based methodologies and tools to help determine them.

MEthod

A mixed methods research design was embedded in a three-step prioritisation approach, which included desk reviews, expert consultations and data triangulation. Diverse groups of specialists, including patient and public representatives, worked together to increase decision-making quality and dialectical inquiry. A multi-criteria decision analysis (MCDA) model was used to combine participants’ varied opinions, data and judgments about the data’s relevance to the issues at hand during a decision conferencing workshop where the priorities were finalised.

results

The study identified four mental health priority topic areas: strengthening community engagement systems for improving access to care for ethnic minorities, IAPT style services for children and young people, especially in schools mental health inequities, physical health checks and subsequent interventions to manage physical health of people with severe mental illness, and integrated care protocols for mental health and substance use problems

Conclusion

We report (1) a highly inclusive attempt to ensure that the resulting list of mental health priorities (2) agrees with perceived needs on the ground and (3) focuses on evidence-based interventions. Others, not just those in mental health, can benefit from the methodological approach offered if they need to make rapid and tough health-prioritisation decisions.

NIHR GHRG: CRIBS (Capacity. Research. Innovation. Building maternity Systems) Implementation of simple, scalable innovations & research capacity building to improve maternal health in Sierra Leone

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PRESENter

Cristina Fernandez Turienzo

presenter biography

background

NIHR CRIBS is a multidisciplinary group that builds on research partnerships spanning the last 6 years, formalising the partnership between King’s College London and the University of Sierra Leone, and brings many collaborators including the Ministry of Health & Sanitation, iNGO Welbodi Partnership, the National Emergency Medical Services, community based solutions NGO Lifeline Nehemiah Projects, the College of Medicine and Allied Health Sciences and the Midwifery Schools.

The overall aim is to develop and implement simple, scalable innovations to reduce maternal and perinatal mortality and build research capacity and expertise in Sierra Leone.

MEthod

We developed a programme of work addressing locally identified maternal health challenges using local pilot data to inform assumptions and feasibility. We created several projects with the aim of improving health outcomes through implementation, practice and policy, alongside sustainably strengthening research capacity and capability. MRC framework, RE-AIM and Proctor’s outcomes will guide nested implementation evaluations.

results

1) Maternal Health Research. The main work-streams of the programme include:
– CRADLE 5: A stepped-wedge, hybrid type 2 RCT to evaluate the implementation and real-world scale up of the CRADLE device and training across rural Sierra Leone
– 2YoungLives (2YL): A hybrid type 2 cluster pilot RCT to assess the feasibility & implementation of a mentoring scheme from pregnancy through to one-year post-birth for adolescent girls
– APRICOT: An evaluation of shock index as a predictor of morbidity in women with bleeding or infection.
– SIPHRE: validation of a point-of-care creatinine device to detect kidney injury, a preventable cause of maternal morbidity & mortality

2) Research capacity building. We are working together to build research capacity and expertise at individual, institutional and national level, We support 3 PhD students, 3 MPH students and >20 ECRs, plus opportunities for training and development. More than 60 participants (e.g. nurses, midwifes, M&E staff, nutritionists, pharmacists, RAs, data collectors, public health staff, doctors) attended our course ‘Designing Clinical Research’ with an opportunity to develop their own ideas into a research proposal which will be submitted for the competitive awarding of seed funding.

Conclusion

6th UK Implementation Science Research Conference

Co-design of an implementation plan for a digital holistic assessment and decision support framework for people with dementia in care homes

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Juliet Gillam

Implementation and dissemination of home and community-based interventions for informal caregivers of people living with dementia: a systematic scoping review

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Eden Meng Zhu

A co-creation approach to implementing eHealth applications in care organizations: lessons learned from multiple cases.

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Saskia Robben

The Implementation and Evaluation of a Child Weight E-Learning Toolkit (HealthyWEY) for Maternity, Health Visiting and Children’s Centre Workforces

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James Harrison

Implementing patient-centered information tool to increase awareness and utilization of weight-loss surgery among obese Black men in the US

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Ekaterina Noyes

Integrating mental and physical healthcare: Evaluating the implementation of two novel interventions, Physical Health Clinic and Consultant Connect, in a UK mental health NHS Trust

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Theo Boardman-Pretty & George Gillett

Development of the Implementation Science Research Project Appraisal Criteria (ImpResPAC) tool

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Chloe Sweetnam

An evaluation of physical healthcare within Adult Community Mental Health Teams at South London and Maudsley NHS Foundation Trust (SLaM)

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Gracie Tredget

Tailoring strategies to support the implementation of Dose Adjustment For Normal Eating (DAFNE), a structured patient education programme for people with Type 1 diabetes

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Fiona Riordan

Characterising processes and outcomes of tailoring implementation strategies in healthcare: a protocol for a scoping review

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Fiona Riordan

Experts consensus on multilevel implementation hypotheses to promote the uptake of youth care guidelines: a Delphi study

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Evelien Dubbeldeman

Implementation strategies for an Australian school-based mental health prevention program: A realist evaluation

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Rachel Baffsky

Specifying and reporting implementation strategies used in the implementation of matrix support in mental health care in a medium-sized Brazilian city

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Carlos Alberto dos Santos Treichel

Implementing telemedicine at scale in Denmark: Barriers and facilitators at the political-administrative level of the implementation process

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Stina Bollerup

Evaluating the implementation of Tommy’s Clinical Decision Tool, a device for reducing inequity in maternity care.

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Jenny Carter

Implementing brief and low-intensity psychological interventions for children and young people: A rapid realist review

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Anna Roach

Pragmatic and formative evaluation of the pilot implementation of UCLPartners’ Proactive Care Frameworks across multiple primary care sites in England

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Alexandra Ziemann

Implementing guideline-based care in people with knee osteoarthritis -Development and evaluation of a patient education and self-management booklet in Tamil

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Malarvizhi D

Exploration of barriers and facilitators to the implementation of ventilator bundle: a descriptive qualitative study with health care professionals, Nepal

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Dejina Thapa

Beyond input-output: Applying dynamic systems theory to the complexity of implementing mental health interventions in non-western cultures

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Adele Pacini

Development and implementation of educational prescribing resources to mental health pharmacists to improve the physical health of people with severe mental illness

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Annabel Lane

“Mindfulness for parents who care” or ”Mindfulness for parent carers?” Re-framing a mindfulness course to align with parent carers’ identity as a parent before a carer increases uptake: A formative evaluation

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Adele Pacini

Implementation of home practice support strategies for older adults attending an online mindfulness based cognitive therapy course: An adaptive intervention protocol

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Adele Pacini

2 Young Lives: Mentoring scheme for pregnant adolescent girls in Sierra Leone

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Cristina Fernandez Turienzo

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Kelechi Udoh

Result of a feasibility hybrid II randomised controlled trial of volunteer ‘Health Champions’ supporting people with serious mental illness manage their physical health

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Julie Williams

What interventions should we implement in England’s mental-health services? The Mental-Health Implementation Network’s (MHIN) mixed-methods approach to rapid prioritisation.

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