Interventions to promote effective interprofessional collaboration that improves care outcomes for older people: a realist synthesis of evidence.

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PRESENter

Carmel Davies

presenter biography

Dr Carmel Davies is a Lecturer/Assistant Professor School of Nursing, Midwifery and Health Systems, University College Dublin. Dr Davies’s research interest is multidisciplinary applied health and social research. Her research focuses broadly on quality improvement and clinical effectiveness and promoting the implementation of best research evidence into healthcare policy and practice. Her research expertise is in Implementation Science methods, particularly in process/formative evaluation, realist review, clinical practice guideline adaptation and implementation. Her research is strongly participatory, engaging the public, patients, healthcare professionals and policymakers. She has a keen interest in reciprocal knowledge translation and how patient and public involvement can enhance and influence shaping health service policy and applied health research agendas. She is a member of the European Implementation Collaborative European and Implementation Network Ireland and Northern Ireland.

background

Interprofessional Collaboration (IPC) in healthcare integration is promoted in research evidence and health policy as central to the design and delivery of quality healthcare for older people. Health system reform and national policy in Ireland have identified interdisciplinary team-based approaches as critical for enabling care integration for older people. The National Integrated Care Programme for Older Persons are currently implementing Community Specialist Teams for Older People (CST-OP) to support care integration through interprofessional collaborative practice. IPC involves new ways of working conceptualised by the ECLECTIC competency framework under three domains: Knowledge of the Team, Communication and Shared Decision-making.

Research Gap
The new ways of working to support interprofessional collaboration in contexts of healthcare integration are challenging to implement, and evidence to guide implementation is underdeveloped. There is a lack of evidence to explain how to support IPC within care integration for older people. This emphasises the need to ask the research question: what works, for whom, in what context and why?

Project Objective
Based on a synthesis of research evidence, identify interventions and mechanisms that enable interprofessional collaboration for improving care for older people.

MEthod

Realist synthesis is a theory-driven approach based on scientific realism. It is context-driven, explores beyond when an intervention is effective and embraces complexity recognising healthcare as a dynamic social system. It is relevant to synthesise relevant implementation literature systematically. It develops Programme Theory through causal explanations linking Context, Mechanism & Outcome configurations (CMOcs)

The study design is guided by a five steps process involving an exploratory scoping phase (steps 1-2), systematic search, appraisal and synthesis phase (steps 3-5), which is then synthesised and developed into initial programme theories.

results

The relative importance of understanding mechanisms is often understated. We follow Sonia Dalkin and colleagues’ operationalisation using the formula: M (Resources) + C → M (Reasoning) = O
Mechanisms are a combination of resources offered by the intervention under study (ICP) and stakeholders’ reasoning in response. The context is the conditions to activate mechanisms which induce an individual’s reasoning in collaboration, leading to an outcome. Initial programme theory results are presented in tables in the poster.

Conclusion

This work is ongoing as part of a multiphase realist evaluation. The finalised IPTS will be tested and further refined through empirical exploration using case study analysis with CST-OPs implemented recently in Ireland to support scale-up efforts across the Irish health system.

The emerging findings contribute to others adopting similar work; some contextually relevant evidence will inform a roadmap for implementation planning to support workforce planning, capacity building and competency development to improve older people’s health services.

The Impact of After Action Review on Safety Culture and Second Victim Experience: a mixed methods effectiveness implementation study

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PRESENter

Siobhán McCarthy

presenter biography

Siobhán is a Programme Director and Lecturer for the MSc Quality & Safety in Healthcare
Management at the RCSI. Siobhan supervises MSc and PhD dissertations supporting multi-disciplinary healthcare professionals to research and enhance quality and safety. Currently, she is co-investigator on a HRB/HSE funded study measuring the effect of After Action Review (AAR) on safety culture and second-victim experience and its implementation in an Irish Hospital (iCAARE), and was RCSI co-lead of the in-person AAR simulation based training programme. iCAARE findings are currently being prepared for submission for publication. iCAARE educational outputs include open access videos of simulated AARs and accompanying peer reviewed paper. Other research activities include collaborative work with the RCSI Healthcare Outcomes Research Centre and HSE National Quality Improvement Team which involved the conduct of a scoping review of quality improvement studies conducted in Ireland (2015 – 2020). Previously Siobhán has developed and evaluated the effect of online patient safety education on junior doctors’ safety knowledge, beliefs and practices. On behalf of the Irish Medical Council, Siobhán has led a multi-stakeholder study of medical-regulation in Ireland, at the time a new Medical Practitioners Act was being prepared for Ireland. Prior to this, Siobhán worked in a research development and education role in St John of God Hospitaller Services, supporting the development of infrastructure and strategy for research across the service.

background

Originating in the US Army and now in the Incident Management Framework (IMF) of the Irish Health Service, After Action Review (AAR) is a non-hierarchical facilitated approach to team learning. AAR enables groups to come to a shared mental model about what happened, why it happened and to identify learning. AAR has been linked to improved safety culture in the US fire-fighting sector. How best to support adoption of AAR in healthcare is unknown, as well its effectiveness. Therefore, we examined the effect of AAR on safety culture and second victim experience (the impact of patient safety events on staff) and its implementation at an Irish hospital.

MEthod

Drawing on Proctor et al’s framework, we conducted a mixed-methods effectiveness-implementation study. Hospital staff completed surveys (Hospital Survey on Patient Safety 2.0 and Second Victim Experience and Support Tool) before, and at the end of a twelve-month AAR intervention period. Core implementation strategies were the site adoption of AAR as part of the Health Service Executive IMF and the training of hospital selected staff (one in twelve) as AAR Facilitators using a simulation-based training programme. Six months after the training, using the Theoretical Domains Framework (TDF), focus groups were conducted with AAR Facilitators to explore the enablers and barriers to AAR implementation. Information about number of AAR meetings, their quality and financial costs were also estimated.

results

Findings were triangulated using Proctor’s framework. These will demonstrate potential changes in safety culture and second victim experience and support and the impact of AAR practice and the implementation context. Recommendations for behaviour change techniques to support future AAR implementation are made.

Conclusion

Results will directly inform local hospital decision making and national policy approaches to incorporating AAR in hospitals in Ireland.

Rapid-RT Study: The feasibility of implementing rapid-learning methodology to inform radiotherapy treatment: Healthcare professionals’ views

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PRESENter

Arbaz Kapadi

presenter biography

Arbaz Kapadi is a Research Associate in the Division of Psychology & Mental Health at The University of Manchester, working on implementation science research funded by the National Institute for Health Research (NIHR). His current research study seeks to explore the feasibility of implementing quality improvement informed rapid-learning approaches to inform radiotherapy development. Prior to this, Arbaz recently completed his PhD which explored the landscape of healthcare quality improvement with particular focus on organisational behaviour and culture, and the role of service users within these spaces.

background

Pragmatic continuous learning approaches (‘rapid-learning’) using real-world data (RWD) have the potential to provide evidence to optimise interventions in radiotherapy [1,2]. RWD is the data routinely collected as standard of care about all patients. An NIHR-funded method-development study, RAPID-RT, is currently evaluating the clinical effectiveness of a rapid-learning approach within lung cancer and the feasibility of implementing rapid-learning in practice [2]. We report on radiotherapy professionals’ perceptions of rapid-learning and RWD, and identifying key factors that affect implementation in the clinic.

MEthod

Interviews were conducted with radiotherapy professionals (n=23) based across five geographically diverse UK cancer sites. Interview participants included clinical oncologists, physicists, radiographers, treatment planning and digital services staff. Data collection took place between January and May 2023, analysing data using inductive thematic analysis [3].

results

Participants’ opinions centred on four themes: 1) The alignment of rapid-learning methodologies with the reality of practice, 2) Concerns related to the variability of clinical and RWD, 3) The maturity of data and digital infrastructures for rapid-learning, 4) Further support, education and evidence needed to convince adoption of rapid-learning approaches.

Conclusion

Rapid-learning approaches using RWD offer alternatives to traditional randomised controlled trials for the evaluation of changes in radiotherapy practice. They may also provide better external validity. However, rapid-learning is dependent upon the quality of supporting data. The development of data and digital infrastructures are necessary to improve data accessibility and quality, along with support mechanisms for implementation (e.g. analytical support, time, resource investment). This will strengthen the evidence needed to support rapid-learning approaches.

Transdisciplinary implementation science for complex futures

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PRESENter

Dr Hossai Gul

presenter biography

Hossai Gul is a transdisciplinary (TD) implementation scientist and practitioner, specialising in leading TD teams to implement evidence-based innovations into practice within complex systems. Hossai has worked within the Australian health and medical sector for over 10 years in health services, biomedical research, and health system and implementation science research. Hossai has a Bachelor of Advanced Science, an Honours by thesis in cancer drug discovery, a Master of Research by thesis in bioinformatic analysis, and a PhD in Implementation Science and Complexity Science. She is currently a Lecturer and the Head of Implementation Lab at TD School, University of Technology Sydney.

background

The innovation-to-implementation gap remains an elusive wicked challenge across sectors from health, education, social services, and business. Implementation science offers effective tools for guiding change; however, reductionist application of these tools risks the discipline becoming redundant amidst rapidly evolving complex systems. This presentation reports on a transdisciplinary approach to conducting implementation science research.

MEthod

A sequence of studies were conducted via a mixed method methodology and structured by the process model Implementation Mapping (IM) to guide the development of implementation strategies. Ten tools were used to operationalise each step of IM via a transdisciplinary co-production process.

results

Transdisciplinary research is distinct from multidisciplinary (the coordinated effort to solve a problem but remaining within disciplinary boundaries) and interdisciplinary (coherent synthesis of knowledge from a variety of disciplines). Implementation science is an interdisciplinary field where knowledge from many disciplines have been integrated into theories, models, and frameworks which focus on various aspects of implementation. However, solving complex implementation challenges cannot be approached by implementation science alone. Implementation is a hyper-connected challenge and requires the input of many disciplines and spheres of individuals and groups outside of research. Transdisciplinary implementation science incorporates the following features: (1) integration of knowledge from many disciplines in a way that transcends and responds to implementation challenges, (2) the research involves participation by actors outside of the research sphere (going beyond consumers) and values their expertise and experience as indispensable for effective implementation, (3) implementation complexity is centralised via a holistic systems lens, (4) the implementation research is action-oriented (practical strategy deployment), future-focused (scale and sustainability), and impact-driven (outputs are secondary).

Conclusion

Transdisciplinary implementation science was a challenge in practice in numerous forms, however, the process was continuously improved via reflexivity by the research team which led to more impactful implementation research and practice.

Systems science approach to conducting and integrating implementation assessments across multiple settings within complex healthcare systems

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PRESENter

Dr Hossai Gul

presenter biography

Dr Hossai Gul is a transdisciplinary (TD) implementation scientist and practitioner, specialising in leading TD teams to implement evidence-based innovations into practice within complex systems. Hossai has worked within the Australian health and medical sector for over 10 years in health services, biomedical research, and health system and implementation science research. Hossai has a Bachelor of Advanced Science, an Honours by thesis in cancer drug discovery, a Master of Research by thesis in bioinformatic analysis, and a PhD in Implementation Science and Complexity Science. She is currently a Lecturer and the Head of Implementation Lab at TD School, University of Technology Sydney.

background

Implementation needs assessments are a critical first stage in implementation research and can consist of mapping target behaviours, processes, and barriers and facilitators. These barriers and facilitators are often reported as discrete lists despite the complex, interrelated, and dynamic reality that shapes implementation determinants. The aim of this body of work was to conduct an implementation needs assessment that provided a holistic view of implementation determinants to guide the development of evidence-informed implementation strategies in support of real-world genomic implementation efforts.

MEthod

The model of care being implemented combined specialist clinical genetics services with nongenetic primary paediatric services. The implementation needs assessment began within genetics services via qualitative semi-structured interviews (n=14 participants, clinical genetics professionals) and continued within paediatrics via a cross-sectional survey (n=114 respondents, paediatricians) and semi-structured interviews (n=22, paediatricians). The resultant data were analysed using: (1) the Interactive Systems Framework (ISF) for mapping the implementation system; (2) pathway mapping techniques to visualise changes required in processes and practices; (3) Implementation Mapping to identify target behaviours; (4) mapping of implementation barriers and facilitators using the Consolidated Framework for Implementation Research (CFIR) (within genetic services) and the TDF in combination with descriptive statistics (within paediatric services); and (5) to integrate all findings a rich picture was developed using soft system methodology.

results

A systems science approach to implementation needs assessment revealed the specific relationships between barriers and facilitators that informed strategy design, bundling, and sequence of deployment. A rich picture view of implementation needs within a system also provided clear leverage points and areas within the system that change was not feasible, ethical, or outside of the sphere of influence of implementation teams – enabling better resource utilisation.

Conclusion

Integrating implementation science tools with systems science tools allows for a more effective implementation needs assessments rooted in truer depictions of complex realities

The post-implementation scenario: investigating the sustainability of matrix support through professional practices

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PRESENter

Ana Laura Salomé Lourencetti

presenter biography

Bachelor and Licensed in Nursing currently a Master’s student in Health Sciences in the area of Care and Technological Innovation in Health and Nursing with an emphasis on Mental Health and Primary Health Care at the State University of Campinas (UNICAMP)

background

In Brazil, matrix support is a collaborative care program that proposes the integration of mental health and primary care services. Similar to other public health policies, the sustainability of this program in these services depends on several factors, such as the behavioral change of health professionals in care practice. Placed in a post-implementation scenario this study aims to investigate the perceptions of workers about the process of matrix support implementation in a medium-sized municipality seeking the barriers and facilitators regarding the sustainability of this program in the services routine.

MEthod

The matrix support implementation process took place between 2019 and 2021 and, one year after its completion and removal of the research team, professionals from primary care and mental health services participated in in-depth interviews and observations guided by previous scripts based on the domains proposed by The Theoretical Domains Framework.

results

Eleven professionals participated in the interviews, and approximately 50 professionals were observed during team and matrix support meetings. After a hybrid analysis of the contents collected, it was identified that the most significant facilitators related to domains of knowledge, skills, and beliefs about capabilities. The barriers were related with contexts and resources (material resources and organizational culture) and beliefs about consequences

Conclusion

Domains of knowledge, skills, and beliefs about capabilities can be associated with the effectiveness of training and stakeholder education strategies used during the implementation process. However, the reported barriers stand out: the sustainability of matrix support was affected by the lack of beliefs about the effectiveness of the program in a context with a lack of resources and organizational barriers. This study also reinforces the use of TDF to identify barriers and facilitators that support the practice of health policies in routine services

Qualitative exploration of the views and experiences of Making Every Contact Count (MECC) within service providers and users within the Third and Social Economy (TSE) sector: a reflexive thematic analysis of semi-structured interviews

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PRESENter

Beth Nichol (virtually), Angela Rodrigues (for in-person questions)

presenter biography

Beth Nichol is a PhD student at Northumbria University, exploring the optimisation of Making Every Contact Count (MECC)- an opportunistic approach to health behaviour change- within voluntary and community settings. Beth’s PhD project explores the conceptualisation of MECC, available evidence to support the application of MECC within voluntary and community settings, barriers and facilitators to implementation, and whether current MECC training addresses those unique barriers. Her PhD is multidisciplinary, supervised by academics from Public Health (Prof Katie Haighton), Health Psychology (Associate Prof Angela Rodrigues), and Innovation and Strategy (Prof Rob Wilson) disciplines. Beth is also involved in ongoing MECC projects, such as exploring the implementation of MECC within the North East and North Cumbria.

background

The Making Every Contact Count (MECC) initiative encourages brief, opportunistic advice around health and wellbeing. Minimal research exists on MECC within the Third and Social Economy (TSE) sector (groups or organisations operating independently to family and government with social justice as the primary aim), despite increasing funding and training roll-out in this area. The current study aimed to assess the barriers and facilitators of implementation of MECC within the TSE and consider how training and delivery of MECC could be amended to optimise implementation within this setting.

MEthod

Purposive sampling was applied to capture a wide variety of TSE settings including charities, religious settings, and youth clubs. To explore whether MECC conversations are already occur without formal MECC training, service provider participants did not need to have received MECC training. 20 qualitative semi-structured interviews were conducted with service users (n = 5) and providers (n = 15). Reflexive thematic analysis was applied using Nvivo.

results

Health and wellbeing conversations occur naturally within these settings, without the need for specific training. However, unlike traditional MECC conversations, these conversations emphasise passivity, namely waiting for the service user to initiate and listening without provision of advice. Trusting relationships facilitate conversations between service users and providers within TSE settings, but also act as a barrier to initiating MECC conversations due to fear of damaging these relationships. Service providers draw upon a breadth of previous experience to apply advanced interpersonal skills. However, having the resources to signpost to further services, ideally internally, is essential.

Conclusion

MECC training should be adapted for TSE settings, with an acknowledgement that conversations around health and wellbeing already occur. Service providers within the TSE particularly would benefit from training on how to initiate conversations around health and wellbeing and play an active role in assisting the person to realise health behaviour change.

‘Implementing Change Relationships in Multi-site Youth Justice Settings- A Methodological Design’

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PRESENter

Jacqueline Dwane

presenter biography

Biography
Jackie Dwane is a research fellow on the Research Evidence into Policy, Programmes and Practice (REPPP) Project in the University of Limerick. Jackie worked on the Action Research Project (ARP) to co-design and implement a new model of relationship practice with youth justice professionals. Jackie led the implementation evaluation for the project and is now working with colleagues to disseminate and implement the relationship model across all Youth Diversion Projects (YDPs) in collaboration with the Department of Justice.
Jackie previously worked as Youth Officer with the Limerick and Clare Education and Training Board. The role included trialing a new framework for projects involved in a reform process with the Department of Children and Youth Affairs and supporting the National Quality Standards Framework for youth projects and groups. Prior to her Youth Officer role, Jackie worked as Coordinator of a YDP in Limerick city. She has worked as a youth worker in various parts of Limerick city and with young people in Residential Care settings. Jackie is an experienced trainer and facilitator of Restorative Practice.
Jackie completed an MSocSc in Youth and Community Work in UCC in 2001. Currently in the second year of her PhD research, Jackie is interested in implementation science and examining effective co-creation processes. Jackie is a recipient of the Honourable Mr. Justice John Murray Scholarship for doctoral research from the School of Law, University of Limerick.

background

This paper outlines a methodological approach to implementation research in youth justice settings. A multi-site study examined relationships between youth justice practitioners and young people in Youth Diversion Projects (YDPs). We found that effective relationships in YDPs are a crucial change mechanism in reducing offending. We coded findings from a practitioner-led evaluation to the updated CFIR (1) to categorise implementation determinants. We co-designed an evidence-informed relationship model to guide effective relationship practices. The policymaker endorsed full scale out of the model. Young people can gain from high-quality practitioner relationships in all YDPs (n105).

MEthod

The findings from the multi-site (n16) study inform four discrete implementation strategies (2). These involve capacity development and support measures to implement agile and effective relationships. We will conduct an antecedent assessment of attitudes towards the practice change (3). A process evaluation will examine practitioners’ experience of the model and capacity development strategies. Quarterly online meetings will collect systematic real-time qualitative insights from 105 project teams. We will also ask projects to answer one prescribed question to measure success as part of their discussion. We will record the transcripts from this longitudinal study for analysis.

results

We will provide quarterly evidence of the implementation experience to the funder. Later, we will analyse the data according to the Implementation Outcomes Framework (4).

Conclusion

This paper builds on knowledge from a three-year action research process. It proposes a method to advance scale-out and implement an evidence-informed relationship model. We welcome guidance from other methodologists and implementation experts to advance the methodology.

Insights on barriers, facilitators, and lessons learned in the implementation of complex suicide prevention interventions: A systematic review

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PRESENter

Sadhvi Krishnamoorthy

presenter biography

Sadhvi Krishnamoorthy is a PhD candidate at the Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Australia. She has had experience of working with large-scale, community-based complex implementation programs in low-resource settings in India. She is interested in understanding the mechanisms involved in translation of research into practice. Her doctoral work aims to explore pathways for harnessing implementation science for suicide prevention.

background

Understanding what works in preventing suicidal behaviour is complex and remains largely unaddressed. A clear evidence-practice gap exists. One of the ways to bridge this gap is to understand the influence of determinants on intervention delivery, adoption, and sustainment along with experiences and lessons learned on the ground. This study examines barriers, facilitators and lessons learned from implementing complex suicide prevention interventions across the world.

MEthod

This study reports on data from a comprehensive systematic review of complex suicide prevention interventions, using updated PRISMA guidelines. All English language records (including grey literature) between 1990-2022 were searched on PubMed, CINAHL, PsycINFO, ProQuest, SCOPUS and CENTRAL. Interventions were defined as being complex if they consisted of three or more components, implemented across two or more levels of the social ecology. Data on barriers, facilitators and lessons learned was extracted from clusters of reports on interventions and were mapped using the updated Consolidated Framework for Implementation Research (CFIR).

results

The most common barriers were reported in the setting within which the intervention was implemented and were related to the compatibility of the intervention, culture and maintaining relational connections. The most frequently reported facilitators were related to the individual motivation, capability, and need. Lessons learned focused on the importance of adaptation and ensuring responsiveness to contextual needs.
Limitations
Data on barriers, facilitators and lessons learned was inferred from the reports included in the study and hence was limited in its understanding of implementation experiences.

Conclusion

This study emphasises the importance of documenting and analysing important influences on the implementation process. This information can help develop a better understanding of how the evidence-practice translation happens in suicide research and prevention.

Understanding implementation and impact of post-Covid remote monitoring pathways in Integrated Care Systems.

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PRESENter

Judith Fynn

presenter biography

Dr Judith Fynn is Principal Advisor for real-world evaluation at Eastern Academic Health Science Network (AHSN). Her work focuses on the design and delivery of rapid, robust evaluation to generate relevant evidence and insights from interventions including new products, pathways, and ways of working. Judith’s research interests include exploring approaches to evaluation and knowledge exchange to support implementation of evidence-based interventions. The work being presented was an evaluation of remote monitoring health care pathways, conducted as a collaboration between research staff from East of England Applied Research Collaboration (ARC) especially Jennifer Lynch at the University of Hertfordshire and Adam Wagner and Lisa Miners at the University of East Anglia with Eastern AHSN. The work was funded by the NHS National Insights Prioritisation Programme (NIPP) as part of the Accelerated Access Collaborative in NHS England with support from the National Institute for Health and Care Research (NIHR).

background

Remote monitoring (RM) enables observation and reporting of physiology and behaviour with the intention of supporting patients to self-manage their conditions. In England, RM is central to the National Health Service (NHS) recovery from the COVID-19 pandemic and the government’s plan to drive efficiency, free up hospital beds, clinician time and reduce the COVID backlog (1). Improving understanding of RM implementation and its impacts on patients, staff, carers and health and care systems is critical to enable system resilience post pandemic.
We evaluated the implementation of technology-enabled RM pathways at four sites within different Integrated Care Systems (ICS), each varying in health condition/patient cohort and delivery model.

MEthod

The four mixed method evaluations were designed and conducted with patient and public involvement (PPI). The evaluations had distinct overlapping phases: (1) pathway mapping and logic modelling; (2) quantitative analysis to understand patient characteristics, resources and costs and qualitative staff interviews to understand delivery and impacts; (3) knowledge mobilisation.

results

We used the NASSS framework (2) to identify key factors affecting the implementation of RM pathways in ICS. Cross-cutting themes included: potential for access inequities; system-level challenges and enablers; importance of reporting, sharing and use of data. Variability in data recorded and informatics processes within health systems affects the ability to fully understand patient characteristics, including excluded patients, and wider impacts of RM pathways on staff, patients and carers. Clinical champions were key to driving the development and delivery of RM pathways. Differing staffing and delivery models influenced acceptability and potential for scale-up, spread and sustainability.

Conclusion

Understanding impacts of different implementation models, including staffing integrated working and co-production, is critical to enabling health systems to deliver RM at scale. Improved data sharing and recognition of system level resource requirements is critical to sustaining delivery of novel pathways in the new ICS infrastructure and improving patient experience.

The connected Yorkshire community health checks programme for Cardiovascular Disease prevention

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PRESENter

Dr. Ciaran O’Neill

presenter biography

Ciaran is a junior doctor in emergency medicine in West Yorkshire. He joined the Improvement Academy as a Clinical Leadership Fellow in August 2022. His areas of interest include health inequalities and patient safety.
His work includes developing community based health checks aiming to reduce health inequalities related to cardiovascular disease. The health checks project has a strong focus on community engagement and co-production and Ciaran enjoys collaborating with organisations to understand how the projects can be more responsive to people’s needs.

background

Bradford District is one of the most deprived local authorities in England1 and the rate of Cardiovascular Disease is also higher than the national average2. This project was co-designed in response to a community expectation to implement pre-emptive actions to reduce this risk. The aim of this project is to implement a series of outreach health check events with a community centred approach for cardiovascular disease prevention, and improving community access to social prescribers and primary care.

MEthod

Community engagement and co-design are central to the implementation process. It is a mixed-methods evaluation based on Implementation Science and Participatory Action Research principles. The quantitative measures include hypertension case finding, identification of pre-diabetes and improved blood pressure and HbA1c control. The qualitative implementation evaluation uses a combination of traditional implementation science and rapid qualitative evaluation approaches using the Stanford Lightning Reports method3 to explore contextual factors that impact implementation, and assess implementation fidelity, appropriateness, and feasibility.

results

The first event was in February 2023, 61% of the 103 who attended had an abnormal blood pressure and two subsequently received a new diagnosis of Type 2 Diabetes. The event was perceived as useful by the community. Initial analysis revealed good community and stakeholder engagement, and access to funding were major implementation facilitators. Scope creep, unclear commitment from some stakeholders, system and structural challenges, and limiting beliefs of some community members about health improvement emerged as significant implementation barriers.

Conclusion

The health check event was successful in responding to community health needs, and developing and implementing a community-based, co-designed approach. Initial data demonstrated usefulness of the approach and its potential for improving engagement amongst people from deprived communities; however system level barriers remain a significant challenge to the sustainability of the intervention.
References:
1) City of Bradford Metropolitan District Council. Joint Strategic Needs Assessment, The Population of Bradford District. Bradford. 2022. Available here date accessed 18th July 2022.

Tailoring implementation strategies which target patients in healthcare contexts: protocol for a scoping review sub-study

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PRESENter

Laura-Jane McCarthy

presenter biography

Laura-Jane McCarthy is a Research Assistant in the School of Public Health, University College Cork, Ireland. Laura-Jane is currently working on the CUSTOMISE project, which aims to explore the process and impact of tailoring strategies to implement evidence-based interventions in healthcare. Laura-Jane interests include, implementation science, health protection, women’s health and global health equity. Laura-Jane has a background in nursing (RGN) and has a Masters in Public Health.

background

Tailoring strategies to target salient barriers to and enablers of implementation is considered important to support the successful delivery and uptake of evidence-based healthcare interventions (EBI). We are conducting a scoping review to explore how tailoring has been conceptualised, operationalised, and evaluated in healthcare contexts. Our understanding of how to tailor patient-level strategies to support the uptake of an EBI (e.g., screening intervention) is limited; this extends to cultural tailoring, whereby consideration is given to the culture, language and local factors that reflect the preferences and needs of patients. [1] How and when patients should be included in the tailoring process is also unclear. To address this gap, we will conduct a sub-analysis which will specifically focus on tailoring strategies which target patients.

MEthod

The scoping review is being conducted in line with best practice guidelines [2] and will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for scoping reviews (PRISMA-ScR). Searches have been conducted of MEDLINE, Embase, Web of Science, Scopus, from 2005 to present. Articles related to cultural tailoring or tailoring of patient-level implementation strategies will be isolated and sub-analysed. Analysis will be quantitative, including descriptive numerical summaries of study characteristics and the tailoring process. Qualitative content analysis will also be conducted.

results

Title/abstracts of 5936 articles identified through database searches have been screened. Full text screening of 956 articles is currently being conducted by the research team and expected to be completed by August 2023.

Conclusion

Findings from this sub-study will identify how patient level tailoring, including cultural tailoring of implementation strategies has been conceptualised, operationalised, and evaluated in healthcare. Furthermore, findings may provide more clarity on how and when patients should be included in the tailoring process.

A cross-sectional exploration of the generative mechanisms and potential staff outcomes associated with interprofessional collaboration within the newly established community specialist teams integrating care for older people in Ireland

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PRESENter

Apolonia Radomska

presenter biography

Apolonia is a research assistant with the University College Dublin School of Midwifery, Nursing and Health Systems. Apolonia is working as part of the ECLECTIC Project funded by the Health Research Board. The project is a realist evaluation exploring what works, for whom and why when fostering interprofessional collaboration within the newly established community specialist ambulatory teams for older people in Ireland. Apolonia’s interests include implementation science and the translation of evidence into policy and practice. Apolonia has a BA degree in Psychology from Trinity College Dublin.

background

The National Clinical Programme for Older Persons Service Model1 describes comprehensive service delivery supported by interdisciplinary teams transitioning care for older people along end-to-end integrated care pathways. Interprofessional Collaboration (IPC) is core to the implementation of this service model. However, there is an evidence gap in understanding what works to support IPC in this context. Furthermore, little is known about the staff outcomes that may be associated with these new ways of working for Medicine, Nursing and Health and Social Professionals (HSCPs) employed in interprofessional teams.

This study describes the generative mechanisms and staff outcomes that may be associated with IPC among professionals employed in the 30 newly established community specialist teams for older persons (CST-OPs). This local stakeholder knowledge supports an ongoing realist review of international evidence generating initial programme theory (IPTs) on what works and why to support IPC in community-based care integration for older people.

MEthod

A cross-sectional representative survey of members (N=69 ) employed in the 30 CST-OPs was undertaken. The survey measured indicators of competence identified in a co-designed ECLECTIC framework for core competencies for IPC in interdisciplinary care teams for older persons.2 These included generative mechanisms such as internal team processes and systems, as well as values and beliefs supporting collaboration.

results

The findings describe the generative mechanisms associated with IPC and outcome factors for staff including higher job satisfaction, work engagement, trust and psychological safety. Findings elaborate on instances of service innovation which resulted from IPC.

Conclusion

The findings support the development of IPTs hypothesising the dynamic relationship between context, mechanisms and staff outcomes associated with team collaboration. These IPTs will be tested, refined and expanded through a planned realist implementation evaluation of the co-designed ECLECTIC framework among CST-OPs. This realist evidence will support implementation of the Older Person’s Service Model.

Addressing physical healthcare in mental health settings: implementation and evaluation of two novel interventions

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PRESENter

Ray McGrath

presenter biography

Ray is a registered mental health nurse. He trained at King’s College London and since qualifying has worked at South London and Maudsley NHS Foundation Trust in a variety of nursing roles. In his current role, Ray uses his clinical experience to support implementation of initiatives in practice; he also has responsibilities for navigating the clinical systems – auditing and service evaluation.
Ray is also undertaking an ICA Pre-doctoral Clinical and Practitioner Academic Fellowship supported by Health Education England and the NIHR.

background

People with severe mental illness (SMI) have significantly worse physical health and are less likely to receive medical interventions compared to the general population. The IMPHS Project [1] implemented and evaluated two novel service interventions (Consultant Connect and a Physical Health Clinic) in inpatient settings at the UK’s largest Mental Health NHS Foundation Trust, during the Covid-19 pandemic.
Consultant Connect (CC) is an app-based communications platform, now available in all clinical areas in the Trust. The Physical Health Clinic is available to 12 wards, and provides a consultant physician to respond to referrals.
The interventions aim to increase support for mental health clinicians managing physical health conditions and improve integration between the mental health Trust and its partner acute Trusts.

MEthod

Both interventions have been evaluated separately, in terms of 1) understanding the process of implementation, and 2) establishing acceptability and feasibility. Implementation activities have been logged and mapped to strategies and domains in the Expert Recommendations for Implementing Change (ERIC) framework. Data on uptake and usage has also been collected, as well as qualitative feedback from users (n=18).

results

Statistical analysis of the implementation strategies used and how they map to uptake and usage data over the same period is currently ongoing. The mapping exercise identified 39 ERIC strategies were employed once or more, to either or both interventions, since the launch. CC has been used >2700 times, and its app has been downloaded and registered >550 times by Trust clinicians. The PHC has received >240 referrals and been used by >60 clinicians.

Conclusion

Integration of services is a priority for the UK health and care system and has the potential to improve health outcomes for the population as a whole. Results from this evaluation can provide insights for future novel service developments and can help to overcome implementation and sustainability challenges.

Scale-up of a novel vital signs alert device to improve maternity care in Sierra Leone: a mixed methods evaluation of device repair and maintenance

P22

PRESENter

Dr Alice Pearson & Dr Charlotte Greene

presenter biography

We both began medical school as post-graduates; Alice having studied Biochemistry at Bristol and Charlotte History at Oxford. We then graduated from medical school at King’s College London in 2020 where we lucky enough to meet Professor Andrew Shennan and learn about the CRADLE device. Having completed foundation training in Edinburgh, we spent three months this year in Sierra Leone working on this project. It was a hugely educational, rewarding and fun experience. We are very grateful for the grants we received from the organisations listed on our poster. This summer Alice will be starting speciality training in Paediatrics and Charlotte will be starting Anaesthetics. We both hope to continue working in global health in the future.

background

Sierra Leone (SL) has one of the highest rates of maternal mortality globally. The CRADLE VSA is a vital signs monitoring device with an associated training package designed to enable early recognition and management of unwell pregnant women. Following a successful trial in SL which showed a reduction in maternal mortality of 60%, the CRADLE device was rolled out across 8 (of 16) health districts in May 2020 – March 2021. Anecdotally there have been some reports amongst users of broken devices, and this needs further evaluation to ensure sustainability of the intervention.

MEthod

Aims
1) To establish the proportion of CRADLE VSA devices reported as ‘broken’ and to systematically identify causes
2) To explore existing ‘maintenance and repair’ pathways to inform development of a robust maintenance strategy that can be applied at national level
Methods
Data was collected from five districts in Sierra Leone between January-March 2023. ‘Broken’ devices were collected and categorized by problem. A selection of district health team, medical technicians and clinical staff were interviewed to explore barriers to maintenance and sustainability.
Results

results

During the national scale up, 1257 devices were distributed amongst the 5 districts. Of these n = 261 (20.8%) were reported ‘broken’. Allowing for devices that were working or damaged in storage, the commonest problems were cuff, n= 176 (75%), bulb, n= 100 (43%) and machine, n=43 (18%). 100% of interviewees were able to identify these specific problems. Barriers to repair included logistical challenges transporting broken devices, communication breakdown and high staff turnover.

Conclusion

The commonest problems were related to the cuff and bulb. These are cheap and easily replaced at the healthcare facility by local staff. We provided districts supplies of spare cuffs and bulbs and produced a training video for users and medical store staff to identify and repair common problems. These simple changes could improve the sustainability of the device and facilitate long-term use.

Challenges for oral health promotion in the School Health Program in Brazil: a literature review informed by the CFIR framework

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PRESENter

Carlos Alberto dos Santos Treichel

presenter biography

Professor at the Department of Maternal-Child and Psychiatric Nursing, School of Nursing, University of São Paulo. Bachelor’s and Master’s degrees in Nursing from the Federal University of Pelotas and a PhD in Collective Health with a focus on Policy, Planning, and Management from the State University of Campinas. Engaged in Postdoctoral activities at the Department of Collective Health, State University of Campinas (PD-FAPESP Fellow) from 2021 to 2023, and conducted Research Interships abroad as a visiting research student at the Centre for Implementation Science (CIS) at King’s College London through the CAPES PrInt and BEPE FAPESP programs in 2019 and 2021. In recent years, has dedicated their work to the study of the implementation of mental health public policies, with a focus on efforts to integrate specialized services and primary care. Their main areas of research include Implementation Research, Service Evaluation, Collaborative Care, Psychosocial Rehabilitation, Mental Health in the workplace, and the Impact of Care on families of individuals with mental disorders.

background

Established in 2007, the Programa de Saúde na Escola/ School Health Program (PSE) aims to contribute to the comprehensive education of Brazilian students in the public school system through health promotion, prevention and care [1]. Among the actions included in the program, are those aimed at improving oral health conditions through the participation of dentists in activities such as health education, topical application of fluoride, atraumatic restorative treatment (ART) and supervised brushing [1]. Although it presents favourable results, the implementation of the oral health component within the scope of the program is still low in several regions of the country. The objective of this study was to identify the challenges for promoting oral health in the School Health Program.

MEthod

We conducted an integrative literature review in PubMed (Publisher Medline) and SciELO (Scientific Electronic Library Online) databases. The search took place between February and March 2022 and tracked studies published between 2007 and 2022 using the descriptors: Programa de Saúde na Escola; PSE; School Health Services; Dentistry; Dental surgeon; Dentist; Oral Health Promotion; Oral health; Preventive Dentistry. We categorized the identified challenges based on the Consolidated Framework for Implementation Research (CFIR) [2]. For this categorization, we used Minayo’s thematic categorical content analysis model [3].

results

Challenges related to the internal context were the most frequent, with emphasis on those related to relationship and communication networks, and readiness for implementation. Among the most repeated challenges were the low promotion of intersectoriality and the lack of materials and adequate structure to carry out the program’s activities.

Conclusion

Despite a political definition at the national level, the lack of local preparation for organizing and maintaining program activities is an obstacle to promoting oral health through the program, thus demanding the use of implementation strategies to ensure its effectiveness and sustainability.

Palliative care implementation in the intensive care unit: Using the Implementation Research Logic Model as a framework for systematic review and synthesis

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PRESENter

Stephanie Meddick-Dyson

presenter biography

Stephanie Meddick-Dyson is an Academic Clinical Fellow in Palliative Medicine working in Yorkshire. She trained in acute medicine with intensive care and emergency care experience, developing her clinical and research interest in acute palliative care. Her research, based at the Wolfson Palliative Care Research Centre, focuses on optimising palliative and end-of-life care services in the intensive care unit. Stephanie is co-chair of the End-of-life and Palliative Care in the ICU Research Network (EPCIN), a network she developed to share knowledge and encourage collaboration in the field. Holding high regard for the translation of evidence to practice, Stephanie’s work is underpinned by implementation science. She is working towards helping ICUs successfully implement their complex interventions to provide palliative care, by understanding the implementation factors, and processes involved.

background

Logic models help conceptualise and manage complexity and can provide a framework for systematic reviews. The Implementation Research Logic Model (IRLM) allows examination of causal pathways and mechanisms enabling implementation. This systematic review aimed to identify and synthesise knowledge on how models of integrating palliative care into the ICU have been implemented, providing critical recommendations for future development and implementation of complex interventions in the field. The IRLM has not yet been used in a systematic review. This study demonstrates the utility of the IRLM as an a priori framework for synthesis.

MEthod

Standard systematic review methods following PRISMA guidelines. The IRLM was used as an a priori framework for synthesis of intervention characteristics, determinants, implementation strategies, mechanisms, and outcomes reported within effectiveness trials and process evaluations of palliative care interventions in the intensive care unit.

results

71 effectiveness and/or feasibility studies, and 8 process evaluations referenced 66 interventions. The IRLM provided a clear framework to organise data. Consolidated Framework for Implementation Research and Expert Recommendations for Implementing Change headings formed NVivo codes for determinants of implementing palliative care interventions in the Intensive Care Unit (ICU), implementation strategies to address these, and mechanisms for how these strategies lead to change. These codes successfully captured nearly all data. Within included studies, determinants and implementation strategies were widely reported, but implementation mechanisms were not. The IRLM allowed for reporting of relationships between determinants, strategies, and mechanisms, and how these varied with intervention characteristics including ICU type and model of delivery of palliative care.

Conclusion

The IRLM was successfully used to guide a framework synthesis of evidence on implementation of palliative care interventions within ICUs. This methodology could be transferred to other subject areas to systematically review implementation factors. Future work is needed to understand the processes behind these strategies by use of theory.

De-implementation of low value care in mental health services

P27

PRESENter

Qandeel Shah

presenter biography

Qandeel is a PhD student at the University of Leeds supervised by Professor Rebecca Lawton, Dr Sarah Alderson, and Ed Breckin. Her research interests include patient safety, de-implementation and mental health care. Qandeel’s PhD research project looks at the de-implementation of low value practices in mental health care and she is particularly interested in looking at this from the service user’s perspective.

background

The use of healthcare practices with little or no benefit is a widespread problem, as evidence shows 20-25% of all healthcare provided is unnecessary or harmful. These potentially unsafe practices are known as low value care. Although there has been some progress in de-implementing low value care in primary and acute settings, little research has looked at low value practices in mental health care. With mental health services currently experiencing huge demands and a lack of resources it is has become increasingly important to de-implement low value care in this area. Therefore, this study aims to identify practices in mental health care that are potential targets for de-implementation.

MEthod

A Qualitative exploratory research design was used. 15 peer support workers were recruited from 5 different mental health charities to take part in interviews. The interviews were semi-structured and involved in-depth discussions about experiences of ineffective and wasteful care. Interviews were conducted online and lasted 30-90 minutes. The data was subject to abductive thematic network analysis which incorporates the principles of abductive theory of method, thematic network analysis, and thematic analysis.

results

The findings show 3 main practices peer support workers consider to be low value: (1) long term use of antidepressants, (2) physical restraint and (3) enhanced observations. Participants viewed these practices as ineffective, wasteful, and even harmful for the service user. They also made recommendations for how low value practices could be de-implemented. This included removing, reducing, restricting or replacing practices with more effective and safe alternatives.

Conclusion

This study identifies potential targets for de-implementation in mental health care from the perspective of peer support workers. De-implementing harmful or unnecessary care could help free up the vital resources needed to provide safe, high quality mental health care.

Development of a Video-based Evidence Synthesis Knowledge Translation Resource: Drawing on a User-Centred Design Approach

P30

PRESENter

Elaine Toomey

presenter biography

Dr Elaine Toomey is a Lecturer in the University of Galway and Programme Director of the MSc in Evidence-Based Future Healthcare. She is also a Health Research Board ‘Applying Research into Policy and Practice’ Research Fellow and PI of the INTREPiD (Integrating Research into Public Health Decision-making) project. She is a Cochrane Ireland Research Associate and a member of the Centre for Health Research Methods (University of Galway), and the Health Behaviour Change Research Group (University of Galway). Elaine’s research has two main strands – 1) utilising health behaviour change for chronic disease prevention and management, and 2) enhancing the methods used for the implementation of health research into policy and practice. She has specific methodological expertise in evidence synthesis and fidelity/adaptation of behaviour change interventions.

background

Understanding evidence synthesis is vital for people to make informed decisions about their health. We aimed to develop a video animation knowledge translation (KT) resource to explain the purpose, use and importance of evidence synthesis to the public regarding healthcare decision-making.

MEthod

We drew on user-centred design approaches to develop a spoken animated video (SAV) by conducting two cycles of idea generation, prototyping, user testing, analysis and refinement. Six researchers identified the initial key messages of the SAV and informed the first draft of the storyboard and script. Seven members of the public provided input on this draft and the key messages through think-aloud interviews, which we used to develop a SAV prototype. Seven additional members of the public participated in think-aloud interviews while watching the video prototype. All members of the public also completed a questionnaire on perceived usefulness, desirability, clarity and credibility. We subsequently synthesised all data to develop the final SAV.

results

Researchers identified the key messages as 1) the importance of evidence synthesis, 2) what an evidence synthesis is and 3) how evidence synthesis can impact healthcare decision-making. Members of the public rated the initial video prototype as 9/10 for usefulness, 8/10 for desirability, 8/10 for clarity and 9/10 for credibility. Using their guidance and feedback, we produced a three-and-a-half-minute video animation. The video was uploaded on YouTube and has been viewed over 12,000 times to date.

Conclusion

Drawing on user-centred design methods provided a structured and transparent approach to the development of our SAV. Involving members of the public enhanced its credibility and usefulness. Future work could explore involving the public from the outset to identify key messages in developing KT resources explaining methodological topics. This study describes the systematic development of a KT resource with limited resources and provides transferrable learnings for others wishing to do similar.

Views and Experiences of Mental Health Services Implementation Stakeholders in Ukraine after the Onset of the Invasion of Russia into Ukraine

P32

PRESENter

Alyona Mazhnaya

presenter biography

Alyona Mazhnaya is a senior lecturer at the National University of Kyiv-Mohyla academy in Kyiv, Ukraine and a recipient of the NIH K43 Emerging Global Leader Award to examine knowledge attitudes, mental health treatment practices and implementation environment among primary healthcare providers in Ukraine. After Russia invaded Ukraine on February 24th, 2022, the project focused on characterising the emergent landscape and dynamics of mental health services providers working in response to the war in Ukraine. Alyona is interested in understanding the context for scaling-up mental health services for the people in Ukraine and other LMIC and humanitarian settings. Dr Mazhnaya has a background in Epidemiology and Behavioural sciences and completed her PhD at Johns Hopkins Bloomberg School of Public Health.

background

According to the WHO situation report, approximately 18 million people have been affected by the escalation of the war in Ukraine since February 24, 2022. As the war continues, the population of Ukraine continues to experience acute psychological distress, exacerbation of chronic mental health problems, and socioeconomic effects imposed by the war. In contrast, access to psychological and psychiatric support is limited. As the healthcare system has been stretched beyond capacity, multiple local and international organisations have mobilised to provide mental health services for various target groups and in many locations using different modalities. A steep increase in the number of service providers and the type of services that followed presents both: the opportunity and challenges from the perspective of scaling up mental health services to meet the needs and be sustainable. The gap remains in documenting, systematising, and analysing the implementation landscape for mental health services in Ukraine and humanitarian settings.

MEthod

We conducted semi-structured interviews to gather insights about perceived features of outer context, bridging factors, and preparation and implementation of interventions according to the EPIS framework. Data collection is ongoing, with a target sample size of up to 30 participants. Completed interviews include 8 participants who are mental health service providers working on regional, national, and international levels directly providing mental health services, organising them, or funding. Data were analysed thematically by identifying deductive (stemming from EPIS framework) and inductive themes.

results

Several salient themes originated during analysis: recognition of mental health as a critical current and future area of public health in Ukraine, changing needs and services, and challenges to coordination and strategy-based programming. The most salient theme is the shared understanding of the critical role of mental health services for the population and the government’s commitment to reforming mental health services in Ukraine. Participants described the changing needs since the full-scale invasion, and service providers have been adapting programs and services to meet those needs. The data also highlights the need to build partnerships and find a place in the national mental health service provision system. Partnerships and referrals are largely based on ad-hoc collaborations and a need to solve particular programmatic/project goals. Initiatives, projects, programs, volunteer efforts and state-funded services are challenging to coordinate and navigate for the end user.

Conclusion

Currently and in the future, mental health is a central public health issue in Ukraine. Programs and services are changing in response to needs. However, they need to be integrated into a mental health government strategy to improve experiences for the end user.

Navigating uncertainty in the implementation of a Compassionate Care Initiative in a NHS mental health setting during Covid-19: Findings from a case study with implications for sustainability

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PRESENter

Cindy Brooks

presenter biography

Cindy Brooks is a Research Fellow and Medical Sociologist within the Ageing and Dementia Research Group, School of Health Sciences and Applied Research Collaboration (ARC) Wessex Implementation Team at the University of Southampton.
Cindy is Lead investigator of a project to co-produce an online implementation module to support the successful uptake of innovations in practice. She also leads with Dr Michelle Myall, a project to evaluate a co-produced web-based Implementation Toolkit. Combining enterprise with research is integral to Cindy’s work, and she leads projects focused upon using her combined professional roles as researcher, artist and musician to co-produce and research innovative art and music tools to support wellbeing. She is also involved in a study to improve implementation of a compassionate care initiative (CCI) in mental health settings, as well as research intervention studies in the area of polypharmacy and person-centred care relating to social care settings.

background

This paper presents findings from a novel theoretically informed agency-structure study involving implementation of a Compassionate Care Initiative (CCI) in a NHS mental health setting during Covid-19 in the UK. We argue that implementation during Covid-19, not only compounded existing barriers to implementation identified in earlier studies reporting on implementation of CCI in acute hospital settings, such as staffing levels and working practices [1,2,3], but presented an unprecedented implementation landscape of uncertainty operating at micro, meso and macro levels with key implications for conceptualising sustainability.

MEthod

The study adopted a longitudinal case study design [4] in one NHS mental health setting in the UK involving semi-structured interviews with staff involved in the implementation of CCI (managers, facilitators and frontline care staff including registered nurses), alongside documentary analysis of key documents. A theoretically informed approach, involving a combination of structuration theory (ST) and Normalisation Process Theory (NPT) informed analysis [5,6,7,8].

results

Conclusion

Navigating uncertainty in the implementation of CCI during Covid-19 provides invaluable insight into the often contradictory dynamics of implementation in highly adaptive circumstances. It prioritises the importance of understanding the perceptions and experiences of those at the forefront of this agency and structure interface, conceptualising sustainability as a fluid and dynamic space to be continually revisited in accordance with these dynamics.

Content validity indexes assigned to the Brazilian version of the ImpRes-tool: a tool to improve the quality of implementation projects and research

P35

PRESENter

Carlos Alberto dos Santos Treichel

presenter biography

background

Implementation Science is still very much a novel field in Brazil. No resources to guide the design of implementation research and real-world implementation projects exist that have been developed or adapted for use in Brazil. In addressing this gap, we translate and cross-culturally adapt and validate the Implementation Science Research development (ImpRes) tool and its complementary guide, previously developed in the United Kingdom. ImpRes contains ten domains that, according to the current literature and expert consensus, cover the core elements of implementation research that should be considered in the preparation of implementation research and projects [1]. The aim of this work was to appraise the content validity of the ImpRes-BR tool.

MEthod

After the stages of translation, back-translation, and pilot testing, the ImpRes-BR tool and guide were reviewed by an expert panel, consisting of specialists in the field of applied health research composed of 10 members. Based on the experts’ responses, who rated the items on a four-point Likert scale, the content validity index at the item level (CVI-I) and at the scale level (CVI-E) was calculated using the mean calculation method (CVI-E/Med) [2]. A CVI-I of 0.78 and a CVI-E of 0.90 were defined as minimum acceptable indices [3,4].

results

In addition to conceptual validity indices greater than 90%, a CVI-I of at least 0.90 was observed in all domains of the tool and its guide and an IVC-E of 0.98, thus exceeding the limits of CVI-I: 0.78 and CVI-E: 0.90 necessaries for its validity.

Conclusion

The Brazilian version of the ImpRes-tool and guide showed good content validity indices, both at the item level and at the scale level, thus demonstrating its usability to guide project design and implementation research in the Brazilian context.

Stakeholder’s experiences of tailoring implementation of the DAFNE structured education programme for type 1 diabetes

P43

PRESENter

Jane Murphy

presenter biography

Dr Jane Murphy is a Postdoctoral Researcher on the CUSTOMISE (Comparing and Understanding Tailoring Methods for Implementation Strategies) project in the Health Implementation Research Hub at the School of Public Health, University College Cork. In CUSTOMISE, she is leading the evaluation of the tailoring approach for an ongoing national study developing tailored strategies to enhance the implementation of Dose Adjustment for Normal Eating (DAFNE), a patient education programme for people living with type 1 diabetes. Dr Murphy is also working on an update of a Cochrane review on tailored interventions to address determinants of professional practice, along with a scoping review to characterise the processes and outcomes of tailoring in healthcare. Prior to this, she worked as a Postdoctoral Researcher on the Horizon2020 SEURO (Scaling EUROpean citizen driven transferable and transformative digital health) project at Trinity College Dublin. Dr Murphy completed her PhD in the School of Psychology at University of Galway in 2021. Her PhD research employed multiple methods to evaluate the role of digital health interventions to support medication adherence in young adults living with asthma. Dr Murphy’s research interests include management of chronic conditions across the lifespan, digital health and implementation science.

background

Tailored implementation strategies effectively support implementation of interventions in healthcare. However, it is unknown which tailoring approaches are most feasible and acceptable to stakeholders and which outcomes they consider important. Dose Adjustment for Normal Eating (DAFNE) is an evidence-based patient education programme recommended for type 1 diabetes management, however its implementation and how best to support delivery are underexplored. Using DAFNE as a case study, we evaluated clinical stakeholder’s experiences of the process to tailor strategies to support programme implementation.

MEthod

DAFNE clinical teams participated in a tailoring process involving three group discussions to prioritise determinants and select implementation strategies. Employing a mixed methods convergent design, participants’ experiences of tailoring are evaluated using multiple data sources (observation notes, surveys, interviews). Findings are integrated using a triangulation protocol. Data are combined using joint displays for within and cross-case analysis.

results

In total 8 DAFNE centres in Ireland comprising 40 clinicians have participated to date in the tailoring process. Teams prioritised determinants important to address now, including lack of available resources (administration support), access to knowledge and information (familiarity with course content), and networking and communication (long-standing relationships). A total of 27 clinicians from 7 centres have completed post-tailoring evaluation interviews to date. Findings from these interviews suggest the process is acceptable and feasible to clinicians, facilitating a dedicated opportunity to discuss DAFNE. However, additional guidance and evidence were not often used when prioritising determinants.

Conclusion

The findings will inform best-practices for developing tailoring approaches which are feasible and acceptable to clinical stakeholders, and which incorporate the guidance and evidence they use and value to make decisions during tailoring.

Supporting vulnerable families online – Exploring the experiences of service users and practitioners and the development of a best practice framework to support the implementation of digital social care services

P44

PRESENter

Gráinne Hickey

presenter biography

Dr Gráinne Hickey is Research and Evaluation Manager in Barnardos Ireland. She previously held the position of Project Manager on the ENRICH (Evaluation of wRaparound in Ireland for CHildren and families), as well as postdoctoral posts on a Process Evaluation of youngballymun and the Incredible Years Ireland Study in the Centre for Mental Health and Community Research, Maynooth University. Her work is focused on preventative and early interventions which support parental wellbeing, positive parenting and children’s social-emotional and behavioural outcomes. Her interests include evidence-based practice, community-based research, evaluation and implementation science.

background

Digital technology is an increasing feature of social care practice, and its use has accelerated greatly in response to the Covid-19 pandemic. Yet there remains much that we need to learn regarding the implementation of digital interventions in social care settings. We explored service user and practitioner experiences of working online during the pandemic and outline the development of a digital practice framework. This work was conducted in the Republic of Ireland as part of an evaluation of web-based services delivered by Barnardos Ireland during the Covid-19 pandemic.

MEthod

A mixed methods study combining survey and qualitative research was conducted. In total, 139 parent/adult service users and 102 practitioners took part in online surveys. Nineteen focus groups with 106 practitioners were also conducted. The findings informed the development of a best practice framework that includes guidance documents, protocols, and assessment tools to support staff and service users working online.

results

Survey results indicated that more than half of participating parents identified a blended approach of online and face-to-face meetings as their preferred option for receiving services. Results from the survey and focus groups with practitioners indicted they generally felt confident and comfortable engaging in digital service delivery. Benefits of digital practice included perceived positive impacts on participation rates, ease of access and removal of barriers to engagement. Challenges included lack of access to technology/WiFi, inadequate spaces to engage in digital intervention, concerns regarding privacy and safeguarding and developmental considerations in direct work with children online.

Conclusion

The findings highlight benefits and challenges within the implementation of digital social care supports. The digital practice framework developed in response to these findings provides implementation guidance for web-based social care services including: session planning guidance; safeguarding and risk assessments; maintaining programme fidelity; building therapeutic relationships; and evaluation and reflection following intervention delivery.

Applying an implementation science lens to Ireland’s National Care Experience Programme

P45

PRESENter

Lisa Ann Kennedy

presenter biography

Lisa Ann Kennedy is an analyst on the National Care Experience programme where she leads on the analysis and reporting of survey findings and on the development of new surveys. She holds a PhD in Psychology and an MSc in Health Psychology from the University of Galway.

background

Ireland’s National Care Experience Programme (NCEP) is a joint initiative from the regulator (Health Information and Quality Authority, HIQA), the provider (the Health Service Executive, HSE) and the policy-maker (the Department of Health). The Programme has conducted surveys of people’s experiences in Irish care settings since 2017, including experiences of inpatient, maternity, maternity bereavement, nursing home, and end of life care. Survey findings help to identify areas requiring improvement at local and national levels. Implementation science provides frameworks for understanding how the findings can be used to inform meaningful changes in care settings.

MEthod

Five of the dominant Implementation Science frameworks were adopted in the analysis: the Consolidated Framework for Implementation Research (CFIR)[1], Reach Effectiveness Adoption Implementation and Maintenance (RE-AIM)[2], Active Implementation Framework (AIF)[3], Normalisation Process Theory (NPT)[4], and Promoting Action on Research Implementation in Health Services (PARIHS)[5]. The aims, objectives and operationalisation of the NCEP were mapped to key elements of each framework using a framework-based approach with a view to understanding how each could contribute to the impact of the NCEP.

results

The frameworks identified were potentially useful at the practice and policy levels, and could assist in identifying barriers and facilitators to implementing change, developing appropriate implementation strategies, and evaluating implementation success. The frameworks also provided insights into the design and development of the NCEP surveys themselves.

Conclusion

Insights from implementation science can aid the development and implementation of care experience surveys, as well as facilitating the utilisation of the survey findings to optimise their overall impact. An implementation science lens can support the translation of the findings of care experience surveys into meaningful improvements in the delivery of care.

Using Geographic Information System (GIS) to Understand Service User’s Patterns of Accessing Primary Healthcare Facilities in Goa, India

P46

PRESENter

Luanna Fernandes

presenter biography

Luanna Fernandes is a Research Coordinator at the Addictions and related Research Group, Sangath, Goa, India. She is an early career researcher interested in scaling up evidence-based treatments for common mental health conditions, particularly depression and trauma. Currently, she is working on the IMPRESS and PEERS projects which are scaling up the Healthy Activity Program of Depression which is being delivered by lay counsellors working in the state public health system. Previously, she has worked as a school counsellor and on the Umeed II project developing a depressing treatment program for people living with HIV at Sangath. She has a Master’s in Psychology.

background

Geographic Information Systems (GIS) have been widely used for planning and monitoring health programs. However, this is not the case for implementation planning in low- and middle-income countries. We aimed to use GIS to understand patterns of accessing primary health services to inform the implementation of the IMPRESS program. About the study:
IMPRESS is a Hybrid Type 2 Implementation Effectiveness Cluster Randomised Controlled Trial. Through IMPRESS we are scaling up an evidence-based psychological treatment for depression through the primary healthcare system in the state of Goa. This is the first-ever state-wide scale-up of depression care in India.

MEthod

1.An administrative map of Goa was uploaded on the Quantum GIS (QGIS) platform.
2.Health centre (n=30) coordinates were collected using Google Maps.
3.To help understand patterns of accessing services, data about the area of residence of health centre attendees were collected through

(1) retrospective (three months: April-June 2022) review of clinic registers, and

(2) a brief questionnaire about area of residence, administered to a convenience sample of primary health centre attendees over one week in November 2022.

results

1. Of the 425 villages in Goa, people from only 17% of villages exclusively attended the health centre from the catchment area to which they belonged.
2. Residents of the remaining 83% of villages accessed multiple health centres which were not in their catchment area.
3. The highest count of health centres attended by people from a single village was 25 facilities.

Our findings suggest that:

1.The proximity of area of residence to the health centre and administrative boundaries of catchment areas did not influence decisions related to health centre utilisation.

2.Decisions to access a particular health centre are based on contextual factors such as location of the facility along a bus route, and availability of specialist services in the health centre.

3.Pre-determined health centre catchment areas which are meant to ensure equitable access to care do not hold true in the real world.

Conclusion

Our findings allowed us to understand patterns of accessing primary healthcare facilities and define clusters for health centres based on actual utilisation of services for the IMPRESS trial.

Key takeaway: GIS technology has the potential to enhance accurate mapping of catchment areas to support optimal implementation of health programs based on contextually relevant data, which may be considered for pre-implementation planning of facility-based health programs.

Implementing a new ‘Test, Evidence, Transition’ Programme to accelerate the effective and equitable adoption of cancer pathway innovations

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PRESENter

Alexandra Feast

presenter biography

Dr Alexandra Feast has a background in Psychology, Neuroscience, Dementia and Cancer research. She has conducted, commissioned and managed Health Research for 15 years, and has a particular interest in complex psychosocial interventions, implementation science and improving health services for people affected by cancer. She is an Honorary Research Fellow at University College London and a research programme Manager at Cancer Research UK. She manages the Test Evidence Transition programme, which provides funding and support to NHS teams to implement and evaluate new models of cancer service delivery.

background

Cancer Research UK has launched a new programme of commissioned activity, ‘Test Evidence Transition’, which aims to accelerate the effective adoption of innovations whilst reducing inequalities. The objective is to drive the transition of effective interventions from innovation into mainstream NHS practice, addressing the ‘implementation gap’ to improve the experience and outcomes of those affected by cancer.

MEthod

The programme closely supports frontline NHS teams working to achieve three objectives: Test innovations to support optimal cancer pathways that transform clinical practice; Evidence the process, outcome, and impact of implementation; and work with strategic partners to ensure the Transition of evidence-based approaches into effective and equitable adoption across the NHS.
The programme combines top-down ‘push’ approaches (system levers) with bottom-up ‘pull’ approaches (real-time learning and collaboration) to stimulate sustained pathway improvements. As an active commissioner, we provide strategic oversight, creating a community of stakeholder expertise, including academic and clinical partners who will co-design resources, informed by relevant implementation science frameworks, to support implementation, evaluation and scalability.

results

We present emerging findings and insights from the first phase of the programme, commenced in April 2023 and concluding in October 2024, providing funding and support to three frontline NHS teams exploring pathway innovations for cancer. Evaluation plans cover clinical impact, acceptability and cost effectiveness, including analysis of health economic and patient reported outcomes. Projects will report on programme inputs, outputs, outcomes, and factors influencing implementation, sustainability, scalability and evaluability.

Conclusion

In delivering a focused model to pioneer health system transformational change, the programme provides a test bed for innovations that transform clinical practice and optimise the cancer pathway, triangulating and interpreting evidence and evaluation to enable acceleration into mainstream practice. The programme will provide high-quality evidence to decision-makers on how best to address the challenges of translation, aiding the implementation and spread of identified best practice.

What is needed to implement self-management support (SMS) in cancer care delivery? A qualitative study of SMS implementation in Ireland

P50

PRESENter

Nickola Pallin

presenter biography

Nickola is a HRB SPHeRE (Structured Population and Health Services Research Education) PhD scholar at the School of Public Health, University College Cork. Her PhD is focusing on developing an implementation intervention to improve the quality and reach of self-management support in cancer care. Her research interests include cancer survivorship, quality improvement and implementation science. Prior to her PhD she was a lecturer in Therapeutic Radiography in London Southbank University, and a Cancer Research UK pre-doctoral fellow in the Department of Behavioural Science and Health in University College London.

background

Self-management support (SMS) is a key component of quality cancer survivorship delivery. However, implementation is a problem internationally. In response to national policy an evidence-based SMS programme ‘Cancer Thriving and Surviving’ (CTS) has been rolled out in Ireland. However, implementation is not uniform across contexts. We report the main barriers, facilitators, and contextual factors relevant to implementing SMS across cancer organisations in Ireland.

MEthod

The Consolidated Framework for Implementation Research (CFIR) informed the topic guide and analysis. Transcripts were analysed inductively by the interview guide and the research questions. Categories were then coded deductively to the CFIR constructs. Analysis of the interviews were further sensitised by Normalisation Process Theory to help uncover why determinants may influence implementation.

results

Interviews were conducted with 47 stakeholders (nurses, physiotherapists, occupational therapists, dietitians, oncologists, psychologists, psychiatrists, social workers, and programme deliverers living with and beyond cancer) from 19 organisations. Findings highlight that when stakeholders believe in the benefit of CTS on patient outcomes and when these outcomes are aligned with personal and organisational goals implementation becomes a priority. When aligned with organisational goals leadership had stronger buy-in and secured resources to enable implementation. The need for policy support; regulatory and professional guidelines highlighting CTS for implementation may secure buy in. Enablers included a positive organisational culture of deliverer-centeredness, with performance feedback and incentives. As well as collaboration among stakeholders, characterised by close working relationships and communication processes across and within organisations.

Conclusion

These findings highlight theoretically based factors that influence implementation of SMS, which can be used to inform tailoring of implementation strategies. Strategies that improve awareness regarding the positive impact of SMS, align SMS with organisational goals, secure buy-in and support a culture of delivered centeredness and collaboration may be needed to implement SMS.

Exploring outcomes from a novel shared professional training and wrap around support package on sustaining complex intervention fidelity: Lessons from LISTEN’

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PRESENter

Dr Fiona Leggat

presenter biography

Fiona works as a Research Associate from the Population Health Research Institute at St George’s, University of London. Her primary role is supporting the NIHR funded Long Covid personalised Self-management support co-design and evaluation (LISTEN) project. As part of the LISTEN project, Fiona’s supported the co-design of the trial intervention together with people with lived experience, and she now works on the trial mixed methods process evaluation.

Previously, Fiona was awarded her PhD in Applied Health Psychology from St Mary’s University, Twickenham, in 2021. Working within lower limb amputation rehabilitation, her thesis drew upon knowledge translation and narrative pedagogy, with a focus on co-design and qualitative methods.

background

Healthcare professionals (HPs) play primary roles in delivering complex rehabilitation interventions. However, when delivering a complex intervention within a trial context, additional training and support is critical to enhance HP’s ability to ensure fidelity and deliver as intended. Intervention delivery is recognised within implementation science frameworks, yet the appropriateness and influence of training on fidelity and adherence to core principles is often not evaluated. Developed for a clinical trial to co-design and evaluate self-management support for people with Long Covid (LISTEN), we report on the design and impact of a novel training and support package on HPs’ knowledge, confidence, and skills.

MEthod

Underpinned by the Consolidated Framework for Implementation Research, the co-designed LISTEN training was formatively evaluated using a self-report online survey. All HPs (e.g., physiotherapists [PTs], occupational therapists [OTs], psychologists, nurses, and other practitioners) who undertook the 8-hour interactive group-based training took part in the survey. The survey asked HPs to separately score knowledge and confidence across 9 intervention fidelity criteria (37 items) . 3-point Likert scales (1-3) were used for each item. Impacts from the training and the support package will be assessed using focus groups and fidelity observations. Data were analysed using descriptive statistics.

results

57 HPs completed the survey and subsequently delivered intervention sessions. Average knowledge (94%) and confidence (90%) varied across skills and between professions. Psychologists’ self-assessment of overall knowledge (97%) and confidence (92%) post-training was higher than those of OTs (94%, 90%) and nurses (93%, 91%). PTs reported lowest levels of knowledge (88%) and confidence (81%), although for some skills (e.g., attentive listening, being curious) scores mirrored other professions .

Conclusion

HPs participating in shared professional training to deliver a complex intervention require tailored support to address profession specific needs. The influence of the support package on intervention fidelity continues to be evaluated within the ongoing LISTEN trial.

Barriers and enablers to participating in self-management support among those living with and beyond cancer: a qualitative study informed by the TDF and COM-B

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PRESENter

Nickola Pallin

presenter biography

background

National policy in Ireland has recommended that cancer services implement survivorship programmes which includes self-management with support. Self-management support (SMS) programmes have been adopted but implemented with varying levels of reach (uptake) among people living with and beyond cancer (LWBC). This study aimed to identify the enablers and barriers to participating in SMS among those LWBC in Ireland to inform tailoring of implementation strategies to increase reach of SMS.

MEthod

This is a qualitative study. Semi-structured interviews were conducted with people LWBC. The Theoretical Domains Framework (TDF) informed the topic guide and analysis. Inductive thematic analysis was conducted to identify categories relating to barriers and enablers to participating in SMS. These were then deductively mapped onto the TDF and capability, opportunity, motivation and behaviour (COM-B) model.

results

Twenty-eight interviews were conducted. Eleven had taken part in a SMS programme. Emotion and identity (illness perception) shaped participants’ beliefs about whether they would choose to participate in a programme. A lack of knowledge of available programmes and how to access were commonly reported barriers, with participants describing limited information received from their healthcare providers. Inaccessible programmes due to timing and place of delivery (environmental context and resources) was also a common barrier. Social influences which include healthcare professionals and peer support groups were identified as key enablers. As well as supportive reminders (memory, attention, and decision-making).

Conclusion

We identified key factors that influence the capability, opportunity and motivation among those LWBC to participate in SMS. Findings suggest implementation strategies aiming to improve reach of SMS at the patient level could target knowledge, memory, identity, emotion, environmental context and social influences.

Perceived sustainability of a community paramedicine model to reduce acute care utilization: a case study in two settings

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PRESENter

Terri Menser
Jennifer Ridgeway

presenter biography

Terri Menser is a health services researcher with broad ranging research interests that include patient engagement, assessing health disparities and intervening to increase equity where possible, and system improvement and implementation evaluation efforts to decrease care fragmentation and lessen burnout. She is currently serving as the Internal Communications Director for the Justice, Equity, Diversity, and Inclusion Special Interest Group with ACTS and is also the Treasurer for the Healthcare Management Division of Academy of Management. She was trained at Texas A&M, completed a postdoc at OSU, and conducted research at Houston Methodist hospital prior to joining the Kern Center at Mayo Clinic in August 2022.

Jennifer Ridgeway is an Associate Professor of Health Services Research and a Senior Associate Consultant at Mayo Clinic (Rochester, MN, USA). Her expertise is in qualitative and mixed methods research, formative and process evaluation, and implementation science. Her research interests include relationship-centered care, generalist-specialist collaboration across networks, and implementation of remote and technology-enabled models of multidisciplinary care, especially for patients with multiple chronic conditions and patients in cancer survivorship. She is currently leading a pragmatic trial of shared decision making in three diverse U.S. health systems, and she is a co-investigator on trials of remote cancer symptom management interventions, community paramedicine models of care, and evidence-based approaches to clinical decision making. https://impsciconference.com/speaker/jennifer-ridgeway/

background

Community paramedics (CPs) provide services to patients with intermediate acuity needs in community settings.1 The Care Anywhere with Community Paramedics (CACP) program was evaluated in a pragmatic, point-of-care randomized clinical trial of CACP versus usual care on days alive outside the hospital or emergency department (ED) within 30 days.2 This study reports key informant perspectives of program sustainability at trial completion.

MEthod

The trial was conducted in an academic medical center and affiliated health system (Midwest USA). A purposive sample of CPs, clinicians, and administrators were invited to complete a survey, including items from the Clinical Sustainability Assessment Tool (CSAT).3 A subset were also invited to complete an individual interview. Surveys were analyzed descriptively, and interview transcripts utilized applied thematic analysis.

results

Between January and March 2023, 63 individuals completed surveys and 20 completed interviews. CSAT scores were highest in clinician perspectives of outcomes and effectiveness and lowest in CP perspectives of organizational readiness and among CPs overall. Interviews highlighted clinician views that the program addressed persistent acute care gaps, especially in rural communities, and provided them with important information to manage care and keep patients stable at home. However, CPs suggested that sustainability hinged on a varied nature of referrals—so they were not a “catch all” resource for very complex patients—and improved staffing.

Conclusion

CP programs may provide critically needed options for patients with intermediate acuity needs, but sustainability will require a balance between filling gaps in the healthcare system and CP capacity to address them.

Implementi ng a web-based applicati on for men’s health screening in a primary care setti ng duringthe Covid-19 pandemic: a mixed-methods pilot study

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PRESENter

Chor Yau Ooi

presenter biography

Chor Yau Ooi is a Family Medicine Specialist and a medical lecturer at Universiti Malaysia Sarawak, Malaysia. He is currently pursuing his doctorate in implementation science at University of Malaya, Malaysia. His work is focused on implementing a web-based application to increase the uptake of health screening in men.

background

Men’s use of health screening remains low globally [1]. This was more evident during the Covid-19 pandemic as most non-urgent services in the clinic were halted, including health screening. Technology can be used to overcome barriers to screening by improving accessibility, motivating and reminding individuals to get screened. ScreenMen is a web-based application that was developed to increase the uptake of men’s health screening. This study was a process evaluation of the implementation of ScreenMen in a primary care setting.

Reference
1. Teo CH, Ling CJ, Ng CJ. Improving Health Screening Uptake in Men: A Systematic Review and Meta-analysis. American journal of preventive medicine. 2018;54(1):133-43.

MEthod

This study was conducted in a government health clinic using a mixed-method explanatory sequential design driven by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework [2]. We used a tailored intervention including: mandate change, provide education and training, identify and prepare champions, use of information and communication technology, and audit and provide feedback. Participants were staff and patients. We used Google Analytics to monitor patient uptake of ScreenMen for 5 months and conducted staff interviews to understand the implementation process. We used template analysis based on the RE-AIM framework [3].

References
2. Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 1999;89(9):1322-7.
3. QualRIS. Qualitative Methods in Implementation Science 2019 [Available from: https://cancercontrol.cancer.gov/IS/docs/NCI-DCCPS-ImplementationScience-WhitePaper.pdf.]

results

A total of 75 patients accessed the app. Access was higher as implementation started but subsequently dropped, and increased again towards the end of the period. The majority (51%) of patients accessed the app through QR codes. In qualitative analysis we found that access was lower than expected because of decreased patients in the clinic during the pandemic. The later increase in access was related to champion activity. Bunting promotes access due to its size and strategic placement. Staff found that mandated change was not useful as an implementation strategy.

Conclusion

Making patients access the app in the clinic and using bunting were reported to be effective in implementing ScreenMen while mandate change was found to be least helpful.

Developing a Theory of Change for implementing the novel UK Children’s Palliative care Outcome Scale (C-POS:UK) into routine paediatric palliative care

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PRESENter

Hannah Scott

presenter biography

Hannah joined the Cicely Saunders Institute as a Research Assistant in 2020 working on the Children’s Palliative care Outcome Scale study. She was awarded a National Institute for Health and social care Research Applied Research Collaboration South London Grant in 2021 to undertake a PhD on Implementing the Children’s Palliative care Outcome Scale into routine paediatric palliative care in the UK.
Hannah graduated from York St John University in 2019 with a Bachelor of Arts in Children, Young People and Families and was awarded both the Undergraduate Prorgramme Prize for achieving the highest classification mark on her programme and the Undergraduate Dissertation Prize for achieving the highest mark in her programme for her dissertation on transitions through UK mental health services. Hannah also earned a Masters of Science in Social Policy and Social Research from University College London from which she graduated in 2020.

background

To ensure a newly developed measure (C-POS:UK) can be successfully implemented, it is important to draw together existing evidence and work collaboratively with key stakeholders to develop an experience-informed, evidence-based Theory of Change.

MEthod

The STRiDE guidance (1) for Theory of Change Workshops was used to inform the workshops. Parents of children with life-limiting or life-threatening conditions and health and social care professionals working in the NHS were recruited through social media and networks. Theory of Change Maps were developed and refined based on stakeholder contributions using a template adapted from Stories for Impact (2).

results

Eight multi-disciplinary professionals and eight parents took part in the workshops. Both parents and professionals felt the long-term goal of implementing a measure would be improving care and comfort for children and their families. Professionals emphasised the importance of having adequate, staffing, time and monetary resources, as well as the importance of education and training on using the measure, and reminders or prompts to help them remember to use it. Parents felt a pre-requisite to the successful implementation of a measure was for all professionals to have an understanding of what palliative care is. Parents wanted a trusted professional to support completion of the measure and nurses were identified as most appropriate due to the relationship they had with families. Parents also highlighted a need to improve communication and information sharing to avoid children and families having to answer distressing questions or share their stories multiple times and professionals also felt the measure may help facilitate this.

Conclusion

These workshops have supported the development of a UK context-specific, evidence-based and experience-informed Theory of Change and will inform the development of an implementation plan for C-POS in the UK. Future work will involve the review of the Theory of Change as part of a pilot study to test the Implementation Plan in practice.

HEAL-D Online – is it feasible to implement a virtual culturally tailored diabetes self-management programme for African and Caribbean communities in south London.

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PRESENter

Joe Low

presenter biography

Joe Low is a mixed methods researcher from an academic health care services research background. He started his career at the University of Southampton and completed his PhD in 2001, looking at the impact of stroke rehabilitation on informal carers. He then moved to University College London (UCL) in 2001 as a senior researcher and was responsible for running the following two research programmes: the provision of supportive care in non-malignant disease and the provision of psychological support in palliative care populations. He also worked as a General Advisor for the Research Design Service London (UCL), supporting health professionals and researchers with their grant and fellowship funding applications. Since November 2022, he joined the Health Innovation Network South London in November 2022 as part of the Insight Team.

background

Type 2 diabetes is a major health concern for UK African and Caribbean people. To tackle ethnic inequalities in diabetes healthcare access, a virtual culturally tailored diabetes self-management education programme (HEAL-D Online) was rolled out in South London for this community. We present findings from our evaluation assessing the acceptability and feasibility of implementing this new programme.

MEthod

Mixed methodology. Quantitative: Service activity data assessed service user engagement, acceptability and benefit (self-reported weight loss and diabetes-related emotional distress). Data was analysed using frequencies and percentages. Qualitative: Semi-structured interviews were conducted with 14 service users and 7 service delivery staff to explore their perceptions of the feasibility and acceptability of HEAL-D Online, and data collected was analysed using Framework Methodology. Fidelity was measured through observations using a fidelity checklist.

results

Service activity data showed that initial uptake of HEAL-D Online was low but once patients attended their first session, there was a completion rate of 77%, demonstrating high adherence. A high fidelity was observed, and qualitative findings showed that staff and service users were satisfied with all aspects of course delivery. Both service activity and qualitative data indicated that attendees felt more confident in controlling their diet and managing their diabetes post-HEAL-D, with many reporting a reduction both in weight and diabetes-related psychological distress.

Conclusion

HEAL-D Online was well received by attendees with a high completion rate. It was successful in its goals of providing attendees with the knowledge and necessary skills to elicit behavioural change to support their diabetes management, ultimately leading to weight loss in some attendees. Challenges were identified around the identification, recruitment and referral of eligible patients into the programme and these need to be addressed for successful implementation of this programme on a wider scale.

A qualitative analysis of experiences, enablers and barriers to implementing nationally endorsed health and social care standards in Ireland

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PRESENter

Yvonne Kelly

presenter biography

Yvonne is a general nurse and a PhD student in the Health Information and Quality Authority. She is a PhD scholar on the Structured Population health, Policy and Health-services Research Education (SPHeRE) programme, University College Cork. Her research interests include implementation science, quality improvement and adult nursing. Yvonne’s PhD is focusing on the implementation of health and social care standards in health and social care services. Currently, she is developing an evidence- and theory-informed process and digital platform, to guide research teams in identifying implementation strategies and then selecting tailored support tools and support actions. Yvonne has a Masters in Nursing and Healthcare Quality Improvement.

background

Health and social care standards are complex interventions that describe safe, high-quality care. They require multiple collective actions from multiple stakeholders across diverse services in health systems [1]. Standards are typically enforced or encouraged through statutory requirements or quality improvement initiatives. Limited evidence exists on appropriate implementation strategies to enhance their implementation [2,3]. We aimed to explore experiences of implementing nationally endorsed standards from stakeholders working at multiple levels in the health system, and to identify enablers and barriers to effective implementation. This exploration will inform implementation strategies that can optimise standards implementation.

MEthod

Using a descriptive qualitative design, six focus groups and eight individual interviews were conducted with stakeholders at individual-level (n=10), organisational-level (n=14) and system-level (n=14). Discussions were audio-recorded with consent, transcribed verbatim and analysed using Braun & Clarke’s reflexive thematic analysis [4]. Interpretation of data was underpinned by social constructionism [5]. Collective reflexivity and Lincoln & Guba’s criteria of trustworthiness was used to enhance rigour [6].

results

Six themes were generated from patterns of shared meanings across participants’ stories. Participants reported that implementation should incorporate: a “top-down, bottom-up approach”, accessible “bite-size” support tools, “meaningful” language, and “leaders at every single level.” An enabler to implementing standards was collegial support from the regulatory body that included reassurance that services were “doing the right thing.” A barrier was a “tired, worn out” workforce.

Conclusion

Themes generated described intervention and organisational characteristics that are reflected in existing implementation determinant frameworks. A novel finding was how an external organisation such as a regulatory body can influence implementation of standards. Few determinant frameworks address external organisational influences [7]. Adopting organisational theory may help to better understand these external influences on implementation in health and social care services. Findings from this exploration can be used by researchers to inform implementation strategies that can optimise safe, high-quality care delivery.

References
1. Kelly Y, O’Rourke N, Flynn R, Hegarty J, O’Connor L. Definitions of health and social care standards used internationally: A narrative review. Int J Health Plann Manage. 2023;38(1):40-52.
2. Proctor EK, Powell BJ, McMillen JC. Implementation strategies: recommendations for specifying and reporting. Implement Sci. 2013;8(1):139.
3. Powell BJ, Beidas RS, Lewis CC, Aarons GA, McMillen JC, Proctor EK, et al. Methods to Improve the Selection and Tailoring of Implementation Strategies. J Behav Health Serv Res. 2017;44(2):177-94.
4. Braun V, Clarke V. One size fits all? What counts as quality practice in (reflexive) thematic analysis? Qual. Res. Psychol. 2021;18(3):328-52.
5. Burr V. An Introduction to Social Constructionism. Routledge; 1995.
6. Lincoln Y, Guba E. Naturalistic inquiry. Beverly Hills: Sage Publications. 1985.
7. Nilsen P, Bernhardsson S. Context matters in implementation science: a scoping review of determinant frameworks that describe contextual determinants for implementation outcomes. BMC Health Serv. Res. 2019;19(1):189-99.
Acknowledgements
This work was conducted as part of the Structured Population health, Policy and Health-services Research Education (SPHeRE) programme (Grant No. SPHeRE/2019/1). Yvonne Kelly has conducted this work as part of a PhD studentship that is funded by the Health Information and Quality Authority (HIQA).

Using the Consolidated Framework of Implementation Research and Implementation outcomes to develop interview scripts: methodological insights from the Mental Health in Primary Health Care project (SMAPS) Implementation assessment research

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PRESENter

Ilana Eshriqui

presenter biography

Ilana Eshriqui is Researcher at the Albert Einstein Center for Studies, Research and Practices in Primary health Care (CEPPAR) of the Hospital Israelita Albert Einstein, Sao Paulo Brazil. Ilana is graduated in Nutrition at Federal University of Rio de Janeiro (UFRJ, 2014), with master’s degree in human nutrition (UFRJ, 2017) and PhD in Sciences at School of Public Health of University of Sao Paulo (USP, 2020), with a period as visitor researcher at the Folkhälsan Research Center in Helsinki. She has expertise in Public Health and Nutritional Epidemiology, with focus in practice-based research and implementation science.

background

The SMAPS is developed in three Brazilian states aiming to support mental health care in Primary Health Care (PHC), using the Health Care Planning method (HCP) [1] and mhgap training as central implementation strategies [2]. This work aims to present the process to prepare qualitative data collection scripts used to interview multiple levels of SMAPS stakeholders in an implementation assessment research.

MEthod

The value of the collected data depends on the strength of the interview questions to capture meanings and experiences [3]. Thus, scripts to different levels of stakeholders were constructed through a collaboration between researchers and SMAPS proponents, considering the potential of each question to inform implementation outcomes [4] and determinants according to Consolidated Framework of Implementation Research (CFIR) [5].

results

Scripts were constructed considering four levels of SMAPS stakeholders, who perform different roles in state and municipality government levels (Figure 1). When asked to different stakeholder levels, the same question shows potential to inform different implementation outcomes. However, questions for Innovation delivers and receivers show potential to capture more implementation outcomes then for high and mid-leaders’ levels. All questions show potential to inform the same CFIR determinants independently of stakeholder level.

Conclusion

Beyond being useful to guide research analysis, implementation outcomes and CFIR are useful to construct implementation research scripts and to training interviewers.

References:
1- Evangelista MJO, Guimarães AMDN, Dourado EMR, Vale FLBD, Lins MZS, Matos MAB, Silva RBMDPM, Schwartz SA. Planning and building Health Care Networks in Brazil’s Federal District. Cien Saude Colet. 2019; 27;24(6):2115:2124.
2- World Health Organization. MhGAP training manuals for the mhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings, version 2.0 (for field testing). 2017; https://apps.who.int/iris/handle/10665/259161. Licença: CC BY-NC-SA 3.0 IGO
3- Roberts, R. E. Qualitative Interview Questions: Guidance for Novice Researchers. The Qualitative Report. 2020; 25(9), 3185:3203
4- Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A, Griffey R, Hensley M. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health. 2011; 38(2):65:76.
5- Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009; 7;4:50.

Design and Implementation of an Online Older Person-Student Nurse Intergenerational Café using CFIR

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PRESENter

Dympna Tuohy

presenter biography

Dympna Tuohy, Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
I have taught and been involved in nurse education, teaching & assessment; from undergraduate to post graduate level since 1996. This includes programme development, curriculum development and review, taught and research final year projects & dissertation supervision. I currently teach modules on older person care and person centred care. Prior to this, I spent several years nursing people in clinical practice.
My current research areas of interest include Intergenerational Cafés (to increase intergenerational learning between student nurses and older people), Digital delirium education, Nursing Metrics, Day care centres and people living with dementia. I am also interested in intercultural care, specifically intercultural communication. I have with colleagues developed a hand massage online programme for use in the care of older people.
Qualifications include PhD, MSc Nursing, Grad-Dip. Medical/Surgical Nursing, BNS,ICU cert. RGN, RNT

background

Most older people live independently but at times may require nursing care either at home, in primary and community care, in hospital or in nursing homes. Most nurses will care for older people during their career. It is crucial that older people and nurses can work together in caring partnerships. Student nurses need to be supported to develop this knowledge and skill. In effort to break down barriers, promote respect, build links and promote understanding between generations, it is useful to develop ways to increase intergenerational learning and connections. The aim of this research was to determine the feasibility of using intergenerational discussion cafés as an implementation strategy.

MEthod

Ethically approved research guided by the Consolidated Framework for Implementation Research (CFIR) (Damschroder et al1). Online intergenerational discussion cafés were held for 3rd year student nurses and older people. Participants were invited post café to participate in an anonymous online survey with student nurses (n=50) older people (n=49) and facilitators (n=9) responding. Data were collected through survey questionnaires (descriptive statistical and thematic data analysis ) and facilitator reflections. Post hoc ‘CFIR’ analysis using adapted codebooks was undertaken to evaluate the café implementation.

results

Organisational factors (e.g. clear instructions, being organised and sufficient time) are important for the effective implementation. More students than older people felt that the purpose, topics and online running of the café were clear and organised. More older people than students wanted more time in the discussion groups and some of this cohort experienced technical difficulties. All were positively disposed to the cafés as a way of increasing intergenerational learning. Facilitator teamwork enable smooth running of the cafés.

Conclusion

This intervention was worthwhile as it facilitated mutual learning and understanding. Intergenerational cafés are now embedded in the BSc Nursing (General, Intellectual Disability and Mental Health) curricula.

Experiences in paediatric healthcare of using physical activity on prescription for children with obesity – a focus group study

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PRESENter

Charlotte Boman

presenter biography

Charlotte Boman is a PhD student and physiotherapist from Sweden at Gothenburg University, Sahlgrenska Academy, at the Institution of neuroscience and physiology. She works at the Centre for Physical Activity in Gothenburg providing, among other things, support to the health and medical care in the work with physical activity and especially the intervention physical activity on prescription (PAP). Her thesis is called Implementation of PAP for children with obesity in paediatric health care. The overall aim is to investigate the prerequisites, determinants, and feasibility of implementing PAP for children with obesity in paediatric outpatient clinics.

background

Background: Insufficient amounts of physical activity are a growing public health concern that is closely related to childhood obesity. While Swedish physical activity on prescription (PAP) is successful in increasing levels of physical activity in adults it has not been well-studied in children. The purpose of the study was to get an in depth understanding of paediatric healthcare professionals’ experiences of using PAP for children with obesity.

MEthod

Method: Seven focus group discussions with 26 healthcare professionals from paediatric outpatient clinics in western Sweden were conducted. Data were analysed both inductively and deductively, framed by the Normalization Process Theory and its four domains: coherence, cognitive participation, collective action, and reflexive monitoring.

results

Preliminary results:
The PAP work for children with obesity is experienced to be about helping children to start being more physically active, and less about losing weight. The PAP work is considered unclear, and participants experienced a lack of guidelines. The children were perceived to have great needs and collaboration with physiotherapists and physical activity organisers was considered necessary. Healthcare professionals indicated several barriers that need to be addressed to better meet the children’s needs, especially in transitions between clinics and sports facilities.

Conclusion

Conclusion: PAP is a well-known intervention that is used inconsistently for children with obesity. To meet children’s needs, physiotherapists and physical activity organisers are perceived indispensable as collaborators, although there are several barriers that need to be addressed to adopt and improve the delivery of PAP

The application of Theories of Change and Logic Models to inform Healthcare Policy: a scoping review

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PRESENter

Maria Karadimova-Watts

presenter biography

Maria Karadimova-Watts is a Medical Student who has just completed her third year of studies at King’s College London.

As her first research endeavour, she is affiliated with Cicely Saunders institute of Palliative Care, Policy & Rehabilitation, with a particular focus towards how healthcare policy can be refined in order to deliver better outcomes. This particular project focuses on using Logic Models and Theories of Change to understand why healthcare policy outcomes are achieved.

Her broad areas of research interest include palliative care, person-centred care, primary care, lifestyle medicine and medical education.

As part of her medical degree, she will be commencing an intercalated BSc in September, where she hopes to continue developing her research skills and get involved in more research projects.

background

Theories of Change and Logic Models are policy-mapping tools to aid understanding of policy. A Theory of Change is ‘a theory of how and why an initiative works’ [1]. Similarly, a Logic Model ‘illustrates how a program is designed to meet its intended outcomes’ [2]. The objectives of this study were to: (i) examine how Theories of Change and Logic Models are currently used in healthcare policy, and (ii) to explore trends in use across time, countries, and research fields.

MEthod

A scoping review was conducted, using PubMed. Inclusion criteria included mentioning Theories of Change or Logic Models in the context of informing policy, and primary research published within the last 10 years. Exclusion criteria included absence of explanation of ‘policy’, non-healthcare focus and absence of a methods section. A data extraction form was used to extract data on seven outcomes: primary research type, Theory of Change or Logic Model approach, extent of integral use of Theory of Change or Logic Model, revision of the Theory of Change or Logic Model, date of publication, country of publication and topic.

results

346 initial studies were identified, with 25 being included. Results demonstrated 64% of studies implemented a model prior to their research, with 40% of studies revising this initial model after their findings. The highest frequency of models was seen across Africa (28%), although other countries were utilising these (such as America and Australia). 68% of papers focussed on public health.

Conclusion

The focus on public health could be potentially attributable to Governmental requirements in some countries to include a Theory of Change or Logic Model in community-based health intervention applications. Further research is recommended to understand the public health focus, as well as how varying the timepoint of model employment may affect the healthcare policy outcome.

Access to healthcare in Covid-19: evidence from a specialist acute service

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Rona Inniss

presenter biography

Rona Inniss is a Clinical Nurse Specialist at Guy’s Hospital, London, and a HEE/NIHR ICA Pre-doctoral Clinical and Practitioner Academic Fellow. Rona is interested in researching healing and healthy environments. She changed career after studying and working in architecture, gaining her nurse registration at King’s College University. She started at King’s College Hospital NHS Trust as a staff nurse, and then a Parkinson’s Research and Clinical Nurse Specialist, before joining the neurofibromatosis team at Guys in 2016. Rona wants to improve the experiences of healthcare environments by evaluating patient, staff, and visitor experiences.

background

The Neurofibromatosis Service provides lifelong care to patients with nerve tumour predisposition syndromes [1,2]. Attendance is typically face-to-face outpatient appointments with consultant neurologists, clinical nurse specialists, physiotherapists, psychologists, and a social worker.

Covid-19 forced a severe reduction in face-to-face appointments, with remote offered instead [3,4]. The NHS long-term sustainability plan [5] aims to avert up to 1/3 of face-to-face consultations by 2029. Evidence from patients who had remote appointments during the pandemic can help us shape the roll-out of this long-term plan.

MEthod

Paper questionnaires were sent to all patients with an appointment within the same 2-week period during August 2020, 2021, 2022.

Response rates were similar: 26% (32/122, 2020), 22% (23/106, 2021), and 25% (26/104, 2022).

results

In 2020 most patients had an appointment by telephone / video. In 2021 and 2022, less than 25% did.

In 2020 just over half of people wanted their next appointment to be remote. By 2021 / 2022 just under half wanted their next appointment to be remote.

Patients report positive and negative experiences of remote appointments but over all three years the most popular choice was still a face-to-face appointment.

Positive experiences included reduced language barriers and improved accessibility (less time off work / childcare). Negative experiences included lack of access to / confidence with technology, and perceived negative impact on relationship with professional.

Conclusion

To meet the UN Sustainable Development Goal of good health and wellbeing [6], and the NHS long-term plan [5] to use technology to reduce face-to-face appointments, our research demonstrates that the UK needs to improve access to and confidence in technology, whilst acknowledging the importance the patient places on the in-person relationship with their health professional.

Costing digital health implementation efforts in hospitals: a qualitative framework analysis of semi-structured interviews

P78

PRESENter

Thomasina Donovan

presenter biography

Thomasina Donovan is a PhD candidate from Brisbane, Australia. She is studying within the Australian Centre for Health Services Innovation (AusHSI) in the School of Public Health and Social Work, Faculty of Health at the Queensland University of Technology (QUT). Her PhD aims to combine knowledge from health economics and implementation science to develop an implementation costing instrument. She is conducting this research within the digital health field and has investigated the implementation of computerised decision support systems (CDSS). Prior to her PhD, Thomasina worked in cellular and molecular biology, particularly epigenetics, in the fields of oncology and exercise science.

background

Economic evaluations determine the relative value for money of health innovations and are important for decision makers when allocating scarce resources. However, implementation strategies require additional resourcing which is typically not accounted for in published economic evaluations. This study sought to understand current practices for capturing the costs associated with implementing digital health initiatives in hospital settings, where the complexities of technology and systems present unique challenges for implementation efforts.

MEthod

A qualitative study of semi-structured interviews with 16 purposively sampled experts in implementation science, health economics and/or digital health was conducted. The interview guide was informed by a literature review and was pilot tested. Interviews were digitally recorded and transcribed. A hybrid inductive/deductive framework analysis was conducted using thematic analysis to elicit key concepts related to the research question.

results

Interviews were conducted with eight implementation scientists, six health economists, and eleven digital health specialists. Four participants were experienced in more than one field. Five key themes were elicited from the data: types of costs, why implementation is costed, how to cost implementation, implementation phases, and barriers and enablers to costing implementation. Broadly, interviewees recognised implementation costs as important but only some costs were considered in practice due to inconsistencies in terminology and the perceived ill-defined boundaries of implementation. Implementation costs were typically recorded to support the delivery of high value care. A variety of methods were used to collect and analyse implementation costs in practice. Multidisciplinary collaboration facilitated this process, but the burden of collecting the necessary data was highlighted.

Conclusion

Understanding current practices for capturing implementation costs of digital health initiatives provides opportunities to improve practice and progress research in this space. Ongoing research should establish appropriate methodology for costing implementation efforts within digital health, and healthcare settings more broadly.

Culturally-Appropriate End-of-life Care: Do and Don’t Review Findings to Inform Healthcare and Other Service Providers

P80

PRESENter

Donna Wilson

presenter biography

Donna Wilson is a Registered Nurse, Professor Emerita at the University of Alberta and adjunct professor at the University of Limerick. She gained a 3-year nursing diploma, BSN degree (University of Alberta), MSN degree majoring in gerontology and healthcare management (University of Texas at Austin), and a Doctor of Philosophy degree in Educational Administration majoring in management, teaching, and research (University of Alberta). Donna’s program of research focuses on health services and health policy, primarily in relation to aging and end-of-life care, including bereavement. Her work is oriented to myth busting, to eliminate ageism and ensure effective and accessible healthcare services for all people. Her investigations often involve population data and mixed-methods research. She has over 400 published articles, books, book chapters, and other peer-reviewed communications in print. She is frequently and widely consulted for expert commentary on aging, end-of-life care, bereavement, health policy, healthcare services, and health system trends.

background

End-of-life (EOL) care practices vary considerably between cultures, based on social and religious norms or taboos. As more highly diverse people immigrate to Canada and to other countries, it becomes increasingly important for family physicians, nurses, and many other providers to plan for and provide culturally-appropriate EOL care. What happens before, during, and after dead is extremely important to family members, terminally-ill people, and every society.

MEthod

A scoping review of grey and published material identified preferred practices and also practices to avoid as death nears, at the time of death, and following death for 10 different cultural groups who are relatively new immigrants to Canada: The Philippines, India, China/Hong Kong, Pakistan, Vietnam, Mexico, Korea, Nigeria, Ethiopia, and Lebanon.

results

Significant differences were noted across these groups, often related to religious or spiritual beliefs and social customs. For example, people from Muslim cultures recite verses from the Holy Koran or have it read to them when dying; however, people who are not Muslim should not read this holy text to the dying person. Openly talking about death and dying is another subject that varied between cultural groups, with this related to social norms. It is taboo to talk about death for 8/10 groups; yet open conversations about death and dying is an accepted and encouraged practice in Mexico and Pakistan. Some similarities were noted across all 10 groups, including the importance of involving family members in EOL decision-making and enabling them to care for their dying loved one.

Conclusion

Although there were some similarities, many differences were noted. Case-by-case individualized care may be essential for appropriate EOL care, as EOL practices not only differ by culture, but they also can change over time and they can also vary between families.

NICO: Narrative Intervention for Long COVID-19 Feasibility and Acceptability Pilot Study

P84

PRESENter

Rachel Johnson

presenter biography

Rachel Johnson-Koenke, PhD, MSW, LCSW
Pronounced: Johnson-Kinky
Dr. Rachel Johnson-Koenke is a licensed clinical social worker and health science researcher in Denver, Colorado, USA. She is an assistant professor at the College of Nursing, University of Colorado where her research interest is the use of narratives and Unitary Caring Science to improve health equity for people living with chronic illness. Dr. Johnson-Koenke conducts research at the Eastern Colorado Healthcare System, VA Medical Center and the University of Colorado. She also mentors, supervises and supports clinician researchers and nursing students to conduct research from their unique and insightful disciplinary lens.

background

People living with Long COVID frequently experience high symptom burden and trouble with activities of daily living (ADLs). COVID impacted not only those people living with Long COVID but also put further stress on the mental health system in the US. The NICO research study aimed to establish the acceptability and feasibility of implementing an asynchronous narrative intervention for people living with Long COVID.

MEthod

People with self-reported Long COVID were recruited through social media. Measures were administered at both baseline and 3 months. Program satisfaction semi-structured interviews were conducted with intervention participants. Results were analyzed using conventional content analysis. Descriptive statistics were also used to describe the population and measures.

results

Seventeen study participants consented and enrolled, while eleven completed the intervention (65%). Multiple participants reported that they enjoyed the asynchronous program because it allowed them to engage with it when they had time (Table 1). Results suggest NICO is feasible and acceptable.

Conclusion

The NICO research study provides evidence to support the feasibility and acceptability of this asynchronous narrative intervention for people living with chronic illnesses like Long COVID. Many chronic illnesses impact a person’s ability to engage with traditional in-person talk therapy. Combined with limited mental health availability, flexible mental health intervention implementation will be an essential part of helping the increasing number of people living with chronic illnesses. Additional research is needed to refine and implement the NICO intervention to help the many people living with Long COVID and other life-limiting chronic illnesses.

Evaluating the implementation of a national programme for transforming mental health in schools across south west London: The Children and Young People (CYP) Emotional Wellbeing in Schools Programme

P87

PRESENter

Helen Sheldon

presenter biography

Since working on a study of negotiated implementation in the 1980’s, Helen has evaluated initiatives in settings across health and social care, using a broad range of techniques. She joined the Health Innovation Network in 2018, working on a large mixed methods process and impact evaluation of the national roll out of ESCAPE-pain in the community and leisure sectors. Since then, she has led large scale, complex evaluations, including regional scale-up of remote monitoring in Rheumatoid Arthritis, national evaluation of micro-volunteering in health and care, and a regional programme to increase emotional wellbeing in children and young people. She has also supported companies on the Digital Health.London Accelerator and Launchpad Programmes develop their evidence base and been part of a multi-agency collaboration to extend the work of the DH.L Evidence Generator to create a national digital evidence hub. Helen is particularly passionate about involving patients/service users and the public to co-produce and deliver evaluations.

background

In 2017, the UK Government provided a vision and funding for the transformation of mental health (MH) for children and young people (CYP)[1]. South West London (SWL) secured funding to develop and implement a programme of transformation. The creation of school clusters with a Mental Health Support Team (MHST), is a key feature of the programme. The MHSTs deliver targeted evidence-based interventions in schools/colleges to CYP, their parents, and staff. The programme aims to support schools/colleges to develop a Whole School Approach (WSA)[2] to improving emotional wellbeing. The aim was to understand the implementation and impacts of the programme. Here we report the case study element only.

MEthod

A case study approach was used with four school clusters (n=51 schools/colleges) comprising interviews/focus groups (n=196), surveys (n=226), school cluster meetings (n=8). Perspectives were captured from school/college staff, MH service providers, CYP and parents/carers. Staff from schools not involved in the programme were interviewed (n=8) to provide a counterfactual. The eight WSA principles were used as an analytical framework.

results

There is evidence of positive change associated with the development and implementation of interventions across the eight WSA domains. There has been increased activity around emotional wellbeing for CYP in schools/colleges, especially interventions delivered by the MHSTs, access to self-help resources, and direct support via an online platform. Factors influencing successful implementation functioned at two levels: (1) Schools clusters – additional resources, leadership and workforce development, relational connections; and (2) System – effective governance, leadership, partnerships, national funding. Tensions between the different programme levels linked to priorities and autonomy and differences between education and health sectors (e.g. culture, priorities) impeded implementation.

Conclusion

Implementation of a complex system-wide programme has improved emotional wellbeing provision for the whole school community across SWL. Factors operating at multiple levels – school, school clusters and the system – interacted to influence implementation.

Evaluating the early implementation of digitally enabled virtual wards: A case study approach

P88

PRESENter

Dr Camille Aznar

presenter biography

Camille has ten years’ experience of working in health policy research. Her current role at the Health Innovation Network (the Academic Health Science Network for South London), and former roles at Ipsos MORI and NatCen have involved managing and delivering health policy evaluation and research projects. Since working at the HIN, she has managed and carried out a number of real world evaluations of complex interventions within complex systems. Examples of work she has delivered include evaluations of virtual wards, remote monitoring services, and innovative health programmes in London. Camille has also an interest in developing methodological strategies that facilitate research participation for vulnerable and disadvantaged groups. For instance, her doctoral research involved in-depth research with Congolese and Cameroonian francophone participants.

background

Virtual wards (VWs) support patients to receive the acute care, monitoring and treatment in their own home, which would otherwise be provided in hospital. The rapid implementation of VWs was a direct response to the pandemic; however, there is an ambition in England for the expansion of the model i.e. 40–50 ‘virtual ward beds’ per 100,000 population by December 2023(1). There still is limited evidence about all aspects of VWs(1,2). This evaluation explores the early implementation of VWs in 2021-22.

References
1. Enablers for success: virtual wards including hospital at home [Internet]. NHS England; 2022. Available from: https://www.england.nhs.uk/wp-content/uploads/2022/04/B1382_supporting-information-for-integrated-care-system-leads_enablers-for-success_virtual-wards-including-hos.pdf
2. Best J. The virtual wards aiming to ease hospital pressures. BMJ. 2022 Jul 6;378:o1603.

MEthod

A mixed-methods case study approach was used of three NHS VWs across South-West London (SWL) using in-depth interviews with clinical staff in/working directly with VWs (n=14), patients admitted and treated on VW (n=14), documentation, and routinely collected demographic, activity and outcome data.

results

VWs were used for a range of conditions beyond COVID-19 (e.g. exacerbation of a long-term condition). Patients tended to >65 years old, white and female. Although discharge outcomes varied between the VW models, patients across the three services were able to be cared for at home. Patients felt they were being kept out of hospital whilst receiving the same standard of care as they would in a hospital environment. Clinical VW staff highlighted positive experiences of working on the ward.
Factors influencing the successful implementation of VW models were:
• Offering continuous monitoring to all patients
• Referring a small but targeted cohort of patients
• Developing established clinical and referral pathways
• In-reach virtual ward staff based in acute settings
• Strengthening relationships with acute trust and VW staff
• Building multi-disciplinary teams
• Clear clinical governance arrangements in place

Conclusion

Early evidence in SWL shows VWs have been successfully implemented and expanded to care pathways beyond patients with COVID-19 with patients being treated safely and comfortably at home. Common factors enabling implementation were identified across three different VWs models.

2YoungLives: Meaningful community engagement and involment, ‘changing mindsets with a million conversations’ in Sierra Leone

P90

PRESENter

Mangenda Kamara

presenter biography

Mangenda is a Gender specialist and an educator; her research area for her M.Phil in Gender Studies was on the school going experiences of pregnant and mothering teenagers. She co-founded 2YoungLives, a community-based mentoring scheme for pregnant adolescents, in 2017 and became the Research Assistant for this project as part of CRIBS, a NIHR-funded global health group in 2021. She is currently studying for her PhD at the University of Sierra Leone where she will be focussing on using photovoice methodology to better understand the lived experiences of this group of young women in Sierra Leone.

background

2YoungLives is a community-based mentoring scheme for pregnant adolescents in Sierra Leone developed by community-based organisation Lifeline Nehemiah Projects (LNP) [1] after exploring contributing factors to high adolescent maternal mortality [2]. Women are trained to mentor pregnant girls to; start a small business, reconcile with families, take up maternity care and postpartum contraception, breastfeed exclusively, and re-engage in education. A pilot cluster-randomised trial is underway to assess feasibility and implementation strategies in new communities and to inform future scale-up [3].

MEthod

We discuss the strategy for meaningful and comprehensive community engagement and involvement (CEI), a core component of the 2YoungLives programme, essential for scale-up and sustainability. The strategy included three CEI visits to each intervention site: 1) introductions and paying respects to town chiefs; 2) meeting key stakeholders and conducting open community-wide meetings to share local beliefs and voice concerns; 3) identify mentors in collaboration with community stakeholders. Listening, discussing and connecting is imperative to building trusting relationships, mitigating issues which inevitably arise during implementation.

results

Important barriers were raised and discussed (i.e. cultural/ religious, historical, political), and time given for co-development of bespoke solutions. For example, in one community, mentees were reluctant to attend the government health facility for fear of a practice of reporting pregnant under-18s to the police. The LNP team engaged facility staff and community stakeholders, and invited the midwife to attend the monthly 2YoungLives meeting, building a trusting relationship and giving girls confidence to attend. There are many examples of discussions about gender-based issues such as child-marriage or FGM leading to wider socio-cultural changes to attitudes and practices beyond the 2YoungLives intervention.

Conclusion

The CEI showcased in this case-study is not a tick-box exercise but a vital component of successful implementation and sustainability with many lessons learned for others implementing complex interventions in similar contexts.

Barriers and Facilitators to Scale-Up of Hospital-at-Home: an Observational Cohort Study Protocol

P91

PRESENter

Stephanie Ko

presenter biography

Dr Stephanie Ko, MBBS MMed MPH, is currently a Consultant of Advanced Internal Medicine at the National University Hospital. She is the Lead Clinician of NUHS@Home a technology-enabled hospital-at-home programme at the National University Healthcare System. Her research interests include the evaluation of clinical effectiveness and implementation new care delivery models, including hospital-at-home models and telehealth enabled programmes.

background

Hospital-at-home interventions have been shown to be clinically and cost-effective, and many healthcare systems internationally are investing in scaling-up such interventions. However, most existing studies are focusing on how effective the intervention is, rather than how to successfully scale it up. We report a study protocol for a theory-driven investigation of a hospital-at-home intervention. We propose a novel combination of two established implementation science frameworks – the EPIS framework and the Scale-Up framework – and apply it to a planned scale-up of a hospital-at-home intervention in Singapore.

MEthod

EPIS offers a useful macro-framework by identifying contextual influences across the phases of Exploration, Preparation, Implementation, and Sustainment. The macro approach of EPIS needs to be further supported by an action-orientated framework of the scale-up process. The Scale-Up framework breaks down scaling-up into 4 phases: set-up, develop the scalable unit, test of scale-up, and go to full-scale. We will conduct an observational cohort study across 24 months (May 2022 to April 2024) to evaluate the association of outer and inner contextual factors on key implementation outcomes – the volume of patients admitted, operational efficiency and levels of adoption. Statistical process control graphs will be used to examine variation in the implementation outcomes over time. Linear regression will be applied to assess associations of outcomes with contextual factors that are continuous variables; logistic regression will be applied to assess the associations of outcomes with binary/descriptive contextual factors. To supplement these, qualitative methods will be applied using a content analysis of monthly meeting minutes and focus groups of the implementation team to understand and explain the outcomes of the observational cohort study.

results

NA (study protocol)

Conclusion

This study protocol applies implementation frameworks to systematically evaluate the scale-up process and identifying barriers and facilitators towards going to full scale.

Regulation of infant formula: the role of health policy in dissemination and implementation strategy

P92

PRESENter

Bartosz Helfer

presenter biography

Bart holds the role of Director at the Meta-Research Centre within the University of Wroclaw in Poland. His academic journey is rooted in evidence-based medicine, which he pursued at the Technical University in Munich, Germany, and King’s College London, UK. Further honing his expertise, he engaged in post-doctoral work at Imperial College London, UK.

Bart specializes in evidence synthesis and meta-research. His work primarily revolves around critically examining research methods and practices, aiming to discern how biases in science can be mitigated to ensure that the conclusions drawn from research studies are both reliable and valid.

One of Bart’s core areas of interest is the examination of clinical trials. He is inquisitive about the degree of trust that can be placed in their findings. Moreover, he is actively engaged in identifying aspects of the research process that could be enhanced to boost the overall value of the outcomes, and in doing so, effectively curtail the unnecessary expenditure of time and resources.

background

There is an ongoing debate regarding safety, quality, and marketing of infant formula products with many authors calling for a new improved regulatory framework. Health policy plays a key role in the development, dissemination, and implementation of evidence-based practices to address these concerns. This analysis aimed to examine the health policy role in the dissemination and implementation strategy regarding improved regulation of infant formula, using Crable et al.’s [1] recommendations as a guide.

MEthod

A health policy analysis was conducted to identify the key dimensions of the policy’s function and form, examine the nonlinear phases of policy dissemination and implementation, describe the temporal roles of stakeholders, consider policy-relevant outer and inner context adaptations, and identify bridging factors necessary for policy success. The analysis included a review of relevant literature, stakeholder views, and an assessment of existing regulatory frameworks.

results

There is a clear need to strengthen the evidence base for infant formula regulation, enhance transparency in policy development, develop new evidence-based guidelines, establish robust monitoring and enforcement systems, promote public awareness, and facilitate international collaboration. Stakeholders, including healthcare professionals, researchers, manufacturers, consumer advocates, and caregivers should work together to help develop a successful dissemination and implementation strategy for health policy.

Conclusion

A comprehensive and evidence-based health policy approach is necessary to fully address the current controversy regarding regulation of infant formula. By applying Crable et al.’s [1] recommendations, health policies can be more effectively disseminated and implemented to ensure better safety, quality, and appropriate marketing of infant formula products. This approach will ultimately contribute to better infant nutrition and public health outcomes.
References
1. Crable EL, Lengnick-Hall R, Stadnick NA, Moullin JC, Aarons GA. Where is “policy” in dissemination and implementation science? Recommendations to advance theories, models, and frameworks: EPIS as a case example. Implementation Science. 2022 Dec 12;17(1):80.

Evaluating the prioritization and implementation process within the Mental Health Implementation Network

P96

PRESENter

Blossom Fernandes

presenter biography

I’m a Research Fellow on the Mental Health Implementation Network project which supports the delivery of evidence based mental health interventions in England. More specifically, I’ll be working with the team to evaluate the impact of carefully selected interventions with the aim of scaling up. Previously, I was a project manager and postdoctoral researcher at the department of Psychiatry at Oxford University, where I worked on the MindKind Study, and the OxWell School Mental Health Survey looking at factors which directly affect young people’s mental health in their everyday lives. My research so far has largely focused on youth mental health both globally and more locally within the UK, working on interventions aimed at children and young people’s mental health.

background

A cross-disciplinary consortium called the Mental Health Implementation Network (MHIN) with key stakeholders was established in England in 2020 implementing mental health interventions in 6 regions of England. Led by local Applied Research Collaborations and their partners. The aim of the present study is twofold: to develop an overarching evaluation strategy for programme level and site level evaluations of MHIN, and b) programme wide evaluations which focuses on the relational work between prioritisation and implementation, including the development of sustainability constructs linked with the implementation support packages at each sites.

MEthod

The study is underpinned by an embedded mixed method approach [1]. Data collection methods include observations, expert consultations, document analysis, structured questionnaire and semi structured interviews with key stakeholders encompassing the public and local communities, multi-sector health and care providers, commissioners, government, NGO, clinical, managerial, commissioning, academic and other partners. Overall the Exploration, Preparation, Implementation, Sustainment (EPIS) framework [2] is used to understand and support the implementation process at the six delivery sites. Evaluation strategy was developed using expert consultations and document analysis.

results

Data is currently analysed using different qualitative approaches including narrative synthesis and framework analysis. We will share emerging themes from an ongoing analyses; these are centred around the relations between stakeholders, the resources needed for setting up a priority network and regional vs national implication of setting up a network. Further findings include the negotiations recorded at site activities, and local evaluation of the tailored implementation support for the sites.

Conclusion

The findings from MHIN stakeholders in this process to support a wide variety of projects and ARC sites will provide insightful information relating to the factors promoting or inhibiting implementation from different stakeholder perspectives. This could be extended beyond the specific project and be useful for implementation researchers and implementation practitioners.

Co-development workshops as an implementation strategy?

P98

PRESENter

Leah Bührmann

presenter biography

Leah’s research centres around the development of implementation tools to improve implementation processes within integrated care systems, with a focus on implementation context assessment, stakeholder engagement, and co-development processes. With a background in Psychology, Leah is especially interested in improving the implementation of preventative interventions for mental health.
Previously, Leah was part of a European study that aimed to improve the implementation of internet-delivered Cognitive Behavioural Therapy across Europe and Australia through a tailored approach to implementation. Leah has a special interest in quantitative implementation outcome measures and their psychometric validation and is currently part of different international working groups to validate a normalisation measurement. Since 2019, Leah has the position of the Scientific Secretary of the European Implementation Collaborative (EIC) which involves academic projects, such as a stream of work on implementation support practices.

background

Implementing interventions across complex systems, at different levels and between different professional groups and organisations is challenging. Co-design methods have the potential to support implementation of boundary-crossing interventions but are often used implicit. We aimed to make these processes explicit and reflected with stakeholders on the benefits of co-design methods for their own implementation practices.

MEthod

In this study, an implementation toolkit that supports the integration of health and social care in the Integrated Care System of North East England was co-developed. Regional stakeholders (n=13), including health care professionals, service users, and decision makers, were invited to participate in a series of seven co-development workshops. Workshops were conducted according to a systematic intervention development process. After each workshop, participants rated the workshops on five questions ranging from overall satisfaction to how the workshop might have influenced individual practices. The workshops were held online, recorded, and transcribed.

results

The workshops resulted in a series of co-developed materials, including a comprehensive context assessment, a list of local determinants to implementation, a detailed power-interest mapping of key stakeholders for local implementation, planned implementation activities, and best practice examples for implementation. Feedback from participants indicated how useful such workshops are for their own practices. The workshops stimulated the exchange of perspectives among stakeholders from different backgrounds, facilitated the sharing of best practices, and established new collaborations that directly impact workshop participants’ daily practice. This being an implicit product of the workshops, it raised the question of how we can best utilise co-development workshops as part of an implementation process.

Conclusion

Co-development workshops have the potential to be an explicit implementation strategy. If considered during study planning, such workshops have the potential to build capacity for participant’s individual practices as well as to contribute to an infrastructure that will ultimately support implementation of the co-developed materials in practice.

6th UK and Ireland Implementation Science Research Conference 2023

Interventions to promote effective interprofessional collaboration that improves care outcomes for older people: a realist synthesis of evidence.

P1

Carmel Davies

The Impact of After Action Review on Safety Culture and Second Victim Experience: a mixed methods effectiveness implementation study

P2

Siobhán McCarthy

Rapid-RT Study: The feasibility of implementing rapid-learning methodology to inform radiotherapy treatment: Healthcare professionals’ views

P5

Arbaz Kapadi

Transdisciplinary implementation science for complex futures

P7

Dr Hossai Gul

Systems science approach to conducting and integrating implementation assessments across multiple settings within complex healthcare systems

P8

Dr Hossai Gul

The post-implementation scenario: investigating the sustainability of matrix support through professional practices

P9

Ana Laura Salomé Lourencetti

Qualitative exploration of the views and experiences of Making Every Contact Count (MECC) within service providers and users within the Third and Social Economy (TSE) sector: a reflexive thematic analysis of semi-structured interviews

P10

Beth Nichol (virtually), Angela Rodrigues (for in-person questions)

‘Implementing Change Relationships in Multi-site Youth Justice Settings- A Methodological Design’

P11

Jacqueline Dwane

Insights on barriers, facilitators, and lessons learned in the implementation of complex suicide prevention interventions: A systematic review

P12

Sadhvi Krishnamoorthy

Understanding implementation and impact of post-Covid remote monitoring pathways in Integrated Care Systems.

P13

Judith Fynn

The connected Yorkshire community health checks programme for Cardiovascular Disease prevention

P14

Dr. Ciaran O’Neill

Tailoring implementation strategies which target patients in healthcare contexts: protocol for a scoping review sub-study

P15

Laura-Jane McCarthy

A cross-sectional exploration of the generative mechanisms and potential staff outcomes associated with interprofessional collaboration within the newly established community specialist teams integrating care for older people in Ireland

P17

Apolonia Radomska

Addressing physical healthcare in mental health settings: implementation and evaluation of two novel interventions

P18

Ray McGrath

Scale-up of a novel vital signs alert device to improve maternity care in Sierra Leone: a mixed methods evaluation of device repair and maintenance

P22

Dr Alice Pearson & Dr Charlotte Greene

Challenges for oral health promotion in the School Health Program in Brazil: a literature review informed by the CFIR framework

P24

Carlos Alberto dos Santos Treichel

Palliative care implementation in the intensive care unit: Using the Implementation Research Logic Model as a framework for systematic review and synthesis

P26

Stephanie Meddick-Dyson

De-implementation of low value care in mental health services

P27

Qandeel Shah

Development of a Video-based Evidence Synthesis Knowledge Translation Resource: Drawing on a User-Centred Design Approach

P30

Elaine Toomey

Views and Experiences of Mental Health Services Implementation Stakeholders in Ukraine after the Onset of the Invasion of Russia into Ukraine

P32

Alyona Mazhnaya

Navigating uncertainty in the implementation of a Compassionate Care Initiative in a NHS mental health setting during Covid-19: Findings from a case study with implications for sustainability

P34

Cindy Brooks

Content validity indexes assigned to the Brazilian version of the ImpRes-tool: a tool to improve the quality of implementation projects and research

P35

Carlos Alberto dos Santos Treichel

Stakeholder’s experiences of tailoring implementation of the DAFNE structured education programme for type 1 diabetes

P43

Jane Murphy

Supporting vulnerable families online – Exploring the experiences of service users and practitioners and the development of a best practice framework to support the implementation of digital social care services

P44

Gráinne Hickey

Applying an implementation science lens to Ireland’s National Care Experience Programme

P45

Lisa Ann Kennedy

Using Geographic Information System (GIS) to Understand Service User’s Patterns of Accessing Primary Healthcare Facilities in Goa, India

P46

Luanna Fernandes

Implementing a new ‘Test, Evidence, Transition’ Programme to accelerate the effective and equitable adoption of cancer pathway innovations

Terri Menser
Jennifer Ridgeway