6th UK Implementation Science Research Conference
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Authors: Nadine Seward, Charlotte Hanlon, Richard Harding, Rosie Mayston, Jamie Murdoch, Martin Prince, Graham Thornicroft, Gao Wei, Nick Sevdalis
Presented by: Nadine Seward
Biography: Nadine Seward is a Lecturer in Global Implementation, based within the Centre for Implementation Science. Nadine holds a BSC (Hons Life Science) from Queen’s University in Canada, an MSC (Epidemiology) from LSHTM and a PhD (Epidemiology) from UCL.
Prior to starting at KCL in August 2018, Nadine worked at LSHTM on community trials aimed at improving maternal and newborn health outcomes as well as trials trying to better educational outcomes. Her interests were focused on using causal mediation analyses and other techniques to evaluate the “how and why” behind the effectiveness of different complex interventions. Before LSHTM, Nadine worked at UCL, Institute of Global Health on community trials that involved women’s groups using participatory learning and action, to improve maternal and newborn health outcomes.
Nadine is currently working with the NIHR Global Health Research Unit on Health System Strengthening in Sub-Saharan Africa (ASSET) to improve the quality of integrated primary health care, surgical and maternal and newborn care. As a Lecturer in Global Implementation Science, Nadine is interested in brining interventions that are known to be effective, to scale through the application of appropriate models, frameworks and theories. Nadine will be working with the different ASSET partners and across the different care platforms to use implementation science methodology to evaluate practical ways to improve the quality and coverage of care.
Nadine is also interested in developing implementation science methodologies as well as applying and adapting causal inference techniques to evaluate the effectiveness of different implementation programmes in low- and- middle- income countries.
This session takes place on Friday 17th July at 09:10
Background: Achieving Universal Health Coverage that includes the availability and delivery of high-quality evidence-based care has been identified as a priority for health system strengthening (HSS) in Low- and Middle-Income Countries (LMICs).(1) ASSET is an implementation research programme for HSS working on three care platforms across four sub-Saharan African countries; Ethiopia, Sierra Leone, South Africa, and Zimbabwe. The overall aim of the implementation science theme within ASSET is to advance our understanding of how to design and evaluate HSS interventions across different health systems and contexts to: (1) understand what implementation strategies work, for whom and how, and (2) improve implementation science methodologies applied to such HSS interventions.
Methods: Using a mixed-method approach we will use implementation determinant and evaluation frameworks as part of ‘effectiveness-implementation hybrid trial’ designs to evaluate ASSET programme interventions. The pre-implementation phase will collect information on contextual barriers and/or enablers that influence selection of different HSS interventions. The implementation and evaluation phase will evaluate: (1) effectiveness of implementation strategies (based on standardised implementation outcomes assessment), (2) influence of context on the effectiveness of implementation strategies in delivering the interventions, and (3) influence of context on the mechanisms introduced by the interventions to produce improvement. To facilitate comparisons between countries/platforms, we will adapt the ‘matrixed multiple case study’ approach.(2) This methodology organises, analyses and presents common and heterogeneous findings across implementation sites, in order to seek generalizable knowledge regarding what and how local factors influence implementation.
Conclusions: This research programme will create a compilation of implementation strategies used in LMIC contexts and compare the associated barriers and the effectiveness on implementation outcomes. Given this is one of the first large scale programmes to design and evaluate HSS interventions across multiple study sites, we hope to use this opportunity to address key methodological challenges associated with such programmes.
Authors: M. Hurley, M. Connelly, H. Sheldon, A. Gibney, R. Hallett, A. Carter.
Presented by: Mike Hurley
Biography: Mike Hurley qualified as a physiotherapist at King’s College Hospital in 1985. After completing his PhD at University College London he was Lecturer, Reader and Professor at Kings College London between 1990-2010. In 2010 he became Research Lead in the School of Rehabilitation Sciences at St George’s University of London, and in 2013 was appointed Clinical Director for the Musculoskeletal Programme of the Health Innovation Network. Professor Hurley has been a Clinical Advisor to Arthritis Research UK (2002-2008), Chair of Chartered Society of Physiotherapy’s Research and Clinical Effectiveness (2001-2004), has contributed to several national working groups, clinical guideline committee and conferences. He has authored more than 80 papers. A major part of his work was the development of ESCAPE-pain – a rehabilitation programme to help people with knee, hip and back pain that is now being delivered in nearly 300 clinical and community venues across the UK.
This session takes place on Friday 17th July at 09:10
Background: ESCAPE-pain is a rehabilitation programme for knee and/or hip osteoarthritis (1,2). It is usually delivered in physiotherapy departments, but NHS constraints limits access to the programme. Delivering ESCAPE-pain in community venues could increase accessibility and provide on-going support (3). This study extended delivery of ESCAPE-pain into community venues and evaluated its effectiveness and participant’s experiences.
Method: We trained 369 exercise professionals to deliver ESCAPE-pain in 41 community centres. Pain, function and quality of life (using Knee or Hip Osteoarthritis Outcome Score, K/HOOS) and self-reported activity levels (minutes/week) were measured before and after the programme. Semi-structured interviews estimated people’s experiences of the programme.
Results: 386 participants were recruited, mean age 70 years. Before the programme only 24% of participants were “active”, i.e. doing >30 mins activity/week, after participating almost 78% were “active” doing >30 mins/week. Participants reported improvements in pain (10 K/HOOS points; p<0.0001), function (9pts; p<0.0001), QoL (10pts; p<0.0001). These improvements enabled people to walk better, farther, without aids and reduced their social isolation. Better understanding of their problems, ability to self-manage their problems and exercise self-efficacy (the confidence to use exercise to control pain and its impact), made people much more optimistic and they described “the world was a brighter place”. Concomitant with these improvements overall healthcare utilisation reduced. Because they enjoyed the programme most participants were planning to continue exercising to try to maintain these benefits, had joined classes and taken up activities (swimming, golf, walking, yoga).
Conclusion: ESCAPE-pain can be safely delivered by exercise professionals as a community-based rehabilitation programme, it retains its effectiveness and nurtures habitual exercise in participants. As a community-based programme will enable many more people to access the programme and benefit. As a result of this study ESCAPE-pain is now being in many more community venues across the UK (3).
Biography: My name is Chelsea and I am a PhD student at the Department of Women’s and Children’s Health at Uppsala University in Sweden. My project is broadly focused on exploring the implementation of e-mental health interventions for informal cancer caregivers. My research is part of the Marie Sklodowska-Curie Innovation Training Network ENTWINE, which is focused on informal care and supporting caregivers using technology. Prior to starting my PhD, I completed a Master of Science in Public Health at McGill University in Montreal, Canada. I am interested in learning more about the implementation and evaluation of programs aimed at supporting caregivers.
Presented by: Chelsea Coumoundouros
This session takes place on Friday 17th July at 13:30
Method: Multiple electronic databases were searched for studies published since 2007 reporting on the implementation and/or effectiveness of e-mental health interventions for informal caregivers of adults with chronic diseases. A thematic synthesis of data related to implementation will be used to identify implementation barriers and facilitators. A qualitative comparative analysis, using data from pragmatic randomized controlled trials, will be used to determine combinations of conditions related to an intervention’s implementation or program features, sufficient for intervention effectiveness.
Results: Electronic database searches yielded 9248 unique records to undergo title/abstract screening. The literature screening process is currently underway to identify full-texts eligible for inclusion in the analysis. Preliminary findings will be presented. Implementation barriers and facilitators identified in the thematic synthesis will be presented. These barriers and facilitators will be linked to initial results from the qualitative comparative analysis, as barriers and facilitators may relate to conditions important for intervention effectiveness. Practical applications of these findings will be discussed. If a qualitative comparative analysis cannot be completed prior to the conference, pragmatic trials reporting on intervention effectiveness will be descriptively summarized and analysis plans discussed.
Conclusions: This review will identify key factors to consider during implementation of e-mental health interventions for informal caregivers and present potential solutions to overcome implementation barriers. These findings can be used to inform intervention design and implementation strategies to facilitate the implementation of e-mental health services for informal caregivers.
Authors: Slemming W, Drysdale R, Makusha T & Richter L.
Presented by: Wiedaad Slemming (MPH, PhD)
Biography: Wiedaad Slemming (MPH, PhD) is employed in the Division of Community Paediatrics at the University of the Witwatersrand, and is involved in undergraduate and postgraduate teaching and curriculum development in the health sciences. She is an active researcher and her range of professional, research and academic interests and expertise include early child development, childhood disability, child health and health systems strengthening, as well as health science education. She serves on various national and international technical working groups and steering committees for child health and development and has been involved in the development and review of a number of national policies and programmes.
This session takes place on Friday 17th July at 13:30
Background: The 2015 South African Department of Health and the 2016 World Health Organization’s antenatal care guidelines include the recommendation of a routine pregnancy ultrasound before 24 weeks. The HPHB study in Soweto, South Africa, uses scientific evidence on the value of early ultrasounds as a basis for designing an intervention that capitalises on the socioemotional responses of prospective parents to images of their foetus’s development, the sound of their heartbeat and images that they can share with family and friends. The intervention is embedded in routine health services at Chris Hani Baragwanath Hospital (CHBH) in Soweto, South Africa, and is being tested through a randomised controlled trial with evaluation of benefits for parents and children at 6 weeks and 6 months follow-up. This ongoing study employed multilevel stakeholder engagement strategies during early conceptualisation and development, as well as throughout implementation of the trial.
Method: Stakeholder engagement included workshops/meetings and presentations with health policy and management representatives at national and provincial levels; management, clinicians and clerical staff at the referring hospital; district and ward health service staff, non-governmental organizations , academics and researchers.
Results: Formative research conducted with pregnant women attending antenatal clinic at CHBH was key to the intervention development and design. Close collaborations were established with the clinical services at CHBH to ensure efficient and effective recruitment practices and clinical oversight of the trial procedures. Ongoing consultation with a key stakeholder network comprising policy makers, programme implementers, academics, researchers and representatives of multilateral and public benefit organisations, inform intervention procedures and strategies to address challenges that arise during trial implementation. Implementation is monitored and informed through ongoing reflection from staff and formal and informal feedback received from participants.
Conclusion: Meaningful and effective stakeholder engagement is necessary for the development and translation of promising interventions that can be integrated into routine health services, especially in lower-resourced settings.
Authors: Kristina Medlinskiene, Justine Tomlinson, Iuri Marques, Susan Richardson, Katherine Stirling, and Duncan Petty
Presented by: Kristina Medlinskiene
Biography: Kristina Medlinskiene is a Pharmacy Doctoral Training Fellow undertaking a PhD at the University of Bradford funded by Pharmacy Research UK (grant reference: PRUK-2018-GA-1-KM) and Leeds Teaching Hospitals NHS Trust. Alongside her involvement in research, she continues working as a hospital pharmacist and teaching at the School of Pharmacy and Medical Sciences at the University of Bradford. Her PhD “A study of barriers and enablers in the introduction of direct oral anticoagulants (DOACs) for atrial fibrillation into patient care” aims to understand the key issues undermining the uptake of innovative medicines into practice by using DOACs as an exemplar. The study explores views of patients, healthcare professionals, and key stakeholders from three health economies in England. The study aims to learn from the case of DOACs and use the study findings to produce recommendations to improve implementation of nationally recommended cost-effective medicines within the National Health Service.
This session takes place on Friday 17th July at 13:30
Method: The systematic review followed the developed protocol registered with PROSPERO database (CRD42018108536). Results The search yielded 35,806 unique titles. Screening of titles and abstracts resulted in 151 papers for full-text review, which further excluded 113 papers. Eleven studies were identified after screening references and citations of included studies. A total of 49 studies were included in the review. The majority of the studies (n=47) were quantitative. Most of the studies (n=36) used secondary data from various databases, e.g. insurance databases. The methodological quality of studies ranged from 45% to 81% with a mean score of 67%. The review findings were grouped into five thematic areas: patient, prescriber, drug, organisational, and external environment factors (Figure 1). Of the five thematic areas coded, organisational, external environment, prescriber and patient factors were the most frequently discussed in the reviewed studies.
Conclusions: The systematic review highlighted various factors affecting the uptake of new medicines. However, factors related to behaviour change were scarcely studied in the reviewed studies. Our further research builds on and explores the review findings using a qualitative approach to identify factors that may not be present in the secondary data, for instance factors related to behaviour change.
Authors: Humma Andleeb, Aislinn Bergin, Dan Robotham, Sue Brown, Jennifer Martin
Presented by: Humma Andleeb
Biography: Humma Andleeb is a Senior Researcher at The McPin Foundation, a research charity specialising in involving people with lived experience in research, based in London. She achieved a BSc (Hons) in Biochemistry and Neuroscience from Keele University in 2017 and has been working in mental health research since. Her research interests include peer support, virtual reality for people with psychosis and the involvement of minoritized communities in research. Involving and working with people with lived experience of mental health problems throughout the research process to maximise impact and relevance is fundamental to all the research she does. She also advocates for the collaboration of mental health and neuroscience research for more effective prevention and treatment of mental health conditions and the implementation of novel interventions.
This session takes place on Friday 17th July at 13:30
Method: Barriers and facilitators were identified and, along with the expertise of the project’s Lived Experience Advisory Panel, iteratively informed meetings, workshops and visits involving stakeholders (including staff and service users) in all participating trial sites. The condition, technology, organisation and adopters as well as wider system and value proposition were considered so as to facilitate implementation [1].
Results: The research and design of the VRT was shaped through experiential and professional expertise of the condition and the organisation; through geographical and organisational knowledge accounting for appropriate recruitment and site variability. It also enabled reflection of research practice through prioritisation of data collection methods and analysis, strengthening relevance to real-life practice.
Conclusion: The involvement of potential users from early in development can support not just the intervention’s design but also its delivery and implementation. This enables even new and untried digital health interventions to be designed, developed and delivered in more contextually relevant ways. Consequently, these DHIs can be adopted more confidently into healthcare services. Thus, we conclude that relevance in practice can come from involvement in research.
Authors: Shalini Ahuja, Gregory Godwin, Gabriel Birgand, Andrew Leather, Sanjeev Singh, Pranav V, Nathan Peiffer-Smadja, Esmita Charani, Alison Holmes, Nick Sevdalis, on behalf of co-investigators of ASPIRES
Presented by: Greg Godwin
Biography:Greg Godwin is an intercalating Neuroscience iBSc student at King’s College London for the academic year 2019-2020, having intercalated externally from the University of Sheffield where he has completed three years of a medical degree to date. He is particularly interested in the interface between psychology and global public health. Greg is undertaking research as part of the ASPIRES (Antibiotic use across Surgical Pathways – Investigating, Redesigning and Evaluating Systems) project which aims to optimise antibiotic usage along surgical pathways and overall addressing antimicrobial resistance. He is involved in the work focusing on the intervention design and implementation, specifically the process of designing behavioural interventions for perioperative antibiotic usage in LMICs.
This session takes place on Friday 17th July at 13:30
Background: Increased antibiotic consumption, linked to antimicrobial resistance and health care associated infections, is a major health issue in low- and middle income countries1. Antimicrobial stewardship is a crucial intervention to improve antibiotic usage throughout the surgical pathway and decrease surgical site infection. The aim of this study is to understand the co-design process of selecting interventions and implementation strategies, and to identify barriers and facilitators to the delivery of interventions targeting infection prevention and control (IPC) and antibiotic use perioperatively.
Method: A two-phased qualitative study was undertaken. Phase 1: in depth interviews (n=10) were conducted to understand the context and to identify potential interventions and strategies. Phase 2: theory of change consultative workshops (n=2) explored barriers and facilitators in the implementation of the interventions2. Data were analysed using framework thematic analysis and thematic synthesis principles.
Results: Overburdened health workforce along with cultural and professional hierarchies were amongst the various factors identified, exacerbated by organisational factors including lack of resources and ineffective information relay systems. In comparison, existing antimicrobial stewardship (AMS) programme and department specific IPC protocols within the hospital were critical facilitators. Potential implementation strategies were selected: cascade feedback to health workers on infection rates; emphasise AMS and IPC protocols through additional on the job trainings; ensure communication consistency amongst IPC and AMS teams.
Conclusion: Context specific barriers and facilitators can inform implementation practice to reduce inappropriate antibiotic use. Future intervention design studies can consider three policy implications strategies which emerged from our analysis and experience: enhancing consultations during the intervention design, better consideration of implementation challenges during design, and better recognition of co-ordinating mechanisms between different departments.
Authors: Julia E Moore and Sobia Khan
Presented by: Julia E. Moore and Sobia Khan
Biography: Dr. Julia E. Moore is the Senior Director for the Center for Implementation. Dr. Moore has a PhD from Penn State in Human Development, where she was trained as an implementation scientist, researching the best ways to implement evidence-based programs. She has worked on over 100 implementation projects. Dr. Moore is known internationally for her ability to communicate complex implementation science concepts in a clear and practical ways. Dr. Moore developed the online mini-course, Inspiring Change: creating impact with evidence-based implementation, which has been completed by over 4000 professionals from around the world. She is an invited keynote speaker at implementation and healthcare conferences and events. Dr. Moore is most passionate about supporting professionals how to use implementation science; she has delivered dozens workshops to thousands of participants.
This session takes place on Friday 17th July at 13:30
Results: Step 1. Select a process model. Implementation efforts should first be guided by a process model that describes the actionable steps required to close the evidence-to-practice gap.
Step 2. Select a theory of change. At its core, implementation science is about creating individual, organizational, and/or systems change. Therefore, implementation efforts require a theory of change of each level of change (individual, team, organization, community, system). Theories are typically applied during program development stages of implementation process models, where barriers and facilitators to change are assessed and behavior change strategies are selected that are linked to specific change theories.
Step 3. Select frameworks that align with the objectives of each process model stage. There are over 150 frameworks used in implementation science; therefore, it can be challenging to select an appropriate framework. Most implementation efforts require the use of multiple frameworks, for example a framework to consider individual barriers and facilitators to change, contextual factors, roles in implementation, and implementation outcomes.
Conclusion: This approach to practice implementation provides a roadmap for how to understand and organize the implementation science MTFs in a practical and applied manner. What makes this approach unique is the way that these distinct elements from implementation science, which are inherently interconnected, are linked and woven together to build a practical bridge from research to practice.
Authors: Alexandra Ridout, Venetia Goodhart, Sophie Bright, Sattu Issa, Betty Sam, Jane Sandall, Andrew Shennan
Presented by: Alexandra Ridout
Biography: Dr Alexandra Ridout is an Obstetrics & Gynaecology Registrar and Clinical Research Fellow completing her MD at King’s College London. She is currently the UK co-ordinator for the National CRADLE Scale Up in Sierra Leone, working in partnership with the Sierra Leoneon Ministry of Health and Sanitation and iNGO Welbodi Partnership. She has a passion for research within the field of high-risk pregnancy management, including interventions to prevent pre-eclampsia and preterm birth. She sees research as a fundamental tool to bring about long-term change, with a focus on building sustainable community projects in order to make a difference to women’s lives.
This session takes place on Friday 17th July at 09:10
Background: In Sierra Leone (SL) 1 in 17 women die during pregnancy. The majority of deaths are preventable, detectable by abnormalities in blood pressure and heart rate (vital signs). The CRADLE vital signs monitor is accurate and affordable, incorporating a traffic-light early warning system and shock index calculator.
A hybrid effectiveness-implementation RCT demonstrated that the CRADLE device and training significantly reduced maternal death and eclampsia in SL. Working with the Ministry of Health and Sanitation (MOHS), funded by DfID, we are implementing a national scale-up built on locally piloted strategies.
Methods: The “Theory of Readiness for Change” and “IHI Framework for Going to Full Scale” guided scale-up of this complex intervention. Support systems and adoption mechanisms were continuously iterated. We recorded acceptability, fidelity, adoption and reach alongside policy and practice implications.
Results: MoHS, WHO and UNICEF provided political and organisational leadership alongside key stakeholders at the national launch in January2020. To date 402 MoHS and 23 NGO staff from two districts have been trained. This Test of Scale has refined the implementation package across a range of healthcare settings. MoHS have built ownership and sustainability by integrating the programme into SL’s EmONC and Midwifery Schools’ Curricula. The project has benefitted from local redesign, guided by a national working group. The training schedule and device distribution plan have been adapted to align with district health meetings. Whatsapp groups have improved timely data collection and beneficiary feedback.
Conclusion: During this Test of Scale we have built a learning system, rolling out 280 CRADLE devices across 139 healthcare facilities and training 402 MoHS healthcare providers. The refined full scale is expected to reach 2500 healthcare providers and >750,000 pregnant women in the first year, strengthening the health system capacity, reducing maternal mortality and promoting rollout of the CRADLE package in other countries.
Authors: Ben Grodzinski, Harry Bestwick, Faheem Bhatti, Rory Durham, Maaz Khan, Celine Partha Sarathi, Jye Quan Teh, Oliver Mowforth, Benjamin Davies (on behalf of AO Spine RECODE-DCM Consortia)
Presented by: Mr Ben Grodzinski BA Hons. (Cantab.)
Biography: Ben is a fourth year medical student at the University of Cambridge, expecting to graduate in June 2022. Alongside his medical studies, he is currently working with Dr Benjamin Davies in Cambridge’s Academic Neurosurgery Unit, researching Degenerative Cervical Myelopathy.
This session takes place on Friday 17th July at 09:10
Methods: To facilitate implementation key stakeholders termed ‘Agents of Change’ (AoC) were identified at a multi-disciplinary workshop. A tailored international search strategy was then conducted to identify potential agents, itemising with key meta-data and indexing against relevant research priorities. Results Researchers, funders, non-profit and charities and scientific conferences were identified as key AoC. These were identified in three project arms. The research arm created a database of conferences at which to promote the research priorities, a database of researchers already working on the priorities, and a database of journals in which this work is being published. The funding arm created a database of current and potential funders. The organisations arm created a database of charities and non-profit organisations which could help promote the priorities. Project completion date 20th May 2020.
Conclusion: Research on DCM, whilst currently under-developed, is rapidly accelerating. The RECODE-DCM Enviro-Scan has identified and indexed key agents for its implementation.
Authors: Nataliya Brima, N Sevdalis, K Daoh, B Deen, TB Kamara, H Wurie, J Davies* and A Leather
Presented by: Nataliya Brima
Biography: Nataliya is a PhD student in Global Health linked to ASSET – a Health System Strengthening (HSS) Unit in Sierra Leone. The research question of her PhD is “Can quality of surgical care be improved within government health facilities in the Western Area of Sierra Leone, through the introduction of a bundle of HSS interventions”.
After completing MSc in statistics at University College London (UCL) in 2008, Nataliya was working as a Research Associate in Medical Statistics at UCL and a Clinical Data Manager for Sexual and Reproductive Services, Camden NHS Trust. During this time, she gained extensive experience in statistical designing, statistical data analysis, data management planning and clinical data evaluation and auditing, including RCTs, surveys and cohorts and covering varying aspects of sexual and reproductive health (SRH) at national and community levels.
Before starting her PhD she was awarded and completed the following Global Health projects: “HIV prevalence and testing in Sierra Leone”, “Accessibility and Acceptability of Sexual Health Services among adolescents in most deprived communities of Western Area, Sierra Leone”, “Measuring pregnancy intentions in Western Area, Sierra Leone”.
This session takes place on Friday 17th July at 09:10
Background: The global health community is placing greater emphasis on quality of care, while not neglecting access to care, in order to reduce avoidable mortality and morbidity from surgical diseases in low- and middle-income countries. However, many of these health systems are weak and provide low quality health care. There is a lack of knowledge on how health system strengthening quality improvement interventions can be implemented effectively in these settings. To address this gap, we developed a multifaceted quality improvement project to improve the quality of nursing documentation, through implementation and evaluation of a set of hospital-based activities.
Methods: This multifaced quality improvement, mixed-method, quasi-experimental design interventional study has been co-designed during an intensive formative phase guided by a theory of change process. It will take place within the surgical department of a national referral hospital in Freetown, Sierra Leone.
The study is structured around five distinct phases – pre-implementation, awareness drive, training package, audit and feedback, and evaluation. Plan-Do-Study-Act quality improvement method will be used to provide further evidence to optimise the set of interventions and implementation strategies.
Results: The primary outcome of the study is composite measure of completeness of the Nurses Daily Report form. In addition, several process and implementation outcomes will be evaluated to study effects of interventional components and implementation strategies. Further information on sustainability of nursing documentation quality improvement processes will also be collected.
Conclusion: We seek to test if the quality of nursing documentation can be improved through the introduction of a set of health system strengthening interventions, using implementation and improvement sciences methods.
The results will generate knowledge to inform good nursing documentation practices for surgical patients in Sierra Leone, add to the body of evidence on the development and implementation of effective health system strengthening quality improvement interventions in low resource settings.
Authors: Andreas Xyrichis, Katerina Iliopoulou
Presented by: Katerina Iliopoulou
Biography: Dr Katerina Iliopoulou is currently a post-doctoral Fellow at King’s College London. She also holds an MSc and a Doctorate in Health Care (2019) from King’s. Since 2019, Katerina has been an elected member of the N&AHPs committee of the European Society of Intensive Care Medicine. Her background is in critical care nursing, and her research interest focuses on implementation science, critical care telemedicine and exploration of factors influencing critical care personnel to implement effective quality improvement interventions. Mixed methods methodology, including the development of survey questionnaire, non-participant observation, and focus-group interview, are areas of her methodological expertise.
This session takes place on Friday 17th July at 09:10
Method: We systematically searched five databases for empirical qualitative studies published in any language. The search combined terms for telemedicine with critical care, decision support, and remote monitoring. We independently screened the reference lists of included studies and searched five sources for grey literature. Two reviewers extracted data and appraised included studies independently and in duplicate. Conflicts were resolved in the team. We used the CFIR[4] to inform data synthesis. Additional themes not captured by CFIR were classified under a separate theme. We used GRADE-CERQual [5] to assess our confidence in the findings.
Results: Thirteen studies were included representing a range of settings but all from North America. We identified 20 review findings that affect the implementation of CCT. The majority of factors mapped to three CFIR domains: intervention characteristics, inner setting, and characteristics of individuals. Factors relating to networks and communication, along with interactions between hub and bedside teams, were the most prominent review findings
Conclusion: We have high or moderate confidence in the evidence contributing to several of the review findings. Further qualitative research, especially in contexts other than North America, which are subject to different social and cultural values, would strengthen the evidence base. Future implementation research is needed to build on our findings and examine appropriate strategies for further implementation of CCT.