How can educational institutes in Switzerland prepare physiotherapy students to implement advanced practice roles - a view point paper.

This viewpoint paper focuses on challenges for Swiss physiotherapy education institutes related to the transition towards evidence-based practice and the incorporation of advanced roles within the profession. To tackle such challenges, it is essential to establish structured pathways and competency frameworks and position physiotherapists as integral contributors to innovative healthcare.

Operational and organizational variation in determinants of policy implementation success: the case of policies that earmark taxes for behavioral health services.

BACKGROUND: Research on determinants of health policy implementation is limited, and conceptualizations of evidence and implementation success are evolving in the field. This study aimed to identify determinants of perceived policy implementation success and assess whether these determinants vary according to: (1) how policy implementation success is operationally defined [i.e., broadly vs. narrowly related to evidence-based practice (EBP) reach] and (2) the role of a person's organization in policy implementation. The study focuses on policies that earmark taxes for behavioral health services. METHODS: Web-based surveys of professionals involved with earmarked tax policy implementation were conducted between 2022 and 2023 (N = 272). The primary dependent variable was a 9-item score that broadly assessed perceptions of the tax policy positively impacting multiple dimensions of outcomes. The secondary dependent variable was a single item that narrowly assessed perceptions of the tax policy increasing EBP reach. Independent variables were scores mapped to determinants in the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework. Multiple linear regression estimated associations between measures of determinants and policy implementation success. RESULTS: Perceptions of tax attributes (innovation determinant), tax EBP implementation climate (inner-context determinant), and inter-agency collaboration in tax policy implementation (outer-context and bridging factor determinant) were significantly associated with perceptions of policy implementation success. However, the magnitude of associations varied according to how success was operationalized and by respondent organization type. For example, the magnitude of the association between tax attributes and implementation success was 42% smaller among respondents at direct service organizations than non-direct service organizations when implementation success was operationalized broadly in terms of generating positive impacts (ß = 0.37 vs. ß = 0.64), and 61% smaller when success was operationalized narrowly in terms of EBP reach (ß = 0.23 vs. ß = 0.59). Conversely, when success was operationalized narrowly as EBP reach, the magnitude of the association between EBP implementation climate and implementation success was large and significant among respondents at direct service organizations while it was not significant among respondents from non-direct service organizations (ß = 0.48 vs. ß=-0.06). CONCLUSION: Determinants of perceived policy implementation success may vary according to how policy implementation success is defined and the role of a person's organization in policy implementation. This has implications for implementation science and selecting policy implementation strategies.

Evidence-based practice in respiratory healthcare professionals in Latin America: a survey of the Latin American Thoracic Association (ALAT).

Background: Evidence-based practice (EBP) is a systematic approach to professional practice using the best available evidence to make informed clinical decisions in healthcare. It is necessary to measure and identify strengths and opportunities for improvement. Objective: To assess the knowledge and application of EBP in respiratory health professionals in Latin America. Methods: A cross-sectional study was conducted. The questionnaire was distributed online to health professionals in Latin American countries. Demographic data, professional characteristics, EBP training, and questionnaire responses were collected. Descriptive and inferential statistical analyses were performed. Results: A total of 448 respiratory health professionals participated in the study. Responses were obtained from 17 countries where the majority were female, with an average age of 42. Participants included physicians, physiotherapists, nurses, respiratory therapists, speech therapists, and occupational therapists. Overall scores indicated moderate to high levels of EBP knowledge and application. However, variations were observed in different dimensions. Factors such as EBP training, reading scientific articles, and professional characteristics were associated with higher scores. Barriers to implementing EBP were identified mostly related to institutional support. Conclusions: This study provides information on the knowledge and implementation of EBP in respiratory health professionals in Latin America. Although the overall levels of knowledge and application of EBP were moderate to high, there are options for improvement, especially in addressing barriers to implementation.

Introducción: La práctica basada en evidencia (PBE) es un enfoque sistemático para la práctica profesional que utiliza la mejor evidencia para tomar decisiones informadas. Es necesario identificar fortalezas y oportunidades de mejora. Objetivo: Evaluar el conocimiento y la aplicación de la EBP en profesionales de la salud respiratoria en Latinoamérica. Métodos: Se desarrolló un estudio transversal. El cuestionario se distribuyó en línea a profesionales de la salud en países latinoamericanos. Se recopilaron datos demográficos, características profesionales, capacitación en EBP y respuestas al cuestionario. Se realizaron análisis estadísticos descriptivos e inferenciales. Resultados: Un total de 448 profesionales de la salud respiratoria participaron en el estudio. Se obtuvieron respuestas de 17 países donde la mayoría eran mujeres, con una edad promedio de 42 años. Los participantes incluyeron médicos, fisioterapeutas, enfermeras, terapeutas respiratorios, fonoaudiólogos y terapeutas ocupacionales. Las puntuaciones generales indicaron niveles moderados a altos de conocimiento y aplicación de la EBP. Sin embargo, se observaron variaciones en diferentes dimensiones. Factores como la capacitación en EBP, la lectura de artículos científicos y las características profesionales se asociaron con puntuaciones más altas. Se identificaron barreras para implementar la EBP, principalmente relacionadas con el apoyo institucional. Conclusiones: Este estudio proporciona información sobre el conocimiento y la implementación de la EBP en profesionales de la salud respiratoria en América Latina. Aunque los niveles generales de conocimiento y aplicación de la EBP fueron moderados a altos, existen opciones de mejora, especialmente en abordar las barreras.

Knowledge, attitudes, behavior, and self-efficacy related to evidence-based practice among healthcare professionals working in the municipal healthcare service in Norway: a cross-sectional survey.

BACKGROUND: Practicing the process of evidence-based practice (EBP) may be challenging for healthcare professionals and may be affected by their EBP knowledge, attitudes, self-efficacy, and behavior. We have some insight into how Norwegian healthcare professionals and students perceive EBP. However, research on the perception of EBP among primary healthcare professionals working in the Norwegian municipal health service is lacking. This study aimed to map EBP knowledge, attitudes, behavior, and self-efficacy among healthcare professionals working with older people in the municipal health service in Norway and to examine associations between how they score and their background characteristics. METHODS: A cross-sectional web-based survey was conducted among healthcare professionals in the Norwegian municipal healthcare service. We used the revised Norwegian version of the Evidence-based practice profile questionnaire (EBP2-N) to measure the healthcare professionals' EBP knowledge, attitudes, behavior, and self-efficacy, operationalized through the five domains of the EBP2-N. We calculated the mean scores for each EBP domain across the total sample and for each subgroup of healthcare professionals. We used a one-way between-groups analysis of variance (ANOVA) to analyze the differences in mean scores between the professions. We also calculated eta-squared values to determine effect size. We used linear regression analyses to examine associations with background variables. RESULTS: A total of 313 healthcare professionals, including nurses, assistant nurses, physical therapists, occupational therapists, and medical doctors, responded to the survey. The total sample scored the highest on the relevance domain, with a mean domain score of 58.9 (95% CI = 58.1-59.7) on a scale ranging from 14 to 70. The practice domain had the lowest score, with a mean domain score of 22.2 (95% CI = 20.8-21.6) on a scale ranging from 9 to 45. Statistically significant differences in mean scores were found between professions in all domains except the confidence domain. The most considerable differences between professions' mean scores were found for the relevance and terminology domains, with eta-squared values of 0.13 and 0.19, respectively. The multivariate regression results showed that EBP training was significantly associated with the sum score of the relevance, terminology, and confidence domain. However, EBP training was not associated with the sum score of the practice and sympathy domains. CONCLUSIONS: Primary healthcare professionals in the Norwegian municipal healthcare service hold positive attitudes toward EBP. However, they report a low understanding of research terms, low self-efficacy in performing EBP activities, a lack of perceived compatibility of EBP with professional work, and a low frequency of EBP behavior. Additionally, we observed differences among the included professions in four out of five domains, suggesting that various professions may be unequally prepared for EBP. Finally, our results indicate potential positive outcomes of EBP training. Those who received EBP training exhibited more positive attitudes, a better understanding of common research terms, and higher self-efficacy in performing EBP activities. However, EBP training was not associated with their self-reported EBP behavior. TRIAL REGISTRATION: Retrospectively registered (prior to data analysis) in OSF Preregistration. Registration DOI: https://doi.org/10.17605/OSF.IO/428RP .

Integrating Evidence-Based Screening, Brief Intervention, and Referral to Treatment Into a Family Nurse Practitioner Program.

PROBLEM STATEMENT: Substance use disorder (SUD)-and more specifically opioid use disorder-is a national epidemic. With the increasing amounts of people suffering from SUD, all healthcare professionals should be educated to identify substance abuse, provide a brief intervention, and refer patients for treatment when indicated. PURPOSE: The purpose of this project is to integrate the SBIRT into the curriculum of a graduate-level family nurse practitioner (FNP) program in southeastern Pennsylvania and to determine if educating FNP students on the SBIRT process increases their knowledge of SUDs and their treatment and increases their motivation to work with patients with SUD. MEASUREMENTS: The measurements used were as follows: shortened Alcohol and Alcohol Problems Perception Questionnaire (S-AAPPQ), shortened Drug and Drug Problems Perception Questionnaire (S-DDPPQ), a 10-question knowledge test, and demographic data. RESULTS: All subscales of the S-DDPPQ, the S-AAPPQ, and the knowledge test showed a statistically significant change from the pretest score means and to posttest means. This evidence-based practice project supports the integration of SBIRT education into FNP programs to increase their ability to identify and treat individuals with SUDs.

Investigating the influencing factors of evidence-based healthcare practice adoption.

BACKGROUND:  In healthcare facilities, evidence-based healthcare practice (EBHP) is becoming more widely acknowledged as a critical element of patient care delivery. An increasingly important component of EBHP is the implementation of electronic health records (EHRs). OBJECTIVES:  This study aims to investigate factors that influence EBHP adoption in public healthcare institutions in South Africa. METHOD:  Four hundred and fifty patients were self-administered to healthcare professionals at an academic public hospital in Gauteng and used in this study. A total of 300 responses were available for use in the final analysis following the data cleaning procedure. Utilising structural equation modelling (SEM), the collected data were analysed. RESULTS:  Perceived ease of use (PEOU) and perceived usefulness (PU) were found to be major variables in the adoption of EBHP along with technological, organisational and environmental factors. The technology context relative advantage (RELA) was shown to have a positive significant influence on the adoption of evidence-based healthcare practice by the PEOU and PU, with the environmental context government laws and regulations (GLRS) and organisational context organisational readiness (ORGR) coming in second and third, respectively. CONCLUSION:  Perceived ease of use, PU, ORGR, and GLRS are regarded as a vital variables in the implementation of EBHP in South African public hospitals.Contribution: The study's conclusions would be helpful to policymakers as they redefine nursing practice. Furthermore, the findings heighten the consciousness of healthcare practitioners regarding the significance of employing evidence-based practice while making decisions.

Development and Implementation of an Evidenced-Based Practice (EBP) Educational Program for a Multidisciplinary Rehabilitation Department.

OBJECTIVE: Describe the development and implementation of an evidence-based practice (EBP) training program for occupational and physical therapists in a large pediatric hospital. CONTEXT: EBP is valued, but a known knowledge-to-practice gap between academic training and clinical practice limits routine use. This gap was addressed through an academic-clinical partnership to develop an EBP training program. RESULTS: Sixty-one therapists completed the program. Therapists demonstrated improved EBP skills, knowledge, and confidence following training and a positive trend in change score for clinical outcomes and decision-making scores was noted. CONCLUSION: Academic-clinical partnerships have a unique and valuable role to support professional EBP knowledge and skill development. Stakeholder support and engagement supported program development, execution, and meaningful outcomes. IMPACT STATEMENT: The knowledge-to-practice gap for EBP is a challenge to regular EBP use. The described program addressed this challenge and improved therapists' knowledge, skills, and confidence. It provides a model for professional development.

Revisiting the scope and expectations of Implementation Science and Implementation Science Communications.

This editorial updates the scope and submission expectations of Implementation Science and Implementation Science Communications. We refine our protocol publishing policies and set out new expectations for reporting studies describing determinants and their relationship with implementation outcomes. Our central focus remains on the implementation of evidence-based interventions into healthcare practice and policy. We are most interested in rigorous empirical studies of the implementation of evidence-based healthcare interventions, practices, and policies, and the de-implementation of those that are demonstrated to be of low-value or no benefit. Alongside this, we remain interested in the systematic study of implementation mechanisms and processes and on the influences of patient, professional, and organizational behaviours. Novel theoretical and methodological developments are considered. For all submissions, we expect authors to demonstrate how their work is integrated with existing knowledge in the field and to clearly state the added value of the work to the field broadly.

The validity and reliability properties of a Persian version of the evidence-based practice profile (EBP2) questionnaire among Iranian students of health-related fields.

BACKGROUND: Evidence-based medicine is defined as searching for medical information, reviewing and comparing it to each patient's situation, and then judging the optimal decision. We aimed to measure the psychometric properties of the Evidence-Based Performance Profile (EBP2) Questionnaire among the students of health-related fields at Shiraz University of Medical Sciences. METHODS: This cross-sectional study was conducted in 2021. The EBP2 questionnaire, which includes 74 five-Likert-scale items, was translated into the Persian language using the forward-backward translation method. A panel of five experts approved the face, content, and structural validity of the questionnaire. The Cronbach's alpha and McDonald's Omega coefficients were utilized to assess the questionnaire's internal consistency. Furthermore, both confirmatory and exploratory factor analyses were used to assess the questionnaire's construct validity. SPSS software version 25 and LISREL software version 8.8 were used for statistical analysis. RESULTS: Overall, 339 students participated in this study. The cultural adaptability, linguistic equivalence, and content validity of the Persian version of the EBP2 questionnaire were approved by a five-member team of medical experts. In addition, the results showed excellent internal consistency of the Persian version of the EBP2 questionnaire (Cronbach's alpha = 0.962, McDonald's Omega (ML) = 0.963). Moreover, all domains had acceptable reliability (> 0.7), except the Practice domain which had a marginally acceptable Cronbach's alpha coefficient equal to 0.686. Exploratory factor analysis discovered six domains for the questionnaire. Moreover, the confirmatory factor analysis demonstrated that all indices except the comparative fit index (CFI) and adjusted goodness of fit (AGFI) confirmed the validity of the EBP2 questionnaire. CONCLUSION: The study's findings indicate that the Persian translated of the EBP2 questionnaire exhibited satisfactory validity and reliability for assessing students' evidence-based performance in health-related fields.

Psychometric Evaluation of a Measure of Evidence-Based Practice in Occupational Health.

BACKGROUND: Occupational Health Services (OHS) are obliged to follow the principles of evidence-based medicine. However, there needs to be tools to measure this. Therefore, we developed and validated a questionnaire for evaluating OHS practitioners' attitudes, competence, and organisational support to perform evidence-based practice (EBP-OHS) following the JBI Model of Evidence-Based Healthcare. METHODS: The questionnaire's content validity was assessed by 12 experts in the field. Then, an opportunity sample of 549 OHS practitioners completed the questionnaire. We examined the questionnaire's psychometric properties using exploratory factor analysis and subjected it to construct validity and reliability testing. RESULTS: The content validity index of the chosen items was 0.78 or higher. Exploratory factor analysis revealed that the measure's construct validity was adequate (KMO 0.9). Principal component factor analysis supported a three-factor structure (all eigenvalues 1.3 or more), which explained 60.3 % of the total variance. Aligned with these three factors, the EBP-OHS consists of three domains: Organisational support (seven items), OHS practitioners' competence (six items) and OHS practitioners' attitudes (two items). The scale's reliability is good (Cronbach alpha 0.88). CONCLUSIONS: The EBP-OHS is a valid tool for measuring occupational health services' evidence-based practice and enabling the implementation of research into practice. It embodies the phases of evidence transfer and implementation described in the JBI Model of Evidence-Based Healthcare and translates them into concrete measurable activities in the OHS context.

Evidence Synthesis and Clinical Recommendations for Supporting School Students With Sensory Processing Challenges: A Rapid Review.

IMPORTANCE: Children with sensory processing challenges often need supports to access, participate in, and achieve at school. However, research on best practice is varied, presenting difficulty for practitioners to assess the appropriateness of each support. OBJECTIVE: To provide evidence-informed recommendations regarding best practices in school-based supports for students with sensory processing challenges via a Rapid Evidence Assessment of current literature. DATA SOURCES: Searches were run in CINAHL Complete, Education Research Complete, ERIC, MEDLINE, PsycINFO, and Scopus (for articles published 2010 to 2023). Informed by a 2010 review, articles citing publications identified in the prior review were also included. STUDY SELECTION AND DATA COLLECTION: A reviewer screened the title and abstract of each article for inclusion, and another screened the full texts, with 10% of each reviewer's articles assessed by the other. Interrater reliability was excellent. FINDINGS: The review included 61 articles, with only 15% constituting good evidence (38% provided adequate evidence, 31% provided poor evidence, and 16% were reviews). No support could be wholly recommended without caveats, but there was some evidence that sound amplification systems, alternate seating, and multisensory environments may be beneficial in certain conditions or with certain populations. The use of weighted vests is not recommended. CONCLUSIONS AND RELEVANCE: Most research had small sample sizes and inconsistent protocols, highlighting the importance of ongoing research. Evidence-informed practitioners should review research findings carefully and integrate evidence from comprehensive clinical assessment and understanding of the child, school, and family contexts when assessing the appropriateness of a support for each student. Plain-Language Summary: Children with sensory processing challenges often need supports to access, participate in, and achieve at school. Occupational therapists provide school-based supports for children with sensory processing challenges with the goal of enabling access, participation, and achievement. It is difficult, however, for practitioners to assess the appropriateness of each support because research on best practice varies. This review of the current literature provides practitioners with evidence on supports for school children with sensory processing challenges to inform decision-making and the selection of appropriate supports for their clients. When assessing the appropriateness of a support for a student, practitioners should carefully review current research findings and integrate evidence from comprehensive clinical assessments along with an understanding of the student, school, and family contexts.

What validated instruments, that measure implementation outcomes, are suitable for use in the Paediatric Intensive Care Unit (PICU) setting? A systematic review of systematic reviews.

BACKGROUND/AIMS: The measurement of implementation outcomes can establish the success of implementing evidence into practice. However, implementation outcomes are seldom measured in acute healthcare settings, such as Paediatric Intensive Care Units (PICU), and if they are used, are likely to be non-validated, site or intervention-specific measures. To address this literature gap, this systematic review of systematic reviews aims to identify validated instruments to measure implementation outcomes of new EBP interventions in a PICU setting. METHODS: A systematic review of systematic reviews was conducted in two phases. Phase One: Five electronic databases were searched between 06/10/22 and 14/10/22. Systematic reviews were selected using pre-determined eligibility criteria. Methodological quality was assessed using the Critical Appraisal Skills Programme tool and a data extraction table was used to allow further synthesis. Phase Two: Secondary eligibility criteria were used to extract and review instruments from the systematic reviews selected in Phase One. Instruments were analysed and mapped to the Consolidated Framework of Implementation Research (CFIR). RESULTS: Phase One: Searches resulted in 3195 unique papers. Five systematic reviews were eligible for inclusion. All examined the psychometric properties of each instrument, utilising different methods to do so; three considered their pragmatic or usability properties; and one identified instruments that were transferrable to different settings. Each systematic review identified that most included instruments had limited evidence of their validity or reliability and had poor psychometric properties. Phase two: 93 instruments were screened, and nine were eligible for analysis. After analysis and CFIR mapping, two instruments were identified as potentially adaptable to the PICU setting. CONCLUSIONS: The methodological quality of implementation outcome measurement instruments is inadequate, warranting further validation research. Two instruments were identified that cover multiple CFIR domains and have scope to be adapted for use when implementing evidence-based practice into the PICU. Further work is needed to adapt and further validate an instrument for use in practice. TRIAL REGISTRATION: For transparency of procedures and methods, the protocol for this systematic review was registered with PROSPERO (registration number CRD42022361638L).

Physical Therapy Management of Congenital Muscular Torticollis: A 2024 Evidence-Based Clinical Practice Guideline From the American Physical Therapy Association Academy of Pediatric Physical Therapy.

BACKGROUND: Congenital muscular torticollis (CMT) is a postural condition evident shortly after birth. The 2013 CMT Clinical Practice Guideline (2013 CMT CPG) set standards for the identification, referral, and physical therapy management of infants with CMT, and its implementation resulted in improved clinical outcomes. It was updated in 2018 to reflect current evidence and 7 resources were developed to support implementation. Purpose: This 2024 CMT CPG is intended as a reference document to guide physical therapists, families, health care professionals, educators, and researchers to improve clinical outcomes and health services for children with CMT, as well as to inform the need for continued research. Results/Conclusions: The 2024 CMT CPG addresses: education for prevention, screening, examination and evaluation including recommended outcome measures, consultation with and referral to other health care providers, classification and prognosis, first-choice and evidence-informed supplemental interventions, discontinuation from direct intervention, reassessment and discharge, implementation and compliance recommendations, and research recommendations.

Why Research From Lower- and Middle-Income Countries Matters to Evidence-Based Intervention: A State of the Science Review of ACT Research as an Example.

Despite the global nature of psychological issues, an overwhelming majority of research originates from a small segment of the world's population living in high-income countries (HICs). This disparity risks distorting our understanding of psychological phenomena by underrepresenting the cultural and contextual diversity of human experience. Research from lower- and middle-income countries (LMIC) is also less frequently cited, both because it is seemingly viewed as a "special case" and because it is less well known due to language differences and biases in indexing algorithms. Acknowledging and actively addressing this imbalance is crucial for a more inclusive, diverse, and effective science of evidence-based intervention. In this state-of-the-science review, we used a machine learning method to identify key topics in LMIC research on Acceptance and Commitment Therapy (ACT), choosing ACT due to the significant body of work from LMICs. We also examined one indication of study quality (study size), and overall citations. Research in LMICs was often nonindexed, leading to lower citations, but study size could not explain a lack of indexing. Many objectively identified topics in ACT research became invisible when LMIC research was ignored. Specific countries exhibited potentially important differences in the topics. We conclude that strong and affirmative actions are needed by scientific associations and others to ensure that research from LMICs is conducted, known, indexed, and used by CBT researchers and others interested in evidence-based intervention science.

Closing the Theory-to-Practice Gap: Quantifying the Impact of Ovid Synthesis for Clinical Improvement Projects.

This article presents a program evaluation study involving 18 health system leaders who use Ovid Synthesis, a web-based workflow solution for evidence-based practice, quality improvement, and research initiatives. The findings demonstrate the critical prioritization of standardization, collaboration, dissemination, and patient outcomes in order to successfully implement evidence-based practice (EBP) and how Ovid Synthesis successfully supports these priorities. Significant interest in measuring return on investment underscores the importance of demonstrating the value of EBP, in order to support continued investments in EBP practices.

Outcomes of Providing Children Aged 7-12 Years With Access to Evidence-Based Anxiety Treatment Via a Standalone Digital Intervention Using Immersive Gaming Technology: Real-World Evaluation.

Background: Anxiety disorders are among the most common mental health conditions in childhood, but most children with anxiety disorders do not access evidence-based interventions. The delivery of therapeutic interventions via digital technologies has been proposed to significantly increase timely access to evidence-based treatment. Lumi Nova (BfB Labs Limited) is a digital therapeutic intervention designed to deliver evidence-based anxiety treatment for those aged 7-12 years through a mobile app incorporating immersive gaming technology. Objective: We aimed to evaluate the real-world impact of providing access to Lumi Nova through UK National Health Service-funded mental health services. Methods: We analyzed precollected anonymized data routinely captured through the implementation of Lumi Nova from children aged 7-12 years, who lived in the United Kingdom and had the opportunity to use the intervention for at least 1 week over an 18-month period. Engagement indices included whether the game key was activated, number of unique sessions, time spent engaging, and number of "challenges" completed. Clinical outcomes were assessed using the Goal-Based Outcomes measure and Child Outcome Rating Scale. Demographic data were analyzed to assess the health equality implications of Lumi Nova. Results: Of 1029 eligible families invited to use Lumi Nova, 644 (62.5%) activated their game key, of whom 374 (58.1%) completed at least one in-game graded exposure challenge. The median number of unique sessions was 6 (IQR 3-12) and the median time spent engaging with the intervention was 42 (IQR 15-79) minutes. For the subset of young people with paired outcomes, there were statistically significant small to medium improvements in goal-based outcome scores (n=224; t223=5.78, P<.001; d=0.37, 95% CI 0.25-0.52) and Child Outcome Rating Scale scores (n=123; t122=5.10, P<.001; d=0.46, 95% CI 0.27-0.65) between the first and last data points. Two in 5 young people's scores reflected a change that would be considered reliable. Analysis of demographic characteristics tentatively suggested that children from ethnic minority backgrounds and those living in the most deprived neighbourhoods may be less likely to access Lumi Nova, but children from socioeconomically deprived areas were more likely to successfully complete a challenge once they accessed the intervention (P=.02). However, the level of missing data and small number of children in some demographic groups limited meaningful statistical comparisons. Conclusions: This study provides initial evidence that Lumi Nova may be associated with improved outcomes for those aged 7-12 years seeking anxiety treatment in real-world settings. However, the lack of a control comparator group and information about concurrent treatments accessed by the young people, in addition to substantial attrition, limited the analysis that could be conducted and confidence in the conclusions drawn.

Implementation Science and Pediatric Diabetes: A Scoping Review of the State of the Literature and Recommendations for Future Research.

PURPOSE OF REVIEW: This scoping review aimed to identify implementation science (IS) research in pediatric diabetes, report integration of IS theory and terminology, and offer guidance for future research. RECENT FINDINGS: Of 23 papers identified, 19 were published since 2017 and 21 focused on type 1 diabetes. Most involved medical evidence-based practices (EBPs; n = 15), whereas fewer focused on psychosocial (n = 7) and diabetes education (n = 2). The majority either identified barriers and facilitators of implementing an EBP (n = 11) or were implementation trials (n = 11). Fewer studies documented gaps in EBP implementation in standard care (n = 7) or development of implementation strategies (n = 1). Five papers employed IS theories and two aimed to improve equity. There is a paucity of IS research in pediatric diabetes care literature. Few papers employed IS theory, used consistent IS terminology, or described IS strategies or outcomes. Guidance for future research to improve IS research in pediatric diabetes is offered.

A learning health systems approach to scaling up an evidence-based intervention for integrated primary mental healthcare case finding and referral in South Africa.

Despite progress in the development and evaluation of evidence-based primary mental health interventions in low-income and middle-income countries, implementation and scale-up efforts have had mixed results. Considerable gaps remain in the effective translation of research knowledge into routine health system practices, largely due to real-world contextual constraints on implementation and scale-up efforts. The Southern African Research Consortium for Mental Health Integration (S-MhINT) programme used implementation research to strengthen the implementation of an evidence-based integrated collaborative depression care model for primary healthcare (PHC) services in South Africa. To facilitate the scale-up of this model from a testing site to the whole province of KwaZulu-Natal, a capacity building programme was embedded within the Alliance for Health Policy and Systems Research (AHPSR) learning health systems (LHS) approach. The paper discusses efforts to scale up and embed case finding and referral elements of the S-MhINT package within routine PHC. Data from semistructured interviews, a focus group discussion, proceedings from participatory workshops and outputs from the application of continuous quality improvement (CQI) cycles were thematically analysed using the AHPSR LHS framework. Learning particularly occurred through information sharing at routine participatory workshops, which also offered mutual deliberation following periods of applying CQI tools to emergent problems. Individual-level, single-loop learning seemed to be particularly observable elements of the AHPSR LHS framework. Ultimately, our experience suggests that successful scale-up requires strong and sustained relationships between researchers, policy-makers and implementers, investments into learning platforms and organisational participation across all levels to ensure ownership and acceptance of learning processes.

Effectiveness of evidence-based fall prevention programs to reduce loneliness in the United States.

Introduction: Falls are associated with activity limitations and injuries among older adults. An estimated 25% of older adults fall each year, and over 40% of older adults report they are lonely. Small group, evidence-based fall prevention programs are widely available in the United States and may be a strategy to improve social connectedness within our aging population. The purpose of this study was to identify the effectiveness of evidence-based fall prevention programs to reduce loneliness among older adults. Administration for Community Living (ACL) grantee data were collected in a national repository. Methods: Data were analyzed from 12,944 participants across 12 fall prevention programs (e.g., A Matter of Balance, Stepping On, Tai Ji Quan, Otago Exercise Program, Bingocize) between January 2021 and July 2023. To assess loneliness, participants were asked, "how often do you feel lonely or isolated?" The response choices for this single 5-point item ranged from "never" to "always." A linear mixed-effects multivariable regression, with program type included as a random effect, was fitted to assess changes in loneliness before and after fall prevention workshops. The model controlled for program type and delivery site type as well as participants' age, sex, ethnicity, race, education, living alone, number of chronic conditions, number of falls in the three months preceding baseline, and workshop delivery site type and attendance. Results: Significant reductions in loneliness scores were observed from baseline to post-workshop (p < 0.001), which were more pronounced among participants with more frequent baseline loneliness (p < 0.001). Participants who attended more workshop sessions reported reduced loneliness at post-workshop (p = 0.028). From baseline to post-workshop, loneliness increased among participants who lived alone (p < 0.001) and reported two or more falls in the three months preceding baseline (p =0.002). From baseline to post-workshop, compared to White participants, increased loneliness was observed among Black (p = 0.040), and Asian (p < 0.001) participants. Participants with more chronic conditions reported more loneliness from baseline to post-workshop (p = 0.004). Relative to participants who attended workshops at senior centers, increased loneliness was observed among participants who attended workshops at residential facilities (p = 0.034) and educational institutions (p = 0.035). Discussion: Findings expand our understanding about the benefits of small-group fall prevention workshops to reduce loneliness among older participants. Results suggest that disease profiles, living alone, fall history, and workshop location (and attendee dynamic) may impede social connection among some participants. Beyond small group activities, purposive strategies should be embedded within fall prevention programs to foster meaningful interactions and a sense of belonging between participants. Other social connection programs, services, and resources may complement fall prevention programming to reduce loneliness.