A development and implementation of a preconception counseling program for black women and men in the southeastern United States: a pilot protocol.

Introduction: Racial/ethnic disparities in maternal mortality rates represent one of the most significant areas of disparities amongst all conventional population perinatal health measures in the U.S. The alarming trends and persistent disparities of outcomes by race/ethnicity and geographic location reinforce the need to focus on ensuring quality and safety of maternity care for all women. Despite complex multilevel factors impacting maternal mortality and morbidity, there are evidence-based interventions that, when facilitated consistently and properly, are known to improve the health of mothers before, during and after pregnancy. The objective of this project is to test implementation of pre-conception counseling with father involvement in community-based settings to improve cardiovascular health outcomes before and during pregnancy in southeastern United States. Methods and analysis: This study has two components: a comprehensive needs and assets assessment and a small-scale pilot study. We will conduct a community informed needs and assets assessment with our diverse stakeholders to identify opportunities and barriers to preconception counseling as well as develop a stakeholder-informed implementation plan. Next, we will use the implementation plan to pilot preconception counseling with father involvement in community-based settings. Finally, we will critically assess the context, identify potential barriers and facilitators, and iteratively adapt the way preconception counseling can be implemented in diverse settings. Results of this research will support future research focused on identifying barriers and opportunities for scalable and sustainable public health approaches to implementing evidence-based strategies that reduce maternal morbidity and mortality in the southeastern United States' vulnerable communities. Discussion: Findings will demonstrate that preconception counseling can be implemented in community health settings in the southeastern United States. Furthermore, this study will build the capacity of community-based organizations in addressing the preconception health of their clients. We plan for this pilot to inform a larger scaled-up clinical trial across community health settings in multiple southeastern states.

Barriers and Facilitators to Implementing Keep It Up!, A Digital Health Intervention, in Community-Based Organizations.

Despite ongoing investments in the development and testing of new digital interventions for HIV prevention, the widespread use of interventions with proven effectiveness remains limited. This study assessed real-world implementation of a digital HIV prevention intervention, Keep It Up!. The study aimed to identify barriers and facilitators to implementing Keep It Up! within community-based organizations (CBOs) serving racially diverse sexual and gender minoritized populations. The Keep It Up! trial is a type III effectiveness-implementation hybrid trial to compare two delivery approaches: direct-to-consumer and CBO-based implementation. This manuscript focuses on the CBO-based approach through interviews with CBO staff members before and during implementation (n = 37 and n = 25, respectively). Interviews were coded according to the Consolidated Framework for Implementation Research and thematically analyzed. Staff highlighted adaptability, leadership engagement, compatibility, and organizational culture as facilitators of Keep It Up! implementation. Identified barriers included self-efficacy, motivation, staff turnover, and partnerships and connections. CBO infrastructure, capacity, research experience, and processes influenced the relative importance of these barriers and facilitators. This study is one of the first to detail barriers and facilitators experienced by staff implementing a digital HIV prevention intervention in CBOs. Interviews illuminated the need for interventions like Keep It Up! for young men who have sex with men and detailed the need for additional strategies to assist CBOs unfamiliar with implementing digital health interventions. Trial Registration Number: NCT03896776.

RESUMEN: A pesar de a las inversiones hechas en el desarrollo y prueba de nuevas intervenciones digitales para prevenir el VIH, el uso generalizado de intervenciones eficaces aun es limitado. Este estudio evaluó la implementación en el mundo real de una intervención digital de prevención del VIH, Keep It Up!. El estudio identificó barreras y facilitadores para implementar Keep It Up! dentro de organizaciones comunitarias que atienden a personas minorizadas por género y sexualidad. El ensayo de Keep It Up! es un ensayo híbrido de efectividad-implementación de tipo III para comparar dos enfoques de entrega: implementación directa al consumidor e implementación en organizaciones comunitarias. Este manuscrito se centra en la implementación en organizaciones comunitarias a través de entrevistas con miembros del personal de las organizaciones antes y durante la implementación (n = 37 y n = 25, respectivamente). Las entrevistas se codificaron de acuerdo con el Marco Conceptual Consolidado para la Investigación de Implementación y se analizaron temáticamente. El personal destacó la adaptabilidad, el compromiso del liderazgo, la compatibilidad, y la cultura organizacional como facilitadores de la implementación de Keep It Up!. Las barreras identificadas incluyeron la autoeficacia, la motivación, la rotación de personal, y las asociaciones y conexiones. La infraestructura, capacidad, experiencia en investigación, y procesos de las organizaciones comunitarias influyeron en la importancia relativa de estas barreras y facilitadores. Este estudio es uno de los primeros en detallar las barreras y los facilitadores que experimenta el personal que implementa una intervención digital de prevención del VIH en las organizaciones comunitarias. Las entrevistas iluminaron la necesidad de intervenciones como Keep It Up! para hombres jóvenes que tienen sexo con hombres y detalló la necesidad de estrategias adicionales para ayudar a las organizaciones comunitarias que no están familiarizadas con la implementación de intervenciones de salud digitales.

Psychiatric nurses' experiences implementing a model for constructive group therapy in mood disorders.

BACKGROUND:  In South Africa, various treatment modalities from abroad have been implemented to treat patients with mood disorders. This article is based on a South African model that has been developed, implemented and evaluated for psychiatric nurses to use in facilitating constructive group therapy for patients with mood disorders. OBJECTIVES:  This study aimed to describe psychiatric nurses' experiences in implementation of a model to facilitate constructive group therapy for patients with mood disorders. METHOD:  A qualitative, exploratory, descriptive and contextual research design was used for this study. Participants were psychiatric nurses working in an inpatient unit for patients with mood disorders in a public psychiatric hospital. RESULTS:  The study revealed that psychiatric nurses experienced the model as a supportive tool to facilitate constructive interaction among patients with mood disorders. The model was beneficial in creating a safe space for patients to share and deal with their challenges, promoting optimal functioning outside the hospital setting. The model's implementation also fostered improvement in psychiatric nurses' personal and professional skills. CONCLUSION:  The model emphasised psychiatric nurses' importance in treating patients with mood disorders and ensuring positive patient experiences and outcomes.Contribution: This study contributes to the theory of clinical psychiatric nursing practice and the empowerment of psychiatric nurses, creating self-awareness related to working with patients with mood disorders.

Improving TRansitions ANd outcomeS for heart FailurE patients in home health CaRe (I-TRANSFER-HF): a type 1 hybrid effectiveness-implementation trial: study protocol.

BACKGROUND: Some of the most promising strategies to reduce hospital readmissions in heart failure (HF) is through the timely receipt of home health care (HHC), delivered by Medicare-certified home health agencies (HHAs), and outpatient medical follow-up after hospital discharge. Yet national data show that only 12% of Medicare beneficiaries receive these evidence-based practices, representing an implementation gap. To advance the science and improve outcomes in HF, we will test the effectiveness and implementation of an intervention called Improving TRansitions ANd OutcomeS for Heart FailurE Patients in Home Health CaRe (I-TRANSFER-HF), comprised of early and intensive HHC nurse visits combined with an early outpatient medical visit post-discharge, among HF patients receiving HHC. METHODS: This study will use a Hybrid Type 1, stepped wedge randomized trial design, to test the effectiveness and implementation of I-TRANSFER-HF in partnership with four geographically diverse dyads of hospitals and HHAs ("hospital-HHA" dyads) across the US. Aim 1 will test the effectiveness of I-TRANSFER-HF to reduce 30-day readmissions (primary outcome) and ED visits (secondary outcome), and increase days at home (secondary outcome) among HF patients who receive timely follow-up compared to usual care. Hospital-HHA dyads will be randomized to cross over from a baseline period of no intervention to the intervention in a randomized sequential order. Medicare claims data from each dyad and from comparison dyads selected within the national dataset will be used to ascertain outcomes. Hypotheses will be tested with generalized mixed models. Aim 2 will assess the determinants of I-TRANSFER-HF's implementation using a mixed-methods approach and is guided by the Consolidated Framework for Implementation Research 2.0 (CFIR 2.0). Qualitative interviews will be conducted with key stakeholders across the hospital-HHA dyads to assess acceptability, barriers, and facilitators of implementation; feasibility and process measures will be assessed with Medicare claims data. DISCUSSION: As the first pragmatic trial of promoting timely HHC and outpatient follow-up in HF, this study has the potential to dramatically improve care and outcomes for HF patients and produce novel insights for the implementation of HHC nationally. TRIAL REGISTRATION: This trial has been registered on ClinicalTrials.Gov (#NCT06118983). Registered on 10/31/2023, https://clinicaltrials.gov/study/NCT06118983?id=NCT06118983&rank=1 .

Breaking the barriers: Methodology of implementation of a non-mydriatic ocular fundus camera in an emergency department.

Despite evidence that non-mydriatic fundus cameras are beneficial in non-ophthalmic settings, they are only available in a minority of hospitals in the US. The lag from research-based evidence to change in clinical practice highlights the complexities of implementation of new technology and practice. We describe the steps used to implement successfully a non-mydriatic ocular fundus camera combined with optical coherence tomography (OCT) in a general emergency department (ED) using Kotter's 8-Step Change Model. We prospectively collected the number of trained personnel in the ED, the number of imaging studies obtained each week during the first year following implementation, and we documented major achievements each month, as well as outcome measures, barriers to implementation and possible solutions. Between 12 and 42 patients were imaged per week, resulting in a total of 1274 patients imaged demonstrating sustained usage of non-mydriatic fundus camera/OCT in the ED one year after implementation. The implementation process was contingent upon multidisciplinary collaboration, extensive communication, coordinated training of staff, and continuous motivation. The future will likely include the use of artificial intelligence deep learning systems for automated interpretation of ocular imaging as an immediate diagnostic aid for ED or other non-eye care providers.

'A challenge to my professional identity'- resisting the shift from over-management to self-management for back pain within an implementation trial: a qualitative study.

OBJECTIVE: The Enhanced Transtheoretical Model Intervention (ETMI) is based on behavioral models and focuses on guiding Chronic Low Back Pain (CLBP) patients to self-manage symptoms and engage in recreational physical activity. While there is promising evidence that ETMI benefits patients, it is unclear how challenging it might be to implement widely. This investigation focused on the perceptions of physiotherapists trained to deliver ETMI for CLBP. DESIGN: A Qualitative study comprised of semi-structured interviews (July to November 2023). Interviews were audio-recorded, transcribed, coded, and analyzed thematically by two independent researchers. SETTING: Data were obtained as part of a large implementation study evaluating the uptake and impact of ETMI amongst physiotherapists in a large public healthcare setting. PARTICIPANTS: 22 physiotherapists trained to deliver the ETMI approach and chose to use it with at least one patient. RESULTS: While physiotherapists acknowledged the evidence base behind ETMI and the clarity of the approach, they struggled to adapt it to routine delivery. Exploration of the reasons for this identified an overarching meta-theme, 'A challenge to my professional identity', and three main themes consisting of 1) interventions such as ETMI contradicted my training. 2) I am ambivalent/ do not accept evidence that contradicts my habitual practice, and 3) I am under-skilled in psychological and communication skills. CONCLUSION: This study highlights the reluctance of physiotherapists to implement evidence-based interventions such as ETMI, which fundamentally challenge their traditional practice and therapeutic identity. The shift from over-management by experts seeking cures to supporting self-management was not palatable to physiotherapists. The challenge of embracing a new professional identity must be addressed to enable a successful implementation of the approach. CONTRIBUTION OF THE PAPER.

Perspectives of health care providers on obstetric point-of-care ultrasound in lower-level health facilities in Kenya.

BACKGROUND: Ultrasound technology has become integral in antenatal care for its diagnostic effectiveness and potential to improve maternal and neonatal outcomes. Despite its proven benefits, challenges persist in its widespread adoption, particularly in low-resource settings like Kenya. AIM: The aim of this study was to explore the perspectives of healthcare providers regarding the integration of obstetric point-of-care ultrasound into routine maternal services in low-level facilities Kenya. METHODS: Using a descriptive qualitative study embedded in a large scale implementation study 76 healthcare providers who had undergone obstetric point-ofcare ultrasound training and were providing maternal services were purposively sampled from healthcare facilities across eight counties. Data was collected using structured audiotaped interviews, which were transcribed, and analyzed using thematic analysis. RESULTS: Five main themes with several subthemes emerged from the analysis: (1) Clinical Decision-Making (2) Quality of Services, (3) Training, (4)Technology Issues, and (5) Sustainability. DISCUSSION: Findings from this study suggest that use of obstetric Point-of-Care Ultrasound in resource-limited primary care settings, can enhance clinical decision making and influence patient management, ultimately resulting in significant health outcomes. CONCLUSION: Equipping health care providers with skills to conduct obstetric point of care ultrasound can lead to better-informed clinical decisions and ultimately contribute to improved health outcomes in underserved populations.

Pre-exposure Prophylaxis (PrEP) implementation among latino MSM: a qualitative scoping review of implementation determinants and change methods.

INTRODUCTION: The increasing rates of HIV among Latino men who have sex with men (MSM) necessitate innovative and rigorous studies to evaluate prevention and treatment strategies. Pre-exposure prophylaxis (PrEP) is a highly effective tool in preventing HIV acquisition and plays a crucial role in the Ending the HIV Epidemic in the U.S. initiative. However, there is a scarcity of PrEP research specifically focused on Latino MSM, and the factors influencing its implementation remain largely unknown. METHODS: To address this gap, we conducted a comprehensive review exploring the determinants (barriers and facilitators) of PrEP implementation among Latino MSM, as well as the change methods (implementation strategies and adjunctive interventions) that have been evaluated to promote its adoption. Our review encompassed 43 peer-reviewed articles examining determinants and four articles assessing change methods. Determinants were coded using the updated Consolidated Framework for Implementation Research (CFIR 2.0) to understand the multilevel barriers and facilitators associated with implementation. RESULTS: The majority of research has focused on PrEP recipients (i.e., patients), primarily examining their awareness and willingness to use PrEP. Fewer studies have explored the factors influencing clinicians and service delivery systems. Additionally, the evaluation of change methods to enhance clinician adoption and adherence to PrEP and recipient adherence to PrEP has been limited. CONCLUSION: It is evident that there is a need for culturally adapted strategies tailored specifically for Latino MSM, as the current literature remains largely unexplored in this regard. By incorporating principles from implementation science, we can gain a clearer understanding of the knowledge, skills, and roles necessary for effective cultural adaptations. Future research should emphasize factors influencing implementation from a clinician standpoint and focus on innovative change methods to increase PrEP awareness, reach, adoption, and sustained adherence among Latino MSM.

Continuous adaptation of conversation aids for uterine fibroids treatment options in a four-year multi-center implementation project.

BACKGROUND: Fibroids are non-cancerous uterine growths that can cause symptoms impacting quality of life. The breadth of treatment options allows for patient-centered preference. While conversation aids are known to facilitate shared decision making, the implementation of these aids for uterine fibroids treatments is limited. We aimed to develop two end-user-acceptable uterine fibroids conversation aids for an implementation project. Our second aim was to outline the adaptations that were made to the conversation aids as implementation occurred. METHODS: We used a multi-phase user-centered participatory approach to develop a text-based and picture-enhanced conversation aid for uterine fibroids. We conducted a focus group with project stakeholders and user-testing interviews with eligible individuals with symptomatic uterine fibroids. We analyzed the results of the user-testing interviews using Morville's Honeycomb framework. Spanish translations of the conversation aids occurred in parallel with the English iterations. We documented the continuous adaptations of the conversation aids that occurred during the project using an expanded framework for reporting adaptations and modifications to evidence-based interventions (FRAME). RESULTS: The first iteration of the conversation aids was developed in December 2018. Focus group participants (n = 6) appreciated the brevity of the tools and suggested changes to the bar graphs and illustrations used in the picture-enhanced version. User-testing with interview participants (n = 9) found that both conversation aids were satisfactory, with minor changes suggested. However, during implementation, significant changes were suggested by patients, other stakeholders, and participating clinicians when they reviewed the content. The most significant changes required the addition or deletion of information about treatment options as newer research was published or as novel interventions were introduced into clinical practice. CONCLUSIONS: This multi-year project revealed the necessity of continuously adapting the uterine fibroids conversation aids so they remain acceptable in an implementation and sustainability context. Therefore, it is important to seek regular user feedback and plan for the need to undertake updates and revisions to conversation aids if they are going to be acceptable for clinical use.

National implementation trial of BeUpstanding™: an online initiative for workers to sit less and move more.

BACKGROUND: The online BeUpstanding™ program is an eight-week workplace-delivered intervention for desk-based workers to raise awareness of the benefits of sitting less and moving more and build a supportive culture for change. A workplace representative (the "champion") delivers the program, which includes a workshop where teams collectively choose their sit less/move more strategies. A toolkit provides the champion with a step-by-step guide and associated resources to support program uptake, delivery, and evaluation. Here we report on the main findings from the Australian national implementation trial of BeUpstanding. METHODS: Recruitment (12/06/2019 to 30/09/2021) was supported by five policy and practice partners, with desk-based work teams from across Australia targeted. Effectiveness was measured via a single arm, repeated-measures trial. Data were collected via online surveys, toolkit analytics, and telephone calls with champions. The RE-AIM framework guided evaluation, with adoption/reach (number and characteristics); effectiveness (primary: self-reported workplace sitting time); implementation (completion of core components; costs); and, maintenance intentions reported here. Linear mixed models, correcting for cluster, were used for effectiveness, with reach, adoption, implementation, and maintenance outcomes described. RESULTS: Of the 1640 website users who signed-up to BeUpstanding during the recruitment period, 233 were eligible, 198 (85%) provided preliminary consent, and 118 (50.6%) champions consented and started the trial, with 94% (n = 111 champions) completing. Trial participation was from across Australia and across industries, and reached 2,761 staff, with 2,248 participating in the staff survey(s): 65% female; 64% university educated; 17% from a non-English speaking background. The program effectively changed workplace sitting (-38.5 [95%CI -46.0 to -28.7] minutes/8-hour workday) and all outcomes targeted by BeUpstanding (behaviours and culture), with small-to-moderate statistically-significant effects observed. All participating teams (n = 94) completed at least 5/7 core steps; 72.4% completed all seven. Most champions spent $0 (72%) or >$0-$5 (10%) per team member; most (67/70 96%) intended to continue or repeat the program. CONCLUSIONS: BeUpstanding can be adopted and successfully implemented by a range of workplaces, reach a diversity of staff, and be effective at creating a supportive culture for teams of desk-based workers to sit less and move more. Learnings will inform optimisation of the program for longer-term sustainability. TRIAL REGISTRATION: ACTRN12617000682347.

Effects of implementation strategies on nursing practice and patient outcomes: a comprehensive systematic review and meta-analysis.

BACKGROUND: Implementation strategies targeting individual healthcare professionals and teams, such as audit and feedback, educational meetings, opinion leaders, and reminders, have demonstrated potential in promoting evidence-based nursing practice. This systematic review examined the effects of the 19 Cochrane Effective Practice and Organization Care (EPOC) healthcare professional-level implementation strategies on nursing practice and patient outcomes. METHODS: A systematic review was conducted following the Cochrane Handbook, with six databases searched up to February 2023 for randomized studies and non-randomized controlled studies evaluating the effects of EPOC implementation strategies on nursing practice. Study selection and data extraction were performed in Covidence. Random-effects meta-analyses were conducted in RevMan, while studies not eligible for meta-analysis were synthesized narratively based on the direction of effects. The quality of evidence was assessed using GRADE. RESULTS: Out of 21,571 unique records, 204 studies (152 randomized, 52 controlled, non-randomized) enrolling 36,544 nurses and 340,320 patients were included. Common strategies (> 10% of studies) were educational meetings, educational materials, guidelines, reminders, audit and feedback, tailored interventions, educational outreach, and opinion leaders. Implementation strategies as a whole improved clinical practice outcomes compared to no active intervention, despite high heterogeneity. Group and individual education, patient-mediated interventions, reminders, tailored interventions and opinion leaders had statistically significant effects on clinical practice outcomes. Individual education improved nurses' attitude, knowledge, perceived control, and skills, while group education also influenced perceived social norms. Although meta-analyses indicate a small, non-statistically significant effect of multifaceted versus single strategies on clinical practice, the narrative synthesis of non-meta-analyzed studies shows favorable outcomes in all studies comparing multifaceted versus single strategies. Group and individual education, as well as tailored interventions, had statistically significant effects on patient outcomes. CONCLUSIONS: Multiple types of implementation strategies may enhance evidence-based nursing practice, though effects vary due to strategy complexity, contextual factors, and variability in outcome measurement. Some evidence suggests that multifaceted strategies are more effective than single component strategies. Effects on patient outcomes are modest. Healthcare organizations and implementation practitioners may consider employing multifaceted, tailored strategies to address local barriers, expand the use of underutilized strategies, and assess the long-term impact of strategies on nursing practice and patient outcomes. TRIAL REGISTRATION: PROSPERO CRD42019130446.

Mobilizing strategic inflection points for sustainment of an effective intervention in an integrated learning health system: an interpretive description.

BACKGROUND: Innovative models of care have the potential to improve the sustainability of health systems by improving patient and provider experiences and population outcomes while simultaneously reducing costs. Yet, it is challenging to recognize the distinctive points during research and quality improvement processes that contribute to sustainment of effective interventions. The business concept of an inflection point-the position on the curve of a trajectory where the progress in implementation of an intervention is accelerated or decelerated-may be useful to understand implementation and improve sustainability and ultimately sustainment of effective interventions. The purpose of this study was to retrospectively identify and describe strategic inflection points that accelerated the sustainability process and led to the sustainment of Alberta Family Integrated Care. METHODS: This qualitative study was conducted in Alberta, Canada and employed an interpretive description design. Purposively sampled documents (proposals, project management plans, reports to funders and sponsors, meeting minutes, and fidelity audit and feedback checklists) from the Alberta Family Integrated Care cluster randomized controlled trial and quality improvement project constituted data for this study. RESULTS: To accelerate sustainability in the research context, we identified (1) alignment with strategic priorities, (2) iterative, user-centered co-design, and (3) contextualization of implementation as strategic inflection points. To accelerate sustainability in the health system context, we identified (1) the learning health system, (2) enduring partnerships, (3) responsivity to societal and system change, (4) embedded governance, and (5) intentional integration into the health system as strategic inflection points. Capitalizing on these strategic inflection points led to sustainment of Alberta Family Integrated Care in the provincial health system. CONCLUSIONS: We identified key inflection points in the research and health system contexts that led to sustainment of Alberta Family Integrated Care. By anticipating, recognizing, and leveraging inflection points in the sustainability process, researchers may be able to accelerate implementation and achieve sustainment of multi-component interventions in complex systems. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02879799. Registration date: May 27, 2016. Protocol version: June 9, 2016; version 2. Protocol publication: https://doi.org/10.1186/s13063-017-2181-3 .

Protocol for COACH, an evidence-based intervention for improved head impact safety in youth American football developed using a community-engaged approach.

Subconcussive, repetitive head impacts sustained in collision sports may negatively affect brain health. American football practices are controlled environments amenable to intervention. Engaging community members is essential for successful development, implementation, and sustainability of viable interventions. The objective of this study is to develop and pilot test an evidence-based intervention to reduce head impact exposure in youth American football (i.e., football), using a community-engaged approach. This manuscript describes the co-design of the intervention and associated implementation plan and the study protocol for evaluating the effectiveness and feasibility of the intervention and implementation plan. In the first part of this study, focus groups with parents and coaches, and individual interviews with organizational leaders associated with two teams at the middle school level were conducted. An anonymous survey assessing beliefs and perceptions of non-concussive head impacts was given to parents, coaches, and organizational leaders within the local youth football league. Following the football season, qualitative and quantitative data describing determinants of head acceleration events in football were shared with 12 stakeholders of coaches, league and school administrators, parents, an athletic trainer, and local university player development director. Together, we co-designed COACH (COmmunities Aligned to reduce Concussion and Head impact exposure) and implementation plan using a strategic planning approach. The preliminary effectiveness and feasibility were assessed in the second part of this study. Youth football players participating on the teams in year 1 (control teams) were fitted with mouthpiece-based head kinematic sensors which measure head acceleration events (HAEs). HAEs were collected and quantified during team activities. Preliminary effectiveness of the intervention to reduce HAEs was measured among two new teams pilot testing COACH with mouthpiece-based sensors, while simultaneously monitoring implementation of the intervention. We report our study design and evaluation, and opportunities and challenges with our approach. The results will inform a future full-scale pragmatic trial to assess the implementation and effectiveness of the intervention program. NCT04908930.

Applying an extended theoretical approach to identifying Canadian dental students' acceptance of teledentistry: A cross-sectional study.

Objective: Teledentistry is a promising innovation for improving service quality and patient outcomes. While studies have shown the relevance of theoretical frameworks in understanding behaviour change predictors for telehealth implementation efforts, their application in dentistry is limited. This study aimed to test different theoretical approaches to identify the factors affecting dental students' behavioural intention to use teledentistry. Methods: This cross-sectional study involved students in their final two years of undergraduate dental programmes, from three Canadian provinces (Quebec, Nova Scotia, and Saskatchewan) using an electronic self-reported questionnaire. Following descriptive analyses, we tested three theoretical models (the technology acceptance model, psychosocial model, and integrated model) using path analysis and multiple linear regression analysis. We analyzed the modifying effect of sociodemographic characteristics and prior use of teledentistry. Results: Out of the 46 students who participated, the majority were female (53.5%) and aged over 25 years (62.8%). The three models successfully explained a substantial portion of the variance in behavioural intention to use teledentistry, ranging from 58.0% to 76.6%. Social role beliefs (p < 0.001) and control beliefs (p < 0.001) were the most significant predictors of behavioural intention to use. Prior use of teledentistry modified the association between control beliefs and behavioural intention to use teledentistry. Conclusions: The original technology acceptance model was a good predictive model of behavioural intention to use teledentistry with perceived use as the strongest predictor. However, the integrated model performed the best in highlighting the relevance of training and education to foster teledentistry implementation in dental schools. The generalizability of the findings is constrained by the modest sample size, warranting larger studies for validation.

Considerations for widespread implementation of blood-based biomarkers of Alzheimer's disease.

Diagnosing Alzheimer's disease (AD) poses significant challenges to health care, often resulting in delayed or inadequate patient care. The clinical integration of blood-based biomarkers (BBMs) for AD holds promise in enabling early detection of pathology and timely intervention. However, several critical considerations, such as the lack of consistent guidelines for assessing cognition, limited understanding of BBM test characteristics, insufficient evidence on BBM performance across diverse populations, and the ethical management of test results, must be addressed for widespread clinical implementation of BBMs in the United States. The Global CEO Initiative on Alzheimer's Disease BBM Workgroup convened to address these challenges and provide recommendations that underscore the importance of evidence-based guidelines, improved training for health-care professionals, patient empowerment through informed decision making, and the necessity of community-based studies to understand BBM performance in real-world populations. Multi-stakeholder engagement is essential to implement these recommendations and ensure credible guidance and education are accessible to all stakeholders.

Spine surgical site infection outcome with preoperative application of a pre-saturated 10% povidone-iodine nasal decolonization product in a 32-bed surgical hospital.

BACKGROUND: To pursue an irreducible minimum overall surgical site infection (SSI) rate, a 32-bed surgical hospital employed an outside consultant and performed sterile processing and surgery internal audits: no obvious improvements were identified. A ten-year review determined 70% of SSI's were spine procedure patients. After a nasal decolonization product literature review an intervention was implemented. The purpose of this study was to assess if the intervention impacted spine SSI rates. METHODS: A 36-month implementation science study was conducted. The 18-month intervention was immediate preoperative application of a manufactured pre-saturated 10% povidone iodine nasal decolonization product in spine surgery patients, with monthly product application documentation surveillance feedback to the preoperative staff. Chi-square test was used to determine the difference in types of spine SSI surgery rates pre and post intervention. RESULTS: Overall spine SSI decreased 35.7% (p=0.04) with 58.7% reduction in superficial incisional SSI (p=0.02). The 16.1% decline in deep incisional SSI was not significant (p=0.29). CONCLUSION: Within this hospital, conducting 7,576 surgical spine procedures over 36-months, with the immediate preoperative application of a pre-saturated ten percent povidone-iodine nasal decolonization product, the only intervention in SSI prevention protocol, produced a statistically significant decrease in spine patient SSI rate percent.

Promoting sustained access to cognitive behavioral therapy for insomnia in Australia: a system-level implementation program.

STUDY OBJECTIVES: Insomnia is a highly prevalent and debilitating disorder. Cognitive behavioral therapy for insomnia (CBTi) is the recommended 'fist line' treatment, but is accessed by a minority of people with insomnia. This paper describes a system-level implementation program to improve access to CBTi in Australia to inform CBTi implementation in other locations. METHODS: From 2019 to 2023, we conducted a program of work to promote sustained change in access to CBTi in Australia. Three distinct phases included 1) Scoping and mapping barriers to CBTi access, 2) Analysis and synthesis of barriers and facilitators to devise change goals, and 3) Structured promotion and coordination of change. We used a system-level approach, knowledge brokerage, and co-design, and drew on qualitative, quantitative, and implementation science methods. RESULTS: We identified barriers to CBTi access from the perspectives of people with insomnia, primary care clinicians, and the health system. A stakeholder advisory committee was convened to co-design change goals, identify modifiable barriers, devise program logic and drive change strategies. We commenced a program to promote system-level change in CBTi access via; improved awareness and education of insomnia among primary care clinicians, self-guided interventions, and advocating to Government for additional CBTi funding mechanisms. CONCLUSIONS: This implementation program made significant progress toward improving access to CBTi in Australia. Ongoing work is required to continue this program, as long-term system-level change requires significant and sustained time, effort and resources from multiple stakeholders. This program may be used to inform CBTi implementation activities in other locations.

A novel rural hospital/clinic-system practice-based research network: the Rural Addiction Implementation Network (RAIN) initiative and its goals, implementation, and early results.

Background: Rural and frontier communities face high rates of opioid use disorders (OUDs). In 2021, the Rural Addiction Implementation Network (RAIN) sought to establish a rural hospital/clinic-system practice-based research network (RH-PBRN) to facilitate implementation of evidence-based addiction-related prevention, treatment, and recovery (PTR) services to reduce the morbidity of OUD and substance use disorder (SUD) in rural communities.Objective: To describe the goals and implementation of PTR activities of RAIN, a novel RH-PBRN.Methods: RAIN identified teams of external/internal facilitators at four rural hospitals/clinic-networks to achieve at least 15 PTR activities involving OUD and other SUDs. RAIN utilized an implementation-facilitation approach: facilitators assessed the implementation environment and promoted interventions to overcome barriers to PTR implementation. Other interventions included site visits, community of learning calls, and e-communication. RAIN assessed and recorded facilitators and barriers to implementation, milestone attainment, and outcomes of PTR activities. At 18 months, we queried facilitators about the fidelity and implementation of RAIN activities.Results: RAIN established an HP-PBRN in four sites (Idaho, Montana, Utah, and Wyoming). Within the HP-PBRN, 20 PTR activities were established (p = 7, T = 10, R = 3; range 3-7 per site). Barriers to implementation of PTR activities included competing clinical demands, especially due to COVID-19, lack of dedicated effort for staff at sites, and stigma of addiction and its treatment. Facilitators of implementation included the use of trained expert facilitators and communication between the sites.Conclusions: RAIN implemented 20 addiction-related PTR activities in four rural hospitals/clinic-networks. RAIN's intervention model could be replicated to address addiction-related harms in other rural communities.

The Positive School Safety Program (PSSP) for School Officers: Implementation Processes and Outcomes.

Approximately 50% of U.S. students attend a school with a school officer. The Positive School Safety Program (PSSP) is a 16-session, manualized peer-to-peer coaching program that teaches school officers positive approaches to behavioral management (e.g., trauma-informed reinforcement strategies) to enhance interactions with students, improve school climate, and reduce school-based arrests. A convergent, mixed methods longitudinal design was used to investigate the implementation process and outcomes of the PSSP among school safety officer coaches in the School District of Philadelphia (SDP) who were trained in the 2020-2021 school year. Via surveys, officer coaches (n = 25) provided quantitative data at three time points regarding their knowledge, attitudes, and confidence in utilizing positive approaches to behavioral management and trauma-informed skills, as well as their mindset toward coaching. These data were analyzed using mixed effects modeling. Perceptions of program acceptability, appropriateness, and feasibility were assessed post-training and analyzed descriptively. Qualitative interviews, informed by the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, were conducted with coaches and untrained school officers and were analyzed via thematic analysis. Significant changes over the course of training were detected in coaches' knowledge, confidence, and their willingness to use the skills, which aligned with coaches' qualitative self-reports. Coaches agreed that the PSSP was acceptable, appropriate, and feasible. School districts interested in improving school climate and reducing school-based arrests by using the PSSP, or similar peer-to-peer coaching programs, should consider how they will target identified determinants to support successful implementation in their unique contexts.

Current status of implementation of trauma registries' in LMICs & facilitators to implementation barriers: A literature review & consultation.

Background & objectives Many low- and middle- income countries (LMICs) have attempted to implement trauma registries with varying degrees of success. This study aimed to understand the registry implementation mechanism in LMICs better. Study objectives include assessment of the current use of trauma registries in LMICs, identification of barriers to the process and potential areas for intervention, and investigation of the registry implementation experience of key stakeholders in LMICs. Methods An initial narrative review of articles on trauma registry use in LMICs published in English between January 2017 and September 2023 was conducted. Key findings identified in this review were used to establish a theoretical framework from which an interview guide was subsequently developed. Expert consultation with key stakeholders in trauma registry implementation in two LMICs was conducted to assess the experience of registry implementation further. Results The presence of trauma registries in LMICs is limited. Key implementation barriers include funding concerns, uncoordinated administrative efforts, lack of human and physical resources (i.e., technology, equipment), and challenges in data management, analysis, and quality. Stakeholder interviews highlighted the importance of trauma registry development but echoed some obstacles, notably funding and data collection barriers. Interpretation & conclusions Barriers to registry implementation are ubiquitous and may contribute to the low uptake of registries in LMICs. One potential solution to these challenges is the application of the WHO International Registry for Trauma and Emergency Care. Future studies examining context-specific challenges to registry implementation and sustained utilization are required.