Digital transformation in schools of two southern regions of Sweden through implementation-informed approach: A mixed-methods study protocol.

BACKGROUND: The enhancement of-or even a shift from-traditional teaching and learning processes to corresponding digital practices has been rapidly occurring during the last two decades. The evidence of this ongoing change is still modest or even weak. However, the adaptation of implementation science in educational settings, a research approach which arose in the healthcare field, offers promising results for systematic and sustained improvements in schools. The aim of this study is to understand how the systematic professional development of teachers and schools principals (the intervention) to use digital learning materials and learning analytics dashboards (the innovations) could allow for innovative and lasting impacts in terms of a sustained implementation strategy, improved teaching practices and student outcomes, as well as evidence-based design of digital learning material and learning analytics dashboards. METHODS: This longitudinal study uses a quasi-experimental cluster design with schools as the unit. The researchers will enroll gradually 145 experimental schools in the study. In the experimental schools the research team will form a School Team, consisting of teachers/learning-technologists, school principals, and researchers, to support teachers' use of the innovations, with student achievement as the dependent variable. For the experimental schools, the intervention is based on the four longitudinal stages comprising the Active Implementation Framework. With an anticipated student sample of about 13,000 students in grades 1-9, student outcomes data are going to be analyzed using hierarchical linear models. DISCUSSION: The project seeks to address a pronounced need for favorable conditions for children's learning supported by a specific implementation framework targeting teachers, and to contribute with knowledge about the promotion of improved teaching practices and student outcomes. The project will build capacity using implementation of educational technology in Swedish educational settings.

Normalization of Prevention Principles and Practices to Reduce Substance Use Disorders Through an Integrated Dissemination and Implementation Framework.

Major research breakthroughs over the past 30 years in the field of substance use prevention have served to: (1) enhance understanding of pharmacological effects on the central and peripheral nervous systems and the health and social consequences of use of psychoactive substances, particularly for children and adolescents; (2) delineate the processes that increase vulnerability to or protect from initiation of substance use and progression to substance use disorders (SUDs) and, based on this understanding, (3) develop effective strategies and practices to prevent the initiation and escalation of substance use. The challenge we now face as a field is to "normalize" what we have learned from this research so that it is incorporated into the work of those involved in supporting, planning, and delivering prevention programming to populations around the world, is integrated into health and social service systems, and helps to shape public policies. But we wish to go further, to incorporate these effective prevention practices into everyday life and the mind-sets of the public, particularly parents and educators. This paper reviews the advances that have been made in the field of prevention and presents a framework and recommendations to achieve these objectives generated during several meetings of prevention and implementation science researchers sponsored by the International Consortium of Universities for Drug Demand Reduction (ICUDDR) that guides a roadmap to achieve "normalization."

Repeated measures of implementation variables.

It is commonly acknowledged that implementation work is long-term and contextual in nature and often takes years to accomplish. Repeated measures are needed to study the trajectory of implementation variables over time. To be useful in typical practice settings, measures that are relevant, sensitive, consequential, and practical are needed to inform planning and action. If implementation independent variables and implementation dependent variables are to contribute to a science of implementation, then measures that meet these criteria must be established. This exploratory review was undertaken to "see what is being done" to evaluate implementation variables and processes repeatedly in situations where achieving outcomes was the goal (i.e., more likely to be consequential). No judgement was made about the adequacy of the measure (e.g., psychometric properties) in the review. The search process resulted in 32 articles that met the criteria for a repeated measure of an implementation variable. 23 different implementation variables were the subject of repeated measures. The broad spectrum of implementation variables identified in the review included innovation fidelity, sustainability, organization change, and scaling along with training, implementation teams, and implementation fidelity. Given the long-term complexities involved in providing implementation supports to achieve the full and effective use of innovations, repeated measurements of relevant variables are needed to promote a more complete understanding of implementation processes and outcomes. Longitudinal studies employing repeated measures that are relevant, sensitive, consequential, and practical should become common if the complexities involved in implementation are to be understood.

Competences for implementation science: what trainees need to learn and where they learn it.

Education in implementation science, which involves the training of health professionals in how to implement evidence-based findings into health practice systematically, has become a highly relevant topic in health sciences education. The present study advances education in implementation science by compiling a competence profile for implementation practice and research and by exploring implementation experts' sources of expertise. The competence profile is theoretically based on educational psychology, which implies the definition of improvable and teachable competences. In an online-survey, an international, multidisciplinary sample of 82 implementation experts named competences that they considered most helpful for conducting implementation practice and implementation research. For these competences, they also indicated whether they had acquired them in their professional education, additional training, or by self-study and on-the-job experience. Data were analyzed using a mixed-methods approach that combined qualitative content analyses with descriptive statistics. The participants deemed collaboration knowledge and skills most helpful for implementation practice. For implementation research, they named research methodology knowledge and skills as the most important ones. The participants had acquired most of the competences that they found helpful for implementation practice in self-study or by on-the-job experience. However, participants had learned most of their competences for implementation research in their professional education. The present results inform education and training activities in implementation science and serve as a starting point for a fluid set of interdisciplinary implementation science competences that will be updated continuously. Implications for curriculum development and the design of educational activities are discussed.

Learning Active Implementation Frameworks: the role of implementation teams in a case study from Pakistan.

In Pakistan, although coverage of Maternal, Newborn, and Child Health (MNCH) services has increased, the attributable disease burden remains high, indicating quality of these services remains suboptimal. To address this quality gap, challenges associated with the implementation of MNCH services will need to be addressed and effective use of the various MNCH guidelines will need to be supported, evaluated, and continuously improved. Even though the application of the field of implementation science and practice in the low- and middle-income settings has been limited, it is our belief, based on the experience described in this article that these competencies could enhance health professionals' ability to, not only successfully integrate MNCH guidelines into health systems, but to also support their effective and sustainable use. To address this capacity gap in Pakistan, the Health Services Academy, as a member of the World Health Organization's Human Reproduction Program (HRP) Alliance for Research Capacity Strengthening (RCS), has engaged, over the course of 16 months, in the 'Implementation for the Professional Learner Program' in 2019. This innovative implementation science and practice capacity-building program is developed and conducted by The World Health Organization (WHO) Collaborating Centre for Research Evidence for Sexual and Reproductive Health at the University of North Carolina at Chapel Hill (UNC). The initial cohort of this Program also included Palestine's West Bank, and Egypt. The objectives of this Program were to cultivate implementation science and practice competencies, and to support the development of national, community-based or institution-based implementation teams. The expected outcomes of this program included, further enhancement of the capacity of local health professionals in implementation science, systemic change and the effective use of innovations in practice at sub-national/regional levels.

The Teaching-Family Model: The First 50 Years.

The Teaching-Family Model was perhaps the first "evidence-based program" in human services. This article describes the development of the treatment model, the failure of the first attempts to replicate the treatment model, the discovery of larger units for replication, the modest success of first attempts to replicate larger units, and the eventual success of replications. The Teaching-Family Model is a testament to the sustainability (and continual improvement) of innovation and implementation methods and the value of the Teaching-Family Association for sustaining a community of practice and for managing the practitioner fidelity and organization fidelity data systems nationally. The benefits of applied behavior analysis and the implications for a new science of implementation for having research purposefully used in practice are explored.

Implementing Innovations in Global Women's, Children's, and Adolescents' Health: Realizing the Potential for Implementation Science.

The launch of the United Nations Sustainable Development Goals and the new Secretary General's Global Strategy for Women's, Children's, and Adolescents' Health are a window of opportunity for improving the health and well-being of women, children, and adolescents in the United States and around the world. Realizing the full potential of this historic moment will require that we improve our ability to successfully implement life-saving and life-enhancing innovations, particularly in low-resource settings. Implementation science, a new and rapidly evolving field that addresses the "how-to" component of providing sustainable quality services at scale, can make an important contribution on this front. A synthesis of the implementation science evidence indicates that three interrelated factors are required for successful, sustainable outcomes at scale: 1) effective innovations, 2) effective implementation, and 3) enabling contexts. Implementation science addresses the interaction among these factors to help make innovations more usable, to build ongoing capacity to assure the effective implementation of these innovations, and to ensure enabling contexts to sustain their full and effective use in practice. Improving access to quality services will require transforming health care systems and, therefore, much of the focus of implementation science in global health is on improving the ability of health systems to serve as enabling contexts. The field of implementation science is inherently interdisciplinary and academe will need to respond by facilitating collaboration among scientists from relevant disciplines, including evaluation, improvement, and systems sciences. Platforms and programs to facilitate collaborations among researchers, practitioners, policymakers, and funders are likewise essential.

Implementing Effective Educational Practices at Scales of Social Importance.

Implementing evidence-based practices is becoming both a goal and standard across medicine, psychology, and education. Initial successes, however, are now leading to questions about how successful demonstrations may be expanded to scales of social importance. In this paper, we review lessons learned about scaling up evidence-based practices gleaned from our experience implementing school-wide positive behavioral interventions and supports (PBIS) across more than 23,000 schools in the USA. We draw heavily from the work of Flay et al. (Prev Sci 6:151-175, 2005. doi: 10.1007/s11121-005-5553-y ) related to defining evidence-based practices, the significant contributions from the emerging "implementation science" movement (Fixsen et al. in Implementation research: a synthesis of the literature, University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network (FMHI Publication #231), Tampa 2005), and guidance we have received from teachers, family members, students, and administrators who have adopted PBIS.

When evidence is not enough: the challenge of implementing fall prevention strategies.

PROBLEM: As the evidence-based movement has advanced in public health, changes in public health practices have lagged far behind creating a science to service gap. For example, science has produced effective falls prevention interventions for older adults. It now is clearer WHAT needs to be done to reduce injury and death related to falls. However, issues have arisen regarding HOW to assure the full and effective uses of evidence-based programs in practice. SUMMARY: Lessons learned from the science and practice of implementation provide guidance for how to change practices by developing new competencies, how to change organizations to support evidence-based practices, and how to change public health systems to align system functions with desired practices. The combination of practice, organization, and system change likely will produce the public health benefits that are the promise of evidence-based falls prevention interventions. IMPACT ON PUBLIC HEALTH: For the past several decades, the emphasis has been solely on evidence-based interventions. Public health will benefit from giving equal emphasis to evidence-based implementation. IMPACT ON INDUSTRY: We now have over two decades of research on the effectiveness of fall prevention interventions. The quality of this research is judged by a number of credible international organizations, including the Cochrane Collaboration (http://www.cochrane.org/), the American and British Geriatrics Societies, and the Campbell Collaboration (http://www.campbellcollaboration.org/). These international bodies were formed to ponder and answer questions related to the quality and relevance of research. These developments are a good first step. However, while knowing WHAT to do (an evidence-based intervention) is critical, we also need to know HOW to effectively implement the evidence. Implementation, organization change, and system change methods produce the conditions that allow and support the full and effective use of evidence-based interventions. It is time to focus on utilization of implementation knowledge in public health. Without this focus the vast amount on new evidence being generated on the prevention of falls and related injuries among older adults will have little impact on their health and safety.

Mobilizing communities for implementing evidence-based youth violence prevention programming: a commentary.

Evidence-based programs have struggled for acceptance in human service settings. Information gleaned from these experiences indicates that implementation is the missing link in the science to service chain. The science and practice of implementation is progressing and can inform approaches to full and effective uses of youth violence prevention programs nationally. Implementation Teams that know (a) innovations, (b) implementation best practices, and (c) improvement cycles are essential to mobilizing support for successful uses of evidence-based programs on a socially significant scale. The next wave of development in implementation science and practice is underway: establishing infrastructures for implementation to make implementation expertise available to communities nationally. Good science, implemented well in practice, can benefit all human services, including youth violence prevention.

Specifying and reporting complex behaviour change interventions: the need for a scientific method.

Complex behaviour change interventions are not well described; when they are described, the terminology used is inconsistent. This constrains scientific replication, and limits the subsequent introduction of successful interventions. Implementation Science is introducing a policy of initially encouraging and subsequently requiring the scientific reporting of complex behaviour change interventions.

Research utilization among children's mental health providers.

BACKGROUND: Children with emotional and behavioural disorders should be able to count on receiving care that meets their needs and is based on the best scientific evidence available, however, many do not receive these services. Implementation of evidence-based practice (EBP) relies, in part, on the research utilization practices of mental health care providers. This study reports on a survey of research utilization practices among 80 children's mental health (CMH) service provider organizations in Ontario, Canada. METHODS: A web-based survey was distributed to 80 CMH service provider organizations, to which 51 executive directors and 483 children's mental health practitioners responded. Research utilization was assessed using questions with Likert-type responses based on the Canadian Health Services Research Foundation's Four-A's approach: access, assess, adapt, apply. RESULTS: There was general agreement among executive directors and practitioners regarding the capacity of their organizations to use - access, assess, adapt, and apply - research evidence. Overall, both groups rated their organizations as using research information 'somewhat well.' The low response rate to the practitioner survey should be noted. CONCLUSION: These findings provide a useful benchmark from which changes in reported research utilization in the Ontario CMH sector can be tracked over time, as a function of EBP training and implementation initiatives, for instance. The need to improve access to research evidence should be addressed because it relates to the eventual implementation and uptake of evidence-based practices. Communities of practice are recommended as a strategy that would enable practitioners to build capacity in their adaptation and application of research evidence.