Evidence-based treatment delivery in nontraditional settings: Comparing treatment dropout, barriers, and attitudes in a mobile unit versus an outpatient clinic.

INTRODUCTION: Families of young children face numerous barriers to accessing evidence-based mental health treatments. These barriers contribute to low engagement and treatment dropout; thus, researchers have examined initiatives to reduce barriers and increase treatment involvement, such as the use of mobile health units (MHUs). Initial research suggests the delivery of services using MHUs is promising for treatment outcomes, yet little is known about whether MHUs improve access to services for long-term mental health treatments, particularly for families of young children. METHOD: The current study explored differences for families participating in parent-child interaction therapy (PCIT) delivered in an MHU versus an outpatient clinic. We compared treatment dropout, number of sessions attended, as well as reported barriers and treatment attitudes across locations. RESULTS: Findings indicated comparable dropout rates and severity of treatment barriers, but families accessing services at the MHU reported less positive treatment attitudes compared with families at the outpatient clinic. DISCUSSION: Our results highlight the need to understand the impact of MHUs for delivering mental health services, specifically which barriers are addressed, how this influences treatment completion, and how delivery of services in an MHU can influence family perceptions of therapy. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Practitioner use of and attitudes towards videoconferencing for the delivery of evidence-based telemental health interventions: A mixed methods study.

The implementation of evidence-based psychosocial interventions using video-conference delivery (VCD) has the potential to increase accessibility to effective treatments, although its use remains limited and understudied. This study employed a mixed methods approach in surveying mental health practitioners about their attitudes regarding VCD of interventions that are considered evidence-based (i.e., have been shown to improve targeted outcomes in rigorous research). One hundred and eleven practitioners were sampled from several national and regional U.S. practice organizations and were administered quantitative surveys about their use of and attitudes towards VCD of evidence-based interventions (EBI). We examined the relationship between practitioner-level technology access, experience, and training with technology fluency and acceptability of using VCD. Quantitative results indicated the most frequently used adaptation for VCD was Tailoring and that practitioner education predicted attitudes towards EBIs. A subset (n = 20) of respondents were then purposively selected for qualitative interviews to further investigate accessibility, appropriateness, and feasibility of delivering EBIs via video conference. A conventional content analysis revealed that VCD was appropriate and acceptable for EBIs; however, many practitioners also described barriers related to feasibility of implementation. The results of this study have important implications for telemental health dissemination efforts which seek to extend services to populations not served well by traditional, in-person mental health services.

Aligning implementation and user-centered design strategies to enhance the impact of health services: results from a concept mapping study.

BACKGROUND: Innovative approaches are needed to maximize fit between the characteristics of evidence-based practices (EBPs), implementation strategies that support EBP use, and contexts in which EBPs are implemented. Standard approaches to implementation offer few ways to address such issues of fit. We characterized the potential for collaboration with experts from a relevant complementary approach, user-centered design (UCD), to increase successful implementation. METHOD: Using purposive and snowball sampling, we recruited 56 experts in implementation (n = 34) or UCD (n = 22). Participants had 5+ years of professional experience (M = 10.31), worked across many settings (e.g., healthcare, education, human services), and were mostly female (59%) and white (73%). Each participant completed a web-based concept mapping structured conceptualization task. They sorted strategies from established compilations for implementation (36 strategies) and UCD (30 strategies) into distinct clusters, then rated the importance and feasibility of each strategy. RESULTS: We used multidimensional scaling techniques to examine patterns in the sorting of strategies. Based on conceptual clarity and fit with established implementation frameworks, we selected a final set of 10 clusters (i.e., groups of strategies), with five implementation-only clusters, two UCD-only clusters, and three trans-discipline clusters. The highest-priority activities (i.e., above-average importance and feasibility) were the trans-discipline clusters plus facilitate change and monitor change. Implementation and UCD experts sorted strategies into similar clusters, but each gave higher importance and feasibility ratings to strategies/clusters from their own discipline. CONCLUSIONS: In this concept mapping study, experts in implementation and UCD had perspectives that both converged (e.g., trans-discipline clusters, which were all rated as high-priority) and diverged (e.g., in importance/feasibility ratings). The results provide a shared understanding of the alignment between implementation science and UCD, which can increase the impact and sustainability of EBP implementation efforts. Implications for improved collaboration among implementation and UCD experts are discussed.

Integrating implementation and user-centred design strategies to enhance the impact of health services: protocol from a concept mapping study.

BACKGROUND: Innovative approaches are needed to maximise the uptake and sustainment of evidence-based practices in a variety of health service contexts. This protocol describes a study that will seek to characterise the potential of one such approach, user-centred design (UCD), which is an emerging field that seeks to ground the design of an innovation in information about the people who will ultimately use that innovation. The use of UCD to enhance strategies for implementation of health services, although promising, requires a multidisciplinary perspective based on a firm understanding of how experts from each discipline perceives the interrelatedness and suitability of these strategies. METHOD: This online study will use a combination of purposive and snowball sampling to recruit a sample of implementation experts (n = 30) and UCD experts (n = 30). These participants will each complete a concept mapping task, which is a mixed-method conceptualisation technique that will allow for identification of distinct clusters of implementation and/or UCD strategies. The research team has selected a set of implementation strategies and UCD strategies that each participant will sort and rate on dimensions of importance and feasibility. Data analyses will focus on describing the sample, identifying related clusters of strategies, and examining the convergences, divergences, and potential for collaboration between implementation science and UCD. DISCUSSION: By leading to a better understanding of the overlap between implementation science and UCD, grounded within established theoretical frameworks, this study holds promise for improving the impact and sustainability of evidence-based health services in community settings.

A glossary of user-centered design strategies for implementation experts.

User-centered design (UCD), a discipline that seeks to ground the design of an innovation in information about the people who will ultimately use that innovation, has great potential to improve the translation of evidence-based practices from behavioral medicine research for implementation in health care settings. UCD is a diverse, innovative field that remains highly variable in terms of language and approaches. Ultimately, we produced a glossary of UCD-related strategies specifically for experts in implementation research and practice, with the goal of promoting interdisciplinary collaboration in implementation efforts. We conducted a focused literature review to identify key concepts and specific strategies of UCD to translate into the implementation field. We also categorized the strategies as primarily targeting one or more levels of the implementation process (i.e., interventions, individuals, inner context, and outer context). Ultimately, we produced a glossary of 30 UCD strategies for implementation experts. Each glossary term is accompanied by a short, yet comprehensive, definition. The strategies and their definitions are illustrated, using a hypothetical behavioral medicine intervention as an example, for each of the four levels of the implementation process. This UCD glossary may prove useful to implementation experts who wish to develop effective collaborations and "shared language" with UCD experts to enhance use of behavioral medicine research in health services. Directions for future research are also discussed.

Relational Intimacy Mediates Sexual Outcomes Associated With Impaired Sexual Function: Examination in a Clinical Sample.

BACKGROUND: Relational intimacy is hypothesized to underlie the association between female sexual functioning and various sexual outcomes, and married women and women with sexual dysfunction have been generally absent from prior studies investigating these associations, thus restricting generalizability. AIM: To investigate whether relational intimacy mediates sexual outcomes (sexual satisfaction, coital frequency, and sexual distress) in a sample of married women with and without impaired sexual functioning presenting in clinical settings. METHODS: Using a cross-sectional design, 64 heterosexual married women with (n = 44) and without (n = 20) impaired sexual functioning completed a battery of validated measurements assessing relational intimacy, sexual dysfunction, sexual frequency, satisfaction, and distress. Intimacy measurements were combined using latent factor scores before analysis. Bias-corrected mediation models of the indirect effect were used to test mediation effects. Moderated mediation models examined whether indirect effects were influenced by age and marital duration. OUTCOMES: Patients completed the Female Sexual Function Index, the Couple's Satisfaction Index, the Sexual Satisfaction Scale for Women, the Inclusion of the Other in the Self Scale, and the Miller Social Intimacy Test. RESULTS: Mediation models showed that impaired sexual functioning is associated with all sexual outcomes directly and indirectly through relational intimacy. Results were predominantly independent of age and marital duration. CLINICAL IMPLICATIONS: Findings have important treatment implications for modifying interventions to focus on enhancing relational intimacy to improve the sexual functioning of women with impaired sexual functioning. STRENGTHS AND LIMITATIONS: The importance of the role relational intimacy plays in broad sexual outcomes of women with impaired sexual functioning is supported in clinically referred and married women. Latent factor scores to improve estimation of study constructs and the use of contemporary mediation analysis also are strengths. The cross-sectional design precludes any causal conclusions and it is unknown whether the results generalize to male partners, partners within other relationship structures, and non-heterosexual couples. CONCLUSION: Greater relational intimacy mitigates the adverse impact of impaired sexual functioning on sexual behavior and satisfaction in women. Witherow MP, Chandraiah S, Seals SR, et al. Relational Intimacy Mediates Sexual Outcomes Associated With Impaired Sexual Function: Examination in a Clinical Sample. J Sex Med 2017;14:843-851.