Fundamentals of Implementation Science: an intensive course on an emerging field of research / Fundamentos de la Ciencia de la Implementación: un curso intensivo sobre un emergente campo de investigación / Fundamentos da Ciência da Implementação: um curso intensivo sobre um emergente campo de pesquisa

Abstract Objective: Report the participation in the Intensive Course on Fundamentals of Implementation Science (IS) in Global Health and present the theoretical scope of IS methods and the potential applicability perspectives for improving global health. Method: Experience report on participation in the course, promoted by the University of Washington, USA, September, 2017. Results: The course introduced IS methodologies and selected case studies, focusing on opportunities and challenges in applying IS in practice. Conclusion: The IS offers tools for the selection of published scientific material and its use through plans, programs, intervention projects, models and protocols that assume diminishing inconsistencies and leverage results on a large scale in health science. Implications for practice: Multidisciplinary teams can benefit from IS training to address in a related way the gaps consistent with progress in the health sciences.

Resumen Objetivos: Relatar la participación en el Curso Intensivo sobre Fundamentos de la Ciencia de la Implementación (CI) en Salud Global y presentar la programación teórica de los métodos CI y potenciales perspectivas de aplicabilidad para la mejoría de la salud global. Método: Relato de experiencia sobre el curso, propuesto por la University of Washington, EE.UU., 2017. Resultados: El curso presentó metodologías de la CI y estudios de caso, enfocando oportunidades y desafíos en su aplicación en la práctica. Conclusión: La CI ofrece herramientas para la selección de material científico y su utilización a través de planes, proyectos de intervención y protocolos, que asumen disminuir incongruencias y aprovechar resultados en la ciencia de la salud. Implicaciones para la práctica: Equipos multidisciplinarios pueden beneficiarse del entrenamiento en CI para contemplar de forma conexa las lagunas que concuerdan con el progreso en las ciencias de la salud.

Resumo Objetivos: Relatar a participação no Curso Intensivo sobre Fundamentos da Ciência da Implementação (CI) em Saúde Global e apresentar o escopo teórico dos métodos da CI e as potenciais perspectivas de aplicabilidade para melhoria da saúde global. Método: Relato de experiência sobre a participação no curso, promovido pela University of Washington, EUA, setembro de 2017. Resultados: O curso apresentou metodologias da CI e estudos de caso selecionados, focalizando oportunidades e desafios na aplicação da CI na prática. Conclusão: A CI oferece ferramentas para seleção de material cientifico publicado e sua utilização por meio de planos, programas, projetos de intervenção, modelos e protocolos que assumam diminuir incongruências e alavancar resultados em larga escala na ciência da saúde. Implicações para a prática: Equipes multidisciplinares podem se beneficiar do treinamento em CI, para contemplar de forma conexa as lacunas condizentes com o progresso nas ciências da saúde.

Conceptualizations of illness among relatives of patients diagnosed with schizophrenia.

Family concepts of a relative's illness are an important part of the coping process and reveal the cultural construction of the experience of illness. As part of a qualitative study conducted in the Schizophrenia Outpatient Clinic of the Department of Psychiatry, Escola Paulista de Medicina - UNIFESP, 14 relatives of eight outpatients diagnosed with schizophrenia were interviewed and invited to talk freely about their ideas and feelings concerning their relative's problem. Qualitative analysis was used to identify categories of illness representations. Three main categories were discussed, including Problema de Nervoso, Problema na Cabeça and Problema Espiritual (Problem of the Nerves, Problem in the Head and Spiritual Problem). The authors present evidence of these categories as cultural constructions, and discuss the relevance of popular notions of illness to the understanding of the course and outcome of schizophrenia, and the planning of culturally meaningful interventions.

Development and validation of the Somali WHOQOL-BREF among refugees living in the USA.

PURPOSE: This study is the first translation and validation of the WHOQOL-BREF for general use in Somali refugee populations. METHODS: A community sample of 303 Somali refugees living in the USA responded to the WHOQOL-BREF following translation, adaptation, and validation guidelines established by the World Health Organization. Psychometric properties of the quality of life instrument were assessed including tests of the four-domain factor structure using multiple regression and principal component analysis. RESULTS: Principal component analysis demonstrated an acceptable fit between PCA components and original WHOQOL-BREF domains. Four components had eigenvalues greater than one and explained 63.4% of the observed variance. Most scale items loaded like the original WHOQOL-BREF domains, with the notable difference among four items of physical health that loaded more strongly under the environment domain. Construct validity of the scale was confirmed by higher intercorrelations of each WHOQOL-BREF item with its intended domain (all r (2) > 0.50) than with other domains. Multiple regression analyses of the domain scores on overall quality of life (Q1) and health satisfaction (Q2) explained half of the observed variance in each measure. Item correlations showed good internal consistency (0.65 ≥ Cronbach's alpha ≤ 0.82). CONCLUSIONS: Validation of this first Somali version of the WHOQOL-BREF provides further evidence that this instrument can be a valid measure for cross-cultural comparative studies of quality of life. Policies that address health disparities can be more broadly evaluated if quality of life is systematically measured in the community. This is particularly important for evaluating policy impact and implications for refugee populations.

Heart failure performance measures: do they have an impact on 30-day readmission rates?

Congestive heart failure (CHF) accounts for more health care costs than any other diagnosis. Readmissions contribute to this expenditure. The authors evaluated the relationship between adherence to performance metrics and 30-day readmissions. This was a retrospective study of 6063 patients with CHF between 2001 and 2008. Data were collected for 30-day readmissions and compliance with CHF performance measures at discharge. Rates of readmission for CHF increased from 16.8% in 2002 to 24.8% in 2008. Adherence to performance measures increased concurrently from 95.8% to 99.9%. Except for left ventricular function (LVF) assessment, the 30-day readmission rate was not associated with adherence to performance measures. Readmitted patients had twice the odds of not having their LVF assessed (odds ratio = 2.0; P < .00005; 95% confidence interval = 1.45-2.63). CHF performance measures, except for the LVF assessment, have little relationship to 30-day readmissions. Further studies are needed to identify performance measures that correlate with quality of care.

Development of the pretreatment readiness scale for substance abusers: modification of an existing motivation assessment.

The Texas Christian University-Treatment Motivation Assessment (TCU-TMA) was originally developed to assess motivation among in-treatment opiod users. Numerous studies of in-treatment substance abusers in a variety of settings have confirmed the three factors present in the scale, including Problem Recognition, Desire For Help, and Treatment Readiness. The goal of the present study was to examine the factor structure of the TCU-TMA in a sample of 367 pretreatment substance abusers assessed at a centralized intake unit who had not yet entered treatment. Exploratory and confirmatory factor analyses led to the development of the Pretreatment Readiness Scale (PRS) that, like the TCU-TMA, contained Problem Recognition and Treatment Readiness factors. Desire for Change replaced Desire for Help in the new scale and Treatment Reluctance indicated mixed feelings about entering treatment. The implications of these findings on developing interventions for the pretreatment group will be discussed.

Improving linkage with substance abuse treatment using brief case management and motivational interviewing.

BACKGROUND: Poor linkage with substance abuse treatment remains a problem, negating the benefits that can accrue to both substance abusers and the larger society. Numerous behavioral interventions have been tested to determine their potential role in improving linkage. METHODS: A randomized clinical trial of 678 substance abusers compared the linkage effect of two brief interventions with the referral standard of care (SOC) at a centralized intake unit (CIU). Interventions included five sessions of strengths-based case management (SBCM) or one session of motivational interviewing (MI). A priori hypotheses predicted that both interventions would be better than the standard of care in predicting linkage and that SBCM would be more effective than MI. We analyzed the effect of the two interventions on overall treatment linkage rates and by treatment modality. Logistic regression analysis examined predictors of treatment linkage for the sample and each group. RESULTS: Two hypotheses were confirmed in that SBCM (n=222) was effective in improving linkage compared to the SOC (n=230), 55.0% vs. 38.7% (p<.01). SBCM improved linkage more than MI (55.0% vs. 44.7%, p<.05). Motivational interviewing (n=226) was not significantly more effective in improving linkage than the standard of care (44.7% vs. 38.7%; p>.05). The three trial groups differed only slightly on the client characteristics that predicted linkage with treatment. CONCLUSIONS: The results of this study confirm a body of literature that supports the effectiveness of case management in improving linkage with treatment. The role of motivational interviewing in improving linkage was not supported. Results are discussed in the context of other case management and motivational interviewing linkage studies.

Individual and system influences on waiting time for substance abuse treatment.

Waiting time is a contemporary reality of many drug abuse treatment programs, resulting in substantial problems for substance users and society. Individual and system factors that influence waiting time are diverse and may vary at different points in the treatment continuum. This study assessed waiting time preceding clinical assessment at a centralized intake unit and during the period after the assessment but before treatment entry. The present study included 577 substance abusers who were enrolled in a large clinical trial of two brief treatment interventions in a midsize metropolitan area in Ohio. Bivariate analyses identified individual and system factors that influenced preassessment and postassessment waiting time, as well as total wait to treatment services. Multivariate analyses demonstrated that longer wait time for an assessment is influenced by being court referred, less belief in having a substance abuse problem, and less desire for change. A shorter wait to actually enter treatment is predicted by having a case manager, being more ready for treatment, and having less severe employment and alcohol problems. The different influences present during the two waiting periods suggest that assessment and treatment programs need to implement system changes and entry enhancement interventions that are specific to the needs of substance abusers at each waiting period.

Understanding the working alliance between persons with substance abuse problems and strengths-based case managers.

A substantial body of literature has examined the importance of the working alliance in psychotherapy; few works have examined it in the context of case management Qualitative methods were used to examine how 26 persons with substance abuse problems perceived the working alliance with case managers who practice from the strengths perspective. Clients' narratives emphasized the personal qualities of the case manager and the nature of the client-case manager relationship. Their narratives also reflected two guiding principles of strengths-based case management: personal control over goal-setting, and an emphasis on strengths. Most clients concluded that a positive working alliance helped them to build trust, self-worth, and self-esteem.

Understanding treatment readiness in recently assessed, pre-treatment substance abusers.

The goal of this study was to more fully understand readiness for treatment in a pre-treatment sample of 446 substance abusers. Structural Equation Modeling (SEM) was used to: (1) examine the relationships between readiness factors identified in the Pre-Treatment Readiness Scale; and (2) identify the effects of predisposing, illness, and inhibiting determinants on the factors. As with in-treatment samples, Problem Recognition was found to influence Treatment Readiness, although through a different intervening factor, Desire for Change rather than Desire for Help. A fourth factor, Treatment Reluctance, was also influenced by the Desire for Change factor. Fixed characteristics such as age and gender had minimal influences on readiness factors, as did inhibiting characteristics that reflected recent functioning. Illness characteristics including drug severity and perceived treatment barriers had a more robust influence on readiness factors. This study provides an increased understanding of readiness for treatment among pre-treatment substance abusers and also supported the construct validity of the Pre-Treatment Readiness Scale.

A folk model of treatment readiness among drug users in Ohio.

Despite the benefits of substance abuse treatment, only a small proportion of drug users enter treatment. Understanding "readiness" is critical for engaging drug users in treatment and for involving them in the recovery process. This paper reports on ethnographic interviews conducted with 35 active drug users as they were entering treatment services, to describe how they perceive readiness for treatment. Drug users expressed readiness for treatment in terms reflective of twelve step programs, a folk model of treatment. A better understanding of drug users' perceptions can help to inform interventions designed to improve readiness for treatment.

Pathways of Substance Users Linking (Or Not) With Treatment.

This qualitative paper describes different pathways substance users experience as they decide whether to link to treatment or not after being assessed in a centralized intake unit in a Midwestern city. The narratives of 16 participants who did not link with treatment were compared with the narratives of 20 participants who did. Narratives from both groups described similar themes that were experienced differently. Nonlinkers were characterized by pretreatment abstinence, a negative experience with previous treatment, little previous engagement in a treatment career, and meaningful social support coming from AA. Linkers were more likely to continue using drugs before treatment entry, yet they described more readiness for treatment and were more engaged in a treatment career. The treatment careers approach provides a broader framework for understanding linkage versus nonlinkage to treatment.

Waiting Time as a Barrier to Treatment Entry: Perceptions of Substance Users.

Many substance users report that they experience multiple barriers that produce significant challenges to linking with treatment services. Being on a waiting list is frequently mentioned as a barrier, leading some people to give up on treatment and to continue using, while prompting others to view sobriety during the waiting period as proof they do not need treatment. This ethnographic study examines the views that 52 substance users have of the waiting time before treatment and the strategies they created to overcome it. Understanding how substance users react to waiting time itself and in relation to other barriers can lead to services that are effective in encouraging treatment linkage.

Participant perspectives on satisfaction with assertive community treatment.

This report explores participants' satisfaction with Assertive Community Treatment Programs in Ontario, Canada through a general satisfaction questionnaire that includes three open-ended questions. Open-ended questions are a simple tool for obtaining more detail about areas of satisfaction and dissatisfaction, and responses seem to be less influenced by social desirability than quantitative ratings. Participants particularly used the opportunity of answering open-ended questions to express feelings about their relationships with the team workers.

Religious construction of a first episode of psychosis in urban Brazil.

Religion plays an important role in the lives of people with psychosis. Based on fieldwork with 21 families living in poor neighborhoods of São Paulo, Brazil, this article examines how youth suffering a first episode of psychosis resort to religion for help (including, Catholicism, Pentecostalism, Candomblé, and Umbanda) and how this frames their experience of psychosis and that of their family members. For young people, the personal articulation of religious idioms and signifiers served to communicate, elaborate and transform their experience of psychosis. Family members resorted to religion as a source of healing, complementary to psychiatric treatment, as well as for personal relief and comfort. For youth, involvement with religion worked in both 'progressive' and 'regressive' ways, to improve and, at times, to diminish functioning and well-being.

Concepções de doença por familiares de pacientes com diagnóstico de esquizofrenia / Illness conceptions among relatives of patients diagnosed with schizophrenia

A elaboração de um significado para a compreensão e a convivência com a esquizofrenia constitui uma das maneiras de os familiares lidarem com a doença e a evidência como um fenômeno culturalmente constituído. A partir de uma abordagem antropológica, este estudo entrevistou 14 familiares de 8 pacientes com diagnóstico de esquizofrenia, buscando formular uma compreensão da esquizofrenia através dos conceitos e imagens do universo cultural e social familiar. Os dados produzidos foram analisados segundo metodologia qualitativa. Três categorias de concepção de doenças são discutidas, Problema de Nervoso, Problema na Cabeça e Problema Espiritual. Argumenta-se que as concepções analisadas podem ser compreendidas como construções culturais e discute-se a importância desta abordagem para a compreensão da evolução da doença e para a elaboração de programas de intervenção culturalmente apropriados.

Alguns estereótipos na relaçäo dos profissionais de saúde com os portadores de câncer de cabeça e pescoço / Some stereotypes in the health care professional's relationship with head and neck cancer patients

Este artigo discute a relaçäo de 23 profissionais de saúde com 54 portadores de câncer de cabeça e pescoço, assim como alguns estereótipos que säo construídos nessa interaçäo. Tais estereótipos envolvem conotaçöes por vezes contraditórias mas apesar disso, parecem orientar atos, comportamentos e racionalizaçöes de todos os envolvidos