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1.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(1): 8-12, 2020 Jan 06.
Artigo em Chinês | MEDLINE | ID: mdl-31914562

RESUMO

With the rapid development of medical practice, evidence-based medicine combines the best evidence, clinical experience and patient value, the role of evidence-based public health in public health has become increasingly prominent. However, only about half of the evidence-based medical evidence can be truly translated into regular health care services, and the conversion process takes a long time. In order to bridge the gap between best evidence and clinical or public health applications, implementation research emerged as a new discipline. This paper introduce the background, development, theory and methods of implementation research, and discusses it's application and challenges of implementing scientific in the field of public health in China.


Assuntos
Ciência da Implementação , Saúde Pública , China , Medicina Baseada em Evidências/organização & administração , Humanos
3.
BMC Public Health ; 19(1): 1362, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31651273

RESUMO

BACKGROUND: To increase access to voluntary family planning (FP) services, Nigerian policymakers are debating how to task share injectable contraceptive services to drug shop owners known as Patent and Proprietary Medicine Vendors (PPMVs). Task sharing FP services to drug shops is a promising practice, but information is needed on how to ensure high quality FP services. This analysis assesses the effects of job aids on PPMVs' knowledge of injectable contraceptives 9 months after receiving a standardized training. METHODS: One hundred ninety-four PPMVs were trained on FP counseling and administration of injectable contraceptives in Bauchi, Cross River, Ebonyi and Kaduna states. PPMVs were interviewed before, after, and 9 months after the training. Three variables were used to assess injectable contraceptive knowledge: 1) intramuscular depot-medroxyprogesterone acetate (DMPA-IM) knowledge: a combination of three questions related to device type, injection location, and reinjection frequency; 2) subcutaneous DMPA (DMPA-SC) knowledge: a combination of the same three questions but for DMPA-SC; and 3) knowledge of at least 4 of the 7 common injectable side effects. Three separate adjusted logistic regression models were conducted to determine the factors that influence PPMV knowledge of injectable contraceptives 9 months after the training. RESULTS: Over half of PPMVs (56%) reported using at least two job aids at 9 months. PPMVs' knowledge of DMPA-IM, DMPA-SC and side effects were low before the training but increased immediately after. Nine months later, knowledge remained higher than pre-test levels but generally reduced compared to posttest levels. PPMVs who reported using at least two FP job aids were 2.6 (95% CI: 1.4-5.1) times more likely to have DMPA-IM knowledge 9 months after the training compared to those who used one or no job aids, while adjusting for PPMV characteristics. Similar results were observed for knowledge of DMPA-SC (AOR: 2.5; 95% CI: 1.2-4.6) and side effects (AOR: 2.5; 95% CI: 1.3-4.8). CONCLUSION: PPMVs who used at least two FP job aids were more likely to correctly answer key injectable contraceptive questions 9 months after training. Incorporating proven job aids into routine trainings is a low-cost strategy that can reinforce knowledge and help PPMVs to retain information.


Assuntos
Comércio/educação , Anticoncepcionais Femininos/administração & dosagem , Conhecimentos, Atitudes e Prática em Saúde , Acetato de Medroxiprogesterona/administração & dosagem , Adolescente , Adulto , Serviços de Planejamento Familiar/estatística & dados numéricos , Feminino , Acesso aos Serviços de Saúde , Humanos , Ciência da Implementação , Injeções Intramusculares , Injeções Subcutâneas , Estudos Longitudinais , Nigéria , Adulto Jovem
4.
Res Nurs Health ; 42(6): 429-435, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31599468

RESUMO

With mounting pressure to move toward precision health care and implementation science, nurse researchers are faced with the challenge of producing evidence that their interventions are applicable in real-world clinical settings. Pragmatic clinical trials are critically important to generate evidence that is relevant to clinical practice. Pragmatic designs closely replicate true-to-life settings thereby expediting research translation and improving health outcomes. The Sequential Multiple Assignment Randomized Trial (SMART) is a valuable a pragmatic trial design that is receiving greater attention in nursing. SMART designs can be used to provide relevant clinical evidence by comparative evaluation of two or more alternative interventions. The objectives of this article are to provide: (a) A description of the main considerations and key components of SMART designs, and (b) a summary of three different nursing studies using SMART designs. Information provided by pragmatic nursing trials using SMART designs, which more closely mirror clinical practice, will facilitate evidence-based clinical practice.


Assuntos
Enfermagem Baseada em Evidências , Pesquisa em Enfermagem , Projetos de Pesquisa , Humanos , Ciência da Implementação
5.
Fam Med ; 51(8): 664-669, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31509217

RESUMO

BACKGROUND AND OBJECTIVES: Facilitation is common in the era of practice transformation. Much of the literature on practice facilitators focuses on the role of external facilitators who come into a practice to aid in practice transformation efforts. Our study sought to better understand the attributes of exemplary facilitators. METHODS: We conducted 10 structured interviews in four family medicine residencies. RESULTS: Program directors easily identified internal staff who serve informally as exemplary facilitators. Despite varying jobs, they possess seven identifiable attributes within three broad domains: task orientation, relational skills, and emotional intelligence. CONCLUSIONS: Given the increasing cost of practice transformation and the finite resources in many clinics, this study can help leaders identify current employees best suited for facilitation.


Assuntos
Comportamento Cooperativo , Medicina de Família e Comunidade/educação , Medicina de Família e Comunidade/organização & administração , Ciência da Implementação , Internato e Residência , Inovação Organizacional , Inteligência Emocional , Humanos , Entrevistas como Assunto , Pesquisa Qualitativa , Melhoria de Qualidade
6.
Am J Occup Ther ; 73(5): 7305347010p1-7305347010p6, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31484036

RESUMO

Despite advancements in occupational therapy research, the widespread research-to-practice gap continues to delay how quickly evidence-based practices are implemented in real-world clinical settings. Implementing research in practice is a complex process that mandates attention from all occupational therapy stakeholders; however, researchers are uniquely positioned to help minimize the 17-yr lag between scientific discovery and the implementation of research findings into practice. Our article serves as a response to Marr's (2017) Centennial Topics article, which proposed that purposeful efforts are needed to advocate for implementation research in occupational therapy. We provide an implementation science research agenda informed by concepts from the implementation science literature and suggest how researchers can structure methodologies to examine implementation-related outcomes and strategies. We provide explanations of gold-standard implementation outcomes and offer several recommendations for how researchers can report and disseminate implementation research findings to occupational therapy stakeholders.


Assuntos
Terapia Ocupacional , Prática Clínica Baseada em Evidências , Humanos , Ciência da Implementação , Terapia Ocupacional/métodos
7.
BMC Health Serv Res ; 19(1): 643, 2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31492184

RESUMO

BACKGROUND: Value-based healthcare (VBHC) is a concept that focuses on outcome measurement to contribute to quality improvement. However, VBHC does not offer a systematic approach for implementing improvement as implementation science does. The aim is to, firstly, investigate the implementation of improvement initiatives in the context of VBHC and secondly, to explore how implementation science could be of added value for VBHC and vice versa. METHODS: A case study with two cases in heart care was conducted; one without the explicit use of a systematic implementation method and the other one with the use of the Implementation of Change Model (ICM). Triangulation of data from document research, semi-structured interviews and a focus group was applied to evaluate the degree of method uptake. Interviews were held with experts involved in the implementation of Case 1 (N = 4) and Case 2 (N = 7). The focus group was held with experts also involved in the interviews (N = 4). A theory-driven qualitative analysis was conducted using the ICM as a framework. RESULTS: In both cases, outcome measures were seen as an important starting point for the implementation and for monitoring change. Several themes were identified as most important: support, personal importance, involvement, leadership, climate and continuous monitoring. Success factors included intrinsic motivation for the change, speed of implementation, complexity and continuous evaluation. CONCLUSION: Application of the ICM facilitates successful implementation of quality- improvement initiatives within VBHC. However, the practical use of the ICM shows an emphasis on processes. We recommend that monitoring of outcomes be added as an essential part of the ICM. In the discussion, we propose an implementation model that integrates ICM within VBHC.


Assuntos
Assistência à Saúde/normas , Serviços de Saúde/normas , Melhoria de Qualidade , Procedimentos Cirúrgicos Cardíacos/métodos , Proteínas na Dieta/administração & dosagem , Difusão de Inovações , Humanos , Ciência da Implementação , Liderança , Estudos Longitudinais , Cuidados Pré-Operatórios/métodos , Pesquisa Qualitativa
8.
Implement Sci ; 14(1): 80, 2019 08 14.
Artigo em Inglês | MEDLINE | ID: mdl-31412887

RESUMO

BACKGROUND: Designing implementation research can be a complex and daunting task, especially for applied health researchers who have not received specialist training in implementation science. We developed the Implementation Science Research Development (ImpRes) tool and supplementary guide to address this challenge and provide researchers with a systematic approach to designing implementation research. METHODS: A multi-method and multi-stage approach was employed. An international, multidisciplinary expert panel engaged in an iterative brainstorming and consensus-building process to generate core domains of the ImpRes tool, representing core implementation science principles and concepts that researchers should consider when designing implementation research. Simultaneously, an iterative process of reviewing the literature and expert input informed the development and content of the tool. Once consensus had been reached, specialist expert input was sought on involving and engaging patients/service users; and economic evaluation. ImpRes was then applied to 15 implementation and improvement science projects across the National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London, a research organisation in London, UK. Researchers who applied the ImpRes tool completed an 11-item questionnaire evaluating its structure, content and usefulness. RESULTS: Consensus was reached on ten implementation science domains to be considered when designing implementation research. These include implementation theories, frameworks and models, determinants of implementation, implementation strategies, implementation outcomes and unintended consequences. Researchers who used the ImpRes tool found it useful for identifying project areas where implementation science is lacking (median 5/5, IQR 4-5) and for improving the quality of implementation research (median 4/5, IQR 4-5) and agreed that it contained the key components that should be considered when designing implementation research (median 4/5, IQR 4-4). Qualitative feedback from researchers who applied the ImpRes tool indicated that a supplementary guide was needed to facilitate use of the tool. CONCLUSIONS: We have developed a feasible and acceptable tool, and supplementary guide, to facilitate consideration and incorporation of core principles and concepts of implementation science in applied health implementation research. Future research is needed to establish whether application of the tool and guide has an effect on the quality of implementation research.


Assuntos
Ciência da Implementação , Projetos de Pesquisa , Guias como Assunto , Humanos
9.
Implement Sci ; 14(1): 81, 2019 08 14.
Artigo em Inglês | MEDLINE | ID: mdl-31412894

RESUMO

BACKGROUND: The National Diabetes Prevention Program (National DPP) is rapidly expanding in an effort to help those at high risk of type 2 diabetes prevent or delay the disease. In 2012, the Centers for Disease Control and Prevention funded six national organizations to scale and sustain multistate delivery of the National DPP lifestyle change intervention (LCI). This study aims to describe reach, adoption, and maintenance during the 4-year funding period and to assess associations between site-level factors and program effectiveness regarding participant attendance and participation duration. METHODS: The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to guide the evaluation from October 2012 to September 2016. Multilevel linear regressions were used to examine associations between participant-level demographics and site-level strategies and number of sessions attended, attendance in months 7-12, and duration of participation. RESULTS: The six funded national organizations increased the number of participating sites from 68 in 2012 to 164 by 2016 across 38 states and enrolled 14,876 eligible participants. By September 2016, coverage for the National DPP LCI was secured for 42 private insurers and 7 public payers. Nearly 200 employers were recruited to offer the LCI on site to their employees. Site-level strategies significantly associated with higher overall attendance, attendance in months 7-12, and longer participation duration included using self-referral or word of mouth as a recruitment strategy, providing non-monetary incentives for participation, and using cultural adaptations to address participants' needs. Sites receiving referrals from healthcare providers or health systems also had higher attendance in months 7-12 and longer participation duration. At the participant level, better outcomes were achieved among those aged 65+ (vs. 18-44 or 45-64), those who were overweight (vs. obesity), those who were non-Hispanic white (vs. non-Hispanic black or multiracial/other races), and those eligible based on a blood test or history of gestational diabetes mellitus (vs. screening positive on a risk test). CONCLUSIONS: In a time of rapid dissemination of the National DPP LCI the findings of this evaluation can be used to enhance program implementation and translate lessons learned to similar organizations and settings.


Assuntos
Diabetes Mellitus Tipo 2/prevenção & controle , Promoção da Saúde/organização & administração , Guias como Assunto , Promoção da Saúde/economia , Humanos , Ciência da Implementação , Estilo de Vida , Avaliação de Programas e Projetos de Saúde , Estados Unidos
10.
Presse Med ; 48(7-8 Pt 1): 780-787, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31383383

RESUMO

Interprofessional simulation-based education is effective for learning non-technical critical care skills and strengthening interprofessional team collaboration to optimize quality of care and patient outcome. Implementation of interprofessional simulation sessions in initial and continuing education is facilitated by a team of "champions" from each discipline/profession to ensure educational quality and logistics. Interprofessional simulation training must be integrated into a broader interprofessional curriculum supported by managers, administrators and clinical colleagues from different professional programs. When conducting interprofessional simulation training, it is essential to account for sociological factors (hierarchy, power, authority, interprofessional conflicts, gender, access to information, professional identity) both in scenario design and debriefing. Teamwork assessment tools in interprofessional simulation training may be used to guide debriefing. The interprofessional simulation setting (in-situ or simulation centre) will be chosen according to the learning objectives and the logistics.


Assuntos
Cuidados Críticos/métodos , Educação Médica/métodos , Relações Interprofissionais , Equipe de Assistência ao Paciente , Treinamento por Simulação , Competência Clínica , Cuidados Críticos/normas , Currículo/normas , Educação Médica/normas , Avaliação Educacional/métodos , Humanos , Ciência da Implementação , Equipe de Assistência ao Paciente/organização & administração , Equipe de Assistência ao Paciente/normas , Treinamento por Simulação/métodos , Treinamento por Simulação/organização & administração , Treinamento por Simulação/normas
11.
Implement Sci ; 14(1): 78, 2019 08 09.
Artigo em Inglês | MEDLINE | ID: mdl-31399105

RESUMO

BACKGROUND: Advanced physiotherapist-led services have been embedded in specialist orthopaedic and neurosurgical outpatient departments across Queensland, Australia, to ameliorate capacity constraints. Simulation modelling has been used to inform the optimal scale and professional mix of services required to match patient demand. The context and the value of simulation modelling in service planning remain unclear. We aimed to examine the adoption, context and costs of using simulation modelling recommendations to inform service planning. METHODS: Using an implementation science approach, we undertook a prospective, qualitative evaluation to assess the use of discrete event simulation modelling recommendations for service re-design and to explore stakeholder perspectives about the role of simulation modelling in service planning. Five orthopaedic and neurosurgical services in Queensland, Australia, were selected to maximise variation in implementation effectiveness. We used the consolidated framework for implementation research (CFIR) to guide the facilitation and analysis of the stakeholder focus group discussions. We conducted a prospective costing analysis in each service to estimate the costs associated with using simulation modelling to inform service planning. RESULTS: Four of the five services demonstrated adoption by inclusion of modelling recommendations into proposals for service re-design. Four CFIR constructs distinguished and two CFIR constructs did not distinguish between high versus mixed implementation effectiveness. We identified additional constructs that did not map onto CFIR. The mean cost of implementation was AU$34,553 per site (standard deviation = AU$737). CONCLUSIONS: To our knowledge, this is the first time the context of implementing simulation modelling recommendations in a health care setting, using a validated framework, has been examined. Our findings may provide valuable insights to increase the uptake of healthcare modelling recommendations in service planning.


Assuntos
Assistência Ambulatorial/normas , Assistência à Saúde/normas , Ciência da Implementação , Modelos Organizacionais , Neurocirurgia/normas , Ortopedia/normas , Pacientes Ambulatoriais , Técnicas de Planejamento , Melhoria de Qualidade , Grupos Focais , Necessidades e Demandas de Serviços de Saúde , Humanos , Pesquisa Qualitativa , Queensland
12.
Best Pract Res Clin Rheumatol ; 33(1): 188-201, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-31431272

RESUMO

Although safety in sports and physical activity is an important prerequisite for continuing participation and maintenance of a healthy, physically active lifestyle, to date little effort has been placed upon moving evidence into preventive practice. Amongst researchers it is still often assumed that a program will disseminate itself after proven to be effective. Recently, however, there has been an increased recognition of the importance of theory-driven approaches to enhance implementation research. This manuscript aims to provide guidance for sports and physical activity injury researchers and practitioners to perform implementation research and practice. First, we will discuss the differences between research questions across the research spectrum and explain the 'drop' in effect when moving controlled evidence to a practical context. We will discuss two ways of increasing real-world effectiveness of preventive programs, i.e. through targeting the users' behaviour or through revising the intervention. Finally, we will present various implementation frameworks and tools that can guide the reader in their own efforts towards implementation practice and research.


Assuntos
Traumatismos em Atletas/epidemiologia , Exercício/fisiologia , Esportes/fisiologia , Humanos , Ciência da Implementação , Prevalência
13.
Stud Health Technol Inform ; 264: 1656-1657, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438278

RESUMO

Health programs are reliant on complex decision-making to efficiently utilize limited resources, but local-level data use is still challenging. This study aimed to assess barriers to fostering local-level data use culture at each level of a health system. Results show that awareness gaps, lack of motivation, inconsistent supervision, poor community engagement, and lack of accountability are major bottlenecks. Establishing an accountability system and capacity building on health data use could improve its implementation.


Assuntos
Programas Governamentais , Ciência da Implementação , Fortalecimento Institucional , Tomada de Decisões , Responsabilidade Social
14.
J Autism Dev Disord ; 49(11): 4468-4481, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31463631

RESUMO

Despite the need for parent education and training programmes in autism spectrum disorder (ASD), there is no generally-accepted evaluation framework to select programmes for different settings. Here we generated an evaluation framework using a multi-stakeholder, implementation science approach. Purposive sampling identified ASD experts, implementation/health systems experts, and parents/carers of individuals with ASD. A consensus-building stakeholder workshop with 14 stakeholders and thematic analysis was used to generate themes and components of the framework. Main themes included 'Outcomes' (parent, child, family and community), 'Processes and Procedures' (accessibility, acceptability, psychological process, and referral pathways) and 'Implementation Landscape' (sustainability, scalability, integration and coordination, and monitoring and evaluation). We propose that the evaluation framework and Evaluation Framework Checklist generated could guide clinicians, researchers and policy-makers.


Assuntos
Transtorno do Espectro Autista/psicologia , Educação não Profissionalizante , Poder Familiar/psicologia , Avaliação de Programas e Projetos de Saúde/métodos , Participação dos Interessados/psicologia , Adulto , Criança , Feminino , Humanos , Ciência da Implementação , Masculino , Pais/educação , Pais/psicologia
15.
J Abnorm Psychol ; 128(6): 547-562, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31368734

RESUMO

Quantitative methods remain the fundamental approach for hypothesis testing, but in approaches to data analysis there is substantial evidence of a gap between what is optimal and what is typical. It is clear that diffusion and dissemination alone are not maximally effective at improving data analytic practices in clinical psychological science. Amid declines in quantitative psychology training, and growing demand for advanced quantitative methods, applied researchers are increasingly called upon to conduct and evaluate research using methods in which they lack expertise. This "research-to-practice" gap in which rigorously developed and empirically supported quantitative methods are not applied in practice has received little attention. In this article, we describe how implementation science, which aims to reduce the research-to-practice gap in health care, offers a promising set of methods for closing the gap for quantitative methods. By identifying determinants of practice (i.e., barriers and facilitators of change), implementation strategies can be selected to increase adoption and high-fidelity application of new quantitative methods to improve scientific inferences and policy and practice decisions in clinical psychological science. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Pesquisa Biomédica , Bioestatística , Interpretação Estatística de Dados , Ciência da Implementação , Psicologia Clínica , Pesquisa Biomédica/métodos , Pesquisa Biomédica/normas , Bioestatística/métodos , Humanos , Psicologia Clínica/métodos , Psicologia Clínica/normas
16.
Implement Sci ; 14(1): 77, 2019 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-31387596

RESUMO

In the 13 years since the inception of Implementation Science, we have witnessed a continued rise in the number of submissions, reflecting the growing global interest in methods to enhance the uptake of research findings into healthcare practice and policy. We now receive over 800 submissions annually, and there is a large gap between what is submitted and what gets published. To better serve the needs of the research community, we announce our plans to introduce a new journal, Implementation Science Communications, which we believe will support publication of types of research reports currently not often published in Implementation Science. In this editorial, we state both journals' scope and current boundaries and set out our expectations for the scientific reporting, quality, and transparency of the manuscripts we receive.


Assuntos
Ciência da Implementação , Publicações Periódicas como Assunto , Políticas Editoriais , Humanos , Objetivos Organizacionais , Editoração
20.
Glob Heart ; 14(2): 135-141, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31324367

RESUMO

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide and in low- and middle-income countries, and hypertension (HTN) is a major risk factor for CVD. Although effective evidence-based interventions for control of HTN in high-income countries exist, implementation of these in low- and middle-income countries has been challenging due to limited capacity and infrastructure for late-phase translational research. In Rwanda, the 2015 STEPS NCD (STEPwise Approach to Surveillance of Noncommunicable Diseases) risk survey reported an overall prevalence of HTN of 15% (95% confidence interval [CI]: 13.8 to 16.3) for those ages 15 to 64 years; prevalence increased with increasing age to 39% (95% CI: 35.7 to 43.1) for those ages 55 to 64 years; CVD was the third most common cause of mortality (7%). Suboptimal infrastructure and capacity in Rwanda hinders research and community knowledge for HTN control. OBJECTIVES: To address the issue of suboptimal capacity to implement evidence-based interventions in HTN, this project was designed with the following objectives: 1) to develop a regional needs assessment of infrastructure for dissemination and implementation (D & I) strategies for HTN-CVD control; 2) to develop HTN-CVD research capacity through creation of countrywide resources such as core research facilities and training in the fields of HTN-CVD, D & I, and biostatistics; and 3) to engage and train multiple stakeholders in D & I and HTN-CVD evidence-based interventions. METHODS: A weeklong training program in HTN-CVD, biostatistics, and D & I was conducted in Rwanda in August 2018, and pre- and post-D & I training competency questionnaires were administered. RESULTS: Questionnaire results show a statistically significant increase in D & I knowledge and skills as a result of training (full scale pre- to post-test scores: 2.12 ± 0.78 vs. 3.94 ± 0.42; p < 0.0001). CONCLUSIONS: Using principles of community engagement and train-the-trainer methods, we will continue to adapt guidelines and treatments for HTN-CVD developed in high-income countries to the context of Rwanda with the goal of establishing a sustainable platform to address the burden of disease from HTN-CVD.


Assuntos
Pesquisa Biomédica/educação , Cardiologia/educação , Competência Clínica , Educação de Pós-Graduação em Medicina/métodos , Hipertensão/prevenção & controle , Ciência da Implementação , Médicos/normas , Feminino , Humanos , Hipertensão/epidemiologia , Masculino , Prevalência , Avaliação de Programas e Projetos de Saúde , Fatores de Risco , Ruanda/epidemiologia
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