The state of the art of adaptation strategies for HIV-related interventions.

Background Inequities in service utilization between immigrant families and native populations have emerged within the Nordic welfare countries, highlighting the need for culturally sensitive parenting support. Despite the proven efficacy of parenting interventions, their implementation phases have not been adequately addressed in extant implementation research, particularly regarding structural racism and inequities. This study aims to contribute to the literature from an implementation perspective by describing a pilot of ‘Being a Parent in Finland,’ a culturally sensitive group-based intervention for migrant parents. Its specific focus is on investigating barriers to and facilitators of implementation outcomes from the perspectives of service providers. Methods The qualitative data consisted of thematic interviews (N = 6) with service providers (N = 9) compiled at distinct phases of the pilot from 2021 to 2023. In addition, data triangulation was utilized through document analysis of 125 pages of various documents regarding the pilot as a supplementary data collection method. Content analysis was conducted on the data using Atlas.ti 23. Results The findings stress the alignment of the target group, service placement, and preventive measures for enhancing parenting intervention’s acceptability, appropriateness, and feasibility. Implicit objectives, such as perceiving the target group as ‘at-risk,’ can impede intervention success and exacerbate stigmatization of the target group. Culture- and context-specific adaptations, and community engagement foster parental trust and intervention accessibility. Conclusions The findings underscore the significance of congruent objectives, community engagement, and adaptive iterations in preventive parenting interventions. Advocating for these elements in implementation strategies is crucial for reducing stigmatization and enhancing equity and efficacy in services tailored to minority parents. Key messages • Acknowledging equity in both implementation research and strategies is paramount. • Implementing trust-building is crucial for culturally sensitive parenting interventions.

This study aims at identifying national salt reduction initiatives in countries of the Eastern Mediterranean Region and describing their progress towards the global salt reduction target. A systematic review of published and grey literature was conducted. Key characteristics of strategies were extracted and classified according to a pre-defined framework: salt intake assessments; leadership and strategic approach; implementation strategies; monitoring and evaluation of program impact. Salt intake levels were estimated in 15 out of the 22 countries (68%), while national salt reduction initiatives were identified in 13 (59%). The majority of countries were found to implement multifaceted reduction interventions, characterized by a combination of two or more implementation strategies. The least common implementation strategy was taxation, while the most common was reformulation (100%), followed by consumer education (77%), initiatives in specific settings (54%), and front of pack labelling (46%). Monitoring activities were conducted by few countries (27%), while impact evaluations were lacking. Despite the ongoing salt reduction efforts in several countries of the region, more action is needed to initiate reduction programs in countries that are lagging behind, and to ensure rigorous implementation and evaluations of ongoing programs. Such efforts are vital for the achievement of the targeted 30% reduction in salt intake.

Equitable implementation of innovations to promote successful aging in place.

Background:Since 1998, the Veterans Health Administration (VHA) Quality Enhancement Research Initiative (QUERI) has supported more rapid implementation of research into clinical practice.Objectives:With the passage of the Veterans Access, Choice and Accountability Act of 2014 (Choice Act), QUERI further evolved to support VHA’s transformation into a Learning Health Care System by aligning science with clinical priority goals based on a strategic planning process and alignment of funding priorities with updated VHA priority goals in response to the Choice Act.Design:QUERI updated its strategic goals in response to independent assessments mandated by the Choice Act that recommended VHA reduce variation in care by providing a clear path to implement best practices. Specifically, QUERI updated its application process to ensure its centers (Programs) focus on cross-cutting VHA priorities and specify roadmaps for implementation of research-informed practices across different settings. QUERI also increased funding for scientific evaluations of the Choice Act and other policies in response to Commission on Care recommendations.Results:QUERI’s national network of Programs deploys effective practices using implementation strategies across different settings. QUERI Choice Act evaluations informed the law’s further implementation, setting the stage for additional rigorous national evaluations of other VHA programs and policies including community provider networks.Conclusions:Grounded in implementation science and evidence-based policy, QUERI serves as an example of how to operationalize core components of a Learning Health Care System, notably through rigorous evaluation and scientific testing of implementation strategies to ultimately reduce variation in quality and improve overall population health.

Driven by the demand for evidence of development effectiveness, the field of mobile learning for development (ML4D) has recently begun to adopt rigorous evaluation methods. Using the findings of an ongoing systematic review of ML4D interventions, this paper critically assesses the value proposition of rigorous impact evaluations in ML4D. While a drive towards more reliable evidence of mobile learning’s effectiveness as a development intervention is welcome, the maturity of the field, which continues to be characterised by pilot programmes rather than well-established and self-sustaining interventions, questions the utility of rigorous evaluation designs. The experiences of conducting rigorous evaluations of ML4D interventions have been mixed, and the paper concludes that in many cases the absence of an explicit programme theory negates the effectiveness of carefully designed impact evaluations. Mixed-methods evaluations are presented as a more relevant evaluation approach in the context of ML4D.Keywordsmobile learningdevelopment effectivenessML4Ddevelopingcountry educationimpact evaluation

BackgroundIn 2016, over one-quarter of births in the UK (28.2%) were to foreign-born women. Maternal and perinatal mortality are disproportionately higher among some immigrants depending on country of origin, indicating the presence of deficits in their care pathways and birth outcomes.ObjectivesOur objective was to undertake a systematic review and narrative synthesis of empirical research that focused on access and interventions to improve maternity care for immigrant women, including qualitative, quantitative and mixed-methods studies.Review methodsAn information scientist designed the literature database search strategies (limited to retrieve literature published from 1990 to 2018). All retrieved citations (45,954) were independently screened by two or more team members using a screening tool. We searched grey literature reported in related databases and websites. We contacted stakeholders with subject expertise. In this review we define an immigrant as a person who relocates to the destination country for a minimum of 1 year, with the goal of permanent residence.ResultsWe identified 40 studies for inclusion. Immigrant women tended to book and access antenatal care later than the recommended first 10 weeks of pregnancy. Primary factors included limited English-language skills, lack of awareness of availability of the services, lack of understanding of the purpose of antenatal appointments, immigration status and income barriers. Immigrant women had mixed perceptions regarding how health-care professionals (HCPs) had delivered maternity care services. Those with positive perceptions felt that HCPs were caring, confidential and openly communicative. Those with negative views perceived HCPs as rude, discriminatory or insensitive to their cultural and social needs; these women therefore avoided accessing maternity care. We found very few interventions that had focused on improving maternity care for these women and the effectiveness of these interventions has not been rigorously evaluated.LimitationsOur review findings are limited by the available research evidence related to our review questions. There may be many aspects of immigrant women’s experiences that we have not addressed. For example, few studies exist for perinatal mental health in immigrant women from Eastern European countries (in the review period). Many studies included both immigrant and non-immigrant women.ConclusionsAvailable evidence suggests that the experiences of immigrant women in accessing and using maternity care services in the UK are mixed; however, women largely had poor experiences. Contributing factors included a lack of language support, cultural insensitivity, discrimination and poor relationships between immigrant women and HCPs. Furthermore, a lack of knowledge of legal entitlements and guidelines on the provision of welfare support and maternity care to immigrants compounds this.Future workStudies are required on the development of interventions and rigorous scientific evaluation of these interventions. Development and evaluation of online antenatal education resources in multiple languages. Development and appraisal of education packages for HCPs focused on the provision of culturally safe practice for the UK’s diverse population. The NHS in the UK has a hugely diverse workforce with a vast untapped linguistic resource; strategies could be developed to harness this resource.Study registrationThis study is registered as PROSPERO CRD42015023605.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 8, No. 14. See the NIHR Journals Library website for further project information.

Local authorities in England commission the NHS Health Check programme to invite everyone aged 40-74 years without pre-existing conditions for risk assessment and eventual intervention, if needed. However, the programme's effectiveness, cost-effectiveness and equity impact remain uncertain. To develop a validated open-access flexible web-based model that enables local commissioners to quantify the cost-effectiveness and potential for equitable population health gain of the NHS Health Check programme. The objectives were as follows: (1) co-produce with stakeholders the desirable features of the user-friendly model; (2) update the evidence base to support model and scenario development; (3) further develop our computational model to allow for developments and changes to the NHS Health Check programme and the diseases it addresses; (4) assess the effectiveness, cost-effectiveness and equity of alternative strategies for implementation to illustrate the use of the tool; and (5) propose a sustainability and implementation plan to deploy our user-friendly computational model at the local level. Co-production workshops surveying the best-performing local authorities and a systematic literature review of strategies to increase uptake of screening programmes informed model use and development. We then co-produced the workHORSE (working Health Outcomes Research Simulation Environment) model to estimate the health, economic and equity impact of different NHS Health Check programme implementations, using illustrative-use cases. Local authorities in England. Stakeholders from local authorities, Public Health England, the NHS, the British Heart Foundation, academia and other organisations participated in the workshops. For the local authorities survey, we invited 16 of the best-performing local authorities in England. The user interface allows users to vary key parameters that represent programme activities (i.e. invitation, uptake, prescriptions and referrals). Scenarios can be compared with each other. Disease cases and case-years prevented or postponed, incremental cost-effectiveness ratios, net monetary benefit and change in slope index of inequality. The survey of best-performing local authorities revealed a diversity of effective approaches to maximise the coverage and uptake of NHS Health Check programme, with no distinct 'best buy'. The umbrella literature review identified a range of effective single interventions. However, these generally need to be combined to maximally improve uptake and health gains. A validated dynamic, stochastic microsimulation model, built on robust epidemiology, enabled service options analysis. Analyses of three contrasting illustrative cases estimated the health, economic and equity impact of optimising the Health Checks, and the added value of obtaining detailed local data. Optimising the programme in Liverpool can become cost-effective and equitable, but simply changing the invitation method will require other programme changes to improve its performance. Detailed data inputs can benefit local analysis. Although the approach is extremely flexible, it is complex and requires substantial amounts of data, alongside expertise to both maintain and run. Our project showed that the workHORSE model could be used to estimate the health, economic and equity impact comprehensively at local authority level. It has the potential for further development as a commissioning tool and to stimulate broader discussions on the role of these tools in real-world decision-making. Future work should focus on improving user interactions with the model, modelling simulation standards, and adapting workHORSE for evaluation, design and implementation support. This study is registered as PROSPERO CRD42019132087. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 35. See the NIHR Journals Library website for further project information.

Few studies have described the range and health impacts of obesity prevention strategies in local communities supported by the Communities Putting Prevention to Work program. To address this gap, we reviewed implemented strategies in Los Angeles County (LAC) for 3 program focus areas: physical activity-promotion, health marketing, and creation of healthy food environments. Local context and results from an impact simulation are presented. Information on population reach and program milestones was synthesized to describe historical and programmatic progress of the obesity prevention efforts during 2010-2012. To forecast health impacts, the Prevention Impacts Simulation Model (PRISM) was used to simulate population health outcomes, including projected changes in obesity burden and health behaviors 30 years into the future. LAC with more than 9.8 million residents. Low-income adults and youth who were the intended audiences of the Communities Putting Prevention to Work program in LAC. Implemented strategies for the 3 focus areas. Documentation of program reach and PRISM forecasting of obesity rates and health impacts. Implemented strategies in LAC ranged from best practices in healthy food procurement (estimated reach: 600 000 students, 300 000 meals per day) to completed shared-use agreements (10+ agreements across 5 school districts) to a series of strategically designed health marketing campaigns on healthy eating (>515 million impressions). On the basis of PRISM simulations, these highlighted program activities have the potential to reduce by 2040 the number of youth (-29 870) and adults (-94 136) with obesity, youth (-112 453) and adults (-855 855) below recommended levels of physical activity, and youth (-14 544) and adults (-28 835) who consumed excess junk food, as compared with baseline (2010-2011). Program context and PRISM-simulated health impacts showed modest but promising results in LAC, which may lead to further population health improvements in the future. Downstream health and behavioral surveillance data are needed to confirm these estimates.

A systematic review of primary prevention strategies for sexualviolence perpetration☆

Changing the diet of America's children: What works and why?

BackgroundDoes the importance of context in implementation imply that generalizing about the effects of strategies is ultimately limited? Conceptual approaches for generalizing in the presence of significant contextual heterogeneity could advance implementation research but require novel perspectives.Main bodyDrawing from perspectives from Realist approaches, Pearl’s transportability framework and philosophy of science, this paper outlines a mechanism-based approach to generalizing about the effects of implementation strategies. We suggest that understanding mechanisms creates a conceptual bridge between the effects of a strategy and the influence of the implementation context. Using directed acyclic graphs to represent the mechanisms of strategies, we show how conceptualizing mediators of overall effects offer a basis for considering the effects of context. Hence, theorizing and testing a mechanistic understanding enriches the ways in which we can consider how context could change those effects. Such an approach allows us to understand how a strategy works within a given implementation context, determine what information from new contexts are needed to infer across contexts, and if that information is available, what those effects would be — thereby advancing generalizing in implementation research. We consider particular implementation strategies (e.g., Community Adherence Groups and practice facilitation) as examples to illustrate generalizing into different contexts.ConclusionMechanisms can help implementation research by simultaneously accommodating the importance of context as well as the imperative to generalize. A shift towards a mechanism-focused approach that goes beyond identifying barriers and facilitators can enhance the value of implementation research.

BackgroundImproving access to culturally appropriate mental healthcare has been recognised as a key strategy to address the often greater burden of mental health issues experienced by Indigenous populations. We present data from the evaluation of a national attempt at improving access to culturally appropriate mental healthcare for Indigenous Australians through a mainstream primary mental healthcare program, the Access to Allied Psychological Services program, whilst specifically focusing on the implementation strategies and perspectives of service providers.MethodsWe conducted semi-structured interviews with 31 service providers (primary care agency staff, referrers, and mental health professionals) that were analysed thematically and descriptively.ResultsAgency-level implementation strategies to enhance service access and cultural appropriateness included: the conduct of local service needs assessments; Indigenous stakeholder consultation and partnership development; establishment of clinical governance frameworks; workforce recruitment, clinical/cultural training and supervision; stakeholder and referrer education; and service co-location at Indigenous health organisations. Dedicated provider-level strategies to ensure the cultural appropriateness of services were primarily aimed at the context and process of delivery (involving, flexible referral pathways, suitable locations, adaptation of client engagement and service feedback processes) and, to a lesser extent, the nature and content of interventions (provision of culturally adapted therapy).ConclusionsThis study offers insights into key factors underpinning the successful national service implementation approach. Study findings highlight that concerted national attempts to enhance mainstream primary mental healthcare for Indigenous people are critically dependent on effective local agency- and provider-level strategies to optimise the integration, adaptation and broader utility of these services within local Indigenous community and healthcare service contexts. Despite the explicit provider focus, this study was limited by a lack of Indigenous stakeholder perspectives. Key study findings are of direct relevance to inform the future implementation and delivery of culturally appropriate primary mental healthcare programs for Indigenous populations in Australia and internationally.

This research describes organizational level implementation strategies utilized in piloting enhancements to the school-based mentoring program from Big Brothers Big Sisters of America. Semi-structured interviews (n=15) with lead agency implementers along with conference call meeting notes were analyzed using qualitative content analysis. Findings yield a description of the challenges to implementation and strategies to overcome these challenges, formal implementation strategies engaged in, and the extent to which these align with an implementation framework put forth by Klein, Conn, and Sorra (2001) with supplement from Fixsen, Naoom, Blase, Friedman, and Wallace (2005). Findings from this study indicate that financial resources, management support, implementation climate and select implementation policies and practices are important to attend to during the implementation of a school-based mentoring program. Additionally, organizational readiness for change and organizational climate should be attended to before program implementation. Implementation strategies identified through this research help to define important organizational factors that drive the implementation of school-based mentoring programs.

Inclusive approaches to urban climate adaptation planning and implementation in the Global South

The research that underlies evidence-based practices is often based on relatively homogenous study samples, thus limiting our ability to understand how the study findings apply in new situations as well as our understanding of what might need to be adapted. In a preliminary effort to address those gaps, the requirements for the Tribal Maternal Infant and Early Childhood Home Visiting Program (MIECHV) included the expectation that grantees design and implement rigorous evaluations to address local priorities and to help build the knowledge base regarding the use of evidence-based home-visiting programs in tribal communities. A priority that emerged across many Tribal MIECHV grantees was to determine the added benefit of the cultural adaptations that they were making to their home-visiting programs. While there is literature to describe recommended processes for making cultural adaptations to evidence-based programs themselves, there are very few guidelines for evaluating these adaptations. In this article, we review the varied evaluation approaches utilized by Tribal MIECHV grantees and provide three case examples of how evaluators and tribal communities worked together to articulate evaluation questions and choose appropriate and feasible evaluation designs. The lessons derived from these Tribal MIECHV evaluation experiences have implications for the role of the evaluator in diverse communities across the country evaluating home visiting and other evidence-based practices in settings characterized by unique cultural contexts.