Context-specific Implementation Research Articles

Using the IFASIS (Inventory of Factors Affecting Successful Implementation and Sustainment) to Advance Context-Specific and Generalizable Knowledge of Implementation Determinants: Case Study of a Digital Contingency Management Platform.

Background Contingency management (CM) is the most effective treatment for stimulant use disorder but is underutilized by opioid treatment programs (OTPs), despite the high prevalence of stimulant use in this setting. As part of a state-wide initiative, we piloted a novel assessment, the Inventory of Factors Affecting Successful Implementation and Sustainment (IFASIS), to examine determinants of implementation of a digital CM platform across a set of OTPs. We describe how the IFASIS was used to elucidate both generalizable and context-specific implementation determinants, and to guide the provision of implementation facilitation. Methods Six OTPs received a multi-level implementation strategy (including facilitation) to promote programmatic uptake of a digital CM platform. Pre-implementation, OTPs completed the IFASIS, a 27-item questionnaire that assesses both the valence (positive/negative) and importance of determinants across 4 domains: outside the organization, within the organization, about the intervention, and about intervention recipients. OTP staff completed the IFASIS as a team, identifying consensus ratings during recorded discussions. Transcripts of IFASIS recordings were analyzed using rapid qualitative analysis. Quantitative IFASIS results were aggregated into medians and ranges within and across organizations. Implementation facilitation meeting notes were analyzed to examine how the IFASIS was used to guide facilitation. Results Quantitative ratings and qualitative feedback revealed common barriers to implementation of the digital CM platform, including a lack of sustainable funding sources, absence of external and organizational policies, insufficient higher-level leadership support, and mixed attitudes among staff members toward CM. Common implementation facilitators included enthusiasm and commitment among organization leadership and the perception that the digital CM platform would reduce the workload and burden on OTP counselors. The IFASIS was used to guide facilitation in several ways, including stimulating discussion about barriers and facilitators, brainstorming strategies to address barriers rated as "very important", and identifying facilitators that could be harnessed as part of implementation efforts. Conclusions The IFASIS identified important determinants of CM implementation in OTPs and was instrumental in shaping facilitation. The IFASIS may be a valuable assessment for the implementation science community to identify and address generalizable and context-specific implementation determinants.

Co-creation of social innovations for healthy ageing in rural Europe – a process evaluation of a volunteer-led guided conversation toolkit using Normalisation Process Theory (NPT)

ABSTRACT We critically explored the use of Normalisation Process Theory (NPT) in the evaluation of a co-designed intervention toolkit for Healthy Ageing through Innovation in Rural Europe (HAIRE). The toolkit was co-designed and implemented in rural communities in Belgium, France, the Netherlands and the United Kingdom. NPT was applied as a novel analytical framework to shed light on key practices and processes that supported implementation. Further, the paper discusses how social innovation research helps frame co-designing such interventions with local communities. During the study, 25 semi-structured interviews were conducted with project partners and volunteers who were involved in toolkit co-design and implementation. A need for co-designing toolkits that explore ageing holistically was identified. Holistic understandings of ageing can be developed by paying attention to person-centred and place-based (context-specific) aspects of ageing. Finally, we illustrate how NPT can guide future evaluation frameworks as it offers the flexibility required to understand context-specific implementation.

Strengthening facility-based integrated emergency care services for time sensitive emergencies at all levels of healthcare in India: An implementation research study protocol

BackgroundThe healthcare system in India is tiered and has primary, secondary and tertiary levels of facilities depending on the complexity and severity of health challenges at these facilities. Evidence suggests that emergency services in the country is fragmented. This study aims to identify the barriers and facilitators of emergency care delivery for patients with time-sensitive conditions, and develop and implement a contextually relevant model, and measure its impact using implementation research outcomes.MethodsWe will study 85 healthcare facilities across five zones of the country and focus on emergency care delivery for 11 time-sensitive conditions. This implementation research will include seven phases: the preparatory phase, formative assessment, co-design of Model “Zero”, co-implementation, model optimization, end-line evaluation and consolidation phase. The “preparatory phase” will involve stakeholder meetings, approval from health authorities and the establishment of a research ecosystem. The “formative assessment” will include quantitative and qualitative evaluations of the existing healthcare facilities and personnel to identify gaps, barriers and facilitators of emergency care services for time-sensitive conditions. On the basis of the results of the formative assessment, context-specific implementation strategies will be developed through meetings with stakeholders, providers and experts. The “co-design of Model ‘Zero’” phase will help develop the initial Model “Zero”, which will be pilot tested on a small scale (co-implementation). In the “model optimization” phase, iterative feedback loops of meetings and testing various strategies will help develop and implement the final context-specific model. End-line evaluation will assess implementation research outcomes such as acceptability, adoption, fidelity and penetration. The consolidation phase will include planning for the sustenance of the interventions.DiscussionIn a country such as India, where resources are scarce, this study will identify the barriers and facilitators to delivering emergency care services for time-sensitive conditions across five varied zones of the country. Stakeholder and provider participation in developing consensus-based implementation strategies, along with iterative cycles of meetings and testing, will help adapt these strategies to local needs. This approach will ensure that the developed models are practical, feasible and tailored to the specific challenges and requirements of each region.

Stronger together: Implementing patient-reported symptom tool in routine cancer care in diverse Asia—A multi-national pilot feasibility study (PROMiSE-Pilot).

TPS180 Background: Patients diagnosed with cancer often experience disease or treatment-related symptoms, which can be under-elicited and under-appreciated by clinicians during time-poor consultations. This is particularly challenging in Asia where structural disparities in healthcare access mean oncology services are often under-resourced. Five oncologists from Thailand, India, Singapore, Philippines and Australia formed a working group as part of ASCO Asia-Pacific Leadership Development Program (LDP-AP). Systematic symptom monitoring using patient-reported outcomes measures (PROM) was identified as a potential solution to improve care in diverse Asian settings. PROM has demonstrated improved outcomes in Western settings but its utility in resource limited Asian contexts is less well established. A study was developed to evaluate the feasibility of implementing PROM in routine outpatient care across diverse cultural contexts in Asia. Methods: PROMiSE-Pilot is a prospective, multi-centre, feasibility study of integrating PROM in routine outpatient care across Asia. The Edmonton Symptom Assessment Scale questionnaire (ESAS-r) was selected as the PROM tool. Clinicians in 4 hospitals in Singapore, Manila, Bangkok and Hyderabad will be invited to participate, and their patients will be invited to complete the ESAS-r on paper before each visit. The primary aim is to evaluate if proportion of patients who complete ≥5 of 10 items on ESAS-r is ≥85% (Clopper Pearson). Secondary aims include assessing proportion who complete ≥8 and all 10 items and perceived utility of ESAS-r evaluated through surveys adapted to measure patient and clinician satisfaction. Site-specific patient, clinician, administrative barriers and facilitators will be studied. A pragmatic approach to context-specific implementation was adopted with each site developing its own process map for delivering the pilot and adapting to local patient demographics (e.g. low literacy), cultural contexts and resources. Translated versions of ESAS-r were acquired where necessary. Recruitment commenced in March 2024 following ethics approval at 2 sites. 87 patient encounters have been captured from 5 participating clinicians in Singapore. 5 clinicians have agreed to participate in Bangkok. Target recruitment is 200 encounters per site. Multi-centre data will be presented at the Breakthrough congress. Clinicians from ASCO LDP-AP identified PROM as a low-cost but potentially high-value approach to improving quality of care in resource limited settings in Asia. Understanding the feasibility of such a tool is vital prior to consideration of wider scale adoption by stakeholders. This co-developed multi-national pilot additionally demonstrates the value of collaboration, our strength in diversity and a pragmatic model for investigator-initiated studies in Asia.

Improving quality and patient safety in surgical care through standardisation and harmonisation of perioperative care (SAFEST project): A research protocol for a mixed methods study.

Adverse events in health care affect 8% to 12% of patients admitted to hospitals in the European Union (EU), with surgical adverse events being the most common types reported. SAFEST project aims to enhance perioperative care quality and patient safety by establishing and implementing widely supported evidence-based perioperative patient safety practices to reduce surgical adverse events. We will conduct a mixed-methods hybrid type III implementation study supporting the development and adoption of evidence-based practices through a Quality Improvement Learning Collaborative (QILC) in co-creation with stakeholders. The project will be conducted in 10 hospitals and related healthcare facilities of 5 European countries. We will assess the level of adherence to the standardised practices, as well as surgical complications incidence, patient-reported outcomes, contextual factors influencing the implementation of the patient safety practices, and sustainability. The project will consist of six components: 1) Development of patient safety standardised practices in perioperative care; 2) Guided self-evaluation of the standardised practices; 3) Identification of priorities and actions plans; 4) Implementation of a QILC strategy; 5) Evaluation of the strategy effectiveness; 6) Patient empowerment for patient safety. Sustainability of the project will be ensured by systematic assessment of sustainability factors and business plans. Towards the end of the project, a call for participation will be launched to allow other hospitals to conduct the self-evaluation of the standardized practices. The SAFEST project will promote patient safety standardized practices in the continuum of care for adult patients undergoing surgery. This project will result in a broad implementation of evidence-based practices for perioperative care, spanning from the care provided before hospital admission to post-operative recovery at home or outpatient facilities. Different implementation challenges will be faced in the application of the evidence-based practices, which will be mitigated by developing context-specific implementation strategies. Results will be disseminated in peer-reviewed publications and will be available in an online platform.

Community tuberculosis screening, testing and care, Uganda.

To assess the effectiveness of a community-based tuberculosis and leprosy intervention in which village health teams and health workers conduct door-to-door tuberculosis screening, targeted screenings and contact tracing. We conducted a before-and-after implementation study in Uganda to assess the effectiveness of the community tuberculosis intervention by looking at reach, outputs, adoption and effectiveness of the intervention. Campaign 1 was conducted in March 2022 and campaign 2 in September 2022. We calculated percentages of targets achieved and compared case notification rates during the intervention with corresponding quarters in the previous year. We also assessed the leprosy screening. Over 5days, campaign 1 screened 1 289 213 people (2.9% of the general population), of whom 179 144 (13.9%) fulfilled the presumptive tuberculosis criteria, and 4043 (2.3%) were diagnosed with bacteriologically-confirmed tuberculosis; 3710 (91.8%) individuals were linked to care. In campaign 2, 5 134 056 people (11.6% of the general population) were screened, detecting 428 444 (8.3%) presumptive tuberculosis patients and 8121 (1.9%) bacteriologically-confirmed tuberculosis patients; 5942 individuals (87.1%) were linked to care. The case notification rate increased from 48.1 to 59.5 per 100 000 population in campaign 1, with a case notification rate ratio of 1.24 (95% confidence interval, CI: 1.22-1.26). In campaign 2, the case notification rate increased from 45.0 to 71.6 per 100 000 population, with a case notification rate ratio of 1.59 (95% CI: 1.56-1.62). Of the 176 patients identified with leprosy, 137 (77.8%) initiated treatment. This community tuberculosis screening initiative is effective. However, continuous monitoring and adaptations are needed to overcome context-specific implementation challenges.

Receipt of seasonal malaria chemoprevention by age-ineligible children and associated factors in nine implementation states in Nigeria

BackgroundAs part of implementation quality standards, community distributors are expected to ensure that only age-eligible children (aged 3–59 months) receive seasonal malaria chemoprevention (SMC) medicines during monthly campaigns. There is uncertainty about the extent to which SMC medicines are administered to ineligible children. This study aimed to assess the magnitude of this occurrence, while exploring the factors associated with it across nine states where SMC was delivered in Nigeria during the 2022 round.MethodsThis analysis was based on data from representative end-of-round SMC household surveys conducted in nine SMC-implementing states in Nigeria. Data of 3299 age-ineligible children aged > 5 years and their caregivers were extracted from the survey dataset. Prevalence of receipt of SMC medicines by ineligible children was described by child-, caregiver- and SMC-related factors. Mixed-effects multivariable logistic regression models were fitted to explore the factors associated with ineligible receipt of SMC medicines.Results30.30% (95% CI 27.80–32.90) of ineligible children sampled received at least one dose of SMC medicines in 2022, the majority (60.60%) of whom were aged 5–6 years while the rest were aged 7–10 years. There were lower odds of an age-ineligible child receiving SMC medicines among caregivers who were knowledgeable of SMC age eligibility (OR: 0.53, 95% CI 0.37–0.77, p < 0.001), compared with those who were not knowledgeable of age eligibility. Higher odds of receipt of SMC were found among age-ineligible children whose caregivers had higher confidence in the protective effect of SMC against malaria (OR: 2.01, 95% CI 1.07–3.72, p = 0.030), compared with those whose caregivers were less confident. Compared with ineligible children of younger caregivers (aged < 20 years), those whose caregivers were older had lower odds of receiving SMC than those whose caregivers were younger; with lower odds among children of caregivers aged 20–39 years (OR: 0.50, 95% CI 0.30–0.82, p = 0.006).ConclusionsThis study contributes important evidence on the magnitude of the receipt of SMC medicines by age-ineligible children, while identifying individual and contextual factors associated with it. The findings provide potentially useful insights that can help inform and guide context-specific SMC implementation quality improvement efforts.

Spatial–Temporal Evolution, Impact Mechanisms, and Reclamation Potential of Rural Human Settlements in China

In China’s pursuit of modernization, the government has introduced the rural revitalization strategy to combat rural decline, foster balanced urban–rural development, and reduce the urban–rural gap. Rural human settlements, as key components of this strategy, play a vital role. This paper examines the types and characteristics of human–earth relationships within rural settlements, emphasizing their significance. Using national land use and population census data, we analyze the spatiotemporal evolution of rural settlements at the county level, investigating landscape pattern changes, assessing the degree of coupling coordination between rural population and settlements, categorizing relationship types and features, and estimating the potential for remediation. Our findings reveal a growing trend in the scale of rural human settlements, particularly sourced from arable land, with significant expansions observed in the North China Plain and Northeast Plain, indicating potential for farmland reclamation and village consolidation. Landscape patterns of rural human settlements exhibit increased fragmentation, complex shapes, and aggregation. We categorize the utilization of rural human settlements into two types, each with four distinct features: human–land coordination is observed in regions characterized by either a higher rural population and larger rural settlement areas, or lower rural population and smaller rural settlement areas. Human–land trade-offs are evident in areas where there is either a higher rural population and smaller rural settlement areas, or lower rural population and larger rural settlement areas. This provides valuable insights for the Chinese government’s context-specific implementation of the rural revitalization strategy. It also serves as an experiential reference for the governance of rural human settlements in other developing countries.

Implementing the water-energy-food nexus approach to create synergies and reduce tradeoffs between the Sustainable Development Goals

The Food-Energy-Water nexus approach to resource governance is a paradigm-shifting approach that moves away from “siloed” resource management and pursues integration and holistic planning between food, energy, and water governance. The Food-Energy-Water nexus approach carries the potential to increase synergies and reduce tradeoffs between the Sustainable Development Goals. However, theoretical challenges remain, and practical implementations of the nexus approach have lagged. The purpose of the article is to respond to the theoretical challenges and the need for practical implementations. The article first outlines the relationship between the Food-Energy-Water nexus approach and the Sustainable Development Goals. It then analyzes the relationship between the Sustainable Development Goals, human rights, and the capability approach, an influential account of wellbeing. I then discuss how the Food-Energy-Water nexus approach, in alignment with the capability approach, can contribute to trade-off reductions and synergies between the Sustainable Development Goals. I finally discuss an outline of a context-specific implementation model for a Food-Energy-Water nexus approach capable of mapping and quantifying carbon footprints creating synergies and reducing tradeoffs between the Sustainable Development Goals. A carbon capture and utilization project in the Arctic serves as a test case. Important policy implications of the study include a criterion for what it means to “optimize” the “output” of an algae cultivation system. This criterion is a tool for adjudication between stakeholders’ conflicting priorities.

Reanalysis of genomic data, how do we do it now and what if we automate it? A qualitative study

Automating reanalysis of genomic data for undiagnosed rare disease patients presents a paradigm shift in how clinical genomics is delivered. We aimed to map the current manual and proposed automated approach to reanalysis and identify possible implementation strategies to address clinical and laboratory staff’s perceived challenges to automation. Fourteen semi-structured interviews guided by a simplified process map were conducted with clinical and laboratory staff across Australia. Individual process maps were integrated into an overview of the current process, noting variation in service delivery. Participants then mapped an automated approach and were invited to discuss perceived challenges and possible supports to automation. Responses were analysed using the Consolidated Framework for Implementation Research, linking to the Expert Recommendations for Implementing Change framework to identify theory-informed implementation strategies. Process mapping demonstrates how automation streamlines processes with eleven steps reduced to seven. Although participants welcomed automation, challenges were raised at six of the steps. Strategies to overcome challenges include embedding project champions, developing education materials, facilitating clinical innovation and quality monitoring tools, and altering reimbursement structures. Future work can build on these findings to develop context specific implementation strategies to guide translation of an automated approach to reanalysis to improve clinical care and patient outcomes.

Gamification for staff motivation: Impact on work efficiency and corporate culture at the international level

Aim/purpose – This article analyzes the impact of gamification on staff motivation, performance, and corporate culture at the international level. It also examines the inte- gration of advanced technologies such as AI (artificial intelligence), AR (augmented reality), and VR (virtual reality) into gamification strategies to enhance their effective- ness. Design/methodology/approach – The study utilizes a semi-systematic literature review, synthesizing information from various scientific sources. This approach allows for a comprehensive analysis of gamification’s impact on employee engagement and produc- tivity, focusing on incorporating advanced technologies. Findings – The research identified that gamification significantly enhances employee motivation and performance. It highlights the additional benefits of AI-driven personali- zation, AR, and VR, which create immersive and adaptive learning environments. A framework for gamification implementation in business is proposed, including six steps such as (1) define objectives, (2) analyze the audience, (3) select game elements, (4) develop a game mechanism, (5) implement and train, (6) collect feedback and adapt. Research implications/limitations – The study’s reliance on a semi-systematic litera- ture review may not capture all practical nuances and recent advancements. Future em- pirical research involving direct observation within organizations is recommended. Ad- ditionally, the findings are based on theoretical analyses and case studies, which may not fully represent the diversity of real-world applications across different industries and cultural settings. Originality/value/contribution – This research contributes to the existing literature by expanding traditional gamification models to include advanced technologies. It provides actionable insights for businesses seeking to implement gamification strategies, offering examples and recommendations for practice. The study underscores the need for strategic and context-specific implementation of gamification to ensure its effectiveness. Keywords: gamification, staff motivation, HR management, artificial intelligence, virtual reality in working process. JEL Classification: M12, M14, M20.

A global research agenda on public health and social measures during emergencies.

The importance of strong coordination for research on public health and social measures was highlighted at the Seventy-fourth World Health Assembly in 2021. This article describes efforts undertaken by the World Health Organization (WHO) to develop a global research agenda on the use of public health and social measures during health emergencies. This work includes a multistep process that started with a global technical consultation convened by WHO in September 2021. The consultation included experts from around the world and from a wide range of disciplines, such as public health, education, tourism, finance and social sciences, and aimed to identify research and implementation approaches based on lessons learnt during the coronavirus disease 2019 pandemic. To prepare for future epidemics and pandemics, it is essential to adopt a more robust, comparable and systematic research approach to public health and social measures. Such comprehensive approach will better inform agile, balanced and context-specific implementation decisions during future emergencies. This article describes the methods used to develop global research priorities for public health and social measures and the next steps needed.

What affects organic farming adoption in emerging economies? A missing link in the Indian agriculture sector

PurposeThis article intends to explore critical factors that affect the adoption of organic farming in emerging economies. The authors respond to the calls from policymakers, non-government organizations, business firms and scholars to improve the farmers' awareness of the negative impact of synthetic chemical pesticides, phosphorus, potassium fertilizers and mineral nitrogen used in traditional farming.Design/methodology/approachThrough self-administered survey questionnaires, responses were obtained from 397 farmers (conventional) regarding organic farming adoption in Haryana (India). The survey responses were collected between October 2022 and December 2022. The authors apply the “partial least squares structural equation modeling” (PLS-SEM) to test the framed hypotheses.FindingsThe present article demonstrates six critical determinants of organic farming adoption, i.e. behavioral, cultivation, economic, governmental, marketing, and social factors. These six factors drive 71.0% (R2) variation in organic farming adoption. Governmental factors have a positive but insignificant influence on organic farming adoption. Interestingly, the impact of behavioral and cultivation factors is crucial per path coefficient values.Originality/valueFor the first time, the authors conducted a study on organic farming adoption in Haryana that lies in its context-specific implementation, utilization of localized knowledge and expertise, regional policy support, agricultural diversification and community participation. Future research can build upon by adding agriculture scientists to the study to respond to the cost, quality of the crop and impact of socio-economic policies as moderators/mediators on adoption decisions.

Deliberative Improvement of Oral Care Quality: The Horizon Europe DELIVER Project.

The EU DELIVER project aims to enhance the quality of oral health care through codevelopment and coproduction of solutions together with citizens/patients, providers, and policymakers. The unique multicountry nature of the project will facilitate fast-track prototype development and testing of innovative QI approaches in select countries. Reflective learning regarding the transferability of findings between different countries and settings offers unique opportunities to drive progress toward context-specific implementation of innovative oral health care QI approaches. The collective knowledge gained from the 7 European countries involved in DELIVER can also generate knowhow for improving the quality of oral health care in other countries around the globe.

Planning for Implementation: Shifting the Focus of National Biodiversity Strategies to Local Narratives, Existing Institutional Settings and Social Capital

The Convention on Biological Diversity (CBD) has repeatedly failed to meet its global targets in 2010 and 2020, pointing to persistent obstacles to implementation. National Biodiversity Strategies and Action Plans (NBSAPs) are the central instrument for translating global targets into actions across sectors and levels of government, also referred to as mainstreaming. This paper focuses on Peru as a case study to analyse to what extent NBSAPs are capable of addressing context-specific implementation challenges. It develops an analytical framework based on the literature on conservation governance in Peru to analyse to what extent the NBSAP from 2014 and the action plan from 2019 (1) reflect national biodiversity narratives; (2) address dominant causes of biodiversity loss; (3) link targets to sector-specific institutions and processes; and (4) to what extent the Peruvian National Commission for Biological Diversity builds social capital for implementation. The results indicate that the NBSAP (1) is dominated by a capitalist narrative focussing on economic values of biodiversity while giving less importance to other, particularly local narratives; (2) addresses most direct causes, but fails to operationalise its targets into conservation action; (3) has not been designed to connect and guide relevant sector policies, such as environmental impact assessments or agricultural policies; and (4) the strong participation in the commission for biodiversity is not used to foster implementation, but mostly on CBD reporting and planning. Thus, addressing these challenges provides powerful levers for how to harness the NBSAPs’ potential to mainstream biodiversity and increase their relevance for mobilising and guiding implementation and stimulate institutional learning.

An external facilitation intervention to increase uptake of an adverse drug event reporting intervention.

Adverse drug events (ADEs) are a leading cause of emergency department visits and hospital admissions in Canada. ActionADE prevents repeat ADEs by enabling clinicians to document and communicate standardized ADE information across care settings. We used an external facilitation intervention to promote the uptake of ActionADE in four hospitals in British Columbia, Canada. This study examined whether, how and in what context external facilitation influenced the uptake of ActionADE. In this convergent-parallel mixed-methods study, an external facilitator used a four-step iterative process to support site champions using context-specific implementation strategies to increase the ADE reporting rate at their sites. We extracted archival data to assess implementation determinants before and after the implementation of the external facilitation and implementation strategies. We also retrieved data on the mean monthly counts of reported ADEs for each user from the ActionADE server. Zero-inflated Poisson models were used to examine changes in mean monthly counts of reported ADEs per user between pre-intervention (June 2021 to October 2021) and intervention (November 2021 to March 2022) periods. The external facilitator and site champions co-created three functions: (1) educate pharmacists about what and how to report in ActionADE, (2) educate pharmacists about the impact of ActionADE on patient outcomes, and (3) provide social support for pharmacists to integrate ADE reporting into clinical workflows. Site champions used eight forms to address the three functions. Peer support and reporting competition were the two common strategies used by all sites. Sites' responses to external facilitation varied. The rate of mean monthly counts of reported ADEs per user significantly increased during the intervention period compared to the pre-intervention period at LGH (RR: 3.74, 95% CI 2.78 to 5.01) and RH (RR: 1.43, 95% CI 1.23 to 1.94), but did not change at SPH (RR: 0.68, 95% CI: 0.43 to 1.09) and VGH (RR: 1.17, 95% CI 0.92 to 1.49). Leave of absence of the clinical pharmacist champion and failure to address all identified functions were implementation determinants that influenced the effectiveness of external facilitation. External facilitation effectively supported researchers and stakeholders to co-create context-specific implementation strategies. It increased ADE reporting at sites where clinical pharmacist champions were available, and where all functions were addressed.

Collaborative Reflection-on-Action as a Catalyst for Change in Middle-Level General Music

Lack of relevancy, administrative support, collegial support, and time are just a few of the many barriers that prevent practicing music teachers from accessing relevant professional development (PD) and taking steps to improve their practice. Quality music education PD should help teachers transform practice to improve student learning. Some characteristics of impactful PD include long-term engagement, teacher-to-teacher collaboration, and context-specific classroom implementation and documentation. In this intrinsic case study, we examined the role of a collaborative PD group designed to guide music teachers in using the reflection-on-action cycle to make improvements in their middle-level general music practice. Results from this project suggest that the reflection-on-action cycle is useful for PD projects that focus on improving classroom practice and empowering teachers with autonomy and choice. Teacher-to-teacher collaboration may also support teacher resilience during project difficulties.

Real-World Implementation and Outcomes of Adalimumab Therapeutic Drug Monitoring in Psoriasis: A National Specialized Center Experience

Serum adalimumab concentration is a biomarker of treatment response but therapeutic drug monitoring (TDM) is yet to be implemented in routine psoriasis care. We incorporated adalimumab TDM in a national specialised psoriasis service and evaluated it using the RE-AIM implementation science framework. We undertook pre-implementation planning (validating local assays) and implementation interventions targeted to patients (pragmatic sampling at routine reviews), clinicians (introduction of TDM protocol) and healthcare systems (adalimumab TDM as a key performance indicator). Over 5-months, 170 of 229 (74%) individuals treated with adalimumab received TDM. Clinical improvement following TDM-guided dose escalation occurred in 13 of 15 (87%) non-responders with serum drug concentrations <8.3μg/ml (median PASI reduction 3.2 [IQR 2.2-8.2] after 23.4 weeks), and in all non-responders who had TDM-guided switch in biologic due to supratherapeutic drug concentrations (>8.3μg/mL; n=2) or positive anti-drug antibody (n=2) (PASI reduction 7.8 [7.5-12.9] after 20.0 weeks). Proactive TDM led to dose reduction in 5 individuals with clear skin and sub- or supra-therapeutic drug concentrations; 4 (80%) sustained clear skin after 50 [42-52] weeks. Adalimumab TDM based on pragmatic serum sampling is clinically viable and may lead to patient benefit. Context-specific implementation interventions and systematic implementation assessment may bridge the biomarker research-to-practice gap.

Cost-effectiveness analysis of different screening and diagnostic strategies for sexually transmitted infections and bacterial vaginosis in women attending primary health care facilities in Cape Town.

Genital inflammation associated with sexually transmitted infections (STIs) and bacterial vaginosis (BV) is considered a key driver in the HIV epidemic. A new rapid point-of-care test (POC) that detects genital inflammation in women-Genital InFlammation Test (GIFT)-was recently developed by researchers at the University of Cape Town. The objective of this study was to establish the cost-effectiveness of this novel intervention relative to other relevant screening and diagnostic strategies for the management of STIs and BV in women seeking care in the public health sector in South Africa. A decision analysis model was developed for five different screening and diagnostic strategies for women incorporating syndromic management, screening with GIFT and using etiological diagnosis. A decision tree was constructed using Microsoft Excel Office 365, and cost and effectiveness parameters were obtained from published literature and market prices. The model incorporated all clinic-level and treatment costs associated with diagnosing and treating a single episode of disease. The effectiveness of each approach was proxied by its sensitivity. One-way and threshold sensitivity analyses were conducted to test key uncertainties and assumptions in the model. Screening with GIFT, and following with antibiotic treatment according to syndromic management guidelines for GIFT-positive cases, was the most cost-effective strategy with an incremental cost-effectiveness ratio (ICER) of USD 11.08 per women diagnosed with an STI(s) and/or BV and provided treatment. This strategy resulted in lower rates of overtreatment compared to syndromic management, but higher rates compared to etiological diagnosis using nucleic acid amplification tests and microscopy. However, following a GIFT positive test with etiological diagnosis prior to treatment did not increase the effectiveness, but dramatically increased the cost. Screening with GIFT and treating positive cases according to syndromic management guidelines is the most cost-effective strategy for the management of STIs and BV. GIFT has a potential to significantly improve the management of STIs and BV in women by identifying asymptomatic women and reducing their risk of HIV infection. This analysis presents a first step in establishing the cost-effectiveness of these interventions and paves the way for further research to develop optimal context-specific implementation strategies.

Development and Evaluation of Options for Action to Progress on the SDG 6 Targets in Austria

The Agenda 2030 of the United Nations stipulates an ambitious set of 17 Sustainable Development Goals (SDGs). They were globally agreed upon and demand coherent, context-specific implementation at the national level. To address the complexity of challenges therein, the Agenda is designed to be integrated, indivisible, and universal. The numerous multifaceted interactions in-between the SDGs and with corresponding measures pose a complex challenge for decision-makers implementing them worldwide that requires support for a comprehensive discourse in the science-society-policy arena. Research on the interactions between the SDGs has been flourishing and can help to understand where policy options might be most successfully located. A catalytic effect on several other goals is, e.g., often attributed to SDG 6 on water and sanitation. However, beyond the where to locate policy options, it is similarly important to understand how potential policy options would affect the SDGs and their targets. We developed eleven options and 85 measures as context-specific pathways to advance the SDG 6 Targets in Austria. As a country in the Global North and with a generally far-established water and sanitation infrastructure and management, this responds to the Agenda's demand for universal applicability and can serve as an example to illustrate potential challenges beyond basic infrastructure provision and management. The proposed options cover resources-oriented sanitation, blue-green-brown infrastructure, efficient use and integrated management of water resources, maintenance and restoration of ecological functions of inland waters, reduction of diffuse discharge of nutrients and problematic substances as well as trace substances, water, sanitation and hygiene in public spaces, groundwater protection, development cooperation as well as co-design and co-creation. Their effects on the SDG 6 Targets are evaluated using a 7-point-scale. The evaluation method is simple and practicable, and fosters discourse on the entire water cycle amongst the expert group applying the method. The evaluated effects on the targets are found to be unanimously positive or neutral, but trade-offs might arise when including other SDGs in the assessment, making an expansion of the evaluation necessary for coherent implementation. The results can be used as a baseline to support follow-up discussions with stakeholders and decision-makers.