Program Delivery Research Articles

Health literacy development using a short drama programme for dengue fever control in Thailand

Background: Dengue is a viral infection that spreads from mosquitoes to people. It is especially prevalent in tropical and subtropical regions of the world. To address the challenges posed by dengue in countries such as Thailand, effective prevention and control to strengthen health literacy at the community level is needed. One way of achieving this goal is to work with village health volunteers (VHVs). This article documents the use of VHVs for dengue fever prevention in Mueang district, Khon Kaen province, northeast Thailand. Method: A quasi-experimental study was conducted. The experimental group comprised 45 people who received a programme that aimed to enhance health literacy through the provision of knowledge and social support by community-based volunteers accompanied by a short drama programme. A group of 45 people receiving health services without the drama programme comprised the comparison group. The duration of the activity was 12 weeks. Data were collected by means of a pre- and post-test survey and were analysed using descriptive statistics and a comparison of mean health literacy and practice scores before and after the intervention. Results: Following programme delivery, the experimental group had a mean health literacy score which was significantly higher than that of the comparison group, while the mean practice score of the experimental group was also higher than that of the comparison group. Conclusion: The results suggest that a health literacy programme which includes a short drama programme could be effective in bringing about desired changes with respect to dengue fever prevention. The programme provided in this study was effective and easy to understand. The model developed here could also be useful in other villages in epidemic areas.

Operationalizing the Behaviour Change Wheel and APEASE criteria to co-develop recommendations with stakeholders to address barriers to school-based immunization programs

Introduction: School-based immunization programs offer an accessible route to routine vaccines for students. During the COVID-19 pandemic, school closures to comply with public health measures had a drastic effect on school-based immunization program delivery and associated vaccine uptake. We sought to integrate findings from a mixed methods study to co-develop evidence-based and theory-informed recommendations with a diverse group of stakeholders (i.e., decision makers, healthcare providers, school staff, parents and adolescent students) to address barriers to new and existing school-based immunization programs. Methods: Findings from a mixed methods study were integrated using a joint display and narrative summary. These findings were mapped through the Behaviour Change Wheel, a series of tools designed to facilitate the development of behaviour change interventions. Draft recommendations were provided to previous mixed methods study participants who consented to participating in future phases of the research study (n = 26). Feedback was captured using a Likert-scale survey of acceptability, practicality, effectiveness, affordability, safety and equity (APEASE) criteria, with feedback and additional insights captured using open-ended textboxes. Data was used to revise and finalize recommendations. Results: Applying the Behaviour Change Wheel, we drafted 26 evidence-based, theory-informed recommendations to address barriers to school-based immunization programs. Participants (n = 16) provided feedback, with half of the recommendations scoring 80% or higher across all six APEASE criteria. The remaining 13 recommendations received a moderate score across one or more criteria. Stakeholders identified a high level of interest in expanding the use of e-consent forms, expanding programming to offer a meningitis B vaccine, and recommendations to ease student anxiety. Conclusion: We co-developed a range of recommendations to improve school-based immunization programs with stakeholders using data generated from a mixed methods study. Implementation of any single or combination of recommendations will need to be tailored to local clinic procedures, school system and health system resources.

An implementation evaluation of a sports-based health intervention for underrepresented middle school youth in Philadelphia.

Multicomponent, community-based programs aiming to improve health behaviors in youth are needed but can be challenging to implement. Research is needed to better understand the factors that facilitate and inhibit effective implementation of these programs especially for youth at increased risk of health disparities. This study aimed to identify and explore the implementation determinants and outcomes of a multicomponent health intervention conducted from 2021 to 2022 for middle school students living in underserved communities in Philadelphia, PA, USA. Mixed methods approaches, including self-report surveys and semi-structured qualitative interviews, were administered to 18 members of the implementation staff at the end of the program, including coaches (n = 7), assistant coaches (n = 2), school champions (n = 6), administrative leaders (n = 2), and a school district administrator (n = 1). Survey and interview questions were guided by the Consolidated Framework for Implementation Research (CFIR), and interviews were thematically coded following transcription based on 26 CFIR constructs. Innovation source, evidence strength and quality, cosmopolitanism, and the personal attributes of individuals were key constructs associated with implementation effectiveness. Data revealed three multidimensional themes that highlighted broader challenges influencing implementation: (i) broad consensus, different interpretations, (ii) staffing challenges, and (iii) continuity is key. The need for the program was clearly recognized and overall belief in the purpose of the intervention was strong among key program staff and administration. However, issues including limited engagement with training, staffing turnover, and the rotational programming design hindered implementation. Future projects aiming to implement multicomponent after-school time interventions must ensure a consistent vision among partners and continuity in program delivery.

The Association Between Food Insecurity, Parental Stress, and Child Development.

It is recognized that development in the 0-to-5-year period is predictive of lifelong health and well-being and that early childhood development is influenced by parental mental health. Social stressors such as food insecurity can exacerbate parental mental health issues. To improve understanding of this complex interplay, a primary care pediatric practice designed an innovative meal and grocery delivery program for families experiencing food insecurity with at least one child aged 0-5years. As part of the program, food insecurity, parental mental health, and child development were assessed. Food insecurity was found to be correlated with increased stress in the parent-child system, and increased stress was found to be strongly correlated with delays in early childhood developmental progress. These findings suggest that changes in the parent-child relationship resulting from increased parental stress due to food insecurity can play a role in influencing early childhood development.

Influence of employee’s intellectual wellness programmes on service delivery in faith-based hospitals in Nairobi metropolitan area

This study sought to investigate the intellectual wellness programmes on service delivery in faith-based hospitals in the Nairobi metropolitan area. In the modern competitive business environment, organisations and their management have realised that their survival and competitiveness lie in the quality of the services and by extension the service providers. The study adopted descriptive survey and correlational research designs. The study targeted the employees in faith-based hospitals in the Nairobi metropolitan area. A stratified random sampling approach was used in selecting the respondents. The study sample size was 297 respondents. Of the 297 questionnaires distributed to the target respondents, 244 of the questionnaires were filled and returned. Thus, there was a response rate of 82 per cent. The study obtained primary data using a questionnaire. Descriptive and inferential statistics were used to analyse data. Descriptive statistics included frequencies, mean, standard deviation and percentage. Correlational analysis was used to determine the relationship between the independent and dependent variables. The study also carried out a regression analysis to determine the level of association of the study variables. Results were presented in tables. The study established that there were employees' intellectual wellness programmes in the faith-based hospitals in the Nairobi metropolitan area. Correlation analysis results showed that a significant moderate positive correlation existed between service delivery and intellectual wellness programmes. The study also determined that intellectual wellness had a significant influence on service delivery in faith-based hospitals in the Nairobi metropolitan area. The study thus concluded that intellectual employee wellness programmes had a significant influence on service delivery in faith-based hospitals in the Nairobi metropolitan area.

Effectiveness of the Go4Fun program: a comparison of face-to-face and digital delivery.

Pre-post study. We conducted a secondary analysis of Go4Fun cohort data from 1893 face-to-face and 1283 digital participants (January 2018 to May 2022). Outcomes of interest were body mass index z-score (zBMI), physical activity, sedentary behaviour, and fruit, vegetable, sugary drink and takeaway food consumption. A higher proportion of Standard Go4Fun children lived in major cities, in areas of greatest disadvantage and spoke a language other than English at home than in Go4Fun Online. Children in both Standard Go4Fun and Go4Fun Online demonstrated improvements in all outcomes; however, children in Go4Fun Online showed significantly larger improvements. On average, digital participants had a reduction in zBMI of 0.11 more than the reduction seen in face-to-face participants (95% Confidence Interval [CI] -0.12, -0.09), increased the days/week of moderate-to-vigorous-physical-activity by 30% more (95% CI 24%, 36%), were more likely to eat ≥ 2 serves of fruit/day (compared to < 2, Odds Ratio [OR] 1.85; 95% CI: 1.36, 2.52) or eat ≥ 3 serves of vegetables/day (compared to < 3, OR 1.96; CI: 1.58, 2.42). Across both modes, with each additional session attended, the odds of eating ≥ 3 serves of vegetables/day increased by 10% (95% CI 1.02, 1.19). There were no significant differences for other health outcomes. Our evaluation demonstrated that both face-to-face and digital program delivery helped children above a healthy weight to improve their weight and health behaviour outcomes. Go4Fun Online achieved significantly greater improvements in outcomes, which is encouraging for the future of digital interventions. Participation in Standard Go4Fun by more children with obesity from disadvantaged areas and non-English speaking backgrounds suggests that ongoing delivery of both modes of Go4Fun could facilitate program reach among all children above a healthy weight.

Cross-Site Evaluation of Alcohol Screening and Brief Intervention Implementation Programs in Healthcare Systems Serving Individuals of Reproductive Age.

With US Centers for Disease Control and Prevention funding, from 2018 to 2022, 4 large healthcare systems (n = 53 health centers across 7 states) serving people of reproductive age trained staff and provided implementation support for alcohol screening and brief intervention (SBI). This cross-site evaluation explores each healthcare system's implementation approach to implement SBI, reduce excessive alcohol use, and prevent prenatal alcohol exposure (PAE) and fetal alcohol spectrum disorders. The SBIRT (Screening, Brief Intervention, and Referral to Treatment) Program Matrix framed the multilevel strategies to implement alcohol SBI programs from 2018 to 2022. Qualitative and quantitative data sources examined outcomes, guided by one logic model, through systems-level process data and provider-level performance metrics. Data analyses utilized frequencies and means for quantitative data and themes for qualitative data according to an established framework. Successful approaches within systems included using electronic health records, flexible implementation and workflow protocols, customized training and technical assistance programs, quality assurance feedback loops, and stakeholder buy-in. Centralized management structures were efficient in standardizing implementation across health centers. Decentralized management structures used tailored approaches, enhancing provider/staff SBI acceptance. Across systems, 1259 staff (eg, clinicians, medical assistants) were trained to provide alcohol SBI services and reported pre-post training increases in self-efficacy in performing brief intervention; skills in PAE counseling; and confidence in screening. Fifty-three (48 providing data) health centers implemented alcohol SBI, screening 106 826 patients over the study period with most of the 10 087 patients who screened positive for excessive alcohol use receiving a BI. Maximizing the use of technology, employing flexibility in program delivery, and institutionalizing processes and protocols improved workflow, efficiency, and program reach. Ongoing partnership and stakeholder communication identify areas for ongoing improvement, engagement, and best practices for sustainability around substance use screening, which are essential with increases in substance use since the pandemic.

National age-specific mortality trends for cervical and breast cancers in urban–rural areas of China from 2009 to 2021: a population-based analysis

BackgroundCervical and breast cancers are among the top 4 leading causes of cancer-related mortality in women. This study aimed to examine age-specific temporal trends in mortality for cervical and breast cancers in urban and rural areas of China from 2009 to 2021.MethodsAge-specific mortality data for cervical and breast cancers among Chinese women aged 20–84 years were obtained from China’s National Disease Surveillance Points system spanning the years 2009 to 2021. Negative binomial regression models were utilized to assess urban–rural differences in mortality rate ratios, while Joinpoint models with estimated average annual percent changes (AAPC) and slopes were employed to compare temporal trends and the acceleration of mortality rates within different age groups.ResultsFrom 2009 to 2021, there was a relative increase in age-specific mortality associated with the two cancers observed in rural areas compared with urban areas. A rising trend in the screening age of 35–64 [AAPC: 4.0%, 95% confidence interval (CI) 0.5–7.6%, P = 0.026] for cervical cancer was noted in rural areas, while a stable trend (AAPC: − 0.7%, 95% CI − 5.8 to 4.6%, P = 0.78) was observed in urban areas. As for breast cancer, a stable trend (AAPC: 0.3%, 95% CI − 0.3 to 0.9%, P = 0.28) was observed in rural areas compared to a decreasing trend (AAPC: − 2.7%, 95% CI − 4.6 to − 0.7%, P = 0.007) in urban areas. Urban–rural differences in mortality rates increased over time for cervical cancer but decreased for breast cancer. Mortality trends for both cervical and breast cancers showed an increase with age across 4 segments, with the most significant surge in mortality observed among the 35–54 age group across urban and rural areas, periods, and regions in China.ConclusionsSpecial attention should be given to women aged 35–54 years due to mortality trends and rural–urban disparities. Focusing on vulnerable age groups and addressing rural–urban differences in the delivery of cancer control programs can enhance resource efficiency and promote health equity.

Community acceptance of a novel malaria intervention, Attractive Targeted Sugar Baits, in the Zambia phase III trial

BackgroundCommunity acceptance is an important criterion to assess in community trials, particularly for new tools that require high coverage and use by a target population. Installed on exterior walls of household structures, the attractive targeted sugar bait (ATSB) is a new vector control tool designed to attract and kill mosquitoes. ATSBs were evaluated in Western Zambia during a two-year cluster randomized controlled trial to assess the efficacy of ATSBs in reducing malaria transmission. Community acceptance of ATSBs was critical for successful trial implementation.MethodsA community engagement strategy outlined activities and key messages to promote acceptance. Annual cross-sectional surveys, conducted during the peak transmission period, assessed households for presence of ATSBs as well as perceived benefits, concerns, and willingness to use ATSBs. Sixteen focus group discussions and 16 in-depth interviews, conducted at the end of each ATSB station deployment period, obtained a range of perceptions and household experiences with ATSB stations, as well as ITN use in the context of ATSB deployment.ResultsMethods used during the study to promote acceptance and continued use of ATSBs were effective in achieving greater than 90% coverage, a high (greater than 70%) level of perceived benefits, and fewer than 10% of households reporting safety concerns. Common facilitators of acceptance included the desire for protection against malaria and reduction of mosquitoes, trust in health initiatives, and understanding of the product. Common barriers to acceptance included misconceptions of product impact on mosquitoes, continued cases of malaria, association with satanism, and damage to household structures.DiscussionFuture use of the ATSB intervention will likely require activities that foster community acceptance before, during, and after the intervention is introduced. Additional research may be needed to understand the impact of different levels of community engagement on ATSB station coverage, ATSB station perception, and ITN use.ConclusionThere was high acceptance of ATSB stations during the trial in Western Zambia. Continuous and intense community engagement efforts contributed to sustained ATSB coverage and trust in the product. Acceptance of ATSBs during programmatic delivery requires further research.

Analysis of the Implementation of Training and Development Programs for Teachers in the Context of Curriculum Change: Evaluation and Recommendations

The implementation of training and development programs for teachers plays a crucial role in enhancing their skills and capabilities, especially in the context of curriculum change. This study conducts a comprehensive analysis of such programs, focusing on their effectiveness, challenges, and areas for improvement. Through a literature review approach, various scholarly works, empirical studies, and best practices are examined to evaluate the impact of training and development initiatives on teacher performance and student outcomes. The evaluation encompasses aspects such as program design, delivery methods, content relevance, participant engagement, and organizational support. It delves into the strategies employed to address the evolving needs of teachers amid curriculum transformations, considering factors like technological integration, pedagogical innovations, and curriculum alignment. Furthermore, the study explores the role of continuous professional development in sustaining teacher motivation, fostering a culture of lifelong learning, and adapting to dynamic educational landscapes. Based on the analysis, several recommendations are proposed to enhance the efficacy of training and development programs for teachers. These recommendations encompass tailored professional development pathways, collaborative learning communities, mentorship programs, feedback mechanisms, and resource allocation strategies. The findings of this study contribute valuable insights to educational policymakers, administrators, and stakeholders involved in designing and implementing teacher training initiatives within the framework of curriculum change.

Factors influencing older adult community fall prevention exercise implementation: a scoping review.

Exercise that challenges balance is the most effective fall prevention intervention in community-dwelling older adults. Identifying factors influencing implementation of community fall prevention exercise programs is a critical step in developing strategies to support program delivery. To identify implementation facilitators, barriers, and details reported in peer-reviewed publications on community fall prevention exercise for older adults. Scoping review. We searched multiple databases up to July 2023 for English-language publications that reported facilitators and/or barriers to implementing an evidence-based fall prevention exercise program in adults aged 50+ years living independently. At least two reviewers independently identified publications and extracted article, implementation, and exercise program characteristics and coded barriers and facilitators using the Consolidated Framework for Implementation Research (CFIR). We included 22 publications between 2001 and July 2023 that reported factors influencing implementation of 10 exercise programs. 293 factors were reported: 183 facilitators, 91 barriers, 6 described as both a facilitator and barrier, and 13 unspecified factors. Factors represented 33 CFIR constructs across all five CFIR domains: implementation inner setting (n = 95 factors); innovation (exercise program) characteristics (n = 84); individuals involved (n = 54); implementation process (n = 40) and outer setting (n = 20). Eight publications reported implementation strategies used; 6 reported using a conceptual framework; and 13 reported implementation outcomes. The high number of factors reflects the complexity of fall prevention exercise implementation. The low reporting of implementation strategies, frameworks and outcomes highlight the ongoing need for work to implement and sustain community fall prevention exercise programs.

Feasibility and acceptability of a culinary nutrition programme for adults with mild-to-moderate intellectual disability: FLIP Food and Lifestyle Information Programme.

Culinary nutrition education can support improved diet-related health and wellbeing. This pre-post pilot study aimed to assess feasibility and acceptability of an eight-session culinary nutrition programme, the Food and Lifestyle Information Programme (FLIP), for adults with mild-to-moderate intellectual disability. A secondary aim was to evaluate preliminary programme effectiveness. Participants were recruited through a disability service provider. Feasibility measures were: recruitment and retention; implementation; engagement and participation; adverse outcomes; and feasibility of outcome measures. Acceptability was assessed using an interactive process evaluation. Effectiveness measures included cooking frequency, cooking and food skill confidence and diet quality. Six of eight participants completed the intervention with high attendance and programme engagement. FLIP was well received by participants and support workers. No adverse outcomes occurred. Diet quality was feasible to assess. Findings can inform content, delivery and evaluation of future culinary nutrition programmes for adults with mild-to-moderate intellectual disability.

A prospective non-randomized feasibility study of an online membership-based fitness program for promoting physical activity in people with mobility impairments

BackgroundPeople with mobility limitations have a disproportionately higher rate of acquiring secondary conditions such as obesity, cardiovascular comorbidity, pain, fatigue, depression, deconditioning, and type 2 diabetes. These conditions often result from poor access to home and community-based health promotion/wellness programs. The aim of this project was to determine the feasibility of delivering an online community membership-based fitness program for individuals with mobility impairments.MethodsFor this prospective single-arm study, participants were recruited from members of a community fitness facility that serves people with physical disabilities and chronic health conditions. While all members had access to the online platform, individuals had to opt-in to participate in the research component. Activity options included 16 pre-recorded videos and 9 live exercise classes. During the 8-week program, participants had an opportunity to earn three exercise incentives for reaching certain activity milestones. Enrollment percentage, attendance, and attrition were tracked to assess program feasibility and acceptability. Changes in participant-reported outcomes including self-reported physical activity, psychosocial outcomes, and health-related quality of life (HRQOL) were examined using non-parametric analyses.ResultsA total of 146 eligible individuals were screened of which 33 enrolled (22.6%). Two participants withdrew from the study, so a total of 31 were used for analyses. Participants included 29 women and 12 Black people with an average age of 60 (± 15.9) years. Health conditions included stroke, post-polio, arthritis, neuropathy, cerebral palsy, and obesity. Ten participants used an assistive device to get around inside the home. Twenty-six participants (78.8%) completed the online program, and 5 participants earned all 3 participation incentives. The mean number of live Zoom exercise classes attended by the participants was 12.8 (range = 0–43) over 8 weeks; 3 of 31 participants did not attend any classes. On average, participants watched 128 min (range = 0–704 min) of pre-recorded videos; 6 of 31 participants did not view any pre-recorded videos. Self-reported physical activity showed the largest improvement (11.15 units; 95% CI, 3.08, 19.56) with an effect size of 0.51 (Cohen’s d).ConclusionsThis pilot study of an online membership-based fitness program for people with mobility impairments demonstrated preliminary effectiveness in increasing physical activity and was found to be feasible and acceptable. Feasibility endpoints do indicate potential to improve retention. These results suggest that online delivery of exercise programs can broaden the reach of specialized community fitness programs and is a promising direction for future work and fully powered trials are warranted to assess intervention efficacy.Trial registrationClinicalTrials.gov, NCT05138809. Registered September 2, 2021, ClinicalTrials.gov PRS: Record Summary NCT05138809.

Pickle Squad: Intervention Protocol for Adolescents and Young Adults with Intellectual and Developmental Disabilities (I/DD)

Nurturing self-determination, promoting intrinsic motivation, and exercising control of their lives should be important outcomes of sport programs for people with intellectual and developmental disabilities. This protocol presents Pickle Squad, a pickleball recreational therapy intervention for eight adolescents and young adults with intellectual and developmental disabilities delivered by a Certified Therapeutic Recreation Specialist (CTRS®). The purpose of Pickle Squad was to cultivate the participants’ self-determination and promote the development of sport-specific pickleball skills; this small group intervention applied the recreational therapy process (i.e., APIED) in the delivery of an 8-session program. Each participant completed one pickleball skills assessment and one self-determination assessment pre and post intervention. Individual and group goals and objectives were developed for participants. Each session lasted two hours and started with lessons and activities focused on self-determination, followed by lessons and drills targeting pickleball skills, and concluded with processing. Progress notes were documented for each participant. Evaluation results via single sample t-tests revealed that overall participants increased their self-determination t(7) = 2.61, p = .035. and developed sport-specific pickleball skills, t(7) = 4.77, p = .00. By conventional criteria, t-test results obtained were statistically significant. A discussion with limitations and implications for practice and research is included. In conclusion, this protocol suggested that self-determination levels could be increased through a pickleball intervention focused on self-determination and sport-specific pickleball skills.

An 8-Week Virtual Exercise Training Program for Pediatric Solid Organ Transplant Recipients.

Musculoskeletal strength can be impaired in pediatric solid organ transplant recipients. Exercise training programs can be beneficial but in-person delivery can be challenging; virtual exercise programs can alleviate some of these challenges. This feasibility study aimed to deliver an 8-week virtual exercise program in pediatric solid organ transplant recipients. Program delivery occurred 3 times per week for 30minutes. An exercise stress test was completed prior to program start. The Bruininks-Oseretsky Test of Motor Proficiency strength subtest and self-report surveys were used to assess musculoskeletal strength, quality of life, fatigue, and physical activity. Contact was maintained through a text messaging platform. Z scores were calculated using standardized normative data. Medians (interquartile range) are reported for all other data. Eleven participants completed the program (2 liver, 5 kidney, 4 heart; 58% females; median age = 11.5 [10.3-13.8]y). Six participants attended ≥60% of classes, 5 participants attended <50% of classes. After 8weeks, strength scores improved (Z score, Pre: -1.0 [-1.65 to -0.60] to Post: -0.2 [-1.30 to 0.40]; P = .007) with no change in other outcome measures. The virtual exercise program was delivered without technical issues and received positive participant feedback. Engagement and costs need to be considered.

A qualitative study of individuals with acquired brain injury’ and program facilitators’ experiences in virtual acquired brain injury community support programs

Purpose Acquired brain injury (ABI) community support programs aim to help support long-term needs through informational and psychosocial support. Due to the COVID-19 pandemic, many support programs adopted virtual program delivery. However, the experiences of facilitators and people with ABI who participate in virtual support programs are understudied. This study aimed to describe the experiences of people with ABI and program facilitators participating in virtual ABI community support programs. Materials and Methods This was a qualitative descriptive study. Semi-structured interviews were conducted with people with ABI and program facilitators who participated in virtual ABI community support programs. Data were analyzed using inductive thematic analysis. Results In total, 16 participants were included in this study. Of the 16 participants, 14 were people with ABI (three of whom were also program facilitators) and two were program facilitators without ABI. Our analysis generated three themes including perceived benefits (theme 1), perceived challenges (theme 2), and considerations to improve program quality (theme 3). Each theme outlines subthemes relaying the experiences of participants. Conclusions These findings highlight the need for stakeholders to implement guidelines and training for program facilitators and attendees of virtual ABI support programs to maximize accessibility, usability, inclusivity and safety. IMPLICATIONS FOR REHABILITATION This study described the experiences of people with acquired brain injury and facilitators who participated in virtual support programs. Benefits of virtual support programs include connecting with peers, increased access to resources, and enhanced feasibility and accessibility. Difficulties with virtual support programs include intrapersonal (e.g., increased side effects), interpersonal (e.g., communication barriers), and environmental and contextual (e.g., privacy concerns) challenges. Suggestions to improve program quality include creating a safe and respectful environment, fostering engagement and managing challenging situations, and enhancing accessibility and inclusivity.

Site-initiated adaptations in the implementation of an evidence-based inpatient walking program.

There is increasing recognition of the importance of maximizing program-setting fit in scaling and spreading effective programs. However, in the context of hospital-based mobility programs, there is limited information on how settings could consider local context and modify program characteristics or implementation activities to enhance fit. To fill this gap, we examined site-initiated adaptations to STRIDE, a hospital-based mobility program for older Veterans, at eight Veterans Affairs facilities across the United States. STRIDE was implemented at eight hospitals in a stepped-wedge cluster randomized trial. During the pre-implementation phase, sites were encouraged to adapt program characteristics to optimize implementation and align with their hospital's resources, needs, and culture. Recommended adaptations included those related to staffing models, marketing, and documentation. To assess the number and types of adaptations, multiple data sources were reviewed, including implementation support notes from site-level support calls and group-based learning collaborative sessions. Adaptations were classified based on the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME), including attention to what was adapted, when, why, and by whom. We reviewed the number and types of adaptations across sites that did and did not sustain STRIDE, defined as continued program delivery during the post-implementation period. A total of 25 adaptations were reported and classified across seven of the eight sites. Adaptations were reported across five areas: program documentation (n = 13), patient eligibility criteria (n = 5), program enhancements (n = 3), staffing model (n = 2), and marketing and recruitment (n = 2). More than one-half of adaptations were planned. Adaptations were common in both sustaining and non-sustaining sites. Adaptations were common within a program designed with flexible implementation in mind. Identifying common areas of planned and unplanned adaptations within a flexible program such as STRIDE may contribute to more efficient and effective national scaling. Future research should evaluate the relationship between adaptations and program implementation.

Improving Access to Specialist Eye Care for Indigenous Australians via Telehealth: An Observational Cohort Study.

Background: Indigenous people are often neglected in eye health research and service delivery programs, despite having a greater burden of vision loss, most of which is avoidable. The objective of this work was to improve access to specialist eye care for Indigenous Australians living in rural and remote areas, by providing direct access to expert diagnostic services based in metropolitan areas through a tele-ophthalmology system. Methods: Over a four-year study period, 13 remote communities in Queensland and the Northern Territory were identified that had limited or no access to eye screening services. Relationships with health service providers in the communities were established to codesign a sustainable model of service delivery and referral pathways to ensure that patients identified with eye issues received appropriate treatment. Results: Over the course of the study, screening records from 378 patients were uploaded to a web-based telehealth system and diagnosed by ophthalmologists. From these examinations, 64 new cases of diabetic retinopathy (DR) were identified (including 2 cases of proliferative DR and 4 cases of severe nonproliferative DR), and diabetic macular edema was noted in 18 patients. The majority of participants screened had no eye problems, which enables the removal of these patients from the queues of overwhelmed specialist lists, improving service efficiency. The study also demonstrates capacity building of healthcare workers to perform eye screening and improved patient health awareness where the retinal cameras were used as an educational tool. Conclusions: A valuable screening service has been established in the target areas, where access to ophthalmic services has been improved for residents of the study screening locations. Routine eye examination (instead of opportunistic eye examination) is feasible for early detection of some eye diseases for remote and rural patients.

Structure, governance and delivery of specialist training programs in periodontology and implant dentistry.

To update the competences and learning outcomes and their evaluation, educational methods and education quality assurance for the training of contemporary specialists in periodontology, including the impact of the 2018 Classification of Periodontal and Peri-implant Diseases and Conditions (2018 Classification hereafter) and the European Federation of Periodontology (EFP) Clinical Practice Guidelines (CPGs). Evidence was gathered through scientific databases and by searching for European policies on higher education. In addition, two surveys were designed and sent to program directors and graduates. Program directors reported that curricula were periodically adapted to incorporate advances in diagnosis, classification, treatment guidelines and clinical techniques, including the 2018 Classification and the EFP CPGs. Graduates evaluated their overall training positively, although satisfaction was limited for training in mucogingival and surgical procedures related to dental implants. Traditional educational methods, such as didactic lectures, are still commonly employed, but they are now often associated with more interactive methods such as case-based seminars and problem-based and simulation-based learning. The evaluation of competences/learning outcomes should employ multiple methods of assessment. An update of competences and learning outcomes of specialist training in periodontology is proposed, including knowledge and practical application of the 2018 Classification and CPGs. Harmonizing specialist training in periodontology is a critical issue at the European level.

Determinants of the Quality of Delivery of Agricultural Training Programs among Farmers in Greater Giyani Municipality, South Africa

Determinants of the Quality of Delivery of Agricultural Training Programs among Farmers in Greater Giyani Municipality, South Africa