Evidence-based Implementation Research Articles

Methodology for adapting a co-created early childhood development intervention and implementation strategies for use by frontline workers in India and Guatemala: a systematic application of the FRAME-IS framework

ABSTRACT There is little evidence on optimizing the effectiveness and implementation of evidence-based early childhood development (ECD) interventions when task-shifted to frontline workers. In this Methods Forum paper, we describe our adaptation of the International Guide for Monitoring Child Development (GMCD) for task-shifting to frontline workers in Guatemala and India. In 2021–2022, implementers, trainers, frontline workers, caregivers, and international GMCD experts collaborated to adapt the GMCD for a task shifted implementation by frontline workers. We used an eight-step co-creating process: assembling a multidisciplinary team, training on the existing package, working groups to begin modifications, revision of draft modifications, tailoring of visual materials and language, train-the-trainers activities, pilot frontline worker trainings, final review and feedback. Preliminary effectiveness of adaptations was evaluated through narrative notes and group-based qualitative feedback following pilot trainings with 16 frontline workers in India and 6 in Guatemala. Final adaptations included: refining training techniques to match skill levels and learning styles of frontline workers; tailoring all visual materials to local languages and contexts; design of job aids for providing developmental support messages; modification of referral and triage processes for children in need of enhanced support and speciality referral; and creation of post-training support procedures. Feedback from pilot trainings included: (1) group consensus that training improved ECD skills and knowledge across multiple domains; and (2) feedback on ongoing needed adjustments to pacing, use of video-based vs. role-playing materials, and time allocated to small group work. We use the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) framework to document our adaptations. The co-creating approach we use, as well as systematic documentation of adaptation decisions will be of use to other community-based early childhood interventions and implementation strategies.

Qualitative Insights Into Enhancing Neonatal Resuscitation in Post-Pandemic Vietnam: A Stakeholder Perspective on the Helping Babies Breathe Program.

The neonatal phase is vital for child survival, with a substantial portion of deaths occurring in the first month. Neonatal mortality rates differ significantly between Vietnam (10.52/1000 live births) and the United States (3.27/1000). In response to these challenges, interventions such as the Helping Babies Breathe (HBB) program have emerged, aiming to enhance the quality of care provided during childbirth, and the postpartum period in low-resource settings. The purpose of this study was to explore stakeholder perceptions of the HBB program in Vietnam postpandemic, aiming to identify requisites for resuming training. Utilizing qualitative content analysis, 19 in-person semistructured interviews were conducted with diverse stakeholders in 2 provinces of Central Vietnam. The content analysis revealed following 5 main themes: (1) the pandemic's impact on HBB training; (2) resource needs for scaling up HBB training as the pandemic abates; (3) participants' perceptions of the pandemic's effect on HBB skills and knowledge; (4) the pandemic's influence on a skilled neonatal resuscitation workforce; and (5) future prospects and challenges for HBB training in a postpandemic era. This research highlights the importance of sustainable post-HBB training competencies, including skill assessment, innovative knowledge retention strategies, community-based initiatives, and evidence-based interventions for improved healthcare decision-making and patient outcomes. Healthcare institutions should prioritize skill assessments, refresher training, and collaborative efforts among hospitals, authorities, non-government organizations, and community organizations for evidence-based education and HBB implementation.

Assessment and management of constipation in post-operative patients in the spinal surgery ward: a best practice implementation project.

Constipation is a common complication following spinal surgery that can result in distension, abdominal pain, infection, and even intestinal perforation. This study reports on an evidence-based implementation project to reduce the incidence of constipation in spinal surgery wards. The project was conducted in the spinal surgery ward of a general tertiary hospital in Changsha City, China, from March to August 2022. We used the JBI Implementation Framework and the JBI Model of Evidence-Based Healthcare for audits and feedback. Data were collected and analyzed using JBI's Practical Application of Clinical Evidence System (PACES) software. Seven audit criteria were developed based on the best practice recommendations summarized by JBI. A baseline audit was conducted with 20 nurses and 50 patients in the spinal surgery ward, and a follow-up audit was conducted using the same sample size and setting. The baseline audit revealed compliance below 46% for five of the seven criteria. Strategies developed to address poor compliance included educating nurses and patients, developing a post-operative constipation risk assessment sheet, organizing stakeholder focus group meetings, establishing a constipation management routine, and effective empowerment of nurses. The follow-up audit showed positive compliance results, with the highest rate for Criterion 7 (100%) and the greatest increase for Criterion 2 (from 0% to 78%). Furthermore, the incidence of post-operative constipation decreased from 48% to 16%. The project improved compliance with audit criteria, reduced the incidence of constipation, and enhanced the efficiency of quality management in the spinal surgery ward. http://links.lww.com/IJEBH/A186.

Survival After Out-of-Hospital Cardiac Arrest Before and After Legislation for Bystander CPR

The lack of evidence-based implementation strategies is a major contributor to increasing mortality due to out-of-hospital cardiac arrest (OHCA) in developing countries with limited resources. To evaluate whether the implementation of legislation is associated with increased bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use and improved clinical outcomes for patients experiencing OHCA and to provide policy implications for low-income and middle-income settings. This observational cohort study analyzed a prospective city registry of patients with bystander-witnessed OHCA between January 1, 2010, and December 31, 2022. The Emergency Medical Aid Act was implemented in Shenzhen, China, on October 1, 2018. An interrupted time-series analysis was used to assess changes in outcomes before and after the law. Data analysis was performed from May to October 2023. The Emergency Medical Aid Act stipulated the use of AEDs and CPR training for the public and provided clear legal guidance for OHCA rescuing. The primary outcomes were rates of bystander-initiated CPR and use of AEDs. Secondary outcomes were rates of prehospital return of spontaneous circulation (ROSC), survival to arrival at the hospital, and survival at discharge. A total of 13 751 patients with OHCA (median [IQR] age, 59 [43-76] years; 10 011 men [72.83%]) were included, with 7858 OHCAs occurring during the prelegislation period (January 1, 2010, to September 30, 2018) and 5893 OHCAs occurring during the postlegislation period (October 1, 2018, to December 31, 2022). The rates of bystander-initiated CPR (320 patients [4.10%] vs 1103 patients [18.73%]) and AED use (214 patients [4.12%] vs 182 patients [5.29%]) increased significantly after legislation implementation vs rates before the legislation. Rates of prehospital ROSC (72 patients [0.92%] vs 425 patients [7.21%]), survival to arrival at the hospital (68 patients [0.87%] vs 321 patients [5.45%]), and survival at discharge (44 patients [0.56%] vs 165 patients [2.80%]) were significantly increased during the postlegislation period. Interrupted time-series models demonstrated a significant slope change in the rates of all outcomes. These findings suggest that implementation of the Emergency Medical Aid Act in China was associated with increased rates of CPR and public AED use and improved survival of patients with OHCA. The use of a systemwide approach to enact resuscitation initiatives and provide legal support may reduce the burden of OHCA in low-income and middle-income settings.

Optimizing evidence-based practice implementation: a case study on simulated patient protocols in long-term opioid therapy

BackgroundSubstantial work has been done to update or create evidence-based practices (EBPs) in the changing health care landscape. However, the success of these EBPs is limited by low levels of clinician implementation.ObjectiveThe goal of this study is to describe the use of standardized/simulated patient/person (SP) methodology as a framework to develop implementation bundles to increase the effectiveness, sustainability, and reproducibility of EBPs across health care clinicians.DesignWe observed 12 clinicians’ first-time experiences with six unique decision-making algorithms, developed previously using rigorous Delphi methods, for use with patients exhibiting concerning behaviors associated with long-term opioid therapy (LTOT) for chronic pain. Clinicians were paired with two SPs trained to portray individuals with one of the concerning behaviors addressed by the algorithms in a telehealth environment. The SP evaluations were followed by individual interviews, guided by the Consolidated Framework for Implementation Research (CFIR), with each of the clinician participants.ParticipantsTwelve primary care clinicians and 24 SPs in Western Pennsylvania.Main measurementThe primary outcome was identifying likely facilitators for the successful implementation of the EBP using the SP methodology. Our secondary outcome was to assess the feasibility of using SPs to illuminate likely implementation barriers and facilitators.ResultsThe SP portrayal illuminated factors that were pertinent to address in the implementation bundle. SPs were realistic in their portrayal of patients with concerning behaviors associated with LTOT for chronic pain, but clinicians also noted that their patients in practice may have been more aggressive about their treatment plan.ConclusionsSP simulation provides unique opportunities for obtaining crucial feedback to identify best practices in the adoption of new EBPs for high-risk patients.SettingZoom simulated patient evaluations.

How different attributes are weighted in professionals' decision-making in Pediatric Dentistry-a protocol for guiding discrete choice experiment focused on shortening the evidence-based practice implementation for dental care.

Important evidence has been constantly produced and needs to be converted into practice. Professional consumption of such evidence may be a barrier to its implementation. Then, effective implementation of evidence-based interventions in clinical practice leans on the understanding of how professionals value attributes when choosing between options for dental care, permitting to guide this implementation process by maximizing strengthens and minimizing barriers related to that. This is part of a broader project investigating the potential of incorporating scientific evidence into clinical practice and public policy recommendations and guidelines, identifying strengths and barriers in such an implementation process. The present research protocol comprises a Discrete Choice Experiment (DCE) from the Brazilian oral health professionals' perspective, aiming to assess how different factors are associated with professional decision-making in dental care, including the role of scientific evidence. Different choice sets will be developed, either focusing on understanding the role of scientific evidence in the professional decision-making process or on understanding specific attributes associated with different interventions recently tested in randomized clinical trials and available as newly produced scientific evidence to be used in clinical practice. Translating research into practice usually requires time and effort. Shortening this process may be useful for faster incorporation into clinical practice and beneficial to the population. Understanding the context and professionals' decision-making preferences is crucial to designing more effective implementation and/or educational initiatives. Ultimately, we expect to design an efficient implementation strategy that overcomes threats and potential opportunities identified during the DCEs, creating a customized structure for dental professionals. https://osf.io/bhncv .

Redesigning an Autism Evidence-Based Practice Adoption and Decision-Making Implementation Toolkit for Middle and High Schools

Redesigning an Autism Evidence-Based Practice Adoption and Decision-Making Implementation Toolkit for Middle and High Schools

Nursing Leaders’ Influence on Clinical Nurses’ Evidence-Based Practice Implementation: Impact of an Evidence-Based Practice Leadership Behavior Program

Unit-level nursing leaders’ behaviors may foster the organization’s implementation climate for evidence-based practice. This study used a quantitative, pre-test, post-test comparative design to determine whether acute and critical care nursing leaders’ participation in an EBP Leadership Behavior Program made a difference in nursing leaders’ self-reported and clinical nurses’ perceptions of nursing leaders’ EBP leadership behaviors and competencies. The program was designed for nursing leaders that included synchronous and asynchronous activities. Findings indicated that nursing leaders’ EBP competencies and EBP leadership behaviors significantly improved following participation in the program. However, clinical nurses’ perceptions did not statistically significant change.

Role Development and Extension for Radiographers in Computed Tomography: Literature Review Findings and their Application to Zimbabwe

Computed Tomography (CT) technology has evolved into a vital diagnostic tool in modern medical practice, leading to the development and extension of the CT radiographer's role. While some countries have made progress in developing and extending radiographers' roles in CT, resource-constrained settings like Zimbabwe have been slower to implement these changes. The purpose of this review is to inform role changes for radiographers in Zimbabwe and similar settings by reviewing the literature on role development and extension for radiographers in CT. The review explores the concepts of role development and extension, emphasizing the necessity for changes in radiographers' roles in CT due to factors such as radiologists shortages, cost containment, quality improvement needs, and technological advancements. It also addresses the opposition to role development and extension, emphasizing the fundamental impetus for these changes should be to provide high-quality and effective patient-centered care. The paper delves into specific areas of role development and extension for radiographers in CT, including intravenous (IV) cannulation and contrast media administration, performing CT colonoscopy examinations, reporting on CT brains, and the significance of research and clinical audit in CT. It underscores the potential benefits of these expanded roles, such as improved patient care, workflow efficiency, and the workload of radiologists, as well as advancements in education, service delivery, and technological innovations. The review underscores the need for further research to ensure evidence-based implementation of role development and extension for radiographers in CT. Embracing these changes and providing the necessary support and training can lead to improved patient care, address skill shortages, and advance the radiography profession in resource-constrained settings like Zimbabwe.

Enhancing Behavioral Health Implementation in a Care Coordination Program at a Federally Qualified Health Center: A Case Study Applying Implementation Frameworks.

Federally Qualified Health Centers are charged with providing comprehensive health care in traditionally underserved areas, underscoring their importance in caring for and promoting health equity for the large portion of historically marginalized communities in this setting. There is a significant need to ensure Federally Qualified Health Centers are equipped to appropriately address the immense behavioral health needs common among patients served. Care coordination is an evidence-based model that is increasingly utilized in Federally Qualified Health Centers to improve care equity and outcomes. Addressing and supporting behavioral health needs is a key aspect of such care coordination models. Context-specific considerations and programmatic supports, particularly those that address the needs of care coordinators and the complex patients they serve, are needed to ensure such models can appropriately meet and address the behavioral health concerns of the diverse populations served. The goal of this study was to present a mixed-methods case study that systematically applies implementation frameworks to conduct a needs and context assessment to inform the development and testing of evidence-based practice strategies and implementation support as part of a care coordination program within a partnered Federally Qualified Health Center.

An assessment of adaptation and fidelity in the implementation of an audit and feedback-based intervention to improve transition to adult type 1 diabetes care in Ontario, Canada

BackgroundThe fit between an intervention and its local context may affect its implementation and effectiveness. Researchers have stated that both fidelity (the degree to which an intervention is delivered, enacted, and received as intended) and adaptation to the local context are necessary for high-quality implementation. This study describes the implementation of an audit and feedback (AF)-based intervention to improve transition to type 1 diabetes adult care, at five sites, in terms of adaptation and fidelity.MethodsAn audit and feedback (AF)-based intervention for healthcare teams to improve transition to adult care for patients with type 1 diabetes was studied at five pediatric sites. The Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) was used to document the adaptations made during the study. Fidelity was determined on three different levels: delivery, enactment, and receipt.ResultsFidelity of delivery, receipt, and enactment were preserved during the implementation of the intervention. Of the five sites, three changed their chosen quality improvement initiative, however, within the parameters of the study protocol; therefore, fidelity was preserved while still enabling participants to adapt accordingly.ConclusionsWe describe implementing a multi-center AF-based intervention across five sites in Ontario to improve the transition from pediatric to adult diabetes care for youth with type 1 diabetes. This intervention adopted a balanced approach considering both adaptation and fidelity to foster a community of practice to facilitate implementing quality improvement initiatives for improving transition to adult diabetes care. This approach may be adapted for improving transition care for youth with other chronic conditions and to other complex AF-based interventions.Trial registrationClinicalTrials.gov NCT03781973. Registered 13 December 2018. Date of enrolment of the first participant to the trial: June 1, 2019.

Prevention of cisplatin-induced hearing loss in children: achievements and challenges for evidence-based implementation of sodium Thiosulfate.

Ototoxicity is a devastating direct, irreversible side effect of platinum use in children with cancer, with its consequent effect on speech, language and social development, quality of life and adult productivity. Cisplatin, an essential chemotherapeutic agent for the treatment of solid tumors in children, is a DNA cross-linking agent. Which causes hearing loss in 50-70% of cisplatin treated children. Fortunately, to prevent hearing loss, sodium thiosulfate (STS), which binds to cisplatin, and reduces the superoxides in both tumor and outer hair cells of the cochlea has now been discovered to be an effective and safe otoprotectant if administered correctly. The aim of this perspective paper is to explore the key safety issues and challenges important for pediatric oncologists and pharmacists when considering the clinical use of STS as an otoprotectant for children and adolescents receiving cisplatin. These include: the choice of the formulation; the timing, both that of the STS in relation to cisplatin as well as the timing of the cisplatin infusion itself; the dosing; the challenge left by the definition of localized versus disseminated disease and the difference in indication for STS, between cisplatin treated patients and those receiving another platinum chemotherapeutic agent, carboplatin.

Exploring teachers’ perspectives on movement integration using a job-embedded professional development intervention

PurposeThe purpose of this study was to gain teachers’ insight and evaluate a teacher training intervention on movement integration (MI). MethodsAn embedded mixed methods study was used to combine post-intervention qualitative and quantitative data from 12 teachers. ResultsFour themes were generated: employable strategies, increased student engagement, value of additional support, and space, time, and behaviour management. These themes illustrate the intrapersonal, institutional, and public policy barriers that impact MI implementation. ConclusionAn evidence-based teacher MI implementation intervention that utilizes best practices can address intrapersonal barriers to MI use but does not alleviate institutional and public policy barriers.

Individual and social system factors influencing evidence-based practices among nurses in general hospitals: A cross-sectional multi-institutional study.

To investigate evidence-based practices and examine the influence of individual and social system factors on evidence-based practices among nurses in general hospitals. Evidence-based practice is essential for improving healthcare quality. However, a challenge for nursing worldwide is nurses' limited use of evidence-based practices. It is crucial to determine the individual and social system factors affecting nurses' use of evidence-based practices. This study employs a multi-institutional cross-sectional design. With a multistage random sampling method, 336 registered nurses were recruited from 17 general hospitals in the Republic of the Union of Myanmar. Data were collected through a seven-part questionnaire, including the Evidence-Based Practice Implementation Scale and individual and social system factors. Data were analyzed using descriptive statistics and multiple linear regression. Nurses in general hospitals perceived low levels of evidence-based practices. Individual factors, such as perceived barriers (p < .001), knowledge (p < .001) and attitudes (p = .001), were related to EBP as well as social system factors, including the work environment (p < .001) which influence nurses' practice, explaining 34% variance among nurses. Nurses perceived the work environment as the most influencing factor related to evidence-based practices. Individual characteristics, including perceived knowledge, attitudes and barriers, were critical factors in performing evidence-based practices in Myanmar. Nurse administrators and policymakers can develop strategies and interventions for improving knowledge, attitudes and work environment towards evidence-based practice. Minimizing the barriers to evidence-based practice will promote evidence-based practices in Myanmar general hospitals. In addressing the individual and social system factors influencing the evidence-based practices of nurses, this study contributes to enhancing healthcare quality and outcomes. This study adhered to the STROBE checklist. There was no patient or public contribution.

Drug Interactions in the Treatment of Chronic Heart Failure: Analysis of Clinical Guidelines

Background. According to Russian epidemiological studies, the prevalence of chronic heart failure (CHF) in the general population is high and amounts to 7–10%. Therapy of any disease, and especially chronic disease, is associated with the prescription of drugs. With the development of evidence-based medicine and implementation of its achievements in real clinical practice all over the world there is an increase in the number of prescribed drugs. This explains the high relevance of the problem of drug-drug interactions. Aims — analysis of interactions of drugs recommended for prescription to patients suffering from CHF. Methods. Based on the Clinical Guidelines (CG), all possible interdrug interactions of recommended medicinal products were analysed. Information on potential drug-drug interactions was obtained from the specialised website Drugs.com. Know more. Be sure (https://www.drugs.com/interactions/list/). Results. ACE inhibitors / ARA II / valsartan+sacubitril, beta-adrenoblockers and aldosterone antagonists are recommended as part of combination therapy for treatment according to CG for all patients with symptomatic heart failure (class II–IV) and reduced LV ejection fraction 40%. Amiodarone, verapamil and diltiazem are among the drugs not recommended for use in patients with the diagnosis of CHF. Also, according to clinical guidelines, HMG-CoA reductase inhibitors (atorvastatin, lovastatin, pitavastatin, rosuvastatin, simvastatin, fluvastatin), direct renin inhibitors (heparin), COX-2 inhibitors (parecoxib, polmacoxib, celecoxib, etoricoxib) are among the unrecommended drugs in chronic heart failure.For ACE inhibitors, no adverse effects from interaction with beta-blockers have been identified. This combination is widely used and recommended by the CG. According to the “Major” type for ACE inhibitors with drugs indicated for use in CHF according to CG, 4 potential interactions were identified: with valsartan-sacubitril; angiotensin II receptor antagonists; with aldosterone antagonist (spironolactone); with loop and thiazide diuretics. Therefore, the appointment of angiotensin II receptor antagonists is carried out in case of ineffectiveness of initial therapy with ACE inhibitors, when changing the treatment tactics. These drugs are not used in combination with each other due to the risk of hyperkalemia. The prescription and use of diuretics while taking ACE inhibitors should be controlled by a physician also due to the risk of hyperglycaemia. In Moderate type, potential interactions with dapagliflozin, eplerenone, cardiac glycosides and heparin have been identified for ACE inhibitors. For beta-blockers, no potential Major-type interactions were identified with drugs from CG. Combinations with dapagliflozin, loop and thiazide diuretics, cardiac glycosides, spironolactone and ivabradine require special attention. It is recommended to avoid the combination of beta-blockers with valsartan. Of the recommended angiotensin II receptor antagonists, no risk of potential interactions with beta-blockers has been identified for candesartan and losartan.

Scientific Literacy is A Valuable Tool for Modern Politicians A Comprehensive Analysis

Scientific literacy plays a pivotal role in shaping informed decision-making, and its importance extends beyond academia to significantly impact modern politicians’ effectiveness. This paper explores the critical relationship between scientific literacy and political leadership, emphasising the role of well-informed policymakers in addressing complex societal challenges. Drawing on existing literature and empirical evidence, we delve into the multifaceted aspects of scientific literacy and its potential as a powerful tool for guiding evidence-based policy formulation and implementation. Through an in-depth analysis, we aim to underscore the need to foster scientific literacy among politicians to enhance their ability to navigate the intricacies of contemporary issues.

Feasibility of Evidence-Based Social and Emotional Learning in Prairie Canadian Schools

This study examined opportunities and barriers for implementing evidence-based Social and Emotional Learning (SEL) programs in Prairie Canadian Schools. Educators from Manitoba, Saskatchewan and Alberta completed an online survey on SEL feasibility and reported on five feasibility domains: (1) attitudes about SEL, (2) knowledge about SEL, (3) job stress, (4) resources for implementing SEL, and (5) SEL practices. Results indicated that positive attitudes toward SEL significantly predicted increased perceived feasibility for evidence-based SEL implementation. Additionally, both knowledge and access to resources predicted increased SEL practice by Prairie Canadian educators. Analyses for open-ended responses paralleled quantitative results. Specifically, Canadian educators had positive views about SEL programing, but like previous research conducted in other countries, indicated that they require better access to SEL training, and resources (e.g., more time to plan and teach SEL, funding and program materials). A unique Canadian context-related finding from this study was that some Prairie Canadian educators indicated a paucity of French materials for SEL programs, which impeded implementation. In order to effectively implement evidence-based SEL in Prairie Canadian schools, policy makers must address the indicated barriers for Canadian educators, such as increased SEL training and resources, and easy access to appropriate French materials.

Toward Equitable Kidney Function Estimation in Critical Care Practice. Guidance From the Society of Critical Care Medicine's Diversity, Equity, and Inclusion in Renal Clinical Practice Task Force.

Accurate glomerular filtration rate (GFR) assessment is essential in critically ill patients. GFR is often estimated using creatinine-based equations, which require surrogates for muscle mass such as age and sex. Race has also been included in GFR equations, based on the assumption that Black individuals have genetically determined higher muscle mass. However, race-based GFR estimation has been questioned with the recognition that race is a poor surrogate for genetic ancestry, and racial health disparities are driven largely by socioeconomic factors. The American Society of Nephrology and the National Kidney Foundation (ASN/NKF) recommend widespread adoption of new "race-free" creatinine equations, and increased use of cystatin C as a race-agnostic GFR biomarker. Literature review and expert consensus. English language publications evaluating GFR assessment and racial disparities. We provide an overview of the ASN/NKF recommendations. We then apply an Implementation science methodology to identify facilitators and barriers to implementation of the ASN/NKF recommendations into critical care settings and identify evidence-based implementation strategies. Last, we highlight research priorities for advancing GFR estimation in critically ill patients. Implementation of the new creatinine-based GFR equation is facilitated by low cost and relative ease of incorporation into electronic health records. The key barrier to implementation is a lack of direct evidence in critically ill patients. Additional barriers to implementing cystatin C-based GFR estimation include higher cost and lack of test availability in most laboratories. Further, cystatin C concentrations are influenced by inflammation, which complicates interpretation. The lack of direct evidence in critically ill patients is a key barrier to broad implementation of newly developed "race-free" GFR equations. Additional research evaluating GFR equations in critically ill patients and novel approaches to dynamic kidney function estimation is required to advance equitable GFR assessment in this vulnerable population.

Multidisciplinary Perceptions and Considerations for Spiritual Care and Biblical Framework Counseling in Mental Health

Background: Religious/Spiritual (R/S) care is often desirable by mental health clients for culturally sensitive, patient-focused treatment; yet providers may experience hesitancy or overlook this need and treatment guidelines are limited. The aim of this qualitative study was to explore existing R/S care, as well as perspectives on what support care would be considered for patients choosing BFC. This is part of a project to collaboratively extend population-based mental health care access in resource–constrained communities of both the US, a High-Income Country (HIC) and Low-to-Middle Income Countries (LMICs) in Africa. &#x0D;  &#x0D; Methods: A qualitative literature synthesis, then an online survey was conducted with 54 multidisciplinary participants recruited via snowballing. Survey participants were asked to review a case as described by a BFC provider and respond  anonymously to an open-ended questionnaire. The data collected was distilled with qualitative coding and thematic analysis. &#x0D;  &#x0D; Results: Literature synthesis identified multidisciplinary health professional provision of R/S, medical and/or psychological interventions as monotherapy or integrated strategies. There was a paucity of medical education guidelines. Qualitative themes included willingness to coordinate care for BFC clients, to what capacity should care be provided, and perceptions of BFC efficacy. R/S care was often integrated as part of a holistic treatment approach. Scheduled BFC patient follow-ups, ethical hand-offs or referrals were considered important for majority of survey respondents based on comfort-level with biblical counseling and perceived relapse potential. Spiritual growth and maintenance, medication management, and individual psychotherapy were recommended by survey respondents. There were contrasts in BFC and non-R/S provider perspectives on pertinent mental health history and inferences from the case. Significant information for patient support included symptoms and confirmatory diagnosis, medical comorbidities, relevant childhood issues, faith-health beliefs, family history and genetics, medication and therapy adherence, and substance use. Faith-health belief congruence of providers with BFC patients and ethical decision-making should be considered. Graduate Medical Education (GME) and other health professional programs may incorporate these considerations, existing R/S interventions, and multidisciplinary provider scope of practice as options for clinician training. Future research steps should include growing the body of anecdotal case reports, evidence-based case series and implementation science studies across a broader range of mental disorders.&#x0D;  

Beyond Validation: Getting Wearable Activity Trackers into Cardiovascular Care - A Discussion Paper.

This paper addresses the challenge of integrating wearable activity trackers into cardiovascular disease care. Despite evidence supporting the use of trackers for monitoring and promoting physical activity, implementation challenges persist in clinical settings. The paper emphasises the lack of systematic, evidence-based implementation approaches for integrating trackers. It underscores the urgent need for stakeholder collaboration between clinicians, patients, implementation scientists, researchers, health and technology partners, and the use of proven implementation science methodologies. This is crucial for bridging the gap and ensuring effective translation of wearable activity trackers into cardiovascular disease care, meeting the increasing demand from patients and clinicians.