Implementation Experience Research Articles

Deepening the participation of neurodivergent youth in qualitative mental health research: Co‐development of a general approach and the evaluation of its implementation in a study on emotion

AbstractBackgroundThere is a growing expectation that neurodivergent young people, such as those with diagnoses of attention‐deficit/hyperactivity disorder (ADHD) and/or autism, should play a central role in shaping research on neurodevelopmental conditions. However, currently, their involvement is typically limited to arms‐length advice. To address this, the Regulating Emotions‐Strengthening Adolescent Resilience (RE‐STAR) programme has co‐developed a framework for deepening the involvement of neurodivergent participants in translational research. Here we apply this to build, implement and evaluate a new approach to participatory qualitative research.MethodsDevelopment – Building on the track record of successful collaboration between RE‐STAR academic researchers (ARs) and its Youth Researcher Panel (Y‐RP), a cycle of meetings was convened to co‐develop a collaborative protocol for the participatory approach. Implementation – ARs and Y‐RPers applied the general protocol to study a specific topic. This involved co‐designing and co‐delivering an interview schedule to study the emotional experiences of 12 adolescents with diagnoses of ADHD and/or autism and then co‐analysing the interviews. Evaluation – ARs, Y‐RPers and interviewees shared their reflections on the participatory approach and its implementation, during interviews (N = 36) and short open‐ended surveys (N = 22).ResultsDevelopment ‐ The protocol for the participatory approach gave detailed advice on how to engage Y‐RP members (or equivalent) in the co‐design, co‐delivery and co‐analysis of interviews. Implementation ‐ The approach was successfully implemented by ARs and Y‐RPers working together to co‐design an interview to study the emotional lives of adolescents with diagnoses of ADHD and/or autism, co‐deliver it and then co‐analyse the interview scripts. Evaluation ‐ The implementation experience of the Y‐RP, ARs and interviewees was characterised by common themes relating to (a) adapting research methods and making practical adjustments; (b) taking on new roles, adding value to research and (c) valuing neurodivergent characteristics.ConclusionsThis new RE‐STAR protocol proved feasible to implement in a way that was generally perceived, from multiple perspectives, to add depth and authenticity to research into the experiences of neurodivergent young people.

Measuring Patient Well-Being During Whole-Person Clinical Care: Lessons From the Veterans Health Administration Well-Beings Signs Implementation Pilot.

Measuring patient well-being during clinical care may enhance patient-centered communication and treatment planning. The Veterans Health Administration (VHA) piloted the use of the Well-Being Signs (WBS), a self-report measure of psychosocial well-being, in clinical care. To understand early WBS implementation and health care team member experiences with its use before developing detailed support materials and finalizing the measure. We conducted a mixed-methods evaluation of the WBS implementation pilot at 4 VHA facilities, including surveys of (n=4) Whole Health (WH) leaders/clinical leads, and semi-structured interviews with (n=11) clinical leads and team members. Survey data were characterized using descriptive statistics; interview data were analyzed using rapid qualitative analysis. Facilities supported WBS implementation by disseminating information to clinical team members, primarily during staff meetings (3/4 facilities), individual discussions (3/4), and email (3/4); only half provided training sessions. In interviews, some care team members expressed the need for more training on using the WBS in clinical care. Some interviewees also provided suggestions for changes to the draft measure, including response option format and question look-back period. Although there have been growing calls for attention to patient well-being in clinical care, our results suggest barriers to the implementation of well-being measures in this context. Findings were used to inform the development of enhanced training materials and make modifications to enhance the acceptability of the WBS to providers. Other identified barriers will need to be addressed in future implementation efforts, including bolstering leadership support and easing the added time and burden of administration.

Implementing Primary Care Reform in France: Bargaining, Policy Adaptation, and the Maisons de Santé Pluriprofessionnelles

Context: The organization of primary care in France has long remained a secondary issue on the political agenda. The government began to address the difficulties of care access and coordination in the 2000s, when a seemingly viable solution emerged from the field: the maisons de santé pluriprofessionnelles (MSPs). In a corporatist system and a predominantly private sector, the government chose an incentive-based contractual policy to encourage providers to join these structures. This article analyzes the implementation of this policy, which depends on private providers’ commitment. Methods: The article offers a comparative case study of six MSPs. Data were collected through semistructured interviews, observation sessions, and document analysis. Findings: First, the article shows that the emergence of MSPs has only been possible thanks to an unprecedented alliance between general practitioners, the state, and the health insurance fund. Second, it argues that MSP policy implementation relies on a complex bargaining process between private providers and public authorities that enables the former to shape it to their local needs. Conclusions: MSP implementation experiences raise questions both about the understanding of medical corporatism in France and the assimilation of policy changes and local variation through policy implementation.

The role of artificial intelligence and machine learning in optimizing U.S. healthcare supply chain management

This paper aims to review the role of Artificial Intelligence and Machine Learning in managing the healthcare supply chain in the United States. Healthcare supply chains face several challenges such as fragmentation, lack of real-time visibility, and inventory management issues. However, there are solutions with the help of AI and machine learning, including the availability of predictive analytics to improve demand forecasting, optimization algorithms for inventory and logistics, and automated quality control. Application areas demand forecasting, supplier selection, logistics optimization, quality control, and real-time tracking. The applications of AI in healthcare supply chains have the potential to improve the healthcare supply chain in terms of reduced costs, increased efficiency, optimized decision-making, and better patient outcomes. However, the implementation experience has shown several challenges such as data quality, privacy concerns, regulatory compliance, and workforce adaptation within organizations. Successful implementations in various health organizations in the US give valuable insights into how AI could be well implemented. The future presents several opportunities for supply chain optimization with the rise of blockchain and Internet of Things (IoT) integration. For healthcare supply chains to adopt AI, organizations should have specific AI plans, start with pilot projects in high-impact areas, invest in data infrastructure, and ensure strong leadership support. As AI becomes increasingly critical for competitive advantage, it has the potential to create more resilient, efficient, and patient-centric supply chains in the US healthcare system.

Implementation facilitators and barriers of stress first aid to protect mental health of frontline health care workers during the COVID-19 pandemic: a qualitative study.

The COVID-19 pandemic has taken a toll on frontline health care workers (HCWs), leading to poor mental and physical well-being. We conducted a large, cluster randomized controlled trial to implement an adapted Stress First Aid (SFA) intervention to support HCW well-being using a train-the-trainer (TTT) approach for rapid deployment in the United States and collected qualitative data through interviews to understand implementation. The goal of this study is to understand barriers and facilitators to deploying SFA using a TTT model, with particular emphasis on the acceptability, uptake, and barriers from the implementation. We conducted seven individual and seven group semi-structured qualitative interviews with 28 trainers (i.e., site champions) who delivered SFA training to their local HCWs from Spring 2021 to Winter 2022 in hospitals and health care centers within the United States. We utilized both inductive and deductive approaches to coding transcripts. All transcripts were coded in Dedoose. We used the Consolidated Framework for Implementation Research (CFIR) to rigorously assess implementation experiences. Site champions highlighted leadership buy-in, protected time and incentives, and teams as implementation facilitators, while implementation barriers included unhelpful training materials and content, time constraints and scheduling difficulties, and pandemic-related factors, such as COVID-19 surges. SFA implementation processes varied: some champions had virtual SFA presentations, while others held informal discussions about SFA material in person. Champions also differed on their perceptions of SFA sustainability: some indicated it would be difficult to sustain SFA in their organization due to limited structure and time, while others stated they would continue to utilize it. Limited research has examined the implementation of HCW well-being interventions using a TTT approach in a changing environment. Site champions were able to implement SFA during a period of rapid and frequent change and shared several implementation facilitators and barriers related to the SFA intervention. In the future, addressing the implementation barriers proactively and prioritizing the implementation facilitators may prove to be useful for large-scale interventions implemented during disease outbreaks and pandemics.

Examining the Implementation Experience of the Universal Health Coverage Pilot in Kenya

ABSTRACT The Kenyan government implemented a Universal Health Coverage (UHC) pilot project in four (out of 47) counties in 2019 to address supply-side gaps and remove user fees at county referral hospitals. The objective of this study was to examine the UHC pilot implementation experience using a mixed-methods cross-sectional study in the four UHC pilot counties (Isiolo, Kisumu, Machakos, and Nyeri). We conducted exit interviews (n = 316) with health facility clients, in-depth interviews (n = 134) with national and county-level health sector stakeholders, focus group discussions (n = 22) with community members, and document reviews. We used a thematic analysis approach to analyze the qualitative data and descriptive analysis for the quantitative data. The UHC pilot resulted in increased utilization of healthcare services due to removal of user fees at the point of care and increased availability of essential health commodities. Design and implementation challenges included: a lack of clarity about the relationship between the UHC pilot and existing health financing arrangements, a poorly defined benefit package, funding flow challenges, limited healthcare provider autonomy, and inadequate health facility infrastructure. There were also persistent challenges with the procurement and supply of healthcare commodities and with accountability mechanisms between the Ministry of Health and county health departments. The study underscores the need for whole-system approaches to healthcare reform in order to ensure that the capacity to implement reforms is strengthened, and to align new reforms with existing system features.

Critical Success Factors of Sustainability Implementation in the Construction Industry

Sustainability is one of the emerging areas in building construction, and it is widely investigated in terms of bringing sustainable technology into construction. However, one of the biggest challenges in the construction industry is implementing sustainability. Building contractors and construction practitioners mostly struggle with the implementation of sustainability due to the lack of certain parameters that define sustainability. Therefore, this study investigates the factors for effective sustainability implementation to provide industry practitioners with the benefit of the extensive list of parameters when designing their sustainability program. To research the parameters, a questionnaire was designed and administered to construction professionals with wide experience in sustainability implementation. The respondents were asked to evaluate a set of sustainability factors in the economic, social, and environmental domains. This way, the study provides reflections from construction practitioners working on large projects. The findings indicated that Ethical and Relational Factors in economic sustainability, Historical and Social Relations Factors in social sustainability, and Material Usage Factors in environmental sustainability are the most important for effective sustainability implementation. The findings are expected to help construction practitioners understand metrics of sustainability, effectively manage their projects, and successfully implement sustainability with the consideration of proper metrics.

Analysis of the Teacher Rotation System from the Perspective of Educational Equity

Abstract: As a key policy to promote the balanced distribution of educational resources and realise educational equity, the teacher rotation system aims to alleviate the disparity in the level of teachers between urban and rural areas and among schools through the rational allocation of teacher resources. With the perspective of better achieving educational equity, this paper systematically comprehends the implementation status and experience of the teacher rotation system at home and abroad through literature reading and analysis. It is found that although the teacher rotation system plays a significant role in promoting educational equity, there are still challenges in the implementation process, such as teachers' adaptation difficulties, schools' conflict of interest, and imperfect supporting measures. In response to these problems, this paper proposes optimisation paths, including providing policy support to help teachers adapt to the new environment, strengthening publicity to enhance public acceptance, and improving monitoring mechanisms to ensure the effectiveness of policy implementation. The conclusion stresses that the effective implementation of the teacher rotation system requires the joint efforts of the government, schools, teachers and all sectors of the society, so as to promote the balanced development of education and achieve educational equity through the continuous optimisation of the system design and supporting measures.

The influence of policy advocacy and education on medical staff's adaptation to diagnosis related groups payment reform in China: an analysis of the mediating effect of policy cognition.

In recent years, China has been carrying out the Diagnosis Related Groups (DRGs) payment reform, which has an impact not only on payment methods and medical expenses, but also on the behaviors of medical staff. Some of these behaviors are unexpected by policymakers, such as turning away critically ill patients, disaggregating hospitalization costs, setting up disease groups with higher points, and so on. This phenomenon attracted the attention of some scholars, who put forward a few positive intervention measures, mainly including policy advocacy and system improvement. The scholars believed that the former was more feasible. However, there is a lack of research on the effects and influencing processes of these interventions. Therefore, this study aims to explore the influence of policy advocacy and education on medical staff's adaptation to DRGs payment reform in China and the role of policy cognition in this process, in order to provide experiences for the smooth implementation and sustainable development of DRGs payment system. A questionnaire survey was conducted among 650 medical staff in five large general hospitals in Zhejiang Province, China, to understand their participation and feedback on policy advocacy and education, their adaptation to the current DRGs payment reform, and their cognition of relevant policies. After descriptive statistical analysis, partial correlation analysis, multiple linear regression models and bias correction Bootstrap sampling method were used to analyze the mediating effect of policy cognition factors. All respondents had participated in organized collective policy advocacy and education activities in the past year, but the degree of satisfaction and recognition was not very high. 59.5 percent said their adaptation to the DRGs payment reform was average. Nearly half did not regularly pay attention to and participate in the management of the medical costs of patients with DRGs through compliance. And they had a low understanding of the specific rules of DRGs payment and did not form a high policy identity. The mediating effect values of policy cognition were 0.148, 0.152, 0.108, and 0.057, respectively, when the frequency and quality of policy advocacy and education influenced medical staff's adaptive perception and adaptive behaviors. The organized collective policy advocacy and education can promote medical staff's adaptation to DRGs payment reform by improving their policy cognition, and the action paths are diverse. Policymakers and hospital managers need pay attention to this phenomenon, and formulate demand-centered, value-oriented whole-process advocacy and education strategies while constantly improving the DRGs payment system. All of these provided a basis for further research and practice of positive intervention in DRGs payment reform.

TECHNICAL SOLUTIONS FOR DRILLING WELLS IN CHALLENGING CONDITIONS

Abstract. Drilling modern wells in difficult mining and geological conditions poses a number of tasks for engineers that require special solutions. These include instability of borehole walls in difficult geomechanical conditions, drilling of directional wells with long horizontal boreholes and their completion by multi-stage hydraulic fracturing, drilling in conditions of a narrow «window» of drilling mud density, as well as drilling of wells with extended reach from the vertical. The article describes the main difficulties and problems encountered in solving these problems, such as: wellbore collapse, absorption during drilling in difficult geomechanical conditions, the impossibility of running casing strings and liners into wells with a large deviation from the vertical by traditional methods, difficulties in cementing long horizontal liners, running completion for multi-stage hydraulic fracturing of a formation with packers in an open hole, difficulties in drilling in conditions of insignificant difference in pore pressure gradients and hydraulic fracturing. Certain proven solutions are offered to overcome such problems and difficulties, examples of solutions to the described problems are given. Among these solutions are geomechanical modeling with subsequent calculation of wellbore stability, as well as optimization of well trajectories, the product of multi-stage hydraulic fracturing by the Plug & Perf method of isolation and perforation in order to achieve a larger number of stages, as well as solutions for improving the quality of cementing horizontal liners. Pressure-controlled drilling technology and flotation of casing and liners into ERD wells will be considered. It concludes with conclusions about the relevance of the solutions described, the possibility of combining them to increase efficiency or under complex conditions, as well as aspects that require attention when choosing technologies and their implementation, such as the importance of risk assessment and the importance of technical integration of technologies, as well as preliminary calculations and analysis of technology implementation experience.

Navigating Digital Transformation

This paper outlines the design and implementation experience of a mentorship-based teaching approach for a third-year undergraduate Information Systems on Digital Strategy and Transformation. In its first iteration in 2021, the course struggled with a lack of engagement between staff and students, and overwhelmed students at the end of the semester. The mentorship-based teaching approach was trialled in the second iteration of the course to encourage learner agency and improvement in the students’ learning journey. Implementation of mentorship-based teaching resulted in a higher overall course satisfaction rate and improved staff-student engagement. The application of the mentorship model has been continually fine-tuned each semester since its implementation in 2021. The experience from this design and implementation serves as a case study to incorporate mentorship into the curriculum to facilitate learner agency. Educators may apply a similar process and framework to design a mentorship-based teaching strategy regardless of discipline.

Increasing interprofessional education experiences and collaboration: Outcomes of a virtually-based continuing education program

PurposeAn academic medical center implemented a yearlong virtual continuing education program to prepare health professions educators to develop, deploy and evaluate new interprofessional educational experiences for providers and learners. Materials and methodsPrimary program outcome measures were the number of participants who (1) completed the program, (2) presented a medical education topic to program participants, and (3) designed an interprofessional educational experience in collaboration with fellow participants or colleagues. Participation outcomes were measured by session attendance and completion of presentations on the medical education topic and designed interprofessional educational experience. Surveys administered at 3 time points assessed participants’ perceptions of the program. Changes in knowledge, skills, and attitudes were analyzed using paired t-tests. ResultsNineteen participants (100 %) from 7 professions achieved the primary program participation outcomes and met their own goals. There were statistically significant increases in knowledge and skills at the end of the program. High rates of implemented interprofessional educational experiences (57 %) were reported one year after program completion. Participants also identified program strengths and areas for improvement. ConclusionsLongitudinal continuing education programs in virtual formats can support both individuals and teams of educators in their own professional development and in designing interprofessional education experiences.

Exploring the role of primary care pharmacists in NHS Lanarkshire following the implementation of the pharmacotherapy hub: a service evaluation

Abstract Introduction The General Medical Service (GMS) contract was produced in Scotland in an attempt to tackle General Practitioner (GP) workforce issues. The pharmacotherapy work stream is part of this and provides a framework for pharmacy teams, dividing services into level 1 (core), level 2 (advanced) and level 3 (specialist).1 A statement by the Royal Pharmaceutical Society (RPS) and the British Medical Association (BMA) discussed the introduction of pharmacotherapy hubs to complete level 1 work for multiple practices, centralising the medicines reconciliation process. Theoretically, this would release pharmacists to carry out clinical and more advanced/specialist services.2 There are currently 8 pharmacotherapy hubs within NHS Lanarkshire (NHSL), incorporating level 2 and 3 services into job plans for General Practice Clinical Pharmacists (GPCPs). No work has been undertaken to explore changes in practice since the implementation of these hubs. The qualitative study explored drivers and motivators for pharmacists in practice, shaping future pharmacotherapy services in NHSL and Scotland. Aim To explore the views and attitudes of primary care pharmacists towards their practice role in NHSL following the implementation of the pharmacotherapy hub. Methods Ethical approval was granted from the School of Pharmacy and Life Sciences Ethics Committee (Robert Gordon University). Pharmacists working within the 8 hub localities were invited to participate via email correspondence if they had over 6 months experience in practice pre-hub implementation and then 6 months post-hub implementation. Participants attended a one-to-one interview to share their views towards their practice role since the hub was implemented. Interviews were recorded, transcribed verbatim and thematically analysed. Results Twelve pharmacists across six localities participated. The five key themes identified were job role, managing time, professional development, professional belonging and patient care. The implementation of the hub was an enabler for pharmacists to partake in advanced pharmacotherapy tasks. Pharmacists negatively perceived level 1 core pharmacotherapy tasks in comparison to level 3 clinical patient-facing time. Participants linked the hubs impact on practice with role development, an increase in autonomy, confidence and job satisfaction. Discussion/Conclusion The hub has enabled in-practice pharmacists to move to a more sustainable balance between core and advanced/specialist tasks. Collaboration is required between pharmacy teams and practices to understand the pharmacist role in pharmacotherapy. Further recommendations include continuing the roll-out of pharmacotherapy hubs, standardisation of pharmacist clinical time balanced with core tasks and implementation of protected learning time for pharmacy teams. The study was open to response bias but this was addressed by using semi-structure interview guides in the one-to-one interviews. Researcher bias was minimised by two researchers analysing the data and practicing reflexivity. The study was open to recall bias due to participant’s retrospective thinking. In NHSL prioritising the hub roll-out and collaboration with stakeholders are essential. This will ensure the balance between efficient pharmacotherapy services and maintaining attractive roles, contributing to a sustainable workforce.

Ensuring Safe Practice by Late Career Physicians: Institutional Policies and Implementation Experiences.

Late career physicians (LCPs; physicians working beyond age 65 to 75 years) may be at higher risk for delivering unsafe care. To oversee LCPs, some health care organizations (HCOs) have adopted LCP policies requiring cognitive, physical, and practice performance screening assessments. Despite recent controversies, little is known about the content and implementation of such policies. To characterize key features of LCP policies and the perspectives of medical leaders responsible for policy development and implementation. Mixed-methods study using content analysis and key informant interviews. 29 U.S. HCOs with LCP policies active in 2020. 21 purposively sampled interviewees in physician leadership roles at 18 HCOs. Descriptive statistics of policy features and content analysis of interviews. Although policies had many commonalities-mandatory universal screening at a trigger age around 70 years, a strategy of screening followed by in-depth assessment of positive results, and commitment to patient safety as the key motive-they varied substantially in the testing required, funding, processes after a positive screening result, and decision making around concerning results. Policies prioritized institutional discretion in interpreting and responding to test results; many lacked clear language about appeals or other procedural protections for physicians. Leaders were generally satisfied with policies but reported preemptive retirements as physicians approached the screening age and cautioned that substantial investment in cultivating physicians' buy-in was required for successful rollout. Sampled policies and interviews may not be representative of all HCOs. The analysis excluded the experiences of HCOs that tried and failed to implement LCP screening. Policies about LCPs are considered successful by institutional leaders. Policy variations and early adopters' implementation experiences highlight opportunities to improve physician acceptance and program rigor. The Greenwall Foundation.

Produce prescription benefits redemption and activity in an observational study of 2,680 Massachusetts Medicaid members

BackgroundFood is Medicine interventions are increasingly employed to address food and nutrition insecurity and diet sensitive conditions, and advance health equity. Produce prescription (PRx) programs hold particular promise, providing funds to purchase fruits and vegetables as part of a treatment plan. Despite early evidence, key knowledge gaps remain regarding redemption and activity rates, identified as critical but understudied factors with research, clinical, and policy implications. ObjectiveThis prospective observational study investigates benefits utilization in a population of 2,680 Massachusetts Medicaid members enrolled in the Fresh Connect PRx intervention between July 2020 – December 2022. DesignWe examined trends overall, by duration of participation, alongside program changes, and by individual-level characteristics, providing a more complete picture of key correlates to benefits utilization. ResultsParticipants enrolling during program periods with access to larger number of stores had up to 14.5% absolute higher redemption rates (95% CI 10.4, 18.7) and, separately, five-fold greater likelihood of shopping each month (OR 5.0, 95% CI 3.7, 6.7) than those enrolled with fewest locations. Within individuals in the program 24 months, participation increased with time, with active shoppers rising from 65% in month 1 to 75% in month 12 to 85% in month 24; and redemption rising from 31% to 68% to 88% over the same period. Redemption was also higher for females compared to males (5.9% higher, 95% CI 3.0, 8.7), Asian compared to White participants (18.3% higher, 95% CI 10.6, 26.1) and for participants reporting Spanish as their preferred language compared to English (13.9% higher, 95% CI 10.9, 16.9). ConclusionsActivity and redemption can each be high in PRx, and may be positively associated with more shopping locations, longer participation and program implementation experience, and specific participant demographic factors. These findings inform interpretation of prior and design of future research on PRx, health outcomes, and health care utilization.

Digital technologies in linguistic education: Experience of development and implementation

The aim of this study was to share our experience of developing a digital Natural Language Processing Tool and its implementation in the process of training future linguists. In this article, we demonstrate the process of creating the web application SENTIALIZER, which is a multilingual Sentiment Analysis Tool developed with the help of the Python programming language and its libraries NLTK, BS4, TextBlob, Googletrans. The integration of Sentiment Analysis Tools into the educational framework is relied on the Unified Theory of Acceptance and Use of Technology (UTAUT) as its foundation. The results show that students see the prospects of using Sentiment Analysis Tools in their educational and professional activities, are ready to use them in the future, but are not ready to participate personally in projects to develop and improve such technologies. The reasons for this attitude are discussed. The presented study has a clear focus on student learning outcomes, which is an important criterion for the successful integration of technology into the educational process.

Examining the Impact of PBIS Experience on MTSS Implementation in Secondary Schools: A Mixed Methods Study

This sequential explanatory mixed methods study with a complementarity rationale examined the differential experiences of MTSS implementation in three Positive Behavior Interventions and Supports (PBIS)-implementing and three non-implementing secondary schools in the Midwestern United States. Using a survey and follow-up interviews with a sample of 25 secondary school leadership team (SLT) members, this study sought to understand (1) their beliefs and attitudes toward MTSS prior to implementation and (2) unique barriers and facilitators to MTSS implementation in secondary education following initial MTSS implementation. Overall, the results of this study indicated that generally, SLT members had positive beliefs and attitudes toward MTSS prior to implementation which were maintained a year later at follow-up. Additionally, several differential barriers and facilitators to implementation emerged between PBIS and non-PBIS schools, though shared barriers and facilitators were also evident. Lastly, experience with PBIS differentially impacted the experiences of SLT members from PBIS and non-PBIS schools. Implications for secondary school practitioners, schools, and local educational agencies are discussed.

International experience and standards of implementation of innovative technologies in document management in Ukraine

The article discusses international experience and standards of implementation of innovative technologies in the processes of document management, which significantly affects the efficiency of the organization and contributes to the rapid and effective development of information technology. One of the main goals of information technology implementation is to ensure efficient document management, which includes the creation, implementation, processing, storage and transfer of documents. Therefore, the implementation of electronic document management systems and document automation is an important element of using international standards to develop strategies that include effective recommendations adapted to local requirements. Such integration will help improve document management systems, increase efficiency and transparency.

Barriers and facilitators of implementing a health literacy-based intervention in Portugal

Abstract Background Despite the effectiveness of cervical cancer screening (CCS) in reducing mortality rates, disparities persist in access to screening among women with low health literacy, often termed ‘hard-to-reach women’. Health literacy-based interventions can help promote screening uptake. Based on a health literacy-based intervention for CCS implemented in Lisbon with the support of community workers, this study explores barriers and facilitators of the implementation process as perceived by these actors. Methods The intervention consisted of educational sessions on cervical cancer and CCS aimed at 246 women, implemented in community settings in 2023-2024. Within a mixed-methods approach, a pre-and post-intervention survey was applied to assess willingness to screen, and two focus groups were conducted with 10 community workers on their implementation experiences. Descriptive analysis and content analysis were performed where appropriate. Results Of the 665 women invited, 37% were enrolled in the sessions; 91% completed the follow-up. Community workers valued the informative content as adequate to raise awareness. Implementation facilitators included women’s trust in collaborating organisations and a complement of peer recruitment. Challenges included the additional workload of community workers, finding creative strategies to engage women, scheduling the sessions that best suited women’s time demands, and limited spaces to accommodate several group sessions. Proposed solutions to overcome barriers included increasing the time availability of community workers to support participants’ recruitment and session delivery, conducting itinerant and open sessions, and integrating the sessions within the organisation’s health-promoting activities. Conclusions Health literacy-based interventions are helpful in raising CCS awareness. Tailored interventions sensitive to context demands may contribute to successful actions. Key messages • Health literacy interventions can be key to promoting cervical cancer screening among hard-to-reach women. • Tailored community-based interventions may help address barriers to cervical cancer screening.

Evidence-Based Programs in France: Insights and Strategies for Implementation Support

Abstract Issue In France, both regional and national health institutions increasingly support and fund the implementation of evidence-based programs (EBP), promoted at the national level by the French Public Health agency. Description of the problem practitioners who implement EBP face several operational questions: scaling issues, implementation in specific and varying contexts, integration and adjustment to daily regional practices. Results/effects In 2023, the French Society for Public Health initiated a collaborative effort to create a platform for discussion among practitioners, researchers, and decision-makers involved in EBP implementation. The first step was to assess EPB implementation experiences, using 3 types of data: an analysis of 6 documented EBP (capitalization works), an online questionnaire answered by 29 stakeholders, and four focus groups with funders, researchers, practitioners, and institutions. Data analysis was based on thematic content analysis and structural data analysis. Lessons Different ways to implement EBP were identified through a typology. The results highlight favorable conditions and levers for EPB implementation in France: • Facilitate access and adoption of EBP by concerned stakeholders, including through clear communication and knowledge sharing; • Strengthen and value support for implementation support (i.e., providing necessary resources and continuous monitoring); • A ‘favorable environment’ is also required (i.e. regional context acceptability and information on program themes or topics); • Breadthen perspectives and promote mutual learning through sharing and comparing implementation experiences across regions; • Value transferability and adaptation studies, which are key to enable EBP adaptations to account for context specificities while maintaining effectiveness. The platform’s next steps are to develop deployment tools and structure an advocacy strategy to mobilize stakeholders around the issue. Key messages • Achieving wide-scale implementation of EBP requires to tackle key implementation issues such as scaling, context adaptation, etc. and to give support to implementing stakeholders. • A collaborative assessment helped identify levers and barriers to EBP implementation in France. Involvement in EBP fosters an evidence-based mindset among practitioners.