Implementation Of Framework Research Articles

Implementation Mapping of the Collaborative University of California Teleophthalmology Initiative (CUTI): A Qualitative Study Using the Exploration, Preparation, Implementation, and Sustainment (EPIS) Framework.

Background This study aimed to investigate the rationale, barriers, and facilitators of teleretinal camera implementation in primary care and endocrinology clinics for diabetic retinopathy (DR) screening across University of California (UC) health systems utilizing the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework. Methodology Institutional representatives from UC Los Angeles, San Diego, San Francisco, and Davis participated in a series of focus group meetings to elicit implementation facilitators and barriers for teleophthalmology programs within their campuses. Site representatives also completed a survey regarding their program's performance over the calendar year 2022 in the following areas: DR screening camera sites, payment sources and coding, screening workflows including clinical, information technology (IT), reading, results, pathologic findings, and follow-up, including patient outreach for abnormal results. Focus group and survey results were mapped to the EPIS framework to gain insights into the implementation process of these programs and identify areas for optimization. Results Four UC campuses with 20 active camera sites screened 7,450 patients in the calendar year 2022. The average DR screening rate across the four campuses was 55%. Variations between sources of payment, turn-around time, image-grading structure, image-report characteristics, IT infrastructure, and patient outreach strategies were identified between sites. Closing gaps in IT integration between data systems, ensuring the financial sustainability of the program, and optimizing patient outreach remain primary challenges across sites and serve as good opportunities for cross-institutional learning. Conclusions Despite the potential for long-term cost savings and improving access to care, numerous obstacles continue to hinder the widespread implementation of teleretinal DR screening. Implementation science approaches can identify strategies for addressing these challenges and optimizing implementation.

A Framework for Extensive Content-Based Image Retrieval System Incorporating Relevance Feedback and Query Suggestion

Over the last decade, there is a huge amount of images in which visual information has become increasingly important. If the images are to be utilized, they must be organized into databases, from there it can be searched based on different criteria. Content-based Image retrieval (CBIR) frameworks have turned into a mainstream subject of exploration; for their ability to retrieve images based on the real visual content rather than by manually connected textual descriptions. In the CBIR framework, analysis and interpretation of image information in large and diverse image databases is evidently complex because there is no prior information on the size or scale of individual structures within the images to be analyzed. In CBIR, retrieval is based on visual image features, which can be extracted automatically from the images with the help of human intervention, namely a technique called relevance feedback. Nonetheless, an efficient way of differentiating the visual content of images is complex to produce. Therefore, rather than a perfect solution CBIR systems must be able to exploit a partial solution to the problem of image understanding. In this paper, there is implementation of a CBIR framework is introduced that not only tries to efficiently capture the user intent based on the feedback but also provide query suggestions that can help its users to pose better queries in order to retrieve desired results in an efficient manner. The proposed technique is straightforward to implement and scopes efficiently to huge datasets. Extensive experiments on diverse real datasets with image similarity measures have revealed the dominance of the proposed method over original algorithms.

Strategic use of resources to enhance colorectal cancer screening for patients with diabetes (SURE: CRC4D) in federally qualified health centers: a protocol for hybrid type ii effectiveness-implementation trial

BackgroundPersons with diabetes have 27% elevated risk of developing colorectal cancer (CRC) and are disproportionately from priority health disparities populations. Federally qualified health centers (FQHCs) struggle to implement CRC screening programs for average risk patients. Strategies to effectively prioritize and optimize CRC screening for patients with diabetes in the primary care safety-net are needed.MethodsGuided by the Exploration, Preparation, Implementation and Sustainment Framework, we conducted a stakeholder-engaged process to identify multi-level change objectives for implementing optimized CRC screening for patients with diabetes in FQHCs. To identify change objectives, an implementation planning group of stakeholders from FQHCs, safety-net screening programs, and policy implementers were assembled and met over a 7-month period. Depth interviews (n = 18–20) with key implementation actors were conducted to identify and refine the materials, methods and strategies needed to support an implementation plan across different FQHC contexts. The planning group endorsed the following multi-component implementation strategies: identifying clinic champions, development/distribution of patient educational materials, developing and implementing quality monitoring systems, and convening clinical meetings. To support clinic champions during the initial implementation phase, two learning collaboratives and bi-weekly virtual facilitation will be provided. In single group, hybrid type 2 effectiveness-implementation trial, we will implement and evaluate these strategies in a in six safety net clinics (n = 30 patients with diabetes per site). The primary clinical outcomes are: (1) clinic-level colonoscopy uptake and (2) overall CRC screening rates for patients with diabetes assessed at baseline and 12-months post-implementation. Implementation outcomes include provider and staff fidelity to the implementation plan, patient acceptability, and feasibility will be assessed at baseline and 12-months post-implementation.DiscussionStudy findings are poised to inform development of evidence-based implementation strategies to be tested for scalability and sustainability in a future hybrid 2 effectiveness-implementation clinical trial. The research protocol can be adapted as a model to investigate the development of targeted cancer prevention strategies in additional chronically ill priority populations.Trial registrationThis study was registered in ClinicalTrials.gov (NCT05785780) on March 27, 2023 (last updated October 21, 2023).

Promoting running as the best treatment for lower back pain in physiotherapy practice: a best practice implementation project.

This project aimed to promote running as the best treatment for lower back pain (LBP) in an outpatient setting. LBP is one of the most prevalent conditions worldwide. Sixty-two percent of all Germans experience episodes of non-specific back pain at least once a year, with one-fifth developing chronic conditions. Intervertebral disc (IVD) degeneration is a natural process, contributing to periods of acute LBP. However, the scientific literature and guidelines partially overlook the significance of water management in IVD. This implementation project sought to address this gap by educating patients about this process. Running and/or walking were chosen as general approaches for treatment rather than specific disease-related approaches. This implementation project was conducted in an outpatient physiotherapy clinic in Brandenburg, Germany, utilizing the JBI Evidence Implementation Framework. An evidence-informed clinical audit and feedback strategy was used to measure compliance with ten audit criteria. Five physiotherapists and 20 patients took part in the audits. At baseline, only 20% of participating physiotherapists screened for yellow flags regarding psychological issues. However, after project implementation, this criterion scored 100% compliance. Some patients performed exercises independently, but confusion persisted regarding the choice of beneficial exercises. Patients continued running, but those who took a break due to pain expressed uncertainty about resuming. The project highlighted the effectiveness of collaborative efforts between patients and therapists to address the issue. The project team's conviction in action and solution strategies serves as the foundation for this collaboration. This implementation strategy provided "running" patients with the confidence to either resume or reintegrate running after an extended break. http://links.lww.com/IJEBH/A222.

Introducing multidisciplinary ward rounds in Malawi: a best practice implementation project.

The Royal College of Physicians (RCP) and the Royal College of Nursing (RCN) in the United Kingdom advocate the use of structured multidisciplinary team (MDT) ward rounds since they can enable safe, effective, improved care and enhanced staff satisfaction. This project sought to implement best practices for MDT ward rounds in a male medical ward in a hospital in Malawi. The project was conducted in line with the JBI Evidence Implementation Framework. A baseline audit of MDT ward rounds was conducted with six staff members. Audit criteria consisted of ten best practices, as recommended by JBI, the RCP, and the RCN. Stakeholder meetings were held to review the baseline audit results and highlight areas of non-compliance. JBI's Getting Research into Practice (GRiP) tool was used to identify barriers to compliance with best practices, and a follow-up audit was conducted to determine changes in practice. The results only showed improvement for one criterion, which rose from 33% to 100% (n=6) where nurses attended the ward round. This study demonstrated some challenges in evidence implementation projects and how these can, in part, be overcome. While the results only demonstrated improvement for one criterion, this paper shows how audits can be used to promote best practice, which in this case resulted in nurses being more involved in ward rounds, improvements in MDT communication, enhanced nurse inclusion in decision-making and, consequently, patient care. http://links.lww.com/IJEBH/A233.

From theory to practice in implementation science: qualitative insights from the implementation model developed by a commercial eMental Health provider

BackgroundAlthough eMental health interventions are a viable solution to address disparities in access to mental healthcare and increase its efficiency, they still face challenges of implementation. Literature highlights numerous barriers such as diffusion of responsibility and unclear expectations of what implementation entails might hinder this process. While research mostly focuses on analyzing these barriers, there is an urgent need to increase uptake in practice. In turn, commercial companies focus mostly on increasing uptake, while overlooking research outputs. To bridge the gap between research and practice, attention to how implementation occurs in practice is required. This study investigates “Make it Happen” (MiH), the implementation model developed by the eMental Health company Minddistrict, aiming to gain more insight into operationalizing implementation frameworks by 1) describing MiH and its conceptual underpinnings, and 2) gaining lessons learned from the development of MiH. Ultimately, this work aims at improving existing scientific frameworks by extending them with knowledge from practice.MethodsFirst, individual interviews and focus groups with Minddistrict implementation managers were performed. Second, individual interviews with project leads in mental healthcare organizations that were involved in the implementation of Minddistrict were conducted. Within Minddistrict, 7 implementation managers and account managers were involved, in addition to 11 project leads from mental healthcare organizations. Data were elaborated with thematic analysis.ResultsA comprehensive description of MiH and its 5 main phases was achieved. During the 1) Onboarding phase, implementing organizations are guided by Minddistrict to build a team responsible for implementation, which then 2) designs patient and client journeys, 3) builds, tailors and configures their offer, 4) trains key-users and, 5) evaluates the success of implementation. All participants had extensive and aligned definitions and articulated expectations on implementation. Points of improvement for the model such as role ambiguity and excessive workload were identified. As strengths, internal motivation and good relationships with the provider were valued.ConclusionThe present study highlights the importance of clear role division and stakeholder engagement in implementation processes, and suggest that a strong collaboration between companies and academia could optimize implementation efforts and ensure a better fit between humans, context, and technologies.

Engagement of medication users in the development and implementation of digital medication adherence technologies: a multi-stakeholder study

ABSTRACT Background This study aims to create a comprehensive framework for the development and implementation of digital medication adherence technologies (DMATech), focusing on critical stages where engagement of medication users (MU) is considered meaningful, i.e. adds significant value, as agreed upon by participating stakeholders. Methods Through a literature review and expert consensus, a framework was outlined covering key DMATech development and implementation phases and steps. An in-person workshop with MU representatives and adherence experts, using the Nominal Group Technique, further refined these stages for MU engagement. Results The DMATech framework included three phases: ‘Innovation,’ ‘Research and Development,’ and ‘Launch and Implementation,’ each encompassing multiple steps. The workshop, attended by five MU representatives and nine adherence experts, identified critical stages for MU input including context analysis, ideation, proof of concept, prototype creation, DMATech’s iteration, critical evaluation, healthcare implementation, real-world assessment, and improvement. Nevertheless, there was a divergence of consensus regarding the importance of MUs engagement in regulatory, financial, and marketing aspects. Conclusions This study provides a holistic framework for DMATech development and implementation and underscores the necessity of MU engagement at various stages. Modes of MU engagement cannot be generalized; a case-by-case evaluation of engagement strategies is essential.

Integration of Sensor-Based Technology in Mental Healthcare: A Systematic Scoping Review

AbstractSensor-based technologies can collect objective and real-time data on physiological, behavioral, and contextual factors related to mental disorders. This not only holds potential for mental healthcare but also comes with challenges, such as handling large amounts of data and supporting the integration of sensors in clinical practice. This systematic scoping review aims to provide an overview of studies explicitly addressing the integration of sensor-based technology in mental healthcare by reporting on the way that therapists and patients work with sensors. In addition, we explore barriers and facilitators for the integration of sensor-based technology in clinical practice. Four databases were searched on April 5, 2023. Studies on sensor-based technology integrated in mental healthcare were included. A total of 14 studies were included. In these studies, a variety of sensor-based technologies were used. All studies were conducted between 2016 and 2022. Most studies showed that sensor-based technologies are accepted by patients and that their use is associated with symptom reduction. However, most studies did not systematically report on barriers and facilitators and mainly focused on the technology itself rather than on the broader context of its intended use. Also, sensor-based technologies are not yet embedded in clinical protocols. From the current review, we can conclude that sensor-based technologies are sufficiently accepted and feasible, and that sensors are promising for enhancing clinical outcomes. However, sensors are not properly integrated in treatment protocols yet. Therefore, we propose a next phase in research on sensor-based technology in mental healthcare treatment. This next phase asks for a multifaceted approach consisting of (1) embedding sensor-based technology in treatment protocols in co-creation with patients and clinicians, (2) examining the feasibility of these interventions together with small-scale evidence studies, and (3) systematically examining the implementation of sensor-based technology in clinical practice using existing frameworks for technology implementation. Open Science Framework: https://doi.org/10.17605/OSF.IO/XQHSY.

Frailty management in older patients: a best practice implementation project

ABSTRACT Introduction: Frailty in older adults can lead to a gradual decline in organ function. Without timely diagnosis and intervention, this condition can progress rapidly, increasing the risk of disability and mortality. Objectives: The aim of this project was to implement evidence-based practices for managing frailty in the medical ward to prevent disability in older patients. Methods: This project was conceptually informed by the JBI Evidence Implementation Framework. This framework uses an audit and feedback approach and a pre- and post-test design to measure baseline compliance, develop implementation strategies responsive to gaps in compliance, and conduct a final evaluation to measure changes in compliance. JBI PACES and JBI GRiP situational analysis software were used to support data collection and implementation planning. Ten audit criteria were used with a sample of 30 patients in a regional teaching hospital in southern Taiwan. Results: The baseline audit showed poor compliance, with rates below 30% for all ten audit criteria. Through strategies such as professional training and education, the implementation of evidence-based care guidelines, and interdisciplinary consensus-building, the follow-up audit revealed an increase in compliance to over 90% for each audit criterion. Conclusions: Frailty management strategies based on evidence-based audit criteria were implemented and routinely measured. The most effective strategies for improving compliance included the development of a training course, a digitized assessment tool, team meetings, interdisciplinary collaboration, communication, and consensus-building. Spanish abstract: http://links.lww.com/IJEBH/A225

Implementing energy justice through corporate social responsibility of multinational corporations in energy and extractive industries: old body in new robes

This article proposes a new implementation framework based on Corporate Social Responsibility (CSR) to facilitate energy justice. To accomplish this, it analyses how CSR constructs linked to Multinational Corporations (MNCs) operating within the energy and extractive industry could be used to realise energy justice. This conception is premised on the observation that MNCs possess significant economic influence, which enables them to spur socio-economic transformation. The article advances the conversation on energy justice, shifting the focus from conceptual examination of the concept to ways to enable its practical implementation via the lens of CSR. This proposal represents an active step towards bridging a void in the energy justice literature, as it offers practical solutions for addressing implementation gaps and ensuring the effective implementation of energy justice. The article develops a framework with four dimensions of energy justice – (1) distributive, (2) procedural, (3) recognition, and (4) restorative via CSR constructs of MNCs. It concludes that CSR is crucial for achieving energy justice and creating energy and extractive industries that are just and equitable for all stakeholders.

Developing 'Brand India' as a premier destination for medical and wellness tourism: PESTEL analysis and implementation framework

Developing 'Brand India' as a premier destination for medical and wellness tourism: PESTEL analysis and implementation framework

All-in-One Framework for Design, Simulation, and Practical Implementation of Distributed Multiagent Control Systems

All-in-One Framework for Design, Simulation, and Practical Implementation of Distributed Multiagent Control Systems

Non-invasive Transcutaneous Spinal Cord Stimulation Programming Recommendations for the Treatment of Upper Extremity Impairment in Tetraplegia

ObjectivesThis study analyzes the stimulation parameters implemented during two successful trials that used non-invasive transcutaneous spinal cord stimulation (tSCS) to effectively improve upper extremity function after chronic spinal cord injury (SCI). It proposes a framework to guide stimulation programming decisions for the successful translation of these techniques into the clinic. Materials and MethodsProgramming data from 60 participants who completed the Up-LIFT trial and from 17 participants who subsequently completed the LIFT Home trial were analyzed. All observations of stimulation amplitudes, frequencies, waveforms, and electrode configurations were examined. The incidence of adverse events and relatedness to stimulation parameters is reported. A comparison of parameter usage across the American Spinal Injury Association Impairment Scale (AIS) subgroups was conducted to evaluate stimulation strategies across participants with varying degrees of sensorimotor preservation. ResultsActive (cathodal) electrodes were typically placed between the C3/C4 and C6/C7 spinous processes. Most sessions featured return (anodal) electrodes positioned bilaterally over the anterior superior iliac spine, although clavicular placement was frequently used by 12 participants. Stimulation was delivered with a 10-kHz carrier frequency and typically a 30-Hz burst frequency. Biphasic waveforms were used in 83% of sessions. Average stimulation amplitudes were higher for biphasic waveforms. The AIS B subgroup required significantly higher amplitudes than did the AIS C and D subgroups. Device-related adverse events were infrequent, and not correlated with specific waveforms or amplitudes. Within the home setting, participants maintained their current amplitudes within 1% of the preset values. The suggested stimulation programming framework dictates the following hierarchical order of parameter adjustments: current amplitude, waveform type, active/return electrode positioning, and burst frequency, guided by clinical observations as required. ConclusionsThis analysis summarizes effective stimulation parameters from the trials and provides a decision-making framework for clinical implementation of tSCS for upper extremity functional restoration after SCI. The parameters are aligned with existing literature and proved safe and well tolerated by participants.

Dissemination and implementation science frameworks and strategies to increase breast cancer screening for at-risk women in the United States: A scoping review.

Dissemination and implementation science (D&I) can help bridge the gap between research and practice by addressing how to facilitate and maintain pre-existing evidence-based interventions (EBIs) in various contexts within different fields, including that of breast cancer screening and treatment. Yet, despite the availability of D&I frameworks and strategies, there is a lack of studies exploring knowledge transfer dissemination and implementation models, strategies, and frameworks in the setting of breast cancer care. There is a need for studies that create guidelines and roadmaps built on theoretical foundations of D&I research to scale up successful D&I of strategies, frameworks, and protocols proven to cater to the needs of all breast cancer patients when seeking screening and treatment services. The Arksey and O'Malley (2005) York methodology was used as guidance for this review: (1) identifying research questions; (2) searching for relevant studies; (3) selecting studies relevant to the research questions; (4) charting the data; (5) collating, summarizing, and reporting results. Most cited barriers (n = 46) sorted into the category of "Recruitment, Measurement, and Delivery Challenges." The predominant ERIC strategy, featured in a noteworthy 84% of studies, was "Tailor strategies" (#16), which belongs to the "Adapt and tailor to context: culture, language, data analysis, collection" domain. This study can guide researchers, physicians, and community workers in improving accessibility, affordability, and quality of breast cancer screening and adequate follow-up opportunities through D&I strategies and models improving the reach and sustainability of evidence-based programs in at-risk female populations.

Healing the Past by Nurturing the Future: trauma-aware, healing-informed care to improve support for Aboriginal and Torres Strait Islander families – implementation and evaluation study protocol

IntroductionComplex trauma can have serious impacts on the health and well-being of Aboriginal and Torres Strait Islander families. The perinatal period represents a ‘critical window’ for recovery and transforming cycles...

Implementation of MOVIN by a Nurse-Led Clinical Team: A Multiple Methods Evaluation Using the RE-AIM Framework.

To evaluate the implementation of MOVIN, a multicomponent mobility intervention, by a nurse-led team and measure the effectiveness on unit-level outcomes. A pragmatic quasi-experimental study was conducted on an inpatient adult medical unit. Evaluation was guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Interviews with 13 organizational partners were conducted to understand barriers and facilitators to adoption. Thematic analysis was used to analyze the data. Quantitative data to determine effectiveness on distance of patient ambulation and percent of patients ambulated by nursing staff were analyzed using an interrupted time series. A significant increase in total weekly distances for patient ambulation and percent of patients ambulated by nursing staff occurred between preintervention, intervention, and postintervention periods. Themes for adoption included: Value, Immediate Feedback, Inclusive Implementation, Resource Needs, and Lack of Organizational Evidence. The nurse-led team demonstrated high fidelity to maintaining the core components of MOVIN. A nurse-led team can successfully launch a multicomponent mobility intervention and sustain impact. RE-AIM supported assessments of key partners at multiple organizational levels, capturing critical unit level outcomes. Multiple methods for data collection and analysis yielded rich results to inform future dissemination of MOVIN. [Research in Gerontological Nursing, 17(4), 189-201.].

Traditional healer support to improve HIV viral suppression in rural Uganda (Omuyambi): study protocol for a cluster randomized hybrid effectiveness-implementation trial

BackgroundRural African people living with HIV face significant challenges in entering and remaining in HIV care. In rural Uganda, for example, there is a threefold higher prevalence of HIV compared to the national average and lower engagement throughout the HIV continuum of care. There is an urgent need for appropriate interventions to improve entry and retention in HIV care for rural Ugandans with HIV. Though many adults living with HIV in rural areas prioritize seeking care services from traditional healers over formal clinical services, healers have not been integrated into HIV care programs. The Omuyambi trial is investigating the effectiveness of psychosocial support delivered by traditional healers as an adjunct to standard HIV care versus standard clinic-based HIV care alone. Additionally, we are evaluating the implementation process and outcomes, following the Consolidated Framework for Implementation Research.MethodsThis cluster randomized hybrid type 1 effectiveness-implementation trial will be conducted among 44 traditional healers in two districts of southwestern Uganda. Healers were randomized 1:1 into study arms, where healers in the intervention arm will provide 12 months of psychosocial support to adults with unsuppressed HIV viral loads receiving care at their practices. A total of 650 adults with unsuppressed HIV viral loads will be recruited from healer clusters in the Mbarara and Rwampara districts. The primary study outcome is HIV viral load measured at 12 months after enrollment, which will be analyzed by intention-to-treat. Secondary clinical outcome measures include (re)initiation of HIV care, antiretroviral therapy adherence, and retention in care. The implementation outcomes of adoption, fidelity, appropriateness, and acceptability will be evaluated through key informant interviews and structured surveys at baseline, 3, 9, 12, and 24 months. Sustainability will be measured through HIV viral load measurements at 24 months following enrollment.DiscussionThe Omuyambi trial is evaluating an approach that could improve HIV outcomes by incorporating previously overlooked community lay supporters into the HIV cascade of care. These findings could provide effectiveness and implementation evidence to guide the development of policies and programs aimed at improving HIV outcomes in rural Uganda and other countries where healers play an essential role in community health.Trial registrationClinicalTrials.gov NCT05943548. Registered on July 5, 2023. The current protocol version is 4.0 (September 29, 2023).

Exploring Generalizable Distillation for Efficient Medical Image Segmentation.

Efficient medical image segmentation aims to provide accurate pixel-wise predictions with a lightweight implementation framework. However, existing lightweight networks generally overlook the generalizability of the cross-domain medical segmentation tasks. In this paper, we propose Generalizable Knowledge Distillation (GKD), a novel framework for enhancing the performance of lightweight networks on cross-domain medical segmentation by generalizable knowledge distillation from powerful teacher networks. Considering the domain gaps between different medical datasets, we propose the Model-Specific Alignment Networks (MSAN) to obtain the domain-invariant representations. Meanwhile, a customized Alignment Consistency Training (ACT) strategy is designed to promote the MSAN training. Based on the domain-invariant vectors in MSAN, we propose two generalizable distillation schemes, Dual Contrastive Graph Distillation (DCGD) and Domain-Invariant Cross Distillation (DICD). In DCGD, two implicit contrastive graphs are designed to model the intra-coupling and inter-coupling semantic correlations. Then, in DICD, the domain-invariant semantic vectors are reconstructed from two networks (i.e., teacher and student) with a crossover manner to achieve simultaneous generalization of lightweight networks, hierarchically. Moreover, a metric named Fréchet Semantic Distance (FSD) is tailored to verify the effectiveness of the regularized domain-invariant features. Extensive experiments conducted on the Liver, Retinal Vessel and Colonoscopy segmentation datasets demonstrate the superiority of our method, in terms of performance and generalization ability on lightweight networks.

Exploring the implementation of whole school emotionally based school non-attendance (EBSN) guidance in a secondary school

Aim:This research aims to explore the implementation of whole school guidance for Emotionally Based School Non-Attendance (EBSN).Method/Rationale:School attendance is an area of increasing concern and many local authorities have produced guidance to support schools and others in their practice. How such guidance is implemented is likely to have a key influence on improving outcomes however, available implementation frameworks tend to focus on time-limited, specific universal or group programmes with little guidance on the implementation of more complex multi-component whole school approaches. Action research within a mainstream secondary school in the Northwest of England was used to explore the implementation of EBSN guidance through the following research question: What do school staff perceive as key factors (facilitators and barriers) influencing implementation of EBSN guidance in their school context?Findings:Key factors identified as influencing implementation in the school context were leadership and compatibility of practice and expectations; staff knowledge, perceptions and attitudes; and resources. These themes require communication, cohesion and consistency, and they sit within the current context and its internal and external systems, including parents and the community.Limitations:Initial stages of implementation are explored but timescales did not allow for exploration of how implementation of the guidance would be sustained.Conclusions:Key reflections are explored, and findings are used to further delineate a recently developed framework relating to facilitators and barriers to implementing whole school approaches. Implications for practice and future research are outlined.

Optimising Perinatal Mental Health: Implementation Framework for Integrating Interventions into Primary Healthcare Systems

BackgroundThe high burden of perinatal mental health (PMH) conditions has spurred international efforts to integrate PMH services into primary healthcare (PHC). Despite the existence of evidence-based PMH interventions endorsed by the World Health Organization (WHO), there is lack of guidance frameworks for the effective and sustainable integration of these interventions into PHC systems to make them fair and responsive to women and infant needs, particularly in low- and middle-income countries (LMICs). ObjectiveWe propose the "Implementation Framework for Integration into the Primary Healthcare System" (IF-IPHS) – a systematic approach to guide integration of PMH interventions into PHC settings. Approach and framework componentsOur approach is based on contemporary, empirically-derived frameworks and WHO guidelines on PMH, emphasising the significance of implementation science and health system thinking. The implementation framework for integration into the PHC system consists of two iterative phases: (I) Adaptation: involves modifying and pilot-testing of established PMH interventions to meet target population needs, guided by human-centred design. (II) Adoption: focuses on development of policies and resource allocation mechanisms through mobilization and stakeholder engagement for sustained integration of PMH intervention across all healthcare system components. Broader applicabilityThe IF-IPHS is designed to assist and empower health system stakeholders (e.g. policymakers, practitioners, researchers, funders) in LMICs. It offers practical guidance for systematically integrating effective PMH interventions into PHC systems through context-specific adaption process and adoption strategies, taking a holistic approach beyond mere clinical and programmatic considerations. It can also serve as a flexible roadmap for integrating various health interventions beyond PMH within PHC systems.