Context Of Implementation Research Articles

Using Stakeholder Input to Guide Data Visualization and Reporting to Promote Evidence-based Practice Use in Public Schools

BackgroundHigh-quality implementation is crucial for students to reap the benefits of school-based evidence-based practices (EBP). Despite data being routinely used to support EBP delivery to students, there is a dearth of data-driven decision-making related to school-wide implementation of universal EBPs like Multi-Tiered Systems of Support (MTSS). The lack of specialized knowledge (e.g., what data to collect and how to interpret it) and systems (e.g., data teams) required to support data collection, analysis, and presentation act as barriers to school teams’ effective use of data to guide and be responsive to implementation efforts.MethodsGuided by principles of human-centered design, semi-structured interviews were conducted with 30 school-based implementation practitioners and stakeholders (principals, administrators, and expert intermediaries) to guide the development of data reports that provided information on a school or district’s implementation context (leadership, climate, and citizenship behavior).ResultsFour themes emerged from the interviews including: (1) interpretation and description of the report/feedback; (2) application of data to districts and/or schools; (3) reactions to the report; and (4) use of the report. The results of this qualitative case study point to the importance of incorporating stakeholder feedback as a methodology to ensure the end product (e.g., data report) is meaningful and applicable to the setting and has direct implications for how to incorporate stakeholder feedback to help shape and improve data visualization and interpretation for better use in schools’ decision-making process to support MTSS and other EBP implementation.ConclusionsPractical implications related to report redesign and the utility of well-designed data products to support school-based implementation are discussed.

Implementation of a Cancer Rehabilitation Navigation Program: a qualitative analysis of implementation determinants and strategies.

Cancer rehabilitation navigation (CRNav) is a care delivery model that expedites identification and management of symptom-related functional morbidity for individuals undergoing cancer treatment. A CRNav program is unique in that it embeds a cancer rehabilitation professional in the cancer center for patient screening and assessment. The implementation of CRNav programs has not been studied and doing so could facilitate greater uptake of these programs. Using implementation science frameworks, we conducted a qualitative, post-implementation analysis of a CRNav program that was implemented in 2019. Semi-structured, 1:1 interviews were guided by the Consolidated Framework for Implementation Research (CFIR) and a combination of deductive and inductive analyses, using a priori established codes, was used to assess the implementation context, and identify emergent themes of barriers and facilitators to implementation. Participant described implementation strategies were characterized and defined using the Expert Consensus Recommendations for Implementing Change (ERIC) taxonomy. Eleven stakeholders including physicians, administrators, clinical staff, and patients, involved with program development and the implementation effort, participated in interviews. Predominant barriers to implementation included developing the program infrastructure, and lack of awareness of rehabilitation services among oncology professionals, predominant facilitators of implementation included; physical co-location of the navigator in the cancer center, individual characteristics of the navigator, and unique characteristics of the program. Strategies described that supported implementation included developing stakeholder interrelationships, evaluating and iteratively adapting the program, creating infrastructure, training and education, and supporting clinicians. This analysis uses implementation science to methodically analyze and characterize factors that may contribute to successful implementation of a CRNav program. These findings could be used alongside a prospective context-specific analysis to tailor future implementation efforts. Implementing a CRNav program expedites a patient's direct contact with arehabilitation provider complementing the cancer care delivery team, and providing an additive and often missingservice.

Translation of a family-based behavioral intervention for adolescent obesity using the RE-AIM framework and common steps from adaptation frameworks.

Interventions for adolescent weight management that are ready to use in clinical settings are needed to address the obesity epidemic and improve the health and wellbeing of affected adolescents. This report describes the systematic process our team followed to adapt an evidence-based intervention (EBI) for adolescent weight management from its randomized control trial protocol to a package for delivery in a group-based telehealth format within a medical center. The EBI adaptation was clinician initiated, prompted by identified practice needs, and involved collaboration of the clinical team with the EBI developer. The process was guided by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework and followed key steps for adapting EBIs to new contexts. RE-AIM-aligned adaptations included telehealth delivery and broader inclusion criteria, separate clinical and research evaluation batteries, adaptations to fit the clinical practice, practical fidelity checklists to guide and record session delivery, and continuous quality improvement processes aimed to facilitate program longevity and family engagement. The process culminated in a package of adapted intervention materials deemed by stakeholders as appropriate to the practice and congruent with the EBI model. This report provides a much-needed practical demonstration of the translation of an EBI for adolescent weight management from research protocol to group telehealth delivery in a medical center. Key lessons include the value of clinician-researcher collaboration, the breadth of resources needed to adapt EBIs for real-world delivery, and the importance of considering delivery context in implementation and evaluation decisions, including defining inclusion criteria, staffing, and outcomes assessments.

Ensuring that a school-based smoking cessation program for adolescents is successful: A realist evaluation of the TABADO program and the program theory.

A smoking cessation program for adolescents, TABADO, demonstrated its effectiveness following a controlled trial conducted in 2007/2009. The program is now being scaled up nationally. In order to retain its efficacy across the diversity of contexts in the generalization process, we needed to assess the processes and mechanisms that inform its effects. Theory-driven evaluation is one approach used to address these issues. The aim of the present research is to develop the TABADO program theory. More specifically, we attempt to identify the factors and mechanisms that promote or hinder the enrollment and retention of student smokers in the program. We conducted a realist evaluation of the TABADO program through 1) a documentary analysis to construct the initial program theory, and 2) a multiple case study (n = 10) conducted in three regions in France to test and enrich the initial theory with contextual, organizational and mechanistic components. We used the Intervention-Context-Actors-Mechanisms-Outcomes configurations to guide our analysis and to present our results. Our analysis highlighted 13 mechanisms that foster the enrollment and retention of student smokers in the TABADO program (e.g., being prepared to quit smoking, feeling encouraged in the attempt to quit smoking). To activate these mechanisms, the involvement of various actors is required (e.g., the school nurse, teachers), together with a combination of interventional and contextual factors (e.g., confidentiality, informal speaking time). These findings allowed us to transform the TABADO program into a new optimized strategy, TABADO2, which is theory-based. Our research helps to explain why adolescent smokers enroll and stay in a school-based smoking cessation program. TABADO2 needs to be considered in a more comprehensive way than the original research-based TABADO, and should be tailored to its implementation context.

Young magicians in kindergarten: Skill development through performing magic tricks

ABSTRACT Magic has been a very popular form of entertainment for thousands of years and the learning and developmental processes that take place during the process of practicing and performing the trick—are a precious phenomenon from an educational point of view. The MiniMagic kindergarten program was launched in September 2021 in a kindergarten in Józsefváros, Budapest (Hungary), in a district with a very diverse population that calls for an inclusive attitude and pedagogical methods to educate all the children successfully. The innovative program aims to develop skills and build community by integrating magic tricks into the curriculum. A well-known Hungarian magician teaches magic tricks appropriate for 4 to 6-year-old children with unanimous success. The program does not simply introduce tricks; he embeds them in storytelling sessions. This article presents how the theory about the educational values of magical tricks is turned into practice in a kindergarten showing the educational values and developmental results. I complement the analysis of the theory and practice with recommendations for practitioners, explaining the ideal context and methods of implementation.

Here’s something we prepared earlier: Development, use and reuse of a configurable, inter-disciplinary approach for tackling overcrowding in NHS hospitals

Overcrowding affects hospital emergency departments (ED) worldwide. Most OR studies addressing overcrowding develop bespoke models to explore potential improvements but ignore the organisational context in which they would be implemented, and few influence practice. There is interest in whether reusable models, for ED crowding and in healthcare generally, could have more impact. We developed a configurable approach for tackling ED overcrowding. A reusable queuing model for exploring drivers of ED performance was augmented by a qualitative approach for exploring the implementation context and a generic framework for assessing the likely compatibility of interventions with a given organisation. At the hospital where the approach was developed it directly informed strategy. We describe reuse of the approach at three hospitals. One project was completed and well-received by hospital management, two were terminated partway when data problems surfaced. The primary contribution of this work is its novelty in considering, alongside quantitative modelling, evidence-based interventions to overcrowding and qualitative assessment of a hospital’s aptitude and capability to adopt different interventions. A secondary contribution is to further the debate on model reuse, particularly by introducing more complex, modelling-centred approaches that acknowledge how models must relate to tangible interventions with reasonable prospects of being adopted locally.

505 Use of Implementation Science to Identify Implementation Determinants of Chronic Obstructive Pulmonary Disease Practice Guidelines

OBJECTIVES/GOALS: COPD is a progressive airways disease that results in death or disability. There is poor uptake of clinical guidelines (CPG) to manage COPD and studies to bridge this implementation gap have shown inconsistent results. Using implementation science principles we aim to understand COPD-CPG implementation determinants from providers’perspective. METHODS/STUDY POPULATION: The study is being conducted in ten VA Primary Care Clinics. Guided by the Consolidated Framework for Implementation Research (CFIR), a conceptual framework developed to guide systematic assessment of multilevel implementation contexts, we are using semi-structured guides to conduct key informant qualitative interviews (physicians, physician extenders and nurses), to support a formative evaluation. CFIR domains relevant to the study were determined by a multidisciplinary team. Informants are identified through online outreach and voluntary participation. Sampling adequacy will be assessed by achievement of code saturation. A qualitative template analysis will be used to summarize the barriers and facilitators of each component of COPD-CPG organized by CFIR-domain. RESULTS/ANTICIPATED RESULTS: We anticipate a list of modifiable and non-modifiable contextual, recipient (provider and patient), and COPD CPG content (innovation) barriers to implementation. Many settings do not have critical elements of these CPG, such as a standardized inhaler education/assessment pathway, patient education material, or pulmonary rehabilitation referral pathway. Existing literature indicate reasons behind the insufficient uptake of COPD CPG include low familiarity with guidelines, perception of minimal value of guidelines by physicians, and time constraints; we will present contextual, recipient and innovation determinants specific to our setting. DISCUSSION/SIGNIFICANCE: This comprehensive assessment of barriers and facilitators to COPD-CPG will inform tool development and implementation strategies identification to improve COPD CPG uptake. COPD is the most common veteran lung disease. Improvement in COPD care has enormous potential for benefit for local veterans, as well as potential for wider dissemination.

Ea$ing into the USA: study protocol for adapting the Economic and Social Empowerment (EA$E) intervention for US-based, forcibly based populations

IntroductionImmigrant and forcibly displaced women and girls are disproportionately impacted by the harmful health consequences of intimate partner violence (IPV) in the USA. Economic and Social Empowerment (EA$E), a women’s...

Nurses’ promotion of Mental Health First Aid Training Programmes for upper secondary students: a modified Delphi approach

BackgroundMental Health First Aid Training Programmes can be carried out by nurses in schools. Adolescents have reported the importance of these interventions, the contents to be addressed, and intervention strategies that should be used. Mental health nurses have also discussed the characteristics of these training programmes. This study sought to create a consensus on the features of Mental Health First Aid Training Programmes promoted by nurses aimed at upper secondary students.MethodsA descriptive mixed method study was developed using the modified e-Delphi technique. Original statements on the topic were drawn from the results section of previous studies with nurses and adolescents. The statements were included in a structured online questionnaire. An expert panel of 78 mental health nurses participated in the two-rounds online survey from October to December 2021. Absolute and relative frequencies of responses were analysed. The experts’ comments were also considered.ResultsIn the first round, experts suggested 4 new ideas about training programmes. Experts took a position on a total of 59 declarations. At least 75% of participants agreed with 58 statements about training programmes, namely about facilitators, intervention foci, evaluation methodology, participants, the implementation context, period and regularity, intervention strategies and content. The experts’ opinions differed only in one statement that expressed the impaired sexual behaviour as a mental health problem to be addressed in the training programmes.ConclusionsMental health nurses can lead the delivery of training programmes in upper secondary schools, improving adolescent competencies in mental health. Several educational approaches can be used to teach about mental health, related problems and actions underlying these conditions. Valid and appropriate assessment methods must be used. Our findings guide the planning, implementation and evaluation of these interventions in upper secondary schools and encourage nurses to explore these programmes and include them in their educational curricula.

Usability and Acceptability of Electronic Immunization Registry Data Entry Workflows From the Health Care Worker Perspective in Siaya, Kenya (Part 3): Pre-Post Study.

Digital health tools such as electronic immunization registries (EIRs) have the potential to improve patient care and alleviate the challenges that arise from the use of paper-based clinic records for reporting. To address some of these challenges, the Kenya Ministry of Health and the International Training and Education Center for Health Kenya implemented an EIR system in 161 immunizing clinics in Siaya County between 2018 and 2019. The successful implementation of digital health tools depends on many factors, one of which is alignment between the technology and the context in which it is used. One important aspect of that implementation context is the perceptions of the health care workers (HCWs) using the EIR. This study aimed to evaluate HCWs' perceptions of the usability and acceptability of multiple clinic workflows using the new EIR. We performed a mixed methods pre-post study using semistructured interviews with HCWs at 6 facilities in Siaya County, Kenya. We interviewed HCWs at each facility 4 times: at baseline and once after the implementation of 3 different workflow modifications (n=24 interviews). The baseline state was dual data entry with paper records and the EIR. We then implemented 3 workflow modifications for 1 full day each: fully paperless data entry, preparation of an appointment diary before patient visits for the day, and a combination of the 2 workflows. We compared ratings and themes across interviews after each of the 4 workflows to understand the changes in the usability and acceptability of the EIR. HCWs considered the EIR clinic workflows to be usable and acceptable. Of the modified workflows, HCWs perceived the fully paperless workflow most favorably. In all workflows, HCWs' perceived benefits included ease of clinical decision-making using the EIR, reduced mental burden of data entry when using the EIR, and ease of identification of errors. Perceived barriers to the workflow included contextual challenges such as staffing shortages and lack of network connectivity, EIR platform challenges such as errors in saving records and missing fields, and workflow challenges such as the dual data entry burden of using paper and digital tools simultaneously. Fully paperless EIR implementation shows great promise from a workflow acceptability standpoint, contingent upon the presence of supporting contextual clinic factors and the resolution of system performance and design challenges. Rather than trying to identify a singular best workflow, future efforts should provide adequate flexibility for HCWs to implement the new system in their unique clinic context. Future EIR implementation stands to benefit from continued monitoring of EIR adoption acceptability during implementation, both for Siaya's program and for other efforts around the globe, as digital health interventions become more widely used.

Implementing relational contracting in a public client organization: the influence of policy clashes, resources and project autonomy

Relational contracting models are increasingly being used for large and complex public infrastructure construction projects, but both practices and outcomes still widely vary. When analyzing the causes of failures and successes, most studies have focused on practices at the project level. In this paper, we add to the current understanding of relational contracting in public construction by examining the influence of factors at the organizational and institutional levels. We develop a framework based on theories of policy implementation and analyze two projects piloting a new Early Contractor Involvement model in a large public infrastructure client organization. In this case, a previous marketization policy, prescribing low client involvement in project processes, interfered with the relational contracting policy. This policy clash was not openly acknowledged from the start, despite causing significant confusion and frustration at the project level, but became recognizable largely through its consequences for resource allocation and managerial attention. We conclude that policy ambiguities, combined with a project-based implementation context, produce local interpretations and variations in relational contracting models. When project autonomy is high, industry-level agreements, standards and resources are important to align practices also between projects within the same client organization.

Content of Policy and Context of Implementation in Tourism Sector: Case Bintan Regency to Handling Covid-19

This paper discusses efforts to strengthen policy implementation in handling COVID-19 in the tourism sector in Indonesia as a form of strengthening every tourism policy. This study uses the grindle concept to identify Policy Content and Implementation Context in Handling COVID-19 in the Tourism Sector of Bintan Regency. The method used is a qualitative approach including data collection techniques, observation, interviews, and documentation so that the data obtained are tested using NVivo 12 Pro, then analyzed with a triangulation approach. The results of the study indicate that the emphasis on handling COVID-19 in the tourism sector in the Regency needs to be strengthened by existing stakeholders, meaning that on the Policy Content side it consists of the interests affected, types of benefits, degree of change, location of decision making, program implementation and resources used. still focused on central regulations and rules so that local government authorities cannot initiate policy strategies for handling COVID-19 in the tourism sector in Bintan Regency. showed a good contribution in handling COVID-19 in the tourism sector in Bintan Regency.

Improving quality of life in patients with rare autoimmune liver diseases by structured peer-delivered support (Q.RARE.LI): study protocol for a transnational effectiveness-implementation hybrid trial

BackgroundPsychosocial support is a crucial component of adequate rare disease care, but to date psychosocial support needs of this patient population are insufficiently met. Within Q.RARE.LI, we strive to evaluate the effectiveness of a structured, transdiagnostic, and location-independent psychosocial support intervention in routine care of patients with rare autoimmune liver diseases in five countries and prepare its implementation.MethodsWithin an effectiveness-implementation hybrid trial, we aim to a) investigate the effectiveness of the intervention in routine care in five diverse healthcare systems and b) assess implementation outcomes, examine and prepare the implementation context, and develop country-specific implementation strategies. To assess effectiveness, we will include N = 240 patients with rare autoimmune liver diseases. Within a two-armed randomized controlled trial (allocation ratio 1:1), we will compare structured and peer-delivered psychosocial support in addition to care-as-usual (CAU) with CAU alone. Outcomes will be assessed via electronic database entry prior to intervention, directly after, and at a three-month follow-up. Our primary effectiveness outcome will be mental health-related quality of life at post-assessment. Secondary outcomes include depression and anxiety severity, perceived social support, helplessness, and disease acceptance. Implementation outcomes will be assessed within a mixed-methods process evaluation. In a quantitative cross-sectional survey, we will examine perceived acceptability and feasibility in patients, peer-counselors, and healthcare providers involved in delivery of the intervention. In qualitative focus groups, we will analyze the implementation context and determine barriers and facilitators for implementation with different stakeholders (patients and/or representatives, peer-counselors, healthcare providers, health insurers). Based on these results, we will derive country-specific implementation strategies and develop a concrete implementation plan for each country.DiscussionThe intervention is expected to help patients adjust to their disease and improve their mental quality of life. The transdiagnostic and location-independent program has the potential to reach patients for psychosocial support who are usually hard to reach. By preparing the implementation in five countries, the project can help to make low-threshold psychosocial support available to many patients with rare diseases and improve comprehensive healthcare for an often neglected group.Trial registrationISRCTN15030282

Medical advice for sick-reported students in a Dutch vocational school: a process evaluation.

Medical Advice for Sick-reported Students (MASS) is an intervention that aims to reduce medical absenteeism and prevent dropout among students. The current study reports on a process evaluation of the implementation of MASS at a vocational school in the Netherlands. The evaluation included the implementation process, fidelity, context, and participant satisfaction. The study had a qualitative case study design. Data was gathered through semi-structured interviews with relevant stakeholders, including a child and youth healthcare physician, MASS coordinators, career advisors, mentors, and students with concerning sickness absence. MASS was largely implemented as intended, but some deviations from the original intervention were found. For example, not all mentors identified concerning sickness absence through recommended criteria. A fit between the intervention and the values of the involved organizations was found. Facilitating contextual factors were identified, such as a perceived need for reducing school absence recognized within the care network, as well as hampering contextual factors, for example the limited visibility of students' absence during the COVID-19 pandemic. Participants were generally satisfied with MASS and its implementation. Overall, MASS was implemented well according to interviewees, but several improvement points for both the implementation and execution of MASS were identified. These include full implementation across the setting, providing and repeating necessary trainings, minimizing administrative burden, and securing financial and human resources for sustainment of the intervention. These points could help to guide future implementation efforts, as they may help to overcome common barriers to implementation.

The Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) for serious mental illness in community mental health part 1: study protocol for a hybrid type 2 effectiveness-implementation cluster-randomized trial

BackgroundSerious mental illness (SMI) can have devastating consequences. Unfortunately, many patients with SMI do not receive evidence-based psychological treatment (EBPTs) in routine practice settings. One barrier is poor “fit” between EBPTs and contexts in which they are implemented. The present study will evaluate implementation and effectiveness outcomes of the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) implemented in community mental health centers (CMHCs). TranS-C was designed to target a range of SMI diagnoses by addressing a probable mechanism and predictor of SMI: sleep and circadian problems. We will investigate whether adapting TranS-C to fit CMHC contexts improves providers’ perceptions of fit and patient outcomes.MethodsTranS-C will be implemented in at least ten counties in California, USA (N = 96 providers; N = 576 clients), via facilitation. CMHC sites are cluster-randomized by county to Adapted TranS-C or Standard TranS-C. Within each county, patients are randomized to immediate TranS-C or usual care followed by delayed treatment with TranS-C (UC-DT). Aim 1 will compare TranS-C (combined Adapted and Standard) with UC-DT on improvements in sleep and circadian problems, functional impairment, and psychiatric symptoms. Sleep and circadian problems will also be tested as a mediator between treatment condition (combined TranS-C versus UC-DT) and functional impairment/psychiatric symptoms. Aim 2 will evaluate whether Adapted TranS-C is superior to Standard TranS-C with respect to provider perceptions of fit. Aim 3 will evaluate whether the relation between TranS-C treatment condition (Adapted versus Standard) and patient outcomes is mediated by better provider perceptions of fit in the Adapted condition. Exploratory analyses will (1) compare Adapted versus Standard TranS-C on patient perceptions of credibility/improvement and select PhenX Toolkit outcomes and (2) evaluate possible moderators.DiscussionThis trial has the potential to (a) expand support for TranS-C, a promising transdiagnostic treatment delivered to patients with SMI in CMHCs; (b) take steps toward addressing challenges faced by providers in delivering EBPTs (i.e., high caseloads, complex patients, poor fit); and (c) advance evidence on causal strategies (i.e., adapting treatments to fit context) in implementation science.Trial registrationClinicaltrials.gov NCT04154631. Registered on 6 November 2019. https://clinicaltrials.gov/ct2/show/NCT04154631

Value Creation for Refugees by Social Partnerships: A Frames Perspective

Refugee crises are one of the grand challenges of the 21st century. Despite the theoretical importance attached to value created for beneficiaries in the partnership literature, research tends to focus on internal processes and value created for partners and partnerships, leading to widespread calls to further specify the value created by partnerships for beneficiaries. Applying an analytical framework from the value creation and social impact literatures, we report on a study of multiple social partnerships of a nongovernmental organization in the refugee issue field. Our results demonstrate that frames of refugees held by partners and in partnerships’ implementation contexts shape the value creation activities undertaken for beneficiaries, and determine whether value is created and what types of value. The dual contribution of this article comprises a rare empirical study of value creation activities for beneficiaries (here, refugees) and theorization of how and when implementation context affects value creation by partnerships.

Context matters in curriculum reform: An analysis of change in surgical training.

Education and training reforms are typically devised by accreditation bodies and rolled out nationally. This top-down approach is positioned as contextually independent, yet context is highly influential in shaping the impact of change. Given this, it is critical to consider how curriculum reform plays out as it meets local settings. We have therefore used a national-level curriculum reform process of surgical training, Improving Surgical Training (IST), to examine the influence of context in IST implementation across two UK countries. Adopting a case study approach, we used document data for contextualisation purposes and semi-structured interviews with key stakeholders across multiple organisations (n = 17, plus four follow-up interviews) as our main source of data. Initial data coding and analysis were inductive. We followed this with a secondary analysis using Engeström's second-generation activity theory nested within an overarching framework of complexity theory to help tease out some key elements of IST development and implementation. The introduction of IST into the surgical training system was historically situated within a landscape of previous reforms. IST's aims collided with existing practices and rules, thus creating tensions. In one country, the systems of IST and surgical training came together to some extent, mostly due to processes of social networks, negotiation and leverage nested in a relatively cohesive setting. These processes were not apparent in the other country, and instead of transformative change, the system contracted. Change was not integrated, and the reform was halted. Our use of a case study approach and complexity theory deepens understanding of how history, systems and contexts interact to facilitate or inhibit change within one area of medical education. Our study paves the way for further empirical work examining the influence of context in curriculum reform, and thus determining how best to bring about change in practice.

ADIWIYATA GREEN SCHOOL PROGRAM IMPLEMENTATION ANALYSIS: A PORTRAIT FROM THE ELEMENTARY SCHOOLS IN SURABAYA, INDONESIA

The direction of sustainable development (SDGs) in Indonesia is one of the pillars of environmental action. Green environmental development emphasizes environmental insight and minimizes damage and negative impacts on the environment. Attention to the environment is a shared responsibility for the next generation, so it is vital to shape the character of caring for the environment from an early age. One way is through the adiwiyata school program, a program from the Ministry of Environment and Forestry in collaboration with local governments. Building pro-environment character and behavior is certainly not an easy thing. It needs support and innovative studies to support its implementation and sustainability, so this study's main objective is to examine the implementation model of the adiwiyata program more deeply. We collected data through literature studies, semi-structured interviews, and surveys involving schools and several informants from the government offices related to the adiwiyata program. The obtained data were reduced and analyzed using triangulation techniques. From the data obtained, the analysis of the performance of the adiwiyata program is based on the content of the policy and the context of implementation. The results showed that the policy’s content and the context of the implementation of the adiwiyata program had been going well. The follow-up of this study is to improve the performance of the adiwiyata program properly and provide a reward and punishment system to the implementors involved.

Factors affecting implementation of patient-reported outcome and experience measures in a pediatric health system

BackgroundThe use of patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) in pediatric clinical practice can enhance clinical care and bring children and families’ perspectives into evaluations of healthcare services. Implementing these measures is complex and requires a thorough assessment of the context of implementation The purpose of this study is to describe the barriers and facilitators to PROMs and PREMs implementation and to recommend strategies for implementing these measures in a pediatric health system.MethodsWe used a qualitative descriptive approach to analyse data from interviews to understand the experiences of PROMs and PREMs users across different pediatric settings in a single Canadian healthcare system.ResultsThere were 23 participants representing a variety of roles within the healthcare system and pediatric populations. We found five main factors that affected implementation of PROMs and PREMs in pediatric settings: 1) Characteristics of PROMs and PREMs; 2) Individual’s beliefs; 3) Administering PROMs and PREMs; 4) Designing clinical workflows; and 5) Incentives for using PROMs and PREMs. Thirteen recommendations for integrating PROMs and PREMs in pediatric health settings are provided.ConclusionsImplementing and sustaining the use of PROMs and PREMs in pediatric health settings presents several challenges. The information presented will be useful for individuals who are planning or evaluating the implementation of PROMs and PREMs in pediatric settings.

Avian regulation of crop and forest pests, a meta-analysis.

Birds have been shown to reduce pest effects on various ecosystem types. This study aimed to synthesize the effect of birds on pest abundance, product damage and yield in agricultural and forest systems in different environments. Our hypothesis is that birds are effective pest regulators that contribute to a reduction in pest abundance, enhancement of yield quality and quantity and economic profit, and that pest regulation may depend on moderators such as the type of ecosystem, climate, pest, and indicator (ecological or economic). We performed a systematic literature review of experimental and observational studies related to biological control in the presence and absence of regulatory birds. We retained 449 observations from 104 primary studies that were evaluated through qualitative and quantitative analyses. Of the 79 studies with known effects of birds on pest regulation, nearly half of the 334 observations showed positive effects (49%), 46% showed neutral effects, and very few (5%) showed negative effects. Overall effect sizes were positive (mean Hedges' d=0.38 ± 0.06). A multiple model selection retained only ecosystem and indicator types as significant moderators. Our results support our hypothesis that there is a positive effect of avian control of pests for each analyzed moderator and this effect was significant for both ecological and economic indicators. Avian regulation of pests is a potential effective approach for environmentally friendly pest management that can reduce pesticide use regardless of the context of implementation. © 2023 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.