Implementation Fidelity Research Articles (Page 10)

Integrating and sustaining evidence-based interventions (EBIs) in routine care is crucial to improving HIV treatment outcomes among youth living with HIV (YLH). However, EBIs are often not sustained post clinical trial. An Adolescent Transition Package (ATP) delivered by health care workers (HCWs) and tested in Kenya in 2021 significantly improved YLH readiness to transition to independent care. Post-trial, participating clinics could continue using the ATP. We conducted 30 in-depth interviews with health care workers to evaluate determinants of continued ATP implementation one-year post-trial. Interviews used semi-structured guides, informed by the Consolidated Framework for Implementation Research version 2.0 (CFIR v2.0). Transcripts were analyzed thematically to identify key influences of ATP sustainment and fidelity post-trial. Effective training during and after the trial, and continued internal and external support for implementation, were crucial for sustained acceptability and feasibility. In contrast, staff shortages and high turnover, lack of integration into the existing electronic medical system, and maintaining staff motivation were barriers to ATP sustainment. Implementation fidelity was limited by workforce constraints and HCW beliefs about the importance of individualizing content and delivery to be responsive to individual client needs. ATP adaptability afforded optimization of delivery to overcome workforce constraints and meet client needs, increasing HCW perceptions of feasibility and motivating continued use. Alignment between observed impact and care provision goals further motivated ongoing ATP utilization. Strategies to ensure continued training and integration of tools into existing systems have the potential to further enhance ATP sustainability.

Abstract There is an increasing focus on helping low‐performing adolescents in school. We have randomly exposed low‐performing adolescents in mathematics in grade 8 to variations in key school inputs: teacher training, teaching material, and group size. Test scores of students in small groups taught by newly trained teachers provided with teaching material increased by 0.06 standard deviation. We find no impact on students in large groups with trained teachers and no new teaching material. Classroom observations indicate higher implementation fidelity of the didactic method among teachers of small groups, suggesting that targeted instruction with suitable teaching material in small and homogeneous groups can improve results for low‐performing adolescents and reduce achievement gaps in lower secondary education.

BackgroundDespite the benefits of physical activity (PA), cancer survivors report engagement barriers, and existing interventions often lack comprehensive solutions. Theory-based interventions using evidence-based behavior change techniques (BCTs) have been shown to be effective in promoting PA for breast cancer survivors, although their feasibility and acceptability lack evidence. The PAC-WOMAN trial is a three-arm randomized controlled trial aimed at promoting short- and long-term PA and improving the quality of life of breast cancer survivors. This study describes the development of a brief counseling theory-based motivational intervention from the PAC-WOMAN trial, assessing its feasibility and acceptability.MethodsA broad search of theory-based interventions for people with chronic diseases was conducted. Key strategies from each intervention helped shape the main components and BCTs used in the eight bimonthly sessions of the PAC-WOMAN brief counseling intervention, which was based on self-determination theory principles and aimed at empowering participants to develop self-regulation resources for PA through basic psychological needs satisfaction. A toolkit and manuals for intervention facilitators and participants were developed. A feasibility study was conducted to monitor implementation fidelity, acceptability, adherence, and participants’ experiences (via a focus group).ResultsTwelve women (mean age 55.9 ± 6.7 years) participated. Implementation monitoring indicated that the intervention was feasible. The attrition rate was 25%. Focus-group discussion suggested that weekly sessions would increase attendance, highlighted the helpfulness of self-monitoring and the importance of role models for PA, and identified the session on safely exercising at home as key in improving PA levels.ConclusionsThis research aims to enhance systematic reporting in intervention development by detailing the specific BCTs used, translating them into implementation strategies, providing comprehensive resources for facilitators/participants, and supporting the implementation, dissemination, and adoption of a theory-based intervention informed by previous research. Feasibility testing suggests that the intervention was well accepted by participants and feasible, although it could benefit from adjustments in format to increase compliance.Trial registrationNCT05860621, registered 20 April 2023 — retrospectively registered, https://clinicaltrials.gov/study/NCT05860621. Registered 21 April 2023 — retrospectively registered, https://doi.org/10.17605/OSF.IO/ZAQ9N. UMIN000050945, registered 27 April 2023 — retrospectively registered, https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000058070.

Family-centered care (FCC) in neonatal intensive care units (NICUs) is critical for parental involvement and infant well-being, yet few studies have evaluated the impact of FCC interventions on practice or examined how implementation fidelity may affect these outcomes. To evaluate the association between the Close Collaboration With Parents intervention and FCC practices and how implementation fidelity may modify these outcomes. This nonrandomized clinical trial had a before-and-after design. It was conducted between March 2021 and June 2023 at 6 NICUs in Estonia and included the parents of all newborns and all staff. Close Collaboration With Parents is an educational intervention for multiprofessional NICU staff including e-learning and bedside practices combined with reflection sessions. It aims to improve FCC culture by developing staff skills in communication and collaboration with parents and parenting support. The quality of FCC was assessed using a 1-time questionnaire for the parents with 9 questions from the Digi Family-Centered Care-Parent version tool, and daily questions for the staff using Digi Family-Centered Care-Nurse version tool. The association between implementation fidelity, defined as the proportion of staff who completed the full education, and the quality of FCC was also analyzed. A total of 186 infants (with responses from 186 mothers and 22 fathers) were included in the preintervention period. The median (IQR) gestational age was 37.4 (34.0-39.9) weeks, 94 infants (50.5%) were male, and the median (IQR) parental age was 32 (28-36) years. A total of 208 infants (with responses from 208 mothers and 55 fathers) were included in the postintervention period. The median (IQR) gestational age was 38.1 (35.4-39.9) weeks, 114 infants (55.1%) were male, and median (IQR) parental age was 32 (27-35) years. From the staff, 7448 and 6717 daily responses were analyzed in the preintervention and postintervention periods, respectively. The total rating was significantly higher after the intervention than before, by both the parents (r = 0.07; P < .001) and the staff (r = 0.10; P < .001). The median ratings did not, however, change: the parents' median (IQR) overall rating before and after was 7.0 (6.0-7.0), and the staff's median (IQR) overall rating was 6.0 (5.0-7.0) before and 6.0 (6.0-7.0) after. Implementation fidelity ranged from 4 of 30 health care professionals (13.3%) to 37 of 45 (82.2%) at the NICUs. The NICUs with high fidelity, as opposed to low fidelity, had significantly greater improvement in FCC ratings by the staff after the intervention (β = 2.1 [95% CI, 0.8-3.4]; P = .002). In this nonrandomized clinical trial, FCC practices were rated higher by the staff and parents after the Close Collaboration With Parents intervention. Implementation fidelity was identified as an important factor. ClinicalTrials.gov Identifier: NCT06258655.

Heart failure (HF) is a common and deadly disease, precipitated by physical inactivity and sedentary behavior. Although the 1-year survival rate after the first diagnosis is high, physical inactivity and sedentary behavior are associated with increased mortality and negatively impact the health-related quality of life (HR-QoL). We tested the recruitment frequency, implementation fidelity, and feasibility of outcomes of the Activity Coach app that was developed using an existing mobile health (mHealth) tool, Optilogg, to support older adults with HF to be more physically active and less sedentary. In this pilot clinical randomized controlled trial (RCT), patients with HF who were already using Optilogg to enhance self-care behavior were recruited from 5 primary care health centers in Sweden. Participants were randomized to either have their mHealth tool updated with the Activity Coach app (intervention group) or a sham version (control group). The intervention duration was 12 weeks, and in weeks 1 and 12, the participants wore an accelerometer daily to objectively measure their physical activity. The HR-QoL was measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ), and subjective goal attainment was assessed using goal attainment scaling. Baseline data were collected from the participants' electronic health records (EHRs). We found 67 eligible people using the mHealth tool, of which 30 (45%) initially agreed to participate, with 20 (30%) successfully enrolled and randomized to the control and intervention groups in a ratio of 1:1. The participants' daily adherence to registering physical activity in the Activity Coach app was 69% (range 24%-97%), and their weekly adherence was 88% (range 58%-100%). The mean goal attainment score was -1.0 (SD 1.1) for the control group versus 0.6 (SD 0.6) for the intervention group (P=.001). The mean change in the overall HR-QoL summary score was -9 (SD 10) for the control group versus 3 (SD 13) in the intervention group (P=.027). There was a significant difference in the physical limitation scores between the control (mean 45, SD 27) and intervention (mean 71, SD 20) groups (P=.04). The average length of sedentary bouts increased by 27 minutes to 458 (SD 84) in the control group minutes and decreased by 0.70 minutes to 391 (SD 117) in the intervention group (P=.22). There was a nonsignificant increase in the mean light physical activity (LPA): 146 (SD 46) versus 207 (SD 80) minutes in the control and intervention groups, respectively (P=.07). The recruitment rate was lower than anticipated. An active recruitment process is advised if a future efficacy study is to be conducted. Adherence to the Activity Coach app was high, and it may be able to support older adults with HF in being physically active. ClinicalTrials.gov NCT05235763; https://clinicaltrials.gov/study/NCT05235763.

Despite the proven efficacy of evidence-based healthcare interventions in reducing adverse outcomes and mortality associated with Sickle Cell Disease (SCD), a vast majority of affected individuals in Africa remain deprived of such care. Hydroxyurea (HU) utilization among SCD patients in Sub-Saharan Africa (SSA) stands at less than 1%, while in Nigeria, approximately 13% of patients benefit from HU therapy. To enhance HU utilization, targeted implementation strategies addressing provider-level barriers are imperative. Existing evidence underscores the significance of addressing barriers such as inadequate healthcare worker training to improve HU adoption. The ACCELERATE study aims to evaluate the adoption of HU among providers through the Screen, Initiate, and Maintain (SIM) intervention, facilitated by healthcare worker training, clinical reminders, and task-sharing strategies, thereby enhancing patient-level SCD management in Nigeria. This study will implement the SIM intervention, encompassing patient screening, initiation of HU treatment, and maintenance of dosage, which will be implemented via the TAsk-Strengthening Strategy for Hemoglobinopathies (TASSH TCP), derived from our team's TAsk-Strengthening Strategy for Hypertension control (TASSH) trials. Employing a sequential exploratory mixed-methods approach within the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, this study will assess SIM adoption by providers in Nigeria. The primary outcome is the rate of SIM adoption at clinical sites at 12 months, with secondary outcomes including sustainability/maintenance of SIM intervention and implementation fidelity. This study's findings will offer crucial insights into effective SCD management strategies, leveraging existing SCD clinical networks and resources in Nigeria to enhance HU adoption among providers in a scalable and sustainable manner. Additionally, the study will inform best practices for implementing HU therapy in resource-constrained settings, benefiting healthcare providers, policymakers, and stakeholders invested in improving SCD care delivery. NCT06318143.

Home-based sexual health care (including self-sampling testing) could reduce barriers to clinic-based testing. This study systematically evaluated the implementation of home-based sexual health care (‘Limburg4Zero’) among men who have sex with men (MSM) in a mixed urban–rural region of the Netherlands. We systematically assessed implementation outcomes (contextual domains, population reached, effectiveness, adoption by health care providers (HCP), implementation fidelity, and maintenance) using the practical, robust implementation and sustainability model. We used a mixed-methods research design that combined survey and in-depth interview data from our priority population (MSM) and implementers with insights from our community advisory board and field notes from monthly meetings with the implementers. Of 1076 requested tests, 906 MSM received a (self-sampling STI/HIV) test kit and sexual health information. Most participants (median age 31) had a university or college degree and had a Western ethnicity. The return rate for laboratory testing was 67%. Home-based care participants more often never tested HIV before (39%) compared to STI clinic attendees (28%). Adoption by HCP was highly acceptable, although perceived pragmatic and technical challenges were experienced. Key elements of the home-based care service were implemented as designed, with co-created adjustments for optimization during the implementation. Maintaining the innovation in the long term was desirable, although future recommendations for efficient continuation should be considered. Implementation of home-based sexual health care has demonstrably increased care accessibility for MSM who had never previously been tested. Therefore, a systematic approach is crucial to foster the impact of home-based sexual health care.

Identification of likelihood for autism in the U.S. early intervention (EI) system facilitates referrals to diagnostic assessments and targets autism-specific needs. However, performance of autism screeners in high-likelihood preschool children and barriers to implementation need to be further studied. The current effectiveness-implementation hybrid type 1 study examined the impact of administering the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) in a sample of preschool children during the EI intake phone call. Data from 2,661 educational records showed that 42.8% of them received the M-CHAT-R. Only 14.0% of the screen-positive children completing the process to determine eligibility for EI services were referred for an autism-specific evaluation. Most of these (94.8%), regardless of screener status, received an autism diagnosis, suggesting that referrals are based on clinical judgment. Training and incorporation to current protocols within agencies are necessary to introduce a screening tool and support implementation fidelity and effective autism detection.

BackgroundRural School Support Strategies (RS3) is a bundle of implementation supports (including training, technical assistance, and a virtual learning collaborative) designed for the scale-up of universal prevention initiatives. This study addresses mechanisms of action, exploring whether positive effects of RS3 on implementation fidelity are attributable to improvements in functioning of school implementation teams, and increases in organizational readiness.MethodsData are from a cluster-randomized hybrid Type 3 implementation-effectiveness trial of RS3 among rural Idaho schools implementing Positive Behavioral Interventions and Supports (PBIS). Forty public K-12 schools in Idaho, located in rural areas or townships, were recruited for the trial and were equally randomized to either the basic supports condition, including standard trainings, or to the RS3 condition. Condition was not masked. The mechanistic aims were hypothesized prior to the trial and tested with survey data from individuals on each school’s implementation team (n = 205). Surveys were collected in spring 2019 and 2020 regarding organizational readiness and team functioning. The outcome measure was PBIS implementation fidelity, measured by school teams during the summers of 2019 and 2020 using the Tiered Fidelity Inventory. School-level path models tested the effect of RS3 on implementation fidelity, controlling for baseline, school grade level, and school location. Multilevel (2–1-2) mediation models tested the degree to which individual team members’ perceptions of organizational readiness and team functioning mediated the relationship between school-level experimental condition and fidelity, controlling for the team members’ role.ResultsSchools receiving RS3 reported significantly greater implementation fidelity, although effects were slightly reduced (b = 8.40, p = .056, 95% CI [-0.22,17.01], β = 0.54) after inclusion of baseline and demographic controls. Models indicated a significant indirect effect of RS3 on fidelity through increased team productivity (b = 6.30, SE = 2.63, p = .017, MC 95% CI [0.83,13.86], β = 0.21), and effects through organizational readiness, change commitment, team culture, and team goal setting.ConclusionsExternal supports may improve implementation of universal prevention initiatives in rural schools through improvements in readiness and fostering teaming in organizations.Trial registrationThis research was prospectively registered on ClinicalTrials.gov (NCT03736395), on November 9, 2018.

Violence against children is a global public health issue that can lead to long-lasting negative consequences for child outcomes. The Irie Homes Toolbox (IHT) is an early childhood, violence prevention, parenting program designed for integration into early childhood educational services in Jamaica. We have previously shown that the program is effective in reducing child maltreatment when implemented by the research team. For wide-scale dissemination, the IHT needs to be delivered by preschool staff as part of their routine duties. We adapted the IHT using results from our previous evaluations, and we are conducting a mixed-method feasibility trial of the IHT fully integrated into preschool provision. Twenty-four basic schools in Kingston and St. Andrew, Jamaica, have been randomly assigned to intervention (n = 12) or wait-list control (n = 12) with 10 caregivers per school participating in the study (240 caregivers, 120/group). The intervention is delivered through 12 weekly, 1-hr sessions by a preschool teacher with groups of 10 caregivers of children aged 2-6 years. An ongoing process evaluation includes quantitative measures of caregiver attendance, teacher compliance, and fidelity of intervention implementation and qualitative measures of enablers and barriers to implementation and suggestions for improvement. In the impact evaluation, the primary outcome is the frequency of caregivers' use of violence against their child. Secondary outcomes are caregiver attitudes to violence, preferences for harsh punishment, involvement with their child, and child conduct problems. All outcomes are measured through caregiver report. The results of the study will be used to inform revisions of the IHT for implementation at scale. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

An increasing number of multicomponent workplace interventions are being developed to reduce sedentary time and promote physical activity among office workers. The Physical Activity at Work (PAW) trial was one of these interventions, but it yielded an inconclusive effect on sedentary time after 6 months, with a low uptake of movement breaks, the main intervention component. This study investigates the factors contributing to the outcomes of the PAW cluster randomized trial. Following the Medical Research Council's guidance for process evaluation of complex interventions, we used a mixed methods study design to evaluate the PAW study's recruitment and context (how job nature and cluster recruitment affected movement break participation), implementation (dose and fidelity), and mechanisms of impact (assessing how intervention components affected movement break participation and identifying the facilitators and barriers to participation in the movement breaks). Data from accelerometers, pedometers, questionnaires, on-site monitoring, and focus group discussions were used for the evaluation. Linear mixed effects models were used to analyze the effects of different intervention components on the movement breaks. Subsequently, qualitative analysis of the focus group discussions provided additional insights into the relationship between the intervention components. The participation in movement breaks declined after the third week, averaging 12.7 sessions (SD 4.94) per participant per week for the first 3 weeks, and continuing to decrease throughout the intervention. On-site monitoring confirmed high implementation fidelity. Analysis of Fitbit data revealed that each additional movement break was associated with a reduction of 6.20 (95% CI 6.99-5.41) minutes in sedentary time and an increase of 245 (95% CI 222-267) steps. Regarding the mechanisms of impact, clusters with higher baseline sedentary time demonstrated greater participation in movement breaks, while those with frequent out-of-office duties showed minimal engagement. Moreover, clusters with enthusiastic and encouraging movement break leaders were associated with a 24.1% (95% CI 8.88%-39.4%) increase in participation. Environmental and organizational support components using posters and leaders' messages were ineffective, showing no significant change in percentage participation in movement breaks (4.49%, 95% CI -0.49% to 9.47% and 1.82%, 95% CI -2.25% to 5.9%, respectively). Barriers such as high workloads and meetings further hindered participation, while the facilitators included participants' motivation to feel active and the perceived health benefits from movement breaks. Despite high fidelity, the PAW trial did not significantly reduce sedentary time, with limited uptake of movement breaks due to context-related challenges, ineffective environmental support, and high workloads during the COVID-19 pandemic.

As the use of guided digitally-delivered cognitive-behavioral therapy (GdCBT) grows, pragmatic analytic tools are needed to evaluate coaches' implementation fidelity. We evaluated how natural language processing (NLP) and machine learning (ML) methods might automate the monitoring of coaches' implementation fidelity to GdCBT delivered as part of a randomized controlled trial. Coaches served as guides to 6-month GdCBT with 3,381 assigned users with or at risk for anxiety, depression, or eating disorders. CBT-trained and supervised human coders used a rubric to rate the implementation fidelity of 13,529 coach-to-user messages. NLP methods abstracted data from text-based coach-to-user messages, and 11 ML models predicting coach implementation fidelity were evaluated. Inter-rater agreement by human coders was excellent (intra-class correlation coefficient=.980-.992). Coaches achieved behavioral targets at the start of the GdCBT and maintained strong fidelity throughout most subsequent messages. Coaches also avoided prohibited actions (e.g. reinforcing users' avoidance). Sentiment analyses generally indicated a higher frequency of coach-delivered positive than negative sentiment words and predicted coach implementation fidelity with acceptable performance metrics (e.g. area under the receiver operating characteristic curve [AUC]=74.48%). The final best-performing ML algorithms that included a more comprehensive set of NLP features performed well (e.g. AUC=76.06%). NLP and ML tools could help clinical supervisors automate monitoring of coaches' implementation fidelity to GdCBT. These tools could maximize allocation of scarce resources by reducing the personnel time needed to measure fidelity, potentially freeing up more time for high-quality clinical care.

BackgroundImplementation fidelity measures are critical for understanding complex interventions. Though maternity waiting homes (MWHs) are recommended by the WHO and have been used to help pregnant women access health facilities...

Motor skill interventions addressing global developmental delays have shown to be effective, but there is limited ecological validity and evidence of long-term effects in these studies. This naturalistic, cross-sectional study compared the MC of children (n = 87) in classes of teachers previously trained in the Successful Kinesthetic Instruction for Preschoolers (SKIP)-Cymru early years motor skill program with children (n = 61) whose teachers had no training in motor skill instruction. A secondary aim assessed teachers’ ability to deliver SKIP-Cymru with fidelity 6–31 months after training. MC was assessed using the ball skills subscale of the Test of Gross Motor Development third edition (TGMD-3) and Movement Assessment Battery for Children-Second Edition. Fidelity was assessed through a fidelity of implementation evaluation completed during a lesson observation for teachers trained with SKIP-Cymru in the same week. Two, 2-Condition (SKIP-Cymru, non-SKIP) × 2-Sex (girls, boys) analyses of variances revealed a significant main effect for Condition (p &lt; .001; TGMD-3, Movement Assessment Battery for Children-Second Edition). The TGMD-3 showed a main effect for sex. Children taught by teachers trained in SKIP-Cymru had significantly better MC than those in the non-SKIP schools, and boys outperformed girls in the TGMD-3. Teachers delivered SKIP-Cymru with fidelity of implementation (between 68% and 87%). This study provides initial evidence to support more robust training of teachers to embed principles of SKIP-Cymru in practice and impact child outcomes.

IntroductionLung cancer is the leading cause of cancer-related mortality globally, with non-small cell lung cancer (NSCLC) comprising the majority of cases. For advanced NSCLC, immunotherapy offers substantial survival benefits but...

The need for well-implemented evidence-based interventions (EBIs) for the prevention of behavioral issues among children and adolescents is substantial. In rural areas, the need often matches or surpasses that of urban areas. Schools have a wide reach for prevention-focused EBIs. However, implementation in rural schools is often hindered by limited resources and capacity. Rural School Support Strategies (RS3) are a bundle of implementation supports that address implementation challenges in rural settings. They include providing additional leadership and coaching training, individualized technical assistance (mostly virtual), and monthly meetings of a virtual learning collaborative. A cluster-randomized Hybrid Type 3 implementation-effectiveness trial tested RS3 for implementing school-wide positive behavioral interventions and supports (PBIS), a universal prevention approach to improving student behavior, academic outcomes, and school climate. Forty rural schools received a multi-day training on PBIS each summer for 3 years. Half were randomized to also receive RS3 support. Linear and logistic regression models examined the effect of treatment condition and dosage of support on implementation fidelity for Tier 1 (universal) PBIS. Condition and dosage (number of hours) of support increased the odds of schools achieving the 70% threshold for adequate implementation fidelity. In the first year, the higher dosage of technical assistance events increased the likelihood of schools reaching fidelity, whereas later in the trial, the higher dosage of attendance at the virtual learning collaborative sessions yielded significant improvements in fidelity. Implications for accelerating the implementation of universal prevention initiatives in schools—particularly in rural settings—are discussed. This study was prospectively registered on ClinicalTrials.gov (NCT03736395), on November 9, 2018.

Individualized Coordination and Empowerment for Care Partners of Persons with dementia (ICECaP): Feasibility and acceptability

This paper reports on the pilot results of the first independent evaluation of Accelerated Reader (AR), an online reading programme, in China. Despite its adoption in over 800 Chinese schools and robust evaluation elsewhere, AR has not been independently assessed in China. The sample included 528 Year 5 and 6 pupils from two public schools in China. The pilot was a cluster randomised control trial, where four classes (195 pupils) were randomised to receive the AR intervention, while seven (333 pupils) followed business-as-usual instruction. The intervention lasted 12-13 weeks, with one session per week. Impact evaluation showed positive effects on English reading outcome (effect size [ES] = +0.27), overall reading habits (ES = +0.14) and attitudes (ES = +0.15), though regression models suggested these may reflect pre-existing differences. Compliance analysis showed that pupils who complied made greater progress than non-compliers (ES = +0.56), highlighting the importance of session completion. Process evaluation reflected large variation in implementation fidelity, driven by teacher experience, classroom management, and technical support. Key challenges included pupils’ limited English proficiency, digital skills, large class sizes, and mismatched book access. Path analysis indicated a small positive indirect impact of reading behaviours on performance, mainly through reading attitudes.

This study evaluated the feasibility of the Knowledge, Language, and Inquiry (K.L.I.) intervention, designed to support Grades 3–5 multilingual students classified as English learners (ML-ELs) in building content knowledge, language skills, and reading comprehension through inquiry-based small-group instruction. Feasibility was examined across five dimensions—acceptability, practicality, integration, implementation fidelity, and effectiveness—using teacher interviews, ratings, lesson observations, and student and teacher learning outcome assessments. Findings suggest that the intervention was generally well-received by teachers, with structured lesson plans and resources facilitating implementation. Teachers demonstrated increased knowledge in reading instruction and the intervention following professional development, and students showed gains in vocabulary, text structure awareness, and topic-specific knowledge. However, time constraints during standardized testing periods limited consistent implementation. These findings inform the refinement of the K.L.I. intervention for broader application, emphasizing the need to address contextual challenges and conduct future evaluations to support its larger-scale implementation and improve ML-ELs’ literacy outcomes.

This participatory, mixed methods study will explore how iHEAL, a woman-led, nurse-delivered health promotion intervention for women who have experienced intimate partner violence (IPV), can be implemented in real-world, community-based health care settings located in 3 Canadian provinces. Grounded in the Active Implementation Frameworks, the study's primary aim is to identify the processes, resources and supports necessary to implement and sustain this novel program with fidelity while maintaining its benefits for women. Over 2.5 years, each organization will plan for and deliver the iHEAL program, supported by an iHEAL Consultant. To explore implementation processes and fidelity, successes and challenges, and any value-added of iHEAL to organizations and/or communities, qualitative interviews will be conducted with 3 groups of participants: 1) organizational leaders; 2) implementation/delivery team members (nurses and supervisors); and 3) external stakeholders or agencies supporting iHEAL through referrals or other collaboration. High level notes capturing key issues and decisions at planning meetings will supplement these data. Administrative program data will be collected to assess program reach, participant engagement, and aspects of fidelity. Women participating in iHEAL will also be invited to complete pre/post intervention surveys to assess changes in key outcomes, with a subsample of 60 women to be interviewed about their experiences of iHEAL and suggestions for strengthening the program. Qualitative data will be analyzed using Rapid Team Based Qualitative Analysis and Reflective Thematic Analysis. Quantitative data will be summarized using descriptive statistics; pre-post intervention changes in outcomes collected in women's surveys will be analyzed using paired t-tests. Ethical approval has been obtained, and all participants will provide informed consent. The findings of this research are expected to yield insights about organizational factors that shape the delivery of iHEAL and support the development of guidance materials for future iHEAL implementation and scale up.