Implementation Of Interventions Research Articles

Program Implementation Strategies Associated With Reduced Acute Care Utilization for Medicaid Beneficiaries in California's Whole Person Care Pilot Program.

Public health care policymakers and payers are increasingly investing in efforts to address patients' health-related social needs (HRSNs) as a strategy for improving health while controlling or reducing costs. However, evidence regarding the implementation and impact of HRSN interventions remains limited. California's Whole Person Care Pilot program (WPC) was a Medicaid Section 1115 waiver demonstration program focused on the provision of care coordination and other services to address eligible beneficiaries' HRSN. In this study, we examine pilot-level variation in impact on acute care utilization and identify factors associated with differential outcomes. The majority of pilots reduced emergency department (ED) visits for enrollees relative to matched controls; however, only four pilots reduced both ED visits and hospitalizations. Coincidence analysis results highlight the importance of cross-sector partnerships, field-based outreach and engagement, and adequate program investment in differentiating pilots that reduced acute care utilization from those that did not.

Adapting and Evaluating a Brief Advice Tobacco Cessation Intervention in High-reach, Low-resource Settings in India: Protocol for a Cluster Randomized Controlled Trial.

About 1.35 million deaths annually are attributed to tobacco use in India. The main challenge, given the magnitude of tobacco use and limited resources, is delivering cessation support at scale, low cost, and through a coordinated cross-system effort; one such example being brief advice interventions. However, highly credentialed staff to identify and counsel tobacco users are scarce. Task-shifting is an important opportunity for scaling these interventions. The LifeFirst SWASTH (Supporting Wellbeing among Adults by Stopping Tobacco Habit) program-adapted from the LifeFirst program (developed by the Narotam Sekhsaria Foundation, Mumbai, India)-is a tobacco cessation program focusing on lower-socioeconomic status patients in Mumbai receiving private health care. This parallel-arm, cluster randomized controlled trial investigates whether the LifeFirst SWASTH program increases tobacco cessation rates in low-resource, high-reach health care settings in Mumbai. This study will target tuberculosis-specific nongovernmental organizations (NGOs), dental clinics, and NGOs implementing general health programs serving lower-socioeconomic status patients. Intervention arm patients will receive a pamphlet explaining tobacco's harmful effects. Practitioners will be trained to deliver brief cessation advice, and interested patients will be referred to a Narotam Sekhsaria Foundation counselor for free telephone counseling for 6 months. Control arm patients will receive the same pamphlet but not brief advice or counseling. Practitioners will have a customized mobile app to facilitate intervention delivery. Practitioners will also have access to a peer network through WhatsApp. The primary outcome is a 30-day point prevalence abstinence from tobacco. Secondary outcomes for patients and practitioners relate to intervention implementation. The study was funded in June 2020. Due to the COVID-19 pandemic, the study experienced some delays, and practitioner recruitment commenced in November 2023. As of July 2024, all practitioners have been recruited, and practitioner recruitment and training are complete. Furthermore, 36% (1687/4688) of patients have been recruited. It is hypothesized that those patients who participated in the LifeFirst SWASTH program will be more likely to have been abstinent from tobacco for 30 consecutive days by the end of 6 months or at least decreased their tobacco use. LifeFirst SWASTH, if found to be effective in terms of cessation outcomes and implementation, has the potential to be scaled to other settings in India and other low- and middle-income countries. The study will be conducted in low-resource settings and will reach many patients, which will increase the impact if scaled. It will use task-shifting and an app that can be tailored to different settings, also enabling scalability. Findings will build the literature for translating evidence-based interventions from high-income countries to low- and middle-income countries and from high- to low-resource settings. ClinicalTrials.gov NCT05234983; https://clinicaltrials.gov/study/NCT05234983. DERR1-10.2196/57236.

Exploring the Views of Barbers and Stylists on the Acceptability of Delivering Community-Based Interventions to Promote COVID-19 Testing and Vaccination in South Carolina

Background: The COVID-19 pandemic has underscored the need for effective community-based interventions to promote disease prevention and reach high-risk, underserved communities. Trusted community leaders like barbers and stylists may serve as effective conduits for intervention implementation. This study aimed to explore the perceived acceptability of an intervention to promote COVID-19 testing and vaccination delivered by barbers in South Carolina. Methods: We conducted exploratory in-depth interviews to ascertain barbers’ and stylists’ perceptions and identify potential barriers and facilitators. Data analysis used a deductive coding approach to identify themes and was guided by the Theoretical Framework of Acceptability. Results: Sixteen participants were interviewed. Participants expressed positive reactions towards the interventions. Acceptability was influenced by strong trust relationships with clients, perceived community influence, self-efficacy in providing the intervention, and a shared sense of responsibility for community health. However, potential barriers included declining public concern about COVID-19, vaccine hesitancy, and limited COVID-19 knowledge among barbers and stylists. Participants emphasized the need for training and incentives for effective and sustained intervention delivery. Conclusions: Barbers and stylists are well-positioned to promote COVID-19 testing and vaccination due to their trusted roles and community influence. Given the complacency from the waning perceived COVID-19 threat and the historical mistrust in health interventions, vaccine hesitancy must be addressed through supportive communication strategies.

The Main Challenges Faced in the Implementation of Government Policy Interventions towards Access to Pre-primary and Primary Education by Street Children in North Rift, Kenya

Aims: Despite of the strong policy measures to have street children in school, many school-going-age are still not attending school. Therefore, the main purpose of this paper was to evaluate challenges faced in the implementation of Government policy interventions towards access to pre-primary and primary education by street children in North Rift, Kenya. Study Design: The study adopted a mixed method research design. Place and Duration of the Study: A survey was conducted in three towns of the North Rift Counties of Kenya (Kapsabet, Eldoret, and Kitale) which are the headquarters of the respective counties. Data collection done in the period between 1st December and 31st December 2022 Methodology: Purposive and simple random sampling was used to select 322 respondents (218 males and 23 females with a modal age of 10 -15 years; 18 female and 27 female teachers were aged between 30 – above 40 years). Data was collected using observation guides, in-depth interviews, and questionnaires. Descriptive and inferential statistics as well as theme analysis were used to analyze the data, respectively. The data was coded and analyzed using themes. Results: Main reasons street children had not enrolled in school were a lack of money for school materials (56.2%) and an unattractive school environment (30%). Other reasons included having to work to support their families (1.3%), distance to school (0.9%), being born and raised on the streets, being over-aged, and early parenting responsibilities. Conclusion: The study concluded that government policy interventions alone are insufficient for improving street children's access to education. Effective implementation requires collaborative efforts from all stakeholders, addressing barriers like poverty and parenting responsibilities, and restructuring education to include informal systems.

Profile of Ocular Trauma in Pediatric Population in a Tertiary Care Hospital

BACKGROUND Ocular trauma is the major cause for preventable monocular blindness and visual impairment worldwide. It accounts for 8%-14% of total injuries in the pediatric age group. Various studies have shown its higher incidence in this age group. They have different patterns of ocular injuries than adults and have age specific type of injuries. The number of blind years that a child lives with compared to an adult is far more. Most of the previous studies have been on ocular trauma among the adult population, specifically the factory workers in the city of Ludhiana. Moreover, this study aimed to derive a relation between the time of presentation from the injury and the final visual outcome which has rarely been reported in other studies. Profile of ocular trauma in an area is a dynamic and ever changing trend. Therefore, we proposed to study the profile of ocular trauma in pediatric population presenting to our hospital. METHODS A total of 60 patients between the age of 0 to 17 years were included in this study. The study was conducted from 15th December 2020 to 31st May 2022. Complete ocular examination was done at the time of presentation and after management; The best corrected visual acuity was noted at the end of three months. RESULTS Among our study subjects 45% belonged to the age group of 11-17 years. A male predominance (68.3%) was noted. For most of the subjects, the duration between time of injury and time of examination was less than 6 hours. The proportion of closed globe type of injury (80%) was significantly higher as compared to open globe (8.3%) and extraocular type of injury (11.7%). At the 3 month follow up, out of the 53 study subjects, 92.45% had good visual outcome (VO), 3.77% had fair VO and 3.77% had poor VO respectively. CONCLUSIONS Most of the pediatric ocular trauma may be avoided, which emphasizes the value of health education, adult supervision, and the implementation of suitable interventions to lessen the frequency and severity of trauma. Better visual outcome is expected with a shorter duration between time of injury and time of presentation.

Assessing the acceptability of a culturally adapted group-based pediatric intervention, Kokajjiriri, for Marshallese mothers and infants to improve nutrition and prevent childhood obesity.

Marshallese Pacific Islanders experience higher rates of obesity than other racial and/or ethnic communities. Despite the obesity rates experienced in this community, there are currently no childhood obesity prevention interventions designed for Marshallese Pacific Islanders in the United States. The purpose of this study is to assess the acceptability and feasibility of a culturally adapted group-based pediatric intervention, Kokajjiriri, with Marshallese mothers to improve nutrition and reduce childhood obesity. A multi-methods design was used to culturally adapt the Kokajjiriri intervention for Marshallese mothers in Arkansas (n = 17). In phase one, we conducted 24-h dietary recalls with 20 Marshallese mothers to inform the cultural adaptation of the group-based pediatric intervention, and then in phase two, we culturally adapted and piloted three sessions of the intervention to determine the acceptability and feasibility of the intervention. Participants found the adapted intervention to be acceptable and feasible, found the location to be convenient and found the facilitator to be knowledgeable. Four themes emerged from the qualitative data: (1) Lactation Support; (2) Introducing Healthy Solids; (3) Rice Portion Control; and (4) Finding Resources. This is the first study to assess the acceptability and feasibility of a culturally adapted group-based pediatric intervention, Kokajjiriri, with Marshallese mothers to improve nutrition and reduce childhood obesity. The results from this culturally adapted group-based pediatric intervention, Kokajjiriri, will be used to inform future adaptations and implementation of the full intervention for Marshallese women and children.

The use of video-based interventions to teach activity of daily living to children with autism spectrum disorder–scoping review

The study aimed to delve into the successful implementation of Video-Based Intervention (VBI) in improving activity of daily living skills (ADL) among children with autism spectrum disorder (ASD). Three primary electronic databases were utilised to perform this review: WOS, Scopus and Google Scholar. The process primarily used the research methodologies by Arksey and O'Malley as a framework. In the course of performing the scoping review, three themes emerged: firstly, a wide range of VBI techniques can be employed to enhance the skills of children with ASD; secondly, when VBI is coupled with adequate implementation support specifically tailored for children with ASD, it can effectively improve their daily living abilities. Essentially, the findings of this study support that VBI implementations can promote desired skills in ADL among children with ASD. Furthermore, additional implementation support complements video modeling, improving skill acquisition in ASD. This research enhances the existing knowledge base dedicated to enhancing the quality of life for children with ASD, providing valuable insights for educators, clinicians, and families involved in their care.

Motivational Factors Influencing the Choice of Medical Studies and Future Career Plans among Montenegrin Students.

There is a concerning trend of emigration among highly educated individuals in Montenegro. This includes medical professionals who seek better job opportunities abroad. The aim of the present study was to identify the primary motivational factors driving Montenegrin medical students to pursue a career in medicine, and whether these factors undergo changes over the course of their studies. A cross-sectional study included 210 medical students in Montenegro, 27.62% were males, and 72.38% were females. The mean age of the students was 21.90 years (SD=3.05) (range 19-39). Their academic motivation was analysed using the Academic Motivation Scale, previously validated in various cultural contexts. The results showed that autonomous motivation levels were higher than controlled motivation levels (p<0.001) among students in Montenegro, which has been previously associated with better learning outcomes. Students with medical doctors among their family members had higher extrinsic motivation related to rewards and punishments (extrinsic motivation with external regulation p=0.018). Amotivation showed a trend of increasing as the students got closer to graduation (p=0.057). Only 8.1% of students planned a career in primary healthcare, and 1% wished to specialize in family medicine. This study's findings, which indicate high levels of autonomous motivation among medical students, are of significant importance. They contribute to a comprehensive understanding of the motivation factors among medical students and young healthcare professionals in Montenegro. Moreover, they provide a basis for the implementation of strategic interventions to retain highly skilled medical professionals within the country's workforce, thereby addressing the concerning trend of emigration among this group.

The perceptions and experiences of caregivers of patients with dysphagia: A qualitative meta-synthesis.

To understand the perceptions and experiences of family caregivers of adult patients with dysphagia. Dysphagia is a common symptom and burdens caregivers greatly. There is a growing body of studies concentrating on caregivers and caregiving experiences. However, no qualitative meta-synthesis has been conducted to explore the perceptions and experiences of family caregivers. A qualitative meta-ethnography. A search was conducted for relevant articles in six electronic databases (PubMed, Web of Science, CINAHL, Ovid, Cochrane Library, ProQuest) and two Chinese databases (CNKI, Wanfang Data) from inception to February 2023. The Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) was used to evaluate study quality. The meta-ethnographic method was used to synthesize data from qualitative studies. The study was reported according to EQUATOR guidelines. Eleven studies were included and three themes emerged: (1) emotion and perception, (2) change and challenge (3) adaption and coping. This review highlighted the challenges and positive coping experienced by caregivers. Findings directly inform the development and implementation of supportive interventions to reduce caregivers' stress and promote adaptive coping. Pay attention to the needs of family caregivers of dysphagia. Family caregivers' perceived severity of dysphagia requires assessment. Caregivers need knowledge, support, and guidance to reduce their burden and fulfill their role.

The effects of progressive muscle relaxation exercise on dementia caregivers

While progressive muscle relaxation has demonstrated effectiveness in reducing anxiety, stress, and depression in general populations, its impact on caregivers of dementia patients remains understudied. This study investigated the effectiveness of Progressive Muscle Relaxation (PMR) in improving the well-being of dementia caregivers. Caregivers of individuals with dementia (n = 57) participated in a 3-month intervention, engaging in PMR thrice weekly. Participants completed assessments of depression, anxiety, stress, and caregiver burden at pre-test and post-intervention period. The intervention led to significant reductions in anxiety, stress, depression, and caregiver burden among participants. Female caregivers reported to have higher levels of anxiety and stress compared to males. Caregivers under financial stress showed high levels of distress and increased caregiver burden. These promising findings suggest the need for further research with larger, multicenter samples. Notably, PMR is a readily implementable intervention by nurses, requiring minimal equipment and offering a cost-effective approach to supporting caregiver well-being.

Implementation of an Opt-Out Outpatient HIV Screening Program.

Screening rates for Human Immunodeficiency Virus (HIV) remain low despite guidelines by both the CDC and USPSTF recommending that all adolescents and adults be screened at least once. The aim of this quality improvement study was to increase HIV screening among eligible patients. This quality improvement study assessed the impact of interventions to increase HIV screening in an outpatient population at a large urban safety-net hospital. Outcomes were compared from the preintervention (December 2020 to November 2021) to postintervention years (December 2021 to November 2022). Stepwise electronic alerts to prompt HIV screening paired with provider financial incentives were implemented. The proportion of eligible individuals screened for HIV were compared after intervention implementation. Average monthly HIV screening increased from 506 ± 97 to 2484 ± 663 between the pre- and postintervention periods, correlating to a 5.1-fold increase in screening (7.8% to 39.8%, P < .01). Increases were seen across all ages, and those aged 55 to 64 and 65+ had the highest relative increase in screening at 7.5 and 9.3-fold, respectively (P < .01). Screening rates increased for Hispanics (7.9% preintervention vs 43.6% postintervention, P < .01). In the pre- and postintervention periods, 41 patients with new HIV diagnoses were identified (13 preintervention and 28 postintervention) and 85.4% were linked to care within 30 days. Stepwise interventions targeted at primary care clinicians are an effective way to increase HIV screening rates, particularly in older demographics. Earlier HIV diagnosis coupled with linkage to care is an important strategy in ending the HIV epidemic.

Analisis Praktik Klinik Keperawatan pada Pasien St Elevation Myocardial Infarction (STEMI) dengan Intervensi Inovasi Terapi Musik Mozart Kombinasi Eye Mask untuk Peningkatan Kualitas Tidur Pasien di Ruang ICCU RSUD Taman Husada Bontang

Heart disease is the leading cause of death worldwide. Approximately 17.5 million people die each year from heart disease, accounting for a significant portion of global mortality. One of the common heart diseases in Indonesia is ACS, or acute coronary syndrome. A complete blockage of a specific coronary blood vessel results in STEMI, which completely stops blood flow and prevents the heart muscle from receiving oxygen and nutrients, ultimately leading to its death. This research aims to improve sleep quality in patients with ST elevation myocardial infarction. (STEMI). The implementation of the innovative Mozart music therapy intervention, in conjunction with an eye mask, resulted in a slight improvement in the patient's sleep pattern quality. Based on the client's observation, the patient achieved a PSQI score of 8. (kualitas tidur klien buruk). From the innovations carried out, it can be concluded that Mozart music therapy is effective in improving the sleep quality of patients, but not significantly, as the score from the post-intervention results of Mozart music initially was 11 and became 8 after 3 days of intervention, indicating that the patients' sleep quality remains poor since the change in score is minimal and not very significant.

Effects of a Parent-Child Single-Session Growth Mindset Intervention on Adolescent Depression and Anxiety Symptoms: Protocol of a 3-Arm Waitlist Randomized Controlled Trial.

Depression and anxiety are common mental health problems among adolescents worldwide. Extant research has found that intelligence, emotion, and failure-is-debilitating beliefs (fixed mindsets) are closely related to more depression and anxiety symptoms, hopelessness, and suicidality. Recent research also points to the importance of parental mindset, which can strongly influence children's affect, behavior, and mental health. However, the effects of parent-child mindset interventions on a child's internalizing problems have not yet been empirically examined. As recent evidence has shown the promise of single-session interventions in reducing and preventing youth internalizing problems, this study develops and examines a parent and child single-session intervention on mindsets of intelligence, failure, and emotion (PC-SMILE) to tackle depression and anxiety in young people. Using a 3-arm randomized controlled trial, this study will examine the effectiveness of PC-SMILE in reducing depression and anxiety symptoms among children. We hypothesize that compared to the waitlist control group, the PC-SMILE group and child single-session intervention on mindsets of intelligence, failure, and emotion (C-SMILE) group will significantly improve child depression and anxiety (primary outcome) and significantly improve secondary outcomes, including children's academic self-efficacy, hopelessness, psychological well-being, and parent-child interactions and relationships, and the PC-SMILE is more effective than the C-SMILE. A total of 549 parent-child dyads will be recruited from 8 secondary schools and randomly assigned to either the PC-SMILE intervention group, the C-SMILE intervention group, or the no-intervention waitlist control group. The 45-minute interventions include parent-version and child-version. Both parents and students in the PC-SMILE group receive the intervention. Students in C-SMILE group receive intervention and their parents will receive intervention after all follow-up ends. Students in 3 groups will be assessed at 3 time points, baseline before intervention, 2 weeks post intervention, and 3 months post intervention, and parents will be assessed in baseline and 3-month follow-up. The intention-to-treat principle and linear-regression-based maximum likelihood multilevel models will be used for data analysis. Recruitment started in September 2023. The first cohort of data collection is expected to begin in May 2024 and the second cohort will begin in September 2024. The final wave of data is expected to be collected by the end of the first quarter of 2025. The results are expected to demonstrate improved anxiety and depression among students assigned to the intervention condition, as well as the secondary outcomes compared to those in the control group. The efficacy and effectiveness of the intervention will be discussed. This study is the first attempt to develop a web-based single-session intervention for students and their parents to enhance their well-being in Hong Kong and beyond, which potentially contributes to providing evidence-based recommendations for the implementation of brief digital parent-child interventions. PRR1-10.2196/63220.

Routine cognitive screening for older people undergoing major elective surgery: Benefits, risks and costs.

Cognitive impairment and older age are major risk factors for postoperative delirium. Professional societies have advocated preoperative screening to identify at-risk individuals for implementation of interventions, which have moderate effectiveness in preventing delirium. However, it remains unclear from the guidelines whether screening should be completed routinely for all older individuals or targeted, and also which specific screening tool is preferred. In addition, the responsibility for screening remains undesignated in the guidelines provided. We reviewed the benefits and risks of routine screening. We also performed a cost-benefit analysis of routine screening (versus no screening). Furthermore, we summarised the sensitivities and specificities of commonly used screening tools and reviewed evolving screening tools that may have an increasing role in future practice. We concluded that routine screening is useful and appears to be cost-effective for reducing postoperative delirium, with a cost-benefit ratio of 2.89 (adjusted ratio of 2.34), and has additional advantages over other approaches such as targeted screening or routine intervention.

Exploring the feasibility of implementing the SPELL-Links to Reading and Writing intervention.

This study examined six reading intervention teachers' implementation of the SPELL-Links to Reading and Writing intervention with students in Grades 2 and 3. The purpose was to explore the extent to which teachers who received a one-day training session without ongoing coaching support were able to implement the intervention with fidelity. It also aimed to better understand the determinants (i.e., barriers and facilitators) of teachers' implementation and their perceptions related to the importance, feasibility, and effectiveness of the intervention. Data from four sources (implementation logs, implementation observations, interviews, and surveys) were collected and analyzed. Participating teachers did not implement the intervention at the intended dosage of 4days per week, but they did demonstrate high adherence and quality on average. Several barriers to implementation were identified, including intervention training, intervention content and structure, compatibility with existing practices, and alignment with goals. Notable facilitators of implementation were teacher capability and peer support. Teachers had varying perceptions of the intervention, with neutral satisfaction on average. These findings indicate a need for further research on determinants of intervention implementation as they may be crucial in supporting teachers' implementation fidelity.

Sustained Spread of HIV-1 CRF55_01B in Its Place of Initial Origin: Dynamics and Hotspots.

Shenzhen, a city with a substantial mobile population, was identified as the first discovered region of HIV-1 CRF55_01B and epicenter of its severe epidemic. During the implementation of venue-based behavioral interventions and the "treat-all" policy, discerning the spread patterns and transmission hotspots of CRF55_01B is imperative. In this study, 1,450 partial pol sequences, with demographic information, were collected from all newly diagnosed CRF55_01B infections in Shenzhen from 2008 to 2020. Molecular networks were constructed using the maximum likelihood and time-resolve phylogenies. Transmission rates, effective reproduction numbers (Re) of clusters and viral dispersal were evaluated using Bayesian inference. In total, 526 sequences formed 114 clusters, including seven large clusters. The status and size of clusters were strongly correlated with age, ethnicity, occupation and CD4+ T cell counts. The transmission rates of clusters were significantly higher than the national epidemic estimate. Four large clusters had Re exceeding 1 at the end of sampling period. Immigrants from Guangdong and Hunan, along with local residents, were identified as the transmission hubs, with heterosexual men being the main source and MSM being the main destination. The virus exhibited a high movement frequency from individuals aged 30-49 years toward diverse age groups. This study demonstrated the hidden CRF55_01B transmissions continued despite current combined interventions in Shenzhen, and special at-risk individuals susceptible to infection or transmission were identified, potentially serving as targets for more effective prevention and control of the local epidemic, thereby mitigating cross-regional spread nationwide due to population migration.

Factors predicting depression among persons post-coronary artery bypass graft surgery: A cross-sectional study in Thailand.

Coronary artery bypass graft (CABG) surgery is a highly effective coronary artery disease treatment, providing immediate relief and promising long-term benefits. However, it is a major procedure with significant risks, including the potential for depression. Many patients experience depression following CABG, which can negatively impact their overall recovery, affecting both physical and mental health. This study aimed to determine factors predicting depression in patients following CABG surgery. This cross-sectional study was conducted with data collected between January and April 2024. A total of 272 post-CABG patients from two super tertiary care hospitals in Bangkok, Thailand, were recruited through purposive sampling. All research instruments were validated and tested for reliability. Data were analyzed using multiple regression analysis. The study found that hope, optimism, illness perception, social support, and anxiety were correlated with depression (adjusted R² = 0.381), but these variables explained only 38.1% of the variance (p <0.05). Among these factors, anxiety (β = 0.311), optimism (β = 0.203), social support (β = -0.117), and illness perception (β = -0.143) were significant predictors (p <0.05), while hope was not a significant predictor. Thus, anxiety emerged as the most crucial predictor of depression in patients who have undergone CABG. Nurses play a vital role in preventing and managing depression in post-CABG patients. Screening for anxiety and addressing it can prevent depression, enhance social support, and improve outcomes. To develop effective nursing strategies, it is essential for nurses to assess anxiety and implement interventions that promote social support, optimism, and illness perception. These measures can improve care quality, reduce readmission rates, and enhance patients' overall quality of life.

The unmet mental health needs of adolescents with HIV in eastern Tanzania: Experiences of healthcare providers, adolescents, and caregivers.

Adolescents with Human Immunodeficiency Virus (HIV) are at greater risk for mental health problems than their HIV-negative counterparts. However, there is a dearth of evidence on the need for mental health services, including interventions for depression in adolescents with HIV (AWHIV), in most low- and middle-income countries (LMICs). This study's objective was to explore the unmet mental health needs of AWHIV to inform the development and implementation of a psychological intervention for depression in AWHIV in Dar es Salaam, Tanzania. A descriptive phenomenological qualitative study design was used. Consultative meetings with providers and 45 in-depth interviews were conducted with AWHIV, caregivers, and healthcare providers (HCPs) to explore their experiences and unmet mental health needs for AWHIV. Data from the consultative meetings were triangulated to validate the obtained information with those from interviews. Data were organized and managed with the aid of NVIvo-11. The thematic analysis framework guided data analysis. Five major themes emerged: Experience of complex symptoms, unmet need for services, impact of the unmet needs, ways utilized in managing symptoms, and preferred intervention. Complex depressive symptoms expressed as physical, behavioral, or somatic complaints adversely affected ART adherence and academic performance, led to substance use, and compromised overall quality of life in AWHIV. HIV-Care and Treatment Centers (HIV-CTCs) did not conduct formal mental health screenings. Instead, caregivers and HCPs addressed the symptoms of mental health problems with death threats and corporal punishments. No evidence-based depression interventions existed in HIV-CTCs for observed symptoms. This study reports on unmet mental health needs with a clear impact on the lives of AWHIV, which may have significant implications for treatment adherence. There is an urgent need to develop and implement effective and scalable interventions to address these mental health needs.

Protocol for a mixed-methods study to explore implementation outcomes of the Phone-based Interventions under Nurse Guidance after Stroke (PINGS-II) across 10 hospitals in Ghana

BackgroundStroke survivors are at a substantially higher risk for adverse vascular events driven partly by poorly controlled vascular risk factors. Mobile health interventions supported by task shifting strategies have been...

Community-Engaged Implementation Strategies in Occupational Therapy: A Scoping Review.

Despite the potential of community-engaged implementation research (CEIR) in developing strategies to accelerate the translation of evidence-based interventions (EBIs), there is a noticeable knowledge gap in the current state of CEIR in occupational therapy. A synthesis of the concept, purpose, and operationalization of CEIR is necessary. To identify the contexts, purposes, and operationalization of CEIR, focusing on implementation strategies in occupational therapy. PubMed/MEDLINE, Embase, CINAHL, Scopus, and Web of Science. We included studies that were explicit and intentional about CEIR and that focused on implementation strategies to support the translation of occupational therapy interventions, clinical guidelines, practice models, theories, or assessments. We extracted the research context (e.g., partners, recruitment), purpose (e.g., why community-engaged research was used), and operationalization (e.g., community engagement [CE] activities, how their findings inform the research) using thematic analysis. Of 3,219 records, 6 studies were included. Involved partners were mainly occupational therapy practitioners from existing networks. CEIR that focuses on implementation strategies informs various aspects of research design, ranging from study design to sustainability, by developing community-academia partnerships, building implementation capacity, and creating implementation strategies across diverse research areas. Current research has used various but mostly traditional CE activities (e.g., focus groups). We synthesized evidence on CEIR focused on implementation strategies in occupational therapy. Intentional efforts are needed to collaborate with diverse partners, explore innovative CE activities, produce equitable outputs, and develop multilevel implementation strategies to accelerate the translation of EBIs into practice. Plain-Language Summary: In this review, we synthesize evidence on the contexts, purposes, and operationalization of community-engaged implementation research (CEIR), focusing on implementation strategies in occupational therapy research. We found that current implementation efforts mainly rely on occupational therapy practitioners as community partners and use traditional recruitment methods and community engagement activities. In turn, they develop implementation strategies that mainly target practitioners without comprehensive, multilevel implementation support. We suggest more equitable collaboration with diverse partners to effectively promote the implementation and dissemination of evidence-based interventions in occupational therapy practice.