Implementation Of Health Services Research Articles

Implementation of Cognitive Health Services in Large Systems of Care: Highlights From Coordinated Specialty Care for First Episode Psychosis.

With increasing recognition of the importance of cognitive health for recovery in people with psychosis, questions arise as to how to implement cognitive health services in large systems of care. This paper describes the implementation of cognitive health services in OnTrackNY (OTNY), a network of clinics delivering a Coordinated Specialty Care treatment model for early psychosis, with the goal of documenting the processes, challenges, and useful adaptations. In 2018, OTNY piloted a Cognitive Health Toolkit for implementation across 18 affiliated clinics. The toolkit intended to identify the cognitive health needs of individuals early in the course of psychosis and to integrate cognitive health into the vocabulary of wellness and recovery. Implementation involved creating mechanisms for staff training and support to, in turn, help participants improve how they use cognitive skills in daily life. The toolkit was disseminated to all 28 OTNY programs throughout New York state by 2023. When simple assessment and decision-making tools were embedded in routine care practices, the majority of participants identified that improving memory, attention, and critical thinking skills would be helpful. Consistently, about 70% of those asked wanted to learn more about how to better their cognitive health. Cognitive health services can be implemented in large systems of care that provide a multi-level system of implementation supports. Organizational facilitators of implementation include a training program to educate about cognitive health and the delivery of cognitive health interventions, and embedded quality assurance monitoring and improvement activities.

Who are vaccine champions and what implementation strategies do they use to improve adolescent HPV vaccination? Findings from a national survey of primary care professionals

BackgroundImplementation science researchers often cite clinical champions as critical to overcoming organizational resistance and other barriers to the implementation of evidence-based health services, yet relatively little is known about who champions are or how they effect change. To inform future efforts to identify and engage champions to support HPV vaccination, we sought to describe the key characteristics and strategies of vaccine champions working in adolescent primary care.MethodsIn 2022, we conducted a national survey with a web-based panel of 2527 primary care professionals (PCPs) with a role in adolescent HPV vaccination (57% response rate). Our sample consisted of pediatricians (26%), family medicine physicians (22%), advanced practice providers (24%), and nursing staff (28%). Our survey assessed PCPs’ experience with vaccine champions, defined as health care professionals “known for helping their colleagues improve vaccination rates.”ResultsOverall, 85% of PCPs reported currently working with one or more vaccine champions. Among these 2144 PCPs, most identified the champion with whom they worked most closely as being a physician (40%) or nurse (40%). Almost all identified champions worked to improve vaccination rates for vaccines in general (45%) or HPV vaccine specifically (49%). PCPs commonly reported that champion implementation strategies included sharing information (79%), encouragement (62%), and vaccination data (59%) with colleagues, but less than half reported that champions led quality improvement projects (39%). Most PCPs perceived their closest champion as being moderately to extremely effective at improving vaccination rates (91%). PCPs who did versus did not work with champions more often recommended HPV vaccination at the earliest opportunity of ages 9–10 rather than later ages (44% vs. 33%, p < 0.001).ConclusionsFindings of our national study suggest that vaccine champions are common in adolescent primary care, but only a minority lead quality improvement projects. Interventionists seeking to identify champions to improve HPV vaccination rates can expect to find them among both physicians and nurses, but should be prepared to offer support to more fully engage them in implementing interventions.

Facilitating Evidence-Based Practice among Nurses in a Tertiary General Hospital: A Six-Year Practice of an Implementation Strategy Informed by the i-PARIHS Framework

Aims. To develop an evidence-based practice (EBP) facilitating strategy informed by the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework and evaluates the strategy’s effectiveness on promoting EBP. Background. Nurses are increasingly expected to use research evidence in practice to improve patients’ outcomes, but the application of such evidence is still unsatisfactory. The facilitation of EBP in nursing needs the organization and the individual levels. Methods. Based on an analysis of EBP-promoting strategies and expert consultation, the core team of the nursing department developed an EBP group-based and project-oriented strategy under the guidance of the i-PARIHS framework. The strategy was implemented for six years and evaluated by a longitudinal design. The validated Chinese version of the self-reported Evidence Based Practice Questionnaire (EBPQ) was used to assess the attitudes, knowledge, and practice of the nurses. Results. The mean score of the total EBPQ was 4.46 (SD = 0.92) after one year of the EBP strategy, and the scores for knowledge, attitudes, and practice of EBP members were higher than those of general nurses p&lt;0.05. After four years, EBP members’ scores continued to increase. EBP groups conducted 51 EBP projects in the areas of emergency nursing, surgical and medical nursing, critical care, and so forth. Of these, 33 projects improved nursing practice by changing nursing procedures, upgrading nursing tools, and developing nursing standards, resulting in improved patient outcomes. Conclusion. The EBP group-based and project-oriented strategy can promote EBP. The composition of the EBP group, the annual audit of EBP projects, and the roles of internal and external facilitators were key components of this EBP-facilitating strategy. Implications for Nursing Management. The strategy is an organizational-level EBP-facilitation approach which can improve nurses’ academic preparation for EBP through ongoing training and sustained EBP behavior that involves annual projects.

Implementation Outcomes for the SLUMBER Sleep Improvement Program in Long-Term Care

ObjectivesTo describe the implementation of a mentored staff-delivered sleep program in nursing facilities. DesignModified stepped-wedge unit-level intervention. Setting and ParticipantsThis program was implemented in 2 New York City nursing facilities, with partial implementation (due to COVID-19) in a third facility. MethodsExpert mentors provided staff webinars, in-person workshops, and weekly sleep pearls via text messaging. We used the integrated Promoting Action on Research Implementation in Health Services (i-PARiHS) framework as a post hoc approach to describe key elements of the SLUMBER implementation. We measured staff participation in unit-level procedures and noted their commentary during unit workshops. ResultsWe completed SLUMBER within 5 units across 2 facilities and held 15 leadership meetings before and during program implementation. Sessions on each unit included 3 virtual webinar presentations and 4 in-person workshops for each nursing shift, held over a period of 3 to 4 months. Staff attendance averaged >3 sessions per individual staff member. Approximately 65% of staff present on each unit participated in any given session. Text messaging was useful for engagement, educational reinforcement, and encouraging attendance. We elevated staff as experts in the care of their residents as a strategy for staff engagement and behavior change and solicited challenging cases from staff during workshops to provide strategies to address resident behavior and encourage adoption when successful. Conclusions and ImplicationsEngaging staff, leadership, residents, and family of nursing facilities in implementing a multicomponent sleep quality improvement program is feasible for improving nursing facilities’ sleep environment. The program required gaining trust at multiple levels through presence and empathy, and reinforcement mechanisms (primarily text messages). To improve scalability, SLUMBER could evolve from an interdisciplinary investigator-based approach to internal coaches in a train-the-trainer model to effectively and sustainably implement this program to improve sleep quality for facility residents.

Soulspace: Integrated youth mental health care in Berlin, Germany-An introduction to the program and a description of its users.

A substantial gap between young people's need for mental health care services and their actual access to such services led worldwide organizations (e.g., the WHO) to recommend the implementation of early intervention programs and youth mental health services. Some countries around the world have established structures to meet this recommendation. In this paper, we describe soulspace as the first integrated youth mental health service for young people aged between 15 and 35 years in Berlin, Germany. We introduce soulspace as easily accessible mental health care for young people, and we characterize soulspace along the lines of the internationally established eight key principles of integrated youth mental health services (Killackey, et al., 2020, World Economic Forum). Soulspace is a cooperation between clinical outpatient units of psychiatric clinics for adolescents and young adults as well as a community-based counselling service. It provides initial contact, counselling, diagnostics, and treatment. Our analyses of the pathways to soulspace and the characteristics of the soulspace users suggest that the low threshold is a facilitator to help finding for young people in comparison to more conventional early intervention models. That is, having transferred the early intervention center in a youth-facing counselling service as was done in soulspace seems to have reduced the threshold to seek help for families and for young people in need for support. In summary, with soulspace, an easily accessible mental health care service was established that integrates counselling and specialized psychiatric treatment if needed.

System for classifying antibody concentration against severe acute respiratory syndrome coronavirus 2 S1 spike antigen with automatic quick response generation for integration with health passports

Aim: After the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic and the realization of mass vaccination against the virus, the availability of a reliable, rapid, and easy-to-use system for registering the individual anti-S1 antibody titer could facilitate the personalized assessment of the need for booster vaccine doses and the reduction of social distancing and other measures. Methods: The biosensor system is based on immobilized engineered SK-N-SH neuroblastoma cells, bearing the S1 protein, and it can detect immunoglobulin G (IgG) antibodies against the SARS-CoV-2 S1 spike antigen. A disposable electrode strip bearing the engineered mammalian cells is connected to a customized read-out potentiometric device with real-time data transmission to a wireless fidelity (WiFi)-connected smartphone. Blood samples from past-infected individuals and individuals vaccinated against SARS-CoV-2 were used for validation. Results: In the present study, a smartphone application (app), capable of analyzing data regarding the levels of anti-S1 antibodies in blood is introduced. The app works in conjunction with a portable, ultra-rapid, and sensitive biosensor transmitting real-time measurements to the smartphone. Both historical and current individual data can be encoded by using the app, resulting in a widely accepted quick response (QR) code, which can then be constantly updated to match a person’s status. Conclusions: This novel system could be utilized for the eventual development of a coronavirus disease 2019 (COVID-19) electronic passport, which could be further employed to improve the population-wide, cross-country surveillance of vaccination efficiency, as well as facilitate the implementation of cross-border digital health services in a user-friendly and secure way.

A Qualitative Examination of School Principals’ Self-Perceived Role in School Mental Health Service Implementation

A Qualitative Examination of School Principals’ Self-Perceived Role in School Mental Health Service Implementation

Sustaining the collaborative chronic care model in outpatient mental health: a matrixed multiple case study.

Sustaining evidence-based practices (EBPs) is crucial to ensuring care quality and addressing health disparities. Approaches to identifying factors related to sustainability are critically needed. One such approach is Matrixed Multiple Case Study (MMCS), which identifies factors and their combinations that influence implementation. We applied MMCS to identify factors related to the sustainability of the evidence-based Collaborative Chronic Care Model (CCM) at nine Department of Veterans Affairs (VA) outpatient mental health clinics, 3-4years after implementation support had concluded. We conducted a directed content analysis of 30 provider interviews, using 6 CCM elements and 4 Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) domains as codes. Based on CCM code summaries, we designated each site as high/medium/low sustainability. We used i-PARIHS code summaries to identify relevant factors for each site, the extent of their presence, and the type of influence they had on sustainability (enabling/neutral/hindering/unclear). We organized these data into a sortable matrix and assessed sustainability-related cross-site trends. CCM sustainability status was distributed among the sites, with three sites each being high, medium, and low. Twenty-five factors were identified from the i-PARIHS code summaries, of which 3 exhibited strong trends by sustainability status (relevant i-PARIHS domain in square brackets): "Collaborativeness/Teamwork [Recipients]," "Staff/Leadership turnover [Recipients]," and "Having a consistent/strong internal facilitator [Facilitation]" during and after active implementation. At most high-sustainability sites only, (i) "Having a knowledgeable/helpful external facilitator [Facilitation]" was variably present and enabled sustainability when present, while (ii) "Clarity about what CCM comprises [Innovation]," "Interdisciplinary coordination [Recipients]," and "Adequate clinic space for CCM team members [Context]" were somewhat or less present with mixed influences on sustainability. MMCS revealed that CCM sustainability in VA outpatient mental health clinics may be related most strongly to provider collaboration, knowledge retention during staff/leadership transitions, and availability of skilled internal facilitators. These findings have informed a subsequent CCM implementation trial that prospectively examines whether enhancing the above-mentioned factors within implementation facilitation improves sustainability. MMCS is a systematic approach to multi-site examination that can be used to investigate sustainability-related factors applicable to other EBPs and across multiple contexts.

Implementation of advance care planning in the routine care for acutely admitted patients in geriatric units: protocol for a cluster randomized controlled trial

BackgroundAcutely ill and frail older adults and their next of kin are often poorly involved in treatment and care decisions. This may lead to either over- or undertreatment and unnecessary burdens. The aim of this project is to improve user involvement and health services for frail older adults living at home, and their relatives, by implementing advance care planning (ACP) in selected hospital wards, and to evaluate the clinical and the implementation interventions.MethodsThis is a cluster randomized trial with 12 hospital units. The intervention arm receives implementation support for 18 months; control units receive the same support afterwards. The ACP intervention consists of 1. Clinical intervention: ACP; 2. Implementation interventions: Implementation team, ACP coordinator, network meetings, training and supervision for health care personnel, documentation tools and other resources, and fidelity measurements with tailored feedback; 3. Implementation strategies: leadership commitment, whole ward approach and responsive evaluation. Fidelity will be measured three times in the intervention arm and twice in the control arm. Here, the primary outcome is the difference in fidelity changes between the arms. We will also include 420 geriatric patients with one close relative and an attending clinician in a triadic sub-study. Here, the primary outcomes are quality of communication and decision-making when approaching the end of life as perceived by patients and next of kin, and congruence between the patient’s preferences for information and involvement and the clinician’s perceptions of the same. For patients we will also collect clinical data and health register data. Additionally, all clinical staff in both arms will be invited to answer a questionnaire before and during the implementation period. To explore barriers and facilitators and further explore the significance of ACP, qualitative interviews will be performed in the intervention units with patients, next of kin, health care personnel and implementation teams, and with other stakeholders up to national level. Lastly, we will evaluate resource utilization, costs and health outcomes in a cost-effectiveness analysis.DiscussionThe project may contribute to improved implementation of ACP as well as valuable knowledge and methodological developments in the scientific fields of ACP, health service research and implementation science.Trial registrationClinicalTrials.gov Identifier NCT05681585. Registered 03.01.23.

Using data from mHealth apps to inform person-centred practice: A discussion paper

Background mHealth applications (apps) are tools that can enhance research by efficiently collecting and storing large amounts of data. However, data collection alone does not lead to change. Innovation and practice change occur through utilisation of evidence. The volume of data collected raises questions regarding utilisation of data by nurses and midwives, and how data from mHealth apps can be used to improve person-centred practice. There is limited empirical evidence and a lack of direction from global health authorities to guide nurses and midwives in this area. Aim To describe strategies for nurses and midwives that could enhance the effective use of data generated by mHealth apps to inform person-centred practice. The purpose of this paper is to stimulate reflection and generate actions for data utilisation when using mHealth apps in nursing research and practice. Methods This discussion paper has been informed by current evidence, the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework, and research experience as part of doctoral study. Findings Before engaging in data collection using mHealth apps, nurses and midwives would benefit from considering the nature of the evidence collected, available technological infrastructure, and staff skill levels. When collecting data and interpreting results, use of a team approach supported by engaged leadership and external facilitation is invaluable. This provides support to operate apps, and more importantly use the data collected to inform person-centred practice. Conclusions This paper addresses the limited available evidence to guide nurses and midwives when using mHealth apps to collect and use data to inform practice change. It highlights the need for appropriate technology, external facilitative support, engaged leadership, and a team approach to collect meaningful evidence using mHealth apps. Clinicians, leaders, and researchers can apply the strategies provided to enhance the use of mHealth apps and ensure translation of evidence into practice.

Utilization of Perinatal Depression and Anxiety Assessment Tools in Routine Perinatal Care: a Call for the Integration and Implementation of Maternal Mental Health Services into Perinatal Care in Ghana

Background: This study intends to stimulate critical thinking and generate impactful discussions on the provision of holistic perinatal care. The rationale is to promote the exchange of ideas and collaboration among stakeholders to ensure that the training and practice of midwifery in Ghana become more robust and meet global standards. Additionally, it is meant to inform, prepare competent, resourceful, knowledgeable, and most importantly adaptable midwives who can contribute to and promote the overall health of the women in their care. Objective: To explore midwives’ knowledge and understanding on soliciting the requisite information that impacts the psychological health of the perinatal women in their care during the perinatal period using globally validated and reliable assessment tools for depression and anxiety. Methods: A structured questionnaire was used to collect data from the participants (midwives). The study was conducted in selected hospitals across all 16 regions in Ghana. A total of 319 midwives with varying degrees and experience working at different levels (teaching, municipal, regional and district hospitals) of the health care system in Ghana participated in the study. Basic descriptive quantitative analysis was used based on frequency tables, pie chart and graphical illustration to interpret the data. Results: The participants have adequate knowledge on the impact of perinatal anxiety and depression on birth and maternal outcomes. However, the remains a huge deficit in their ability to use the validated and reliable assessment tools in recognizing clinical cues related to anxiety and depression among perinatal women. Surprisingly, over 50% of the midwives were unfamiliar with the commonly used assessment tools for depression and anxiety such as the EPDS and PHQ-9. Additionally, nearly 40% of the participants lack the requisite assessment skills for assessing perinatal anxiety and depression. Conclusion: Perinatal mental health should be made a critical component of perinatal care, with midwives being well situated to recognize the manifestations of deteriorating mental health among the perinatal women in their care and provide the needed support and required level of supervision. It is therefore imperative to train midwives on basic mental health assessment skills and encourage them to incorporate mental health care into the delivery of routine perinatal care and services.

Abstract TP99: Implementing Telestroke in the Inpatient Setting: Identifying Factors for Success

Background: Inpatient telestroke programs have emerged as a solution to provide timely stroke care in underserved areas, but their successful implementation and factors influencing their effectiveness remain underexplored. This study aimed to qualitatively evaluate the perspectives of inpatient clinicians located at the spoke hospital who were participating in a newly established inpatient telestroke program in order to identify implementation barriers and facilitators. Methods: This was a formative evaluation relying on semi-structured qualitative interviews with sixteen inpatient providers (physicians and nurse practitioners) that have utilized inpatient telestroke services. Interviews were conducted with providers at spoke sites of a hub-and-spoke inpatient telestroke program. The Integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework guided data analysis, focusing on the innovation, recipients, context, and facilitation aspects of implementation. Interviews were transcribed and coded using thematic analysis. Results: Fifteen themes were identified in the data and mapped to the i-PARIHS framework. Themes related to the innovation (telestroke program) included easy access to stroke specialists, the benefits of limiting patient transfers, concerns about duplicating tests, and challenges of timing inpatient telestroke visits and notes to align with discharge workflow. Themes pertaining to recipients (care team members and patients) were communication gaps between teams, concern about the supervision of advanced practice providers, and challenges with nurse empowerment. With regards to the context (hospital and system factors), providers highlighted familiarity with telehealth technologies as a facilitator to implementing inpatient telestroke, yet highlighted resource limitations in smaller facilities. Facilitation (program implementation) was recognized as crucial for education, standardization, and buy-in. Conclusion: This study identified barriers and facilitators in launching an inpatient telestroke program within a health system, highlighting the importance of leveraging facilitators and addressing barriers for effective implementation and continuity.

Proyecto Facil: Using the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) as a Diagnostic Tool to Improve Access to Human Immunodeficiency Virus Pre-Exposure Prophylaxis (PrEP) via Telemedicine.

Following the underutilization of pre-exposure prophylaxis (PrEP) among Latinx men who have sex with men (MSM) and transgender women in Southern California and the growing use of the delivery of PrEP through telemedicine, the California Department of Public Health implemented a telemedicine component to their already existing assistance program. We used the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to identify and characterize factors inhibiting the successful implementation of the telemedicine program through in-depth, online stakeholder interviews and online community focus groups with Latinx MSM and trans women in southern California. Obstacles reported by stakeholders were complicated enrollment process, preference for in-person care, more appealing private sector models of PrEP, while community members reported low awareness of the program, fear of complications due to immigration status, challenges to fulfill enrollment requirements. Findings can used for the future improvement of the ongoing program, as well as other similar PrEP telemedicine programs.

The health service perspective on determinants of success in allied health student research project collaborations: a qualitative study guided by the Consolidated Framework for Implementation Research

BackgroundA research culture in health care organisations is associated with improved healthcare performance. Allied health (AH) students undertake research training as part of their professional degree qualifications. This may include participation in research projects, sometimes undertaken in association with health services. Co-supervision of these projects by health service staff provides research capacity building opportunities and staff-centred outcomes for the individuals involved, as well as improvements in clinical knowledge and practice within the local area. Also, publications from these projects contribute to the wider evidence base. Identification of barriers and facilitators to engagement in, and conduct of, these projects may optimise systems for improved health service outcomes.MethodsThis formative evaluation used the Consolidated Framework for Implementation Research (CFIR) to guide analysis of qualitative data obtained from semi-structured interviews with health service-employed allied health professionals, including clinicians and research fellows, who had supervised students on clinical-related research placements within the previous five years.ResultsEleven AH clinicians described 18 collaborative projects with 24 students from five AH disciplines across four universities. Three health service-employed AH research fellows described their involvement in these and other student research projects. Twenty key determinant constructs were identified and mapped across all five CFIR domains. Facilitators included health service cosmopolitanism, project adaptability and implementation climate (compatibility). Health service-employed research fellows provided readiness for implementation and a facilitator for project execution. The main barriers identified were cost to staff in workload and personal time and aspects related to project complexity. Differing student characteristics affected the relative advantage of collaborative projects in positive and negative manners.ConclusionsThis study describes the facilitators and barriers to the conduct of collaborative AH student research projects. Addressing these determinants when establishing each new project may enable health services to optimise communication, role delineation and project success, and thus ultimately, healthcare performance and patient care.

Hospital Responsibilities Toward Patients In The Implementation Of Health Services

Law Number 36 of 2009 concerning Health provides legal protection for the right to health services. Everyone has the right to health, according to Article 4. To prevent medical errors in patient care, hospitals ensure that doctors and other health workers have legal protection. Patients also receive legal protection from hospital liability and from doctors and other health professionals. Every person has the right and legal right to obtain health services, and the public is free to utilize government and/or regional government health resources. The right to receive public health services, especially in government hospitals, needs to be implemented specifically to guarantee health financing for the poor, and emergency financing in hospitals due to disasters and extraordinary events. Therefore, legal protection of the right to obtain health services for the community is part of implementing the protection of human rights. The fulfillment of the right to adequate health services through hospital facilities is guaranteed and implemented by the government and/or regional governments. The hospital's responsibility for implementing patient rights, including the right to medical information, the right to consent to medical procedures, the right to choose a doctor, and the right to the contents of medical records, has not been implemented properly by the provisions and regulations of the laws and regulations applicable in the health sector

Public Services for Prisoners in Tondano Correctional Institution Class IIB

This research aimed to 1) To find out whether health services for Prisoners (Indonesian: Warga Binaan Pemasyarakatan or WBP) at Tondano Correctional Institution Class IIB have been met according to basic health care service standards; 2) To find out whether health services for Prisoners at Tondano Correctional Institution Class IIB have been met according to basic standards of infrastructure, and; 3) To find out whether health services for Prisoners at Tondano Correctional Institution Class IIB have been met according to basic human resource standards; The research method used is a qualitative research method with purposive sampling technique. The results of the research show that 1) Basic health care service standards in Tondano Correctional Institution Class IIB, which are described in 13 basic health care standard parameters, have in principle been attempted to be implemented, but the facts described show that not all of them meet the standards; 2) The basic standards of facilities and infrastructure to support the implementation of health services as previously described have not been met ideally in accordance with the supposed needs; 3) Fulfillment of basic human resource standards to support health services in Tondano Correctional Institution Class IIB cannot be achieved due to limited human resources.

The Prevalence of Human Papilloma Virus Infection and Its High Risk Genotypes among Healthy Women in 28 Provinces in Iran; A Systematic Review and Meta-Analysis

Introduction: Human Papilloma Virus infection (HPV) high-risk genotypes are responsible for up to 70% of invasive cervical cancers. It was aimed to determine the national and provincial prevalence of the total HPV and its high-risk genotypes including HPV genotype 16 (HPV16) and HPV genotype 18 (HPV18), and HPV genotypes other than genotypes of 16 and 18 (HPV other genotypes) among Iranian healthy women.&#x0D; Methods: Iran with 28 provinces locates at latitude and longitude of 32° 00' north and 53° 00' east. All Persian and English studies reporting HPV infection based on cervical specimens were selected through searching the PubMed, Magiran, Scopus, Irandoc databases, and Google Scholar research search engine. Sample size and event rates were used to compute the overall event rates and 95% confidence interval (95% C.I); Fixed or random effects model, heterogeneity indices including Q-statistics (p-value), and degree of heterogeneity (I2) were reported. The search was done up to February 29, 2022. Comprehensive Meta-analysis 2.2.064 and ArcGIS 10.8.2 software tools were used at a significance level of &lt;0.05.&#x0D; Results: The meta-analysis included nineteen studies with 258839 participants. The national meta-analysis resulted in a total HPV prevalence of 0.025 (95% C.I 0.016, 0.039); those of HPV16, HPV18, and HPV other genotypes were 0.032 (95% C.I 0.019, 0.051), 0.028 (95% C.I 0.019, 0.040), and 0.048 (95% C.I 0.033,&#x0D; 0.069), respectively. The provincial meta-analysis showed that the total HPV prevalence was highest in Zanjn and Kerman (0.323 and 0.240, respectively); that of HPV16 was highest in Boushehr and Khozestan (0.298 and 0.253, respectively); that of HPV18 was highest in Tehran (0.089) and that of HPV other genotypes was highest in Khozestan (0.542).&#x0D; Conclusion: The current results would help policymakers and health managers accentuate on further implementation of screening strategies and health services in needier areas such as Zanjan, Kerma, Khozestan, and Tehran.

Barriers to the implementation of sexual and reproductive health programs for adolescents in Eastern Visayas, Philippines: a thematic synthesis of national policies using a qualitative study.

To review the implementation of essential reproductive health services in Eastern Visayas, Philippines. We reviewed four national policies through a qualitative research design using a series of key informant interviews conducted with service providers and focus group discussions with service beneficiaries. There was a gap between the policies and the implementation of reproductive health services in the Eastern Visayas region. This gap is mainly due to the refusal of service providers to cater to teenagers' needs regarding reproductive health services. This has resulted in teenagers hesitating to seek reproductive health services and related support from primary healthcare facilities. Service beneficiaries have also reported on the unavailability of several reproductive health services in primary healthcare facilities. The gap between national policies and program implementation must be bridged. This can be achieved by creating culturally-specific policies that can improve the implementation of reproductive health programs in the study areas.

Implementing evidence-based practices in rural settings: a scoping review of theories, models, and frameworks.

Rural healthcare has unique characteristics that affect the dissemination and implementation of evidence-based interventions. Numerous theories, models, and frameworks have been developed to guide implementation of healthcare interventions, though not specific to rural healthcare. The present scoping review sought to identify the theories, models, and frameworks most frequently applied to rural health and propose an approach to rural health research that harnesses selected constructs from these theories, models, and frameworks. This resulting synthesis can serve as a guide to researchers, policy makers, and clinicians seeking to employ commonly used theories, models, and frameworks to rural health. We used the Scopus abstract indexing service to identify peer-reviewed literature citing one or more of theories, models, or frameworks used in dissemination and implementation research and including the word "rural" in the Title, Abstract, or Keywords. We screened the remaining titles and abstracts to ensure articles met additional inclusion criteria. We conducted a full review of the resulting 172 articles to ensure they identified one or more discrete theory, model, or framework applied to research or quality improvement projects. We extracted the theories, models, and frameworks and categorized these as process models, determinant frameworks, classic theories, or evaluation frameworks. We retained 61 articles of which 28 used RE-AIM, 11 used Community-Based Participatory Research (CBPR) framework, eight used the Consolidated Framework for Implementation Research (CFIR), and six used the integrated-Promoting Action on Research Implementation in Health Services (iPARIHS). Additional theories, models, and frameworks were cited in three or fewer reports in the literature. The 14 theories, models, and frameworks cited in the literature were categorized as seven process models, four determinant frameworks, one evaluation framework, and one classic theory. The RE-AIM framework was the most frequently cited framework in the rural health literature, followed by CBPR, CFIR, and iPARIHS. A notable advantage of RE-AIM in rural healthcare settings is the focus on reach as a specified outcome, given the challenges of engaging a geographically diffuse and often isolated population. We present a rationale for combining the strengths of these theories, models, and frameworks to guide a research agenda specific to rural healthcare research. https://osf.io/fn2cd/.

Conceptual framework on barriers and facilitators to implementing perinatal mental health care and treatment for women: the MATRIx evidence synthesis.

Perinatal mental health difficulties can occur during pregnancy or after birth and mental illness is a leading cause of maternal death. It is therefore important to identify the barriers and facilitators to implementing and accessing perinatal mental health care. Our research objective was to develop a conceptual framework of barriers and facilitators to perinatal mental health care (defined as identification, assessment, care and treatment) to inform perinatal mental health services. Two systematic reviews were conducted to synthesise the evidence on: Review 1 barriers and facilitators to implementing perinatal mental health care; and Review 2 barriers to women accessing perinatal mental health care. Results were used to develop a conceptual framework which was then refined through consultations with stakeholders. Pre-planned searches were conducted on MEDLINE, EMBASE, PsychInfo and CINAHL. Review 2 also included Scopus and the Cochrane Database of Systematic Reviews. In Review 1, studies were included if they examined barriers or facilitators to implementing perinatal mental health care. In Review 2, systematic reviews were included if they examined barriers and facilitators to women seeking help, accessing help and engaging in perinatal mental health care; and they used systematic search strategies. Only qualitative papers were identified from the searches. Results were analysed using thematic synthesis and themes were mapped on to a theoretically informed multi-level model then grouped to reflect different stages of the care pathway. Review 1 included 46 studies. Most were carried out in higher income countries and evaluated as good quality with low risk of bias. Review 2 included 32 systematic reviews. Most were carried out in higher income countries and evaluated as having low confidence in the results. Barriers and facilitators to perinatal mental health care were identified at seven levels: Individual (e.g. beliefs about mental illness); Health professional (e.g. confidence addressing perinatal mental illness); Interpersonal (e.g. relationship between women and health professionals); Organisational (e.g. continuity of carer); Commissioner (e.g. referral pathways); Political (e.g. women's economic status); and Societal (e.g. stigma). These factors impacted on perinatal mental health care at different stages of the care pathway. Results from reviews were synthesised to develop two MATRIx conceptual frameworks of the (1) barriers and (2) facilitators to perinatal mental health care. These provide pictorial representations of 66 barriers and 39 facilitators that intersect across the care pathway and at different levels. In Review 1 only 10% of abstracts were double screened and 10% of included papers methodologically appraised by two reviewers. The majority of reviews included in Review 2 were evaluated as having low (n = 14) or critically low (n = 5) confidence in their results. Both reviews only included papers published in academic journals and written in English. The MATRIx frameworks highlight the complex interplay of individual and system level factors across different stages of the care pathway that influence women accessing perinatal mental health care and effective implementation of perinatal mental health services. These include using the conceptual frameworks to inform comprehensive, strategic and evidence-based approaches to perinatal mental health care; ensuring care is easy to access and flexible; providing culturally sensitive care; adequate funding of services; and quality training for health professionals with protected time to do it. Further research is needed to examine access to perinatal mental health care for specific groups, such as fathers, immigrants or those in lower income countries. This trial is registered as PROSPERO: (R1) CRD42019142854; (R2) CRD42020193107. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR 128068) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 2. See the NIHR Funding and Awards website for further award information.