Implementation Of Interventions Research Articles

How Can Implementation Science Advance Behavioral Interventions in Preschool? A Scoping Review and Recommendations.

Behavioral interventions delivered in preschools can help young children who need support for their behavior. However, preschool teachers face barriers to implementing behavioral interventions, leading to a research-to-practice gap. To better understand how to support preschool teachers, we conducted a scoping review of determinants (i.e., barriers and facilitators) and strategies used to support the implementation of behavioral interventions in preschool settings. A systematic search identified peer-reviewed manuscripts describing the implementation of teacher-delivered behavioral interventions in preschools. Each included manuscript was evaluated to answer the following questions: (1) what determinants to teacher implementation of behavioral interventions have been explored and (2) what strategies have been identified as promising in addressing determinants (i.e., implementation strategies)? Twenty-two manuscripts met inclusion criteria. Data extraction and synthesis were used to summarize key findings. Results indicate that few studies have explored determinants of implementation, and while these determinants span numerous implementation domains, there was little consensus on common determinants. In contrast, all the included studies deployed an implementation strategy, and there were two clear foci of the strategies: training and quality monitoring. Implications and recommendations are discussed for both the preschool context and the implementation science field.

Evaluating the Impact of an Educational Intervention Using Project-Based Learning on Postpandemic Recovery in Rural Colombia

This study evaluates the impact of a Project-Based Learning (PBL) intervention on postpandemic educational recovery in rural Colombia, focusing on student competencies in mathematics, language, science, and 21st-century skills. Conducted in rural schools, the intervention aimed to address significant learning gaps exacerbated by the COVID-19 pandemic by providing teacher training and direct student support. A pretest–posttest single-group design was used to assess the effectiveness of the intervention, with standardized tests measuring academic competencies and an analytical rubric evaluating 21st-century skills. The results indicate significant improvements in math, language, and science test scores, with notable gains in problem-solving, collaborative work, communication, and critical thinking. However, a decline in creativity scores highlights the need for a stronger emphasis on fostering creativity within the PBL framework. Gender differences were observed, with female students generally outperforming males, suggesting the need for tailored instructional approaches. This study’s limitations, including the absence of a control group, nonrandom sampling, and the use of subjective assessment methods, are acknowledged, with recommendations for future research to address these issues. Despite these limitations, the findings underscore the potential of PBL to enhance student learning outcomes in rural settings, offering valuable insights for educators and policymakers aiming to support educational recovery and development in similar contexts. Further research is recommended to explore the long-term effects of PBL and to refine the intervention for broader implementation.

Interventions to reduce burnout in emergency medicine: a national inventory of the Canadian experience to support global implementation of wellness initiatives.

Burnout in healthcare workers is a global issue, with Emergency Medicine (EM) particularly impacted. Many countries have tried implementing wellness initiatives to reduce burnout and improve wellness. This paper summarizes interventions implemented in Canada to-date with the aim of supporting the design of wellness interventions in EDs globally. A systematic review and a grey literature search were completed in November 2023. Original studies in both English and French that included the implementation and evaluation of a wellness intervention in EDs in Canada were included. The study design, content of the intervention, target population, and outcomes were extracted and narratively analyzed. 13 studies were included. Each implemented a unique wellness intervention for EDs. All three studies (3/3, 100%) that included a structured wellness curriculum demonstrated significant improvement in burnout as measured by the Maslach Burnout Inventory, physical health (PCS-8), and Brief Resident Wellness Profile (BRWP). Other interventions included Ice Cream Rounds, therapy dogs, changing the duration of night shifts, and sessions on resilience and self-care. Our Canada-wide analysis of wellness interventions identified initiatives geared towards trainees, staff, or entire ED workface groups. Examples include educational programs, dedicated sessions for compassion literacy and resilience, critical events debriefing, and optimizing shift schedules. Structured wellness curriculums seem to be effective, and this area warrants further study. Moreover, we identify a need for global collaboration to build wellness programs and for more easily translatable standardized outcome measures for assessing the efficacy of wellness programs in EM.

The Role and Effectiveness of School Social Workers in Addressing Bullying in China

The Chinese government has been working hard since 2006 to professionalize and legitimize social work, especially in schools. The occurrence of school bullying and the insufficient reaction from educational institutions and guardians are factors that lead to the inefficient implementation of social work interventions. Comparing with the United States, Chinese social workers face a number of difficulties, such as poor pay, little prospects for professional advancement, and social undervaluation.Through a detailed analysis of intervention strategies and outcomes, the article highlights the contributions of social workers in creating safer school environments. It also identifies the barriers hindering their effectiveness and offers recommendations for enhancing their roles within schools. Future research is suggested to focus on gathering first-hand data from diverse geographical regions across China, with an emphasis on longitudinal and comparative studies to better understand the impact of social work in varying educational and cultural contexts.

Pharmacist-led interventions at hospital discharge: a scoping review of studies demonstrating reduced readmission rates.

Substantial numbers of hospital readmissions occur due to medication-related problems. Pharmacists can implement different interventions at hospital discharge that aim to reduce those readmissions. It is unclear which pharmacist-led interventions at hospital discharge are the most promising in reducing readmissions. This scoping review aimed to summarise pharmacist-led interventions conducted at hospital discharge that demonstrated a reduction in readmissions. We searched the MEDLINE, EMBASE and CINAHL databases up to February 2024. We included studies that focused on pharmacist-led interventions at hospital discharge and reported significant readmission reductions. Two reviewers independently screened titles, abstracts and full texts. Data extracted included study characteristics, populations and the type of implemented pharmacist-led interventions along with the reduction in readmission rates achieved. We included 25 articles for data synthesis. Many of the studies included either implemented at least two interventions concurrently or were part of broader programmes involving other healthcare professionals. The most common pharmacist-led interventions associated with reduced readmission rates included medication reconciliation, counselling and post-discharge follow-up by telephone. Follow-up primarily aimed to improve patients' treatment adherence through education about their medications. Furthermore, many studies reported on multi-component interventions that began at hospital admission or during inpatient stays, not only at discharge. Successfully reducing readmissions through pharmacist-led interventions at hospital discharge suggests the effectiveness of a holistic approach incorporating multiple interventions. While these findings offer insights for pharmacists, further research should focus on conducting high-quality studies using a multifaceted approach to identify the most appropriate timing and combination.

Transitioning to university in Botswana

Academic and social deficits, a nine-month secondary school-to-university learning loss, a readiness gap for university-level coursework, and limited cultural capital characterize the transition to university for Botswana’s secondary school completers seeking a STEM qualification. This study investigated internationally implemented developmental education interventions that STEM-offering public universities in Botswana may proactively implement to ease the transition and improve matriculant’s chances of success from their first year at university. Findings indicate that a Developmental Winter Bridge Program presents the best option for secondary school completers’ acclimatization, assimilation, and university success. Policy recognition of the Bridge Program as a pre-entry requirement for STEM undergraduate programs is recommended as the first step towards increasing confidence in the preparation of future-ready engineers and scientists.

Effect of School HPV Vaccination Requirements on Pediatricians’ Recommendations

Background/objectives: Pediatrician recommendations are highly influential in parents’ decisions to vaccinate their children against HPV. Unqualified, presumptive, and bundled recommendations (UPBRs) are associated with increased HPV vaccine uptake and are considered best practice. This study analyzes pediatricians’ self-reported data to assess changes in UPBR use and the psychosocial determinants of UPBR use as a result of the implementation of a multi-level intervention, the Adolescent Vaccination Program (AVP). Methods: We surveyed pediatricians across 51 clinics in the Houston area. Baseline surveys (n = 137) were distributed in 2015, and follow-ups (n = 120) in 2019. Results: Pediatrician UPBR use significantly increased as a result of AVP implementation. Change in the provider belief that it is necessary to tell parents that HPV vaccination is not required for public school attendance significantly predicted UPBR use at follow up. This belief was also a significant mediator of increased use of UPBRs at follow-up. Conclusions: AVP was successful in increasing pediatricians’ use of UPBRs. Change in UPBR use is related to one critical psychosocial determinant: beliefs about communication regarding the non-mandatory nature of HPV vaccination for school enrollment. HPV vaccine promotion efforts should devote focus to changing pediatricians’ beliefs about the necessity of disclosing the non-mandatory nature of HPV vaccination for school attendance.

Development and implementation of a firearm safety intervention by medical and physician assistant students in an adult primary care setting

Firearm ownership is associated with an increased risk of adverse health outcomes, including violence, suicide, and accidental firearm injury. Numerous medical governing bodies have placed emphasis on firearm screening and counseling within the healthcare setting. However, few physicians discuss firearm ownership and safety with patients, likely due to limited physician familiarity with firearms or perceived risk to the doctor-patient relationship, among other barriers. Clinical trainees have the capability to confidentially screen for unsafe firearm practices and potentially prevent fatal injury. In this study, we provide one of the first reports of a universal firearm screening and safety intervention developed and implemented by medical and physician assistant students in an adult primary care clinic as part of a longitudinal clerkship experience. Students learned the basics of firearm ownership and storage, developed interview skills for sensitive topics, developed a screening tool for safe firearm storage, and gained a better understanding of firearm safety in the community. Through partnership with the Chicago Police Department, students offered firearm cable locks to all patients who screened positive for unsafe firearm storage practices. Overall, this study aimed to assess the feasibility of a universal firearm safety screening tool and intervention in a primary care clinic. We conclude that such a tool is feasible in a student-led primary care clinic, provides unique educational opportunities for students, and can be adopted in numerous healthcare teaching settings. Future steps may include evaluating other ways to promote firearm safety, such as screening for intimate partner violence and/or concomitant mental illness.

Prospective Teachers’ Self-Regulation: The History of Mathematics as a Tool for Perseverance

The present study investigated the effect of improving prospective teachers’ self-regulation to teach mathematics at primary education through the mathematical courses they attended at a pedagogical department. Forty-eight students of a pedagogical department participated in the conducted quantitative study. The implemented intervention program, which consisted of two math content courses and a teaching methodology course on mathematics, emphasized the acquaintance of unsolved mathematical problems, the historical development of mathematical concepts, the obstacles faced during the development of concepts through the centuries, and the process of mathematical continuity and development. The use of the history of mathematics aimed to enhance participants’ self-regulatory abilities about the learning and teaching of mathematics. We had used data from tools administered four times over a period of the four years of their studies: at the beginning of their studies, after two math content courses, after a course about the teaching of mathematics, and after the field work at a school. The analysis of those data showed that there was an improvement in their mathematical performance and their self-regulation ability to solve problems, but there was a decrease in their self-efficacy beliefs to teach mathematics and to self-regulate their respective teaching behavior. We discuss the effectiveness of the program on the specific dimension and the implications of the design of teacher education programs grounded in the history of mathematics, with the aim to enhance prospective teachers’ self-regulation on handling difficult situation during the teaching of mathematics.

Essential Coaching for Every Mother Tanzania (ECEM-TZ): Protocol for a Type 1 Hybrid Effectiveness-Implementation Randomized Controlled Trial.

Despite global goals to improve maternal, newborn, and child health outcomes, mortality and morbidity continue to be a concern, particularly during the postnatal period in low- and middle-income countries. While mothers have the responsibility of providing ongoing care for newborns at home, they often receive insufficient newborn care education in Tanzania. Mobile health via text messaging is an ever-growing approach that may address this gap and provide timely education. We aim to evaluate a text message intervention called Essential Coaching for Every Mother Tanzania (ECEM-TZ) to improve maternal access to essential newborn care education during the immediate 6-week postnatal period. ECEM-TZ consists of standardized text messages from birth to 6 weeks post partum that provide evidence-based information on caring for their newborn and recognizing danger signs. Messages were developed and then reviewed by Tanzanian mothers and nurse midwives before implementation. A hybrid type 1 randomized controlled trial will compare ECEM-TZ to standard care among mothers (n=124) recruited from 2 hospitals in Dar es Salaam. The effectiveness outcomes include newborn care knowledge, maternal self-efficacy, breastfeeding self-efficacy, maternal mental health, attendance at the 6-week postnatal checkup, and newborn morbidity and mortality. The implementation outcomes include the reach and quality of implementation of the ECEM-TZ intervention. Recruitment for this study occurred between June 13, 2024, and July 22, 2024. A total of 143 participants were recruited, 71 in the control and 72 in the intervention. The 6-week follow-up data collection began on July 30, 2024, and was completed on September 21, 2024. This study will generate evidence about the effectiveness of implementing text messaging during the early postnatal period and the feasibility of doing so in 2 hospitals in Dar es Salaam. The intervention has been designed in collaboration with mothers and nurse midwives in Tanzania. ClinicalTrials.gov NCT05362305; https://clinicaltrials.gov/study/NCT05362305. DERR1-10.2196/63454.

Jail-based interventions to reduce risk for opioid-related overdose deaths: Examples of implementation within Ohio counties participating in the HEALing Communities Study

BackgroundOpioid-related overdose is a leading cause of death for criminal legal-involved individuals and, although naloxone distribution and medications for opioid use disorder (MOUD) are effective means for reducing post-release overdose death risk, jail-based availability is limited. This case report describes the challenges faced by three Ohio communities as they implemented evidence-based practices (EBPs) in jails to combat post-release opioid overdose deaths.MethodWe present case examples of how barriers were overcome to implement jail-based EBPs in three Ohio communities (two urban and one rural) as part of the HEALing Communities Study (UM1DA049417; ClinicalTrials.gov Identifier: NCT04111939). Of the 18 participating Ohio HEALing Communities Study counties, we highlight 3 communities for the novelty of their EBPs implemented, the challenges that they faced, and their rural/urban status. We present descriptive data regarding the EBPs that they implemented and discuss the challenges identified by HEALing Communities Study staff with first-hand experience facilitating their implementation.ResultsNewly implemented interventions included overdose education and direct provision of naloxone to incarcerated individuals upon release (2 of 3 communities), initiating MOUD prior to release (3 of 3), linkage to ongoing MOUD treatment in the community (2 of 3), peer support-facilitated treatment retention efforts (2 of 3) and emergency housing (1 of 3) in the immediate post-incarceration period. Common challenges that emerged included skepticism about the need and feasibility of implementing EBPs to reduce overdose and death, lack of knowledge about the options available and whether external agencies may assist, and difficulty engaging stakeholders to overcome inertia.ConclusionsCreative flexibility, calm persistence, technical facilitation, and collaboration with community service providers were assets that helped these Ohio jails implement evidence-based strategies that combat the opioid epidemic and reduce the likelihood of post-incarceration overdose and death in a high risk, formerly incarcerated population.

Study protocol for a randomized controlled trial to adapt a posttraumatic stress disorder intervention of patients with opioid-stimulant polysubstance use receiving methadone maintenance treatment

BackgroundThe purpose of the Treatment for Harnessing Resiliency, Improving emotional regulation, and empowering indiViduals for a brighter future (THRIVE) study is to adapt an evidence-based posttraumatic stress disorder (PTSD) treatment for use among a polysubstance population receiving methadone maintenance treatment (MMT) at an opioid treatment program. Polysubstance use of high-risk combinations, such as illicit opioids and stimulants, is a critical public health issue. Individuals who engage in these high-risk combinations are more likely to have histories of childhood trauma, multiple traumas, PTSD, and greater PTSD severity as compared to mono-substance using individuals. Trauma, co-morbid mental health disorders such as PTSD, and polysubstance use complicate treatment outcomes. This study will use eight study phases to adapt an existing evidence-based PTSD intervention, Skills Training in Affective and Interpersonal Regulation with Narrative Therapy (STAIR-NT), via a massed treatment model (i.e., condensed treatment schedule) for patients in MMT who are engaged in sustained opioid-stimulant polysubstance use.Methods and analysisThe intervention is an adapted version of the STAIR-NT protocol. The massed version created includes four 60-min sessions of skill building and two weeks of four 60-min sessions of narrative therapy. A preliminary randomized controlled trial (RCT) with 80 participants, randomized 1:1, will be conducted to assess the intervention's implementation and impact on primary short-term outcomes of polysubstance use and PTSD symptoms.Ethics and disseminationThe results of this study will inform a fully-powered effectiveness trial for individuals with PTSD and polysubstance use receiving MMT. The findings are expected to provide valuable insights into improving both PTSD and substance use outcomes, and real-world implementation insights to integrating trauma-informed care in treatment settings for vulnerable populations.RegistrationThis study is registered at ClinicalTrials.Gov as NCT06307340. Registration date 03/2024.

DEVELOPING A PRACTICE-DRIVEN TAXONOMY OF IMPLEMENTATION STRATEGIES FOR HIV PREVENTION.

Effective implementation of evidence-based HIV prevention interventions continues to be a challenge in the United States, and the field is increasingly turning to implementation science for solutions. As such, it is critical to expand the current implementation science vocabulary - and its taxonomy of implementation strategies - to increase its relevance and utility for front-line implementers. Community-based health centers providing HIV prevention services in the Southeastern US. We conducted a collective case-study analysis, combining document review and qualitative interviews with program directors, clinicians, and other providers (N = 30) at five sites. We employed an inductive and iterative analytic approach to specify and categorize strategies, and then conducted in-depth cross-case analysis to derive a practice-driven taxonomy of HIV prevention implementation strategies. From an initial matrix of 264 activities, we identified 50 strategies common across sites. In contrast to existing implementation science frameworks, the majority (68%, n = 34) of strategies were designed to impact implementation outcomes (e.g., acceptability, adoption, feasibility) for patients. We present a practice-driven taxonomy of these strategies, operationalized according to implementation science literature, but with terminology that more directly relates to implementers. Findings demonstrate the feasibility and utility of this method for developing a practice-driven implementation science vocabulary for HIV prevention. Our evidence-based taxonomy provides a framework for implementers seeking data about the universe of strategies they might consider for their own programs, and increases researchers' ability to measure and evaluate the effectiveness of implementation strategies being enacted in practice settings.

A quantitative survey on exposures, knowledge, attitudes, and practices (KAP) related to swine influenza among villagers in different regions of Thailand

This analytical cross-sectional study aimed to determine factors influencing knowledge, attitudes, and practices (KAP) toward the swine influenza virus (SIV) among pig farm owners, workers, and villagers in selected provinces of Thailand. This study was carried out from February to December 2022 in pig farms and villages across the provinces. A structured and standardized quantitative questionnaire was utilized to collect data on socio-demographic variables and KAP related to SIV from 215 participants. The quantitative data was analyzed in two steps using R software. The study findings showed that the average knowledge score on SIV was 6.92 out of 12, indicating moderate understanding of SIV in study participants. Attitudes towards SIV were generally positive, with an average score of 3.74 out of 5. Practices for SIV prevention averaged a score of 3.63 out of 5. Key factors associated with better SIV knowledge included higher education levels, higher monthly income, and direct involvement in vaccination processes. Moreover, those with higher education, employment on pig farms, and prior vaccination experience showed more positive attitudes towards SIV. Occupations related to pig farming and the availability of vaccination services significantly influenced SIV prevention practices. The findings highlighted that improved education and stronger connections with healthcare professionals and the pig farming sector may significantly enhance KAP regarding SIV among targeted populations. In contrast, participants with limited exposure to health services or pig farming activities, such as nearby villagers, require specialized educational interventions. This study recommends that local health authorities should develop and implement communication strategies and interventions focused on educating pig farm owners, managers, and villagers about SIV to mitigate the risks associated with SIV and other zoonotic diseases.

Signal detection and analysis of adverse events associated with Genvoya® based the FAERS database

ObjectiveThis study aims to evaluate and understand the safety profile of Genvoya® by mining and analyzing adverse drug event (ADE, adverse drug event) reports from the FDA Adverse Event Reporting System (FAERS, FDA Adverse Event Reporting System) database, thus providing valuable reference information for individuals infected with HIV.MethodsData were obtained from the FAERS database, covering the period from the first quarter of 2015 to the fourth quarter of 2023, focusing on reports where Genvoya® was the primary suspected drug. Data import and extraction were conducted using MySQL 8.0, with adverse events standardized according to the Medical Dictionary for Regulatory Activities (MedDRA, Medical Dictionary for Regulatory Activities) 27.0 terminology. Potential adverse event signals were identified through disproportionality analysis, including the reporting odds ratio (ROR, reporting odds ratio) method and the comprehensive standard by the Medicines and Healthcare products Regulatory Agency (MHRA, Medicines and Healthcare products Regulatory Agency) method. Statistical analyses and graphical representations were performed.ResultsA total of 2, 376 adverse drug event reports related to Genvoya® were analyzed. Reports from male patients accounted for 74.33%, while those from female patients accounted for 22.39%. Common adverse events included weight gain, drug interactions, and increased viral load. Additionally, new potential adverse reactions, such as fat redistribution, HIV-associated neurocognitive disorders, and meningoencephalitis, were identified. These reactions were not adequately described in the existing literature and drug labels.ConclusionMultiple adverse reactions were observed with the use of Genvoya®. Clinicians should closely monitor these reactions and implement necessary preventive and intervention measures based on patient-specific conditions and treatment guidelines. Although this study has limitations, the analysis of FAERS database data has revealed various potential risks associated with Genvoya®, providing important safety references for HIV treatment.

Family resilience and social support as mediators of caregiver burden and capacity in stroke caregivers: a cross-sectional study

IntroductionCaring for stroke survivors poses significant challenges to survivors and caregivers; understanding these relationships can inform targeted interventions and support systems.AimThis study investigates the influencing factors of caregiver burden and the potential mediating roles of family resilience and perceived social support between caregiver burden and caregiver capacity.DesignThis is a cross-sectional study.MethodsThe participants in this study included 462 stroke survivors and their primary caregivers from Ningbo Lihuili Hospital in Zhejiang Province, China. Primary caregivers completed several assessments, including the Shortened Chinese Version of the Family Resilience Assessment Scale (FRAS), the Perceived Social Support Scale (PSSS), the Zarit Caregiver Burden Interview (ZCBI), and the Family Caregiver Task Inventory (FCTI). The ZCBI was used to evaluate caregiver burden, while the activities of daily living (ADL) were assessed for stroke survivors to measure their actual level of dependence. The mediating effect of family resilience was estimated using the bootstrap method through Jamovi version 2.3.0 with the mediation plug-in, while controlling for sociodemographic variables.ResultsThe results showed that caregiver burden was influenced by stroke survivors’ level of dependence on activities of daily living (ADL), caregiver education level, caregiver health status, and average daily care time. The family resilience mediated the relationship between caregiver burden and caregiver capacity (b = 0.141; 95% confidence interval: 0.091 to 0.176). Additionally, perceived social support mediated the relationship between caregiver burden and caregiver capacity (b = 0.080; 95% confidence interval: 0.041 to 0.110).ConclusionThese findings indicate that enhancing family resilience and perceived social support can be strategies for alleviating caregiver burden. Clinical practitioners should actively assess the family resilience and social support of stroke survivors, and implement interventions that promote resilience and strengthen social support, thereby reducing caregiver burden and improving the health outcomes of stroke survivors.

Leveraging group model building to operationalize implementation strategies across implementation phases: an exemplar related to child maltreatment intervention selection

BackgroundImplementation strategies can help support the adoption and implementation of health interventions that are appropriate for a local context and acceptable to decision makers and community members. Implementation strategies should be designed to handle the complexity of the multi-level, dynamic contexts in which interventions are implemented. Systems science theories and methods explicitly attend to complexity and can be valuable for specifying implementation strategies. Group Model Building (GMB) combines research partner engagement strategies with systems science to support researchers’ and partners’ learning about complex problems and to identify solutions through consensus. This paper specifies how GMB can operationalize implementation strategies — methods for supporting evidence implementation in real-world practice — and describes how GMB can aid in selecting and tailoring both health interventions and implementation strategies. A case study in child maltreatment prevention planning is provided to illustrate how GMB was used to specify the “actions” — strategy activities — for three implementation strategies (conduct local consensus discussions; build a coalition; model and simulate change) during the earliest implementation phases, with the goal of supporting intervention selection decisions. Examples are provided of generalizable research products that can be produced concurrently through GMB, in addition to contextually-driven implementation support.MethodsParticipants (n = 8) were engaged over four sessions using tailored GMB activities. Participants generated a qualitative system dynamics model that described their theory of change for how to prevent child maltreatment in their communities. This theory of change reflected a dynamic understanding of the interconnected determinants of child maltreatment.ResultsGMB was acceptable to participants and resulted in products that could be used for implementation planning (e.g., to model and simulate change) and future research. GMB fostered trust and idea sharing between participants.ConclusionGMB can facilitate learning about which outcomes are (or are not) impacted by interventions, which resources and approaches are required for quality implementation (e.g., implementation strategies), and tradeoffs in outcomes and resources between interventions. GMB also provides a structured, effective process to generate a shared implementation vision amongst participants. Lessons learned include methods for developing trust with and between participants, and the need for researchers to tailor GMB actions for participant and project needs.

General Practitioners' Experiences With Implementing Colon or Prostate Cancer Survivorship Care in Primary Care: A Cross-Sectional Survey Nested Within Two Randomized-Controlled Trials.

To evaluate general practitioners' (GPs) experiences with providing cancer survivorship care and explore readiness for implementation. This cross-sectional survey study was nested within two randomized-controlled trials conducted in the Netherlands between 2015 and 2023, comparing GP- with specialist-led survivorship care for patients with colon or prostate cancer. An adapted version of the normalisation measure development (NoMAD) survey was distributed among participating GPs. NoMAD assesses the implementation of complex interventions and includes seven items on experiences (score ranges, 0-10) and 19 core items (expressed as % agreement). Higher scores indicate greater normalization, that is, embedding in primary care. In total, 214 GPs participated (response rate, 69%). The overall experience with providing survivorship care was 7.0 ± 1.6 for prostate cancer and 6.4 ± 1.8 for colon cancer. Lowest scores were seen for willingness to provide care (5.9 ± 2.4 and 5.0 ± 2.5, respectively), expected future involvement (6.6 ± 2.0 and 5.6 ± 2.5), and appropriateness of involvement (6.4 ± 2.1 and 5.6 ± 2.7). GPs in both trials agreed (±75%) there was potential value for patients, but not for their own work (±50%). Survivorship care for colon cancer was often perceived as different from usual care (74%). GPs' self-reported knowledge of care was high in the prostate cancer trial (62%), but not in the colon cancer trial (41%). GPs from both trials agreed that they could easily integrate management of physical and psychosocial effects into their work (±70%), but integrating routine check-ups was rated less positively (±55%). Financial compensation was deemed necessary (±80% agreed). Twenty-one percent was willing to provide care for other cancer types. GPs recognize value of providing survivorship care for patients, but experiences differ on the basis of cancer type. Implementation of prostate versus colon cancer survivorship care appears more feasible.

Opportunities for Telemedicine to Improve Parents' Well-Being During the Neonatal Care Journey: Scoping Review.

Neonatal intensive care unit admissions of newborns are emotional and stressful for parents, influencing their mental and physical well-being and resulting in high rates of psychological morbidities. Significant research has been undertaken to understand and quantify the burden of a newborn's medical journey on parents' well-being. Simultaneously, an increase has been observed in the development and implementation of telemedicine interventions, defined as the remote delivery of health care. Telemedicine is used as an overarching term for different technological interventions grouped as real-time audio-visual communication, remote patient monitoring, and asynchronous communication. Various telemedicine interventions have been proposed and developed but scarcely with the primary goal of improving parental well-being during their newborn's medical journey. This study aims to identify telemedicine interventions with the potential to improve parents' well-being and to present the methods used to measure their experience. A scoping review was conducted, including empirical studies evaluating telemedicine in neonatal care that either measured parental well-being or included parents in the evaluation. Abstract and title screening, full-text screening, and data extraction were performed by three researchers. Two researchers were needed to reach decisions on both the inclusion and extraction of articles. The review included 50 out of 737 screened articles. Telemedicine interventions focused mainly on daily visits at the neonatal intensive care unit and discharge preparedness for parents. Surveys were the primary tool used for outcome measurement (36/50, 72%). Aspects of parents' well-being were evaluated in 62% (31/50) of studies. Telemedicine interventions developed to provide education and support showed a potential to improve self-efficacy and discharge preparedness and decrease anxiety and stress when they included a real-time telemedicine component. This scoping review identified specific telemedicine interventions, such as real-time audio-visual communication and eHealth apps, that have the potential to improve parental well-being by enhancing self-efficacy and discharge preparedness, and reducing anxiety and stress. However, more insights are needed to understand how these interventions affect well-being. Parents should be included in future research in both the development and evaluation stages. It is important to not only measure parents' perceptions but also focus on the impact of a telemedicine intervention on their well-being.

Innovative strategies and implementation science approaches for health delivery among migrants in humanitarian settings: A scoping review.

Over 100 million displaced people rely on health services in humanitarian contexts, defined as unstable or transitory settings created in response to complex emergencies. While services are often described, there is a dearth of evidence on best practices for successful implementation to guide efforts to optimize health delivery. Implementation science is a promising but underutilized tool to address this gap. This scoping review evaluates implementation science in health services for forced migrants in humanitarian settings. We conducted a scoping review according to JBI methodologies. A search of eight databases yielded 7,795 articles, after removal of duplicates, that were screened using PRISMA-ScR guidelines. Data extraction assessed study descriptors, implementation objects, barriers, facilitators, implementation strategies, and use of implementation frameworks in service delivery. Data from 116 studies represented 37 countries and 11 topic areas. Methods were mainly cross-sectional with low-medium evidence rigor. Mental health programs (25%) and vaccination services (16%) were the most common objects of implementation. Thirty-eight unique barriers were identified including resource limitations (30%), health worker shortages (24%), and security risks (24%). Among 29 facilitators, the most common were health worker availability (25%), pre-existing partnerships (25%), and positive perceptions towards the intervention (20%). More than 90% of studies collectively identified 35 implementation strategies, the most common being capacity building (44%), stakeholder engagement (35%), information dissemination (38%), and feedback mechanisms (25%). Only 10 studies used formal implementation models, with RE-AIM (n = 3) and Intervention mapping (n = 2) being most frequent. In this scoping review, we found similar barriers, facilitators, and implementation strategies across diverse humanitarian migrant settings and services. However, the use of rigorous methods and formal implementation models was rare. Frameworks included RE-AIM, CFIR, and Precede-Proceed. Increased use of implementation science frameworks and methods will help humanitarians more rigorously and systematically evaluate and develop best practices for implementation of health services for migrants in humanitarian settings.