Implementation Of Interventions Research Articles

Operationalizing implementation science frameworks to plan a hybrid effectiveness-implementation study of a digital health intervention.

Background Evaluating implementation of digital health interventions (DHIs) in practice settings is complex, involving diverse users and multistep processes. Proactive planning can ensure desired implementation determinants and outcomes are captured for hybrid studies, but operational guidance for DHI studies is limited. Methods We planned a cluster randomized, type II hybrid effectiveness-implementation trial testing PositiveLinks, a smartphone application for HIV care, compared to usual care (n = 6 sites per arm), among HIV outpatient sites in the DC Cohort Longitudinal HIV Study in Washington, DC. Our process included: 1) Defining components of the DHI and associated implementation strategy, 2) Selecting implementation science frameworks to accomplish evaluation aims, 3) Mapping framework dimensions, domains, and constructs to implementation strategy steps, 4) Modifying/creating instruments to collect data for implementation outcome measures and determinants and 5) Developing a compatible implementation science data collection and management plan. Results Specification of components of the DHI and implementation strategy identified relevant platform usage data and necessary implementer actions, toward planning measurement of program reach and adoption. A priori mapping of implementation strategy steps to the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework identified how data would be collected for each step/corresponding outcome measure. The multi-site cohort study provided infrastructure for prospective, scaled implementation research, including site research assistants (RAs) coordinating implementation. Existing cohort tools (periodic site assessments, patient consent logs) were adapted for the evaluation to further capture representativeness and reach/adoption 'denominators.' New survey instruments allowed for framework-guided evaluation of provider adaptations/dose/fidelity to planned implementation across a large number of participants and multiple timepoints. Some aspects of real-world implementation were challenging to mirror within the planned hybrid trial (e.g. RAs selected as de facto site implementation leads) or were modified to preserve internal validity of effectiveness measurement (e.g. PositiveLinks 'community of practice'). Conclusions Challenges and opportunities arose in planning the implementation evaluation for PositiveLinks within a hybrid trial in a cohort population. Prospective hybrid trial planning must balance generalizability of implementation processes to 'real world' conditions, with rigorous trial procedures to measure intervention effectiveness. Rapid, scalable tools require further study to enable evaluations within large, multi-site hybrid studies. Trial registration : ClinicalTrials.gov NCT04998019, August 10, 2021.https://classic.clinicaltrials.gov/ct2/show/NCT04998019.

Physical Activity Measurement in People with Spinal Cord Injury: A Comparative Review of Different Questionnaires.

Physical activity (PA) provides great health benefits for people with spinal cord injury (SCI). Consequently, the design and implementation of PA interventions addressed to this population is needed. To rigorously evaluate these interventions, the use of valid and comprehensive PA measures is crucial. Since the suitability of PA assessment tools might differ among different populations, and considering that questionnaires are one of the most frequently used tools to quantify PA, the purpose of this comparative review was to examine nine questionnaires that have been used to assess PA in people with SCI. All the questionnaires were analyzed in depth in regard to three main dimensions: (1) SCI-specific development; (2) PA domains measured and PA intensity classification; and (3) reliability and validity. After careful consideration of the evidence available on all these aspects, it is suggested that the most suitable questionnaires to be used in PA research in the SCI population are the PARA-SCI and the LTPAQ-SCI[R]. To conclude, the strengths and limitations of these two questionnaires are discussed, and specific recommendations to SCI researchers and practitioners regarding the suitability, according to the context and characteristics, of the research/intervention are provided.

The Role of Virtual Reality to Promote Mobilization in the Critical Care Setting: A Narrative Review.

Virtual reality (VR) is an emerging technology that can be used as an early complementary intervention to promote early mobilization for critically ill patients. This narrative review examines early mobilization outcomes of VR intervention for patients in the ICU and PCCU. Comprehensive medical databases were searched for publications detailing the application of VR interventions in association with critical care. In total, seven studies were screened and selected for the review. Various VR programs help promote early mobilization by using movement-based programs and virtual environments to encourage increased activity and heightened diversity of movements. Furthermore, VR can enhance engagement and enjoyment for therapies and rehabilitation. The emergence of VR modalities shows increased mobility, motivation, and treatment satisfaction among critically ill patients. However, the limited data available, vulnerability of the patient population, safety concerns, and need for more controlled studies emphasize the importance of continued research and cautious implementation of VR interventions in critical care settings.

A framework for counterfactual analysis, strategy evaluation, and control of epidemics using reproduction number estimates.

During pandemics, countries, regions, and communities develop various epidemic models to evaluate spread and guide mitigation policies. However, model uncertainties caused by complex transmission behaviors, contact-tracing networks, time-varying parameters, human factors, and limited data present significant challenges to model-based approaches. To address these issues, we propose a novel framework that centers around reproduction number estimates to perform counterfactual analysis, strategy evaluation, and feedback control of epidemics. The framework 1) introduces a mechanism to quantify the impact of the testing-for-isolation intervention strategy on the basic reproduction number. Building on this mechanism, the framework 2) proposes a method to reverse engineer the effective reproduction number under different strengths of the intervention strategy. In addition, based on the method that quantifies the impact of the testing-for-isolation strategy on the basic reproduction number, the framework 3) proposes a closed-loop control algorithm that uses the effective reproduction number both as feedback to indicate the severity of the spread and as the control goal to guide adjustments in the intensity of the intervention. We illustrate the framework, along with its three core methods, by addressing three key questions and validating its effectiveness using data collected during the COVID-19 pandemic at the University of Illinois Urbana-Champaign (UIUC) and Purdue University: 1) How severe would an outbreak have been without the implemented intervention strategies? 2) What impact would varying the intervention strength have had on an outbreak? 3) How can we adjust the intervention intensity based on the current state of an outbreak?

A Cost of Illness Analysis of Children with Encephalitis Presenting to a Major Hospital in Vietnam.

Encephalitis is a significant global health problem, especially in children. Knowledge of its economic burden is essential for policymakers in prioritizing the development and implementation of interventions but remains limited. An observational study was prospectively conducted at a major children's hospital in Ho Chi Minh City, Vietnam from 2020 to 2022. Data on direct medical costs, direct nonmedical costs, and productivity costs were collected alongside demographic information, clinical features, diagnosis, severity, and outcomes of study participants. This was used to undertake a cost of illness analysis from a societal perspective. Data were collected from a total of 164 pediatric patients. The median cost of illness was estimated at US $1,859 (interquartile range [IQR]: US $1,273-$3,128). The direct costs were the main cost driver, accounting for 83.9% of the total cost of illness (US $1,560; IQR: US $975-$2,460). The productivity costs accounted for a median of US $275 (IQR: US $154-$474). The cost of illness was higher in more severe patients, patients with sequelae, patients with morbidities, and ventilated patients. Most direct medical costs were attributed to hospitalization and resulted in out-of-pocket payments from the patient's family (30.2%; US $316). The results showed that the cost of illness of encephalitis in children is considerable and will be useful for policymakers in prioritizing resources for the development and implementation of intervention strategies to reduce the burden of pediatric encephalitis.

Leveraging female partner influence in health interventions: a study on prostate cancer screening uptake among men in rural Kiambu County, Kenya

Background: Globally, prostate cancer is the second most common cancer affecting men, with considerably high fatality rates. The aim of this study was to assess the effect of a female partner-led brochure method on perception, attitude, and cultural beliefs toward the intention of prostate cancer screening among men in rural Kiambu County, Kenya. Methods: The research adopted a randomized controlled trial design. Multistage sampling was employed in this study. The Chi-square test was used to assess differences in perception, attitude, and cultural beliefs towards intention to undergo prostate cancer screening (PCS) between the control and intervention groups at baseline and end line. Further, data were subjected to structural equation modeling to assess the influence of perception, attitude, and cultural beliefs on PCS intention pre-and post-intervention. Results: The results revealed no significant difference in perception between the control and intervention groups at baseline and end-line. Regarding attitude, there was a 39.8% and 24.7% increase in positive attitudes in the group that used gain-framed and loss-framed brochure methods, respectively, at the end line. In the end, there was a significant reduction in the number of respondents who had fatalistic beliefs, whereby 23.1% and 13.2% of the respondents in the groups’ intervention used gain-framed and loss-framed brochures, respectively. Conclusions: The study recommends the implementation of female partner-led interventions using gain-framed messaging in prostate cancer screening campaigns, as this approach demonstrated superior effectiveness in improving attitudes, reducing fatalism beliefs, and increasing the perceived benefits of screening among men.

Refugees Labor Market Integration in Kenya

We analyze labor market outcomes among refugees in Kenya during the COVID-19 pandemic. The analyses are based on eight waves of the COVID-19 Rapid Response Phone Surveys dataset. We employ static panel regression, and test for robustness of the results in a staggered difference-in-difference regression. Findings suggest that employment rate, hours worked, and labor income differed across the waves. Employment rate rose in the last four waves relative to the first four waves of the pandemic. Average hours worked declined relative to the level at the onset of the pandemic. Whereas gender insignificantly affected employment rate, females worked fewer hours compared to males. The higher the educational attainment, the likelier the refugee was employed. College graduates earned higher incomes compared to refugees without formal education. Males and females had similar labor market outcomes for the same level of education. In terms of coping actions, adopters were less likely to be employed in waves 5-8, worked fewer hours, and had lower labor incomes compared to non-adopters. In line with the findings, we recommend, among other things, the implementation of job interventions that target refugees, and proper targeting of social protection and education programs to incentivize work, and raise refugees’ human capital.

Toward a gender transformative change perspective for smallholder agricultural commercialization: building consensus among experts

While smallholder agricultural commercialization has been posited as a catalyst to bring about broad economic benefits, evidence demonstrates that commercialization efforts that are gender blind can exacerbate inequalities. This study employed a consensus-building process for gender and agricultural development experts to formulate a perspective for informing the design and implementation of gender transformative smallholder agricultural commercialization interventions. A three-round Delphi process was used to systematically achieve agreement among 23 experts who address gender issues and implement gender transformative approaches (GTAs) in smallholder agricultural systems. Over the three rounds, the experts systematically generated and prioritized 58 intended changes and conceptual considerations for design and implementation into a final set of 23 statements that were categorized as: GTA design and implementation fundamentals, potential target changes in smallholder agriculture, and standard gender integration measures. Unlike many Delphi studies, we also highlight expert statements that did not achieve consensus in both rounds as well as the qualitative divergence. Key themes based on the agreed upon findings include involving diverse actors in co-development of GTAs, applying an intersectional lens, tackling root causes of power relations in the value chain, addressing constraining norms, increasing women’s access to and control of resources, and strengthening agency and solidarity.

Sleep & Nutrition for Athletes

Abstract Sleep is vital for the maintenance of physical and mental health, recovery and performance in athletes. Sleep also has a restorative effect on the immune system and the endocrine system. Sleep must be of adequate duration, timing, and quality to promote recovery following training and competition. Inadequate sleep adversely impacts carbohydrate metabolism, appetite, energy intake and protein synthesis affecting recovery from the energy demands of daily living and training/competition related fatigue. Sleep’s role in overall health and wellbeing has been established. Athletes have high sleep needs and are particularly vulnerable to sleep difficulties due to high training and competition demands, as such the implementation of the potential nutritional interventions to improve sleep duration and quality is commonplace. The use of certain nutrition strategies and supplements has an evidence base i.e. carbohydrate, caffeine, creatine, kiwifruit, magnesium, meal make-up and timing, protein and tart cherry. However, further research involving both foods and supplements is necessary to clarify the interactions between nutrition and the circadian system as there is potential to improve sleep and recovery. Additional research is necessary to clarify guidelines and develop products and protocols for foods and supplements to benefit athlete health, performance and/or recovery. The purpose of this review is to highlight the potential interaction between sleep and nutrition for athletes, and how these interactions might benefit sleep and/or recovery.

Improving measures of context in process evaluations: development and use of the Context Tracker tool

BackgroundProcess evaluations are increasingly integrated into randomised controlled trials (RCTs) of complex interventions to document their delivery and interactions with local systems and dynamics, helping understand observed health outcomes. Yet process evaluations often struggle to assess relevant contextual determinants, leaving much of the important role of “context” in shaping an intervention’s mechanisms opaque in many studies. A lack of easily adapted data collection methods to help define and operationalise indicators of context likely contributes to this.MethodsWe present a method to help structure measures of context in process evaluations and describe its use in two very different settings. The “Context Tracker” is an innovative tool for use within trials and quasi-experiments to more systematically capture and understand key dimensions of context. It was developed in Zimbabwe as part of a cluster randomised controlled trial and then adapted for a quasi-experimental evaluation in the UK. Both studies provided harm reduction and health services for marginalised and hard-to-reach populations.ResultsWe developed the Context Tracker to be both standardised (i.e. formatted and applied in the same way across study sites) and flexible enough to allow unique features to be explored in greater detail. Drawing on the Context and Implementation of Complex Interventions (CICI) and Risk Environments frameworks, we mapped 5 domains across micro, meso and macro levels in a simple table and used existing evidence and experience to predict factors likely to affect delivery of and participation in intervention components. We tracked these over time across study sites using routine programme statistics, observation and qualitative methods. The Context Tracker enables identification and comparison of facilitators and barriers to implementation, variations in engagement with interventions, and how mechanisms of action are (or are not) triggered in different settings.ConclusionsThe Context Tracker is one example of how evidence-based contextual determinants can be used to guide data collection and analysis within process evaluations. It is relevant in low- and high-income settings and applicable to both qualitative and quantitative analyses. While perhaps most useful to process evaluations of complex interventions targeting marginalised communities, the broader approach would benefit a more general research audience.

Human health risk assessment of heavy metals in beer brands from Tanzania market

Heavy metal contamination in the environment, often resulting from industrial activities, mining, and improper waste disposal, leads to the accumulation of heavy metals in soil, water, air, drinks and food. Prolonged exposure to these metals can cause serious health issues in humans, including neurological damage, kidney failure, respiratory problems, and an increased risk of cancer. High levels of heavy metals in food are hazardous to human health. Heavy metals can find their way into beer at different stages, including through raw materials, the brewing process, equipment, bottling, and storage. This study examined the presence of Cu, Cd, Pb, Cr, Fe, and Zn in ten of the most consumed beer brands in Tanzania using an atomic absorption spectrometer (AAS). The results showed that the concentration of heavy metals in the beer samples increased in the order of Zn < Cu < Fe < Cr. Cd and Pb were not detected in any beer samples. Compared to WHO guidelines, the levels of Zn and Cu were below the limit, while Fe and Cr exceeded it. Estimated daily intake (CDI), hazard quotient (HQ), hazard index (HI), and incremental lifetime cancer risk (ILCR) were used to evaluate the potential human health risks. The EDI values of Fe and Zn were lower than the provisional maximum tolerable daily intake (PMTDI) set by the FAO/WHO. However, the mean EDI for Cr surpassed the recommended value, posing a potential risk for moderate and high beer consumers. The HQ and HI values for Zn and Fe were below 1, signifying no non-carcinogenic health concerns. In contrast, Cr had HQ and HI values greater than 1, indicating a notable non-carcinogenic health risk through beers consumption. ILCR due to Cr ranged from 0.029 to 0.695. These ILCR values for Cr in all beer samples are above range of 10−6−10−4 recommended by USEPA, suggesting a potential carcinogenic risk linked to this toxic metal and, consequently, a possible cancer risk for beer consumers. Therefore, beer manufacturers should continuously work to minimize public health risks. Additionally, further research involving a larger variety of beer brands and the implementation of policy interventions is needed.

Making Military Interventions Obsolete: Crafting r2p’s Peaceful Future through Principled Negotiation Strategies

Abstract There is a growing literature about the international community’s ‘Responsibility to Protect’ (r2p) vulnerable populations against mass atrocities, but more is needed to demonstrate the potential of principled negotiation strategies to improve the quality of r2p outcomes. Proponents of the r2p principle base their arguments on the primacy of protecting human life against mass atrocities. Opponents claim national state sovereignty and non-intervention norms must be upheld. This norm contestation often leads to a situation where r2p is either not implemented or military interventions are conducted as a last resort. From an ethical and human rights perspective, both extremes are suboptimal to prevent and reduce human suffering. This article argues that to avoid both extremes, more effective negotiation strategies are needed. An analytical framework is offered that can guide policymakers in their quest to protect human life with peaceful and humanitarian means focusing on prevention under already existing r2p mechanisms.

Exploring New Links Among Keratoconus, Hormonal Factors, and Medications: Insights From a Case-Control Study Utilizing the All of Us Database.

We aimed to identify clinical factors associated with keratoconus (KC) risk in the All of Us database. This retrospective matched case-control study utilized patient data from the All of Us Research Program. All patients with a KC diagnosis (n = 572) were enrolled in the study and matched with three controls (n = 1716) based on age ± 1 year, race, ethnicity, and sex. The patients' medical histories, including diabetes, sleep apnea, obesity, smoking, ocular surface disease (encompassing dry eye, eczema, and allergic or atopic conjunctivitis), allergic rhinitis, pregnancy, estrogen-containing medications, tetracyclines, and vitamin C supplementation, were collected using electronic health records. Multivariable odds ratios (ORs) between KC and health history were calculated using the R programming language. The study included 2288 participants with an average age of 58.7 years. All included variables showed a significant positive correlation with KC except smoking history, which showed a negative correlation. The most significant correlations were ocular surface disease (OR = 6.04) and obesity (OR = 1.82). Significant positive associations were also identified for tetracyclines and estrogen-containing medications with KC. Smoking was negatively correlated. In addition to previously known risk factors, patients with a history of increased estrogen exposure and tetracycline usage were more likely to have a KC diagnosis whereas those with a smoking history were less likely. Understanding the risk factors for KC, including estrogen exposure and tetracycline medications, enhances our ability to identify at-risk patients and implement earlier screening, diagnosis, and interventions.

Reducing stigma and improving access to care for people with mental health conditions in the community: protocol for a multi-site feasibility intervention study (Indigo-Local)

BackgroundStigma and discrimination towards people with mental health conditions by their communities are common worldwide. This can result in a range of negative outcomes for affected persons, including poor access to health care. However, evidence is still patchy from low- and middle-income countries (LMICs) on affordable, community-based interventions to reduce mental health-related stigma and to improve access to mental health care.MethodsThis study aims to conduct a feasibility (proof-of-principle) pilot study that involves developing, implementing and evaluating a community-based, multi-component, awareness-raising intervention (titled Indigo-Local), designed to reduce stigma and discrimination and to increase referrals of people with mental health conditions for assessment and treatment. It is being piloted in seven sites in five LMICs—China, Ethiopia, India, Nepal and Tunisia—and includes several key components: a stakeholder group workshop; a stepped training programme (using a ‘Training of Trainers’ approach) of community health workers (or similar cadres of workers) and service users that includes repeated supervision and booster sessions; community engagement activities; and a media campaign. Social contact and service user involvement are instrumental to all components. The intervention is being evaluated through a mixed-methods pre-post study design that involves quantitative assessment of stigma outcomes measuring knowledge, attitudes and (discriminatory) behaviour; quantitative evaluation of mental health service utilization rates (optional, where feasible in sites); qualitative exploration of the potential effectiveness and impact of the Indigo-Local intervention; a process evaluation; implementation evaluation; and an evaluation of implementation costs.DiscussionThe output of this study will be a contextually adapted, evidence-based intervention to reduce mental health-related stigma in local communities in five LMICs to achieve improved access to healthcare. We will have replicable models of how to involve people with lived experience as an integral part of the intervention and will produce knowledge of how intervention content and implementation strategies vary across settings. The intervention and its delivery will be refined to be feasible and ready for larger-scale implementation and evaluation. This study thereby has the potential to make an important contribution to the evidence base on what works to reduce mental health-related stigma and discrimination and improve access to health care.

Development of inattention and executive dysfunction in youth with spina bifida: condition severity variables as predictors

ABSTRACT Youth with spina bifida (SB) are at increased risk for inattention and executive dysfunction challenges. This study aimed to characterize the development of inattention and executive dysfunction in SB and examine the relationship between condition severity (i.e. lesion level, shunt status, and shunt revisions) and inattention and executive dysfunction at age 11.5 and longitudinally. Participants included 140 youth with SB. Condition severity was collected via parent reports and chart review. Parents and teachers reported on youth’s inattention and executive dysfunction using informant-based measures across five time points. Parents and teachers both reported linear decreases in inhibition and working memory problems. Development of inattention and shifting problems varied by reporter. At 11.5 years, shunt status predicted worse parent- and teacher-reported inattention and executive dysfunction, while shunt revisions predicted worse parent-reported working memory alone. Higher lesion level predicted fewer parent-reported inhibition problems at 11.5 years. Over time, more shunt revisions and higher lesion level predicted worse parent-reported inattention and inhibition, respectively. Findings suggest that inattention and executive dysfunction may significantly change over time in youth with SB, related to condition severity and reporter. Early deficit identification and intervention implementation, particularly for youth with greater SB severity, may result in better longitudinal outcomes.

Workplace-based prevention and management of knee pain: a systematic review.

Knee pain is highly prevalent and disabling among the general and working population. This systematic review explored the effectiveness of workplace-based interventions on knee pain among workers. A PICO-guided systematic search was performed in PubMed and Web of Science Core Collection for articles published from 2003 until January 2023. Eligible articles included randomized and non-randomized controlled trials assessing the effect of workplace-based interventions on knee pain among currently employed adult workers. The quality assessment and evidence synthesis adhered to the systematic review approach, which the Institute for Work & Health developed, and was focused on developing practical recommendations for stakeholders. Of the 13 identified studies, 11 medium- and high-quality studies were entered into the evidence synthesis. Importantly, none of the included studies specifically aimed at reducing of knee pain. Still, among the included studies, a strong level of evidence suggested no benefit of workplace-based physical exercise/activity intervention on knee pain. The level of evidence was deemed too uncertain to guide current policy/practices for ergonomic and multifaceted interventions. No intervention types were associated with negative effects on knee pain. The current evidence-base pertaining to workplace-based prevention and management of knee pain is insufficient to guide effective preventive workplace practice or policy development. Considering the global prevalence and health impact of knee pain, development and implementation of effective workplace interventions aimed at prevention and management of knee pain is needed.

Implementation of a Technology-Based Writing Intervention to Support Writing Quality

ABSTRACT This study investigated teacher implementation of a technology-based writing intervention package with embedded Universal Design for Learning features. Three teachers at a private school in the Eastern United States provided instruction to 65 elementary and secondary students. Changes in both writing quantity and quality from pretest to posttest with the intervention and from pretest to delayed posttest without the intervention are reported. The study extends previous research by also examining the changes in student performance among the disaggregated writing quality elements at different testing times. The results show that all students demonstrated statistically significant improvements in the number of transition words and holistic writing quality that were maintained even when the technology-based writing intervention was removed. While both elementary and secondary students demonstrated improved quality of writing, elementary students also increased how much they wrote. Improved elements of persuasive writing quality included Identify the Opinion, Determine Reasons, and Explain Why or Say More. The areas that could be further improved included Summarize and Word Selection. Student outcomes in this study demonstrate the versatility of the technology-based writing intervention. Authors discuss how looking at targeted elements of a writing quality measure has implications for instructional practice.

Investigating Adoption Determinants, Obstacles, and Interventions for AI Implementation in Emirati Media Organizations

This research explores the integration and impact of artificial intelligence (AI) within Emirati media organizations, focusing on adoption determinants, obstacles, and interventions. Utilizing a mixed-methods approach, the study incorporates qualitative data from 21 in-depth interviews with media professionals and a thematic analysis of 30 scholarly articles published between 2019 and 2024. The research aims to provide a nuanced understanding of AI's transformative effects on the UAE media landscape. Key findings reveal that AI is significantly enhancing content creation, distribution, and audience engagement processes within Emirati media organizations. AI technologies such as machine learning, natural language processing, and predictive analytics are being leveraged to improve operational efficiency, streamline workflows, and deliver personalized content to audiences. These advancements are driving competitive advantages and elevating the overall quality of media output. Despite these benefits, several challenges hinder widespread AI adoption. Technological barriers, including limited access to advanced AI tools and infrastructure, pose significant obstacles. Additionally, there is a pronounced shortage of skilled personnel capable of implementing and managing AI systems, which exacerbates concerns over job displacement and workforce anxiety. Ethical considerations, such as ensuring unbiased AI algorithms and protecting user privacy, are also critical issues that require attention. The study underscores the importance of continuous training and upskilling for media professionals to adapt to the evolving technological landscape. It highlights the role of robust ethical guidelines and governance frameworks in promoting responsible AI use. Government support, through targeted policies, funding initiatives, and incentives, is identified as a crucial factor in facilitating AI integration and addressing adoption barriers. The research concludes by providing strategic recommendations for media organizations and policymakers. It advocates for the development of comprehensive AI adoption roadmaps that include capacity-building initiatives, ethical oversight, and collaborative efforts between industry stakeholders. By addressing these areas, Emirati media organizations can harness the full potential of AI to drive innovation, improve audience engagement, and maintain competitiveness in a rapidly digitizing global media environment. This study contributes to the growing body of knowledge on AI in media, offering valuable insights into the specific context of the UAE. It provides a foundation for future research on AI's role in media and serves as a guide for organizations seeking to navigate the complexities of AI adoption.

Examining the Drivers of Sectarianism and their Impact on Rural Infrastructure: Implications for Rural Women's Plight

The study titled "Examining the Drivers of Sectarianism and their Impact on Rural Infrastructure: Implications for Rural Women's Plight" revealed that during sectarian clashes women's educational institutions, and hospitals were either damaged or fully destroyed. Further, women skills oriented centres and NGOs were forced to close their operations in Kurram. Likely, storage facilities for agriculture production and agro-based markets were also closed in the area. With reference to infrastructure development initiatives, women's voices are less acknowledged which in turn reduces women's participation in affairs pertaining to their socio-economic development. The study recommended devising holistic strategies while taking into consideration women's distress along with recurrence and insurgency through questioning the conventional gender role divisions and implementation of sustainable development interventions in conflicted areas that should be prioritized for women's empowerment and gender equality.

Developing an implementation intervention, and identifying strategies for integrating health innovations in routine practice: A case study of the implementation of an insulin patient decision aid.

Implementation, which is defined as the process of getting evidence-based innovation to be utilised is critical in ensuring innovation is being integrated into real-world practice. The way an implementation intervention (i.e., a bundle of strategies to facilitate implementation) is developed has an impact on the types of strategies chosen, and whether they are relevant to the implementation setting to exert their effects. However, literature pertaining to development of intervention or detailed descriptions of implementation processes are scarce. This study aims to report the development of an implementation intervention to integrate the use of an evidence-based innovation in routine practice, using a Malaysian insulin patient decision aid (PDA) as an exemplar. The development of the insulin PDA implementation intervention was divided into two phases, incorporating step 3 and 4 of the Action Cycle in the Knowledge to Action framework. In Phase 1, barriers to the insulin PDA implementation was explored through qualitative interviews using an interview guide developed based on the Theoretical Domains Framework. In Phase 2, prioritisation of the barriers was conducted using the multivoting technique. Next, potential strategies that can address the barriers were identified based on understanding the clinic context, and evidence from literature. Then, the selected strategies were operationalised by providing full descriptions in terms of its actor, action, action target, temporality, dose, implementation outcome affected, before they were embedded into the patient care pathway in the clinic. The implementation intervention was finalised through a clinic stakeholders meeting. In Phase 1, a total of 15 focus group discussions and 37 in-depth individual interviews were conducted with: healthcare policymakers (n = 11), doctors (n = 22), diabetes educators (n = 8), staff nurses (n = 6), pharmacists (n = 6), and patients (n = 31). A total of 26 barriers and 11 facilitators emerged and they were categorised into HCP, patient, organisational, and innovation factors. The multivoting exercise resulted in the prioritisation of 13 barriers, and subsequently, a total of 11 strategies were identified to address those barriers. The strategies were mandate change, training workshop, involve patients' family members or caretakers, framing/reframing, inform healthcare providers on the advantages of the insulin PDA use, define roles and responsibilities, place the insulin PDA in the consultation room, provide feedback, systematic documentation, to engage patients in treatment discussions, and juxtapose PDA in preferred language with patient's PDA in their preferred language to help with translation. This study highlights main barriers to PDA implementation, and strategies that can be adopted for implementation. The steps for intervention development in this study can be compared with other intervention development methods to advance the field of implementation of evidence-based innovations.