Implementation Program Research Articles

COVID-19 vaccine uptake and associated factors among individuals living in a peri-urban area in Uganda: A cross-sectional study.

The Corona virus disease (COVID-19) is a respiratory illness that is caused by SARS-CoV-2 virus. This virus was first reported in China in December 2019. It then spread to all countries and from March 11, 2020, the World Health Organization declared the COVID-19 outbreak a pandemic. In Uganda, the disease was first reported in March 2020 and COVID-19 vaccines became available by January 2021. Although COVID-19 vaccines were available in Uganda, uptake remained low. The aim of this study was to establish COVID-19 vaccine uptake awareness in a peri-urban setting in Entebbe City, Uganda. This was a cross-sectional study conducted among 127 men and 263 women who reside in Entebbe City, Uganda. Data was collected on socio-behavioral characteristics, knowledge, attitude, and practice (KAP) about COVID-19 vaccine using interviewer administered questionnaires. Uptake of COVID-19 vaccine was defined as the proportion of participants who had received at least one dose of the COVID-19 vaccine. We used descriptive statistics to estimate awareness of COVID-19 vaccines. The 'chi-square test' and 'modified Poisson regression' were used to assess variations in uptake of COVID-19 vaccines among respondents and their socio-demographics as well as other characteristics. Ninety-nine percent (388 out of 390) of the study population were aware of at least one brand of COVID-19 vaccines in the country. Thirty-five percent (138 out of 390) knew that the vaccine immunity was achieved 14 days after the 2nd dose and 98.7% (385 out of 390) admitted that observing the standard operating procedure for COVID-19 infection prevention was necessary after vaccination. There was a gap in knowledge on vaccine safety reported by 74.6% (291 out of 390) participants. Some participants 37.2% (145 out of 390) had concerns about the vaccine. Of these, 57.9% (84 out of 145) believed that the vaccines were not helpful; and 30.3% (44 out of 145) feared serious side effects. Sixty-six percent (257 out of 390) believed that vaccines were not working and 79.0% (308 out of 390) admitted that vaccines were promoted for financial gain. At the time of performing the study, 36.2% and 22.3% had received the 1st and 2nd dose respectively. The main sources of information on COVID-19 vaccine were television (TV) and social media (p-value 0.001). In a multivariate model, COVID-19 vaccine acceptability was associated with salaried and self-employment (p-value 0.046). The other predicative factors were awareness of the COVID-19 vaccine (p-value <0.001) and having vaccine concerns (p-value 0.013). Uptake of COVID-19 vaccination in Entebbe community was low, partly attributed to knowledge gaps and concerns about vaccine safety and effectiveness. This highlights the need to enhance dissemination of information about COVID-19 vaccine. The lessons learnt in this study would be relevant for other emerging infections by informing vaccination implementation programs in similar settings.

How can HIV self-testing facilitate increased access to HIV testing among multiply marginalised populations? Perspectives from GBMSM and trans women in England and Wales

Background HIV self-testing (HIVST) may facilitate marginalised populations’ uptake of HIV testing, but whether the extent of marginalisation challenges individual uptake of HIVST remains under-researched. We aim to explore the perspectives of multiply marginalised cis-gender gay, bisexual and other men who have sex with men (GBMSM) and trans women on whether HIVST might increase their uptake of HIV testing. Methods We reanalysed qualitative interview data from SELPHI (the UK’s largest HIVST randomised trial) collected between 2017 and 2020 from marginalised populations, defined as people self-identifying as non-heterosexual, transgender, non-White ethnicity and/or with low educational attainment. Thirty-eight interviews with multiply marginalised individuals were thematically examined using the framework method. We specifically focussed on kit usability (a function of the interaction between blood-based HIVST kits and users), perspectives on how HIVST can improve access to HIV testing and suggestions on need-based scale-up of HIVST. Results HIVST kits were considered usable and acceptable by multiply marginalised GBMSM and trans women. The majority of interviewees highlighted multi-levelled barriers to accessing HIV testing services due to structural and social marginalisation. Their multiply marginalised identities did not impede HIVST uptake but often form motivation to self-test. Three potential roles of HIVST in the HIV testing landscape were identified: (1) alternation of HIVST and facility-based testing, (2) integration of HIVST into sexual health services and (3) substituting facility-based testing with HIVST in the future. Perceived beneficiaries of HIVST included trans communities, individuals with undisclosed sexuality and people with physical disabilities. Discussion HIVST can facilitate marginalised populations’ access and uptake of HIV testing by alternating with, integrating into and substituting for facility-based services in the UK. Marginalised identities did not present challenges but rather opportunities for person-centred scale-up of HIVST. Future implementation programmes should ensure equitable access to HIVST among trans people, men unable to disclose their sexuality, and perhaps people with physical disabilities.

Breaking Down the Barriers: Rethinking Government's Role in Indonesian Tourism Destination Development

Stakeholder involvement is essential to destination development. They may serve as catalysts or impediments to the growth of tourist sites. This study explores the barriers to tourism destination development associated with the role of local tourism authorities. A qualitative approach, employing semi-structured interviews, was utilized to examine the root causes of these challenges. Sixteen stakeholders, including ten government officials responsible for regional tourism development and six community leaders, were selected as informants in this study. Thematic analysis was used to analyze the interview data. The investigation revealed four main barriers to destination development from government agencies. There are bureaucratic hurdles, contrived program activities, overlapping roles of local governments, and the community’s misconceptions about the government’s role in destination development. These factors collectively hinder the successful implementation of government-led tourism programs. The study suggests that understanding and addressing these barriers are vital to fostering a progressive, sustainable, competitive tourist destination. On a practical level, the findings can help policymakers redesign their strategies to create more community-centric programs, clearly define roles, and manage community expectations. Conceptually, this study expands the existing literature on the role of government and bureaucracy in developing tourist destinations. The study highlights the importance of a participatory approach that engages all stakeholders in the planning and implementation tourism policies and programs.

Preferences for oral and injectable PrEP among qualitative sub-study participants in HPTN 084.

HPTN 084 compared the safety and efficacy of long-acting injectable cabotegravir (CAB) to daily oral TDF/FTC for prevention of HIV-1 in uninfected African women. Like a similar trial in MSM/TGW (HPTN 083), the trial was stopped early for efficacy, expediting the need to consider introduction strategies for different populations. We examine survey and qualitative data from a four-country sub-study to examine oral and injectable PrEP acceptability and considerations for CAB access among African women. Participants completed baseline and follow-up surveys on HIV risk perception, sexual behavior. product acceptability and adherence during the blinded trial. Additionally, up to two in-depth interviews each with 73 sub-study participants explored product use and trial-related experiences, during the blinded and unblinded study periods. Using survey data, we classified participants as: engaged in female sex work (FSW), having multiple non-transactional partners, or monogamous. A study statistician identified participants' assigned study arm. We followed a thematic analysis process to read transcripts, develop a codebook and apply codes in NVivo to transcripts with intermittent intercoder reliability checks; using Excel matrices to explore differences across risk categories and study arms. Participants overwhelmingly preferred injections to pills, appreciating the ease, convenience, and privacy of a long-acting formulation. Many participants described challenges with contraceptive and/or study pill adherence, impeded by late night work, unexpected travel, or heavy drinking. Women in the TDF/FTC arm were more likely to describe side effects, compared to those in the CAB arm. Pain also varied widely by study arm. When considering post-trial access to CAB, limited PrEP knowledge, cost and concerns around stigma and poor service quality were potential access barriers. Women's desire for privacy and ease of use outweighed injectable concerns, resulting in a strong preference for CAB. Cost and accessibility will need to be addressed by implementation programs.

Learning by Doing: The Potential for Experiential Education in Health Promotion

Background: Rural populations face significant health disparities (e.g., high rates of chronic diseases) and unique accessibility barriers (e.g., limited healthcare facilities). Training higher education students to serve as facilitators for chronic disease prevention programs may address rural health promotion needs. Purpose: The purpose of this pilot, exploratory study was to create an experiential learning opportunity for students and examine their experiences. Methodology/Approach: Project leaders completed a Diabetes Prevention Program Lifestyle Coach training and, based on their experiences, created training program goals, content, and schedule. Undergraduate students in health-related programs or courses were recruited to participate. Four students completed a 4-week experiential training program and, at the end of the program, participated in an individual qualitative interview for researchers to understand their experiences. Findings/Conclusions: Data were analyzed through a qualitative-descriptive approach. The main theme, experiential learning, branched into two subthemes: (a) professional development and (b) program implementation and future program directions. Students’ experiential learning influenced their personal and programmatic views of prevention training. Implications: The benefits of experiential learning in prevention will enhance students’ education and future employment experiences. Future studies should improve upon training delivery and examine the acceptability of this method of delivery in the rural population.

Development of a 6-degrees-of-freedom measurement system using a robotic total station for a free-running model test

The measurement of a model ship's six degrees of freedom (6-DOF) using sensors such as Marvelmind beacons and robotic total stations (RTS) has previously demonstrated substantial error margins. To address these limitations, this study introduces a refined approach for accurate and reliable 6-DOF measurement through free-running model tests (FRMT). The tests were meticulously designed, with three RTS strategically positioned to meet the specific requirements of the measurement scenario. Given the potential constraints in an FRMT environment, we proposed feasible installation ranges for the RTS and prisms, ensuring the stable measurement of the model ship's 6-DOF. To achieve high-precision motion measurement, even in complex environments, we employed the prism queue algorithm, which identifies and processes overlapping or untracked prisms monitored by the RTS. The proposed methodology was validated through simulations and FRMT conducted in the ocean engineering basin of the Korea Research Institute of Ships and Ocean Engineering and by developing an actual implementation program. Comparative analysis using high-precision navigation equipment, such as fiber optic gyros, demonstrated that the method provided unbiased and stable data. Consequently, the proposed method shows significant promise as a viable alternative for precision navigation in real-world applications.

Development and Pilot Testing of Evidence-Based Interventions to Improve Adherence after Receiving a Genetic Result.

Previous research indicates that population genomic screening can benefit individuals who act on the genetic results. However, there remains a significant gap between individuals receiving genetic information and acting on current risk management recommendations, prompting exploration of interventions to close this gap. This study aimed to determine the feasibility and acceptability, and conduct a pilot implementation, of existing evidence-based interventions (EBIs) for adherence to disease management for select genetic conditions among individuals ascertained through a population genomic screening program. Surveys of and interviews with individuals who received a genomic screening result were conducted to assess barriers to guideline-recommended care and assess the acceptability of problem solving (PS) and motivational interviewing (MI) EBIs to facilitate adherence to recommendations. A Design Thinking Workshop was conducted with clinicians to co-develop a MI- and PS-based intervention that would fit with current workflows to be piloted. Post-pilot engagement sessions with implementers determined acceptability and feasibility of the MI/PS pilot program for clinical implementation and elicited proposed adaptations for improvement. PS and MI EBIs were reported to be acceptable and feasible to individuals with a result, and barriers to performing recommended management were identified. The pilot program included outreach by genetic counselors to individuals with a result, review of a checklist of barriers, and delivery of PS or MI as appropriate to facilitate care. The protocol as piloted was deemed acceptable and feasible for clinicians to deliver, with adaptations suggested. These results will inform an effectiveness trial to address gaps in adherence in patients who have received actionable genomic results.

Inclusive innovation processes in Tanzania: From national policies to local practices in innovation hubs

Inclusive innovations have the potential to foster socio-economic development and actively involve local communities in innovation processes in sub-Saharan Africa. The importance of inclusive innovations is emphasized in the public strategies and development programmes in the region. Nevertheless, despite some donor-funded initiatives, there remains a lack of systematic knowledge on how to effectively implement inclusive innovation in communities. This research aims to scrutinize the role of inclusive innovation in Tanzania. We conduct policy analyses of the country's official innovation strategies and investigate the inclusive innovation activities undertaken by 12 innovation hubs. These hubs facilitate interactions among diverse actors, provide necessary facilities and technologies, and offer mentorship and peer support. Our results reveal that the definition and significance of inclusive innovation are presented within the national policies. However, implementation programmes are currently modest and scattered. With a few exceptions, innovation hubs have inadequate understanding and limited resources for implementing inclusive innovations in practice. This research contributes by underscoring the need for comprehensive strategies, capacity-building initiatives, and collaborative efforts to fully leverage inclusive innovation for sustainable development in the region.

Promoting sustained access to cognitive behavioral therapy for insomnia in Australia: a system-level implementation program.

Insomnia is a highly prevalent and debilitating disorder. Cognitive behavioral therapy for insomnia (CBTi) is the recommended 'fist line' treatment, but is accessed by a minority of people with insomnia. This paper describes a system-level implementation program to improve access to CBTi in Australia to inform CBTi implementation in other locations. From 2019 to 2023, we conducted a program of work to promote sustained change in access to CBTi in Australia. Three distinct phases included 1) Scoping and mapping barriers to CBTi access, 2) Analysis and synthesis of barriers and facilitators to devise change goals, and 3) Structured promotion and coordination of change. We used a system-level approach, knowledge brokerage, and co-design, and drew on qualitative, quantitative, and implementation science methods. We identified barriers to CBTi access from the perspectives of people with insomnia, primary care clinicians, and the health system. A stakeholder advisory committee was convened to co-design change goals, identify modifiable barriers, devise program logic and drive change strategies. We commenced a program to promote system-level change in CBTi access via; improved awareness and education of insomnia among primary care clinicians, self-guided interventions, and advocating to Government for additional CBTi funding mechanisms. This implementation program made significant progress toward improving access to CBTi in Australia. Ongoing work is required to continue this program, as long-term system-level change requires significant and sustained time, effort and resources from multiple stakeholders. This program may be used to inform CBTi implementation activities in other locations.

A guide to global access to HPV vaccination to all women in low- and middle-income countries; a minireview of innovation and equity.

Cervical cancer is caused by the human papillomavirus (HV), and accounts for more than 311,000 preventable deaths annually, with 85% occurring in low-and middle-income countries. Despite being preventable through screening and screening, significant barriers to implementing HPV vaccination persist in developing nations. This review study aims to identify these barriers and propose innovative, evidence-based solutions to improve vaccination rates and reduce cervical cancer mortality. A systematic review search was conducted using PubMed, Embase, and Cochrane Database of Systemic Reviews. Keywords related to HPV vaccination barriers and implementation strategies in developing countries were used. Relevant demonstration projects, pilot studies, and evidence-based research articles were reviewed. Identifiable barriers to a successful vaccine implementation program in a developing country include vaccine costs, societal, cultural resistance, misinformation, logistical challenges in vaccine delivery, and inadequate human resources. Solutions to these barriers include a subsidized vaccine pricing, community sensitization, education and well-trained media professionals to dispel misinformation, and partnerships with both public and private sector for efficient vaccine distribution. These findings highlight critical barriers that impede HPV vaccination efforts in developing countries and offers practical solutions to overcome these challenges. This aggregate of data can help inform future developing countries' implementation programs to further the World Health Assembly mission to vaccinate 90% of eligible girls globally by 2030.

A Joanna Briggs Institute Framework Approach to Shared Decision Making in End-of-Life.

To implement shared decision-making (SDM) through a patient decision aid (PtDA) for the initiation of palliative care (PC) in end-of-life (EOL) cancer patients. A comprehensive Scoping Review was conducted on SDM in PubMed, CINAHL and PsycInfo. An evidence-based implementation of PtDAs was created using the Joanna Briggs Institute framework, which followed rigorous pillars: (1) context, (2) facilitation and (3) evaluation. Fifteen studies were identified and categorised into (1) Implementation characteristics and (2) Strategies for implementing SDM in terminally ill cancer patients. SDM should consider the decision-making location, optimal timing, participants and decision type. Strategies include professional training, PtDAs and implementation programmes. A PtDA implementation protocol in video format for deciding to initiate PC is proposed, following International Patient Decision Aid Standards (IPDAS) and Clinical Practice Guidelines (CPG). SDM implementation should be guided by evidence-based methodological models justifying and structuring its execution, especially in complex and interdisciplinary contexts. National or international frameworks facilitate the adoption of health innovations, such as PtDAs, benefiting patients and improving their usage. SDM is not just a concept but an important approach to the Care of cancer patients at EOL, enhancing patient satisfaction and improving care quality. The success and sustainability of SDM hinge on the fundamental aspects of staff training, interdisciplinary collaboration and ongoing evaluation. The lack of specific aid in Spanish underscores the immediate need for local development. Further research is needed in this area, as most reviewed studies did not measure SDM effectiveness in diverse hospital settings. This proposal was developed based on the experience and input of the nursing staff from the healthcare service where it is intended to be implemented.

Development of an Emergency Department Safety Checklist through a global consensus process.

Emergency departments (EDs) are at high risk for medical errors. Checklist implementation programs have been associated with improved patient outcomes in other high-risk clinical settings and when used to address specific aspects of ED care. The aim of this study was to develop an ED Safety Checklist with broad applicability across different international ED settings. Athree-round modified Delphi consensus processwasconductedwith a multidisciplinary and multinational panel of experts in emergency medicine and patient safety. Initial checklist items were identified through a systematic review of the literature. Each item was evaluated for inclusion in the final checklist during two rounds of web-based surveys and an online consensus meeting. Agreement for inclusion was defined a priori with a threshold of 80% combined agreement. Eighty panel members from 34 countries across all seven world regions participated in the study, with comparable representation from low- and middle-income and high-income countries. The final checklist contains 86 items divided into: (1) a general ED Safety Checklist focused on diagnostic evaluation, patient reassessment, and disposition and (2) five domain-specific ED Safety Checklists focused on handoff, invasive procedures, triage, treatment prescription, and treatment administration. The checklist includes key clinical tasks to prevent medical errors, as well as items to improve communication among ED team members and with patients and their families. This novel ED Safety Checklist defines the essential elements of high-quality ED care and has the potential to ensure their consistent implementation worldwide.

Learning Curve of Endoscopic Lumbar Discectomy - A Systematic Review and Meta-Analysis of Individual Participant and Aggregated Data.

A systematic review and meta-analysis of individual participant and aggregated data. To define the learning curves of endoscopic discectomies using unified statistical methodologies. Searches returned 913 records, with 118 full-text articles screened. Studies of endoscopic lumbar spine surgery reporting outcomes by case order were included. Mixed-effects nonlinear, logistic, and beta meta-regressions prdwere conducted to define the learning curves. 13 studies involving 864 patients among 15 surgeons were included in total. For transforaminal endoscopic discectomy, the estimated operating time for the first case was 95min [CI: 87-104], and the estimated plateau was 66 minutes [CI: 51-81]. An estimated 21 cases [CI: 18-25] were required to overcome 80% of this deficit, but near-plateau performance was expected only after 59 cases [CI: 51-70]. The estimated risk of surgical complications on the first case was 25% [CI: 11%-46%], with an 80% reduction in relative risk requiring an estimated 41 cases. The expected postoperative VAS leg pain score after the first case was 2.7 [CI: 1.8-3.8], with an 80% improvement requiring an estimated 96 cases. Similar numbers were required to overcome the learning curves in interlaminar and biportal endoscopic discectomies. Approximately 60 cases are required to achieve proficiency in endoscopic lumbar spine surgery, although the greatest part of the learning curve can be overcome with 20 cases. This should be considered when designing implementation programmes for surgeons and service providers that wish to incorporate endoscopic spinal surgery into their practice.

Health Dietary Program for Patient after Sleeve Gastrectomy: Case - Control Study

Background: In general, obesity has been increasing at an alarming rate over the past 50 years. In 2022, obesity and its comorbidities accounted for 14.3 percent of this world healthcare expenditure. Weight loss surgery is considered a safe and durable treatment option for obesity. The techniques have been continuously evolving to yield better outcomes. The studies showed that post-operative complications increased with physical inactivity and therefore reduces patient’s quality of life (1), The Gastroenterology Endoscopic Department Al-Kindy-Teaching Hospital – Baghdad-Iraq (2019), mentioned that dietary habits play a significant role in the development of gastrointestinal disorders(2). so that this activity describes the dietary program after sleeve gastrectomy and highlights the role of the interprofessional team in the management of patients with obesity. and the extent to which a patient's behavior conforms to the instructions given by health practitioners (3). Objective: To find out the effectiveness of rehabilitation program on patient's nutritional status after sleeve gastrectomy, to find out the relationship between patient's nutritional status and demographic characteristics (age, sex, and level of education). Material and Methods: The design used in the current study is a quasi-experimental design -experimental design (two -groups comparison), the study was conducted in center of hepatopathy and digestive diseases in AL-Hussein Teaching Hospital at AL-Muthanna city in Iraq. Study Sample: A non-probability (purposive) sample was taken from patients who performed gastric sleeve and the sample was (50) patients. Use questionnaire in this study. Result: It was found that there is an effectiveness of the program on the case group with the post-test when compared with the control group after implementation program. Conclusion: The patient after sleeve gastrectomy have inadequate knowledge concerning dietary. The program which implemented on patients had a benefit feedback on patients.

Implementation of Strategic Management in Optimizing Merdeka Curriculum

This study aims to describe and analyze the implementation of strategic management in optimizing Merdeka Curriculum at SMA Negeri 3 Unggulan Kayuagung. This study uses qualitative methods. It shows that Implementation of strategic management consists of strategy formulation (environmental analysis, vision, mission, goals, targets and strategies), implementation (operational curriculum, programs, monitoring and communication systems, school resources, organizational structure, school’s principal leadership, and work culture), and strategy evaluation. The obstacles are dynamic policies, limited time, work completion gaps, inconsistency, and evaluation document. The solutions are to optimize growth mindset, digitalization; priority scale-based work plans; collaboration culture; performance work management; evaluation instruments and action plans. Novelty of this study resides in the research setting that implements the Merdeka Curriculum with Mandiri Berbagi category, so this study can contribute to strengthening strategic management in educational units to achieve optimal results in facing changes in the Merdeka Curriculum category options.

An assessment of Ghana’s pilot of the RTS,S malaria vaccine implementation programme; 2019–2021: a retrospective study

BackgroundIn May 2019, Ghana piloted the introduction of RTS,S malaria vaccine into routine immunization in 42 districts of seven of the 16 regions. The RTS,S malaria vaccine implementation programme (MVIP) post-introduction evaluation (PIE) conducted in Ghana, assessed the immunization system as well as healthcare worker and caregiver experiences during the phase-one rollout but was less expressive on quantitative grading of the respective thematic areas of the vaccine introduction plan. Given the utility of summary statistics in programme evaluation and communication, this follow-up study aimed to provide an overall rating of the country's performance regarding the MVIP .MethodsA retrospective study was conducted from 10th January to 5th February 2024. It involved review of records to assess key thematic areas of the national MVIP plan, using a study tool adapted from the WHO New Vaccine Introduction (NVI) checklist. A composite score ranging from zero to 100 per cent was generated to assess the country's overall performance regarding introduction of the malaria vaccine, rated on a Likert scale as comprehensive, good, fair, and poor.ResultsThe overall performance in the MVIP was rated 78.9% (30/38) corresponding to a grading of “good” on the Likert scale. Performance indicators under thematic areas including policy, national coordination mechanisms, waste management, health worker training, and pharmacovigilance were completely achieved. However, some weaknesses were exhibited in areas such as financial consideration, cold chain, logistics, and vaccine management, and monitoring and evaluation.ConclusionGhana’s MVIP demonstrated remarkable strengths worth leveraging to improve the national immunization programme. The weaknesses observed in some of the thematic areas present opportunities to engage key immunization partners and stakeholders towards aligning efforts to ensure a more robust expansion phase. The lessons from the MVIP may be relevant to areas introducing malaria vaccine irrespective of the product type—RTS,S or R21.

Evaluation of the Implementation of a Novel Fluid Resuscitation Device in the Prehospital Care of Sepsis Patients: Application of the Implementation Outcomes Framework

Objectives Early identification and fluid resuscitation are recognized performance measures within sepsis care. Despite fluid resuscitation, fluid goals are often not achieved in the prehospital environment. Furthermore, description of implementation process and evaluation of implementation success are historically underreported in prehospital research. The objective of this study was to contextualize and evaluate the system-wide implementation of a novel fluid resuscitation device, the LifeFlow PLUS®, in the treatment of prehospital sepsis patients. Methods A single urban emergency medical services (EMS) system internally decided to adopt a novel fluid resuscitation device. This EMS system added the device to the clinical care guidelines of suspected sepsis patients. Prior to and during implementation of the new guidelines, several strategies were undertaken to promote consistent, appropriate system-wide use of the device. A mixed methods study design was deployed. Surveys of EMS clinicians and leaders assessed perceptions of the device and sepsis education prior to field implementation of the device. Clinician and leader semi-structured interviews assessed implementation experience and device adoption. Document analysis evaluated deployment of implementation strategies. Data were triangulated to contextualize implementation and evaluate success. Results Clinician (88%) and leader (91%) confidence in appropriate clinician device use and device superiority for sepsis care (73 and 100%, respectively) were high. Clinicians (58%) were less likely to view the device as easy to implement compared to leaders (73%). Three themes were developed from semi-structured interviews, including “exposure” to the device, “reinforcing factors” to prompt device use, and “clinician buy-in.” Twenty unique implementation strategies (e.g., dynamic trainings, mandating change) were used to promote successful system-wide device adoption. Conclusions The overall implementation success of this novel fluid resuscitation device was moderate. Barriers to adoption included complexity of clinical decision-making and ease of device use. Facilitators to adoption included the use of multiple modes of education, clinical reminders, presenting evidence of device benefit, and prehospital culture. Prior to future prehospital implementation programs, EMS systems should focus on identifying and addressing key barriers and facilitators to improve adoption.

Assessment of SADC Countries' National Adaptation Planning Health Impacts Inclusion: A Thorough Review.

Background: The impacts of climate change are recognised as a key challenge of the 21st century. By 2030, Sub-Saharan Africa is projected to have the globally highest burden of disease due to climate change. Objectives: This study aims to evaluate the strengths and weaknesses of the National Adaptation Plans (NAPs) of the Southern African Development Community (SADC), a sub-region under-represented at a global level, in addressing current and future climate change-related health impacts. It specifically assesses the NAPs of Botswana, Mozambique, Namibia, South Africa, and Zimbabwe. Methods: A thorough review was conducted, analysing articles, government reports, and national communications related to NAPs and climate change health outcomes in the selected countries. Sources were evaluated against pre-defined inclusion and exclusion criteria. Main findings: All five countries prioritised health in their NAPs; however, health departments were excluded from assessments in two of the countries. Although health surveillance and early warning systems were included in the NAPs, there was limited evidence of their integration into broader climate, health, economic, and labour policies. National climate change focal points were identified, but governance and implementation at district and local levels were not well-documented. This review highlighted a need for greater inclusion of Indigenous and locally led knowledge. Common barriers identified included the lack of data with appropriate frequency and scale. Governance and implementation difficulties were also identified in all five countries; these difficulties included both a lack of coordination and a lack of institutional capacity. These challenges, especially a lack of political will to address the compound impacts of altered climate and health on all earth systems, are also found at the regional level. Conclusions: National strategies and implementation programs in SADC countries need to be agile in their ability to scale and adapt, yet they also need to include measurable actions and timeframes. Given the shared climate and health trends and the interconnected socio-economic, environmental, and political landscape, there is significant potential for regional coordination to address cross-border climate change impacts and to optimise resource use.

Digital cognitive behavioural therapy for insomnia versus digital sleep education control in an Australian community-based sample: a randomised controlled trial.

Insomnia is a prevalent condition in Australia that increases the risk of depression and anxiety symptoms. Cognitive behaviour therapy for insomnia (CBT-i) is the recommended 'first line' treatment but is accessed by a minority of people with insomnia. To improve CBT-i access in Australia, we aimed to develop and test a self-guided interactive digital CBT-i program. An online randomised controlled trial was conducted from August 2022 to August 2023 to investigate the effect of digital CBT-i, versus digital sleep education control, on symptoms of insomnia (ISI), depression (PHQ-9), anxiety (GAD-7), fatigue, sleepiness and maladaptive beliefs about sleep at 8-week follow-up. The control group accessed the intervention after the 8-week follow-up. Questionnaires were additionally administered at 16 and 24 weeks. Intent-to-treat mixed models and complete-case chi-squared analyses were used. Participants included 62 adults with insomnia symptoms (age M (SD) = 52.5 (16.3), 82% female, ISI = 18.6 (2.9)). There were no between-group differences in baseline characteristics or missing 8-week data (14.5%). After adjusting for baseline scores, CBT-i was associated with lower insomnia (Diffadj (95% CI) = 7.32 (5.0-9.6), P < 0.001, d = 1.64), depression (3.36 (1.3-5.4), p = 0.002, d = 0.84), fatigue (5.2 (2.5-7.9), P < 0.001, d = 1.00) and maladaptive beliefs about sleep (11.0 (4.1-18.0), P = 0.002, d = 0.82), but not anxiety symptoms at 8 weeks (1.84 (-0.1 to 3.8), p = 0.060, d = 0.50). Compared to control, CBT-i was associated with greater rates of insomnia remission (ISI <8; 0.0%, vs 40.0%, P < 0.001) and response at 8 weeks (ISI reduction ≥6; 7.1% vs 72.0%, P < 0.001). Improvements in insomnia and depression were maintained at 24 weeks in the CBT-i group. This interactive digital CBT-i program resulted in large and sustained improvements in symptoms of insomnia, depression, fatigue and maladaptive beliefs about sleep in Australian adults with insomnia symptoms. Implementation programs are required to increase digital CBT-i access and uptake.

Mixed-Method Evaluation to Understand Clinician Perspectives of a Program to Implement High-Intensity Resistance Rehabilitation Into Skilled Nursing Facilities

ObjectiveTo assess rehabilitation clinicians’ viewpoints regarding a multicomponent implementation program aimed at promoting high-intensity resistance rehabilitation (HIR), as well as practical implications for its use in skilled nursing facility (SNF) rehabilitation. DesignProspective convergent mixed-method design. SettingEight rural SNFs within the Department of Veterans Affairs. ParticipantsPhysical rehabilitation clinicians (physical and occupational therapists, physical and occupational therapy assistants, recreational therapists, and kinesiotherapists) who engaged with the implementation program (n=38). InterventionsClinicians engaged with the multicomponent implementation program to promote the use of HIR in clinical practice. The program components included clinician training (i.e., virtual didactic modules with synchronous case discussions), provision of resources (e.g., equipment, job aids), and facilitated implementation (e.g., external implementation facilitator support, distributed tips and tricks). Main Outcome MeasuresAcceptability of Intervention Measure, Training Acceptability Rating Scale, study-specific questionnaires, and qualitative focus groups exploring perceived acceptability, feasibility, and effect on work experience. ResultsQuestionnaires revealed high levels of implementation program acceptability and perceived effect, alongside moderate levels of feasibility. Focus group themes supported these findings, explaining high acceptability and effect through differentiation from other trainings and prolonged engagement. Feasibility results were explained qualitatively by facilitatory factors (i.e., team participation, reduced caseloads, training characteristics) and inhibitory factors (i.e., training timing, self-paced scheduling logistics, lack of protected time and space). There was no reported negative effect on clinician work experience. ConclusionsAccording to SNF clinician perspectives, a positive HIR implementation experience may be enhanced through implementation programs that provide prolonged engagement and a self-paced structure with built-in accountability. Leadership and organizational support appear important to protect time and space for clinicians who experience competing priorities to successfully facilitate evidence uptake. Future work can evaluate the applicability across various contexts beyond rural VA SNFs.