Need For Implementation Research Research Articles

Ready or Not: A Conceptual Model of Organizational Readiness for Embedded Pragmatic Dementia Research.

The National Institute on Aging Alzheimer's Disease/Alzheimer's Disease and Related Dementias Research Implementation Milestones emphasize the need for implementation research that maximizes up-take and scale-up of evidence-based dementia care practices across settings, diverse populations, and disease trajectories. Organizational readiness for implementation is a salient consideration when planning and conducting embedded pragmatic trials, in which interventions are implemented by provider staff. The current article examines the conceptual and theoretical underpinnings of organizational readiness for implementation and the operationalization of this construct. We offer a preliminary conceptual model for explicating and measuring organizational readiness and describe the unique characteristics and demands of implementing evidence-based interventions targeting persons with dementia and/or their care partners. [Research in Gerontological Nursing, 17(3), 149-160.].

Assessment of Institutional Implementation Research Capacity of the National Institutes of Health D43 Network.

Implementation science enhances the efficient practice of solutions from research to real-world application. Low- and lower- to middle-income countries may benefit significantly from implementation research given their limited resources. The National Institutes of Health Fogarty International Center D43 network consists of partnerships between foreign and U.S.-based institutions and aims to strengthen global health research. This paper assesses the D43 network's implementation research focus and training capacity. A survey was distributed to 387 program directors of ongoing and completed D43 projects. Preliminary results show 51.7% of respondents describe "increasing implementation research capacity" as a "high priority." Only 24.8% of faculty in implementation science received formal training, and 60.3% of D43 programs lacked an implementation research training program. Results show there is an increasing need for implementation research but that more can be done to develop implementation research capacity and training. The low response rate of 18% is a limitation of this study.

Tobacco control research on the African continent: a 22-year literature review and network analysis

ObjectiveDescribe the landscape of tobacco-related topics, funders and institutional networks in Africa.Data sourcesWe searched PubMed, Embase and African Index Medicus for published articles from January 1996 to August 2018 in...

Mental health, stigma, and neglected tropical diseases: A review and systematic mapping of the evidence

Recent years have seen an increase in recognition of the important impact that mental health, wellbeing, and stigma have on the quality of life of people affected by neglected tropical diseases (NTDs), including the publication of global normative guidance and policy frameworks. However, systematic collation of the evidence that can guide greater clarity of thinking for research and practical application of effective interventions is lacking. We used systematic mapping methodology to review the state of the evidence around mental health, stigma, and NTDs in low- and middle-income countries, applying a simple theoretical framework to explore intersections between these areas. We built on existing reviews on the links between each domain, bringing the reviews up to date, across the NTDs identified by the WHO (minus recent additions). After systematic searching of major databases, and exclusions, we identified 190 papers. Data extraction was done to inform key topics of interest, namely, the burden of mental distress and illness/stigma associated with NTDs, the mechanisms by which NTDs add to mental distress and illness/stigma, how mental distress and illness/stigma affect the outcome and treatment of NTDs, and efficacy of interventions to address these domains. We also document the recommendations given by the authors of included studies for research and interventions. We found that there has been a substantial increase in research, which remains very heterogeneous. It was dominated by skin conditions, especially leprosy and, less so, lymphatic filariasis. Few studies had a comparative and even fewer had an intervention design. Our findings were however consistent with existing reviews, pointing to a high prevalence of mental conditions, substantially mediated by stigma and exclusion and a lack of sufficient access to support for mental wellbeing in programmes, despite the existence of effective interventions. These interventions cut across mental health services, stigma reduction, community engagement, and empowerment of people affected. We conclude that the evidence justifies increased investment in practical and integrated interventions to support the wellbeing of people affected by NTDs but that there remains a need for implementation research of consistent quality, and basic science around the impact of mental health interventions on NTD outcomes (including on elimination efforts) needs to be strengthened.

Impact of COVID-19 on Adolescent HIV Prevention and Treatment Research in the AHISA Network

Members of the Adolescent HIV Prevention and Treatment Implementation Science Alliance (AHISA) network conduct research aiming to close gaps between what is known to be impactful across the HIV prevention and treatment cascade, and services delivered to optimize outcomes for adolescents/young adults (AYA) in high HIV-prevalence settings. The COVID-19 pandemic introduced new challenges which threaten to exacerbate care and access disparities. We report results of a survey among AHISA teams with active AYA HIV research programs in African countries to determine how the pandemic has impacted their efforts. Results highlighted the detrimental impact of the pandemic on research efforts and the expanded need for implementation research to help provide evidence-based, context-specific pandemic recovery support. Key lessons learned included the viability of remote service delivery strategies and other innovations, the need for adaptive systems that respond to evolving contextual needs, and the need for organized documentation plans, within empathic and flexible environments.

The Need for Implementation Research for Community-based Interventions: Scientific Evidence Is Needed.

The Need for Implementation Research for Community-based Interventions: Scientific Evidence Is Needed.

Cross-Sectional Analysis of Nutritional Status, Knowledge and Uptake of Nutritional Services Among Adolescent Girls in Western India.

PurposeMalnutrition status of adolescent girls remains a major public health problem in India. The present study assessed nutritional status, associated factors contributing to malnutrition and their access to health-care services in Dev Bhumi Dwarka district of Gujarat situated in western part of India.Materials and MethodsThe study was carried out using descriptive cross-sectional design. A total of 1252 adolescent girls from all four blocks of Dev Bhumi Dwarka district were interviewed by field investigators. The data were collected on socio-demographic characteristics, physical activities, diet, and anthropometry. The WHO classification for body mass index (BMI) was used to assess underweight, overweight, and obesity among adolescent girls. Chi-square analyses were performed to identify significant determinants of under-nutrition.ResultsMean age of the study population was 13.82±2.31. Of the total, around 34% of the adolescent girls were out-of-school. The prevalence of underweight (<-2SD) was 19.6%, 8.9% were overweight, and 2.6% were obese. The mean BMI was 19.77±2.42 kg/m2, and height was 149.15 (2.23m2). In terms of knowledge, almost 79.6% were unaware of iron-deficiency anaemia, about 70% were not aware of haemoglobin test, and 44% did not know the benefit of using sanitary napkins. In addition, uptake of nutritional and health services was limited. The study found a statistically significant association of age (p = 0.00), the number of family members (p = 0.016), knowledge (p = 0.05), and use of toilet (0.041) with low-BMI.ConclusionExisting nutritional interventions need to focus on nutrition, health and hygiene education. It also reinforces a need for implementation research to understand barriers in uptake of health and nutrition services.

Comparison of Integrated Outpatient Palliative Care With Standard Care in Patients With Parkinson Disease and Related Disorders

Parkinson disease and related disorders (PDRD) have consequences for quality of life (QoL) and are the 14th leading cause of death in the United States. Despite growing interest in palliative care (PC) for persons with PDRD, few studies are available supporting its effectiveness. To determine if outpatient PC is associated with improvements in patient-centered outcomes compared with standard care among patients with PDRD and their caregivers. This randomized clinical trial enrolled participants at 3 academic tertiary care centers between November 1, 2015, and September 30, 2017, and followed them up for 1 year. A total of 584 persons with PDRD were referred to the study. Of those, 351 persons were excluded by phone and 23 were excluded during in-person screenings. Patients were eligible to participate if they had PDRD and moderate to high PC needs. Patients were excluded if they had urgent PC needs, another diagnosis meriting PC, were already receiving PC, or were unable or unwilling to follow the study protocol. Enrolled participants were assigned to receive standard care plus outpatient integrated PC or standard care alone. Data were analyzed between November 1, 2018, and December 9, 2019. Outpatient integrated PC administered by a neurologist, social worker, chaplain, and nurse using PC checklists, with guidance and selective involvement from a palliative medicine specialist. Standard care was provided by a neurologist and a primary care practitioner. The primary outcomes were the differences in patient quality of life (QoL; measured by the Quality of Life in Alzheimer Disease scale) and caregiver burden (measured by the Zarit Burden Interview) between the PC intervention and standard care groups at 6 months. A total of 210 patients with PDRD (135 men [64.3%]; mean [SD] age, 70.1 [8.2] years) and 175 caregivers (128 women [73.1%]; mean [SD] age, 66.1 [11.1] years) were enrolled in the study; 193 participants (91.9%) were white and non-Hispanic. Compared with participants receiving standard care alone at 6 months, participants receiving the PC intervention had better QoL (mean [SD], 0.66 [5.5] improvement vs 0.84 [4.2] worsening; treatment effect estimate, 1.87; 95% CI, 0.47-3.27; P = .009). No significant difference was observed in caregiver burden (mean [SD], 2.3 [5.0] improvement vs 1.2 [5.6] improvement in the standard care group; treatment effect estimate, -1.62; 95% CI, -3.32 to 0.09; P = .06). Other significant differences favoring the PC intervention included nonmotor symptom burden, motor symptom severity, completion of advance directives, caregiver anxiety, and caregiver burden at 12 months. No outcomes favored standard care alone. Secondary analyses suggested that benefits were greater for persons with higher PC needs. Outpatient PC is associated with benefits among patients with PDRD compared with standard care alone. This study supports efforts to integrate PC into PDRD care. The lack of diversity and implementation of PC at experienced centers suggests a need for implementation research in other populations and care settings. ClinicalTrials.gov Identifier: NCT02533921.

National digital health blueprint of India: A need for implementation research

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Current State of Family-Based Prevention and Therapy of Substance-Use Disorders in Children and Adolescents: A Review

Current State of Family-Based Prevention and Therapy of Substance-Use Disorders in Children and Adolescents: A Review Adolescence is a vulnerable period for substance use disorders (SUD) as indicated by epidemiological studies. Research demonstrates the family's role for the etiology of SUD and provides a rationale for interventions based on family-associated risk and resilience factors. In this article, we summarize published results for family-based interventions from 2008-2018. Taken together, prevention programs can be effective when they focus on the promotion of broader developmental competencies and familial resources, rather than narrowly addressing substance use. Moreover, programs could benefit from targeting youth and parents as done in the "Strengthening Families Program 10-14"; most existing programs however target parents and do not include the adolescents. Family-based treatment programs with an evidence base are Multisystemic Therapy, Functional Family Therapy, Multidimensional Family Therapy and Brief Strategic Family Therapy. Overall, the effects of family-based interventions are small-to-middle sized but vary significantly across populations. Across the field of family-based interventions, there is a need for more knowledge on effective components and differential effects. The results could be improved by translational research such as on the emerging concept of mindfulness. Moreover, there is a need for implementation research and the effectiveness of service delivery programs on the community level in Germany.

Attrition of HIV-exposed infants from early infant diagnosis services in low- and middle-income countries: a systematic review and meta-analysis.

IntroductionIdentification and retention of HIV‐exposed infants in early infant diagnosis (EID) services helps to ensure optimal health outcomes. This systematic review and meta‐analysis examines the magnitude of attrition from EID services in low‐ and middle‐income countries (LMICs).MethodsWe performed a comprehensive database search through April 2016. We included original studies reporting retention/attrition data for HIV‐exposed infants in LMICs. Outcomes included loss to follow‐up (LTFU), death and overall attrition (LTFU + death) at time points along the continuum of EID services. At least two authors determined study eligibility, performed data extraction and made quality assessments. We used random‐effects meta‐analytic methods to aggregate effect sizes and perform meta‐regression analyses. This study adhered to PRISMA reporting guidelines.ResultsWe identified 3040 unique studies, of which 92 met eligibility criteria and were included in the quantitative synthesis. The included studies represent data from 110,805 HIV‐exposed infants, the majority of whom were from Africa (77%). LTFU definitions varied widely, and there was significant variability in outcomes across studies. The bulk of attrition occurred in the first six months of follow‐up, with additional losses over time. Overall, 39% of HIV‐exposed infants were no longer in care at 18 months. When restricted to non‐intervention studies, 43% were not retained at 18 months.ConclusionsThese findings underscore the high attrition of HIV‐exposed infants from EID services in LMICs and the urgent need for implementation research and resources to improve retention among this vulnerable population.

Tuberculosis Treatment Outcomes Among HIV/TB-Coinfected Children in the International Epidemiology Databases to Evaluate AIDS (IeDEA) Network.

Management of tuberculosis (TB) is challenging in HIV/TB-coinfected children. The World Health Organization recommends nucleic acid amplification tests for TB diagnosis, a 4-drug regimen including ethambutol during intensive phase (IP) of treatment, and initiation of antiretroviral therapy (ART) within 8 weeks of TB diagnosis. We investigated TB treatment outcomes by diagnostic modality, IP regimen, and ART status. We conducted a retrospective cohort study among HIV/TB-coinfected children enrolled at the International Epidemiology Databases to Evaluate AIDS treatment sites from 2012 to 2014. We modeled TB outcome using multivariable logistic regression including diagnostic modality, IP regimen, and ART status. Among the 386 HIV-infected children diagnosed with TB, 20% had microbiologic confirmation of TB, and 20% had unfavorable TB outcomes. During IP, 78% were treated with a 4-drug regimen. Thirty-one percent were receiving ART at the time of TB diagnosis, and 32% were started on ART within 8 weeks of TB diagnosis. Incidence of ART initiation within 8 weeks of TB diagnosis was higher for those with favorable TB outcomes (64%) compared with those with unfavorable outcomes (40%) (P = 0.04). Neither diagnostic modality (odds ratio 1.77; 95% confidence interval: 0.86 to 3.65) nor IP regimen (odds ratio 0.88; 95% confidence interval: 0.43 to 1.80) was associated with TB outcome. In this multinational study of HIV/TB-coinfected children, many were not managed as per World Health Organization guidelines. Children with favorable TB outcomes initiated ART sooner than children with unfavorable outcomes. These findings highlight the importance of early ART for children with HIV/TB coinfection, and reinforce the need for implementation research to improve pediatric TB management.

Tailoring mass drug administration to context: implementation research is critical in achieving equitable progress in the control and elimination of helminth neglected tropical diseases in sub-Saharan Africa.

The concept of a technological quick fix or 'magic-bullet' for control and elimination of Neglected Tropical Diseases (NTDs) is flawed. NTDs are embedded within complex biological and social systems that are shaped by ecological and political contexts. This commentary emphasises the need for implementation research to address implementation gaps in the control of NTDs. With a specific focus on sub-Saharan Africa and helminth diseases amenable to preventive chemotherapy through mass drug administration, we explore the important role of context, programme partnerships and community in achieving equitable and effective NTD control.

Implementation of Teacher Consultation and Coaching in Urban Schools: A Mixed Method Study

Guided by implementation science scholarship and school mental health research, the current study uses qualitative and quantitative data to illuminate the barriers, opportunities, and processes underlying the implementation of a teacher consultation and coaching model (BRIDGE) in urban elementary schools. Data come from five public elementary schools, 12 school mental health staff (BRIDGE consultants), and 18 teachers participating in a classroom-randomized trial of BRIDGE. Findings from directed content analysis of teacher focus group and interview data suggest that aspects of the BRIDGE intervention model, school organization and classroom contexts, and teachers/consultants and their relationship were relevant as implementation facilitators or barriers. In addition, case study analysis of intervention materials and fidelity tools from classrooms with moderate-to-high dosage and adherence suggest variation in consultation and coaching by initial level of observed classroom need. Results illuminate the need for implementation research to extend beyond simple indicators of fidelity to the multiple systems and variation in processes at play across levels of the implementation context.

Integrating Clinical Services for HIV, Tuberculosis, and Cryptococcal Disease in the Developing World

The success of antiretroviral therapy (ART) programs in the developing world is limited by the lack of adequate diagnostic tests to screen for life-threatening opportunistic infections such as tuberculosis (TB) and cryptococcal disease. Furthermore, there is an increasing need for implementation research in measuring the effectiveness of currently available rapid diagnostic tests. The recently developed lateral flow assays for both cryptococcal disease and TB have the potential to improve care and greatly reduce the time to initiation of ART among individuals who need it the most. However, we caution that the data on feasibility and effectiveness of these assays are limited and such research agendas must be prioritized.

Community participation in primary care in Ireland: the need for implementation research

There are now several decades of history of community participation in health, with significant international evidence to suggest that there is much to be gained by primary health services and disadvantaged communities working in partnership. In this paper we provide an overview of community participation in primary care, establishing the policy context in which a recent 'Joint Initiative on Community Participation in Primary Health Care' was developed in Ireland. This Initiative was designed to support the involvement of disadvantaged communities and groups in the development of primary health care services at local level. An independent formative evaluation of the Joint Initiative took place between September 2009 and April 2010. We present a summary of key findings from this evaluation. We pay particular attention to the issue of sustaining community participation in newly developed Primary Care Teams (PCTs) in the current and changing economic climate, an issue considered crucial if the documented positive impacts of the Joint Initiative are to be maintained and the potential for health gains in the longer term are to be realised. We then argue that the Joint Initiative referred to in this paper clearly provides a strong prototype for community participation in PCTs in Ireland. We also ask whether it can be replicated across all PCTs in the country and embedded as a core part of thinking and everyday health care. We highlight the need for research to build knowledge about the ways in which innovations such as this can be embedded into ongoing, routine healthcare practice. This research agenda will have relevance for policy makers, practitioners and evaluators in Ireland and other healthcare jurisdictions.

Implementing chronic disease prevention amongst cancer survivors

Implementing chronic disease prevention amongst cancer survivors

Implementation and Outcomes: Evidence from Information Kiosks in Rural India

This paper assesses the effect of implementation quality on program outcomes, within the context of information kiosks deployments in rural India. A firm level fixed-effects model is used to analyze a dataset comprising 132 firms that were surveyed three times over a period of six months. Specifically, the paper examines whether infrastructure ‘shocks’ in the form of Internet connectivity disruptions and hardware repairs significantly affect firm performance, defined in terms of the volumes of kiosk use. Since the implementing organization provides Internet connectivity to the kiosks and a ‘Local Service Partner’ is responsible for technical support, both types of infrastructural shocks simultaneously capture the quality of project implementation. The study finds that shocks to implementation matter, and have a large and significant effect on kiosk use. The paper further discusses the need for implementation research and the problems encountered in conducting such research, both from a research and practical point of view. From a research perspective, the study advises the use of short run panels in conjunction with analysis using longer run panels, since the latter would tend to suffer from attrition bias or small sample size problems, masking the actual effect of implementation on outcomes. From a practical standpoint, the study recommends a closer engagement between researchers and practitioners to collect relevant implementation-related data, which would enable a better appreciation of the role of implementation in influencing project failure or success. The result would be knowledge that begets a more informed approach to policy and practice.

Improving Results for Nutrition: A Commentary on an Agenda and the Need for Implementation Research

Research and implementation often exist in separate worlds. To improve results for nutrition, the nutrition research community needs to go beyond “what” works to understand “how” it works. If they do not, nutrition research risks becoming irrelevant to the needs of those who actually make policies and implement programs. Researchers must prioritize research on effectiveness of policies and programs. They should incorporate knowledge and tools of social sciences, including economics, sociology, political science, and management into their work. They should pay greater attention to environmental and institutional variables and understand change strategies, knowledge utilization, and policy processes. Fundamentally, research on implementation should use a systematic approach to produce generalizable evidence and conceptual models, tools, and methods that are communicated effectively to policymakers and programmers. Nutrition researchers need not expand far beyond their disciplinary comfort zone to do this, but they do need to build bridges with other fields to have greater success in addressing nutritional challenges.

Fidelity Outcomes in the National Implementing Evidence-Based Practices Project

Fidelity Outcomes in the National Implementing Evidence-Based Practices Project