Successful Implementation Of Evidence-based Practices Research Articles

Translating Evidence Into Practice Through Knowledge Implementation

It is well established that it can take upward of 20 years to implement research findings into clinical practice. Research findings do not always translate well into the clinical environment for a number of reasons including organizational/individual resistance to change, disruption in workflow, lack of intervention adaptability, and the complexity of patients in the rehabilitation setting. Physical therapists will benefit from an understanding of implementation science (IS) in order to optimize the integration of evidence-based practices (EBPs) into the clinical setting. Implementation science focuses on how interventions work in real settings, how to improve them, and how to sustain them. It provides a framework for identifying barriers and facilitators to the uptake of the desired behavior and engages stakeholders of multiple levels into the process. Two frameworks, the Knowledge-to-Action framework and the Consolidated Framework for Implementation Research, are presented to provide guidance to clinicians and researchers in oncology rehabilitation who are interested in embarking upon IS projects. A hybrid version of the 2 frameworks is proposed with the aim of providing stakeholders with stronger and targeted tools to increase the likelihood of successful implementation of EBP. The purpose of this perspective is to describe IS, key frameworks, and strategies of knowledge implementation and to identify barriers and facilitators to implementation of contemporary research into clinical practices. The secondary purpose of this article is to demonstrate its application for the Academy of Oncologic Physical Therapy.

Barriers to Implementing Motivational Interviewing in Addiction Treatment: A Nominal Group Technique Process Evaluation.

The successful implementation of evidence-based practices (EBPs) in real-world settings requires an adaptive approach and ongoing process evaluation and tailoring. Although conducting a needs assessment during the preparation phase of implementation is beneficial, it is challenging to predict all barriers to EBP implementation that may arise over the course of implementation and sustainment. This article describes a process evaluation that identified emergent and persistent barriers that impacted the implementation of an EBP across multiple behavioral health organizations and clinics. This study was conducted during the first cohort of a cluster randomized controlled trial testing the effectiveness of the Leadership and Organizational Change for Implementation (LOCI) strategy to implement motivational interviewing (MI) in substance use disorder treatment agencies and clinics. We used a modified nominal group technique (NGT) in which clinic leaders identified barriers faced during the implementation process. Barriers were categorized, then ranked and rated according to leaders' perceptions of each barrier's influence on implementation. The barriers were then contextualized through individual qualitative interviews. Fifteen barriers were identified, grouped into staff-level barriers, management-level barriers, and implementation program barriers. Time and resistance to MI were rated as the most influential staff-level barriers. Among management-level barriers, time was also rated highest, followed by turnover and external contractual constraints. The most influential implementation barrier was client apprehension of recording for fidelity assessment and feedback. Individual interviews supported these findings and provided suggested adaptations for future implementation efforts. EBP implementation is an ongoing process whereby implementation strategies must be proactively and strategically tailored to address emergent barriers. This research described a process evaluation that was used to identify 15 emergent and/or persistent barriers related to staff, management, and the implementation program. Using implementation strategies that can be tailored and/or adapted to such emergent barriers is critical to implementation effectiveness.

A survey for the readiness of Greek midwives for the adoption of evidence-based practice (EBP).

INTRODUCTIONThe holistic approach of healthcare practice in midwifery demands the use of evidence-based practice (EBP) in all aspects of clinical care. Applying EBP in every day healthcare practice by midwives offers various significant benefits. The aim of the present study was to investigate and assess the knowledge and awareness of midwives in Greece with regard to EBP.METHODSData collection took place from October 2012 to January 2013 among midwifery staff within two national ‘urban’ healthcare hospitals of Athens and the department of midwifery in the Athens Technological Institute. The sample consisted of 209 participants of which 109 were midwives and 100 student midwifes. Both were invited to complete a questionnaire specifically designed for the study.RESULTSOnly 43.5% of midwives declared awareness of the term EBP, while 36.4% had to search for general evidence about twice a month in order to support their role. The first source of information to support clinical practice was found to be ‘asking colleagues’ (52.2%) followed by ‘internet search in general’ (48.8%), but not in the EBP databases. In addition, 61.2% of respondents stated that EBP would definitely contribute to the provision of better quality midwifery care.CONCLUSIONSFor a successful implementation of EBP, it is required initially to train personnel to develop their abilities, to provide information on the way to use different data sources and encourage midwifery personnel to take initiatives and be part of the decision-making process.

Getting to implementation: a protocol for a Hybrid III stepped wedge cluster randomized evaluation of using data-driven implementation strategies to improve cirrhosis care for Veterans

Background Cirrhosis is a rapidly increasing cause of global mortality. To improve cirrhosis care, the Veterans Health Administration (VHA) developed the Hepatic Innovation Team (HIT) Collaborative to support VA Medical Centers (VAMCs) to deliver evidence-based cirrhosis care. This randomized HIT program evaluation aims to develop and assess a novel approach for choosing and applying implementation strategies to improve the quality of cirrhosis care.MethodsEvaluation aims are to (1) empirically determine which combinations of implementation strategies are associated with successful implementation of evidence-based practices (EBPs) for Veterans with cirrhosis, (2) manualize these “data-driven” implementation strategies, and (3) assess the effectiveness of data-driven implementation strategies in increasing cirrhosis EBP uptake. Aim 1 will include an online survey of all VAMCs’ use of 73 implementations strategies to improve cirrhosis care, as defined by the Expert Recommendations for Implementing Change taxonomy. Traditional statistical as well as configurational comparative methods will both be employed to determine which combinations of implementation strategies are associated with site-level adherence to EBPs for cirrhosis. In aim 2, semi-structured interviews with high-performing VAMCs will be conducted to operationalize successful implementation strategies for cirrhosis care. These data will be used to inform the creation of a step-by-step guide to tailoring and applying the implementation strategies identified in aim 1. In aim 3, this manualized implementation intervention will be assessed using a hybrid type III stepped-wedge cluster randomized design. This evaluation will be conducted in 12 VAMCs, with four VAMCs crossing from control to intervention every 6 months, in order to assess the effectiveness of using data-driven implementation strategies to improve guideline-concordant cirrhosis care.DiscussionSuccessful completion of this innovative evaluation will establish the feasibility of using early evaluation data to inform a manualized, user-friendly implementation intervention for VAMCs with opportunities to improve care. This evaluation will provide implementation support tools that can be applied to enhance the implementation of other evidence-based practices.Trial registrationThis project was registered at ClinicalTrials.Gov (NCT04178096) on 4/29/20.

Individual level predictors of implementation climate in child welfare services

Abstract Background Child welfare services (CWS) are characterized by having demanding work environments, large diversity in client needs, and limited use of evidence-based practices (EBPs). Thus, CWSs can benefit from quality improvement strategies. Accumulating evidence suggests that an organization’s strategic climate towards implementation of change and EBPs (i.e., Implementation Climate [IC]) is a critical determinant for quality improvement, such as implementation of EBPs. It is also important to understand how practitioner characteristics are implicated in successful implementation. Knowledge about how practitioner characteristics predict IC can inform priorities, improvements, and processes at several levels of CWSs to promote successful EBP implementation and sustainment. Methods We collected data on IC, job satisfaction, job stress, participation in implementation, and practitioner demographics from a total of 233 participants employed in three Norwegian CWSs during a hybrid trial investigating the implementation and effectiveness of an academic intervention (Enhanced Academic Support) for children and families receiving support from CWSs. Data were collected at two time points; before initial implementation and 20–24 months after initial implementation. We ran confirmatory factor analyses to test the factor structures and intercorrelations of translated measures. We compared Implementation Climate Scale scores with a study using the same scale in United States-based CWSs. Hierarchical multiple regression analysis was used to test whether job stress, job satisfaction, practitioner tenure, postgraduate education, and whether respondents were active or inactive participants in an ongoing implementation process predicted IC. Results Measures of IC exhibited acceptable psychometric properties. Significant differences between IC in Norwegian and United States-based CWSs were found for three subscales (educational support-, recognition-, and rewards for EBPs). Composite scores did not differ significantly. Job satisfaction was the strongest and only unique predictor of IC at both time points. Length of tenure was a unique predictor at T2. Discussion To improve the climate for implementation in CWSs, strategies should address the job characteristics and demands that can increase job satisfaction and reduce high levels of job stress. Job satisfaction and tenure may inform strategic priorities and role selection in implementation processes. Differences in the work-culture between Norwegian and United States-based CWSs may produce different interpretations of certain items in the Implementation Climate Scale.

Teacher efficacy and attributes on the implementation of tiered instructional frameworks

United States federal mandates and reforms to address the needs of at-risk students have resulted in many states being required to implement evidence-based practices (EBP) and tiered systems of support (TSS). We examined the relationships between successful implementation of EBP and tiered frameworks, specifically Positive Behavior Interventions and Support (PBIS) and the constructs of teacher self-efficacy, collective efficacy, and teacher attributions. Data were collected using the School-wide Evaluation Tool (SET), Teacher Self-Efficacy Scale (TSES), the Collective Efficacy Scale (CES), and Teachers’ Attributions for Student Behavior Measure (TASBM). Significant correlations were found between PBIS implementation level and 1) Instructional Strategies subscale of the TSES; 2) Collective Efficacy Scale and both of its subscales; and 3) TASBM and its Stable and Blame subscales. Significant differences in mean ratings were found between high implementing schools and low implementing schools on the Instructional Strategies subscale of the TSES, on the CES, and both of its subscale. Results showed a decrease in mean ratings on the Blame subscale of the TASBM in schools that had higher implementation scores on the SET.

Evidence-based practice competency and its related factors among healthcare students

Abstract Background Evidence-based practice today is a worldwide approach in optimizing quality of healthcare. This approach remains little known among Tunisian future healthcare professionals. This study aimed to describe health sciences students' competencies in Evidence-based practice (attitudes, skills and knowledge) and to determine factors associated with these competencies. Methods A descriptive cross-sectional study was conducted from February to March 2018, at the Higher School of Health Sciences and Techniques of Sousse (Tunisia) among health sciences students. Data were collected using the validated Evidence Based Practice Competencies Questionnaire (EBP-COQ) measuring students' knowledge, attitudes and skills in Evidence-based practice. The Statistical Package for Social Sciences (SPSS.20) software was used to analyze data. Independent-Samples T test and One-way ANOVA test were performed to assess the differences between the different subgroups and their association with the Evidence-based practice components. Results Altogether, 365 students participated to the study (response rate: 93.11%). The overall Evidence Based Practice Competencies score was 3.26±0.53 out of 5. The attitude, skills and knowledge subscales received 4.04±0.41; 3.05±0.77 and 2.70±0.74 as mean scores respectively. Students' demographic and academic features were significantly associated with their competencies in Evidence-based practice including age (p < 10-6), gender (p < 10-3), academic degree (p < 10-6), English-language reading skills (p < 10-6), students' education in research methodology (p < 10-6) and statistics (p < 10-5), and their familiarity with the term “Evidence-based practice”(p < 10-6). Conclusions The reported knowledge and attitudes among the future caregivers is considered below the required competency standards. These findings highlight the urgent need for changes in the current educational strategies to ensure successful implementation of Evidence-based practice in Tunisia. Key messages The transition from studentship to a professional health-caring role requires that students are well equipped with EBP competencies to increase their likelihood of utilizing EBP in their future. Understanding the underlying factors that may influence Evidence based practice competencies is useful in developing teaching strategies for effective EBP.

Using Organizational Theory to Explain ‘How’ EBP Implementation Occurs in HCOs

Despite increasing use of theory in the field of implementation science over the past decade, the literature has largely focused on using deterministic frameworks to retrospectively understand ‘what’ factors are essential for effective implementation of evidence-based practices (EBPs). On the other hand, gaps remain in using organizational theory to prospectively understand ‘how’ successful EBP implementation occurs in healthcare organizations (HCOs). This paper discusses the theoretical and empirical contributions of two selected recent exploratory research works, which provide a starting point for addressing the identified gaps in the literature, with the purpose of deriving implications for theory, practice, and research in implementation science. The selected works used the theory of ‘effective knowledge sharing network structures in professional complex systems (PCS),’ developed through an integration of organizational theories, to design prospective interventions for enabling EBP implementation in HCOs. In doing so, these studies have helped explain ‘how’ inter-professional knowledge exchange and collective learning occurred, to enable successful EBP implementation in HCOs. Correspondingly, the selected works have served a dual purpose in 1) identifying evidence-based management practice strategies for successful EBP implementation, while 2) further developing the theoretical literature on ‘effective knowledge sharing networks in PCS.’ Importantly, by addressing the identified gaps in the literature, the selected works serve to either complement or supplement existing theoretical approaches in implementation science. To this effect, they provide unique insights for theory, practice, and research in implementation science, including insights into a potential ‘dual-role’ for the future implementation researcher—one of advancing implementation science, while working to strengthen implementation practice. Based on these contributions, it could be argued that the selected works provide a starting point for a new research stream that has potential to occupy a distinct position in the taxonomy of theoretical approaches used in implementation science.

Implementation of evidence-based practices for early childhood social learning: a viewpoint on the role of teacher attitudes

Purpose Despite their documented benefits, evidence-based practices (EBPs) for early childhood social learning are not systematically implemented. Teachers are key players in the implementation process of intervention programs and instructional practices. This is a viewpoint about teachers’ attitudes towards EBPs and their role in the successful implementation of EBPs for early childhood social learning. Design/methodology/approach The viewpoint draws on theoretical models of intervention implementation and innovation adoption to explore the importance of individual factors for EBPs implementation and to inform the understanding of the relationship between teachers’ attitudes and EBPs implementation in the context of early childhood social learning. Additionally, it is informed by the literature on research-informed teaching to identify novel opportunities of cultivating positive views towards EBPs for early childhood social learning. Findings According to implementation science, in addition to macro-level social and organisation factors, micro-level individual factors that pertain to professionals’ attitudes towards EBPs are related to successful adoption and implementation of EBPs in organisations. Hence, it is important that the investigation of the adoption and implementation of EBPs for early childhood social learning considers the role of teachers’ attitudes towards EBPs. A conceptual model is proposed to explain that research-informed teaching could contribute to fostering positive attitudes towards EBPs for early childhood social learning by raising awareness of the value and potential of research to transform pedagogy. Originality/value This viewpoint draws on EBPs implementation science to identify important factors of EBPs adoption and implementation for early childhood social learning that have not been considered extensively and offers a conceptual framework to help understand how research-informed teaching could be an innovative avenue of promoting EBPs implementation in education.

Understanding Evidence-Based Practice (EBP) Implementation in HCOs Through the Lens of Organizational Theory.

Despite the increasing use of theory in the field of implementation science over the past decade, the literature has largely focused on using deterministic frameworks to retrospectively understand “what” factors are essential for the effective implementation of evidence-based practices (EBPs). On the other hand, gaps remain in using organizational theory to prospectively understand “how” successful EBP implementation occurs in health-care organizations (HCOs). This article discusses the theoretical and empirical contributions of two selected recent exploratory research works, which provide a starting point for addressing the identified gaps in the literature, with the purpose of deriving implications for theory, practice, and future research in implementation science. The selected works used the theory of “effective knowledge sharing network structures in professional complex systems (PCS),” developed through an integration of organizational theories, to design prospective interventions for enabling EBP implementation in HCOs. In doing so, these studies have helped explain “how” inter-professional knowledge exchange and collective learning occurred, to enable successful EBP implementation in HCOs. Correspondingly, the selected works have served a dual purpose in: 1) identifying evidence-based management (EBM) practice strategies for successful EBP implementation; while 2) further developing the theoretical literature on “effective knowledge sharing networks in PCS.” Importantly, by addressing the identified gaps in the literature, the selected works serve to either complement or supplement existing theoretical approaches in implementation science. To this effect, they provide unique insights for theory, practice, and research in implementation science, including insights into a potential “dual-role” for the future implementation researcher—one of advancing implementation science, while working to strengthen implementation practice. Based on these contributions, it could be argued that the selected works provide a starting point for a new research stream that has the potential to occupy a distinct position in the taxonomy of theoretical approaches used in implementation science.

Aligning Organizational Culture and Infrastructure to Support Evidence-Based Practice.

Standardized nursing practice based on the foundations of evidence-based practice leads to high-quality patient care and optimal outcomes. Despite knowing the benefits of evidence-based practice, health care organizations do not consistently make it the standard of care; thus, implementation of evidence-based practice at the system level continues to be challenging. This article describes the process adopted by a facility in the Southwest that took on the challenge of changing the organizational culture to incorporate evidence-based practice. The organization met the challenges by identifying perceived and actual barriers to successful implementation of evidence-based practice. The lack of standardized practice was addressed by developing a group of stakeholders including organizational leaders, clinical experts, and bedside providers. Changing the culture required a comprehensive process of document selection and development, education, and outcome evaluation. The ultimate aim was to implement an integrated system to develop practices and documents based on the best evidence to support patient outcomes.

Survey of Attitudes, Knowledge, and Barriers to Evidence-Based Practice Among Thai Physical Therapists

Purpose: Healthcare professionals are encouraged to use evidence-based practice (EBP) to improve the quality of care and the patient’s quality of life. Knowledge and skill set specific to EBP, critical resources such as time and accessibility to databases, and clinician’s attitude toward EBP are needed for successful implementation of EBP. However, little is currently known about these factors among Thai Physical Therapists (PTs). This study aimed to explore the patterns of attitudes, perceived knowledge, and barriers toward EBP in Thai PTs. Method: An online questionnaire was used to obtain information regarding attitudes, knowledge, and barriers from Thai PTs. Descriptive statistics were used to describe the responses. Multiple logistic regression was used to determine the association between personal and work characteristics and the responses related to attitude, knowledge, and barriers. Results: A total of 719 Thai PTs responded to the questionnaire. Based on this sample, Thai PTs had positive attitudes and perceived themselves as having sufficient background EBP education and skills. They were confident in performing a literature search, critically appraisal, and applying research in their practice. However, the frequencies of searching and reading of literature were relatively low. Less than half of respondents understood terms related to EBP asked in the survey instrument. The barriers to EBP were insufficient time and limited research and statistical skills. PTs who were younger and having higher education were more likely to have better attitudes and knowledge. Conclusions: Despite the positive attitude and perceived knowledge of EBP, time allocation, formal training of EBP skills during academic preparation, and continuing education are required to overcome the barriers toward EBP. The discrepancy between the perception and practice of EBP observed calls for further investigation of actual skills and the barriers to the implementation of EBP.

Implementation leadership: A concept analysis.

To analyse the concept of implementation leadership (IL) in health care and nursing literature. Implementation leadership has emerged as a type of leadership that is lacking but required for the successful implementation of evidence-based practices (EBPs). A concept analysis of IL can help identify, clarify and apply this concept to inform strategies for nursing leadership development. A concept analysis using Rodger's evolutionary method identified attributes of IL, and the context in which it is expressed including antecedents, consequences, references and surrogate terms. Forty-two articles were analysed following a Boolean search of MEDLINE and CINAHL databases. Implementation leadership is a specific and strategic approach to leadership characterized by a set of influencing behaviours leading to positive outcomes for the implementation of EBPs. The concept analysis describes an evolving term that requires further clarification. This analysis contributes to an expanding knowledge base for capacity-building strategies for EBP implementation in nursing and health care. Effective IL, specifically in nurse managers, may be key in facilitating the implementation process for future successes. Nursing managers can build on a foundation of general leadership practices and consider the role of other members of the nurse leadership team in IL.

"I m Not Trained for This " And Other Barriers to Evidence-Based Social Skills Interventions for Elementary Students with High Functioning Autism in Inclusion

More students with High Functioning Autism (HFA) are in inclusive settings than ever before. The physical combination of students with autism and their typical peers alone, is insufficient to address the social deficits of students with autism. While evidence-based practices (EBPs) for social skills exist, these practices are not being implemented routinely in public schools. A mixed-methods study was conducted to identify barriers to the implementation of EBPs for social skills for students with HFA in early elementary inclusive settings. Thirty-three (n=33) district inclusion related elementary school stakeholders completed a survey created to examine the barriers to the implementation of EBPs for social skills. Qualitative data collection methods included an open-ended survey question, a focus group (n=12 of the 33 survey respondents), semi-structured interviews, and researcher field notes. Training, time, support, prioritization, materials, and staff mind-set were the top six barriers to the successful implementation of EBPs for social skills as identified by elementary inclusion stakeholders. The barriers could be summarized into three key ingredients needed to successfully implement EBPs for social skills: support, preparation, and motivation. The identification of barriers is considered the first step in bridging the gap between research and practice within inclusion school settings.

Developing and evaluating a lay health worker delivered implementation intervention to decrease engagement disparities in behavioural parent training: a mixed methods study protocol

IntroductionBehavioural parent training (BPT) programmes are effective in preventing and treating early-onset conduct problems and child maltreatment. Unfortunately, pervasive mental health service disparities continue to limit access to and engagement...

Implementation Science Research Examining the Integration of Evidence-Based Practices Into HIV Prevention and Clinical Care: Protocol for a Mixed-Methods Study Using the Exploration, Preparation, Implementation, and Sustainment (EPIS) Model.

BackgroundThe Exploration, Preparation, Implementation, and Sustainment (EPIS) model is an implementation framework for studying the integration of evidence-based practices (EBPs) into real-world settings. The EPIS model conceptualizes implementation as a process starting with the earliest stages of problem recognition (Exploration) through the continued use of an EBP in a given clinical context (Sustainment). This is the first implementation science (IS) study of the integration of EBPs into adolescent HIV prevention and care settings.ObjectiveThis protocol (ATN 153 EPIS) is part of the Scale It Up program, a research program administered by the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN), described in this issue by Naar et al. The EPIS study is a descriptive study of the uptake of 4 EBPs within the Scale It Up program. The goal of EPIS is to understand the barriers and facilitators associated with the Preparation, Implementation, and Sustainment of EBPs into HIV prevention and clinical care settings.MethodsThe EPIS study is a convergent parallel mixed-methods IS study. Key implementation stakeholders, that is, clinical care providers and leaders, located within 13 ATN sites across the United States will complete a qualitative interview conducted by telephone and Web-based surveys at 3 key implementation stages. The Preparation assessment occurs before EBP implementation, Implementation occurs immediately after sites finish implementation activities and prepare for sustainment, and Sustainment occurs 1 year postimplementation. Assessments will examine stakeholders’ perceptions of the barriers and facilitators to EBP implementation within their clinical site as outlined by the EPIS framework.ResultsThe EPIS baseline period began in June 2017 and concluded in May 2018; analysis of the baseline data is underway. To date, 153 stakeholders have completed qualitative interviews, and 91.5% (140/153) completed the quantitative survey.ConclusionsThe knowledge gained from the EPIS study will strengthen the implementation and sustainment of EBPs in adolescent prevention and clinical care contexts by offering insights into the barriers and facilitators of successful EBP implementation and sustainment in real-world clinical contexts.International Registered Report Identifier (IRRID)DERR1-10.2196/11202

Attributes of context relevant to healthcare professionals\u2019 use of research evidence in clinical practice: a multi-study analysis

BackgroundTo increase the likelihood of successful implementation of evidence-based practices, researchers, knowledge users, and healthcare professionals must consider aspects of context that promote and hinder implementation in their setting. The purpose of the current study was to identify contextual attributes and their features relevant to implementation by healthcare professionals and compare and contrast these attributes and features across different clinical settings and healthcare professional roles.MethodsWe conducted a secondary analysis of 145 semi-structured interviews comprising 11 studies (10 from Canada and one from Australia) investigating healthcare professionals’ perceived barriers and enablers to their use of research evidence in clinical practice. The data was collected using semi-structured interview guides informed by the Theoretical Domains Framework across different healthcare professional roles, settings, and practices. We analyzed these data inductively, using constant comparative analysis, to identify attributes of context and their features reported in the interviews. We compared these data by (1) setting (primary care, hospital-medical/surgical, hospital-emergency room, hospital-critical care) and (2) professional role (physicians and residents, nurses and organ donor coordinators).ResultsWe identified 62 unique features of context, which we categorized under 14 broader attributes of context. The 14 attributes were resource access, work structure, patient characteristics, professional role, culture, facility characteristics, system features, healthcare professional characteristics, financial, collaboration, leadership, evaluation, regulatory or legislative standards, and societal influences. We found instances of the majority (n = 12, 86%) of attributes of context across multiple (n = 6 or more) clinical behaviors. We also found little variation in the 14 attributes of context by setting (primary care and hospitals) and professional role (physicians and residents, and nurses and organ donor coordinators).ConclusionsThere was considerable consistency in the 14 attributes identified irrespective of the clinical behavior, setting, or professional role, supporting broad utility of the attributes of context identified in this study. There was more variation in the finer-grained features of these attributes with the most substantial variation being by setting.

Implementation of change in health care in Sweden: a qualitative study of professionals\u2019 change responses

BackgroundImplementation of evidence-based practices in health care implies change. Understanding health care professionals’ change responses may be critical for facilitating implementation to achieve an evidence-based practice in the rapidly changing health care environment. The aim of this study was to investigate health care professionals’ responses to organizational and workplace changes that have affected their work.MethodsWe conducted interviews with 30 health care professionals (physicians, registered nurses and assistant nurses) employed in the Swedish health care system. An inductive approach was applied, using a semi-structured interview guide developed by the authors. We used an analytical framework first published in 1999 to analyze the informants’ change responses in which change responses are perceived as a continuum ranging from a strong acceptance of change to strong resistance to change, describing seven forms of change responses along this continuum. Change response is conceptualized as a tridimensional attitude composed of three components: cognitive, affective and intentional/behavioral.ResultsAnalysis of the data yielded 10 types of change responses, which could be mapped onto 5 of the 7 change response categories in the framework. Participants did not report change responses that corresponded with the two most extreme forms of responses in the framework, i.e., commitment and aggressive resistance. Most of the change responses were classified as either indifference or passive resistance to changes. Involvement in or support for changes occurred when the health care professionals initiated the changes themselves or when the changes featured their active input and when changes were seen as well founded and well communicated. We did not identify any change responses that could not be fitted into the framework.ConclusionsWe found the framework to be useful for a nuanced understanding of how people respond to changes. This knowledge of change responses is useful for the management of changes and for efforts to achieve more successful implementation of evidence-based practices in health care.

Testing the leadership and organizational change for implementation (LOCI) intervention in Norwegian mental health clinics: a stepped-wedge cluster randomized design study protocol

BackgroundAlignment across levels of leadership within an organization is needed for successful implementation of evidence-based practice. The leadership and organizational change for implementation (LOCI) intervention is a multi-faceted multilevel implementation strategy focusing on enhancing first-level general and implementation leadership while also engaging with organization upper management to develop an organizational climate for implementation. The aim of the project is to evaluate the effectiveness of LOCI in supporting the implementation of evidence-based treatment for PTSD in child- and adult-specialized mental health clinics in health trusts in Norway.MethodsThe study design is a stepped-wedge cluster randomized trial with enrollment of clinics in three cohorts. Executives, clinic leaders, and therapists will be asked to complete surveys assessing leadership and implementation climate. Surveys will be completed at baseline, 4, 8, 12, 16, and 20 months. Results from surveys will be shared with executives and clinic leaders to inform the subsequent creation of tailored leadership and climate development plans for enhanced implementation. Patients will complete surveys measuring traumatic events and post-traumatic stress symptoms during the therapy process. Therapy sessions will be audio or video recorded and scored for fidelity as part of training.DiscussionThis study aims to provide knowledge on how to improve leadership and organizational climate to enhance effective implementation of evidence-based treatments in mental health services.Trial registrationThe study has been registrated in ClinicalTrials with ID NCT03719651.

Comparing a Practice-Based Model with a Research-Based Model of social skills interventions for children with autism in schools

BackgroundSocial impairment is the most challenging core deficit for children with autism spectrum disorder (ASD). Several evidence-based interventions address social impairment in children with ASD; however, adoption, use, and implementation of these interventions in schools is challenging. MethodNinety-two children with ASD who received one of three intervention models: a) School personnel adapted and implemented evidence-based social skills intervention (Practice-Based Model; n = 14); b) University researcher developed and implemented evidence-based social skills intervention (Research-Based Model; n = 45); or c) standard educational practices model (Inclusion Only Model; n = 33) participated. The average age was 8.4 (SD = 1.6) years; majority was male (88%) and white (52.2%). Typically developing classmates completed sociometric ratings to determine children’s social network inclusion, and independent raters observed children on the playground using a time-interval behavior coding system to record solitary engagement and frequency of initiations. ResultsSeparate linear regression models were conducted. Children in the Research-Based Model had significantly higher social network inclusion than children in the other two settings (p = .05). Children in the Practice-Based Model had significantly lower solitary engagement (p = .04) and more initiations on the playground than children in the University Developed Model (p = .04). ConclusionsThe results suggest that researchers: 1) may learn from public school stakeholders who have lived experiences to better understand the context in which implementation occurs; and 2) should partner with schools to learn about their processes of adaptation and adoption in order to facilitate successful implementation of evidence-based practices for children with ASD. Interventions designed with implementation in mind may be more feasible and increase the chances of use in schools.