Use Of Implementation Research Research Articles

General and special education teachers' attitudes towards evidence‐based practice

AbstractIn the context of special and inclusive education, applying evidence‐based practice (EBP) is important for providing equal access to effective and efficient education for students, regardless of their ability status. However, there is a relevant research‐practice gap in this area. To better understand how teachers can be supported using evidence‐based interventions and to identify training and development needs, we developed a questionnaire on attitudes towards EBP and piloted it with a sample of 809 teachers in Germany. The factor structure was determined using categorical exploratory factor analysis in half of the sample and then confirmed using categorical confirmatory factor analysis in the other half. Good model fit and factor reliability were observed. The instrument is measurement‐invariant between general and special education teachers. As expected, we found more positive attitudes towards EBP among special education teachers. No significant differences were observed between the different age groups. Based on these findings, it can be assumed that the measurement instrument is suitable for use in implementation research, as well as in the evaluation of initial and in‐service teacher training programmes. Further studies on convergent, divergent and prognostic validities are necessary.

Implementation factors influencing the sustained provision of tele-audiology services: insights from a combined methodology of scoping review and qualitative semistructured interviews

ObjectivesThe objectives of the current study were to (a) identify long-term tele-audiology services reported to be implemented beyond the research phase and determine whether they are sustained, (b) map the...

Scaling-up Evidence-based Interventions for Communities of Color With Marked Health Disparities: Lessons Learned From COVID-19 Can Be Applied to Reduce Morbidity and Mortality and Achieve Health Equity.

Scaling-up Evidence-based Interventions for Communities of Color With Marked Health Disparities: Lessons Learned From COVID-19 Can Be Applied to Reduce Morbidity and Mortality and Achieve Health Equity.

Implementation Science for the Prevention and Treatment of HIV among Adolescents and Young Adults in Sub-Saharan Africa: A Scoping Review

Despite many evidence-based adolescent and young adult (AYA) HIV interventions, few are implemented at scale in sub-Saharan Africa (SSA). A growing implementation science literature provides important context for scaling up AYA HIV interventions in this high HIV-burden region. This scoping review examined the use of implementation research in AYA HIV studies conducted in SSA. We searched five databases and included articles which focused on AYA (10–24 years old), addressed HIV prevention or treatment, were conducted exclusively in SSA countries, and included an implementation science outcome. We included 44 articles in 13 SSA countries. Most were in East (52.3%) and South Africa (27.3%), and half focused exclusively on HIV prevention components of the care continuum. Acceptability and feasibility were the most cited implementation science outcomes. Only four articles used an established implementation science framework. The findings informed our recommendations to guide the design, implementation, and dissemination of further studies and health policymaking.

Implementation research approaches to promoting universal health coverage in Africa: a scoping review

BackgroundImplementation research has emerged as part of evidence-based decision-making efforts to plug current gaps in the translation of research evidence into health policy and practice. While there has been a growing number of initiatives promoting the uptake of implementation research in Africa, its role and effectiveness remain unclear, particularly in the context of universal health coverage (UHC). Hence, this scoping review aimed to identify and characterise the use of implementation research initiatives for assessing UHC-related interventions or programmes in Africa.MethodsThe review protocol was developed based on the methodological framework proposed by Arksey and O’Malley, as enhanced by the Joanna Briggs Institute. The review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). MEDLINE, Scopus and the Cochrane Library were searched. The search also included a hand search of relevant grey literature and reference lists. Literature sources involving the application of implementation research in the context of UHC in Africa were eligible for inclusion.ResultsThe database search yielded 2153 records. We identified 12 additional records from hand search of reference lists. After the removal of duplicates, we had 2051 unique records, of which 26 studies were included in the review. Implementation research was used within ten distinct UHC-related contexts, including HIV; maternal and child health; voluntary male medical circumcision; healthcare financing; immunisation; healthcare data quality; malaria diagnosis; primary healthcare quality improvement; surgery and typhoid fever control. The consolidated framework for implementation research (CFIR) was the most frequently used framework. Qualitative and mixed-methods study designs were the commonest methods used. Implementation research was mostly used to guide post-implementation evaluation of health programmes and the contextualisation of findings to improve future implementation outcomes. The most commonly reported contextual facilitators were political support, funding, sustained collaboration and effective programme leadership. Reported barriers included inadequate human and other resources; lack of incentives; perception of implementation as additional work burden; and socio-cultural barriers.ConclusionsThis review demonstrates that implementation research can be used to achieve UHC-related outcomes in Africa. It has identified important facilitators and barriers to the use of implementation research for promoting UHC in the region.

Two imperatives for progress in maternal and child nutrition in Subsaharan Africa: better use of implementation research and decentralised governance in nutrition programmes.

Two imperatives for progress in maternal and child nutrition in Subsaharan Africa: better use of implementation research and decentralised governance in nutrition programmes.

Protocol for a scoping review of implementation research approaches to universal health coverage in Africa

IntroductionImplementation research has emerged as part of evidence-based decision-making efforts to plug current gaps in the translation of research evidence into health policy and practice. While there has been a...

Knowing the costs of change: an introduction to health economic analyses and considerations for their use in implementation research

ABSTRACTEconomic evaluations examine the costs and benefits of health interventions and are commonly used to assist decision makers in the appropriate allocation of health resources. Although considered as an important element for informing knowledge translation, they are yet to be routinely used in implementation research. This tutorial provides an introduction to health economics. It defines the different types of economic analysis including cost-minimization, cost-effectiveness, cost-utility, and cost–benefit analysis. The process of planning and collecting data from a health service and societal perspective is discussed, incorporating cost data (human resources, accommodation, and equipment) and outcome data including health-related quality of life measures. Next, an overview of how this data is used in different types of economic analysis is provided, along with how results can be interpreted to guide decision makers. To provide context, four example studies have been chosen to illustrate the application of these concepts in speech-language pathology research. Finally, the application of health economics in implementation research is discussed. This includes informing the cost of implementation and using economic modelling to examine cost changes when altering an intervention’s conditions or environment. Regardless of the analysis to be undertaken, consultation with a health economist is advised to ensure the evaluation is robust and comprehensive, and that the results disseminated use recommended reporting standards to accurately inform the appropriate allocation of healthcare resources.

Evaluating the implementation of a prisoner re-entry initiative for individuals with opioid use and mental health disorders: Application of the consolidated framework for implementation research in a cross-system initiative

Given the interrelated nature of opioid use, criminal justice interaction, and mental health issues, the current opioid crisis has created an urgent need for treatment, including medication assisted treatment, among justice-involved populations. Implementation research plays an important role in improving systems of care and integration of evidence-based practices within and outside of criminal justice institutions. The current study is a formative qualitative evaluation of the implementation of a cross-system (corrections and community-based) opioid use treatment initiative supported by Opioid State Targeted Response (STR) funding. The purpose of the study is to assess the fit of the Consolidated Framework for Implementation Research (CFIR) to a cross-system initiative, and to identify key barriers and facilitators to implementation.The process evaluation showed that adaptability of the clinical model and staff flexibility were critical to implementation. Cultural and procedural differences across correctional facilities and community-based treatment programs required frequent and structured forums for cross-system communication. Challenges related to recruitment and enrollment, staffing, MAT, and data collection were addressed through the collaborative development and continuous review of policies and procedures.This study found CFIR to be a useful framework for understanding implementation uptake and barriers. The framework was particularly valuable in reinforcing the use of implementation research as a means for continuous process improvement. CFIR is a comprehensive and flexible framework that may be adopted in future cross-system evaluations.

Implementation research: new imperatives and opportunities in global health

Implementation research is important in global health because it addresses the challenges of the know-do gap in real-world settings and the practicalities of achieving national and global health goals. Implementation research is an integrated concept that links research and practice to accelerate the development and delivery of public health approaches. Implementation research involves the creation and application of knowledge to improve the implementation of health policies, programmes, and practices. This type of research uses multiple disciplines and methods and emphasises partnerships between community members, implementers, researchers, and policy makers. Implementation research focuses on practical approaches to improve implementation and to enhance equity, efficiency, scale-up, and sustainability, and ultimately to improve people's health. There is growing interest in the principles of implementation research and a range of perspectives on its purposes and appropriate methods. However, limited efforts have been made to systematically document and review learning from the practice of implementation research across different countries and technical areas. Drawing on an expert review process, this Health Policy paper presents purposively selected case studies to illustrate the essential characteristics of implementation research and its application in low-income and middle-income countries. The case studies are organised into four categories related to the purposes of using implementation research, including improving people's health, informing policy design and implementation, strengthening health service delivery, and empowering communities and beneficiaries. Each of the case studies addresses implementation problems, involves partnerships to co-create solutions, uses tacit knowledge and research, and is based on a shared commitment towards improving health outcomes. The case studies reveal the complex adaptive nature of health systems, emphasise the importance of understanding context, and highlight the role of multidisciplinary, rigorous, and adaptive processes that allow for course correction to ensure interventions have an impact. This Health Policy paper is part of a call to action to increase the use of implementation research in global health, build the field of implementation research inclusive of research utilisation efforts, and accelerate efforts to bridge the gap between research, policy, and practice to improve health outcomes.

Evaluation of Communities of Practice performance developing implementation research to enhance maternal health decision-making in Mexico and Nicaragua

Despite the existence of proven solutions to improve maternal health, innovative approaches are still necessary to support the implementation of programs and policies in real-world settings. To address this challenge, we developed a participatory capacity strengthening model based on Communities of Practice (CoPs) of maternal health frontline personnel and decision-makers involved in implementing maternal health programs in Latin America. The activities focused on the conduct and use of implementation research to enhance maternal health decision-making. Our objective is to evaluate the performance of the Communities of Practice in using implementation research to support decision-making in maternal health programs in Mexico and Nicaragua. We evaluated the CoPs’ performance using a mixed methods approach. We appraised the performance of CoPs using five criteria: (i) integration of the CoP, (ii) ownership of the methodology, (iii) timely delivery of products, (iv) feedback to decision-makers, and (v) influence on program changes. We also included an assessment of the barriers and facilitators to the conduct and uptake of implementation research findings in maternal health decision-making. Two CoPs showed “sub-optimal” performance, one was signaled as “needing strengthening,” and three reached “optimal” performance in the use of implementation research to enhance maternal health programs. The relationships between champions, facilitators, and research team were the main internal enabling factor for success. Externally, political and epidemiological environments acted as the main barriers to the performance of CoPs. Our study highlights the value of involving decision-makers in CoPs, ensuring varied skill sets and profiles of health professionals, as well as maintaining strong and continuous collaborations with researchers. Collaborative approaches and meaningful engagement of decision-makers and researchers are useful in conducting implementation research and promoting the use of evidence to improve maternal health programs in resource-strained settings.

A Global Perspective on Using Implementation Research to Address Hypertension-Associated Target Organ Damage.

Hypertension, a major risk factor for cardiovascular disease, imposes a significant public health burden and challenge to address it worldwide. Scaling up delivery of proven, effective interventions for hypertension could significantly advance the goal of reducing the global burden. Although significant progress has been made in many countries, some lament that large-scale initiatives focused on reducing blood pressure in global populations have not effectively addressed this challenge. Late-stage implementation research plays a critical role in determining effective and sustainable scale-up of these initiatives. In this article, we briefly discuss some of the global initiatives that have been funded by the National Heart, Lung, and Blood Institute of the US National Institutes of Health. Intervention delivery strategies in low resource settings must have demonstrated effectiveness and consideration for the social, cultural and physical context (eg, access, affordability, and availability of medications) in which a program is being delivered in order to be sustainable nationally and globally. Hence, the use of implementation research is central to determining sustainable delivery of evidence-based and tailored interventions focused on hypertension control. The sustained control of hypertension in global populations holds tremendous potential for reducing morbidity, premature mortality, and the adverse economic impact of cardiovascular disease in all regions.

A systematic review of the use of the Consolidated Framework for Implementation Research

BackgroundIn 2009, Damschroder et al. developed the Consolidated Framework for Implementation Research (CFIR), which provides a comprehensive listing of constructs thought to influence implementation. This systematic review assesses the extent to which the CFIR’s use in implementation research fulfills goals set forth by Damschroder et al. in terms of breadth of use, depth of application, and contribution to implementation research.MethodsWe searched Scopus and Web of Science for publications that cited the original CFIR publication by Damschroder et al. (Implement Sci 4:50, 2009) and downloaded each unique result for review. After applying exclusion criteria, the final articles were empirical studies published in peer-review journals that used the CFIR in a meaningful way (i.e., used the CFIR to guide data collection, measurement, coding, analysis, and/or reporting). A framework analysis approach was used to guide abstraction and synthesis of the included articles.ResultsTwenty-six of 429 unique articles (6 %) met inclusion criteria. We found great breadth in CFIR application; the CFIR was applied across a wide variety of study objectives, settings, and units of analysis. There was also variation in the method of included studies (mixed methods (n = 13); qualitative (n = 10); quantitative (n = 3)). Depth of CFIR application revealed some areas for improvement. Few studies (n = 3) reported justification for selection of CFIR constructs used; the majority of studies (n = 14) used the CFIR to guide data analysis only; and few studies investigated any outcomes (n = 11). Finally, reflections on the contribution of the CFIR to implementation research were scarce.ConclusionsOur results indicate that the CFIR has been used across a wide range of studies, though more in-depth use of the CFIR may help advance implementation science. To harness its potential, researchers should consider how to most meaningfully use the CFIR. Specific recommendations for applying the CFIR include explicitly justifying selection of CFIR constructs; integrating the CFIR throughout the research process (in study design, data collection, and analysis); and appropriately using the CFIR given the phase of implementation of the research (e.g., if the research is post-implementation, using the CFIR to link determinants of implementation to outcomes).Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0437-z) contains supplementary material, which is available to authorized users.

A checklist for identifying determinants of practice: A systematic review and synthesis of frameworks and taxonomies of factors that prevent or enable improvements in healthcare professional practice

BackgroundDeterminants of practice are factors that might prevent or enable improvements. Several checklists, frameworks, taxonomies, and classifications of determinants of healthcare professional practice have been published. In this paper, we describe the development of a comprehensive, integrated checklist of determinants of practice (the TICD checklist).MethodsWe performed a systematic review of frameworks of determinants of practice followed by a consensus process. We searched electronic databases and screened the reference lists of key background documents. Two authors independently assessed titles and abstracts, and potentially relevant full text articles. We compiled a list of attributes that a checklist should have: comprehensiveness, relevance, applicability, simplicity, logic, clarity, usability, suitability, and usefulness. We assessed included articles using these criteria and collected information about the theory, model, or logic underlying how the factors (determinants) were selected, described, and grouped, the strengths and weaknesses of the checklist, and the determinants and the domains in each checklist. We drafted a preliminary checklist based on an aggregated list of determinants from the included checklists, and finalized the checklist by a consensus process among implementation researchers.ResultsWe screened 5,778 titles and abstracts and retrieved 87 potentially relevant papers in full text. Several of these papers had references to papers that we also retrieved in full text. We also checked potentially relevant papers we had on file that were not retrieved by the searches. We included 12 checklists. None of these were completely comprehensive when compared to the aggregated list of determinants and domains. We developed a checklist with 57 potential determinants of practice grouped in seven domains: guideline factors, individual health professional factors, patient factors, professional interactions, incentives and resources, capacity for organisational change, and social, political, and legal factors. We also developed five worksheets to facilitate the use of the checklist.ConclusionsBased on a systematic review and a consensus process we developed a checklist that aims to be comprehensive and to build on the strengths of each of the 12 included checklists. The checklist is accompanied with five worksheets to facilitate its use in implementation research and quality improvement projects.

Implementation research evidence uptake and use for policy-making

A major obstacle to the progress of the Millennium Development Goals has been the inability of health systems in many low- and middle-income countries to effectively implement evidence-informed interventions. This article discusses the relationships between implementation research and knowledge translation and identifies the role of implementation research in the design and execution of evidence-informed policy. After a discussion of the benefits and synergies needed to translate implementation research into action, the article discusses how implementation research can be used along the entire continuum of the use of evidence to inform policy. It provides specific examples of the use of implementation research in national level programmes by looking at the scale up of zinc for the treatment of childhood diarrhoea in Bangladesh and the scaling up of malaria treatment in Burkina Faso. A number of tested strategies to support the transfer of implementation research results into policy-making are provided to help meet the standards that are increasingly expected from evidence-informed policy-making practices.