Background People with serious mental illness die 10–20 years earlier than the overall population, mainly from cardiovascular disease. Although effective interventions to manage cardiovascular disease...

Background Implementation strategies are methods or techniques to improve the adoption, implementation, sustainment, and scale-up of evidence-based interventions. Limited guidance exists on feasible p...

Background Implementation costs—the combined costs of delivering expert support and participating in an implementation endeavor—are often omitted from economic evaluations. When included, delivery and...

Background Digital health interventions are increasingly promoted in healthcare and prevention practices due to their potential for reaching key populations in a cost-efficient manner. Yet there has been limited research on how to effectively implement them with pragmatic approaches that can facilitate scale-up. Keep It Up! (KIU!) 3.0 was a hybrid type 3 implementation–effectiveness trial comparing two delivery strategies (i.e. trial arms) of an HIV prevention intervention for cisgender, young men who have sex with men. We aimed to determine the level of pragmatism of our two-armed trial before and after changes to the county-randomized design. Methods We applied different versions of the PRagmatic Explanatory Continuum Indicator Summary (PRECIS) tool to the two trial arms: delivery of KIU! by community-based organizations (CBO) versus centralized, direct-to-consumer (DTC) delivery. We scored PRECIS-2 for the original study design and the modified design in which the DTC strategy expanded nationally. We applied PRECIS-2-PS to the modified study design. Nine coders in three groups independently scored the tools. Scores were iteratively discussed to arrive at one consensus score per domain, tool, design stage, and arm. We plotted results using the PRECIS-2 and PRECIS-2-PS wheels and averaged domains scores to describe overall score along the Pragmatic–Explanatory Continuum. Results Using PRECIS-2, the trial was on the pragmatic side of the spectrum for both arms and design stages, with average ratings ranging from 3.89–4.33. Both arms were highly pragmatic in the original and modified design in the Setting and Primary Analysis domains and least pragmatic in the Follow-up domain. In the modified trial design, the CBO and DTC arms again scored rather pragmatic using the PRECIS-2-PS tool, but CBO arm scored higher in the eligibility, recruitment, and organization domains compared to PRECIS-2 (5 vs. 4, respectively). Conclusions Application of both the PRECIS-2 and PRECIS-2-PS tools validated the pragmatic design of KIU! 3.0 as originally designed and after modifications during trial implementation. Our findings highlight instances where one tool may be more suitable than the other to assess the pragmatic–explanatory continuum for emerging digital health interventions delivered in diverse settings and with different implementation strategies.

Background Financial incentives are increasingly used to achieve UNAIDS' 95–95-95 goals for ending HIV by 2030. While evidence supports their effectiveness, scaling these interventions remains challenging. This study examines the implementation successes and challenges of a financial incentive intervention in Tanzania, delivered via an mHealth application that provides automated mobile money disbursements, biometric identification, and SMS reminders. Methods Conducted alongside a Hybrid Type 1 Effectiveness-Implementation trial, the study evaluated financial incentives given to adults starting ART at 32 clinics. We used the Structured Assessment of Feasibility, Compatibility Beliefs in Technology (CBIT) scales, and the Program Sustainability Assessment Tool. Perspectives from 657 participants living with HIV and 90 clinic staff were collected using Proctor’s implementation science framework. Results Clinic staff rated the mHealth system highly on CBIT subscales for perceived usefulness, ease of use, and compatibility, each scoring over 6 out of 7. Integration and applicability of the financial incentive within the mHealth system were well received, with 93.0% of staff agreeing it improved job performance. Among participants, 86.4% found SMS reminders helpful for attending appointments, and 76.7% felt the cash delivery met their expectations. Challenges included unreliable fingerprint identification and undelivered SMS reminders. Conclusions Despite issues with fingerprint identification and SMS delivery, the financial incentive intervention via mHealth was found to be acceptable, feasible, and potentially sustainable in resource-limited settings, with support from host governments. Future research should enhance the intervention's effectiveness and optimize biometric identification methods. Trial registration ClinicalTrials.gov NCT04201353. Registered 17 December 2019, https://clinicaltrials.gov/study/NCT04201353

Background Forensic mental health (FMH) serves as a critical juncture between the mental health and criminal justice systems. Factors on multiple levels – including sociopolitical, organizational, and individual— pose challenges to conducting implementation research in these settings. This hinders the uptake of evidence-based interventions and improvements to patient outcomes. This study examined implementation research conducted in FMH settings to understand its current state and inform future implementation research and practice. Methods We conducted a scoping review following the Joanna Briggs Institute methodology. A comprehensive literature search was performed across seven databases from their inception through April 2024, supplemented by searches in Google Scholar and six review studies, to identify relevant research. We analyzed included studies descriptively to explore determinants, strategies, and outcomes associated with the implementation of evidence-, or policy-based interventions in FMH. Results Of the 1327 records retrieved, 41 implementation studies were included. All studies were conducted in high-income countries and focused on interventions such as risk assessment, rehabilitation, patient support, and technology interventions, primarily using qualitative approaches. Key determinants for implementing interventions in FMH included individual characteristics (e.g., motivation, capacity) and inner setting factors (e.g., intervention compatibility with existing practices, access to knowledge and information). Various strategies, such as using evaluative and iterative strategies, training and educating stakeholders, changing infrastructure, and engaging consumers have been used to facilitate intervention uptake in FMH. Implementation outcomes primarily focused on uptake, fidelity, and acceptability. Conclusions There is a clear need for more implementation research using rigorous study designs in FMH. Multilevel implementation strategies should be employed to address barriers from both the inner settings and individual characteristics, thereby promoting the successful implementation of interventions in FMH. Future implementation research should incorporate a health equity lens throughout the research process to enhance inclusivity and improve reporting on implementation strategies to support replications of interventions in FMH.

Background The demand for homecare is increasing, and reducing low-value care is essential for achieving sustainable healthcare. Low-value care refers to practices that are ineffective, inefficient, unwanted, or potentially harmful to the client. This study aimed to evaluate the effects of a tailored, multifaceted deimplementation strategy in reducing low-value home-based nursing care. Methods A prospective, multicenter, convergent parallel mixed method design was employed, including a before-and-after study, using the Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) framework. The effect of reducing low-value home-based nursing care was assessed from client records, focusing on the number of clients receiving care, minutes of care per week, frequency of visits per week, and clients no longer requiring care. The de-implementation process was evaluated qualitatively through individual interviews with de-implementation ambassadors, registered nurses, and nurse assistants, using Directed Qualitative Content Analysis. This approach served to interpret the effects of the deployment of de-implementation ambassadors and the strategies they implemented. Results We observed a reduction in low-value home-based nursing care, with a decrease of 130 h per week in daily showering, bathing and/or dressing; 54 h per week in the assistance with compression stockings; and 8 h per week in changing bandages enabling clients to regain their independence. Important de-implementation strategies included involving clients and relatives in decision making, organizing informational meetings for homecare professionals, and fostering collaboration with other healthcare professionals. Factors that influenced adoption included providing reassurance and using a stepwise approach with clients and relatives. Homecare professionals noted that the de-implementation ambassadors were highly committed to reducing care. De-implementation ambassadors found their role to be intense, challenging, and exciting. Conclusions This evaluation found that the deployment of de-implementation ambassadors, paired with additional de-implementation strategies, enhanced the reduction of low-value home-based nursing care. Providing reassurance and involving clients and their relatives were identified as beneficial for the de-implementation process.

Background In the U.S., racial and ethnic disparities in hypertension control contribute to disparities in cardiovascular mortality. Evidence-based practices (EBPs) for improving hypertension control have not been consistently applied across patient subgroups, especially in safety-net settings, contributing to observed disparities. The Los Angeles County Department of Health Services serves racially and ethnically diverse, low-income patients with hypertension and represents a valuable setting for research to reduce disparities. We designed a hybrid Type 3 effectiveness-implementation study using a three-arm, crossover randomized controlled trial to compare the effects of patient- and provider-focused strategies and usual implementation strategy on key implementation and clinical outcomes. Methods We will enroll 27 primary care clinics. Patient-focused implementation strategies aim to increase patient access to culturally and linguistically tailored educational materials on hypertension and improve patient engagement in hypertension care. Provider-focused strategies include training in culturally tailored hypertension care and activities to strengthen clinic workflows for home blood pressure monitoring, medication titration, referral to nurse-directed blood pressure clinics, and social needs screening and referral. Implementation facilitators provide support for these EBPs. The primary implementation outcome is provider EBP adoption clustered at the clinic level, based on a scoring system using medical records, clinic observation, and webinar participation. The primary health-related outcome is the proportion of patients in a clinic with controlled hypertension by race and ethnicity. We will use the constrained generalized Poisson mixed-effects model to compare changes in event rate of provider EBP adoption between usual implementation strategy and either provider- or patient-focused strategies. We will use constrained logistic mixed-effects models to assess the effect on change in blood pressure control. We will record implementation progress using the Stages of Implementation Completion tool and identify costs and resource use using the Cost of Implementing New Strategies tool. Discussion Our study contributes to the implementation science literature on cardiovascular health equity by examining alternative implementation strategies to increase use of culturally and linguistically tailored hypertension EBPs and social needs screening and intervention. Findings from our study will build evidence for implementation of hypertension EBPs in safety-net and other health systems serving racial and ethnic minority patients. Trial registration Clinicaltrials.gov NCT06359691, registered April 10, 2024.

Background Despite substance use disorders (SUD) being a leading cause of preventable death in the US, most people who visit primary care in the US are not screened for SUD. There are multiple barriers to screening for, identifying, and managing SUD in primary care. However, there are also promising strategies available to address these barriers, including practice facilitation (PF), learning collaboratives (LC), and performance incentives (PI). Methods This study is a 48-site cluster-randomized 2 × 2 factorial implementation trial that aims to compare the effectiveness of several strategies for implementing evidence-based screening and interventions for SUDs in primary care. Practices will be randomized to one of four implementation strategies: (1) PF only, (2) PF + LC, (3) PF + PI, or (4) all three strategies. An estimated 144 participants from 48 primary care practices will be enrolled. All participants will receive PF to guide them in making changes to implement screening for SUD, focusing on a defined change package and associated tools. PF includes quality improvement (QI) coaching, as well as electronic health record (EHR) support, training, and expert consultation. LC includes monthly virtual education sessions led by content experts to support practice improvement and innovation with didactics on key topics as well as facilitating participant interactions to share experiences. PI includes financial incentives for performance. Primary care practices will be the unit of analysis for both the primary outcome (rate of SUD screening) and secondary outcomes (rates of evidence-based interventions for SUD). Assessments will be conducted during a 12-month implementation phase and 12-month sustainment phase. Discussion This study will produce evidence regarding the comparative effectiveness of several strategies on implementation and sustainment of evidence-based screening and interventions for SUD within primary care. It will also generate knowledge about mechanisms of change in primary care settings. The results are expected to have a positive impact by providing a nuanced understanding of the incremental benefits of LC and/or PI to inform primary care practices, health systems, policymakers, and payers about optimal implementation strategies for SUD screening and evidence-based interventions. Trial registration ClinicalTrials.gov NCT06524232. July 23, 2024 –registered.

Background Implementation scientists increasingly recognize the value of multiple strategies to improve the adoption, fidelity, and scale up of an evidence-based intervention (EBI). However, with this recognition comes the need for alternative and innovative methods to ensure that the package of implementation strategies work well within constraints imposed by the need for affordability, scalability, and/or efficiency. The aim of this article is to illustrate that this can be accomplished by integrating principles of intervention optimization into implementation science. Method We use a hypothetical example to illustrate the application of the multiphase optimization strategy (MOST) to develop and optimize a package of implementation strategies designed to improve clinic-level adoption of an EBI for smoking cessation. Results We describe the steps an investigative team would take using MOST for an implementation science study. For each of the three phases of MOST (preparation, optimization, and evaluation), we describe the selection, optimization, and evaluation of four candidate implementation strategies (e.g., training, treatment guide, workflow redesign, and supervision). We provide practical considerations and discuss key methodological points. Conclusion Our intention in this methodological article is to inspire implementation scientists to integrate principles of intervention optimization in their studies, and to encourage the continued advancement of this integration.

Background The overlapping epidemics of opioid use disorder (OUD) and HIV present a critical public health challenge. Although people with OUD frequently engage with healthcare settings, uptake of HIV...

Background Adverse Childhood Experiences (ACEs) screenings are increasingly being used in primary care clinics to identify toxic stress and potential trauma in children. ACEs are negative life events ...

Background Contextual factors, or determinants, are commonly assessed in implementation studies due to their impact on the implementation process. While a substantial number of determinants have been ...

Background The number of Dissemination and Implementation Science (DIS) capacity building programs is increasing worldwide. These programs aim to enhance diverse DIS skills through a variety of activi...

Background Integrated care is a promising strategy to advance system transformation, care coordination, equity, and better health outcomes. Health services and policy research can drive evidence-infor...

Background The Consolidated Framework for Implementation Research (CFIR) is a determinant framework that includes constructs from many implementation theories, models, and frameworks; it is used to pr...

Background Digital Intensive Care Unit (ICU) diaries can enhance the mental health of ICU survivors and their relatives by bridging memory gaps, improving understanding of ICU experiences, and providi...

Background Implementation failure is a major barrier to program success. It is widely acknowledged that context matters—individual, community, and organizational norms, values, environment, and priori...

Background Rigorous implementation evaluations are needed to understand factors that influence implementation and sustainability of evidence-based interventions across contexts. In this study, we cond...

Background Shifts toward “new public governance” (NPG), where policy decisions and their implementation are “co-produced” by a policy network, have captured the attention of policymakers as an approac...

Background Screening for gastrointestinal (GI) cancers, specifically colorectal cancer (CRC) and hepatocellular carcinoma (HCC), is often inadequately and inequitably implemented, leading to preventab...

Background Community-engaged research (CER) leverages knowledge, insights, and expertise of researchers and communities to address complex public health challenges and improve community well-being. CE...

Background In Malawi and elsewhere in Africa, many children living with HIV are unaware of their status, often because of missed services for the prevention of vertical transmission of HIV (PVTH). Pre...