scholarly journals Evaluation of a Large-Scale School Wellness Intervention Through the Consolidated Framework for Implementation Research (CFIR): Implications for Dissemination and Sustainability

2021 ◽  
Author(s):  
Gabriella M McLoughlin ◽  
Rachel Sweeney ◽  
Laura Liechty ◽  
Joey A Lee ◽  
Richard R Rosenkranz ◽  
...  
Keyword(s):  
Capacity Building ◽  
Implementation Research ◽  
Relative Advantage ◽  
New Schools ◽  
Implementation Support ◽  
School Wellness ◽  
Implementation Outcomes ◽  
Bivariate Correlation ◽  
Correlation Analyses ◽  
Negative Relationships

Abstract BackgroundThe need for sustainable and scalable comprehensive school wellness interventions is evident, and the lack of attention toward capacity-building models warrants investigation. Furthermore, there is a dearth of understanding regarding implementation determinants grounded in dissemination and implementation (D&I) frameworks. This study sought to address: 1) implementation determinants of adoption, fidelity, and penetration for school-wide wellness programming; and 2) nuanced determinants between schools with prior experience and those new to the program, to enhance tailored implementation support and sustainability.MethodsThe School Wellness Integration Targeting Child Health (SWITCH®) capacity-building intervention was adopted in 52 elementary and middle (22 new; 30 experienced) schools across Iowa, United States in the 2019–2020 academic year. Mixed methods data collection and analysis procedures followed the Consolidated Framework for Implementation Research (CFIR) protocols, adapted to school settings. Implementation outcomes included: 1) fidelity/compliance to established quality elements; 2) adoption of best practices in multiple settings; and 3) penetration of behavior change practices across classrooms and grade levels. Assessed determinants comprised organizational readiness/capacity and CFIR constructs via interviews and surveys. Interview data were scored using a systematic process; each CFIR domain was assigned a score (ranging between -2 and +2) to denote either a positive or negative influence on implementation. Independent t-tests were conducted to capture potential differences between new and experienced schools, followed by Pearson bivariate correlation analyses to determine relationships between CFIR determinants and implementation outcomes. ResultsExperienced schools reported insignificantly higher fidelity (t=-1.86 p=.07) and higher rates of adoption (t=-2.03 p=.04) compared to new schools. Correlation analyses revealed positive relationships between implementation outcomes and CFIR determinants including innovation source, culture and relative priority, and leadership engagement. Negative relationships were observed in tension for change and networks and communications. Specific negative relationships for new schools between determinants and outcomes included relative advantage, engaging key stakeholders, and reflecting/evaluating, among others. ConclusionsFindings highlight the specific relationships between implementation outcomes and determinants; nuanced challenges for new schools highlight the need for a more tailored approach to implementation support and offer insights for sustainability. Adapted CFIR protocols provide opportunities for replication in other school-and community-based projects.

Adaptation in Dissemination and Implementation Science

2017 ◽  
Author(s):  
Ana A. Baumann ◽  
Leopoldo J. Cabassa ◽  
Shannon Wiltsey Stirman
Keyword(s):  
Implementation Science ◽  
Implementation Research ◽  
Implementation Strategies ◽  
Dissemination And Implementation ◽  
Research And Practice ◽  
Implementation Outcomes ◽  
Dissemination And Implementation Science ◽  
Dissemination And Implementation Research

This chapter focuses on adaptations in the context of dissemination and implementation research and practice. Consistent with the existing literature, the authors recommend that adaptations be proactively and iteratively determined, strongly informed by a variety of stakeholders, and that efforts be made to carefully describe and document the nature of the adaptations and evaluate their impact on desired service, health, and implementation outcomes. While this chapter focuses on adaptations to interventions and the context of practice, the authors also note that adaptations may need to be made to implementation strategies. Following the call by Proctor and colleagues for further precision in defining and operationalizing implementation strategies, and based on evidence that scholars are not necessarily reporting what and how they are adapting the interventions, scholars are urged to define and evaluate the adaptations they are making not only to the interventions and context of practice but also to the implementation strategies.

scholarly journals Integrating implementation science in clinical research to maximize public health impact: a call for the reporting and alignment of implementation strategy use with implementation outcomes in clinical research

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Brittany N. Rudd ◽  
Molly Davis ◽  
Rinad S. Beidas
Keyword(s):  
Public Health ◽  
Clinical Research ◽  
Implementation Research ◽  
Implementation Strategy ◽  
Health Impact ◽  
Strategy Use ◽  
Reporting Guidelines ◽  
Public Health Impact ◽  
Main Body ◽  
Implementation Outcomes

Abstract Background Although comprehensive reporting guidelines for implementation strategy use within implementation research exist, they are rarely used by clinical (i.e., efficacy and effectiveness) researchers. In this debate, we argue that the lack of comprehensive reporting of implementation strategy use and alignment of those strategies with implementation outcomes within clinical research is a missed opportunity to efficiently narrow research-to-practice gaps. Main body We review ways that comprehensively specifying implementation strategy use can advance science, including enhancing replicability of clinical trials and reducing the time from clinical research to public health impact. We then propose that revisions to frequently used reporting guidelines in clinical research (e.g., CONSORT, TIDieR) are needed, review current methods for reporting implementation strategy use (e.g., utilizing StaRI), provide pragmatic suggestions on how to both prospectively and retrospectively specify implementation strategy use and align these strategies with implementation outcomes within clinical research, and offer a case study of using these methods. Conclusions The approaches recommended in this article will not only contribute to shared knowledge and language among clinical and implementation researchers but also facilitate the replication of efficacy and effectiveness research. Ultimately, we hope to accelerate translation from clinical to implementation research in order to expedite improvements in public health.

scholarly journals Evaluating the implementation of the SWITCH® school wellness intervention and capacity-building process through multiple methods

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Gabriella M. McLoughlin ◽  
Priscila Candal ◽  
Spyridoula Vazou ◽  
Joey A. Lee ◽  
David A. Dzewaltowski ◽  
...  
Keyword(s):  
Physical Education ◽  
Best Practices ◽  
Capacity Building ◽  
Qualitative Data ◽  
Specific Capacity ◽  
Organizational Capacity ◽  
School Capacity ◽  
School Wellness ◽  
Building Process ◽  
Over Time

Abstract Background School wellness programming is important for promoting healthy lifestyles and academic achievement in youth; however, research is needed on methods that can help schools implement and sustain such programs on their own. The purpose of this study was to investigate factors within and outside the school environment that influenced school capacity for implementation and potential sustainability of wellness programming. Methods As part of the School Wellness Integration Targeting Child Health (SWITCH®) intervention, elementary school wellness teams (N = 30) were guided through a capacity-building process focused on promoting the adoption of healthy lifestyle behaviors in students. Data on implementation were collected through three standardized surveys and interviews (pre-mid-post) and a post-implementation interview. Indicators of organizational capacity were assessed using the School Wellness Readiness Assessment (SWRA). Paired t-tests were run to assess changes in implementation (classroom, physical education, and lunchroom settings), capacity, and stakeholder engagement over time. One-way analysis of variance (ANOVA) tests were run to examine how implementation of best practices (low, moderate, high) explained differences in capacity gains. Qualitative data were analyzed through inductive and deductive analysis, following the Consolidated Framework for Implementation Research (CFIR). Results Paired t-tests showed non-significant increases in school and setting-specific capacity and implementation of SWITCH best practices over time, in addition to a consistent level of engagement from key stakeholders. ANOVA results revealed non-significant associations between implementation group and gains in school capacity (F [2, 24] = 1.63; p = .21), class capacity (F [2, 24]=0.20 p = .82), lunchroom capacity (F [2, 24]=0.29; p = .78), and physical education (F [2, 24]=1.45; p = .25). Qualitative data demonstrated that factors within the outer setting (i.e., engaging community partners) facilitated programming. Inner-setting factors (i.e., relationships with administration and staff) influenced implementation. Implementation process themes (e.g., planning, adaptation of resources to meet school capacity/needs, and engaging students as leaders) were cited as key facilitators. Schools discussed factors affecting sustainability, such as school culture and knowledge of school wellness policy. Conclusions The results from this implementation study document the importance of allowing schools to adapt programming to meet their local needs, and highlight the strengths of measuring multiple implementation outcomes. Increased support is needed for schools regarding the formation and improvement of wellness policies as a means to enhance sustainability over time.

scholarly journals Differences in Risk Perception of Water Quality and Its Influencing Factors between Lay People and Factory Workers for Water Management in River Sosiani, Eldoret Municipality Kenya

Water ◽  
2020 ◽  
Vol 12 (8) ◽  
pp. 2248
Author(s):  
Anne Wambui Mumbi ◽  
Tsunemi Watanabe
Keyword(s):  
Water Pollution ◽  
Risk Perception ◽  
Linear Regression ◽  
Multiple Linear Regression ◽  
Risk Perceptions ◽  
Factory Workers ◽  
Bivariate Correlation ◽  
Correlation Analyses ◽  
Lay People ◽  
The Impact

This study evaluates the differences between risk predictors and risk perception regarding water pollution. Specifically, it focuses on the differences in risk perception between factory workers and lay people situated in textile industries near the River Sosiani in Eldoret, Kenya. The lay people are divided into two groups. The respondents living downstream are situated mostly in town centers and at the mid/lower parts of the river, and the respondents living upstream are mainly found at the upper parts of the River Sosiani. Data were obtained from 246 participants using questionnaires. Several factors influencing risk perception were selected to evaluate the degree of perceived risk amongst the groups. Descriptive statistics, mean score and correlation analyses, and multiple linear regression models were used to analyse the data. The one-way ANOVA results showed statistically different levels of risk perceptions amongst the groups. The partial and bivariate correlation analyses revealed the differences in scientific knowledge between respondents upstream and downstream. The multiple linear regression analysis showed that each group used different variables to determine risks in the region. In the factory group, 56.1% of the variance in risk perception is significantly predicted by sensorial factors, trust in the government’s capacity to manage water pollution and the impact of water pollution on human health. About 65.9% of the variance in risk perception of the downstream inhabitants is significantly predicted by sensorial factors, the possibility of industries generating water pollution, and previous experience with water pollution. For the respondents located upstream, age, sensorial factors, trust in the government and the possibility of being impacted by water pollution factors significantly predicted 37.05% of the variance in risk perception. These findings indicate that enhanced public participation in water governance amongst the residents of Eldoret town is needed, along with an understanding of the different characteristics of the respondents in the region during risk communication. This will boost awareness in the region and promote the adoption of better practices to minimise the adverse effects of water pollution faced by the region.

scholarly journals Implementation Determinants and Outcomes of a Technology-Enabled Service Targeting Suicide Risk in High Schools: Mixed Methods Study

10.2196/16338 ◽  
2020 ◽  
Vol 7 (7) ◽  
pp. e16338
Author(s):  
Molly Adrian ◽  
Jessica Coifman ◽  
Michael D Pullmann ◽  
Jennifer B Blossom ◽  
Casey Chandler ◽  
...  
Keyword(s):  
Mental Health ◽  
Data Collection ◽  
Suicide Prevention ◽  
Suicide Risk ◽  
School Setting ◽  
Usability Testing ◽  
School Personnel ◽  
Relative Advantage ◽  
Implementation Outcomes ◽  
Passive Data

Background Technology-enabled services (TESs), which integrate human service and digital components, are popular strategies to increase the reach and impact of mental health interventions, but large-scale implementation of TESs has lagged behind their potential. Objective This study applied a mixed qualitative and quantitative approach to gather input from multiple key user groups (students and educators) and to understand the factors that support successful implementation (implementation determinants) and implementation outcomes of a TES for universal screening, ongoing monitoring, and support for suicide risk management in the school setting. Methods A total of 111 students in the 9th to 12th grade completed measures regarding implementation outcomes (acceptability, feasibility, and appropriateness) via an open-ended survey. A total of 9 school personnel (school-based mental health clinicians, nurses, and administrators) completed laboratory-based usability testing of a dashboard tracking the suicide risk of students, quantitative measures, and qualitative interviews to understand key implementation outcomes and determinants. School personnel were presented with a series of scenarios and common tasks focused on the basic features and functions of the dashboard. Directed content analysis based on the Consolidated Framework for Implementation Research was used to extract multilevel determinants (ie, the barriers or facilitators at the levels of the outer setting, inner setting, individuals, intervention, and implementation process) related to positive implementation outcomes of the TES. Results Overarching themes related to implementation determinants and outcomes suggest that both student and school personnel users view TESs for suicide prevention as moderately feasible and acceptable based on the Acceptability of Intervention Measure and Feasibility of Intervention Measure and as needing improvements in usability based on the System Usability Scale. Qualitative results suggest that students and school personnel view passive data collection based on social media data as a relative advantage to the current system; however, the findings indicate that the TES and the school setting need to address issues of privacy, integration into existing workflows and communication patterns, and options for individualization for student-centered care. Conclusions Innovative suicide prevention strategies that rely on passive data collection in the school context are a promising and appealing idea. Usability testing identified key issues for revision to facilitate widespread implementation.

scholarly journals Toolkits for dissemination and implementation research: Preliminary development

2018 ◽  
Vol 2 (4) ◽  
pp. 239-244
Author(s):  
Ana A. Baumann ◽  
Alexandra B. Morshed ◽  
Rachel G. Tabak ◽  
Enola K. Proctor
Keyword(s):  
Capacity Building ◽  
Research Methods ◽  
Implementation Research ◽  
Dissemination And Implementation ◽  
Local Contexts ◽  
Dissemination And Implementation Research ◽  
Washington University ◽  
Research Resources

The Dissemination and Implementation Research Core, a research methods core from the Clinical and Translation Science Award at Washington University in St. Louis Institute of Clinical and Translational Sciences, developed toolkits about dissemination and implementation (D&I) concepts (e.g., D&I outcomes, strategies). This paper reports on the development of the toolkits. These toolkits respond to 3 identified needs for capacity building in D&I research: resources for investigators new to the D&I field, consolidation of tools, and limitations in local contexts.

scholarly journals Implementing alcohol use disorder pharmacotherapy in primary care settings: a qualitative analysis of provider-identified barriers and impact on implementation outcomes

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Hildi J. Hagedorn ◽  
Jennifer P. Wisdom ◽  
Heather Gerould ◽  
Erika Pinsker ◽  
Randall Brown ◽  
...  
Keyword(s):  
Primary Care ◽  
Alcohol Use ◽  
Primary Care Providers ◽  
Relative Advantage ◽  
Implementation Intervention ◽  
Health Administration ◽  
Care Providers ◽  
Implementation Barriers ◽  
Primary Care Settings ◽  
Implementation Outcomes

Abstract Background Despite the high prevalence of alcohol use disorders (AUDs), in 2016, only 7.8% of individuals meeting diagnostic criteria received any type of AUD treatment. Developing options for treatment within primary care settings is imperative to increase treatment access. As part of a trial to implement AUD pharmacotherapy in primary care settings, this qualitative study analyzed pre-implementation provider interviews using the Consolidated Framework for Implementation Research (CFIR) to identify implementation barriers. Methods Three large Veterans Health Administration facilities participated in the implementation intervention. Local providers were trained to serve as implementation/clinical champions and received external facilitation from the project team. Primary care providers received a dashboard of patients with AUD for case identification, educational materials, and access to consultation from clinical champions. Veterans with AUD diagnoses received educational information in the mail. Prior to the start of implementation activities, 24 primary care providers (5–10 per site) participated in semi-structured interviews. Transcripts were analyzed using common coding techniques for qualitative data using the CFIR codebook Innovation/Intervention Characteristics, Outer Setting, Inner Setting, and Characteristics of Individuals domains. Number and type of barriers identified were compared to quantitative changes in AUD pharmacotherapy prescribing rates. Results Four major barriers emerged across all three sites: complexity of providing AUD pharmacotherapy in primary care, the limited compatibility of AUD treatment with existing primary care processes, providers’ limited knowledge and negative beliefs about AUD pharmacotherapy and providers’ negative attitudes toward patients with AUD. Site specific barriers included lack of relative advantage of providing AUD pharmacotherapy in primary care over current practice, complaints about the design quality and packaging of implementation intervention materials, limited priority of addressing AUD in primary care and limited available resources to implement AUD pharmacotherapy in primary care. Conclusions CFIR constructs were useful for identifying pre-implementation barriers that informed refinements to the implementation intervention. The number and type of pre-implementation barriers identified did not demonstrate a clear relationship to the degree to which sites were able to improve AUD pharmacotherapy prescribing rate. Site-level implementation process factors such as leadership support and provider turn-over likely also interacted with pre-implementation barriers to drive implementation outcomes.

scholarly journals Evaluating the Implementation of the SWITCH® School Wellness Intervention and Capacity-Building Process through Multiple Methods

2020 ◽  
Author(s):  
Gabriella M McLoughlin ◽  
Priscila Candal ◽  
Spyridoula Vazou ◽  
Joey A. Lee ◽  
David A. Dzewaltowski ◽  
...  
Keyword(s):  
Physical Education ◽  
Best Practices ◽  
Capacity Building ◽  
Qualitative Data ◽  
Specific Capacity ◽  
Organizational Capacity ◽  
School Capacity ◽  
School Wellness ◽  
Building Process ◽  
Over Time

Abstract Background: School wellness programming is important for promoting healthy lifestyles and academic achievement in youth; however, research is needed on methods that can help schools implement and sustain such programs on their own. The purpose of this study was to investigate factors within and outside the school environment that influenced school capacity for implementation and potential sustainability of wellness programming. Methods: As part of the School Wellness Integration Targeting Child Health (SWITCH®) intervention, elementary school wellness teams (N = 30) were guided through a capacity-building process focused on promoting the adoption of healthy lifestyle behaviors in students. Data on implementation were collected through three standardized surveys and interviews (pre-mid-post) and a post-implementation interview. Indicators of organizational capacity were assessed using the School Wellness Readiness Assessment (SWRA). Paired t-tests were run to assess changes in implementation (classroom, physical education, and lunchroom settings), capacity, and stakeholder engagement over time. One-way analysis of variance (ANOVA) tests were run to examine how implementation of best practices (low, moderate, high) explained differences in capacity gains. Qualitative data were analyzed through inductive and deductive analysis, following the Consolidated Framework for Implementation Research (CFIR). Results: Paired t-tests showed non-significant increases in school and setting-specific capacity and implementation of SWITCH best practices over time, in addition to a consistent level of engagement from key stakeholders. ANOVA results revealed positive, non-significant variances between implementation group and gains in school capacity (F[2,24] = 1.63; p = .21), class capacity (F[2,24]=0.20 p=.82), lunchroom capacity (F[2,24]=0.29; p=.78), and physical education (F[2,24]=1.45; p=.25). Qualitative data demonstrated that factors within the outer setting (i.e., engaging community partners) facilitated programming. Inner-setting factors (i.e., relationships with administration and staff) influenced implementation. Implementation process themes (e.g., planning, adaptation of resources to meet school capacity/needs, and engaging students as leaders) were cited as key facilitators. Schools discussed factors affecting sustainability, such as school culture and knowledge of school wellness policy. Conclusions: Findings suggest a potential relationship between implementation and capacity change, which is the primary goal of SWITCH. The results document the importance of allowing schools to adapt programming to meet their local needs.

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