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Forecasting Implementation, Adoption, and Evaluation Challenges for an Electronic Game-Based Antimicrobial Stewardship Intervention: Co-Design Workshop With Multidisciplinary Stakeholders.

ABSTRACT: BACKGROUND:Serious games have been proposed to address the lack of engagement and sustainability traditionally affecting interventions aiming to improve optimal antibiotic use among hospital prescribers. OBJECTIVE:The goal of the research was to forecast gaps in implementation, adoption and evaluation of game-based interventions, and co-design solutions with antimicrobial clinicians and digital and behavioral researchers. METHODS:A co-development workshop with clinicians and academics in serious games, antimicrobials, and behavioral sciences was organized to open the International Summit on Serious Health Games in London, United Kingdom, in March 2018. The workshop was announced on social media and online platforms. Attendees were asked to work in small groups provided with a laptop/tablet and the latest version of the game On call: Antibiotics. A workshop leader guided open group discussions around implementation, adoption, and evaluation threats and potential solutions. Workshop summary notes were collated by an observer. RESULTS:There were 29 participants attending the workshop. Anticipated challenges to resolve reflected implementation threats such as an inadequate organizational arrangement to scale and sustain the use of the game, requiring sufficient technical and educational support and a streamlined feedback mechanism that made best use of data arriving from the game. Adoption threats included collective perceptions that a game would be a ludic rather than professional tool and demanding efforts to integrate all available educational solutions so none are seen as inferior. Evaluation threats included the need to combine game metrics with organizational indicators such as antibiotic use, which may be difficult to enable. CONCLUSIONS:As with other technology-based interventions, deploying game-based solutions requires careful planning on how to engage and support clinicians in their use and how best to integrate the game and game outputs onto existing workflows. The ludic characteristics of the game may foster perceptions of unprofessionalism among gamers, which would need buffering from the organization.

SUBMITTER: Castro-Sanchez E

PROVIDER: S-EPMC6746106 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

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Forecasting Implementation, Adoption, and Evaluation Challenges for an Electronic Game-Based Antimicrobial Stewardship Intervention: Co-Design Workshop With Multidisciplinary Stakeholders.

Castro-Sánchez Enrique E Sood Anuj A Rawson Timothy Miles TM Firth Jamie J Holmes Alison Helen AH

Journal of medical Internet research 20190604 6

<h4>Background</h4>Serious games have been proposed to address the lack of engagement and sustainability traditionally affecting interventions aiming to improve optimal antibiotic use among hospital prescribers.<h4>Objective</h4>The goal of the research was to forecast gaps in implementation, adoption and evaluation of game-based interventions, and co-design solutions with antimicrobial clinicians and digital and behavioral researchers.<h4>Methods</h4>A co-development workshop with clinicians an ...[more]

PMID: 31165712

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Project description:BackgroundExploring barriers to the uptake of research based recommendations into practice is an important part of the development of implementation programmes. Techniques to identify barriers can include use of theory-informed questionnaires and qualitative interviews. Conceptualising and measuring theory-informed factors, and engaging health professionals' to uncover all potential barriers, can be a difficult task. This paper presents a case study of the process of trying to identify, systematically, the key factors influencing health professionals' referrals for women diagnosed with mild to moderate postnatal depression for psychological treatment. The paper illustrates how the factors were conceptualised and measured and explores the real world challenges experienced, with implications for future implementation studies.MethodsTheory-informed factors were conceptualised and measured using a questionnaire and interviews. The questionnaire was piloted, before being administered to general practitioners, practice nurses and health visitors working in general practices in one area of the UK NHS. The interviews were conducted with a small sample of general practitioners who had not completed the questionnaire, further exploring factors influencing their referral decisions in the local context.ResultsThe response rate to the questionnaire was low (19%), despite selecting the recommendation to target through engagement with local stakeholders and surveying local health professionals, and despite using two reminders, an incentive prize, and phone calls to practice managers to bolster response rates.ConclusionsTwo significant challenges to achieving higher response rates and successfully exploring local context were identified: the difficulties of developing a robust- but feasible- questionnaire to explore theory-informed factors, and targeting recommendations that are important to policy makers, but which health professionals view as unimportant. This case study highlights the "trade-off" between scientifically rigorous collection of data against the pragmatism and flexibility requirements of "real world" implementation. Future implementation studies should explore different ways of identifying factors influencing the adoption of recommendations to bridge this gulf.

Project description:ObjectivesThis study aims to assess the implementation of the Family Medicine Programme (FMP), which has taken place in Turkey from 2005 to 2010 as a set of comprehensive primary health care (PHC) reforms and involved changes in professional organisation (eg, family medicine specialisation) and service provision (eg, patients' registration list). Our particular interest is to identify the challenges and limitations that PHC physicians and academicians have encountered in the implementation of the FMP which could have influenced the delivery of care and utilisation of services.DesignWe applied the framework method to analyse data obtained through semi-structured interviews conducted in the field. This qualitative approach involved the categorisation of raw data into a predefined framework, which comprised challenges and limitations identified in the literature, and the emergence of a new framework, whose categories corresponded to challenges and limitations identified through thematic analysis of our data.SettingPHC centres and academic departments from five Turkish provinces.ParticipantsPHC physicians and academicians involved in training and/or research were invited to participate. 20 participants agreed to take part and, due to schedule limitations, 15 participants (seven PHC physicians and eight academicians) completed the interviews.ResultsShortcomings in the planning of the reforms, inadequate commitment to integration of PHC in the system and collateral effects of a market model in healthcare emerged as limitations to successful FMP implementation. Uncertainty about care quality and physicians' ethical values as well as perceptions of organisational injustice among healthcare workers were contributing challenges.ConclusionsA systems thinking approach in the FMP design and implementation could help foresee and address these limitations. In decentralisation processes, such as FMP, shared governance by including PHC stakeholders in policy-making and planning could alleviate misalignment of interests and positively affect PHC performance, for example, by removing barriers to gatekeeping implementation.

Project description:BackgroundThe adoption of an electronic health record (EHR) in the healthcare system has the potential to make healthcare service delivery effective and efficient by providing accurate, up-to-date, and complete information. Despite its great importance, the adoptions of EHR in low-income country settings, like Ethiopia, were lagging and increasingly failed. Assessing the readiness of stakeholders before the actual adoption of EHR is considered the prominent solution to tackle the problem. However, little is known about healthcare providers' EHR readiness in this study setting. Accordingly, this research was conducted aiming at examining healthcare providers' readiness for EHR adoption and associated factors in southwestern Ethiopia.MethodsAn institutional-based cross-sectional study was conducted from September 1 to October 30, 2021. A total of 423 healthcare providers working in public hospitals were selected using a simple random sampling technique. Multivariable logistic regression was fitted to identify determinant factors of overall healthcare providers' readiness after the other covariates were controlled.ResultIn this study, the overall good readiness level of EHR adoption was 52.8% (n = 204) [95% CI of 47.9% to 56.6%]. Age, computer literacy, computer access at health facilities, attitude towards EHRs, awareness about EHRs, perceived benefit, and perceived technology self-efficacy were significantly associated with the overall health care providers' readiness for the adoption of EHR using a cut point of P-value less than 0.05.ConclusionAround half of the respondents had a good level of overall healthcare providers' readiness for the adoption of EHR which was considered inadequate. This finding implied that a huge effort is required to improve readiness before the actual implementation of EHRs. The finding implied that younger-aged groups were more ready for such technology which in turn implied; the older one needs more concern. Enhancing computer literacy, confidence building to raise self-efficacy of such technology, addressing the issue of computer availability at health facilities, building a positive attitude, awareness campaign of EHR, and recognizing the usefulness of such systems were the necessary measures to improve EHR readiness in this setting. Additionally, further studies are recommended to encompass all types of EHR readiness such as organizational readiness, technology readiness, societal readiness, and so on. Additionally, exploring the healthcare provider opinion with qualitative study and extending the proposed study to other implementation settings are recommended to be addressed by future works.

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Dataset Information

Forecasting Implementation, Adoption, and Evaluation Challenges for an Electronic Game-Based Antimicrobial Stewardship Intervention: Co-Design Workshop With Multidisciplinary Stakeholders.

Publications

Forecasting Implementation, Adoption, and Evaluation Challenges for an Electronic Game-Based Antimicrobial Stewardship Intervention: Co-Design Workshop With Multidisciplinary Stakeholders.

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