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Measuring implementation: development of the implementation process assessment tool (IPAT).

ABSTRACT: BACKGROUND:Implementation science comprises a large set of theories suggesting interacting factors at different organisational levels. Development of literature syntheses and frameworks for implementation have contributed to comprehensive descriptions of implementation. However, corresponding instruments for measuring these comprehensive descriptions are currently lacking. The present study aimed to develop an instrument measuring care providers' perceptions of an implementation effort, and to explore the instrument's psychometric properties. METHODS:Based on existing implementation literature, a questionnaire was designed with items on individual and team factors and on stages of change in an implementation process. The instrument was tested in a Norwegian study on implementation of evidence based practices for psychosis. Item analysis, factor structure, and internal consistency at baseline were examined. RESULTS:The 27-item Implementation Process Assessment Tool (IPAT) revealed large variation between mean score of the items. The total scale scores were widely dispersed across respondents. Internal consistency for the total scale was high (Cronbach's alpha: .962), and all but one item contributed positively to the construct. The results indicated four underlying constructs: individual stages for behavioural change, individual activities and perceived support, collective readiness and support, and individual perceptions of the intervention. CONCLUSIONS:The IPAT appears to be a feasible instrument for investigating the implementation process from the perspective of those making the change. It can enable examination of the relative importance of factors thought to be essential for implementation outcomes. It may also provide ongoing feedback for leaders tailoring support for teams to improve implementation. However, further research is needed to detect the instrument's properties later in the implementation process and in different contexts. TRIAL REGISTRATION:ClinicalTrials.gov code NCT03271242 (retrospective registered September 5, 2017).

SUBMITTER: Hartveit M

PROVIDER: S-EPMC6805659 | biostudies-literature | 2019 Oct

REPOSITORIES: biostudies-literature

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Measuring implementation: development of the implementation process assessment tool (IPAT).

Hartveit M M Hovlid E E Nordin M H A MHA Øvretveit J J Øvretveit J J Bond G R GR Biringer E E Assmus J J Mariniusson G H GH Ruud T T

BMC health services research 20191021 1

<h4>Background</h4>Implementation science comprises a large set of theories suggesting interacting factors at different organisational levels. Development of literature syntheses and frameworks for implementation have contributed to comprehensive descriptions of implementation. However, corresponding instruments for measuring these comprehensive descriptions are currently lacking. The present study aimed to develop an instrument measuring care providers' perceptions of an implementation effort, ...[more]

PMID: 31638967

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Project description:BackgroundThe World Health Organization describes health literacy as a critical determinant of health and driver of citizen empowerment and health equity. Several studies have shown that health literacy is associated with a range of socioeconomic factors including educational attainment, financial position and ethnicity. The complexity of the health system influences how well a person is able to engage with information and services. Health organisations can empower the populations they serve and address inequity by ensuring they are health literacy responsive. The aim of this study was to develop the Organisational Health Literacy Responsiveness self-assessment tool (Org-HLR Tool), and an assessment process to support organisations with application of the tool.MethodsA co-design workshop with health and social service professionals was undertaken to inform the structure of the tool and assessment process. Participants critiqued existing self-assessment tools and discussed the likely utility of the data they generate. A review of widely used organisational performance assessment tools informed the structure and self-assessment process. The Organisational Health Literacy Responsiveness (Org-HLR) Framework (with seven domains/24 sub-domains) provided the structure for the assessment dimensions of the tool. The performance indicators were drawn from raw data collected during development of the Org-HLR Framework.ResultsTwenty-two professionals participated in the workshop. Based on the feedback provided and a review of existing tools, a multi-stage, group-based assessment process for implementing the Org-HLR Tool was developed. The assessment process was divided into three parts; i) reflection; ii) self-rating; and iii) priority setting, each supported by a corresponding tool. The self-rating tool, consistent with the Org-HLR Framework, was divided into: External policy and funding environment; Leadership and culture; Systems, processes and policies; Access to services and programs; Community engagement and partnerships; Communication practices and standards; Workforce. Each of these had 1 to 5 sub-dimensions (24 in total), and 135 performance indicators.ConclusionsThe Org-HLR Tool and assessment process were developed to address a gap in available tools to support organisations to assess their health literacy responsiveness, and prioritise and plan their quality improvement activities. The tool is currently in the field for further utility and acceptability testing.

Project description:BackgroundThe number of overdose deaths in the United States involving opioids continues to exceed 100,000 per year. This has precipitated ongoing declarations of a public health emergency. Harm reduction approaches, such as promoting awareness of, ensuring access to, and fostering willingness to use naloxone to reverse opioid overdose, are a key component of a larger national strategy to address the crisis. In addition, overdose reversal with naloxone directly and immediately saves lives. Because of pharmacies' ubiquity and pharmacists' extensive clinical training, community pharmacies are well-positioned, in principle, to facilitate naloxone access and education.ObjectiveIn 2022, a single-site pilot study of PharmNet, a community pharmacy intervention incorporating naloxone distribution, awareness building, and referral, showed promising outcomes for both naloxone and resource distribution in the community. As a next step, this study was intended to be a pilot randomized controlled trial of PharmNet in 7 pharmacies. However, due to circumstances outside of the study team's control, data collection was unable to be fully completed as planned. In keeping with open research standards, we transparently report all available data from the study and discuss trial barriers and processes. We do so both to provide insights that may inform similar studies and to avoid the "file-drawer" (publication bias) problem, which can skew the aggregated scholarly literature through nonpublication of registered trial results or selective publication of findings affirming authors' hypotheses.MethodsThis paper reports an in-depth implementation study assessment, provides the available observational data, and discusses implementation considerations for similar studies in independent (eg, nonchain) community pharmacies.ResultsRetrospective assessment of study outcomes and fidelity data provided for robust discussion around how resource differences in independent community pharmacies (vs well-resourced chain pharmacies), as well as high demands on staff, can affect intervention implementation, even when leadership is highly supportive.ConclusionsCommunity pharmacies, particularly independent community pharmacies, may require more support than anticipated to be successful when implementing a new intervention into practice, even if it might affect estimates of real-world effectiveness. Further implementation science research is needed specific to independent community pharmacies. All study elements are outlined in the International Registered Report Identifier (IRRID) PRR1-10.2196/42373. Although this paper reports results associated with that registration, results and conclusions should not be given the weight assigned to findings from a preregistered study.International registered report identifier (irrid)RR2-10.2196/42373.

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Measuring implementation: development of the implementation process assessment tool (IPAT).

Publications

Measuring implementation: development of the implementation process assessment tool (IPAT).

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