Implementation interventions to promote the uptake of evidence-based practices in stroke rehabilitation.
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ABSTRACT:
SUBMITTER: Cahill LS
PROVIDER: S-EPMC8095062 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:IntroductionPeople with lived experience are rarely involved in implementation science research. This study was designed to assess the feasibility of codesigning and delivering implementation strategies with people with lived experience of stroke and health professionals to improve evidence-based stroke rehabilitation.MethodsWe used Experience-Based CoDesign to design and deliver strategies to implement Stroke Clinical Guideline recommendations at one Australian inpatient stroke rehabilitation unit. Workgroups were formed with health professionals and people with 6-12 months experience of living with stroke (survivors and carers). Feasibility of the codesign approach (focusing on acceptability, implementation fidelity, signal of promise) was evaluated using mixed methods, using data from interviews, observations and inpatient self-reported outcomes.ResultsOf 18 people with stroke invited, eight (44%) agreed to join the lived experience workgroup. All disciplines with ≥1 full-time staff members on the stroke unit were represented on the health professional workgroup. Median workgroup attendance over 6 months was n = 8 health professionals, n = 4 survivors of stroke and n = 1 carers. Workgroup members agreed to focus on two Guideline recommendations: information provision and amount of therapy. Workgroup members indicated that the codesign approach was enjoyable and facilitated effective partnerships between health professionals and lived experience workgroup members. Both cohorts reported contributing valuable input to all stages of the project, with responsibility shifting between groups at different project stages. The codesigned strategies signalled promise for improving aspects of information provision and creating additional opportunities for therapy. We could not compare patient-reported outcomes before and after the implementation period due to high variability between the preimplementation and postimplementation patient cohorts.ConclusionIt is feasible to codesign implementation strategies in inpatient rehabilitation with people with lived experience of stroke and health professionals. More research is required to determine the effect of the codesigned strategies on patient and service outcomes.Patient or public contributionPeople with lived experience of stroke codesigned and evaluated implementation strategies. Author F. C. has lived experience of stroke and being an inpatient at the inpatient rehabilitation service, and has provided input into analysis of the findings and preparation of this manuscript.
| S-EPMC10757151 | biostudies-literature
Project description:The purpose of this study is to compare the effect of physician education about evidence based practices for colonoscopy alone, versus physician education plus a multi-component staff implementation strategy to improve adequacy of bowel preparation. Additionally the investigators will examine implementation factors that influence adoption of the evidence based practices.
| 2211402 | ecrin-mdr-crc
Project description:BackgroundStroke has a major impact on survivors and their social environment. Care delivery is advocated to become more client-centered and home-based because of their positive impact on client outcomes. The objective of this study was to explore professionals' perspectives on the provision of Home-Based Stroke Rehabilitation (HBSR) in the Netherlands and on the barriers and facilitators influencing the implementation of HBSR in daily practice.MethodsSemi-structured focus groups were conducted to explore the perspectives of health and social care professionals involved in stroke rehabilitation. Directed content analysis was performed to analyze the transcripts of recorded conversations.ResultsFourteen professionals participated in focus groups (n = 12) or, if unable to attend, an interview (n = 2). Participants varied in professional backgrounds and roles in treating Dutch clients post stroke. Barriers and facilitators influencing the implementation of HBSR in daily practice were identified in relation to: the innovation, the user, the organization and the socio-political context. Participants reported that HBSR can be efficient and effective to most clients because it facilitates client- and caregiver-centered rehabilitation within the clients' own environment. However, barriers in implementing HBSR were perceived in a lack of (structured) inter-professional collaboration and the transparency of expertise of primary care professionals. Also, the current financial structures for HBSR in the Netherlands are viewed as inappropriate.DiscussionIn line with previous studies, we found that HBSR is recognized by professionals as a promising alternative to institution-based rehabilitation for clients with sufficient capabilities (e.g. their own health and informal support).ConclusionMultiple factors influencing the implementation of HBSR were identified. Our study suggests that, in order to implement HBSR in daily practice, region specific implementation strategies need to be developed. We recommend developing strategies concerning: organized and coordinated inter-professional collaboration, transparency of the expertise of primary care professionals, and the financial structures of HBSR.
| S-EPMC6657875 | biostudies-literature
Project description:Evidence-based intergenerational practices are sought by practitioners interested in the potential value of intergenerational programs. These are often difficult to identify as intergenerational program research frequently consists of small samples and pre-post analyses of attitudinal data with little attention to implementation characteristics. We systematically identified evidence-based intergenerational practices linked to program outcomes from peer-reviewed journal articles (n = 21) published between 2000 and 2019. Scoping reviews facilitate synthesis of available evidence-based practices and identification of gaps in the literature. Fifteen evidence-based intergenerational practices were identified; each was coded in at least five articles. The practices informed program content (e.g., using technology), program considerations (e.g., environmental modifications), facilitator and participant preparation (e.g., training), and quality interactions among participants (e.g., incorporating mechanisms of friendship). While these identified practices reflect extant theory and research, rigorous implementation research is needed to advance evidence-based intergenerational practice as policymakers and practitioners advocate for intergenerational program growth.
| S-EPMC8278471 | biostudies-literature
Project description:BackgroundAlignment (i.e., the process of creating fit between elements of the inner and outer context of an organization or system) in conjunction with implementation of an evidence-based intervention (EBI) has been identified as important for implementation outcomes. However, research evidence has so far not been systematically summarized. The aim of this scoping review is therefore to create an overview of how the concept of alignment has been applied in the EBI implementation literature to provide a starting point for future implementation efforts in health care.MethodsWe searched for peer-reviewed English language articles in four databases (MEDLINE, Cinahl, Embase, and Web of Science) published between 2003 and 2019. Extracted data were analyzed to address the study aims. A qualitative content analysis was carried out for items with more extensive information. The review was reported according to the preferred reporting items for systematic reviews and meta-analyses extension for scoping review (PRISMA-ScR) guidelines.ResultsThe database searches yielded 3629 publications, of which 235 were considered potentially relevant based on the predetermined eligibility criteria, and retrieved in full text. In this review, the results of 53 studies are presented. Different definitions and conceptualizations of alignment were found, which in general could be categorized as structural, as well as social, types of alignments. Whereas the majority of studies viewed alignment as important to understand the implementation process, only a few studies actually assessed alignment. Outcomes of alignment were focused on either EBI implementation, EBI sustainment, or healthcare procedures. Different actors were identified as important for creating alignment and five overall strategies were found for achieving alignment.ConclusionsAlthough investigating alignment has not been the primary focus of studies focusing on EBI implementation, it has still been identified as an important factor for the implementation success. Based on the findings from this review, future research should incorporate alignment and put a stronger emphasize on testing the effectiveness of alignment related to implementation outcomes.
| S-EPMC8554825 | biostudies-literature
Project description: Not available
| S-EPMC6360920 | biostudies-literature
Project description:Research in basic and clinical neuroscience of music conducted over the past decades has begun to uncover music's high potential as a tool for rehabilitation. Advances in our understanding of how music engages parallel brain networks underpinning sensory and motor processes, arousal, reward, and affective regulation, have laid a sound neuroscientific foundation for the development of theory-driven music interventions that have been systematically tested in clinical settings. Of particular significance in the context of motor rehabilitation is the notion that musical rhythms can entrain movement patterns in patients with movement-related disorders, serving as a continuous time reference that can help regulate movement timing and pace. To date, a significant number of clinical and experimental studies have tested the application of rhythm- and music-based interventions to improve motor functions following central nervous injury and/or degeneration. The goal of this review is to appraise the current state of knowledge on the effectiveness of music and rhythm to modulate movement spatiotemporal patterns and restore motor function. By organizing and providing a critical appraisal of a large body of research, we hope to provide a revised framework for future research on the effectiveness of rhythm- and music-based interventions to restore and (re)train motor function.
| S-EPMC8801707 | biostudies-literature
Project description:ContextThere is limited research on what factors are most salient to implementation of evidence-based practices (EBPs) among public health agencies in public health emergency preparedness and response (PHPR) and under what conditions EBP implementation will occur.ObjectiveThis study assessed the conditions, barriers, and enablers affecting EBP implementation among the PHPR practice community and identified opportunities to support EBP implementation.DesignA Web-based survey gathered information from public health agencies. Data obtained from 228 participating agencies were analyzed.SettingState, local, and territorial public health agencies across the United States.ParticipantsPreparedness program officials from 228 public health agencies in the United States, including Public Health Emergency Preparedness (PHEP) cooperative agreement awardees (PHEP awardees) and a random sample of local health departments (LHDs).ResultsRespondents indicated that EBP is necessary and improves PHPR functions and tasks and that staff are interested in improving skills for EBP implementation. Top system-level barriers to EBP implementation were insufficient funding, lack of EBP, and lack of clarity regarding which practices are evidence based. PHEP awardees were significantly more likely to report a lack of EBP in the field, whereas LHDs were significantly more likely to report a lack of incentives. The top organizational-level barrier was insufficient staff. Most respondents indicated their agency culture supports EBP; however, LHDs were significantly more likely to report a lack of support from supervisors and leadership. Few respondents reported individual barriers to EBP implementation.ConclusionsFindings indicate an opportunity to improve dissemination strategies, communication efforts, and incentives to support EBP implementation in PHPR. Potential strategies include improving awareness of and accessibility to EBPs through targeted dissemination efforts; building organizational capacity to support EBP implementation, particularly staff capacity, knowledge, and skills; and identifying funding and incentives to promote EBP uptake and sustainment.
| S-EPMC7523532 | biostudies-literature
Project description:BackgroundMental health problems are common in the working population and represent a growing concern internationally, with potential impacts on workers, organisations, workplace health and compensation authorities, labour markets and social policies. Workplace interventions that create workplaces supportive of mental health, promote mental health awareness, destigmatise mental illness and support those with mental disorders are likely to improve health and economical outcomes for employees and organisations. Identifying factors associated with successful implementation of these interventions can improve intervention quality and evaluation, and facilitate the uptake and expansion. Therefore, we aim to review research reporting on the implementation of mental health promotion interventions delivered in workplace settings, in order to increase understanding of factors influencing successful delivery.Methods and analysisA scoping review will be conducted incorporating a stepwise methodology to identify relevant literature reviews, primary research and grey literature. This review is registered with Research Registry (reviewregistry897). One reviewer will conduct the search to identify English language studies in the following electronic databases from 2008 through to July 1, 2020: Scopus, PROSPERO, Health Technology Assessments, PubMed, Campbell Collaboration, Joanna Briggs Library, PsycINFO, Web of Science Core Collection, CINAHL and Institute of Occupational Safety and Health (IOSH). Reference searching, Google Scholar, Grey Matters, IOSH and expert contacts will be used to identify grey literature. Two reviewers will screen title and abstracts, aiming for 95% agreement, and then independently screen full texts for inclusion. Two reviewers will assess methodological quality of included studies using the Mixed Methods Appraisal Tool and extract and synthesize data in line with the RE-AIM framework, Nielson and Randall's model of organisational-level interventions and Moore's sustainability criteria, if the data allows. We will recruit and consult with international experts in the field to ensure engagement, reach and relevance of the main findings.DiscussionThis will be the first systematic scoping review to identify and synthesise evidence of barriers and facilitators to implementing mental health promotion interventions in workplace settings. Our results will inform future evaluation studies and randomised controlled trials and highlight gaps in the evidence base.Systematic review registrationResearch Registry ( reviewregistry897 ).
| S-EPMC7844910 | biostudies-literature
Project description:BackgroundPeople often prefer evidence-based psychosocial interventions (EBPIs) for mental health care; however, these interventions frequently remain unavailable to people in nonspecialty or integrated settings, such as primary care and schools. Previous research has suggested that usability, a concept from human-centered design, could support an understanding of the barriers to and facilitators of the successful adoption of EBPIs and support the redesign of EBPIs and implementation strategies.ObjectiveThis study aimed to identify and categorize usability issues in EBPIs and their implementation strategies.MethodsWe adapted a usability issue analysis and reporting format from a human-centered design. A total of 13 projects supported by the National Institute of Mental Health-funded Accelerating the Reach and Impact of Treatments for Youth and Adults with Mental Illness Center at the University of Washington used this format to describe usability issues for EBPIs and implementation strategies with which they were working. Center researchers used iterative affinity diagramming and coding processes to identify usability issue categories. On the basis of these categories and the underlying issues, we propose heuristics for the design or redesign of EBPIs and implementation strategies.ResultsThe 13 projects reported a total of 90 usability issues, which we categorized into 12 categories, including complex and/or cognitively overwhelming, required time exceeding available time, incompatibility with interventionist preference or practice, incompatibility with existing workflow, insufficient customization to clients/recipients, intervention buy-in (value), interventionist buy-in (trust), overreliance on technology, requires unavailable infrastructure, inadequate scaffolding for client/recipient, inadequate training and scaffolding for interventionists, and lack of support for necessary communication. These issues range from minor inconveniences that affect a few interventionists or recipients to severe issues that prevent all interventionists or recipients in a setting from completing part or all of the intervention. We propose 12 corresponding heuristics to guide EBPIs and implementation strategy designers in preventing and addressing these usability issues.ConclusionsUsability issues were prevalent in the studied EBPIs and implementation strategies. We recommend using the lens of usability evaluation to understand and address barriers to the effective use and reach of EBPIs and implementation strategies.International registered report identifier (irrid)RR2-10.2196/14990.
| S-EPMC9240934 | biostudies-literature