Strengthening capacity for implementation of evidence-based practices for autism in schools: The roles of implementation climate, school leadership, and fidelity.
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SUBMITTER: Melgarejo M
PROVIDER: S-EPMC8202724 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundImplementation researchers have typically studied organizational culture and climate by testing whether individual dimensions are linked to the implementation of evidence-based practices (EBPs) rather than examining how the overarching social context influences implementation. This approach may limit implementation theory and strategy development to the extent that individual dimensions of culture and climate interact, mutually reinforce or counteract one another, or exhibit non-linear relationships. This study tests whether empirically identifiable culture and climate profiles emerge in a sample of organizations and examines how these profiles relate to EBP fidelity and work attitudes that support EBP sustainment, focusing on three EBPs for youth with autism delivered in schools as an example.MethodsThe study included 65 elementary schools in the U.S. that implemented three EBPs-discrete trial training, pivotal response training, and visual schedules-for youth with autism. Organizational culture and climate and work attitudes were assessed using the Organizational Social Context measure at the beginning of the school year. Observations of EBP fidelity occurred mid school-year. We used bias-adjusted stepwise latent profile modeling to (1) identify subpopulations of schools that share similar culture and climate profiles, and (2) test for mean differences across profiles in observed EBP fidelity and teacher and staff work attitudes.ResultsControlling for region, four profiles best characterized the organizational cultures and climates of schools. Teachers and staff in schools with a comprehensive profile (high proficiency culture, positive climate) exhibited higher fidelity to two of three EBPs (d's?=?.95 to 1.64) and reported superior work attitudes (d's?=?.71 to 1.93) than teachers and staff in all other schools. Teachers and staff in supportive schools (low rigidity culture, positive climate) had better work attitudes, but not better fidelity, than those in schools with indifferent (low culture/climate, elevated stress) and constrained (high rigidity and resistance, high stress) profiles.ConclusionsOrganizational culture and climate profiles are a strong predictor of EBP fidelity and work attitudes that support EBP sustainment, highlighting the importance of an organization's overarching social context when developing implementation theory and strategies. Strategies that foster a comprehensive profile may improve EBP implementation.
| S-EPMC6373074 | biostudies-literature
Project description:Prior literature has shown that school learning climate is critical in helping individual learners meet their educational objectives. In this paper, the role of parental involvement in shaping the school learning climate is explored within a multilevel and hierarchical modeling framework using data from the 2015 PISA round. As the schools’ social and relational character, we find that reducing learning barriers is a critical challenge for school leadership. A welcoming environment for parents, as well as the effective design of effective forms of two-way communications, are positively associated with a substantial reduction in the barriers to improving teacher management’s learning climate. We also find that public schools facing social and educational inclusiveness challenges can dramatically enhance their learning environment by activating specific parental involvement mechanisms. Similarly, principal’s leadership in framing and communicating goals and curricular development to the school is also found to be significant for inclusiveness. However, parental involvement is also found to have potential tensions with school management. The worsening of the learning climate may arise due to pressures brought about by laws requiring parental involvement in schools. Because the learning climate is composed of a wide variety of relationships between and within schools, this work demonstrates that parental involvement is an integral part of school leadership and the school improvement process. Further research attention is encouraged to understand the tensions between teacher roles, principal leadership, and parental involvement through employing other quantitative or qualitative research designs.
| S-EPMC7504873 | biostudies-literature
Project description:Objective: To describe the design, delivery and evaluation of the 3rd Global Alliance for Chronic Diseases (GACD) Implementation Science School (ISS), delivered virtually in 2020 for the first time. Methods: Since 2014, GACD has supported the delivery of more than ten Implementation Science Workshops for more than 500 international participants. It has also been conducting an annual ISS since 2018. In this study, we described the design, delivery and evaluation of the third ISS. Results: Forty-six participants from 23 countries in five WHO regions attended the program. The virtual delivery was well-received and found to be efficient in program delivery, networking and for providing collaborative opportunities for trainees from many different countries. The recently developed GACD Implementation Science e-Hub was found to be an instrumental platform to support the program by providing a stand-alone, comprehensive online learning space for knowledge and skill development in implementation research. Conclusion: The delivery of the virtual GACD ISS proved to be feasible, acceptable and effective and offers greater scalability and sustainability as part of a future strategy for capacity strengthening in implementation research globally.
| S-EPMC9395543 | biostudies-literature
Project description:Background"We Act" is a health-promoting school intervention comprising an educational, a parental and a school component. The intervention was implemented in 4 Danish public schools with 4 control schools. The objectives were to improve pupils' dietary habits, physical activity, well-being and social capital using the Investigation, Vision, Action & Change (IVAC) health educational methodology. The target group was pupils in grades 5-6. The purpose of this study was to evaluate implementation fidelity and interacting context factors in the intervention schools.MethodsThe Medical Research Council's new guidance for process evaluation was used as a framework. Data were collected concurrently and evenly at the 4 intervention schools through field visits (n?=?43?days), questionnaires (n?=?17 teachers, 52 parents), and interviews (n?=?9 teachers, 4 principals, 52 pupils). The data were analysed separately and via triangulation.ResultsA total of 289 pupils participated, and 22 teachers delivered the educational component in 12 classes. In all schools, the implementation fidelity to the educational methodology was high for the Investigation and Vision phases as the teachers delivered the proposed lessons and activities. However, the implementation fidelity to the Action & Change phase was low, and little change occurred in the schools. The pupils' presentation of their visions did not work as intended as an impact mechanism to prompt actions. The implementation of the parental and the school components was weak. The main context factors influencing implementation fidelity were a poor fit into the school-year plan and weak management support.ConclusionsAlthough 'We Act' was designed to comply with evidence- and theory-based requirements, IVAC and the health-promoting school approach did not result in change. The time dedicated to schools' preparation and competence development may have been too low. This must be considered in future process evaluation research on health-promoting schools and by school health promotion administrators when planning future school interventions.Trial registrationISRCTN85203017.
| S-EPMC6307196 | biostudies-literature
Project description:BackgroundUntil now, there is no clear overview of how fidelity is assessed in school-based obesity prevention programmes. In order to move the field of obesity prevention programmes forward, the current review aimed to 1) identify which fidelity components have been measured in school-based obesity prevention programmes; 2) identify how fidelity components have been measured; and 3) score the quality of these methods.MethodsStudies published between January 2001-October 2017 were selected from searches in PubMed, EMBASE, PsycINFO, CINAHL, Cochrane Library and ERIC. We included studies examining the fidelity of obesity prevention programmes (nutrition and/or physical activity and/or sitting) at school (children aged 4-18 year) measuring at least one component of implementation fidelity. A data extraction was performed to identify which and how fidelity components were measured. Thereafter, a quality assessment was performed to score the quality of these methods. We scored each fidelity component on 7 quality criteria. Each fidelity component was rated high (>?75% positive), moderate (50-75%) or low (<?50%).ResultsOf the 26,294 retrieved articles, 73 articles reporting on 63 different studies were included in this review. In 17 studies a process evaluation was based on a theoretical framework. In total, 120 fidelity components were measured across studies: dose was measured most often (N =?50), followed by responsiveness (N =?36), adherence (N =?26) and quality of delivery (N =?8). There was substantial variability in how fidelity components were defined as well as how they were measured. Most common methods were observations, logbooks and questionnaires targeting teachers. The quality assessment scores ranged from 0 to 86%; most fidelity components scored low quality (n =?77).ConclusionsThere is no consensus on the operationalisation of concepts and methods used for assessing fidelity in school-based obesity prevention programmes and the quality of methods used is weak. As a result, we call for more consensus on the concepts and clear reporting on the methods employed for measurements of fidelity to increase the quality of fidelity measurements. Moreover, researchers should focus on the relation between fidelity and programme outcomes and determine to what extent adaptations to programmes have been made, whilst still being effective.
| S-EPMC6088402 | biostudies-literature
Project description:BackgroundIt is important that components contributing to success of a program are well understood to ensure better outcomes and strengthen interventions. Hence the purpose of the study was to assess the level of fidelity achieved by school oral health programs in our study district and to determine elements of fidelity that predict the risk of dental decay.MethodsA cross-sectional study design was utilised. A multistage sampling technique was employed to randomly select 10 schools, two grades in each school were selected and all pupils in the selected grades were included in an oral health examination. Ten oral hygienists were observed and interviewed as they carried out the activities of the program and records were reviewed. Data collection tools included an oral health examination form, and an implementation fidelity checklist.ResultsThe average level of fidelity obtained was 40% and it was shown to be inversely correlated with levels of decay, as decay was predicted to decrease with increasing levels of fidelity. The fidelity elements that were found to directly predict the outcome of decay included duration (IRR, 0.49; p = 0.02) coverage (IRR, 0.54; p = 008), content (IRR, 1.36; p = 0.03) and age (IRR, 2.14; p = 0.00). Moderating factors of fidelity which indirectly influenced the outcome of decay included facilitation strategy, duration and age. These were predicted to reduce the risk of decay by 92%, 83% and 48% respectively.ConclusionThe school oral health programs exhibited high levels of pupil coverage, however, the content of the programs offered was low (28%). Coverage was high in the context of lack of dental assistance and time. Multi-sectoral participation is therefore necessary to re-organise the program for improving implementation fidelity and bringing about quality implementation.
| S-EPMC7671500 | biostudies-literature
Project description:BACKGROUND:The promotion of health literacy is seen as an urgent goal in public health and education and, hence, should be integrated in the school context as a component of the holistic health promoting school (HPS) approach. However, only limited empirical studies have addressed health literacy of school staff so far. Hence, this study aimed to examine the level of health literacy among school leaders and its association with the extent of HPS implementation. METHODS:A cross-sectional study with n = 680 school principals and members of the school management board from Germany was carried out at the end of 2018. Individual health literacy, attitudes, and competencies towards HPS and occupational self-efficacy served as independent variables and the level of HPS implementation was the dependent variable. Data were analyzed using univariate and bivariate analysis as well as multiple binary logistic regression. RESULTS:29.3% of school leaders show a limited health literacy with significantly higher values found for male respondents. Regression analyses revealed that male gender (OR: 1.91, 95% CI: 1.22-2.99), HPS attitudes (OR: 3.17, 95% CI: 2.13-4.72), and HPS competencies (OR: 3.66, 95% CI: 2.43-5.50) were associated with a lower level of HPS implementation. Furthermore, regression analyses differentiated by gender showed that limited health literacy is associated with a low level of HPS implementation for male school leaders only (OR: 2.81, 95% CI: 1.22-6.45). CONCLUSIONS:The promotion of health literacy especially for male leaders would not only result in positive effects on an individual level but also could contribute to a stronger implementation of activities on school health promotion. We suggest integrating health literacy, HPS attitudes, and competencies more strongly into the qualification and in further training of school leaders.
| S-EPMC7142764 | biostudies-literature
Project description:BackgroundLeaders can improve implementation outcomes by developing an organizational climate conducive to the implementation of evidence-based practices (EBP). This study tested the lagged associations between individual-level perceptions of implementation leadership, implementation climate, and three anticipated implementation outcomes, that is EBP acceptability, appropriateness, and feasibility.MethodsScreening tools and treatment methods for posttraumatic stress disorder were implemented in 43 Norwegian mental health services. A sample of 494 child and adult mental health care professionals (M = 43 years, 78% female) completed surveys addressing perceptions of first-level leaders' (n = 47) implementation leadership and their clinics' implementation climate. Single-level structural equation models estimating both direct, indirect, and total effects were used to investigate whether perceived implementation climate mediated the association between perceived implementation leadership and perceived acceptability, appropriateness, and feasibility of screening tools and treatment methods.ResultsRegarding the treatment methods, implementation leadership was associated with therapists' perceptions of acceptability, appropriateness, and feasibility. Implementation climate also mediated between implementation leadership and the outcomes. Regarding the screening tools, implementation leadership was not associated with the outcomes. However, implementation climate mediated between implementation leadership and therapists' perceptions of acceptability and feasibility, but not appropriateness. Analyses with the implementation climate subscales showed stronger associations for therapists' perceptions of the treatment methods than of screening tools.ConclusionsLeaders may promote positive implementation outcomes, both directly and through implementation climate. With regard to the effect sizes and explained variance, results indicated that both implementation leadership and implementation climate were more strongly associated with the therapists' perceptions of the treatment methods, implemented by one group of therapists, than the screening tools, implemented by all therapists. This may imply that implementation leadership and climate may have stronger effects for smaller implementation teams within a larger system than for system-wide implementations or when the clinical interventions being implemented are more complex rather than simple ones.Trial registrationClinicalTrials NCT03719651, 25 October 2018.
| S-EPMC10334553 | biostudies-literature
Project description:INTRODUCTION:The 2.5?h Foundations for Safety Leadership (FSL) training program teaches construction supervisors the leadership skills they need to strengthen jobsite safety climate and reduce adverse safety-related outcomes. METHODS:Using a quasi-experimental prospective switching replications study design, we examined (1) if FSL-trained jobsite safety leaders would report improved understanding and practice of the FSL leadership skills, safety practices and crew reporting of safety related conditions, and (2) if their crew perceived a change in (a) their supervisors' practices, (b) their own safety practices and reporting of safety-related conditions, and (c) overall jobsite safety climate. Twenty construction sub-contracting companies were recruited and randomly assigned to either an early or lagged-control training group. Participating supervisors and workers completed surveys at multiple time points before and after the FSL training. We used linear mixed modeling to test changes over time. RESULTS:Only supervisors in the early group reported a statistically significant improvement in their understanding and practice of the leadership skills as well as safety practices from before to 2- and 4-weeks post-training. Overall, no significant change was detected in crew-reported outcomes from before to after their supervisors' participated in the FSL training. CONCLUSIONS:These results provide evidence that the FSL training can, at least in the short-term, improve construction frontline leaders' jobsite leadership skills. Future research could include an evaluation of FSL refresher activities and a longer-term follow-up. Practical applications: The Foundations for Safety Leadership (FSL) program fills an identified need for construction frontline supervisors to learn and practice critical safety leadership skills on the jobsite. It has already reached over 60,000 leaders and has the potential to reach over 100,000 each year during either an OSHA 30-h or a stand-alone course.
| S-EPMC7076738 | biostudies-literature
Project description:Implementation citizenship behavior (ICB) describes extra-role behaviors performed by employees to support evidence-based practice (EBP) implementation. Such behaviors can be measured using the Implementation Citizenship Behavior Scale (ICBS), which divides ICB into two dimensions, namely helping others and keeping informed. The current study extends the use of the ICBS to a context outside the USA and adds to the literature by investigating how leader-perceived ICB relates to practitioner-perceived implementation leadership and practitioners' intentions to use EBPs. Participants were 42 leaders and 152 practitioners in Norwegian mental health services implementing EBPs for post-traumatic stress disorder. Leaders rated each practitioner on ICB, and each practitioner rated their leader on implementation leadership and reported on their own intentions to use EBPs. The psychometric properties of the ICBS were assessed using confirmatory factor analysis and internal consistency reliabilities. The relationships between ICB, implementation leadership and intentions to use EBPs, were investigated through a series of bivariate correlation analyses and a path analysis of the total scales. The ICBS showed excellent psychometric properties. The hypothesized two-factor model provided an excellent fit to the data, and both subscales and the total scale were internally reliable. Leader-perceived ICB was positively and significantly correlated with both practitioner-perceived implementation leadership and practitioners' intentions to use EBPs. Correlations with intentions to use EBPs were stronger for the subscale of keeping informed than for the subscale of helping others. Results indicated that practitioners who rated their leader higher on implementation leadership received higher ICB ratings from their leader and reported higher intentions to use EBPs. The results provide evidence of a reciprocal social exchange relationship between leaders and practitioners during EBP implementation and a link to an important proximal implementation outcome (i.e., intentions to use EBPs). Results also suggest cultural differences in how ICB is perceived and relates to other phenomena. Scientific and practical implications are discussed. Retrospectively registered in ClinicalTrials with ID NCT03719651 .
| S-EPMC8665530 | biostudies-literature