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Adaptations in the Context of COVID-19: Application of an Implementation Science FRAMEwork.

ABSTRACT: Invest in Kids (IIK) is a Denver, Colorado, USA-based intermediary organization that works to bridge the research-to-practice gap for programs that support Colorado's youngest children and their families. IIK supports evidence-based programs (EBPs) including three universal, prevention programs from The Incredible Years® (IY)-Dinosaur School (a classroom curriculum), Teacher Classroom Management (teacher professional development training), and Parent Program (parent training). IIK employs staff (the IIK-IY Team) to deliver implementation supports such as training, coaching, and managing implementation teams with professionals at schools and community agencies who deliver IY programs throughout Colorado. The COVID-19 pandemic presented challenges and opportunities for practitioners using EBPs, and for the IIK-IY Team. The Framework for Reporting Adaptations and Modifications-Expanded, known as the FRAME (Stirman et al., 2019), was identified as a useful tool for documenting information about COVID-19-related adaptations to local sites' delivery of the programs, IIK's implementation supports, and IIK's annual statewide evaluation of IY. This case study includes an in-depth description of the various adaptations made by the IIK-IY Team, highlighting specific examples that demonstrate how the FRAME can be used to support adaptations for numerous sites in a geographic region or state. This case study provides important lessons about what successful IY delivery and implementation supports looked like in the context of the ongoing COVID-19 pandemic, including a description of IY fidelity and program outcomes.

Supplementary information

The online version contains supplementary material available at 10.1007/s43477-022-00048-1.

SUBMITTER: Albrecht EC

PROVIDER: S-EPMC9243998 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundThere is growing evidence that context mediates the effects of implementation interventions intended to increase healthcare professionals' use of research evidence in clinical practice. However, conceptual clarity about what comprises context is elusive. The purpose of this study was to advance conceptual clarity on context by developing the Implementation in Context Framework, a meta-framework of the context domains, attributes and features that can facilitate or hinder healthcare professionals' use of research evidence and the effectiveness of implementation interventions in clinical practice.MethodsWe conducted a meta-synthesis of data from three interrelated studies: (1) a concept analysis of published literature on context (n = 70 studies), (2) a secondary analysis of healthcare professional interviews (n = 145) examining context across 11 unique studies and (3) a descriptive qualitative study comprised of interviews with heath system stakeholders (n = 39) in four countries to elicit their tacit knowledge on the attributes and features of context. A rigorous protocol was followed for the meta-synthesis, resulting in development of the Implementation in Context Framework. Following this meta-synthesis, the framework was further refined through feedback from experts in context and implementation science.ResultsIn the Implementation in Context Framework, context is conceptualized in three levels: micro (individual), meso (organizational), and macro (external). The three levels are composed of six contextual domains: (1) actors (micro), (2) organizational climate and structures (meso), (3) organizational social behaviour (meso), (4) organizational response to change (meso), (5) organizational processes (meso) and (6) external influences (macro). These six domains contain 22 core attributes of context and 108 features that illustrate these attributes.ConclusionsThe Implementation in Context Framework is the only meta-framework of context available to guide implementation efforts of healthcare professionals. It provides a comprehensive and critically needed understanding of the context domains, attributes and features relevant to healthcare professionals' use of research evidence in clinical practice. The Implementation in Context Framework can inform implementation intervention design and delivery to better interpret the effects of implementation interventions, and pragmatically guide implementation efforts that enhance evidence uptake and sustainability by healthcare professionals.

Project description:BackgroundMany interventions found to be effective in health services research studies fail to translate into meaningful patient care outcomes across multiple contexts. Health services researchers recognize the need to evaluate not only summative outcomes but also formative outcomes to assess the extent to which implementation is effective in a specific setting, prolongs sustainability, and promotes dissemination into other settings. Many implementation theories have been published to help promote effective implementation. However, they overlap considerably in the constructs included in individual theories, and a comparison of theories reveals that each is missing important constructs included in other theories. In addition, terminology and definitions are not consistent across theories. We describe the Consolidated Framework For Implementation Research (CFIR) that offers an overarching typology to promote implementation theory development and verification about what works where and why across multiple contexts.MethodsWe used a snowball sampling approach to identify published theories that were evaluated to identify constructs based on strength of conceptual or empirical support for influence on implementation, consistency in definitions, alignment with our own findings, and potential for measurement. We combined constructs across published theories that had different labels but were redundant or overlapping in definition, and we parsed apart constructs that conflated underlying concepts.ResultsThe CFIR is composed of five major domains: intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation. Eight constructs were identified related to the intervention (e.g., evidence strength and quality), four constructs were identified related to outer setting (e.g., patient needs and resources), 12 constructs were identified related to inner setting (e.g., culture, leadership engagement), five constructs were identified related to individual characteristics, and eight constructs were identified related to process (e.g., plan, evaluate, and reflect). We present explicit definitions for each construct.ConclusionThe CFIR provides a pragmatic structure for approaching complex, interacting, multi-level, and transient states of constructs in the real world by embracing, consolidating, and unifying key constructs from published implementation theories. It can be used to guide formative evaluations and build the implementation knowledge base across multiple studies and settings.

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Adaptations in the Context of COVID-19: Application of an Implementation Science FRAMEwork.

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