This article uses the RE-AIM framework to evaluate the feasibility of implementing Enhance Mobility (EM), a tailored, evidence-informed group exercise and walking program for older adults with dementia, into an adult day services center. Participant physical performance outcomes were measured at baseline and 8 months. Program staff were interviewed to understand implementation challenges. Participant outcomes did not change significantly, though gait speed improved from limited to community ambulation levels. Implementation challenges included space reallocation and adequate staffing. Adopting EM in adult day services is feasible, and has potential to reach older adults who could benefit from tailored exercise.
Understanding motivations of research participants is crucial for developing ethical research protocols, especially for research with vulnerable populations. Through interviews with 92 IRB members, prison administrators, research ethicists, and researchers, we explored key stakeholders’ perceptions of what motivates incarcerated individuals to participate in research. Primary motivators identified were a desire to contribute to society, gaining knowledge and healthcare, acquiring incentives, and obtaining social support. The potential for undue influence or coercion were also identified as motivators. These results highlight the need for careful analysis of what motivates incarcerated individuals to participate in research as part of developing or reviewing ethically permissible and responsible research protocols. Future research should expand this line of inquiry to directly include perspectives of incarcerated individuals.
Background: Starting in November 2017, 3 liver transplant centers in a single health care system tested and implemented a new protocol to begin accepting livers from hepatitis C virus–seropositive donors for seronegative liver transplant recipients. Although reports show an increase in donors after protocol implementation, there are no details regarding protocol uptake at each transplant center. Literature is limited on protocol implementation that is developed and disseminated by the same protocol producers. The purpose of this study was to evaluate the implementation of a new liver transplant protocol adopted at 3 transplant centers in the same health care system.
Methods: A multimethod implementation study using interview, survey, and transplant data was conducted to develop a conceptual model of protocol implementation, identify facilitators of and barriers to implementation, and detect differences in implementation between 3 centers.
Results: The conceptual model included 4 domains: rationale, development, implementation, and sustainability. Facilitators included clear, science-based rationale, input from multiple hepatologists, leadership support, and funded pilot data. Barriers included insurance coverage of posttransplant medication and donor field availability. A total of 94 physicians and staff at the 3 transplant centers completed the survey. Implementation factors were all rated moderately high to high at all 3 centers. One-way analysis of variance showed significant differences in mean implementation scores between the centers (F(2, 84)=11.65; P<.001) and between physicians at the 3 centers (F(2, 23)=4.65; P=.02); post hoc comparisons indicated that the scores for physicians differed only between the leading center and 1 participating center. Transplant numbers increased across all 3 centers from 2017 to 2021.
Conclusions: Protocol implementation was successful across all 3 centers, especially at the leading transplant center where the protocol was developed. Future efforts should examine the appropriateness of the protocol for other organs (eg, heart, kidney) and additional medical outcome data (eg, mortality, morbidity, quality of life).
Trial Registration: Not applicable
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