Applying NUDGE to Inform Design of EBP Implementation Strategies in Community Mental Health Settings

Stewart, Rebecca E.; Beidas, Rinad S.; Hoskins, Katelin; Byeon, Y. Vivian; Williams, Nathaniel J.; Buttenheim, Alison M.

doi:10.1007/s10488-020-01052-z

Cited by 20 publications

(35 citation statements)

References 56 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our study uniquely combines an in-depth qualitative analysis and a systematic application of theoretical principles to understand EBP implementation. We applied a novel approach informed by behavioral insights (20) and used a rich data set of in-depth interviews from a diverse cadre of therapists trained in TF-CBT, the gold standard EBP for youth with PTSD. We used these qualitative interviews to identify barriers and facilitators to TN implementation, to identify the corresponding behavioral insights, and to generate mechanistically-linked implementation strategies to target these insights.…”

Section: Discussionmentioning

confidence: 99%

Using behavioral insights to design implementation strategies in public mental health settings: a qualitative study of clinical decision-making

Last

Schriger

Timon

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

Background : Most studies evaluating the barriers and facilitators to evidence-based practice (EBP) implementation tend to overrely on stakeholder perspectives; underuse theory; and evaluate implementation of entire packages or protocols rather than specific, essential components of EBPs. These approaches make it challenging to generate implementation strategies that mechanistically target the core causes of behavior change. The present study seeks to leverage behavioral insights to identify factors that affect clinical decision-making surrounding the use of the trauma narrative (TN), the most active component of trauma focused-cognitive behavioral therapy (TF-CBT)—the gold standard EBP for youth with posttraumatic stress disorder—and to generate implementation strategies informed by these insights. Methods : Through semi-structured qualitative interviews, we sought the perspectives of trained TF-CBT therapists working in community mental health settings across the city of Philadelphia ( n =17) surrounding their clinical decision-making around when and why they use TNs. We used an iterative process of structured brainstorming and rapid validation informed by behavioral insights to uncover the barriers and facilitators to TN use and to generate implementation strategies using the “Easy Attractive Social Timely” (EAST) framework to increase TN implementation. Results : We generated and validated 9 hypothesized barriers to and facilitators of implementation of the trauma narrative that mapped onto 18 behavioral insights. Hypothesized barriers linked therapist perspectives (i.e., the barriers and facilitators they described) and behavioral insights to design 9 implementation strategies. Conclusions : The study responds to the growing need to identify implementation barriers and facilitators and to design implementation strategies that are informed by stakeholder perspectives, causal theories and that target specific components of EBPs. Our results reveal that behavioral insights of TN implementation can generate strategy designs. In the future, we will test the implementation strategies we designed to evaluate whether this process of developing implementation strategies is effective.

show abstract

Section: Discussionmentioning

confidence: 99%

Using behavioral insights to design implementation strategies in public mental health settings: a qualitative study of clinical decision-making

Last

Schriger

Timon

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…PACTS clinicians were asked about their decision-making processes in implementing the TN. We adapted a behavioral insights approach to systematically stage the analysis-Narrow, Understand, Discover, Generate, and Evaluate (NUDGE)-and coded the interview data using a guide from the behavioral insights literature-the Behavioral Economics Guide-to arrive at behaviorally informed hypotheses about the determinants of clinicians' TN use (36,37). We leveraged these hypotheses to generate implementation strategies using the behavioral insights informed "Easy Attractive Social and Timely" (EAST) framework, which organizes strategies for researchers and policy-makers (38).…”

Section: Methodsmentioning

confidence: 99%

“…First, in order to distill qualitative interview transcripts, thematic analysis was applied to organize the qualitative data into a manageable and interpretable amount of text (41). Second, in order to systematize the hypothesis generation process, we selectively borrowed elements from the NUDGE framework, which has been used to design behavioral insights-derived implementation strategies based on hypothesized determinants (36). To structure this part of the analytic process, we relied heavily, though not exclusively, on the Behavioral Economics Guide to code hypothesized behavioral insights determinants of TN implementation (37).…”

Section: Analytic Approachmentioning

confidence: 99%

“…NUDGE is a behavioral insights approach to rigorously identify what drives EBI implementation (36). NUDGE lays out a multi-step process from "Narrowing" the focus to a speci c behavioral target through "Understanding" the context of the behavior, "Discovering" the underlying behavioral insights, "Generating" implementation strategies, and "Evaluating" them through trials.…”

Section: Analytic Approachmentioning

confidence: 99%

“…NUDGE lays out a multi-step process from "Narrowing" the focus to a speci c behavioral target through "Understanding" the context of the behavior, "Discovering" the underlying behavioral insights, "Generating" implementation strategies, and "Evaluating" them through trials. In previous work, the NUDGE approach was used to analyze qualitative data to discover what drives EBI implementation in publicly funded mental health agencies (36). We adapted the "Discover" step of NUDGE into a coding process in which we applied codes for various behavioral insights largely drawn from "The Behavioral Economics Guide" (37).…”

Section: Analytic Approachmentioning

confidence: 99%

See 2 more Smart Citations

Using Behavioral Insights to Design Implementation Strategies in Public Mental Health Settings: a Qualitative Study of Clinical Decision-Making

Last

Schriger

Timon

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

Background: Trauma focused-cognitive behavioral therapy (TF-CBT) is an evidence-based intervention for youth with posttraumatic stress disorder. An important component of TF-CBT is the trauma narrative (TN), a phase in the intervention in which youth are guided to process the memories, thoughts, and feelings associated with their traumatic experience(s). Previous work has shown that only half of TF-CBT clinicians complete the TN with their clients. Drawing from the behavioral insights literature—an interdisciplinary field studying judgment and decision-making—the present study seeks to understand what determines clinician use of the TN and to generate strategies that target these determinants. Methods: Through semi-structured qualitative interviews, we sought the perspectives of trained TF-CBT clinicians working in public mental health settings across the city of Philadelphia (n=17) to understand their decisions to use the TN with clients. We analyzed the qualitative data using a coding approach informed by the behavioral insights literature. We used an iterative process of structured hypothesis generation, aided by a behavioral insights guide, and rapid validation informed by behavioral insights to uncover the determinants of TN use. We then generated implementation strategies that targeted these determinants using the “Easy Attractive Social Timely” framework, a behavioral insights design approach. Results: We generated and validated three broad themes about what determines clinician implementation of the TN: decision complexity, clinician affective experience, and agency norms. We hypothesized the behavioral insights that underlie these implementation determinants and generated a list of nine behavioral insights strategies that theoretically may facilitate TN implementation. Conclusions: Our study investigated why an effective component of an evidence-based intervention is often neglected. We leveraged robust scientific theories and empirical regularities from the behavioral insights literature to understand clinician perspectives on TN implementation. These factors were theoretically linked to implementation strategies. Our work revealed the potential for using behavioral insights in the diagnosis of evidence-based intervention determinants and the design of implementation strategies.

show abstract

Integrating insights from implementation science and behavioral economics to strengthen suicide screening strategies for pediatric populations

Hodson,

Johnson,

Beidas

2024

Current Opinion in Psychology

View full text Add to dashboard Cite

Applying NUDGE to Inform Design of EBP Implementation Strategies in Community Mental Health Settings

Cited by 20 publications

References 56 publications

Using behavioral insights to design implementation strategies in public mental health settings: a qualitative study of clinical decision-making

Using behavioral insights to design implementation strategies in public mental health settings: a qualitative study of clinical decision-making

Using Behavioral Insights to Design Implementation Strategies in Public Mental Health Settings: a Qualitative Study of Clinical Decision-Making

Integrating insights from implementation science and behavioral economics to strengthen suicide screening strategies for pediatric populations

Contact Info

Product

Resources

About