Facilitators and barriers to the utilization of the ACT SMART Implementation Toolkit in community-based organizations: a qualitative study

Sridhar, Aksheya; Drahota, Amy; Walsworth, Kiersten

doi:10.1186/s43058-021-00158-1

Cited by 7 publications

(11 citation statements)

References 34 publications

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“…In this study we used a passive form of implementation; that is, the teams had access to the Planner guide and tools, but no active implementation facilitation or support or any financial incentives were provided. However, there is evidence to suggest that active facilitation can enhance implementation efforts [ 37 , 38 ]. Given the potential value of implementation facilitation, our research team formed a new partnership with March of Dimes Canada, with the goal of having the Planner endorsed and supported by a well-connected and reputable organization in community-based stroke care.…”

Section: Discussionmentioning

confidence: 99%

How Community-Based Teams Use the Stroke Recovery in Motion Implementation Planner: Longitudinal Qualitative Field Test Study

Reszel¹,

Hoek²,

Nguyen³

et al. 2022

JMIR Form Res

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Background The Stroke Recovery in Motion Implementation Planner guides teams through the process of planning for the implementation of community-based exercise programs for people with stroke, in alignment with implementation science frameworks. Objective The purpose of this study was to conduct a field test with end users to describe how teams used the Planner in real-world conditions; describe the effects of Planner use on participants’ implementation-planning knowledge, attitudes, and activities; and identify factors influencing the use of the Planner. Methods This field test study used a longitudinal qualitative design. We recruited teams across Canada who intended to implement a community-based exercise program for people with stroke in the next 6 to 12 months and were willing to use the Planner to guide their work. We completed semistructured interviews at the time of enrollment, monitoring calls every 1 to 2 months, and at the end of the study to learn about implementation-planning work completed and Planner use. The interviews were analyzed using conventional content analysis. Completed Planner steps were plotted onto a timeline for comparison across teams. Results We enrolled 12 participants (program managers and coordinators, rehabilitation professionals, and fitness professionals) from 5 planning teams. The teams were enrolled in the study between 4 and 14 months, and we conducted 25 interviews. We observed that the teams worked through the planning process in diverse and nonlinear ways, adapted to their context. All teams provided examples of how using the Planner changed their implementation-planning knowledge (eg, knowing the steps), attitudes (eg, valuing community engagement), and activities (eg, hosting stakeholder meetings). We identified team, organizational, and broader contextual factors that hindered and facilitated uptake of the Planner. Participants shared valuable tips from the field to help future teams optimize use of the Planner. Conclusions The Stroke Recovery in Motion Implementation Planner is an adaptable resource that may be used in diverse settings to plan community-based exercise programs for people with stroke. These findings may be informative to others who are developing resources to build the capacity of those working in community-based settings to implement new programs and practices. Future work is needed to monitor the use and understand the effect of using the Planner on exercise program implementation and sustainability.

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Section: Discussionmentioning

confidence: 99%

How Community-Based Teams Use the Stroke Recovery in Motion Implementation Planner: Longitudinal Qualitative Field Test Study

Reszel¹,

Hoek²,

Nguyen³

et al. 2022

JMIR Form Res

View full text Add to dashboard Cite

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“…Finally, despite the GTO process, most sites did not adopt an EBP. Barriers to EBP uptake were similar to those identified in other studies and included a limited number of EBPs specific to military populations (Perkins et al, 2016), very few brief interventions that could be fit into a busy training schedule, and limited site resources to purchase or manage new programs (Sridhar et al, 2021). Many sites opted to implement their own programs and instead use GTO to evaluate and improve them.…”

Section: Discussionmentioning

confidence: 73%

Scaling Up Implementation Support for Violence Prevention and Resilience Promotion in the Air Force

et al. 2022

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Closing the gap between research and practice requires that organizations can consistently incorporate new ideas and best practices. The Department of the Air Force (DAF) Integrated Resilience Directorate is leading a coordinated effort to increase the adoption of evidence-based violence prevention and resilience promotion programs across the entire Department. To support this effort, DAF is using Getting To Outcomes (GTO), an evidence-based implementation support that helps organizations plan, implement, and self-evaluate programs. Thus, the DAF is not only scaling up prevention programs but is also embarking on the largest scale-up of GTO to date. The study team trained personnel from every Air Force installation across the world to use GTO for their programs. Quantitative findings from training questionnaires and ratings of implementation plans as well as qualitative results from resilience personnel interviews suggest some lessons learned for scaling up implementation support. This study builds on established implementation science frameworks for scaling up interventions by identifying critical tasks and unique supports needed to scale up evidence-based prevention. Results suggest GTO helped DAF scale-up prevention across the Department, and that establishing leadership buy-in, simplifying evidence-based program selection and adaptation, monitoring implementation and outcomes, and creating dedicated prevention practitioner roles are critical tasks to support scale-up of evidence-based prevention. Unique supports needed to scale-up evidence-based prevention include multitiered learning systems; integrated tools that improve access to data and evolving evidence; prevention personnel with skills in program management, adaptation, and evaluation; timely crosscutting data; continuous learning to support sustainability; and leadership buy-in.

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“…This knowledge may allow for demand optimization when the implementation strategy is being used, which may be particularly important when users of an implementation strategy have competing priorities or contextual factors that make completing the entirety of a blended implementation strategy di cult (32).…”

Section: Discussionmentioning

confidence: 99%

“…Thus, the lower dose in the preparation phase may re ect the need to lower the amount or intensity of toolkit activities required to better align with ASD community agency's capacity to plan for implementation. Considering recently identi ed context-speci c barriers and facilitators to the ACT SMART Toolkit would also likely be critical to enhancing Phase 4 (32,55).…”

Section: Discussionmentioning

confidence: 99%

“…Examining implementation strategy delity can provide insight into the overall potential for ASD community-based agencies to use the toolkit as planned and ultimately report greater use of EBPs. This information may be particularly useful for ASD community-based agencies, given potential competing priorities and contextual barriers to completing the toolkit in its entirety (32). Further, we provide one of the rst process models to assess delity to a blended, multi-phased implementation strategy.…”

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confidence: 99%

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Fidelity to the ACT SMART Toolkit: An Instrumental Case Study of Implementation Strategy Fidelity

Tschida

Drahota

2022

Preprint

Self Cite

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Background: Although evidence-based practices (EBPs) have been shown to improve a variety of outcomes for autistic children, they are often inconsistently implemented or not implemented in community settings where many autistic children receive usual care services. One blended multi-phased implementation strategy developed to support the adoption and implementation of EBPs for autism spectrum disorder (ASD) in community-based settings is the Autism Community Toolkit: Systems to Measure and Adopt Research-Based Treatments (ACT SMART Toolkit). Guided by an adapted version of the EPIS, the ACT SMART Toolkit is comprised multiple phases, each with steps and activities to be completed by agency implementation teams. In the present study, we evaluated implementation strategy fidelity, given the potential for important insights into the use of the toolkit and limited information on the phenomenon of implementation strategy fidelity more broadly.Methods: We used an instrumental case study approach to assess fidelity to the ACT SMART Toolkit during its pilot study with six ASD community agency implementation teams. We assessed adherence, dose, and implementation team responsiveness for each phase and activity of the toolkit at both an aggregate and individual agency level. We also conducted repeated measures ANOVAs to determine whether implementation strategy fidelity significantly differed by toolkit phase. Results: Overall, we found that adherence, dose, and participant responsiveness to the ACT SMART Toolkit were high, with some variability by toolkit phase and activity, as well as by ASD community agency. There was a significant main effect of toolkit phase for dose (F(2,8) = 10.93, MSE = .190, p = .005, η2 = .73), such that dose was significantly lower during the preparation phase as compared to the implementation phase of the toolkit. Conclusions: Our instrumental case study evaluation of fidelity to the ACT SMART Toolkit demonstrated potential for the strategy to be used with fidelity in ASD community-based agencies. Findings related to variability of implementation strategy fidelity in the present study may also inform future adaptations to the toolkit and point to broader trends of how implementation strategy fidelity may vary by content and context.

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Facilitators and barriers to the utilization of the ACT SMART Implementation Toolkit in community-based organizations: a qualitative study

Cited by 7 publications

References 34 publications

How Community-Based Teams Use the Stroke Recovery in Motion Implementation Planner: Longitudinal Qualitative Field Test Study

How Community-Based Teams Use the Stroke Recovery in Motion Implementation Planner: Longitudinal Qualitative Field Test Study

Scaling Up Implementation Support for Violence Prevention and Resilience Promotion in the Air Force

Fidelity to the ACT SMART Toolkit: An Instrumental Case Study of Implementation Strategy Fidelity

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