Factors Associated with Effective Implementation: Research and Practical Implications

Barwick, Melanie; Dubrowski, Raluca; Damschroder, Laura J.

doi:10.1007/978-3-030-03874-8_4

Cited by 17 publications

(33 citation statements)

References 36 publications

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“…These findings are remarkably consistent with past research that has explored CFIR contextual factors associated with implementation success in different sectors (health, global health, and mental health) and settings (LMICs). 4 , 21 , 22 , 25 , 31 , 32 Taken together, these studies highlight a subset of CFIR contextual factors identified by key informants as more highly associated with implementation effectiveness. Knowing which factors are more “important” relative to effective implementation has implications for advancing implementation knowledge and practice in global health, such that factors that emerge as highly associated with success can be taken into account in implementation planning, monitoring, and evaluation.…”

Section: Discussionmentioning

confidence: 72%

“…A mixed methods design 19 , 20 combined qualitative data from interviews with key informants who were purposefully selected public health experts, and quantitative data from a CFIR questionnaire. 21 Data were collected simultaneously with the purpose of seeking complementarity; the “elaboration, enhancement, illustration, and clarification of the results from one method with the results from the other method.” 20 …”

Section: Methodsmentioning

confidence: 99%

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Implementation of Interventions for the Control of Typhoid Fever in Low- and Middle-Income Countries

Barac

Als

Radhakrishnan

et al. 2018

The American Journal of Tropical Medicine and Hygiene

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Abstract.Past research has focused on typhoid fever surveillance with little attention to implementation methods or effectiveness of control interventions. This study purposefully sampled key informants working in public health in Chile, India, Pakistan, Bangladesh, Thailand, Vietnam, South Africa, and Nigeria to 1) scope typhoid-relevant interventions implemented between 1990 and 2015 and 2) explore contextual factors perceived to be associated with their implementation, based on the Consolidated Framework for Implementation Research (CFIR). We used a mixed methods design and collected quantitative data (CFIR questionnaire) and qualitative data (interviews with 34 public health experts). Interview data were analyzed using a deductive qualitative content analysis and summary descriptive statistics are provided for the CFIR data. Despite relatively few typhoid-specific interventions reportedly implemented in these countries, interventions for diarrheal disease control and regulations for food safety and food handlers were common. Most countries implemented agricultural and sewage treatment practices, yet few addressed the control of antibiotic medication. Several contextual factors were perceived to have influenced the implementation of typhoid interventions, either as enablers (e.g., economic development) or barriers (e.g., limited resources and habitual behaviors). Consolidated Framework for Implementation Research factors rated as important in the implementation of typhoid interventions were remarkably consistent across countries. The findings provide a snapshot of typhoid-relevant interventions implemented over 25 years and highlight factors associated with implementation success from the perspective of a sample of key informants. These findings can inform systematic investigations of the implementation of typhoid control interventions and contribute to a better understanding of the direct effects of implementation efforts.

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Section: Discussionmentioning

confidence: 72%

Section: Methodsmentioning

confidence: 99%

Implementation of Interventions for the Control of Typhoid Fever in Low- and Middle-Income Countries

Barac

Als

Radhakrishnan

et al. 2018

The American Journal of Tropical Medicine and Hygiene

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“…Feasibility is closely related to adoption because it indicates that EI providers consider RIT to be a good fit with their context, mission, and demands (Damschroder et al, 2009; Glasziou & Haynes, 2005; White, 2018), which is significant given some of the logistical constraints they encounter (e.g., limited time; other intervention goals). Given that feasibility is also a determinant of sustainability (Barwick et al, 2020), it is notable that these ratings remained high 12 months post‐training, after EI providers had likely established a large experience‐base with RIT.…”

Section: Discussionmentioning

confidence: 99%

“…Overall, RIT may have a relative advantage over the other strategies available to providers because they directly observed the effectiveness and benefits of the intervention (Damschroder et al, 2009). Within the CFIR framework, relative advantage has been described as the ultimate “sine qua non” condition for successful adoption and sustainability (Barwick et al, 2020). These findings align with our a priori rationale for selecting RIT as the NDBI of focus in the study.…”

Section: Discussionmentioning

confidence: 99%

The implementation of reciprocal imitation training in a Part C early intervention setting: A stepped‐wedge pragmatic trial

2021

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Despite the development of several evidence‐based Naturalistic Developmental Behavioral Interventions (NDBIs), very few have been adapted for use in community‐based settings. This study examines the implementation of Reciprocal Imitation Training (RIT)—an NDBI—by community Early Intervention (EI; IDEA Part C) providers serving toddlers from birth to 3 years. Of the 87 EI providers enrolled from 9 agencies in 4 counties across Washington State, 66 were included in the current sample. A stepped‐wedge design was used to randomly assign counties to the timing of RIT training workshops. Self‐report measures of practice and self‐efficacy regarding ASD care were collected at baseline (T1, T2) and 6‐months and 12‐months post‐training (T3, T4). At T3 and T4, providers reported on RIT adoption and rated items about RIT feasibility and perceived RIT effectiveness; at T4, they also reported on child characteristics that led to RIT use and modifications. From pre‐training to post‐training, there were significant increases in providers' self‐efficacy in providing services to children with ASD or suspected ASD. At T3 and T4, provider ratings indicated high levels of RIT adoption, feasibility, and perceived RIT effectiveness. At T4, providers indicated that they most commonly: (a) initiated RIT when there were social‐communication or motor imitation delays, or an ASD diagnosis; and (b) made modifications to RIT by repeating elements, blending it with other therapies, and loosening its structure. While additional research is needed, RIT may help families get an early start on accessing specialized treatment within an established infrastructure available across the United States. Lay Summary Reciprocal imitation training (RIT) is an evidence‐based treatment for ASD that might be a good fit for use by intervention providers in widely accessible community‐based settings. After attending an educational workshop on RIT, providers reported feeling more comfortable providing services to families with ASD concerns, used RIT with over 400 families, and believed that RIT improved important social communication behaviors.

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“…Given the important role that pediatricians play in promoting evidence-based practices, their knowledge, behaviors, and perspectives can inform the design, dissemination, and implementation of PA best practice resources for clinical practice. Previous studies examining knowledge, attitudes, and beliefs about the role of PCPs regarding PA counseling have primarily utilized questionnaires (1,6,16), potentially missing insights that can emerge from structured interviews and an implementation science lens (4). Indeed, our mixed-method approach identified 9 factors that were common to both surveys and focus group discussions, highlighting a way forward to effectively implement and deliver exercise as medicine best practices in primary pediatric practice.…”

Section: Discussionmentioning

confidence: 99%

Exploration of Barriers and Facilitators to Implementing Best Practice in Exercise Medicine in Primary Pediatric Care—Pediatrician Perspectives

Dubrowski

Barwick

et al. 2021

Pediatric Exercise Science

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Purpose: Despite the known health benefits of physical activity (PA), few primary care pediatricians discuss, evaluate, or prescribe PA for children. The goal of this study was to examine pediatricians’ thoughts and practices related to child PA and the perceived facilitators and barriers to implementing PA evaluation and prescription in pediatric primary care clinics. Methods: The Consolidated Framework for Implementation Research was used to explore implementation barriers and facilitators. A mixed-method design combined questionnaires and focus groups with 27 pediatricians. Results: Despite the pediatricians’ beliefs that PA is important for patients, there was wide practice variability in their approaches to discussing PA. Several perceived barriers to implementing PA evaluation and prescription were identified, including lack of knowledge and training, managing time for PA with multiple demands, the need for a team approach and simple PA tools and resources, support for patient tailoring of PA messaging, and a need for PA best practice champions. Conclusion: The identified barriers to implementing evidence in PA suggest several directions for improvement, including a care-team approach; quick, inexpensive, and simple PA tools; community PA partnerships; PA training in medical education; evidence-based strategies; and PA directories for families. These efforts could facilitate the implementation of PA best practices in pediatrics.

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Factors Associated with Effective Implementation: Research and Practical Implications

Cited by 17 publications

References 36 publications

Implementation of Interventions for the Control of Typhoid Fever in Low- and Middle-Income Countries

Implementation of Interventions for the Control of Typhoid Fever in Low- and Middle-Income Countries

The implementation of reciprocal imitation training in a Part C early intervention setting: A stepped‐wedge pragmatic trial

Exploration of Barriers and Facilitators to Implementing Best Practice in Exercise Medicine in Primary Pediatric Care—Pediatrician Perspectives

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