Practical considerations for engaging staff in resource-constrained healthcare settings in implementation research: A qualitative focus group and consensus building study

Journal of Clinical and Translational Science, Journal Year: 2025, Volume and Issue: 9(1)

Published: Jan. 1, 2025

Abstract Background: The primary purpose of this study was to assess perceived burdens and benefits participating in implementation research among staff employed resource-constrained healthcare settings. Another objective use findings generate considerations for engaging across different phases research. Methods: This qualitative focus group consensus building involved researchers affiliated with the National Cancer Institute Implementation Science Centers Control program nine Community Health (CHCs) Massachusetts. Six groups (n = 3 CHC staff; n researchers) assessed barriers facilitators participation During discussions, we used develop as participants partners throughout Results: Sixteen 14 participated separate groups; seven discussions. Themes emerged participant three domains: (1) influences on participation; (2) benefits; (3) ways facilitate Practical included: (a) aligning organizational values priorities; (b) applying user-centered design methods; (c) individual capacity; (d) offering equitable incentives participation. Conclusions: Engaging requires knowledge about what contributes burden addressing context-specific benefits.

Language: Английский

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Assessing the inner setting among Massachusetts community health centers: opportunities for multilevel investigation and expansion of influences on health equity

Implementation Science Communications, Journal Year: 2025, Volume and Issue: 6(1)

Published: April 10, 2025

Abstract Background Implementation science increasingly aims to improve health outcomes in delivery of evidence-based interventions. It is important understand the inner setting organizations where interventions are put into place, as characteristics can have significant impact on implementation outcomes. Community centers engaged efforts use cancer control Taking a comprehensive, partnered approach measuring among network community research ensures assessment variability sites. Methods We conducted cross-sectional survey staff ( n = 63) purposively sampled from 12 Massachusetts at Science Center for Cancer Control Equity. The assessed constructs Consolidated Framework Research, including learning climate, leadership engagement, available resources, and demands/stress using validated measures (Likert scale range: 1 “strongly disagree” 5 agree”). Additional equity-focused items included structural work infrastructure language access services. Descriptive statistics examined differences by role center. Results Staff rated climate (mean 3.98) engagement 3.67) positively, while resources 2.78) had lowest rating, particularly staffing resources. Clinical context compared other roles. All reported supportive human resource benefits caregiving 92% provided tuition assistance, fewer offered formal mentorship (50%) or affinity groups (33%). written materials routinely patients languages than English interpreter services were most common Spanish, Vietnamese, Portuguese. Conclusions This study provides an within start new collaboration. Periodic follow-up surveys will monitor changes over time. Data be used future analyses explore how influence equitable translation practice.

Language: Английский

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Leveraging an implementation science partnership network to understand how Federally Qualified Health Centers operationalize and address health equity

Translational Behavioral Medicine, Journal Year: 2023, Volume and Issue: 14(1), P. 23 - 33

Published: Aug. 5, 2023

Health equity-focused implementation research requires using definitions and approaches that are relevant meaningful to partners. We examined how health equity was operationalized addressed at Federally Qualified Centers (FQHCs). conducted semi-structured interviews with leadership (n = 19) staff 12) 10 FQHCs in an science partnership network for cancer control understand they equity. performed rapid qualitative analysis shared findings a larger group of 13 community centers (including the FQHCs) Implementation Learning Community (ILC) identify action areas practice, followed by second phase synthesizing codes into themes mapping onto framework advancing healthcare organizations. Participants defined as central mission FQHCs, identified barriers (e.g. financing models) facilitators interpreter services) FQHCs. These resonated ILC participants who emphasized challenge addressing root cause social determinants inequities limited available resources importance developing collaboration communities data collection, interpretation, use, ownership. Themes captured recommendations advance daily work including investments staffing, training, resources. Mapping from equity-centered FQHC partners organizations can provide clear, context-specific direction actions aimed improving

Language: Английский

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Challenges and recommendations for measuring time devoted to implementation and intervention activities in health equity-focused, resource-constrained settings: a qualitative analysis

Implementation Science Communications, Journal Year: 2023, Volume and Issue: 4(1)

Published: Sept. 1, 2023

There is little guidance for conducting health equity-focused economic evaluations of evidence-based practices in resource-constrained settings, particularly with respect to staff time use. Investigators must balance the need low-touch, non-disruptive cost data collection on providing services priority subpopulations.This investigation took place within a pilot study examining implementation bundled screening intervention combining social determinants and colorectal cancer at four federally qualified centers (FQHCs) Boston metropolitan area. Methods collecting personnel costs activities, including passive (automatic) active (non-automatic, requiring effort) collection, as well three alternate wordings self-reporting time-use, were evaluated qualitatively using collected through interviews FQHC (including clinicians, population staff, community workers) assessments completeness.Passive methods simple execute resulted no missing data, but missed activities that outside planned meetings. Active spreadsheets was users when applied care processes already tracked this fashion yielded accurate use data. However, tasks where not typical, broken up over multiple sessions, more challenging Questions asking about typical rather than specific period, patients, most reliable actionable Still, even best-performing question had substantial variability estimates. Participants noted patient characteristics interest research, language spoken, adverse health, issues related poverty or mental all contributed significantly variability.Passively are least burdensome should be pursued research efforts possible, accompanied by qualitative ensure an reflection effort. When workflows these also strong methods. Self-reported will questions inquire "typical" types patients.

Language: Английский

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Implementation Science’s Role in Community Engagement for Substance Use Prevention

Journal of Prevention, Journal Year: 2024, Volume and Issue: unknown

Published: June 6, 2024

Language: Английский

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Health equity principles for oncology real world evidence studies

The Oncologist, Journal Year: 2024, Volume and Issue: 29(10), P. e1260 - e1271

Published: July 16, 2024

Abstract Background Real-world research on cancer care in the community should address social determinants of health (SDOH) to advance equity diagnosis, treatment, and survivorship. We sought patient stakeholder perspectives co-develop principles guide researchers when using record data their protocols. Materials methods Key informant interviews with 13 individuals elicited insights related SDOH conducting from community-based oncology care. Interviews included a brief overview prior scoping review questions interview guide. informants experts SDOH, advisory board members. Rapid qualitative analysis was used identify key themes, patterns, data. Principles were developed based results analysis. Results Three overarching categories for promoting (1) education; (2) engagement; (3) design implementation. Education highlight necessity training relevant skills equity. Community engagement various actions that can take conduct inclusive concerns regarding The implementation category provides practical guidelines planning, conducting, disseminating Conclusion Our real-world protocols settings promote These be tailored specific topics communities.

Language: Английский

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Applying cognitive walkthrough methodology to improve the usability of an equity-focused implementation strategy

Implementation Science Communications, Journal Year: 2024, Volume and Issue: 5(1)

Published: Sept. 3, 2024

Our research team partnered with primary care and quality improvement staff in Federally Qualified Community Health Centers (CHCs) to develop Partnered Equity Data-Driven Implementation (PEDDI) promote equitable implementation of evidence-based interventions. The current study used a human-centered design methodology evaluate the usability PEDDI generate redesign solutions address issues context cancer screening intervention. We applied Cognitive Walkthrough for Strategies (CWIS), pragmatic assessment method steps that include group testing end users identify prioritize problems. conducted three facilitated 60-min CWIS sessions (N = 7) from four CHCs included scenarios related tasks implementing colorectal (CRC) Participants rated likelihood completing each task identified generated ideas during audio-recorded sessions. completed pre-post survey usability. consensus coding synthesize problems transcribed Usability ratings (scale 0–100: higher scores indicating usability) averaged 66.3 (SD 12.4) prior Scores 77.8 9.1) following improving "marginal acceptability" "acceptable". Ten were across tasks, comprised 2–3 types per task. participants suggested making data fields social determinants health key background variables identifying equity targets mandatory electronic record using asynchronous communication tools elicit adaptations. indicated was acceptable range Staff provide direction future improvements PEDDI. In addition, this highlights opportunities use inequities other clinical innovations resource-constrained healthcare settings.

Language: Английский

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Assessing the Inner Setting among Massachusetts Community Health Centers: Opportunities for Multilevel Investigation and Expansion of Influences on Health Equity

Research Square (Research Square), Journal Year: 2024, Volume and Issue: unknown

Published: Oct. 15, 2024

Background Implementation science increasingly aims to improve equity in delivery of evidence-based interventions. It is important expand the conceptualization inner setting, organizations like community health centers where interventions are put into place, accordingly. Taking a comprehensive, partnered approach measuring setting among network engaged implementation research ensures assessment variability sites and generates centralized contextual data that can be applied across studies. Methods We conducted cross-sectional survey staff (n = 63) from 12 Massachusetts at Science Center for Cancer Control Equity. The assessed constructs Consolidated Framework Research, including learning climate, leadership engagement, available resources, demands/stress using validated measures. Additional equity-focused items included structural characteristics work infrastructure language access services. Descriptive statistics examined differences by role center. Results Staff rated climate (mean 3.98) engagement 3.67) positively, while resources 2.78) had lowest rating, particularly staffing resources. Clinical context compared other roles. Most provided tuition assistance all reported supportive human benefits caregiving, fewer offered formal mentorship or affinity groups. written materials routinely patients languages than English interpreter services were most common Spanish, Vietnamese, Portuguese. Conclusions This study provides baseline within centers. Periodic follow-up surveys will monitor changes over time. Data used future analyses explore how influence outcomes impact equitable translation practice.

Language: Английский

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Extending the Translational Science Benefits Model to Implementation Science for Cancer Prevention and Control

Journal of Clinical and Translational Science, Journal Year: 2024, Volume and Issue: 8(1)

Published: Jan. 1, 2024

Abstract Introduction: There is increasing pressure on the federal research budget and shifting public opinions about value of academic enterprise. We must develop apply metrics that demonstrate broad benefits for health society. The Translational Science Benefits Model (TSBM) measures impact large-scale translational science initiatives, such as National Cancer Institute’s Moonshot. TSBM provides scaffolding to illustrate how has real-world impacts. propose an expansion explicitly include implementation-focused outcomes. Methods: includes four categories benefits, including (1) clinical medical, (2) community health, (3) economic, (4) policy legislative. Implementation outcomes serve a precursor model’s established domains can help sharpen focus steps needed achieve range provide several examples studies these implementation other benefits. Conclusions: It important consider scientific impacts conditions are necessary them. may accelerate cancer community’s ability goal preventing 4 million deaths by 2047.

Language: Английский

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Bundling Colorectal Cancer Screening Outreach with Screening for Social Risk in Federally Qualified Health Centers: A Stepped-Wedge Implementation-Effectiveness Study

Journal of General Internal Medicine, Journal Year: 2024, Volume and Issue: 39(7), P. 1188 - 1195

Published: Feb. 8, 2024

Abstract Background Bundling is combining individual interventions to meet quality metrics. offers of cancer screening with for social determinants health (SDOH) may enable centers assist patients risks and yield efficiencies. Objective To measure effects bundling fecal immunochemical testing (FIT) SDOH in federally qualified (FQHCs). Design Clustered stepped-wedge trial. Participants Four Massachusetts FQHCs randomized implement bundled FIT-SDOH over 8-week “steps.” Intervention Outreach 50–75-year-olds overdue CRC offer FIT screening. The implementation strategy used facilitation training data monitoring reporting. Main Measures Implementation process descriptions, from meetings, rates. Rates were compared between control each “step” by fitting generalized linear mixed-effects models random intercepts FQHCs, patients, FQHC. Key Results tailored processes their infrastructure, workflows, staffing prioritized different groups outreach. Two population outreach, two integrated within established programs, such as pre-visit planning. Of 34,588 screening, 54% female; 20% Black, 11% Latino, 10% Asian, 47% white; 32% had Medicaid, 16% Medicare, private insurance, uninsured. Odds completion “steps” controls higher overall among outreach (overall: adjusted odds ratio (aOR) 2.41, p = 0.005; prioritized: aOR 2.88, 0.002). did not differ across Conclusions As healthcare systems are required conduct more screenings, it notable that a long-standing requirement increased even when newer requirement. This was feasible real-world safety-net clinical conserve resources, especially complex or intensive strategies. Clinical Trials Registration NCT04585919

Language: Английский

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