L7: Implementation science part 2 Flashcards
inner setting domain?
The setting in which the innovation is implemented e.g., the prostate radiotherapy setting.
CFIR constructs include:
“Resources are available to implement and deliver the innovation”
“Funding is available to implement and deliver the innovation”
“Physical space is available to implement and deliver the innovation”
“Tangible and/or intangible incentives and rewards and/or disincentives and punishments support implementation and delivery of the innovation”
individuals domain?
The roles and characteristics of individuals.
CFIR constructs include:
“Individuals who lead efforts to implement the innovation”
“Individuals with subject matter expertise who assist, coach, or support implementation”
“Individuals who are directly or indirectly receiving the innovation”
implementation process domain?
The activities and strategies used to implement the innovation.
CFIR constructs include:
“Collect information about the priorities, preferences, and needs of recipients to guide implementation and delivery of the innovation”
“Identify roles and responsibilities, outline specific steps and milestones, and define goals and measures for implementation success in advance”
“Attract and encourage participation in implementation and/or the innovation”
Happens first?
MRC framework for complex interventions?
Helps translate evidence-based research into practice (since up to 70% of interventions fail to move from bench to bedside).
Key Phases:
Development of intervention– Adapt an existing intervention for a new context based on research evidence.
Feasibility & Piloting – Testing feasibility, acceptability, and evaluate design to inform next iteration.
Evaluation – Assessing effectiveness through appropriate methodology (RCTs, observational studies, etc.).
Implementation – Scaling up and embedding the intervention into real-world practice. Efforts to increase the impact and uptake of the intervention.
Cyclical Process: You can go back to earlier phases (e.g., refine the design before full implementation).
qualitative evaluation of feasibility study?
Qualitative research can form integral component of feasibility studies:
Inform improvements to intervention prior to full implementation
Facilitate future scale-up and dissemination
Ensure sustainability of implementation
Qualitative interview study undertaken to evaluate feasibility study.
Identify barriers and facilitators to routine clinical PROM collection at Guy’s Cancer Centre.
Qualitative interview study- methods
Semi-structured interview guide developed using the CFIR.
Open-ended interview questions developed using interview guide tool:
Who are the key individuals to engage to ensure success of this implementation project?
What sort of resources (money, training, education, physical space, time etc) would you envisage needing for collection of PROMs routinely in the clinical setting?
Would any training or education be useful and improve the effectiveness of this project?
Deductive analysis - when you have a hypothesis/idea of what you are looking for
Inductive- going in completely blind to what you will find. More hypothesis generating.
Each interview transcribed verbatim
Deductive analysis- application of CFIR codes to the data
Data organised by construct of the cfir
Barriers and facillitators mapped by construct of the cfir and salient quotes selected to represent each.
saturation analysis?
Qualitative Research (Thematic Saturation)
The point at which no new themes or insights emerge from additional data collection (e.g., in interviews or focus groups).
Used to determine when enough data has been gathered for analysis.
applying MRC to proms?
Innovation domain- adaptability
The implementation process will need to be adapted to enable scale-up across Guy’s Cancer.
“when you roll it out it’s going to be a very big scale number of patients, hopefully we’ll get that all worked out electronically and there will be some kind of way to highlight that to make that a bit less labour intensive“
“I think when it gets rolled out, all tumour groups need somebody in a full-time post to be doing it”
Outer setting- local conditions
The implementation process will need to be aligned across Trust sites, tumour types, and treatment modalities.
It is unclear what the impact of the roll-out of the new electronic health record platform will be on routine PROM collection.
Outer setting domain- performance measurement pressure
The routine PROM collection process needs to be aligned with national and international policy.
Resource needs to be available to regularly audit the implementation and ensure the quality of the data.
Inner setting domain- available resources
It is necessary to free up other clinical time to facillitate routine prom collection
There is a lack of dedicated follow-up clinics to refer patients onto
Inner setting domain- space
There is a lack of physical space available in the clinical settings to administer PROMs.
Individuals domain- innovation recipients
Proportion of patients are digitally illiterate.
Health inequality: certain demographics of patients experience difficulties with completing PROMs.
“there’s language barriers, people who might be hard of hearing, or struggle to access the technology, or don’t have any of that support at home yeah I guess issues around reading and that kind of thing“
Implementation process- engaging
Staff need to be engaged to demonstrate the clinical value of routine PROM collection.
CFIR-ERIC?
xpert Recommendations for Implementing Change (CFIR-ERIC) compilation used to map discrete strategies against identified barriers.
CFIR (Consolidated Framework for Implementation Research) – A framework used to assess factors influencing implementation across five domains:
Intervention characteristics
Outer setting
Inner setting
Characteristics of individuals
Process of implementation
ERIC (Expert Recommendations for Implementing Change) – A set of 73 discrete implementation strategies, developed using the Delphi method, to enhance the adoption, implementation, or sustainability of clinical practices.
Key Points:
ERIC strategies are mapped to CFIR constructs, helping researchers and practitioners select appropriate strategies based on the barriers identified in a given setting.
The Delphi process was used to refine and validate these strategies through expert consensus.
quantiative evaluation of feasibility study?
Quantitative evaluation of feasibility study undertaken to facilitate continued advancement of implementation process.
Proctor’s Implementation Outcomes Framework (IOF) used to evaluate feasibility study.
<50% of studies applying CFIR reported investigating implementation outcomes.
Proctor’s implementation outcomes framework?
implementation outcomes:
what is proctor’s implementation outcomes framework
ChatGPT said:
Proctor’s Implementation Outcomes Framework is a model that defines key implementation outcomes to assess how well an intervention is adopted and sustained in real-world settings. It helps evaluate the success of implementation strategies separate from clinical or service outcomes. This framework is often used alongside CFIR to evaluate not just barriers and facilitators (CFIR) but also how well an intervention is implemented and sustained (Proctor’s framework).
The 8 Implementation Outcomes
Acceptability – The perception that a service or innovation is agreeable, palatable, or satisfactory.
Adoption (Uptake) – Adoption is usually assessed by the practice provider(s) and can also be referred to as “uptake”.
Appropriateness –Perceived fit of an innovation or practice to address a particular issue.
Feasibility – The extent to which an innovation can be successfully used or undertaken in a specific setting.
Fidelity – Is the intervention being delivered as intended?
Implementation Cost – What are the financial and resource costs?
Penetration – How well is the intervention integrated within the system?
Sustainability – Can the intervention be maintained over time?
Service and Client Outcomes: Measure the effectiveness or impact of the intervention on the service and clients, typically assessed through clinical or behavioral results. service outcomes- efficency, safety, effectiveness, patient-centerdness, timeliness, equity. client outcomes- satisfaction, functioning, symptomatology
slides 37-42. confusing what we have to know
