A rigorous, stepwise procedure for multi-stakeholder design of implementation actions

To determine if a population health approach to insomnia using internet-based cognitive behavioral therapy for insomnia (ICBT-I) affects dispensed medications and provider encounters compared with usual care. A pragmatic hybrid study design was used to evaluate both the implementation strategy and the long-term effects of ICBT-I on health care utilization in an integrated health system. Adult members with insomnia (a diagnosis or insomnia medication dispensation) or at high risk of insomnia (a diagnosis of depression or anxiety) were randomized to receive information on either an ICBT-I program (intervention arm) or in-person classes on insomnia (usual-care arm). Outcomes included dispensed insomnia medications and provider encounters over 12 months. The effectiveness of our implementation of ICBT-I on the target population was determined by an intention-to-treat analysis and by regression models comparing those who engaged in ICBT-I with matched usual-care arm controls. A total of 136,630 participants were randomized. Six hundred thirty-eight (0.96%) accessed the ICBT-I program while 431 (0.66%) attended 1 or more usual-care insomnia classes. Dispensed insomnia medications and provider encounters were no different in the ICBT-I arm vs the usual-care arm (intention-to-treat) or among those who engaged in ICBT-I vs matched usual-care arm controls. Since ICBT-I program engagement was low, additional strategies to improve engagement should be explored. ICBT-I did not result in a reduction in several measures of health care utilization; nevertheless, it offers an alternative and accessible approach to managing population insomnia. Registry: ClinicalTrials.gov; Name: Trial of Internet-Based Cognitive Behavioral Therapy for Insomnia in Patients Prescribed Insomnia Medications; URL: https://clinicaltrials.gov/ct2/show/NCT03313466; Identifier: NCT03313466. Derose SF, Rozema E, Chen A, Shen E, Hwang D, Manthena P. A population health approach to insomnia using internet-based cognitive behavioral therapy for insomnia. J Clin Sleep Med. 2021;17(8):1675-1684.

To use a practical approach to examining the use of Expert Recommendations for Implementing Change (ERIC) strategies by Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) dimensions for rural health innovations using annual reports on a diverse array of initiatives. The Veterans Affairs (VA) Office of Rural Health (ORH) funds initiatives designed to support the implementation and spread of innovations and evidence-based programs and practices to improve the health of rural Veterans. This study draws on the annual evaluation reports submitted for fiscal years 2020-2022 from 30 of these enterprise-wide initiatives (EWIs). Content analysis was guided by the RE-AIM framework conducted by the Center for the Evaluation of Enterprise-Wide Initiatives (CEEWI), a Quality Enhancement Research Initiative (QUERI)-ORH partnered evaluation initiative. CEEWI analysts conducted a content analysis of EWI annual evaluation reports submitted to ORH. Analysis included cataloguing reported implementation strategies by Reach, Adoption, Implementation, and Maintenance (RE-AIM) dimensions (i.e., identifying strategies that were used to support each dimension) and labeling strategies using ERIC taxonomy. Descriptive statistics were conducted to summarize data. A total of 875 implementation strategies were catalogued in 73 reports. Across these strategies, 66 unique ERIC strategies were reported. EWIs applied an average of 12 implementation strategies (range 3-22). The top three ERIC clusters across all 3 years were Develop stakeholder relationships (21%), Use evaluative/iterative strategies (20%), and Train/educate stakeholders (19%). Most strategies were reported within the Implementation dimension. Strategy use among EWIs meeting the rurality benchmark were also compared. Combining the dimensions from the RE-AIM framework and the ERIC strategies allows for understanding the use of implementation strategies across each RE-AIM dimension. This analysis will support ORH efforts to spread and sustain rural health innovations and evidence-based programs and practices through targeted implementation strategies.

IntroductionChronic diseases are a leading public health concern in the Americas, and physical inactivity contributes significantly to their burden. Open streets program—community initiatives that temporarily close urban streets to vehicles—promote physical activity and community engagement, demonstrating positive health and social impacts. Effective implementation depends on identifying suitable strategies and frameworks. The Expert Recommendations for Implementing Change (ERIC) taxonomy, developed for clinical/healthcare contexts, has not been widely assessed for community-based interventions such as Open Streets. Implementation strategies could lead to specific outcomes (e.g., adoption, sustainability) that differ from program outcomes (e.g., PA levels, chronic disease prevalence). This scoping review focuses on the strategies that influence implementation outcomes. The primary aims of this review were to (1) identify implementation strategies for Open Streets programs and (2) identify opportunities for Open Streets programs to promote chronic disease prevention and physical activity, specifically in the Americas.MethodsA scoping review was conducted using Joanna Briggs Institute methodology and PRISMA-ScR guidelines. Six databases (PubMed, Scopus, Scielo, Web of Science, TRIS, and LILACS) were searched for studies on Open Streets programs in the Americas (January 2004–April 2024). Three reviewers independently screened studies in Rayyan. Strategies were extracted and coded according to the 73 ERIC taxonomy strategies. Quality appraisal used MMAT for empirical studies, AMSTAR-2 for reviews, and AACODS for gray literature.ResultsFifty-nine studies met the inclusion criteria, yielding 63 distinct implementation strategies for Open Streets programs. All 63 strategies were classified within the ERIC taxonomy. Frequently aligned ERIC strategies included building coalitions, capturing local knowledge, conducting needs assessments, and fostering stakeholder engagement. Open Streets strategies emphasized multisectoral collaboration, cultural adaptation, equity, and sustainability.DiscussionAmong the 63 identified Open Streets strategies, many aligned with ERIC, providing a foundation in stakeholder engagement, coalition building, and flexible, context-sensitive implementation. However, several ERIC strategies were not relevant to Open Streets, underscoring that while many ERIC strategies were applicable, not all suited this setting. Open Streets programs may require supplemental approaches to address equity, cultural competence, and multisectoral collaboration. Findings present opportunities to tailor, test, and scale strategies that maximize the population health impact of Open Streets and similar community-based programs.

Introduction: Guidelines recommend cognitive behavioral therapy for insomnia (CBT-I) as the first line of treatment for insomnia in general practice, but CBT-I is rarely available. Nurse-guided Internet-delivered CBT-I might be a solution to improve access to care. Objective: We aimed to determine the effectiveness of nurse-guided Internet-delivered CBT-I (I-CBT-I) on insomnia severity experienced by patients in general practice. Methods: Nurse-guided I-CBT-I (“i-Sleep”) was compared to care-as-usual (and I-CBT-I after 6 months) in 15 participating general practices among 134 patients (≥18 years old) with clinical insomnia symptoms. Assessments took place at 8, 26 and 52 weeks. Primary outcome was self-reported insomnia severity (Insomnia Severity Index) at 8 weeks. Secondary outcomes were sleep diary indices, depression and anxiety symptoms (Hospital Anxiety and Depression Scale), fatigue, daytime consequences of insomnia, sleep medication and adverse events. Results: Two thirds of the 69 intervention patients (n = 47; 68%) completed the whole intervention. At the posttest examination, there were large significant effects for insomnia severity (Cohen’s d =1.66), several sleep diary variables (wake after sleep onset, number of awakenings, terminal wakefulness, sleep efficiency, sleep quality) and depression. At 26 weeks there were still significant effects on insomnia severity (d = 1.02) and on total sleep time and sleep efficiency. No significant effects were observed for anxiety, fatigue, daily functioning or sleep medication. No adverse events were reported. Conclusions: Nurse-guided I-CBT-I effectively reduces insomnia severity among general practice patients. I-CBT-I enables general practitioners to offer effective insomnia care in accordance with the clinical guidelines.

AimTo describe the development and acceptability of a decision aid (DA) for chronic insomnia considering discontinuation of benzodiazepine (BZD) and benzodiazepine receptor agonist (BZRA) hypnotics, and if discontinuing, tapering with or without cognitive behavioral therapy for insomnia (CBT‐I).MethodsWe reviewed relevant literature describing chronic insomnia to identify options. We used the results of the systematic review and meta‐analysis conducted previously to determine the related outcomes of two options: discontinuation of BZD/BZRA hypnotics by gradual tapering alone and discontinuation of BZD/BZRA hypnotics by gradual tapering with CBT‐I. We then developed a prototype of DA following the International Patient Decision Aid Standards. A mixed methods survey was conducted to assess the acceptability among patients and healthcare providers.ResultsThe prototype consisted of a description of insomnia, options of continuing or discontinuing BZD/BRZA hypnotics (if discontinuing, the options of tapering hypnotics with or without CBT‐I), pros and cons of each option, and a value clarification exercise. Patients (n = 24) reported that the DA had acceptable language (79%), adequate information (71%), and well‐balanced presentation (91%). Healthcare providers (n = 20) also provided favorable feedback.ConclusionWe developed a DA for chronic insomnia considering discontinuation of BZD/BRZA hypnotics, which was acceptable for stakeholders. The developed DA was designed to support patients and healthcare providers to make a decision about whether to discontinue BZD/BRZA hypnotics.

Schools, like other service sectors, are confronted with an implementation gap, with the slow adoption and uneven implementation of evidence-based practices (EBP) as part of routine service delivery, undermining efforts to promote better youth behavioral health outcomes. Implementation researchers have undertaken systematic efforts to publish taxonomies of implementation strategies (i.e., methods or techniques that are used to facilitate the uptake, use, and sustainment of EBP), such as the Expert Recommendations for Implementing Change (ERIC) Project. The 73-strategy ERIC compilation was developed in the context of healthcare and largely informed by research and practice experts who operate in that service sector. Thus, the comprehensibility, contextual appropriateness, and utility of the existing compilation to other service sectors, such as the educational setting, remain unknown. The purpose of this study was to initiate the School Implementation Strategies, Translating ERIC Resources (SISTER) Project to iteratively adapt the ERIC compilation to the educational sector. The results of a seven-step adaptation process resulted in 75 school-adapted strategies. Surface-level changes were made to the majority of the original ERIC strategies (52 out of 73), while five of the strategies required deeper modifications for adaptation to the school context. Six strategies were deleted and seven new strategies were added based on existing school-based research. The implications of this study's findings for prevention scientists engaged in implementation research (e.g., creating a common nomenclature for implementation strategies) and limitations are discussed.

The Characteristics of Symptomatic Osteoarthritis in General and Specialist Practice in Italy: Design and Methods of the AMICA Study

Learning collaboratives are a widely used implementation strategy for supporting the spread of complex innovations, but little is known about how learning collaboratives develop and sustain over time. The OncoPRO initiative, a PCORI-funded national learning collaborative focused on implementing remote symptom monitoring (RSM) using electronic patient-reported outcomes (ePROs) in oncology, provides a unique opportunity to explore this process. By examining how OncoPRO fosters collaboration, shares strategies, and adapts to diverse sites, this study offers critical insights into both the development of learning collaboratives and their ability to support the long-term success of complex healthcare initiatives. This study employed a multi-methods implementation science approach to examine the development and first year of the OncoPRO initiative. From conception through year 1 (March 2023-December 2024), OncoPRO provided support to 12 independent health systems. We identified cross-organizational barriers encountered during the development of a national learning collaborative, and the implementation strategies employed to address them, using field notes generated during all OncoPRO-related meetings, site-level communications, and site presentations during meetings. We systematically identified and categorized barriers and implementation strategies using the Consolidated Framework for Implementation Research (CFIR) 2.0 and the Expert Recommendations for Implementing Change (ERIC) frameworks. Strategies were then categorized into domains based on their alignment with each other and learning collaborative implementation components or processes. We identified 29 overarching barriers (e.g., lack of best practices; clinician buy-in) that were addressed through 37 foundational implementation strategies relevant to developing and facilitating the learning collaborative. These implementation strategies were organized into six domains: building a multi-level foundation, engaging and onboarding implementation sites, building shared learning structures, supporting technical rollout, embedding feedback loops and quality monitoring, and stimulating demand for RSM and collaborative participation. Most barriers were addressed using multiple strategies, and individual strategies often targeted several barriers simultaneously. Broad strategies addressing multiple barriers (e.g. build a coalition; identify early adopters) were deployed early to develop a base for the collaborative. As the initiative matured, strategies targeting specific barriers (e.g. develop and implement quality monitoring systems) were added to support site-level operationalization and continuous improvement. This study describes our approach to building a national learning collaborative for ePRO-enabled RSM implementation in oncology, focused on the initial phase of implementation. It offers a case study and potential roadmap for others involved in the initial development of large-scale collaboratives for complex interventions. This descriptive process analysis lays the groundwork for future analyses of implementation variation and strategy effectiveness across participating health systems, and highlights how learning collaboratives can support the implementation of complex quality initiatives like RSM in oncology.

This webinar focuses on strategies for implementing evidence-based practices that will make a real difference to improving maternal and neonatal health, which ties in closely with SDG targets 3.1 and 3.2 in particular. We invite you to read related content in the collection on [Implementation of Evidence-Based Practices for Improving Maternal and Neonatal Health](https://www.biomedcentral.com/collections/IEBP), published in [Implementation Science](https://implementationscience.biomedcentral.com/) and [Implementation Science Communications](https://implementationsciencecomms.biomedcentral.com/). The Guest Editors of the collection - Michelle H. Moniz, Rebecca Hamm, and Jennifer Callaghan Koru - are chairing the event, with the Springer Nature SDG3 chair, Fiona Pring, introducing the event. Implementation research priorities for addressing the maternal health crisis in the USA: results from a modified Delphi study among researchers Background: Maternal health outcomes in the USA are far worse than in peer nations. Increasing implementation research in maternity care is critical to addressing quality gaps and unwarranted variations in care. Implementation research priorities have not yet been defined or well represented in the plans for maternal health research investments in the USA. Methods: This descriptive study used a modified Delphi method to solicit and rank research priorities at the intersection of implementation science and maternal health through two sequential web-based surveys. A purposeful, yet broad sample of researchers with relevant subject matter knowledge was identified through searches of published articles and grant databases. The surveys addressed five implementation research areas in maternal health: (1) practices to prioritize for broader implementation, (2) practices to prioritize for de-implementation, (3) research questions about implementation determinants, (4) research questions about implementation strategies, and (5) research questions about methods/measures. Results: Of 160 eligible researchers, 82 (51.2%) agreed to participate. Participants were predominantly female (90%) and White (75%). Sixty completed at least one of two surveys. The practices that participants prioritized for broader implementation were improved postpartum care, perinatal and postpartum mood disorder screening and management, and standardized management of hypertensive disorders of pregnancy. For de-implementation, practices believed to be most impactful if removed from or reduced in maternity care were cesarean delivery for low-risk patients and routine discontinuation of all psychiatric medications during pregnancy. The top methodological priorities of participants were improving the extent to which implementation science frameworks and measures address equity and developing approaches for involving patients in implementation research. Conclusions: Through a web-based Delphi exercise, we identified implementation research priorities that researchers consider to have the greatest potential to improve the quality of maternity care in the USA. This study also demonstrates the feasibility of using modified Delphi approaches to engage researchers in setting implementation research priorities within a clinical area. Group prenatal care successes, challenges, and frameworks for scaling up: a case study in adopting health care innovations Background Group prenatal care enhances quality of care, improves outcomes, and lowers costs. However, this healthcare innovation is not widely available. Using a case-study approach, our objectives were to (1) examine organizational characteristics that support implementation of Expect With Me group prenatal care and (2) identify key factors influencing adoption and sustainability. Methods We studied five clinical sites implementing group prenatal care, collecting qualitative data including focus group discussions with clinicians (n = 4 focus groups, 41 clinicians), key informant interviews (n = 9), and administrative data. We utilized a comparative qualitative case-study approach to characterize clinical sites and explain organizational traits that fostered implementation success. We characterized adopting and non-adopting (unable to sustain group prenatal care) sites in terms of fit for five criteria specified in the Framework for Transformational Change: (1) impetus to transform, (2) leadership commitment to quality, (3) improvement initiatives that engage staff, (4) alignment to achieve organization-wide goals, and (5) integration. Results Two sites were classified as adopters and three as non-adopters based on duration, frequency, and consistency of group prenatal care implementation. Adopters had better fit with the five criteria for transformational change. Adopting organizations were more successful implementing group prenatal care due to alignment between organizational goals and resources, dedicated healthcare providers coordinating group care, space for group prenatal care sessions, and strong commitment from organization leadership. Conclusions Adopting sites were more likely to integrate group prenatal care when stakeholders achieved alignment across staff on organizational change goals, leadership buy-in, and committed institutional support and dedicated resources to sustain it. Trial registration The Expect With Me intervention’s design and hypotheses were preregistered: https://clinicaltrials.gov/study/NCT02169024. Date: June 19, 2014. Evaluating feedback from an implementation advisory board to assess the rollout of a postpartum patient navigation program Background Patient navigation is an individualized intervention to facilitate comprehensive care which has not yet been fully implemented in obstetric or postpartum care. Methods We aimed to develop and evaluate a mechanism to incorporate feedback regarding implementation of postpartum patient navigation for low-income birthing individuals at an urban academic medical center. This study analyzed the role of an Implementation Advisory Board (IAB) in supporting an ongoing randomized trial of postpartum navigation. Over the first 24 months of the trial, the IAB included 11 rotating obstetricians, one clinic resource coordinator, one administrative leader, two obstetric nurses, one primary care physician, one social worker, and one medical assistant. Members completed serial surveys regarding program implementation, effects on patient care, and areas for improvement. Quarterly IAB meetings offered opportunities for additional feedback. Survey responses and meeting notes were analyzed using the constant comparative method and further interpreted within the Exploration, Preparation, Implementation, Sustainment (EPIS) Framework. Results Members of the IAB returned 37 surveys and participated in five meetings over 24 months. Survey analysis revealed four themes among the inner context: reduced clinician burden, connection of care teams, communication strategies, and clinic workflow. Bridging factors included improved patient access to care, improved follow-up, and adding social context to care. Innovation factors included availability of navigators, importance of consistent communication, and adaptation over time. Meeting notes highlighted the importance of bidirectional feedback regarding implementation, and members expressed positive opinions regarding navigators’ effects on patient care, integration into clinic workflow, and responsiveness to feedback. IAB members initially suggested changes to improve implementation; later survey responses demonstrated successful program adaptations. Conclusions Members of an implementation advisory board provided key insights into the implementation of postpartum patient navigation that may be useful to promote dissemination of navigation and establish avenues for the engagement of implementing partners in other innovations. Trial registration ClinicalTrials.gov, NCT03922334. Registered April 19, 2019. The results here do not present the results of the primary trial, which is ongoing. IMplementation of the Preterm Birth Surveillance PAthway: a RealisT evaluation (The IMPART Study) Background In the UK, 7.6% of babies are born preterm, which the Department of Health aims to decrease to 6% by 2025. To advance this, NHS England released Saving Babies Lives Care Bundle Version 2 Element 5, recommending the Preterm Birth Pathway for women at risk of preterm birth. The success of this new pathway depends on its implementation. The IMPART (IMplementation of the Preterm Birth Surveillance PAthway: a RealisT evaluation) study aimed to research how, why, for whom, to what extent and in what contexts the prediction and prevention aspects of Preterm Birth Surveillance Pathway is implemented through a realist evaluation. Realist implementation studies are growing in popularity. Methods Initial programme theories were developed through a realist informed literature scope, interviews with developers of the NHS England guidance, and a national questionnaire of current practice. Implementation theory was utilised in developing the programme theories. Data (interviews and observations with staff and women) were undertaken in 3 case sites in England to ‘test’ the programme theories. Substantive theory was utilised during data analysis to interpret and refine the theories on how implementation could be improved. Results Three explanatory areas were developed: risk assessing and referral; the preterm birth surveillance clinic; and women centred care. Explanatory area 1 dealt with the problems in correct risk assessment and referral to a preterm clinic. Explanatory area 2 focused on how once a correct referral has been made to a preterm clinic, knowledgeable and supported clinicians can deliver a well-functioning clinic. Explanatory area 3 concentrated on how the pathway delivers appropriate care to women. Conclusions The IMPART study provides several areas where implementation could be improved. These include educating clinicians on knowledge of risk factors and the purpose of the preterm clinic, having a multidisciplinary preterm team (including a preterm midwife) with specialist preterm knowledge and skills (including transvaginal cervical scanning skills), and sites actively working with their local network. This multidisciplinary preterm team are placed to deliver continuity of care for women at high-risk of preterm birth, being attentive to their history but also ensuring they are not defined by their risk status. Trial registration ISRCTN57127874. Using an experience-based co-design approach to develop strategies for implementing an intravenous iron intervention to treat moderate and severe anemia in pregnancy in Malawi Background In low- and middle-income countries, women experiencing anemia during pregnancy are recommended to take 30 mg to 60 mg of oral iron daily throughout pregnancy. However, oral iron tablets are often poorly tolerated and slow in correcting anemia, resulting in low adherence, prolonged anemia, and increased risk of adverse maternal and fetal outcomes. An alternative to oral iron is intravenous (IV) iron, commonly used in high-income countries to restore the body’s iron stores rapidly. A randomized controlled trial was conducted to investigate the effectiveness and safety of IV iron compared to standard-of-care oral iron supplementation for pregnant women with moderate and severe anemia in the third trimester in Malawi (REVAMP-TT). Using an experience-based co-design approach, our study aimed to identify barriers and facilitators to IV iron use to treat anemia in pregnancy in the primary healthcare system of Malawi, and develop mitigating strategies for the successful implementation of REVAMP-TT. Methodology The co-design process involved two phases: i) We conducted an information-gathering exercise to identify barriers and facilitators to IV iron use to treat anemia in pregnancy in the primary healthcare system of Malawi. We interviewed key informants (n = 53) including the policymakers, government partners, healthcare managers, and healthcare providers. We also gathered previous research findings from a formative qualitative study on the perceptions and experiences of IV iron treatment for pregnant women experiencing anemia in Malawi (n = 29). ii) We conducted two co-design workshops with end-users (n = 20) and healthcare providers (n = 20) to confirm and identify the key barriers and facilitators and developed mitigating strategies to inform the successful implementation of the REVAMP-TT trial. We mapped the emerging barriers to the Consolidated Framework for Implementation Research 2.0 (CFIR 2.0) and matched the mitigating strategies to the corresponding Expert Recommendations for Implementing Change (ERIC) compilation. Results The following were identified as key barriers to IV iron use to treat anemia in pregnancy in the primary healthcare system of Malawi: the cost of IV iron, the lack of available resources and knowledge, local attitudes including myths and misconceptions about IV iron and keeping pregnancy a secret, local conditions, the lack of political will and buy-in from high-level leaders, the lack of capability of healthcare providers to deliver IV iron, and the lack of male involvement to support pregnant women's access to antenatal care. The proposed strategies to mitigate the barriers for the successful implementation of the REVAMP TT trial included providing financial strategy, developing stakeholder relationships, training and educating stakeholders, supporting clinicians, and engaging end-users. Conclusion The use of the experience-based co-design approach in our study provided a valuable method to expose the potential barriers and facilitators to IV iron use and develop mitigating strategies to successfully implement the REVAMP-TT trial. Engaging both the key informants and end users promoted ownership and consensus among stakeholders and ensured a collaborative environment for sharing deeply rooted real-world experiences and insights. Not only do these findings address the needs of this study, but they also, lay a groundwork for the possible integration of IV iron into routine care in Malawi and provide knowledge for policymakers to make informed decisions on the management of anemia in the primary healthcare systems of Malawi.

Clinical Scenario: Individuals with knee osteoarthritis (OA) frequently experience difficulty sleeping, and insomnia in this population has been associated with elevated levels of systemic inflammation. Cognitive behavioral therapy designed to treat insomnia is a nonpharmacological intervention that may reduce inflammation by improving sleep quality. Clinical Question: In patients with comorbid knee OA and insomnia, does implementation of Cognitive Behavioral Therapy for Insomnia (CBT-I), compared to control interventions, reduce systemic inflammation as measured by blood biomarker concentrations? Summary of Key Findings: Two randomized controlled trials were included. The two identified studies assessed the impact of CBT-I on inflammatory markers among adults with knee OA and insomnia disorder. Both studies measured inflammation using blood biomarker concentrations to evaluate systemic inflammation. Although neither study found that CBT-I significantly reduced systemic inflammation overall, both reported improvements in sleep and pain-related outcomes, suggesting that the intervention may offer clinical benefits even in the absence of measurable changes in inflammation. Clinical Bottom Line: There is currently inconsistent, limited-quality, patient-oriented evidence that does not support the use of CBT-I to reduce systemic inflammation in patients with knee OA and insomnia compared with the standard of care group. Future research should explore the long-term effects of CBT-I on systemic inflammation and pain outcomes in individuals with comorbid knee OA and insomnia to strengthen clinical applicability. Strength of Recommendation: The grade of B is recommended by the Strength of Recommendation Taxonomy for inconsistent, limited-quality, patient-oriented evidence.

Introduction and aimsPatients undergoing major surgery risk significant blood loss and transfusion, which increases substantially if they have pre-existing anemia. Preoperative Anemia and Iron Deficiency Screening, Evaluation and Management Pathways (PAIDSEM-P) outline recommended blood tests and treatment to optimize patients before surgery. Documented success using PAIDSEM-P to reduce transfusions and improve patient outcomes exists, but the reporting quality of such studies is suboptimal. It remains unclear what implementation strategies best support the implementation of PAIDSEM-P.MethodMaximum variation, purposive sampling was used to recruit a total of 15 participants, including a range of health professionals and patients for semi-structured interviews. Data analysis utilized a deductive approach informed by the Consolidated Framework for Implementation Research (CFIR) for barrier identification and the Expert Recommendations for Implementing Change (ERIC) for reporting recommended implementation strategies. A modified version of the Action, Actor, Context, Target and Time (AACTT) framework assisted with conceptualisation and targeted strategy selection.ResultsThe analysis revealed five barriers: access to knowledge and information, patient needs and resources, knowledge and beliefs about the intervention, available resources, and networks and communications, which had strong ERIC recommendations, including conduct educational meetings, develop educational materials, distribute educational materials, obtain and use patients/consumers family feedback, involve patients/consumers/family members, conduct a local needs assessment, access new funding, promote network weaving, and organize clinician implementation team meetings.ConclusionsMapping the barriers and strategies using the ERIC framework on the basis of individual actor categories proved to be useful in identifying a pragmatic number of implementation strategies that may help in supporting the utilisation of the PAIDSEM-P and other evidence-based healthcare implementation problems more broadly.

Depression and insomnia commonly co-occur, resulting in greater morbidity for patients, and difficult diagnostic and treatment decisions for clinicians. When patients report symptoms of both depression and insomnia, it is common for medical practitioners to conceptualise the insomnia as a secondary symptom of depression. This implies that there is little purpose in treating insomnia directly, and that management of depression will improve both the depression and insomnia symptoms. In this review, we present an overview of research investigating the comorbidity and treatment approaches for patients presenting with depression and insomnia in primary care. Evidence shows that clinicians should avoid routinely conceptualising insomnia as a secondary symptom of depression. This is because insomnia symptoms: (i) often occur before mood decline and are independently associated with increased risk of future depression; (ii) commonly remain unchanged following depression treatment; and (iii) predict relapse of depression after treatment for depression only. Furthermore, compared with control, cognitive behaviour therapy for insomnia improves symptoms of both depression and insomnia. It is critical that primary care clinicians dedicate specific diagnostic and treatment attention to the management of both depression (eg, psychotherapy, antidepressants) and insomnia (eg, cognitive behaviour therapy for insomnia administered by trained therapists or psychologists through a mental health treatment plan referral, by online programs, or by a general practitioner or nurse) when they co-occur. These treatments may be offered concurrently or sequentially (eg, insomnia treatment followed by depression treatment, or vice versa), depending on presenting symptoms, history, lifestyle factors and other comorbidities.

BackgroundMost implementation science resources (e.g., taxonomies) are published in English. Linguistic inaccessibility creates a barrier to the conduct of implementation research among non-English-speaking populations, so translation of resources is needed. Translation into Spanish can facilitate widespread reach, given the large proportion of Spanish speakers around the world. This research aimed to systematically translate the Expert Recommendations for Implementation Change (ERIC) compilation into Spanish as an exemplar for the linguistic translation process.MethodsUsing the World Health Organization guidelines, this work translated the ERIC compilation strategy names, short definitions, and thematic clusters through a three-step process: 1) forward translation into Spanish by a native Spanish-speaking implementation scientist, 2) back-translation into English by a bilingual global health researcher, and 3) piloting via virtual focus group discussions with bilingual researchers not conducting implementation research. To achieve a generalizable translation, recruitment targeted a multicultural group of Spanish-speaking researchers. At the conclusion of each step, the transdisciplinary research team (N = 7) met to discuss discrepancies and refine translations. The Spanish version of the ERIC compilation was finalized through group consensus. Reflections from research team meetings and focus group discussions were synthesized qualitatively.ResultsGiven that dialectical nuances exist between Spanish-speaking regions, efforts prioritized universally accepted terminology. Team discussions focused on difficult translations, word choice, and clarity of concepts. Seven researchers participated in two focus groups, where discussion surrounded clarity of concepts, alternative word choice for Spanish translations, linguistic formality, grammar, and conciseness. Translation difficulties highlighted lack of precision in implementation science terminology, and the lack of conceptual clarity of words underscored limitations in the application of the compilation.ConclusionsThe work demonstrated the feasibility of translating implementation science resources. As one of the first systematic efforts to translate implementation resources, this study can serve as a model for additional efforts, including translation into other languages and the expansion to conceptual modifications. Further, this work yielded insights into the need to provide conceptual clarity in implementation science terminology. Importantly, the development of Spanish resources will increase access to conduct implementation research among Spanish-speaking populations.

BackgroundSubstantial literature has highlighted the importance of patient-reported outcome and experience measures (PROMs and PREMs, respectively) to collect clinically relevant information to better understand and address what matters to patients. The purpose of this systematic review is to synthesize the evidence about how healthcare providers implement individual-level PROMs and PREMs data into daily practice.MethodsThis mixed methods systematic review protocol describes the design of our synthesis of the peer-reviewed research evidence (i.e., qualitative, quantitative, and mixed methods), systematic reviews, organizational implementation projects, expert opinion, and grey literature. Keyword synonyms for “PROMs,” PREMs,” and “implementation” will be used to search eight databases (i.e., MEDLINE, CINAHL, PsycINFO, Web of Science, Embase, SPORTDiscus, Evidence-based Medicine Reviews, and ProQuest (Dissertation and Theses)) with limiters of English from 2009 onwards. Study selection criteria include implementation at the point-of-care by healthcare providers in any practice setting. Eligible studies will be critically appraised using validated tools (e.g., Joanna Briggs Institute). Guided by the review questions, data extraction and synthesis will occur simultaneously to identify biographical information and methodological characteristics as well as classify study findings related to implementation processes and strategies. As part of the narrative synthesis approach, two frameworks will be utilized: (a) Consolidated Framework for Implementation Research (CFIR) to identify influential factors of PROMs and PREMs implementation and (b) Expert Recommendations for Implementing Change (ERIC) to illicit strategies. Data management will be undertaken using NVivo 12TM.DiscussionData from PROMs and PREMs are critical to adopt a person-centered approach to healthcare. Findings from this review will guide subsequent phases of a larger project that includes interviews and a consensus-building forum with end users to create guidelines for implementing PROMs and PREMs at the point of care.Systematic review registrationPROSPERO CRD42020182904.

Nutritional conditions and malnutrition commonly affect people diagnosed with cancer, leading to worse outcomes and reduced quality of life. An implementation science approach may improve the delivery of evidence-based nutrition in cancer. The aim of this review is to systematically evaluate published literature for implementation strategies that have been applied to improve delivery of nutritional interventions in cancer. A literature search of databases including MEDLINE, EMBASE, Global Health, APA PsychINFO, CINAHL, yielded 5164 articles, of which 37 were included, comprising 30 independent studies. Reported barriers were classified according to the updated Consolidated Framework for Implementation Research (CFIR 2.0). Implementation strategies were mapped to the Expert Recommendations for Implementing Change (ERIC). The CFIR-ERIC Implementation Matching Tool was used to evaluate the extent to which current implementation strategies align with existing evidence, and to identify future strategies. Lack of knowledge and awareness of nutritional guidelines among clinicians and available resources were the most frequently reported barriers. The implementation strategies "Audit and provide feedback" and "Conduct educational meetings" were the most widely used. Adoption and fidelity were the most frequently assessed (27/30, 90 % of studies) implementation outcomes, with 22 (81.5 %) studies reporting positive findings. Four out of five (80.0 %) studies measuring patient satisfaction reported improvements with implementation strategies. Deficits in knowledge and available resources are key barriers to implementation of nutritional interventions in cancer. The use of implementation strategies is associated with improved implementation, service, and patient-level outcomes. Key strategies to effective implementation include education, audit and feedback, and assessment of barriers and facilitators. Registry and registry number for systematic reviews and meta-analyses: This review protocol is registered with the PROSPERO group (CRD42023454210).