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Background Workforce development for implementation practice has been identified as a grand challenge in health services. This is due to the embryonic nature of the existing research in this area, few available training programs and a general shortage of frontline service staff trained and prepared for practicing implementation in the field. The interest in the role of “implementation support” as a way to effectively build the implementation capacities of the human service sector has therefore increased. However, while frequently used, little is known about the skills and competencies required to effectively provide such support. Main body To progress the debate and the research agenda on implementation support competencies, we propose the role of the “implementation support practitioner” as a concept unifying the multiple streams of research focused on e.g. consultation, facilitation, or knowledge brokering. Implementation support practitioners are professionals supporting others in implementing evidence-informed practices, policies and programs, and in sustaining and scaling evidence for population impact. They are not involved in direct service delivery or management and work closely with the leadership and staff needed to effectively deliver direct clinical, therapeutic or educational services to individuals, families and communities. They may be specialists or generalists and be located within and/or outside the delivery system they serve. To effectively support the implementation practice of others, implementation support practitioners require an ability to activate implementation-relevant knowledge, skills and attitudes, and to operationalize and apply these in the context of their support activities. In doing so, they aim to trigger both relational and behavioral outcomes. This thinking is reflected in an overarching logic outlined in this article. Conclusion The development of implementation support practitioners as a profession necessitates improved conceptual thinking about their role and work and how they enable the uptake and integration of evidence in real world settings. This article introduces a preliminary logic conceptualizing the role of implementation support practitioners informing research in progress aimed at increasing our knowledge about implementation support and the competencies needed to provide this support.

Information on how school-based programs is implemented and sustained during crises is limited. In this study, we assessed the impact of the COVID-19 pandemic on the implementation of a HIV prevention intervention in The Bahamas. Data were collected from 139 Grade 6 teachers in 2021–2022. Teachers attended virtual training and received implementation monitoring from coordinators. On average, teachers taught 26.4 (SD = 9.2) of the 35 core activities, and 7.4 (SD = 2.4) out of 9 sessions. More than half (58.3%) of teachers completed 28 or more core activities; 69.1% covered eight or all nine sessions, which is equivalent to 80% of the HIV intervention curriculum. Almost half of the teachers (43%) reported that the pandemic negatively impacted their ability to teach the program; 72% of teachers maintained that the program remained “very important” during times of crisis. Greater self-efficacy and supports increased implementation fidelity.

Abstract Support structures are available to schools worldwide for the implementation of Health Promoting School (HPS) programs. To get more insight in these structures, this multiple case study aimed to map variation in levels of support within eight Public Health Service (PHS) regions in the Netherlands and associations with contextual factors. Designed together with a Community of Practice, the study included two rounds of semistructured group interviews (N = 1–4 employees; ±3.5 hours per case) and document analysis. Data were collected on eight indicators of the level of support (e.g. intensity and reach) and 24 contextual factors relating to Healthy School Advisers, PHSs, stakeholder collaboration, and the wider context. Scores were assigned for all indicators and factors per region, and patterns were examined. Results showed large variation in the level of support across cases, mainly in intensity of provided support, integration in the PHS, and reach in terms of percentage of certified HPS schools. Some aspects such as advisers’ context sensitivity scored low in all cases. Key contextual factors were related to the PHS: its policy, internal support, capacity, and (structural) budget. Other important factors related to collaboration with regional stakeholders: coordination, division of responsibilities, and communication structure. Structural budget and strategic stakeholder coordination could be improved in all cases. In conclusion, there is much room for improvement toward sufficient and higher quality HPS implementation support for all schools in the Netherlands. To strengthen support, it is important to establish commitment of the PHS organization, strong coordination between stakeholders, and strong national positioning of the HPS program. These conclusions might also apply to other countries.

Background Neisseria gonorrhoeae , a major cause of sexually transmitted bacterial infections, poses a significant public health challenge, particularly due to rising antimicrobial resistance (AMR). Regions such as South-East Asia and Africa may face substantial and possibly rising burdens of gonorrhoea, though the full extent remains unclear due to limited diagnostic testing, underreporting, and gaps in aetiological and antimicrobial resistance surveillance – especially in countries lacking population-based prevalence estimates. Addressing deficiencies in data from these regions, particularly those with limited diagnostic infrastructure that are underrepresented in population-based studies, is critical for advancing global sexually transmitted infections (STIs) management and the implementation of new treatments. Methods This scoping review focused on the prevalence and reported resistance patterns of N. gonorrhoeae across four target countries: Cambodia, Thailand, Vietnam and South Africa. A systematic literature search using PubMed and WHO reports from 2019 to 2023 was conducted, with studies screened based on predefined inclusion and exclusion criteria. Data on prevalence, susceptibility profiles, and laboratory methodologies were extracted and analysed. Results Of the 217 articles identified, 29 were included, with South Africa contributing 83% of the studies. No eligible studies were identified from Cambodia. Prevalence rates varied, with the highest observed in one study among men with urethral discharge syndrome in South Africa (87.6% CI95% 85.2–89.9%). Antibiotic susceptibility data were limited to a small subset of articles (4/29, 13.8%), with resistance ranging from ≈78% for ciprofloxacin to ≈1% for cefixime. Laboratory methods primarily employed nucleic acid amplification testing, with limited use of phenotypic testing anywhere, hindering comprehensive AMR monitoring. Conclusion This scoping review confirms substantial data gaps on N. gonorrhoeae prevalence and antimicrobial resistance across the studied regions, with Cambodia contributing no eligible studies and Thailand and Vietnam remaining underrepresented in published literature. National programs and international partners should prioritise sentinel culture capacity and standardised antimicrobial susceptibility testing and genotypic testing to inform treatment guidelines, detect emerging resistance patterns, and inform public health interventions in these high-burden regions. Clinical trial number Not applicable.

Problematic rates of alcohol, e-cigarette, and other drug use among US adolescents highlight the need for effective implementation of evidence-based programs (EBPs), yet schools and community organizations have great difficulty implementing and sustaining EBPs. Although a growing number of studies show that implementation support interventions can improve EBP implementation, the literature on how to improve sustainability through implementation support is limited. This randomized controlled trial advances the literature by testing the effects of one such implementation intervention—Getting To Outcomes (GTO)—on sustainability of CHOICE, an after-school EBP for preventing substance use among middle-school students. CHOICE implementation was tracked for 2 years after GTO support ended across 29 Boys and Girls Club sites in the greater Los Angeles area. Predictors of sustainability were identified for a set of key tasks targeted by the GTO approach (e.g., goal setting, evaluation, collectively called “GTO performance”) and for CHOICE fidelity using a series of path models. One year after GTO support ended, we found no differences between GTO and control sites on CHOICE fidelity. GTO performance was also similar between groups; however, GTO sites were superior in conducting evaluation. Better GTO performance predicted better CHOICE fidelity. Two years after GTO support ended, GTO sites were significantly more likely to sustain CHOICE implementation when compared with control sites. This study suggests that using an implementation support intervention like GTO can help low-resource settings continue to sustain their EBP implementation to help them get the most out of their investment. ClinicalTrials.gov Identifier: NCT02135991.

Although high levels of intervention implementation are more likely to lead to improved student outcomes, educators struggle to maintain high implementation levels over time. School psychologists might provide research-supported, consequence-oriented supports (e.g., performance feedback) to promote educators' implementation, yet these are reactive and potentially time intensive. This study evaluated whether a proactive, ­antecedent-oriented support (i.e., daily, preprogrammed e-mailed prompts) could effectively promote educators' implementation. Findings indicate that for 3 of 4 teachers who participated in this multiple baseline single case design study, implementation of the class-wide behavior intervention improved upon receiving e-mailed prompts. In addition, increases in praise, decreases in corrective statements, and corresponding improvements in student outcomes were noted. This initial study suggests that prompts may be a feasible and effective Tier 1 implementation support that can be incorporated by school psychologists to support educators responsible for delivering interventions in the classroom. Additional implications for future research and school-based practice are discussed.

Background Providing secondary prevention through structured and comprehensive cardiac rehabilitation programmes to patients after a myocardial infarction (MI) reduces mortality and morbidity and improves health-related quality of life. Cardiac rehabilitation has the highest recommendation in current guidelines. While treatment target attainment rates at Swedish cardiac rehabilitation centres is among the highest in Europe, there are considerable differences in service delivery and variations in patient-level outcomes between centres. In this trial, we aim to study whether centre-level guideline adherence and patient-level outcomes across Swedish cardiac rehabilitation centres can be improved through a) regular audit and feedback of cardiac rehabilitation structure and processes through a national quality registry and b) supporting cardiac rehabilitation centres in implementing guidelines on secondary prevention. Furthermore, we aim to evaluate the implementation process and costs. Methods The study is an open-label cluster-randomized effectiveness-implementation hybrid trial including all 78 cardiac rehabilitation centres (attending to approximately 10 000 MI patients/year) that report to the SWEDEHEART registry. The centres will be randomized 1:1:1 to three clusters: 1) reporting cardiac rehabilitation structure and process variables to SWEDEHEART every six months (audit intervention) and being offered implementation support to implement guidelines on secondary prevention (implementation support intervention); 2) audit intervention only; or 3) no intervention offered. Baseline cardiac rehabilitation structure and process variables will be collected. The primary outcome is an adherence score measuring centre-level adherence to secondary prevention guidelines. Secondary outcomes include patient-level secondary prevention risk factor goal attainment at one-year after MI and major adverse coronary outcomes for up to five-years post-MI. Implementation outcomes include barriers and facilitators to guideline adherence evaluated using semi-structured focus-group interviews and relevant questionnaires, as well as costs and cost-effectiveness assessed by a comparative health economic evaluation. Discussion Optimizing cardiac rehabilitation centres’ delivery of services to meet standards set in guidelines may lead to improvement in cardiovascular risk factors, including lifestyle factors, and ultimately a decrease in morbidity and mortality after MI. Trial registration ClinicalTrials.gov. Identifier: NCT05889416 . Registered 2023-03-23.

Background Disseminating care guidelines into clinical practice remains challenging, partly due to inadequate evidence on how best to help clinics incorporate new guidelines into routine care. This is particularly true in safety net community health centers (CHCs). Methods This pragmatic comparative effectiveness trial used a parallel mixed methods design. Twenty-nine CHC clinics were randomized to receive increasingly intensive implementation support (implementation toolkit (arm 1); toolkit + in-person training + training webinars (arm 2); toolkit + training + webinars + offered practice facilitation (arm 3)) targeting uptake of electronic health record (EHR) tools focused on guideline-concordant cardioprotective prescribing for patients with diabetes. Outcomes were compared across study arms, to test whether increased support yielded additive improvements, and with 137 non-study CHCs that share the same EHR as the study clinics. Quantitative data from the CHCs’ EHR were used to compare the magnitude of change in guideline-concordant ACE/ARB and statin prescribing, using adjusted Poisson regressions. Qualitative data collected using diverse methods (e.g., interviews, observations) identified factors influencing the quantitative outcomes. Results Outcomes at CHCs receiving higher-intensity support did not improve in an additive pattern. ACE/ARB prescribing did not improve in any CHC group. Statin prescribing improved overall and was significantly greater only in the arm 1 and arm 2 CHCs compared with the non-study CHCs. Factors influencing the finding of no additive impact included: aspects of the EHR tools that reduced their utility, barriers to providing the intended implementation support, and study design elements, e.g., inability to adapt the provided support. Factors influencing overall improvements in statin outcomes likely included a secular trend in awareness of statin prescribing guidelines, selection bias where motivated clinics volunteered for the study, and study participation focusing clinic staff on the targeted outcomes. Conclusions Efforts to implement care guidelines should: ensure adaptability when providing implementation support and conduct formative evaluations to determine the optimal form of such support for a given clinic; consider how study data collection influences adoption; and consider barriers to clinics’ ability to use/accept implementation support as planned. More research is needed on supporting change implementation in under-resourced settings like CHCs. Trial registration ClinicalTrials.gov , NCT02325531. Registered 15 December 2014.

Implementation support interventions have helped organizations implement programs with quality and obtain intended outcomes. For example, a recent randomized controlled trial called Preparing to Run Effective Programs (PREP) showed that an implementation support intervention called Getting To Outcomes (GTO) improved implementation of an evidence-based substance use prevention program (CHOICE) run in community-based settings. However, more information is needed on how these interventions affect organizational barriers and facilitators of implementation. This paper aims to identify differences in implementation facilitators and barriers in sites conducting a substance use prevention program with and without GTO. PREP is a cluster-randomized controlled trial testing GTO, a two-year implementation support intervention, in Boys & Girls Clubs. The trial compares 15 Boys & Girls Club sites implementing CHOICE (control group), a five-session evidence-based alcohol and drug prevention program, with 14 Boys & Girls Club sites implementing CHOICE supported by GTO (intervention group). All sites received CHOICE training. Intervention sites also received GTO manuals, training, and onsite technical assistance to help practitioners complete implementation best practices specified by GTO (i.e., GTO steps). During the first year, technical assistance providers helped the intervention group adopt, plan, and deliver CHOICE, and then evaluate and make quality improvements to CHOICE implementation using feedback reports summarizing their data. Following the second year of CHOICE and GTO implementation, all sites participated in semi-structured interviews to identify barriers and facilitators to CHOICE implementation using the Consolidated Framework for Implementation Research (CFIR). This paper assesses the extent to which these facilitators and barriers differed between intervention and control group. Intervention sites had significantly higher average ratings than control sites for two constructs from the CFIR process domain: planning and reflecting and evaluating. At the same time, intervention sites had significantly lower ratings on the culture and available resources constructs. Findings suggest that strong planning, evaluation, and reflection—likely improved with GTO support—can facilitate implementation even in the face of perceptions of a less desirable implementation climate. These findings highlight that implementation support, such as GTO, is likely to help low-resourced community-based organizations improve program delivery through a focus on implementation processes.Trial RegistrationThis project is registered at ClinicalTrials.gov with number NCT02135991 (URL: https://clinicaltrials.gov/show/NCT02135991). The trial was first registered May 12, 2014.

Digital mental health interventions are often touted as the solution to the global mental health crisis. However, moving mental health care from the hands of professionals and into digital apps may further isolate individuals who need human connection the most. In this commentary, we argue that people, our society’s greatest resource, are as ubiquitous as technology. Thus, we argue that research focused on using technology to support all people in delivering mental health prevention and intervention deserves greater attention in the coming decade.