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Background Obesity is a chronic disease that contributes to additional comorbidities including diabetes, kidney disease and several cancers. Change4Campbelltown implemented a ‘whole of system’ approach to address childhood overweight and obesity. We present methods to track implementation and stakeholder engagement in Change4Campbelltown. Methods Change4Campbelltown aimed to build capacity among key leaders and the broader community to apply techniques from systems thinking to develop community-led actions that address childhood obesity. Change4Campbelltown comprised development of a stakeholder-informed Causal Loop Diagram (CLD) and locally-tailored action plan, formation of key stakeholder and community working groups to prioritise and implement actions, and continuous monitoring of intervention actions. Implementation data included an action register, stakeholder engagement database and key engagement activities and were collected quarterly by the project management team over 2 years of reporting. Results Engagement activities increased level of community engagement amongst key leaders, the school-sector and community members. Community-led action increased as engagement increased and this action is mapped directly to the primary point of influence on the CLD. As action spread diversified across the CLD, the geographical spread of action within the community increased. Conclusions This paper provides a pragmatic example of the methods used to track implementation of complex interventions that are addressing childhood overweight and obesity.

Background There are many approaches in implementation science research and practice to prospectively and pragmatically measure the amount of effort required to implement a particular evidence-based practice (EBP). We sought to 1) demonstrate how to prospectively and pragmatically document implementation activities in a real-world implementation trial; 2) quantify implementation dose (frequency and time spent) across the implementation of four EBPs; and 3) explore potential drivers of variation in implementation dose across EBP, sites, implementation progress, and wave. Methods We built on the existing literature to develop a prospective and pragmatic way to track implementation activities during a type III hybrid effectiveness-implementation stepped wedge trial. We then quantified both total implementation dose (defined as total time spent by the implementer team) and how much of this dose was synchronous (defined as time spent working directly with local implementers at the sites receiving the intervention). We used multiple linear regression to understand what factors may influence differences in total implementation dose delivered (such as which evidence-based practice was being implemented, in which wave of the stepped wedge, at which medical centers), as well as how dose was related to implementation progress, categorized by 1) decision to participate, 2) training, 3) implementation with support, and 4) independent implementation. Results From 2022 to 2023, we prospectively captured implementation dose across 25 implementation instances related to four EBPs that were implemented at seven VA medical centers. We implemented Surgical Pause seven times, TAP six times, CAPABLE six times, and EMPOWER six times. We captured and categorized 1,271 h of implementation activities. Asynchronous administrative activities were most common across implementation phases. Other common synchronous activities include engaging collaborators, problem solving, providing updates, and ongoing action/implementation planning. The EBP was the largest driver of variation in implementation dose overall. Site, implementation progress, and wave did not independently explain variations in implementation dose. Conclusions The EBP being implemented was a much stronger predictor of the implementation dose required than were other factors, such as experience implementing the EBP or characteristics of the medical center where the intervention was being implemented.

On-satellite information processing enables all-weather target tracking. The background of videos from satellite sensors exhibits an affine transformation due to their motion relative to the Earth. In complex moving backgrounds, moving vehicles have a small number of pixels and weak texture features. At the same time, the resources and performance of on-satellite equipment are limited. To address these issues, we propose a multi-object tracking (MOT) algorithm with a detection–association framework for moving vehicles in complex moving backgrounds and implement the algorithm on a satellite to achieve real-time MOT. We use feature matching to effectively eliminate the effects of background motion and use the neighborhood pixel difference method to extract moving vehicle targets in the detection stage. The accurate extraction of motion targets ensures the effectiveness of target association to achieve MOT of moving vehicles in complex moving backgrounds. Additionally, we use a Field-Programmable Gate Array (FPGA) to implement the algorithm completely on a satellite. We propose a pixel-level stream processing mode and a cache access processing mode, given the characteristics of on-satellite equipment and sensors. According to the experimental results, the prototype on-satellite implementation method proposed in this paper can achieve real-time processing at 1024 × 1024 px@47 fps.

Many promising technological innovations in health and social care are characterized by nonadoption or abandonment by individuals or by failed attempts to scale up locally, spread distantly, or sustain the innovation long term at the organization or system level. Our objective was to produce an evidence-based, theory-informed, and pragmatic framework to help predict and evaluate the success of a technology-supported health or social care program. The study had 2 parallel components: (1) secondary research (hermeneutic systematic review) to identify key domains, and (2) empirical case studies of technology implementation to explore, test, and refine these domains. We studied 6 technology-supported programs-video outpatient consultations, global positioning system tracking for cognitive impairment, pendant alarm services, remote biomarker monitoring for heart failure, care organizing software, and integrated case management via data sharing-using longitudinal ethnography and action research for up to 3 years across more than 20 organizations. Data were collected at micro level (individual technology users), meso level (organizational processes and systems), and macro level (national policy and wider context). Analysis and synthesis was aided by sociotechnically informed theories of individual, organizational, and system change. The draft framework was shared with colleagues who were introducing or evaluating other technology-supported health or care programs and refined in response to feedback. The literature review identified 28 previous technology implementation frameworks, of which 14 had taken a dynamic systems approach (including 2 integrative reviews of previous work). Our empirical dataset consisted of over 400 hours of ethnographic observation, 165 semistructured interviews, and 200 documents. The final nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework included questions in 7 domains: the condition or illness, the technology, the value proposition, the adopter system (comprising professional staff, patient, and lay caregivers), the organization(s), the wider (institutional and societal) context, and the interaction and mutual adaptation between all these domains over time. Our empirical case studies raised a variety of challenges across all 7 domains, each classified as simple (straightforward, predictable, few components), complicated (multiple interacting components or issues), or complex (dynamic, unpredictable, not easily disaggregated into constituent components). Programs characterized by complicatedness proved difficult but not impossible to implement. Those characterized by complexity in multiple NASSS domains rarely, if ever, became mainstreamed. The framework showed promise when applied (both prospectively and retrospectively) to other programs. Subject to further empirical testing, NASSS could be applied across a range of technological innovations in health and social care. It has several potential uses: (1) to inform the design of a new technology; (2) to identify technological solutions that (perhaps despite policy or industry enthusiasm) have a limited chance of achieving large-scale, sustained adoption; (3) to plan the implementation, scale-up, or rollout of a technology program; and (4) to explain and learn from program failures.

Abstract Background The PDHS 2012-2013 reported a vaccine coverage of 53.8%, with 0.4 million children classified as zero-dose (not receiving any dose of pentavalent vaccine). Traditional immunization tracking systems face challenges in identifying and following up with these children, leading to missed vaccinations. To address this, the Sindh Electronic Immunization Registry (SEIR) introduced a ‘Zero Dose Tab’ to improve tracking and outreach in December 2024. This study evaluates its implementation and impact on immunization tracking and child enrollment in Sindh, Pakistan. Methods During polio campaigns, field teams gather zero-dose data and upload it to the SEIR, where vaccinators access the information through a mobile app. Data is organised by Union Council, enabling targeted outreach. Once located, vaccinators administer vaccines and enroll children in SEIR using a QR code. Results In December 2024, SEIR identified 61,800 zero-dose children, 52% of whom were located in low-coverage districts. The initiative achieved full participation from all 30 districts, with 3,811 vaccinators trained. In December 2024, the number of children enrolled into the immunization system increased from 11,658,928 to 11,848,035, while immunizations performed rose from 142,604,900 to 145,020,907. In January 2025, enrollment continued to grow, reaching 12,023,535, with immunizations reaching 147,520,956. The increase in enrollment from December to January (1.48%) was notably higher than the increase observed from November to December (1.62%), suggesting a positive impact of the introduction of the ‘Zero Dose Tab’. Conclusions The ‘Zero Dose Tab’ in the SEIR facilitates targeted outreach by providing vaccinators with real-time lists of zero-dose children. directly on their mobile phones. Preliminary findings suggest its role in improving immunization tracking, outreach coordination, and enrollment. Further evaluation is needed to assess long-term effects on vaccine coverage and equity. Key messages • The integration of the ‘Zero Dose Tab’ into the Sindh Electronic Immunization Registry (SEIR) has significantly enhanced the identification and tracking of zero-dose children. • The deployment of the ‘Zero Dose Tab’ exemplifies how digital health innovations can address immunization gaps in underserved populations.

We used the Practical, Robust Implementation and Sustainability Model to evaluate implementation of South Africa’s Central Chronic Medicine Dispensing and Distribution (CCMDD) program, a differentiated service delivery program which allows clinically stable HIV-positive patients to receive antiretroviral therapy refills at clinic- or community-based pick-up points. Across ten clinics, we conducted 109 semi-structured interviews with stakeholders (pick-up point staff, CCMDD service providers and administrators) and 16 focus groups with 138 patients. Participants had highly favorable attitudes and said CCMDD decreased stigma concerns. Patient-level barriers included inadequate education about CCMDD and inability to get refills on designated dates. Organizational-level barriers included challenges with communication and transportation, errors in medication packaging and tracking, rigid CCMDD rules, and inadequate infrastructure. Recommendations included: (1) provide patient education and improve communication around refills (at the patient level); (2) provide dedicated space and staff, and ongoing training (at the organizational/clinic level); and (3) allow for prescription renewal at pick-up points and less frequent refills, and provide feedback to clinics (at the CCMDD program level).

Depression is pervasive, and rates are rising in the United States. Most people with depression receive care from primary care clinicians, but gaps in the quality of care exist. Team-based approaches to depression care have been shown to aid in treatment and management; yet, challenges exist in implementation. Digital health apps have been shown to be effective in improving depression symptoms and enhancing patient engagement in some populations. Many, however, do not share data with clinical care teams. This study aimed to understand the barriers to and facilitators for implementation of a digital health program that supports coordinated use by clinical care teams and patients, via a mobile app and care team-facing web interface, for depression in primary care. This study was part of a larger intervention study that included 4 primary care practices: 2 intervention and 2 control sites. The intervention sites used a patient-facing mobile app and a care team-facing web interface, and the control sites continued usual care. The study team conducted interviews from May to October 2021. Patient and care team participants were recruited toward the end of their study involvement. Separate semistructured interview guides were developed for patient and care team participants. Interviews were recorded and transcribed. Data were coded using Atlas.ti.9, and data analysis was completed using a grounded theory approach. Interviews with patient (n=8) and care team (n=8) participants revealed 3 main topics for program implementation: app/interface usability, tracking, and program recommendations. For app/interface usability, overall, navigation for both patient and care team participants was simple and straightforward. Although app content was relevant, patient participants desired additional educational resources and information to aid in their depression treatment and management. In terms of tracking, care team participants indicated that data obtained via the interface enabled them to monitor patients in between visits; and in some circumstances, these data facilitated conversations with patients about treatment plans. Tracking medication adherence differed among patient participants due to established routines of taking medications consistently, lack of motivation to track, or lack of interest in tracking. Care team participants reported the ability to respond more quickly to side effects. Patients commented on tracking difficulties: confusing response options, insufficient goal attainment response options, not being able to provide details or write notes, and no ability to change goals. Some patient and care team participants perceived that tracking encouraged communication with one another; others perceived tracking as having no impact on shared decision-making. Results suggest implementation of a digital health program for depression treatment and management in primary care practices could impact patient medication adherence, produce faster turnaround time for medication optimization, encourage goal setting, and foster communication between patients and care team members. Program enhancements could optimize patient and care team member engagement.

Multi-unarmed aerial vehicle (UAV) collaborative mission planning is a key technology for the intelligent development of UAV clusters at this stage, where mission assignment under multiple constraints is a core part of UAV mission planning technology. The poor planning ability of an UAV swarm often leads to resource waste and revenue reduction during mission execution, while the adoption of task allocation in the multi-target tracking of UAV clusters guarantees the highest profit. Algorithms of traditional pigeon-inspired optimization(PIO) and contract network protocol reflect defects of low timeliness and high time costs, respectively. Compared with these methods, the multilevel PIO algorithm maximizes the efficiency and profitability of the overall tracking task. A staged UAV cluster task allocation architecture was constructed to complete the global optimal initialization before tracking, and then a parallel auction contract network was employed to further perform the local optimal redistribution of each UAV. The simulation results suggest that this scheme not only guides cluster allocation in stages but also decreases the negotiatory time of a UAV cluster to in-crease the integral profitability under multiple constraints, such as prohibited areas.

Background Published descriptions of implementation strategies often lack precision and consistency, limiting replicability and slowing accumulation of knowledge. Recent publication guidelines for implementation strategies call for improved description of the activities, dose, rationale and expected outcome(s) of strategies. However, capturing implementation strategies with this level of detail can be challenging, as responsibility for implementation is often diffuse and strategies may be flexibly applied as barriers and challenges emerge. We describe and demonstrate the development and application of a practical approach to identifying implementation strategies used in research and practice that could be used to guide their description and specification. Methods An approach to tracking implementation strategies using activity logs completed by project personnel was developed to facilitate identification of discrete strategies. This approach was piloted in the context of a multi-component project to improve children’s access to behavioural health services in a county-based child welfare agency. Key project personnel completed monthly activity logs that gathered data on strategies used over 17 months. Logs collected information about implementation activities, intent, duration and individuals involved. Using a consensus approach, two sets of coders categorised each activity based upon Powell et al.’s (Med Care Res Rev 69:123–57, 2012) taxonomy of implementation strategies. Results Participants reported on 473 activities, which represent 45 unique strategies. Initial implementation was characterised by planning strategies followed by educational strategies. After project launch, quality management strategies predominated, suggesting a progression of implementation over time. Together, these strategies accounted for 1594 person-hours, many of which were reported by the leadership team that was responsible for project design, implementation and oversight. Conclusions This approach allows for identifying discrete implementation strategies used over time, estimating dose, describing temporal ordering of implementation strategies, and pinpointing the major implementation actors. This detail could facilitate clear reporting of a full range of implementation strategies, including those that may be less observable. This approach could lead to a more nuanced understanding of what it takes to implement different innovations, the types of strategies that are most useful during specific phases of implementation, and how implementation strategies need to be adaptively applied throughout the course of a given initiative.

Introduction Evaluation of implementation strategies is core to implementation trials, but implementation strategies often deviate from the original plan to adjust to the real-world conditions. The optimal approach to track modifications to implementation strategies is unclear, especially in low-resource settings. Using data from an implementation trial for people who inject drugs (PWID) with HIV in Vietnam, we describe the tracking of implementation strategy modifications and present findings of this process. Methods SNaP ( S ystems N avigation a nd P sychosocial Counseling) is a hybrid type-III effectiveness-implementation randomized controlled trial aiming to scale up the evidence-based intervention, integrated systems navigation and psychosocial counseling, for PWID with HIV in Vietnam. Forty-two HIV testing sites were randomized 1:1 to a standard or tailored arm. While the standard arm (SA) received a uniform package of strategies, implementation strategies for the tailored arm (TA) were tailored to address specific needs of each site. The central research team also met monthly with the TA to document how their tailored strategies were implemented over time. Five components were involved in the tracking process: describing the planned strategies; tracking strategy use; monitoring barriers and solutions; describing modifications; and identifying and describing any additional strategies. Results Our approach allowed us to closely track the modifications to implementation strategies in the tailored arms every month. TA sites originally identified 27 implementation strategies prior to implementation. During implementation, five strategies were dropped by four sites and two new strategies were added to twelve sites. Modifications of five strategies occurred at four sites to accommodate their changing needs and resources. Difficulties related to the COVID-19 pandemic, low number of participants recruited, high workload at the clinic, lack of resources for HIV testing and high staff turnover were among barriers of implementing the strategies. A few challenges to tracking modifications were noted, including the considerable amount of time and efforts needed as well as the lack of motivation from site staff to track and keep written documentations of modifications. Conclusions We demonstrated the feasibility of a systematic approach to tracking implementation strategies for a large-scale implementation trial in a low-resource setting. This process could be further enhanced and replicated in similar settings to balance the rigor and feasibility of implementation strategy tracking. Our findings can serve as additional guidelines for future researchers planning to report and track modifications to implementation strategies in large, complex trials. Trial registration : clinicaltrials.gov ID: NCT03952520 (first posted 2019-05-16).