Explore the vast range of titles available.

Understanding, categorizing, and using implementation science theories, models, and frameworks is a complex undertaking. The issues involved are even more challenging given the large number of frameworks and that some of them evolve significantly over time. As a consequence, researchers and practitioners may be unintentionally mischaracterizing frameworks or basing actions and conclusions on outdated versions of a framework. This paper addresses how the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework has been described, summarizes how the model has evolved over time, and identifies and corrects several misconceptions. We address 13 specific areas where misconceptions have been noted concerning the use of RE-AIM and summarize current guidance on these issues. We also discuss key changes to RE-AIM over the past 20 years, including the evolution to Pragmatic Robust Implementation and Sustainability Model, and provide resources for potential users to guide application of the framework. RE-AIM and many other theories and frameworks have evolved, been misunderstood, and sometimes been misapplied. To some degree, this is inevitable, but we conclude by suggesting some actions that reviewers, framework developers, and those selecting or applying frameworks can do to prevent or alleviate these problems.

There are complex issues in understanding and categorizing implementation science theories, models, and frameworks. Systematic reviews of these models are important undertakings for synthesizing current knowledge. The issues involved are even more challenging when reviewing a large number of frameworks and when some of the frameworks have evolved significantly over time. This paper addresses how the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework was described in the recent Esmail (2020) review and identifies four mischaracterizations. This is followed by a more general discussion of how advances or extensions of frameworks after an original source publication or influential review tend to be overlooked. We discuss why inadvertent mischaracterization of what a framework is and is not, and what it can and cannot be used for, can have deleterious consequences. Finally, we suggest initial ideas about what could be done to prevent or alleviate some of these problems by reviewers, framework developers, and scholars at large.

Background There is strong evidence that women with gestational diabetes mellitus (GDM) who receive a minimum of three appointments with a dietitian may require medication less often. The aim of this study was to evaluate the impact of a dietitian-led model of care on clinical outcomes and to understand the utility of the integrated Promoting Action on Research Implementation in Health Services ( i -PARIHS) framework as a prospective tool for implementation. Methods This was a pre-post intervention study measuring outcomes before-and-after changing a gestational diabetes (GDM) model of care and included women with GDM managed at a large, regional hospital in Queensland, Australia. The i -PARIHS framework was used to develop, implement and evaluate a dietitian-led model of care which increased dietetic input for women with GDM to a minimum of one initial education and two review appointments. The outcomes were adherence to the schedule of appointments, clinician perspective of the implementation process, pharmacotherapy use, gestational age at commencement of pharmacotherapy and birth weight. Pre- and post- comparisons of outcomes were made using t-tests and chi-squared tests. Results Adherence to the dietetic schedule of appointments was significantly increased from 29 to 82% ( p  < 0.001) but pharmacotherapy use also increased by 10% ( p =  0.10). There were significantly more women in the post-intervention group who were diagnosed with GDM prior to 24 weeks gestation, a strong independent predictor of pharmacotherapy use. Infant birthweight remained unchanged. The i -PARIHS framework was used as a diagnostic tool and checklist in the model of care development phase; a facilitation tool during the implementation phase; and during the evaluation phase was used as a reflection tool to identify how the i- PARIHS constructs and their interactions that may have impacted on clinical outcomes. Conclusions The i -PARIHS framework was found to be useful in the development, implementation and evaluation of a dietitian-led model of care which saw almost 90% of women with GDM meet the minimum schedule of dietetic appointments.

This study explores the implementation of the Age-Friendly Health Systems (AFHS) 4Ms Framework into primary care clinics in rural Arkansas, facilitated by the AGEC and funded by The Health Resources and Services Administration’s Geriatric Workforce Enhancement Program (GWEP) grant. Implementation success is evaluated by monitoring merit-based incentive payment system (MIPS) measures and other variables, providing insight into the effectiveness of integrating AFHS and enhancing older adult care. AGEC employed implementation strategies (train-the-trainer, audit and feedback, and clinical reminders using Electronic Medical Record (EMR)), the i-PARIHS implementation framework, and the RE-AIM evaluation framework to facilitate integration of the AFHS 4Ms Framework into partnered rural federally qualified healthcare clinics (FQHC). AGEC aimed to equip the healthcare workforce through comprehensive training sessions and resource provision. Additionally, the EMR system modifications guided clinicians in aligning care with the AFHS 4Ms Framework. This multifaceted approach ensured a systematic and tailored implementation, enhancing the capacity of rural FQHCs in Arkansas to deliver Age-Friendly care. Improvements were observed in MIPS outcome measures, including increased completion of fall and depression screens, Annual Wellness Visits (AWV) and Advance Care Plans (ACP). These changes reflect a proactive impact on comprehensive care delivery for older adults. Since adopting the AFHS 4Ms Framework, these rural Arkansas FQHC clinics have significantly enhanced their older adult care, earning recognition as AFHS Clinics by the Institute for Health Improvement (IHI). Primary care practices nationwide can implement similar evidence-based approaches to improve care for the expanding older adult population in the U.S.

Abstract Health Impact Assessment (HIA) provides a practical set of tools to appraise the potential health effects of a policy, programme, or project prior to implementation. HIA has gained significant attention in recent decades due to its utility in facilitating a broader understanding of health and bringing diverse stakeholders and evidence into decision-making processes. Despite this interest in HIA its implementation remains challenging within governance, decision making, and regulatory contexts. The Consolidated Framework for Implementation Research (CFIR) 2.0 provides a methodological framework to identify potential factors influencing implementation and the domains in which they operate, within the framework. For the purpose of this scoping review, implementation refers to the process of carrying out an HIA, and where applicable, the implementation of its recommendations. This review presents a novel exploration of HIA from an implementation science perspective. It provides a synthesis of the factors influencing HIA implementation and identifies a range of considerations and strategies that may facilitate and strengthen HIA implementation and support. The findings suggest that the earlier steps are critical in assisting the practical application and implementation of HIA. However, building wider HIA support, awareness, and capacity essential to progressing HIA is dependent on wider public health advocacy and addressing challenges specific to HIA as a method and tool. CFIR offers a useful and adaptable framework that could be used for supporting HIA planning, practice, and implementation.

The socio-environmental challenges the world faces are ‘swamps’: situations that are messy, complex, and uncertain. The aim of this paper is to help disciplinary scientists navigate these swamps. To achieve this, the paper evaluates an integrative framework designed for researching complex real-world problems, the Integration and Implementation Science (i2S) framework. As a pilot study, we examine seven inter and transdisciplinary agri-environmental case studies against the concepts presented in the i2S framework, and we hypothesise that considering concepts in the i2S framework during the planning and delivery of agri-environmental research will increase the usefulness of the research for next users. We found that for the types of complex, real-world research done in the case studies, increasing attention to the i2S dimensions correlated with increased usefulness for the end users. We conclude that using the i2S framework could provide handrails for researchers, to help them navigate the swamps when engaging with the complexity of socio-environmental problems.

Abstract Our objective was to systematically adapt Interrupting Prolonged sitting with ACTivity (InPACT), a classroom-based physical activity intervention, for home delivery to equitably increase access to structured youth physical activity opportunities during the COVID-19 pandemic. Key steps in the rapid-cycle research adaptation process included: (Step 1) identifying partner organizations; (Steps 2 and 3) engaging in problem and knowledge exploration to examine the problem from different perspectives; (Steps 4 and 5) initiating solution development and testing by selecting an intervention and adapting the format and content for home delivery. Using Rapid RE-AIM to guide online assessment and refinement of InPACT at Home; and (Step 6) utilizing dissemination strategies to extend the reach of the program. Core elements of the InPACT program that were retained included: the use of exercise videos, maintenance of the intervention dose, and teacher-led physical activities. Key adaptations included: utilization of physical education specialists to develop the exercise videos, incorporation of health messaging in videos, and utilization of dissemination strategies (intervention website) to reach K-12 students across the state. Intervention website reach included all 83 counties in Michigan, but goals were not met for website pageviews (5,147; 85% of goal) and video view duration (7 min 19 sec; 37% of goal). Accordingly, dissemination was expanded to include public television broadcasting (monthly viewers: 500,000) and videos were shortened to 8 minutes. Dissemination and implementation science frameworks guided the rapid adaptation of an existing intervention, InPACT, to equitably increase access to structured youth physical activity opportunities at home during the pandemic. Dissemination and implementation science frameworks guided the rapid adaptation of an evidence-based intervention to promote statewide access to youth physical activity through public television.

Background Sentinel node biopsy (SN biopsy) is a surgical procedure used to accurately stage patients with primary melanoma at high risk of recurrence. Although Australian Melanoma Management Guidelines recommend SN biopsy be considered in patients with melanomas > 1 mm thick, SN biopsy rates in Australia are reportedly low. Our objective was to identify factors impacting the acceptance, adoption and adherence to the Australian SN biopsy guideline recommendations. Methods Opinions of Australian key informants including clinicians, representatives from melanoma education and training providers, professional associations and colleges, and melanoma advocacy organisations were collected through semi-structured interviews ( n  = 29) and from publicly released statements ( n  = 14 news articles). Data analysis involved inductive and deductive thematic analysis using Flottorp’s determinants framework. Results A complex interplay of contemporary and historical factors was identified as influencing acceptance, adoption and adherence to the SN biopsy guideline recommendations at the individual, guideline, patient, organisational and social levels. Expert and peer opinion leaders have played an important role in facilitating or inhibiting adoption of guideline recommendations, as have financial incentives driven by healthcare-funding policies and non-financial incentives including professional identity and standing. Of critical importance have been the social and knowledge boundaries that exist between different professional groups to whom the guidelines apply (surgeons, dermatologists and primary care practitioners) with adherence to the guideline recommendations having the potential to shift work across professional boundaries, altering a clinician’s workflow and revenue. More recently, the emergence of effective immunotherapies and targeted therapies for patients at high risk of recurrence, the emergence of new opinion leaders on the topic (in medical oncology), and patient demands for accurate staging are playing crucial roles in overcoming the resistance to change created by these social and knowledge boundaries. Conclusions Acceptance and adherence to SN biopsy guideline recommendations in Australia over the past 20 years has involved a process of renegotiation and reframing of the evidence for SN biopsy in melanoma by clinicians from different professional groups and networks. This process has helped to refine the evidence for SN biopsy and our understanding of appropriate adoption. New effective systemic therapies have changed the balance towards accepting guideline recommendations.

Mobile health (mHealth) interventions are becoming more common in low-income countries. Existing research often overlooks implementation challenges associated with the design and technology requirements of mHealth interventions. We aimed to characterize the challenges that we encountered in the implementation of a complex mHealth intervention in Uganda. We customized a commercial mobile survey app to facilitate a two-arm household-randomized, controlled trial of home-based tuberculosis (TB) contact investigation. We incorporated digital fingerprinting for patient identification in both study arms and automated SMS messages in the intervention arm only. A local research team systematically documented challenges to implementation in biweekly site visit reports, project management reports, and minutes from biweekly conference calls. We then classified these challenges using the Consolidated Framework for Implementation Research (CFIR). We identified challenges in three principal CFIR domains: (1) intervention characteristics, (2) inner setting, and (3) characteristics of implementers. The adaptability of the app to the local setting was limited by software and hardware requirements. The complexity and logistics of implementing the intervention further hindered its adaptability. Study staff reported that community health workers (CHWs) were enthusiastic regarding the use of technology to enhance TB contact investigation during training and the initial phase of implementation. After experiencing technological failures, their trust in the technology declined along with their use of it. Finally, complex data structures impeded the development and execution of a data management plan that would allow for articulation of goals and provide timely feedback to study staff, CHWs, and participants. mHealth technologies have the potential to make delivery of public health interventions more direct and efficient, but we found that a lack of adaptability, excessive complexity, loss of trust among end users, and a lack of effective feedback systems can undermine implementation, especially in low-resource settings where digital services have not yet proliferated. Implementers should anticipate and strive to avoid these barriers by investing in and adapting to local human and material resources, prioritizing feedback from end users, and optimizing data management and quality assurance procedures. Pan-African Clinical Trials Registration PACTR201509000877140; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=877.