PSY 342 Midterm Notes PDF

PSY 342 Midterm Notes Class 1 Theories help us understand Events, behaviors, concepts Their relationships with one another Frameworks Strategic, action-oriented Develop, manage, evaluate interve...

PSY 342 Midterm Notes Class 1 Theories help us understand Events, behaviors, concepts Their relationships with one another Frameworks Strategic, action-oriented Develop, manage, evaluate interventions Over 100+ frameworks Types of frameworks ○ Multiphase Ex EPIS model ○ Multilevel Individual, team, organization, larger system Describing and/or guiding the process of translating research into practice Process models Understanding what influences Implementation outcomes Determinant frameworks Classic theories Implementation theories Evaluating implementation Evaluation framework  Class 2 Problem What specific issue are you trying to address Know-Do-Gap The difference between what is known(evidence) and what is done(practice). Identifying this gap is the first step in selecting an appropriate evidence-based intervention Evidence-Based Intervention (EBI) A broad range of activities that are intended to improve the health of individuals or populations Such as programs, practices, principles, procedures, policies, or new pills and products Intervention is considered evidence-based when ○ Its been tested in one or more well-designed research studies and found to be effective at improving health-related outcomes Formats for distributing (disseminating) EBI’s Systematic Review Recommendations Broad recommendation for intervention approaches that are effective Establish best practice Identify EBIs that may be used to close gaps in achieving those best practices Strengths ○ Strongest source of EBI effectiveness, because they synthesize findings from multiple research studies Limitations  ○ Provider evidence in support of EBI effectiveness but offer little guidance on implementation Packaged Interventions Specific interventions with materials, protocols, and other resources to support implementation and delivery Strengths ○ May provide detailed guidance and materials to support the implementation and delivery of a specific EBI Limitations ○ Only a subset of interventions have been packaged and guidance and materials may be designed for a specific setting or population Reports of Intervention Studies Peer-reviewed journal articles that report on how the intervention was developed, protocols used, and its implementation and effectiveness Strengths ○ Provides current information and how the intervention was designed and for what specific population and setting Limitations ○ Time consuming ○ Expertise and times are required for assessing the quality of the evidence base of the intervention Assessing EBIs 1. Research Design  a. The strongest evidence comes from randomized controlled trials 2. Quantity of studies a. Look at how many studies have assessed the intervention and whether the findings are consistent 3. Meaningfulness of results a. Ensure that the results are clinically meaningful, not just statistically significant 4. Applicability to subpopulations a. Were diverse populations included in the studies? If yes, did the intervention show consistent effectiveness? 5. Relevance of findings a. Check if the findings are up to date and still relevant to the current context Potential for Real-World Implementation 1. Reach a. Did the intervention reach its intended population? Were the participants representative of the broader population? 2. Adoption a. Where was the intervention applied, and by whom? How many providers or settings adopted it? 3. Fidelity, Cost, and Readiness a. Was the intervention delivered as designed b. Is the benefit worth the cost of implementing the intervention c. Are the necessary protocols and materials ready for immediate implementation 4. Maintenance  a. How long were the intervention’s outcomes sustained at both the setting and individual levels? Balancing Evidence and Fit Fit comparison tool ○ Balance the strength of evidence with the fit of the EBI for your specific problem, population, and setting Consider how well the intervention aligns with your goals and setting while ensuring strong supporting evidence Class 3 Engaging Stakeholders Stakeholders These are individuals with an interest in the project, either because it related to them directly, impacts their practices, or because they are involved in the administration, finances or policies that may impact/ be impacted by the project End Users One type of stakeholder who will be directly impacted by the intervention (e.g., healthcare providers who will implement the intervention, patients, caregivers, family members who will be impacted by the intervention) Why engage stakeholders? Researchers may have biases. Stakeholders offer critical input, helping improve the decision-making process for implementation Benefits of Stakeholder Engagement Advances health equity  Helps align the intervention with community needs Improved implementation outcomes Improved selection of implementation strategies Key factors for stakeholder analysis Asses the stakeholders position, influence, interest, and network relevance to the project How to decide which know-do gap to prioritize 1. Identify the issue of concern a. Is this an issue of concern? If yes, who is it of concern to? Is there evidence that can be use to determine what should be done? 2. Identify best available evidence w/ stakeholders a. Research evidence summarized in clinical practice guidelines b. Best practice recommendations c. Systematic reviews d. meta-analysis 3. Measure what is currently happening in practice a. Describe what is currently happening in practice or policy by selecting quality indicators that will be measured to determine the scope of the gap Participatory Approaches (Community-Based Participatory Research) Involves communities directly in research, improving trust and the relevance of interventions The eight principles of CBPR include recognizing the community as as unit of identity, promoting equitable partnerships, and balancing research with action  Challenges include time consumption, perceived bias from community involvement, and balancing rigorous research with community needs Class 4 Determinants Determinants of EBIs Factors that might prevent or enable implementation of an EBI ○ Barriers ○ Facilitators Context The context in which EBIs are implemented influences implementation Context is crucial in implementation. While in efficacy trials context is controlled, in implementation science its something to be understood and addressed Understanding context helps anticipate barriers and facilitators and guide the development of strategies to increase adoption and maintenance of the EBI Context is multi-level Structural ○ Political, social, and economic climate Organizational ○ Leadership, support systems, openness to change Provider-level ○ Individual adherence to protocols Patient-level  ○ Motivation, health beliefs, and other personal traits Innovation-level ○ The relative advantage and adaptability of the intervention itself Understanding Determinants 1. Brainstorm potential barriers and facilitators (based on experience, past needs assessments, and published literature) a. Helps align stakeholders experiences with published literature 2. Use theories and frameworks a. 3 main purposes i. Understand why things happened ii. Predict what migh happen iii. Inform the selection or development of implementation strategies to increase 3. Collect new data 4. Prioritize the most important and changeable factors Consolidated Framework for Implementation Research (CFIR) Synthesis of existing implementation theories Based on organizational theory, social psychology, sociology, economics, diffusion of innovation theory Construct that influence effective implementation and organizational change  Class 5 Implementation Strategies EBI The practice (or thing) that is going to be done. The efficacy of this intervention has been established Implementation strategies Methods, techniques, and/or approaches utilized to support the adoption, integration, and sustainability of putting this EBI into practice (Strategies helps us) Understanding how and why How an intervention got into practice and why it worked (or did not) is usually and afterthought or secondary aim to whether the EBI was effective Well-planned and specified implementation strategies contribute to both internal learning for maintaining the ingredients for success (by explaining how success was achieved) and informing future work Types of Implementation Strategies 1. Discrete Strategies a. Involve one action, such as educational meetings, reminders, or audit and feedback (example: distributing educational material) 2. Multifaceted Strategies  a. Combine two or more discrete strategies (example: education or primary care providers, establishment of a patient registry, and use of a clinical reminder) Evidence and Challenges Theres ongoing development in understanding how, when, and where strategies work effectively Challenges include poorly reported strategies a lack of fidelity assessment, and limited guidance on selecting strategies Expert Recommendations for Implementing Change (ERIC) Developed because of two limitations of the published literature ○ Lack of conceptual clarity surrounding terms and definitions for implementation strategies ○ Insufficient guidance about how to select appropriate implementation strategies Selecting a Good Strategy A good implementation strategy should tackle barriers to evidence-based practice and be informed by theory, evidence, and stakeholder input Strategies should be adapted to the specific context, based on assessments of needs and barriers 6 Guiding Principles 1. Context a. Tailored and picked according to barriers and facilitators 2. Methods  a. Process for selecting and tailoring IS(implementation strategies) i. Concept mapping ii. Intervention mapping iii. Conjoint analysis 3. Evidence-Based IS 4. Importance & Feasibility 5. Number of Implmentation Strategies 6. Implementation Outcomes  Class 6 Implementation Outcomes What are Implementation Outcomes The effects of deliberate actions to implement an intervention These are the effects of deliberate actions taken to implement an intervention. They differ from effectiveness outcomes, which focus on the interventions success in achieving health outcomes Importance of Implementation Outcomes Distinguishing implementation outcomes from treatment outcomes is critical to transporting interventions from the lab into the “real world” When such efforts fail, need to know if it was because ○ a) intervention failure: the intervention was ineffective in the new setting or ○ b) implementation failure: a good intervention was deployed incorrectly Preconditions for Success: because an intervention will not be effective if it is not implemented well, implementation outcomes serve as necessary preconditions to attaining subsequent changes in intervention outcomes Common Pitfalls Skipping over implementation outcomes  ○ Inghoriung these outcomes can lead to a failure to understand why an intervention succeeds or fails Including too many implementation outcomes Using home-grown measures ○ It is essential to use validated tools to measure outcomes Failure to directly measure Unit of analysis inconsistency ○ Be clear whether you are measuring outcomes at the individual, clinic, or system level Evaluating Frameworks RE-AIM Framework ○ A frequently used framework for evaluating implementation outcomes, which stands for Reach: How many people the intervention reaches WHO is intended to benefit and who actually participants or is exposed to the intervention Effectiveness: How well the intervention works WHAT is the most importnat benefit you are trying to achieve and what is the likelihood of negative outcomes Adoption: How well the intervention is adopted by organizations or individuals WHERE is the program or policy applied WHO applied it  Implementation: How well the intervention is delivered HOW consistently is the program or policy delivered HOW will it be adapted HOW much will it cost WHY will the results come about Maintenance: How well the intervention is sustained over time WHEN will the initiative become operational; how long will it be sustained; and how long are the results sustained  KEY POINTS Determinants Factors that might prevent or enable the implementation of an EBI Strategies Methods, techniques, and/or approaches utilized to support the adoption, integration, and sustainability of putting this EBI into practice Outcomes The effect of deliberate actions taken to implement an intervention Fit comparison tool Balance the strength of evidence with the fit of the EBI for your specific problem, population, and setting Why do we include Stakeholders? Researchers may have biases. Stakeholders offer critical input, helping improve the decision-making process for implementation End Users One type of stakeholder who will be directly impacted by the intervention (e.g., healthcare providers who will implement the intervention, patients, caregivers, family members who will be impacted by the intervention) Frameworks Determinant frameworks ○ Barriers and Facilitators ○ Multi-level ○ Organizational level ○ System-level ○ Ex CFIR Process models ○ Action-oriented ○ Stage-based Why Outcomes are important a) intervention failure: the intervention was ineffective in the new setting b) implementation failure: a good intervention was deployed incorrectly Multi-Level A framework that considers and operates at different levels of influence within a system Organized in: (Either Multi-lvl Interventions or Implementation) ○ Individual level Changes within an individual ○ Organizational level Changes within an organization ○ System-level  Broader policies or regulations Multi-Phase Refers to a process or model that occurs in distinct stages or phases over time Ex Organized in ○ Exploration ○ Preparation ○ Implementation ○ Sustainment Multi-Level vs. Multi-Phase Multi-Level ○ Refers to analyzing and addressing factors at different levels (e.g., individual, organizational, policy) within a system at the same time Multi-Phase ○ Refers to a temporal sequence of stages or steps that occur over time, with each phase building on the previous one Key Implementation Outcomes Acceptability ○ Perceptions that an intervention is agreeable, palatable, satisfactory Adoption ○ Intention, initial decision, or action to try or employ and intervention Appropriateness ○ Perceived fit, relevance, or compatibility of the intervention for a given setting; and/or perceived fit of the intervention to address a particular issue or problem  Cost ○ The cost impact of an implementation effort Feasibility ○ The extent to which a new intervention can be successfully carried out in a given setting Fidelity ○ The degree to which an intervention was implemented as originally intended Penetration ○ The integration of practice within a service setting and its subsystems Sustainability ○ The extent to which a newly implemented treatment is maintained or institutionalized within a service settings ongoing, stable operations