Medicine and Health Sciences Commons^™

Enablers And Barriers To Implementing An Interdisciplinary Experiential Learning Program For University Students In A Canadian Rehabilitation Centre, Jordan Eggiman-Ketter, Benjamin Derrough, Dalton L. Wolfe, Janelle Unger

Physical Therapy Publications

Objective: This qualitative study aims to identify a comprehensive set of enablers and barriers to implementing an interdisciplinary experiential learning program for university students at a Canadian rehabilitation centre. Methods: A researcher conducted one-on-one semi-structured interviews with individuals from four key stakeholder groups (i.e., rehabilitation centre leadership, clinicians, university clinical coordinators, and health and rehabilitation students). Interviews and data analysis followed the Theoretical Domains Framework (TDF), which is designed to identify possible cognitive, affective, social, and environmental influences on program implementation. Interviews were transcribed verbatim, and two researchers coded data independently to identify the major themes of enablers and barriers …

Barriers To Implementation Of Post-Concussion Grade Exercise Tests, Tyler Beauregard

Journal of Sports Medicine and Allied Health Sciences: Official Journal of the Ohio Athletic Trainers Association

OBJECTIVE

The purpose of this study was to assess the potential barriers to sports physical therapy and athletic training clinicians implementing graded exertional tests, specifically for their patients following concussion.

Addressing Equitable Access In A Safety-Net Hospital System: An Implementation Framework, Hillary Alycon

Dissertations: Doctor of Public Health

Acute care organizations face a significant challenge in effectively implementing health equity programs, particularly in rural areas where guidance is often lacking. Despite abundant literature focusing on health outcomes, there remains a noticeable dearth of published data on implementing health equity initiatives. In response to this gap, I present a comprehensive analysis that utilizes readily available, open-sourced data to address this critical issue.

A thorough assessment of the demographic characteristics of acute care facilities within the catchment regions was conducted based on data from reputable sources such as the US Census Bureau, the American Community Survey, and the County Health …

Refining Successful Implementation Strategies For The Surgical Safety Checklist In High-Income Contexts: Results Of An International Mixed Methods Study, Meagan E. Elam, Christopher J. Louis, Jonathan Woodson, Nathan Turley, Denisa Urban, Mary E. Brindle, Jacey A. Greece

Patient Experience Journal

The WHO Surgical Safety Checklist (SSC) continues to show inconsistent success in reducing surgical complications in high-income settings. Previous implementation research identified potential barriers and facilitators to success, but it primarily consists of qualitative studies with small sample sizes in limited geographic areas. We conducted a multi-country mixed-methods study of barriers and facilitators to SSC implementation to better inform policies and practices for improving SSC buy-in and use to maximize its impact. This convergent parallel mixed-methods study utilized survey and interview data from surgical team members practicing in five countries. Survey data were analyzed using χ² analysis or Fisher’s …

Advancing The Decadal Plan For The Science Of Nutrition: Progressing A Framework For Implementation, Helen Truby, Margaret Allman-Farinelli, Eleanor J. Beck, Emma L. Beckett, Catherine Bondonno, Aimee L. Dordevic, Katherine M. Livingstone, Jane Willcox, Shelley A. Wilkinson

Research outputs 2022 to 2026

Aims: In 2019, the Australian Academy of Science in collaboration with the nutrition community published the decadal plan for the science of nutrition. This article aims to review progress towards each of its pillar goals (societal determinants, nutrition mechanisms, precision and personalised nutrition, and education and training) and two enabling platforms (a national data capability and a trusted voice for nutrition science), prioritise actions, and conceptualise program logic implementation models. This process also brought together public health nutrition researchers to reflect on societal determinants of health, and advise how the next 5 years of the decadal plan could reflect contemporary …

Regulatory Issues In Electronic Health Records For Adolescent Hiv Research: Strategies And Lessons Learned, Sara Ali Shaw Green, Sung-Jae Lee, Samantha Chahin, Meardith Pooler-Burgess, Monique Green-Jones, Sitaji Gurung, Angulique Y. Outlaw, Sylvie Naar

Publications and Research

Background: Electronic health records (EHRs) are a cost-effective approach to provide the necessary foundations for clinical trial research. The ability to use EHRs in real-world clinical settings allows for pragmatic approaches to intervention studies with the emerging adult HIV population within these settings; however, the regulatory components related to the use of EHR data in multisite clinical trials poses unique challenges that researchers may find themselves unprepared to address, which may result in delays in study implementation and adversely impact study timelines, and risk noncompliance with established guidance.

Objective: As part of the larger Adolescent Trials Network (ATN) for HIV/AIDS …

Public Acceptance Of Using Artificial Intelligence-Assisted Weight Management Apps In High-Income Southeast Asian Adults With Overweight And Obesity: A Cross-Sectional Study, Han Shi Jocelyn Chew, Palakorn Achananuparp, Palakorn Achananuparp, Nicholas W. S. Chew, Yip Han Chin, Yujia Gao, Bok Yan Jimmy So, Asim Shabbir, Ee-Peng Lim, Kee Yuan Ngiam

Research Collection School Of Computing and Information Systems

Introduction: With in increase in interest to incorporate artificial intelligence (AI) into weight management programs, we aimed to examine user perceptions of AI-based mobile apps for weight management in adults with overweight and obesity. Methods: 280 participants were recruited between May and November 2022. Participants completed a questionnaire on sociodemographic profiles, Unified Theory of Acceptance and Use of Technology 2 (UTAUT2), and Self-Regulation of Eating Behavior Questionnaire. Structural equation modeling was performed using R. Model fit was tested using maximum-likelihood generalized unweighted least squares. Associations between influencing factors were analyzed using correlation and linear regression. Results: 271 participant responses were …

Exploring Factors For Implementation Of Epas In Pediatric Subspecialty Fellowships: A Qualitative Study Of Program Directors., Angela S. Czaja, Richard B. Mink, Bruce E. Herman, Pnina Weiss, David A. Turner, Megan L. Curran, Diane E J Stafford, Angela Myers, Melissa L. Langhan

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: To understand fellowship program directors' (FPDs) perspectives on facilitators and barriers to using entrustable professional activities (EPAs) in pediatric subspecialty training.

METHODS: We performed a qualitative study of FPDs, balancing subspecialty, program size, geographic region and current uses of EPAs. A study coordinator conducted 1-on-1 interviews using a semistructured approach to explore EPA use or nonuse and factors supporting or preventing their use. Investigators independently coded transcribed interviews using an inductive approach and the constant comparative method. Group discussion informed code structure development and refinement. Iterative data collection and analysis continued until theoretical sufficiency was achieved, yielding a thematic …

Challenges And Promising Solutions To Engaging Patients In Healthcare Implementation In The United States: An Environmental Scan, Eva N. Woodward, Andrea Isabel Castillo, Gala True, Cathleen Willging, Joann E. Kirchner

School of Medicine Faculty Publications

BACKGROUND: One practice in healthcare implementation is patient engagement in quality improvement and systems redesign. Implementers in healthcare systems include clinical leadership, middle managers, quality improvement personnel, and others facilitating changes or adoption of new interventions. Patients provide input into different aspects of health research. However, there is little attention to involve patients in implementing interventions, especially in the United States (U.S.), and this might be essential to reduce inequities. Implementers need clear strategies to overcome challenges, and might be able to learn from countries outside the U.S. METHODS: We wanted to understand existing work about how patients are being …

A Case Study In Program Evaluation, Sydney Wilcoxson

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Evaluation is a critical component of a successful evidence-based health promotion program or intervention. In public health, evaluations ensure that interventions are achieving their intended objectives, provide feedback on program strengths and weaknesses, and serve as a mechanism of accountability and transparency to stakeholders so that they know their invested resources are being utilized in the most efficient manner. Without evaluation, it would be much more difficult to understand how well the intervention is working, and communication between stakeholders would be significantly affected.

A recently confirmed Methicillin-resistant staphylococcus aureus (MRSA) outbreak on a Fayette County Public Schools (FCPS) high school …

Knowledge Translation Task Force For Core Measures Clinical Practice Guideline: A Short Report On The Process And Utilization, Marghuretta D. Bland, Jennifer Moore, Elizabeth Anderl, Megan Eikenberry, Arlene Mccarthy, Geneviève N. Olivier, Tracy Rice, Amelia Siles, Hallie Zeleznik, Wendy Romney

Physical Therapy Faculty Publications

Background

As part of the 2018 Clinical Practice Guideline (CPG): A Core Set of Outcome Measures for Adults with Neurologic Conditions Undergoing Rehabilitation, a Knowledge Translation (KT) Task Force was convened. The purpose of this short report was to (1) demonstrate the potential impact of a CPG KT Task Force through a practical example of efforts to implement a CPG into neurologic physical therapy practice and (2) describe the process to convene a KT Task Force and develop products (KT Toolkit) to facilitate implementation of the CPG.

Methods

To describe the process used by the KT Task Force to develop …

What We Know About School-Based Health Centers: Literature On Outcomes, Cost Impact, Implementation, And Sustainability, Michelle R. Coble, Valerie F. Mcdaniel

Pacific Journal of Health

Many children lack access to adequate healthcare in the United States. School Based Health Centers (SBHC) are a useful resource for accessing those needed services. The purpose of this study is to evaluate the available research for the strengths of SBHCs with improving health outcomes and health equity, cost impact of SBHCs, and best practices for implementing and sustaining an SBHC. The focus of this study was on reviewing the current literature on the impact of SBHCs on improving health equity, health outcomes, cost impact, and to establish best practices for implementing and sustaining an SBHC. Although the current literature …

Clinical Practice Implementation To Address Ascvd Risk: A Practice Change In Primary Care, Elizabeth Wooten

Student Scholarly Projects

Practice Problem: Heart disease stands as the leading cause of mortality in the United States. While healthcare providers strive to identify and optimize prevention strategies, particularly in high-risk patient populations, notable gaps in care persist, notably in the management of modifiable risk factors such as low-density lipoprotein cholesterol (LDL). By harnessing the power of artificial intelligence (AI) integrated software within clinical settings, we can revolutionize the landscape of this devastating chronic disease.

PICOT: The PICOT question that guided this project was: In Primary Care Advanced Practice Providers (APP) caring for high-risk and/or very high-risk patients with atherosclerotic cardiovascular disease (ASCVD) …

Implementation And Utilisation Of Australian Critical Care Practice Standards: What Do We Know?, Yolanda Cox, Justin L. C. Bilszta, Debbie Massey

Research outputs 2022 to 2026

Background: The Australian College of Critical Care Nurses published the third edition of practice standards (PSs) for specialist critical care nurses in 2015. Higher-education providers currently use these standards to inform critical care curricula; however, how critical care nurses perceive and use PSs in clinical practice is unknown. Objectives: The objective of this study was to explore critical care nurses' perceptions about the Australian College of Critical Care Nurses PS for specialty critical care nursing, to understand how the PSs are used in clinical practice, and what opportunities exist to support their implementation. Methods: An exploratory qualitative descriptive design was …

No More Loosies: A Mixed-Methods Study On The Implementation And Enforcement Of The Loose Cigarette And Bidi Sale Ban In India, Mayank Sakhuja

Theses and Dissertations

Background: Sale of loose cigarettes and bidis (loosies) is widely accepted as a key factor in promoting the tobacco epidemic in India. This mixed-methods study aimed to broaden understanding around the sale and purchase of loosies addressed three aims: 1) To determine the prevalence and correlates of loosies purchase in India; 2) To examine the association between purchase behavior and health warning labels (HWLs) exposure and responses, and 3) To conduct a stakeholder analysis regarding the ban on the sale of loosies in India. Methods: Data from the 2018-19 Tobacco Control Policy (TCP) India survey (643 current cigarette users and …

An Electronic Health Record System Implementation In A Resource Limited Country—Lessons Learned, Sayed Karar, Muhammad Haroon Khan, Jasmit Shah, Nadeem Ahmed

Internal Medicine, East Africa

Electronic health records have revolutionized the medical world by improving medical care, refining provider documentation, standardizing care, and minimizing sentinel events. Successful implementation of electronic health records remains a daunting task and requires careful strategic planning and buy-in from key stakeholders. Much has been published in resource-rich settings and high-income countries about implementations of electronic health records. However, little is known about the experience in resource-limited settings where challenges remain unique and distinct from other parts of the world. Our intention is to share lessons learned during implementation of a web-based electronic health record at a tertiary care center in …

Implementing Text-Messaging To Support And Enhance Delivery Of Health Behavior Change Interventions In Low- To Middle-Income Countries: Case Study Of The Lifestyle Africa Intervention., Frank T. Materia, Joshua M. Smyth, Thandi Puoane, Lungiswa Tsolekile, Kathy Goggin, Stephen R. Kodish, Andrew T. Fox, Ken Resnicow, Scott Werntz, Delwyn Catley

Manuscripts, Articles, Book Chapters and Other Papers

The prevalence of non-communicable diseases, such as diabetes and cardiovascular disease, is rising in low- and middle-income countries (LMICs). Health behavior change (HBC) interventions such as the widely used Diabetes Prevention Program (DPP) are effective at reducing chronic disease risk, but have not been adapted for LMICs. Leveraging mobile health (mHealth) technology such as text messaging (SMS) to enhance reach and participant engagement with these interventions has great promise, yet we lack evidence-informed approaches to guide the integration of SMS specifically to support HBC interventions in LMIC contexts. To address this gap, we integrated guidance from the mHealth literature with …

Adaptation And Formative Evaluation Of Online Decision Support To Implement Evidence-Based Strategies To Increase Hpv Vaccination Rates In Pediatric Clinics, Ross Shegog, Lara S Savas, Erica L Frost, Laura C Thormaehlen, Travis Teague, Jack Steffy, Catherine Mary Healy, Laura Aubree Shay, Sharice Preston, Sally W Vernon

Journal Articles

Human papilloma virus (HPV) vaccination rates remain below national goals in the United States despite the availability of evidence-based strategies to increase rates. The Adolescent Vaccination Program (AVP) is a multi-component intervention demonstrated to increase HPV vaccination rates in pediatric clinics through the implementation of six evidence-based strategies. The purpose of this study, conducted in Houston, Texas, from 2019-2021, was to adapt the AVP into an online decision support implementation tool for standalone use and to evaluate its feasibility for use in community clinics. Phase 1 (Adaptation) comprised clinic interviews (

Evidence-Based Practice In Perioperative Nursing: Barriers And Facilitators To Compliance, Benita Ramage, Paula Foran

Journal of Perioperative Nursing

Evidence-based practice (EBP), in combination with clinical expertise and patient values and wishes, enables delivery of exceptional patient-centred care. Providing our perioperative patients care that is informed by best evidence has been proven to provide a safer and higher standard of care.

Best evidence forms the basis for standards and guidelines for nursing practice published by organisations such as Australian College of Perioperative Nurses (ACORN), Australian and New Zealand College of Anaesthetists (ANZCA) and Australian Commission on Safety and Quality in Health Care (ACSQHC). While perioperative nurses strive to provide the best possible care for their patients there is sometimes …

Strengthening Tobacco 21 Implementation And Enforcement To Reduce Tobacco-Related Health Disparities: A Stakeholder Engagement Project., Summer Woolsey, Athena K. Ramos, Kaeli Samson, Delwyn Catley, Keyonna M. King, Rob Crane, Hongying Daisy Dai

Manuscripts, Articles, Book Chapters and Other Papers

INTRODUCTION: As a part of a priority-setting stakeholder engagement project to strengthen the impact of the federal Tobacco 21 (T21) law, we conducted a qualitative study to solicit input from a nationwide sample of tobacco control stakeholders regarding the implementation, enforcement, and equity implications of the T21 law.

METHODS: Following the T21 policy evaluation guidance developed by the Centers for Disease Control (CDC), we identified T21 experts in four domains: policy, evaluation, subject matter, and implementation from a national search of stakeholders (invitations, n=1279) to account for geographical variation. This study presents results from five focus groups conducted in December …

Reducing Medication Errors In Inpatient Hospital Settings By Implementing The Barcode Medication Administration Technology: An Integrative Review, Kali A. Brown

Doctoral Dissertations and Projects

Medication administration errors adversely affect patient outcomes, satisfaction, safety, and quality of care. Barcode medication administration (BCMA) technology automates the verification process during medication administration by requiring that nurses scan the barcode on the medication and the patient identification wristband to confirm the five rights of medication administration. The BCMA thus helps to intercept medication errors that occur at the point of administration. A review of 32 articles published within the past six years was conducted to explore the impact of using BCMA technology on medication error rates in inpatient hospital settings. The review findings indicate that systemic and individual …

Implementing An Emr System In A Small Psychiatric Practice, Brandy Mccrudden

Doctor of Nursing Practice Projects

Electronic medical records (EMRs) can aid in improving surveillance, monitoring, adherence to practice guidelines, improving communication, and reducing medical errors. The adoption of EMRs in psychiatry and mental health settings has been slow despite the offered benefits. This project aimed to develop an implementation and training plan to successfully transition from paper charts to EMRs in a psychiatry practice. An extensive literature review was conducted on the adoption of EMRs in mental health settings, and a guideline for implementation was created to overcome identified barriers. Implementation guidelines included a planning phase, staff training plan, and rollout using a phase-in approach. …

Lessons Learned From All For Them: Best Practices For A Cross-Collaboration Approach To Hpv Vaccination In Public Schools, Paula M Cuccaro, Jihye Choi, Efrat K Gabay, J Michael Wilkerson, Diane Santa Maria, Sanghamitra M Misra, Mayra Aguilar Mcbride, Sally W Vernon

Journal Articles

The Community Preventive Services Task Force endorses vaccination programs in schools to increase access to vaccinations. However, implementing a school-based approach requires substantial coordination, planning, and resources. All for Them (AFT) is a multilevel, multicomponent approach to increase HPV vaccination among adolescents attending public schools in medically underserved areas in Texas. AFT comprised a social marketing campaign, school-based vaccination clinics, and school nurse continuing education. Process evaluation metrics and key informant interviews to understand experiences with AFT program implementation informed lessons learned. Lessons emerged in six domains: strong champion, school-level support, tailored and cost-effective marketing approaches, mobile provider collaboration, community …

Implementation Of 2d Running Gait Analysis In Orthopedic Physical Therapy Clinics, Justin Rasavage, Tristan Trumbull, Melissa Goo-Tam, Micah Wilson

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background: Despite 2D motion analysis being deemed valid and reliable in assessing gait deviations in runners, current use of video-based motion analysis among orthopedic physical therapists is not prevalent. Purpose/Hypothesis: To investigate clinician-perceived effectiveness, adherence, and barriers of using a 2D running gait analysis protocol for patients with running-related injuries. Study Design: Survey Methods: Thirty outpatient physical therapy clinics were contacted to assess interest in participation. The participating therapists were trained on 2D running gait analysis protocol and given a running gait checklist. We used Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to assess the implementation process by collecting …

Evaluating The Feasibility Of Implementing A Prescription Drug Misuse Prevention Intervention In The Community: A Mixed Methods Study, Tamara Al Rawwad, Vaishnavi Tata, Matthew A. Wanat, Danielle Campbell, Douglas Thornton

School of Social Work Faculty Publications and Presentations

Background

This study is part of a state-wide effort to promote the safe disposal of prescription medications and mitigate prescription drug misuse. The objective of this study was to evaluate the implementation of a two-component prevention intervention through Community Prevention Organizations (CPOs) in Texas. The first component involved the distribution of in-home disposal products (IHDP) and the second focused on providing education of the risks of prescription drug misuse.

Methods

This study followed a mixed methods sequential explanatory study design. In the quantitative phase, the extent to which CPOs carried out the intervention was determined by the distribution rate – …

Symptom Management Care Pathway Adaptation Process And Specific Adaptation Decisions, Emily Vettese, Farha Sherani, Allison A. King, Lolie Yu, Catherine Aftandilian, Christina Baggott, Vibhuti Agarwal, Ramamoorthy Nagasubramanian, Kara M. Kelly, David R. Freyer, Etan Orgel, Scott M. Bradfield, Wade Kyono, Michael Roth, Lisa M. Klesges, Melissa Beauchemin, Allison Grimes, George Tomlinson, L. Lee Dupuis, Lillian Sung

School of Medicine Faculty Publications

BACKGROUND: There is substantial heterogeneity in symptom management provided to pediatric patients with cancer. The primary objective was to describe the adaptation process and specific adaptation decisions related to symptom management care pathways based on clinical practice guidelines. The secondary objective evaluated if institutional factors were associated with adaptation decisions. METHODS: Fourteen previously developed symptom management care pathway templates were reviewed by an institutional adaptation team composed of two clinicians at each of 10 institutions. They worked through each statement for all care pathway templates sequentially. The institutional adaptation team made the decision to adopt, adapt or reject each statement, …

Improving The Delivery Of Developmental Care In The Nicu: A Focus On Co-Occupational Engagement, Christina Martella

Occupational Therapy Doctoral Student Capstone Posters

The role of the parent being the primary caregiver is interrupted in the NICU by the advanced care the infant is being provided. These parental role alterations that NICU caregivers experience can negatively impact the parent-infant relationship and ultimately negatively impact overall parental engagement. Even with increased literature showing the need for developmental care through co-occupational engagement with NICU families, it is not systematically integrated into everyday practice. This capstone project aimed to create a systematic way to improve Occupational Therapists’ approach to delivering high quality developmental care through co-occupational parent engagement within the Neonatal Intensive Care Unit.

Development And Piloting Of A Novel Evaluation Tool For Childhood Obesity Prevention Programs, Heather Norman-Burgdolf, Anne R. Lindsay, Kelly Webber, Julie C. Parker, Ingrid K. Richards Adams, Rafida Idris, Laura Hubbs-Tait, Karen Chapman-Novakofski

Journal of Human Sciences and Extension

Childhood obesity remains chronic and high in the U.S., driven by factors including poor dietary habits and lack of physical activity. Interventions that address multiple causal factors may be the most appropriate strategy to address rising childhood obesity rates. The Cooperative Extension Service offers programs across the country to address causal factors of childhood obesity, but few coordinated or concerted efforts have been made to determine overlap, reduce duplication, or identify best practices in programming. To fill this gap, the National Institute of Food and Agriculture Multistate Project W3005 Extension Workgroup sought to develop a novel tool to compare programs …

Architectural Design Of A Blockchain-Enabled, Federated Learning Platform For Algorithmic Fairness In Predictive Health Care: Design Science Study, Xueping Liang, Juan Zhao, Yan Chen, Eranga Bandara, Sachin Shetty

VMASC Publications

Background: Developing effective and generalizable predictive models is critical for disease prediction and clinical decision-making, often requiring diverse samples to mitigate population bias and address algorithmic fairness. However, a major challenge is to retrieve learning models across multiple institutions without bringing in local biases and inequity, while preserving individual patients' privacy at each site.

Objective: This study aims to understand the issues of bias and fairness in the machine learning process used in the predictive health care domain. We proposed a software architecture that integrates federated learning and blockchain to improve fairness, while maintaining acceptable prediction accuracy and minimizing overhead …

Toward A More Comprehensive Understanding Of Organizational Influences On Implementation: The Organization Theory For Implementation Science Framework, Sarah A Birken, Cheyenne R Wagi, Alexandra G Peluso, Michelle C Kegler, Jure Baloh, Prajakta Adsul, Maria E Fernandez, Manal Masud, Terry T-K Huang, Matthew Lee, Mary Wangen, Per Nilsen, Miriam Bender, Mimi Choy-Brown, Grace Ryan, Aliza Randazzo, Linda K Ko

Journal Articles

INTRODUCTION: Implementation is influenced by factors beyond individual clinical settings. Nevertheless, implementation research often focuses on factors related to individual providers and practices, potentially due to limitations of available frameworks. Extant frameworks do not adequately capture the myriad organizational influences on implementation. Organization theories capture diverse organizational influences but remain underused in implementation science. to advance their use among implementation scientists, we distilled 70 constructs from nine organization theories identified in our previous work into theoretical domains in the Organization Theory for Implementation Science (OTIS) framework.

METHODS: The process of distilling organization theory constructs into domains involved concept mapping and …