IntroductionImplementation science frameworks have been used widely for planning and evaluation, but seldom to guide adaptations during program implementation. There is great potential for these frameworks to be used to inform conceptual and data-driven decisions about adaptations.MethodsWe summarize recent applications using Iterative RE-AIM to capture and guide adaptations. Iterative RE-AIM can be repeated at multiple time points customized to each project and involves the following activities: identification of key implementation partners; rating importance of and progress on each RE-AIM dimension (reach, effectiveness, adoption, implementation, and maintenance); use of summary data on ratings to identify one or two RE-AIM dimensions for adaptations and implementation strategies; and evaluation of progress and impact of adaptations. We summarize recent and ongoing Iterative RE-AIM applications across multiple care coordination and pain management projects within the Veterans Health Administration, a hypertension control trial in Guatemala, a hospital-based lung ultrasound implementation pilot, and a colorectal cancer screening program in underserved communities.ResultsIterative RE-AIM appears feasible, helpful, and broadly applicable across diverse health care issues, interventions, contexts, and populations. In general, the RE-AIM dimension showing the largest gap between importance and progress has been Reach. The dimensions most frequently selected for improvement have been Reach and Implementation. We discuss commonalities, differences and lessons learned across these various applications of Iterative RE-AIM. Challenges include having objective real time data on which to make decisions, having key implementation staff available for all assessments, and rapidly scoring and providing actionable feedback. We discuss print and online resources and materials to support Iterative RE-AIM.ConclusionsThe use of Iterative RE-AIM to guide and support understanding of adaptations has proven feasible across diverse projects and in multiple case studies, but there are still questions about its strengths, limitations, essential components, efficiency, comparative effectiveness, and delivery details. Future directions include investigating the optimal frequency and timing for iterative applications; adding contextual assessments; developing more continuous and rapid data on which to make adaptation decisions; identifying opportunities to enhance health equity; and determining the level of facilitation that is most cost-effective.

Background Despite lung cancer being a leading cause of death in the United States and lung cancer screening (LCS) being a recommended service, many patients eligible for screening do not receive it. Research is needed to understand the challenges with implementing LCS in different settings. This study investigated multiple practice members and patient perspectives impacting rural primary care practices related to LCS uptake by eligible patients. Methods This qualitative study involved primary care practice members in multiple roles (clinicians n = 9, clinical staff n = 12 and administrators n = 5) and their patients (n = 19) from 9 practices including federally qualified and rural health centers (n = 3), health system owned (n = 4) and private practices (n = 2). Interviews were conducted regarding the importance of and ability to complete the steps that may result in a patient receiving LCS. Data were analyzed using a thematic analysis with immersion crystallization then organized using the RE-AIM implementation science framework to illuminate and organize implementation issues. Results Although all groups endorsed the importance of LCS, all also struggled with implementation challenges. Since assessing smoking history is part of the process to identify eligibility for LCS, we asked about these processes. We found that smoking assessment and assistance (including referral to services) were routine in the practices, but other steps in the LCS portion of determining eligibility and offering LCS were not. Lack of knowledge about screening and coverage, patient stigma, and resistance and practical considerations such as distance to LCS testing facilities complicated completion of LCS compared to screening for other types of cancer. Conclusions Limited uptake of LCS results from a range of multiple interacting factors that cumulatively affect consistency and quality of implementation at the practice level. Future research should consider team-based approaches to conduct of LCS eligibility and shared decision making.

Objectives: It is important to understand the unique perspectives and values that motivate patients and clinicians in rural primary care settings to participate in clinical care activities. Our objective was to explore perspectives, preferences, and values related to primary care that could influence implementation of evidence-based programs. Methods: Qualitative study utilizing semi-structured interviews and using immersion/crystallization and thematic analysis. Participants were primary care practice members (clinicians, clinical staff, and administrators) and their patients in rural Colorado. Results: Twenty-six practice members and 23 patients across 9 practices participated. There were 4 emergent themes that were consistent across practice members and some patients. Patient perspectives are located in parenthesis. They included: (1) Focus on quality patient care, patient satisfaction, and continuity of care (patients appreciated quality and compassionate care), (2) Importance of prevention and wellness (patients appreciated help with preventing health problems), (3) Clinician willingness and ability to meet patient preferences for care (patients described comfort with local care), and (4) Passion for serving underserved, uninsured, or vulnerable populations (patients described their vulnerabilities). There were differences in how the perspectives were operationalized by practice member role, illustrating the importance of different ways of addressing these values. Conclusions: Successful implementation requires consideration of context, and much of context is understanding what is important to those involved in the primary care experience. This study sheds light on salient values of rural primary care practice members and their patients, which may inform interventions designed with and for this setting.

No abstract

BACKGROUND Dissemination and Implementation (D&I) science is dedicated to increasing the speed and amount of evidence-based research translated into real-world practice and is often guided by one or multiple D&I theories, models, and framework (TMFs). The D&I Models in Health Research and Practice web tool (D&I TMFs web tool) provides researchers, practitioners, and students with guidance on how to Plan, Select, Combine, Adapt, Use, and Measure TMFs. OBJECTIVE Dissemination and Implementation (D&I) science is dedicated to increasing the speed and amount of evidence-based research translated into real-world practice and is often guided by one or multiple D&I theories, models, and framework (TMFs). The D&I Models in Health Research and Practice web tool (D&I TMFs web tool) provides researchers, practitioners, and students with guidance on how to Plan, Select, Combine, Adapt, Use, and Measure TMFs. METHODS An iterative user testing process was conducted with participants of varying levels of expertise and involvement in implementation science to facilitate updates and additions to D&I TMFs and to optimize functionality of the tool. A multi-step usability testing protocol involved the collection of a combination of quantitative and qualitative data including a pre-testing survey and a usability testing session involving (1) pre-testing interview; (2) hands-on usability testing; and (3) post-testing interview. Data from the pre-testing surveys were summarized as frequencies. Data from the usability testing sessions were analyzed and organized using a hybrid deductive and adapted, rapid matrix qualitative analysis approach. RESULTS A total of 15 interviewees represented diverse research and clinical groups, covering various fields utilizing D&I TMFs and levels of expertise in D&I research. When asked about D&I expertise, eight participants self-identified as novice or advanced beginner, three as intermediate, and four as advanced. A total of 847 interview comments were identified through coding. When reviewed for similarities, comments were combined and reduced to a total of 259 unique comments. Of those 259 comments, 142 were classified as a change that fit the priorities of the web tool and were feasible on which to act. Content, format, and functionality changes were made by the team and implemented directly into the web tool. Most notably, from a user experience perspective, the web tool now presents as a tool within a website, making it more intuitive for the intended audience. CONCLUSIONS The iterative, multi-step approach to usability testing was effective in eliciting needed feedback and responses to help the research team update, modify, and improve the web tool. A few features were identified by the participants and added or changed. These included adding more examples, definitions, visuals, tutorials and simplifying the written content. The goal/intention of web tool is now more prominent and the TMF search function is better optimized for intended users. The web tool remains flexible for updates with plans for further additions of health equity, de-implementation, and other advances in the field.