Implementation evaluation of the Telephone Lifestyle Coaching (TLC) program: organizational factors associated with successful implementation

Damschroder, Laura J.; Reardon, Caitlin M.; Sperber, Nina; Robinson, Claire; Fickel, Jacqueline J.; Oddone, Eugene Z.

doi:10.1007/s13142-016-0424-6

Cited by 74 publications

(73 citation statements)

References 34 publications

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“…While champions' stewardship was vital in overseeing and organizing program implementation and maintenance efforts, neither took the next step to initiate any trainings in their LMHAs. Other studies support the importance of champions in leading successful implementation [76]. Champions reported competing duties and demands on their time and uncertainty in their ability to lead such trainings, as the main obstacles to providing in-house trainings.…”

Section: Effectivenessmentioning

confidence: 95%

Using Mixed Methods to Adapt and Evaluate the Implementation of a Multicomponent Tobacco-Free Workplace Program within Behavioral Health Centers

Leal

Chen

Correa-Fernández

et al. 2020

Preprint

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Background: Behavioral health treatment centers (BHTCs) rarely implement existing evidence-based practices for treating tobacco dependence, despite high rates of tobacco use among their clients. Taking Texas Tobacco Free (TTTF) has successfully targeted this disparity by delivering an evidence-based, multilevel, tobacco-free workplace program providing policy implementation and enforcement, education, provider training in tobacco screenings and treatments, and nicotine replacement therapies (NRT) to BHTCs across Texas. We describe a mixed methods design used to conduct a formative evaluation process to adapt implementation strategies to local contexts, evaluate program outcomes and characterize processes influencing program implementation in two BHTCs serving 17 clinics.Methods: Varied data collection included pre and post-implementation leader, provider, and staff surveys; and pre, mid, and post-implementation provider, staff and consumer focus groups. During implementation, data were collected via various logs (tobacco screenings, NRT delivery) to monitor program content delivery. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework guided translation of behavioral interventions into sustainable practice.Results: While program implementation varied between each BHTC, all clinics adopted a 100% tobacco-free workplace policy, integrated tobacco screenings into routine practice, delivered evidence-based interventions, dispensed NRT to consumers and staff, and increased provider knowledge on how to address tobacco dependence. Pre, mid, and post-implementation qualitative findings served to: 1) develop program strategies and materials adapted to local contexts and populations and address barriers; 2) adjust delivery systems of key components to enhance implementation; 3) understand reasons for success or failure to implement specific practices; and 4) reveal program integration into clinic culture, enhancing sustainability.Conclusions: Implementation of TTTF at both BHTCs increased organizational capacity in the provision of evidence-based practices to treat tobacco dependence through successfully meeting most of our RE-AIM targets. Mixing methods involved program adopters and recipients as collaborators directly shaping core interventions to their individual context and needs, thus increasing program fit, ownership, adoption and sustainability; closing the gap between research and practice. These findings contribute to the development of flexible strategies and interventions capable of addressing variable implementation contexts and barriers, thus enhancing the effectiveness and sustainability of a tobacco-free workplace program.

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Section: Effectivenessmentioning

confidence: 95%

Using Mixed Methods to Adapt and Evaluate the Implementation of a Multicomponent Tobacco-Free Workplace Program within Behavioral Health Centers

Leal

Chen

Correa-Fernández

et al. 2020

Preprint

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“…The valence of each construct reflects the impact on implementation (negative or positive); the numbers provide a reference for the impact on implementation as weak or strong, with 2 being the strongest. [ 20 ]…”

Section: Methodsmentioning

confidence: 99%

Formative evaluation and adaptation of pre-and early implementation of diabetes shared medical appointments to maximize sustainability and adoption

2018

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BackgroundUnderstanding the many factors that influence implementation of new programs, in addition to their success or failure, is extraordinarily complex. This qualitative study examines the implementation and adaptation process of two linked clinical programs within Primary Care, diabetes shared medical appointments (SMAs) and a reciprocal Peer-to-Peer (P2P) support program for patients with poorly controlled diabetes, through the lens of the Consolidated Framework for Implementation Research (CFIR). We illustrate the role and importance of pre-implementation interviews for guiding ongoing adaptations to improve implementation of a clinical program, achieve optimal change, and avoid type III errors.MethodsWe conducted 28 semi-structured phone interviews between September of 2013 and May of 2016, four to seven interviewees at each site. The interviewees were physician champions, chiefs of primary care, pharmacists, dieticians, nurses, health psychologists, peer facilitators, and research coordinators. Modifiable barriers and facilitators to implementation were identified and adaptations documented. Data analysis started with immersion in the data to obtain a sense of the whole and then by cataloging principal themes per CFIR constructs. An iterative consensus-building process was used to code. CFIR constructs were then ranked and compared by the researchers.ResultsWe identified a subset of CFIR constructs that are most likely to play a role in the effectiveness of the diabetes SMAs and P2P program based on our work with the participating sites to date. Through the identification of barriers and facilitators, a subset of CFIR constructs arose, including evidence strength and quality, relative advantage, adaptability, complexity, patient needs and resources, compatibility, leadership engagement, available resources, knowledge and beliefs, and champions.ConclusionsWe described our method for identification of contextual factors that influenced implementation of complex diabetes clinical programs - SMAs and P2P. The qualitative phone interviews aided implementation through the identification of modifiable barriers or conversely, actionable findings. Implementation projects, and certainly clinical programs, do not have unlimited resources and these interviews allowed us to determine which facets to target and act on for each site. As the study progresses, these findings will be compared and correlated to outcome measures. This comprehensive adaptation data collection will also facilitate and enhance understanding of the future success or lack of success of implementation and inform potential for translation and public health impact. The approach of using the CFIR to guide us to actionable findings and help us better understand barriers and facilitators has broad applicability and can be used by other projects to guide, adapt, and improve implementation of research into practice.Trial registrationClinicalTrials.gov ID: NCT02132676.

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“…Concerning determinants, the valence should be noted as being either a barrier, a facilitator, neutral, or variable by study unit. This can be achieved by simply adding plus (+) or minus (-) signs for facilitators and barriers, respectively, or by using coding systems such as that developed by Damschroder et al [39], which indicates the relative strength of the determinant on a scale: -2 (strong negative impact), -1 (weak negative impact), 0 (neutral or mixed influence), 1 (weak positive impact), and 2 (strong positive impact). The use of such a coding system could yield better specification compared to using study-specific adjectives or changing the name of the determinant (e.g., greater relative priority, addresses patient needs, good climate for implementation).…”

Section: Determinantsmentioning

confidence: 99%

The Implementation Research Logic Model: a method for planning, executing, reporting, and synthesizing implementation projects

2020

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Background Numerous models, frameworks, and theories exist for specific aspects of implementation research, including for determinants, strategies, and outcomes. However, implementation research projects often fail to provide a coherent rationale or justification for how these aspects are selected and tested in relation to one another. Despite this need to better specify the conceptual linkages between the core elements involved in projects, few tools or methods have been developed to aid in this task. The Implementation Research Logic Model (IRLM) was created for this purpose and to enhance the rigor and transparency of describing the often-complex processes of improving the adoption of evidence-based interventions in healthcare delivery systems. Methods The IRLM structure and guiding principles were developed through a series of preliminary activities with multiple investigators representing diverse implementation research projects in terms of contexts, research designs, and implementation strategies being evaluated. The utility of the IRLM was evaluated in the course of a 2-day training to over 130 implementation researchers and healthcare delivery system partners. Results Preliminary work with the IRLM produced a core structure and multiple variations for common implementation research designs and situations, as well as guiding principles and suggestions for use. Results of the survey indicated a high utility of the IRLM for multiple purposes, such as improving rigor and reproducibility of projects; serving as a “roadmap” for how the project is to be carried out; clearly reporting and specifying how the project is to be conducted; and understanding the connections between determinants, strategies, mechanisms, and outcomes for their project. Conclusions The IRLM is a semi-structured, principle-guided tool designed to improve the specification, rigor, reproducibility, and testable causal pathways involved in implementation research projects. The IRLM can also aid implementation researchers and implementation partners in the planning and execution of practice change initiatives. Adaptation and refinement of the IRLM are ongoing, as is the development of resources for use and applications to diverse projects, to address the challenges of this complex scientific field.

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Implementation evaluation of the Telephone Lifestyle Coaching (TLC) program: organizational factors associated with successful implementation

Cited by 74 publications

References 34 publications

Using Mixed Methods to Adapt and Evaluate the Implementation of a Multicomponent Tobacco-Free Workplace Program within Behavioral Health Centers

Using Mixed Methods to Adapt and Evaluate the Implementation of a Multicomponent Tobacco-Free Workplace Program within Behavioral Health Centers

Formative evaluation and adaptation of pre-and early implementation of diabetes shared medical appointments to maximize sustainability and adoption

The Implementation Research Logic Model: a method for planning, executing, reporting, and synthesizing implementation projects

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