Implementation science in adolescent healthcare research: an integrative review

Abstract

Background Multiple theories, models and frameworks have been developed to assist implementation of evidence-based practice. However, to date there has been no review of implementation literature specific to adolescent healthcare. This integrative review therefore aimed to determine what implementation science theories, models and frameworks have been applied, what elements of these frameworks have been identified as influential in promoting the implementation and sustainability of service intervention, and to what extent, in what capacity and at what time points has the contribution of adolescent consumer perspectives on evidence implementation been considered. Methods An integrative design was used and reported based on a modified form of the PRISMA (2020) checklist. Seven databases were searched for English language primary research which included any implementation science theory, model or framework developed for/with adolescents or applied in relation to adolescent healthcare services within the past 10 years. Content and thematic analysis were applied with the Consolidated Framework for Implementation Research (CFIR) used to frame analysis of the barriers and facilitators to effective implementation of evidence-informed interventions within youth health settings. Results From 8717 citations, 13 papers reporting 12 studies were retained. Nine different implementation science theories, frameworks or approaches were applied; six of 12 studies used the CFIR, solely or with other models. All CFIR domains were represented as facilitators and barriers for implementation in included studies. However, there was little or no inclusion of adolescents in the development or review of these initiatives. Only three mentioned youth input, occurring in the pre-implementation or implementation stages. Conclusions The few studies found for this review highlight the internationally under-developed nature of this topic. Flagging the importance of the unique characteristics of this particular age group, and of the interventions and strategies to target it, the minimal input of adolescent consumers is cause for concern. Further research is clearly needed and must ensure that youth consumers are engaged from the start and consistently throughout; that their voice is prioritised and not tokenistic; that their contribution is taken seriously. Only then will age-appropriate evidence implementation enable innovations in youth health services to achieve the evidence-based outcomes they offer. Trial Registration PROSPERO 2020 CRD42020201142 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=201142

Barriers and facilitators regarding the implementation of policies and programmes aimed at reducing adolescent pregnancy in Ghana: an exploratory qualitative study

“…We identified and mapped barriers and facilitators to the domains of the ecological framework 5. We found this an effective way to analyse our data, aligning well with implementation science and a realist approach to developing understanding of the barriers and facilitators to policy and programme implementation 18. The perceived barriers identified were gender inequality, family poverty, gatekeeping adolescents’ access to SRH information and services, community support for early childbearing and cohabitation, inadequate data systems, lack of collaboration between stakeholders and lack of political will.…”

“… 5 We found this an effective way to analyse our data, aligning well with implementation science and a realist approach to developing understanding of the barriers and facilitators to policy and programme implementation. 18 The perceived barriers identified were gender inequality, family poverty, gatekeeping adolescents’ access to SRH information and services, community support for early childbearing and cohabitation, inadequate data systems, lack of collaboration between stakeholders and lack of political will. Perceived facilitators included effective implementation of community by-laws, youth involvement, informal parental and peer support networks, routinely available data, and collaboration and effective coordination between stakeholders.…”

Adolescent Perspectives on the Pharmacy-Based T-EVER (Teen E-Cigarette and Vaping Educational Resource) and Its Potential Impact on Youth Vaping

“…The adolescents shared that they want to learn more about the dangers of vaping, so providing youth with that information could prove beneficial in curbing the trend of the e-cigarette epidemic. If we reach adolescents early before they are drawn to the allure of vaping, there is hope that they can make an informed decision on their own about the dangers of vaping and elicit social change, reversing the normalization of vaping among their peers [ 27 , 28 ].…”

Population mental health science: Guiding principles and initial agenda.

“…Barriers to Implementing EBPs. Common multilevel factors affecting the implementation and sustainability of EBPs have been identified (Zolfaghari et al, 2022). First, characteristics of EBPs are important, including elements of an EBP that hinder or make delivery difficult (e.g., time required to implement, adaptability of EBPs to match the delivery context).…”