Improving the usefulness of evidence concerning the effectiveness of implementation strategies for knowledge products in primary healthcare: protocol for a series of systematic reviews

Zomahoun, Hervé Tchala Vignon; Massougbodji, José; Bussières, André; Thomas, Aliki; Kairy, Dahlia; Uwizeye, Claude Bernard; Rhéault, Nathalie; Charif, Ali Ben; Diendéré, Ella; Langlois, Léa; Tchoubi, Sébastien; Gaye, Serigne Abib

doi:10.1186/s13643-020-01382-x

Cited by 3 publications

(6 citation statements)

References 39 publications

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“…The protocol of the project was registered on the Open Science Framework platform on February 7, 2020 [ 26 ] and then published [ 27 ]. The review was conducted following the Cochrane methodology [ 28 ] and is reported in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines [ 29 ].…”

Section: Methodsmentioning

confidence: 99%

“…We focused on implementation strategies that were predetermined in our protocol [ 27 ] and based on the Effective Practice and Organization of Care (EPOC) [ 8 ] to include the following implementation strategies: audit, feedback, audit and feedback, clinical incident reporting, monitoring the performance of the delivery of health care, communities of practice, continuous quality improvement, educational games, educational materials, educational meetings, educational outreach visits or academic detailing, clinical practice guidelines, interprofessional education, local consensus processes, local opinion leaders, managerial supervision, patient-mediated interventions, public release of performance data, reminders, routine patient-reported outcome measures, and tailored interventions. A review may have included primary studies that use exclusively 1 type of implementation strategy (mono-faceted) or exclusively more than 1 type (multifaceted).…”

Section: Methodsmentioning

confidence: 99%

“…For the second phase, reanalysis by meta-analysis was not performed [ 27 ]. Using SAS software (SAS Institute Inc) and taking the included review as the unit of analysis, we performed a descriptive analysis that aimed to summarize the characteristics of the implemented knowledge products, implementation strategies used, outcomes measured, and levels of evidence reported.…”

Section: Methodsmentioning

confidence: 99%

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Implementation Strategies for Knowledge Products in Primary Health Care: Systematic Review of Systematic Reviews

Uwizeye¹,

Zomahoun²,

Bussières³

et al. 2022

Interact J Med Res

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Background The underuse or overuse of knowledge products leads to waste in health care, and primary care is no exception. Objective This study aimed to characterize which knowledge products are frequently implemented, the implementation strategies used in primary care, and the implementation outcomes that are measured. Methods We performed a systematic review (SR) of SRs using the Cochrane systematic approach to include eligible SRs. The inclusion criteria were any primary care contexts, health care professionals and patients, any Effective Practice and Organization of Care implementation strategies of specified knowledge products, any comparators, and any implementation outcomes based on the Proctor framework. We searched the MEDLINE, EMBASE, CINAHL, Ovid PsycINFO, Web of Science, and Cochrane Library databases from their inception to October 2019 without any restrictions. We searched the references of the included SRs. Pairs of reviewers independently performed selection, data extraction, and methodological quality assessment by using A Measurement Tool to Assess Systematic Reviews 2. Data extraction was informed by the Effective Practice and Organization of Care taxonomy for implementation strategies and the Proctor framework for implementation outcomes. We performed a descriptive analysis and summarized the results by using a narrative synthesis. Results Of the 11,101 records identified, 81 (0.73%) SRs were included. Of these 81, a total of 47 (58%) SRs involved health care professionals alone. Moreover, 15 SRs had a high or moderate methodological quality. Most of them addressed 1 type of knowledge product (56/81, 69%), common clinical practice guidelines (26/56, 46%) or management, and behavioral or pharmacological health interventions (24/56, 43%). Mixed strategies were used for implementation (67/81, 83%), predominantly education-based (meetings in 60/81, 74%; materials distribution in 59/81, 73%; and academic detailing in 45/81, 56%), reminder (53/81, 36%), and audit and feedback (40/81, 49%) strategies. Education meetings (P=.13) and academic detailing (P=.11) seemed to be used more when the population was composed of health care professionals alone. Improvements in the adoption of knowledge products were the most commonly measured outcome (72/81, 89%). The evidence level was reported in 12% (10/81) of SRs on 62 outcomes (including 48 improvements in adoption), of which 16 (26%) outcomes were of moderate or high level. Conclusions Clinical practice guidelines and management and behavioral or pharmacological health interventions are the most commonly implemented knowledge products and are implemented through the mixed use of educational, reminder, and audit and feedback strategies. There is a need for a strong methodology for the SR of randomized controlled trials to explore their effectiveness and the entire cascade of implementation outcomes.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Implementation Strategies for Knowledge Products in Primary Health Care: Systematic Review of Systematic Reviews

Uwizeye¹,

Zomahoun²,

Bussières³

et al. 2022

Interact J Med Res

Self Cite

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“…These different sources of information are often summarised and combined to create ‘knowledge products’ that aim to support behaviour change. Examples of knowledge products include clinical practice guidelines, standards, policies, guides and casebooks, all of which offer guidance to healthcare providers (HCPs) (Zomahoun et al, 2020). The availability of these products, however, does not mean that they are systematically implemented into clinical practice (Zomahoun et al, 2020), which limits the potential for patients to benefit from EBP (Fernandez et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

“…Examples of knowledge products include clinical practice guidelines, standards, policies, guides and casebooks, all of which offer guidance to healthcare providers (HCPs) (Zomahoun et al, 2020). The availability of these products, however, does not mean that they are systematically implemented into clinical practice (Zomahoun et al, 2020), which limits the potential for patients to benefit from EBP (Fernandez et al, 2019). Implementation challenges include individual‐level factors, such as lack of information and demanding clinical workload, and organisation‐level factors, such as lack of resources and leadership support (Parmar et al, 2022; Warren et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

Putting weight‐related conversations into practice: Lessons learned from implementing a knowledge translation casebook in a disability context

Provvidenza,

Bonder,

McPherson

2024

Child

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BackgroundDue to reported challenges experienced by healthcare providers (HCPs) when having weight‐related conversations with children with disabilities and their families, a knowledge translation (KT) casebook was developed, providing key communication principles with supportive resources. Our aim was to explore how the KT casebook could be implemented into a disability context. Study objectives were to develop and integrate needs‐based implementation supports to help foster the uptake of the KT casebook communication principles.MethodsA sample of nurses, physicians, occupational therapists and physical therapists were recruited from a Canadian paediatric rehabilitation hospital. Informed by the Theoretical Domains Framework, group interviews were conducted with participants to understand barriers to having weight‐related conversations in their context. Implementation strategies were developed to deliver the KT casebook content that addressed these identified barriers, which included an education workshop, simulations, printed materials, and a huddle and email strategy. Participant experiences with the implementation supports were captured through workshop evaluations, pre‐post surveys and qualitative interviews. Post‐implementation interviews were analysed using descriptive content analysis.ResultsTen HCPs implemented the KT casebook principles over 6 months. Participants reported that the workshop provided a clear understanding of the KT casebook content. While HCPs appreciated the breadth of the KT casebook, they found the abbreviated printed educational materials more convenient. Strategies developed to address participants' need for a sense of community and opportunities to learn from each other did not achieve their aim. Increased confidence in integrating the KT casebook principles into practice was not demonstrated, due, in part, to having few opportunities to practice. This was partly because of the increase in competing clinical demands at the onset of the COVID‐19 pandemic.ConclusionsDespite positive feedback on the product itself, changes in the organisational and environmental context limited the success of the implementation plan. Monitoring and adapting implementation processes in response to unanticipated changes is critical to the success of implementation efforts.

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Implementation Strategies for Knowledge Products in Primary Health Care: Systematic Review of Systematic Reviews (Preprint)

Uwizeye¹,

Zomahoun²,

Bussières³

et al. 2022

Preprint

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BACKGROUND The underuse or overuse of knowledge products leads to waste in healthcare, and primary care is no exception. OBJECTIVE We aimed to characterize which knowledge products are frequently implemented, the implementation strategies used in primary care, and the implementation outcomes that are measured. METHODS We performed a systematic review of systematic reviews (SR) using the Cochrane systematic approach to include eligible SR. The inclusion criteria were: any primary care contexts; healthcare professionals and patients; any EPOC implementation strategies of specified knowledge products; any comparator; and any implementation outcomes based on the Proctor framework. We searched the Medline, EMBASE, CINAHL, Ovid PsycINFO, Web of Science, and Cochrane Library databases from their inception to October 2019, without any restriction. We searched the references of the included SR. Pairs of reviewers independently performed selection, data extraction and methodological quality assessment with AMSTAR 2. Data extraction was informed by EPOC taxonomy for implementation strategies and the Proctor framework for implementation outcomes. We performed a descriptive analysis and summarized the results using a narrative synthesis. RESULTS Of the 11,101 records identified, 81 SR were included. Forty-seven SR involved healthcare professionals alone. Fifteen SR were of high or moderate methodological quality. Most of them addressed one type of knowledge product (56/81), common clinical practice guidelines (26/56) or management, and behavioural or pharmacological health interventions (24/56). Mixed strategies were used for implementation (67/81), predominantly educational-based (meetings in 60/81, materials distribution in 59/81, and outreach in 45/81), reminder (53/81) and audit and feedback (40/81) strategies. The improvement of the adoption of knowledge products was the most commonly measured outcome (72/81). The evidence level was reported in 10/81 SR on 62 outcomes (including 48 improvement of adoption), of which 16 outcomes were of moderate or high level. CONCLUSIONS Clinical practice guidelines and management, behavioural or pharmacological health interventions are the most commonly implemented knowledge products through the mixed use of educational, reminders and audit and feedback strategies. There is need for a strong methodology for the SR of RCTs to explore their effectiveness and the whole cascade of implementation outcomes. CLINICALTRIAL The Open Science Framework platform (Registration ID: https://osf.io/eb8w2/).

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Improving the usefulness of evidence concerning the effectiveness of implementation strategies for knowledge products in primary healthcare: protocol for a series of systematic reviews

Cited by 3 publications

References 39 publications

Implementation Strategies for Knowledge Products in Primary Health Care: Systematic Review of Systematic Reviews

Implementation Strategies for Knowledge Products in Primary Health Care: Systematic Review of Systematic Reviews

Putting weight‐related conversations into practice: Lessons learned from implementing a knowledge translation casebook in a disability context

Implementation Strategies for Knowledge Products in Primary Health Care: Systematic Review of Systematic Reviews (Preprint)

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