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Implementation
Research in
Mental Health Service
By
Mahmoud A.
Hashim
6th year Medical
Student
Ain Shams
University Egypt
Under Supervision of
Dr/ Inna Lutsenko
Assistant Professor -
Kyrgyz State Medical
Academy (KSMA),
Kyrgyzstan.
Visiting Scholar
Roles
= 30
Min.
Please Write it in a
paper
Introduction
In 1753, he published
results of his clinical trial
about role of citrus
fruits in treating Scurvy,
but his results weren‟t
translated into clinical
practice till 1795.
James Lind, a Scottish
Physician
42 years to apply
Lind‟s research results
into clinical practice
(Michele Tansella and
Graham Thornicroft, 2009)
Gap
This research to practice gap can lead to
millions of dollars of funded research being
wasted when the treatments themselves never
reach the populations in need.
(Enola K. Proctor et al. 2009)
Indeed, New interventions are estimated to
„„languish‟‟ for 15–20 years before they are
incorporated into usual care
(Boren and Balas 1999).
So, The
problem is
the systematic
study of how a
specific set of
activities and
designated
strategies are
used to
successfully
integrate an
Implementation
Research
Implementation is the utilization of strategies
or approaches to introduce or modify EBIs within
specific settings. This involves the identification of and
assistance in overcoming barriers to the application of
new knowledge obtained from a disseminated
research findings or an evidence based program
(Lomas, 1993).
While,
Implementation Research
Language
Diffusion
• Often conceived as a relatively passive process.
• In the diffusion process, „„natural channels” of
communication
(e.g. word of mouth, publication) allow information to move
via individuals and social networks into larger populations,
slowly over time.
I. Diffusion Vs Dissemination
•Within the scientific context, the slow pace of the
diffusion of data from research through scientific publication
and presentation is valued, as fundamental discoveries are
exposed to the scrutiny of readers of scientific journals and
scientific meeting/conference participants.
(Jon F. Kerner & Kara L. Hall, 2009)
• Is considered an active process.
• “the targeted distribution of information and
intervention materials to a specific public health or clinical
practice audience with the intent to spread knowledge and
the associated evidence- based interventions”
Dissemination
•Effective dissemination involves several steps:
(a) identifying audience characteristics.
(b) understanding the context in which the research
information is likely to be used.
(c) framing the research information.
(d) creating feedback mechanisms.
(Enola K. Proctor et al. 2009)
So, Diffusion (passive
spread), Dissemination (active and planned
efforts to persuade target groups to adopt an
innovation),
(Greenhalgh et al. 2004)
Implementation (the use of strategies to
introduce or change evidence-based health
interventions within specific settings). (Enola K.
Proctor et al. 2009)
II. Efficacy Vs Effectiveness
Efficacy
Refers to the
intervention‟s ability to
do more good than harm
among the target
population in an ideal
setting.
Effectiveness
refers to the
intervention‟s ability to do
more good than harm for
the target population in a
real world setting.
Schillinger, D. (2010). An Introduction to Effectiveness, Dissemination and
Implementation Research.
III. Outcomes and impacts
The end results of public health interventions which
include
effects that people experience and care about.
Implementation Research
Goals
I. Produce Reliable Strategies for improving
health-related processes ,Outcomes and
facilitate the adoption of these strategies.
II. Produce generalizable knowledge and
increased understanding of implementation
processes, barriers, facilitators, strategies.
III. Develop, test and refine implementation
theories and hypotheses; methods and
measuresMittman, B. (2010). Implementation Science in
the VA. CIPRS
Implementation Research
Conceptual ModelsI. Pipeline Model
Mittman, B. (2010). Implementation Science in
the VA. CIPRS
Observations on the pipeline
model
I. “pipeline models” assume an unrealistic uni-linear
progression from efficacy to broad uptake
Addis has reviewed the limitations of unidirectional, linear
models of dissemination. (Enola K. Proctor et al. 2009)
II. Observational studies of implementation processes
permit maximize policy/practice relevance and value.
(Mittman, B. 2010)
III. Implementation trials should be preceded by
adequate
pre-implementation research (Mittman, B. 2010)
IV. Hybrid effectiveness/implementation studies
II. Four Level Problem
Observations on the four
level problem
I. This framework offers enormous benefit
because it specifies multiple levels in the
practice context that are likely to be a key to
change.
II. The organizational context of implementation,
reflects the most substantial deviation from
linear, „„pipeline‟‟ phase models.
(Enola K. Proctor et al. 2009)
iii. Conceptual Model for
Implementation
Research
(Enola K. Proctor et al. 2009)
Implementation Research
challenges
Mittman, B. (2010). Implementation
Science in the VA. CIPRS
Who Should Conduct
Implementation Research?
• Implementation research, whether health or
mental health, is necessarily multi-disciplinary and
requires a convergence of perspectives.
• It requires a partnership of treatment developers, service
system researchers, and quality improvement
researchers.
• They need to be joined by experts in economics and
business and management.
• Because implementation research necessarily occurs in
the „„real world‟‟ of community based settings of care,
implementation researchers also must partner with
community stakeholders.
(Enola K. Proctor et al. 2009)
Need for implementation science in
Mental health
• If the development of implementation science is in its
infancy, then its application to mental health practice
may be considered as embryonic.
• Although there are now thousands of published papers
on the development of clinical guidelines across
healthcare, there are relatively few on how to put
guidelines into cost-effective, routine practice.
• In this sense, we need to undertake work to identify the
barriers at which the implementation of evidencebased
practice can fail and systematically study how each
breakpoint can be successfully bridged.
(Michele Tansella and Graham Thornicroft, 2009)
“To him who devotes
his life to science,
nothing can give
more happiness
than increasing the
number of
discoveries, but his
cup of joy is full
when the results of Louis Pasteur
French chemist and microbiologist
Dr_mahmoud_hashim@yahoo.com

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Implementation research

  • 1. Implementation Research in Mental Health Service By Mahmoud A. Hashim 6th year Medical Student Ain Shams University Egypt Under Supervision of Dr/ Inna Lutsenko Assistant Professor - Kyrgyz State Medical Academy (KSMA), Kyrgyzstan. Visiting Scholar
  • 3. Introduction In 1753, he published results of his clinical trial about role of citrus fruits in treating Scurvy, but his results weren‟t translated into clinical practice till 1795. James Lind, a Scottish Physician 42 years to apply Lind‟s research results into clinical practice (Michele Tansella and Graham Thornicroft, 2009)
  • 4. Gap This research to practice gap can lead to millions of dollars of funded research being wasted when the treatments themselves never reach the populations in need. (Enola K. Proctor et al. 2009) Indeed, New interventions are estimated to „„languish‟‟ for 15–20 years before they are incorporated into usual care (Boren and Balas 1999). So, The problem is
  • 5. the systematic study of how a specific set of activities and designated strategies are used to successfully integrate an Implementation Research
  • 6. Implementation is the utilization of strategies or approaches to introduce or modify EBIs within specific settings. This involves the identification of and assistance in overcoming barriers to the application of new knowledge obtained from a disseminated research findings or an evidence based program (Lomas, 1993). While,
  • 7. Implementation Research Language Diffusion • Often conceived as a relatively passive process. • In the diffusion process, „„natural channels” of communication (e.g. word of mouth, publication) allow information to move via individuals and social networks into larger populations, slowly over time. I. Diffusion Vs Dissemination •Within the scientific context, the slow pace of the diffusion of data from research through scientific publication and presentation is valued, as fundamental discoveries are exposed to the scrutiny of readers of scientific journals and scientific meeting/conference participants. (Jon F. Kerner & Kara L. Hall, 2009)
  • 8. • Is considered an active process. • “the targeted distribution of information and intervention materials to a specific public health or clinical practice audience with the intent to spread knowledge and the associated evidence- based interventions” Dissemination •Effective dissemination involves several steps: (a) identifying audience characteristics. (b) understanding the context in which the research information is likely to be used. (c) framing the research information. (d) creating feedback mechanisms. (Enola K. Proctor et al. 2009)
  • 9. So, Diffusion (passive spread), Dissemination (active and planned efforts to persuade target groups to adopt an innovation), (Greenhalgh et al. 2004) Implementation (the use of strategies to introduce or change evidence-based health interventions within specific settings). (Enola K. Proctor et al. 2009)
  • 10.
  • 11. II. Efficacy Vs Effectiveness Efficacy Refers to the intervention‟s ability to do more good than harm among the target population in an ideal setting. Effectiveness refers to the intervention‟s ability to do more good than harm for the target population in a real world setting. Schillinger, D. (2010). An Introduction to Effectiveness, Dissemination and Implementation Research. III. Outcomes and impacts The end results of public health interventions which include effects that people experience and care about.
  • 12. Implementation Research Goals I. Produce Reliable Strategies for improving health-related processes ,Outcomes and facilitate the adoption of these strategies. II. Produce generalizable knowledge and increased understanding of implementation processes, barriers, facilitators, strategies. III. Develop, test and refine implementation theories and hypotheses; methods and measuresMittman, B. (2010). Implementation Science in the VA. CIPRS
  • 14. Mittman, B. (2010). Implementation Science in the VA. CIPRS
  • 15. Observations on the pipeline model I. “pipeline models” assume an unrealistic uni-linear progression from efficacy to broad uptake Addis has reviewed the limitations of unidirectional, linear models of dissemination. (Enola K. Proctor et al. 2009) II. Observational studies of implementation processes permit maximize policy/practice relevance and value. (Mittman, B. 2010) III. Implementation trials should be preceded by adequate pre-implementation research (Mittman, B. 2010) IV. Hybrid effectiveness/implementation studies
  • 16. II. Four Level Problem
  • 17. Observations on the four level problem I. This framework offers enormous benefit because it specifies multiple levels in the practice context that are likely to be a key to change. II. The organizational context of implementation, reflects the most substantial deviation from linear, „„pipeline‟‟ phase models. (Enola K. Proctor et al. 2009)
  • 18. iii. Conceptual Model for Implementation Research (Enola K. Proctor et al. 2009)
  • 19. Implementation Research challenges Mittman, B. (2010). Implementation Science in the VA. CIPRS
  • 20. Who Should Conduct Implementation Research? • Implementation research, whether health or mental health, is necessarily multi-disciplinary and requires a convergence of perspectives. • It requires a partnership of treatment developers, service system researchers, and quality improvement researchers. • They need to be joined by experts in economics and business and management. • Because implementation research necessarily occurs in the „„real world‟‟ of community based settings of care, implementation researchers also must partner with community stakeholders. (Enola K. Proctor et al. 2009)
  • 21. Need for implementation science in Mental health • If the development of implementation science is in its infancy, then its application to mental health practice may be considered as embryonic. • Although there are now thousands of published papers on the development of clinical guidelines across healthcare, there are relatively few on how to put guidelines into cost-effective, routine practice. • In this sense, we need to undertake work to identify the barriers at which the implementation of evidencebased practice can fail and systematically study how each breakpoint can be successfully bridged. (Michele Tansella and Graham Thornicroft, 2009)
  • 22. “To him who devotes his life to science, nothing can give more happiness than increasing the number of discoveries, but his cup of joy is full when the results of Louis Pasteur French chemist and microbiologist