This document provides an overview of implementation science and introduces a conceptual framework for guiding the assessment and improvement of implementation processes. It engages participants in applying this framework to analyze factors that will influence health worker counseling and mother feeding practices related to the WHO guidelines on infant feeding in the context of HIV, assuming breastfeeding with ARVs is the national policy.
The Consolidated Framework for Implementation Research (CFIR) is used to guide the adaptation and plan for the implementation of public health interventions. The tool is appropriate for individuals and groups involved in planning and implementing existing interventions. To see the summary statement of this tool developed by NCCMT, click here: http://www.nccmt.ca/registry/view/eng/210.html
NCCMT is one of six NCCs for Public Health in Canada. More on the NCCs at www.nccph.ca. Production of this webinar has been made possible through a financial contribution from the Public Health Agency of Canada. The views expressed herein do not necessarily represent the views of the Public Health Agency of Canada.
Construction of an Implementation Science for Scaling Out Interventions HopkinsCFAR
The Johns Hopkins Bloomberg School of Public Health Center for Implementation Research
The Johns Hopkins Center for AIDS Research
& the Dean’s Office invite you to
The Center for Implementation Research Implementation Science Speaker Series
Construction of an Implementation Science for Scaling Out Interventions
Wednesday, May 7, 2014
12:15pm – 1:15pm
W1020 Becton Dickinson – 615 N. Wolfe Street
C Hendricks Brown, Ph. D.
Director, Center for Prevention Implementation Methodology (Ce-PIM)
Director, Prevention Science and Methodology Group (PSMG)
Professor, Department of Psychiatry and Behavioral Sciences and Department of Preventive Medicine
Northwestern University, Feinberg School of Medicine
'Demystifying Knowledge Transfer- an introduction to Implementation Science M...NEQOS
Powerpoint presentation from 'Demystifying Knowledge Transfer: an introduction to Implementation Science' - 28th May 2014.
Facilitated by Professor Jeremy Grimshaw and Dr Justin Presseau
The Importance of Evidence and Investigation: EvidenceNetwork.caEvidenceNetwork.ca
A presentation made at the 2014 conference: Holding Power to Account: Investigative Journalism, Democracy and Human Rights by Dr. Noralou Roos
http://winnipeg2014.com/
Jim Warren
National Institute for Health Innovation, University of Auckland
(Friday, 3.00, General 3)
Provides background and overview of a Health IT Evaluation Framework that has been developed to support the National Health IT Plan and New Zealand health innovation generally. The framework recommends a pragmatic approach that includes use of both quantitative data (particularly data based on the transactional logs of operational IT systems), and qualitative data systematically gathered through stakeholder interviews. An Action Research orientation is recommended where the evaluators actively seek to understand barriers and find pointers to potential solutions. The investigation protocol is recommended to be iterative and flexible, and to involve dissemination of intermediate findings for feedback and broad dissemination of final results. Moreover, evaluation should be integrated with implementation, rather than a standalone post implementation activity. No single type of measurement should dominate the evaluation, which should employ a measurement framework including work and communication patterns, organisational culture, safety, effectiveness, system integrity and usability, as well as vendor factors, project management, participant experience and governance.
Outline of ideas to advance the science of transforming health care organizations. 81. “Advancing Transformational Science”, Bridges to Sustainable Healthcare Transformation Through Evidence, Partnerships & Technology: 19th International Conference San Francisco, CA, January 19-22, 2011.
Vicky Scott: Implementing research into practiceTHL
Presentation by Dr Vicky Scott, Clinical Associate Professor, RN, PhD, Canada, BC Injury Research and Prevention Unit, BC Ministry of Health, Canada at at Safety 2016 World Conference, 18-21 September 2016, Tampere, Finland
#Safety2016FIN
The fourth webinar picks-up directly from the third session, focusing on the next key step to inform implementation initiatives: identifying barriers and enablers to implementation.
READ MORE: http://bit.ly/2kIxtQo
Andrea Williams of Conwy County Council delivered this workshop to provide participants at the All Wales Residential Participation Network 2012 with ideas to develop an action plan after engagement using a real life case study.
Participants identified best practice in developing action plans, developed actions from engagement data using participatory techniques and identified the key components of an action plan to ensure delivery.
Fe wnaeth Andrea Williams o Gyngor Sir Conwy darparu'r gweithdy yma i gyfranogwyr o Rwydwaith Cyfranogaeth Preswyl Cymru Gyfan 2012 i roi syniadau ar datblygu cynllun gweithredu ar ôl ymgysylltu gan ddefnyddio astudiaeth achos bywyd go iawn.
Fe wnaeth cyfranogwyr canfod arferion gorau mewn datblygu cynlluniau gweithredu, datblygu gweithredu o ddata ymgysylltu gan ddefnyddio technegau cyfranogol a chlustnodi prif gydrannau cynllun gweithredu er mwyn sicrhau darpariaeth.
The Consolidated Framework for Implementation Research (CFIR) is used to guide the adaptation and plan for the implementation of public health interventions. The tool is appropriate for individuals and groups involved in planning and implementing existing interventions. To see the summary statement of this tool developed by NCCMT, click here: http://www.nccmt.ca/registry/view/eng/210.html
NCCMT is one of six NCCs for Public Health in Canada. More on the NCCs at www.nccph.ca. Production of this webinar has been made possible through a financial contribution from the Public Health Agency of Canada. The views expressed herein do not necessarily represent the views of the Public Health Agency of Canada.
Construction of an Implementation Science for Scaling Out Interventions HopkinsCFAR
The Johns Hopkins Bloomberg School of Public Health Center for Implementation Research
The Johns Hopkins Center for AIDS Research
& the Dean’s Office invite you to
The Center for Implementation Research Implementation Science Speaker Series
Construction of an Implementation Science for Scaling Out Interventions
Wednesday, May 7, 2014
12:15pm – 1:15pm
W1020 Becton Dickinson – 615 N. Wolfe Street
C Hendricks Brown, Ph. D.
Director, Center for Prevention Implementation Methodology (Ce-PIM)
Director, Prevention Science and Methodology Group (PSMG)
Professor, Department of Psychiatry and Behavioral Sciences and Department of Preventive Medicine
Northwestern University, Feinberg School of Medicine
'Demystifying Knowledge Transfer- an introduction to Implementation Science M...NEQOS
Powerpoint presentation from 'Demystifying Knowledge Transfer: an introduction to Implementation Science' - 28th May 2014.
Facilitated by Professor Jeremy Grimshaw and Dr Justin Presseau
The Importance of Evidence and Investigation: EvidenceNetwork.caEvidenceNetwork.ca
A presentation made at the 2014 conference: Holding Power to Account: Investigative Journalism, Democracy and Human Rights by Dr. Noralou Roos
http://winnipeg2014.com/
Jim Warren
National Institute for Health Innovation, University of Auckland
(Friday, 3.00, General 3)
Provides background and overview of a Health IT Evaluation Framework that has been developed to support the National Health IT Plan and New Zealand health innovation generally. The framework recommends a pragmatic approach that includes use of both quantitative data (particularly data based on the transactional logs of operational IT systems), and qualitative data systematically gathered through stakeholder interviews. An Action Research orientation is recommended where the evaluators actively seek to understand barriers and find pointers to potential solutions. The investigation protocol is recommended to be iterative and flexible, and to involve dissemination of intermediate findings for feedback and broad dissemination of final results. Moreover, evaluation should be integrated with implementation, rather than a standalone post implementation activity. No single type of measurement should dominate the evaluation, which should employ a measurement framework including work and communication patterns, organisational culture, safety, effectiveness, system integrity and usability, as well as vendor factors, project management, participant experience and governance.
Outline of ideas to advance the science of transforming health care organizations. 81. “Advancing Transformational Science”, Bridges to Sustainable Healthcare Transformation Through Evidence, Partnerships & Technology: 19th International Conference San Francisco, CA, January 19-22, 2011.
Vicky Scott: Implementing research into practiceTHL
Presentation by Dr Vicky Scott, Clinical Associate Professor, RN, PhD, Canada, BC Injury Research and Prevention Unit, BC Ministry of Health, Canada at at Safety 2016 World Conference, 18-21 September 2016, Tampere, Finland
#Safety2016FIN
The fourth webinar picks-up directly from the third session, focusing on the next key step to inform implementation initiatives: identifying barriers and enablers to implementation.
READ MORE: http://bit.ly/2kIxtQo
Andrea Williams of Conwy County Council delivered this workshop to provide participants at the All Wales Residential Participation Network 2012 with ideas to develop an action plan after engagement using a real life case study.
Participants identified best practice in developing action plans, developed actions from engagement data using participatory techniques and identified the key components of an action plan to ensure delivery.
Fe wnaeth Andrea Williams o Gyngor Sir Conwy darparu'r gweithdy yma i gyfranogwyr o Rwydwaith Cyfranogaeth Preswyl Cymru Gyfan 2012 i roi syniadau ar datblygu cynllun gweithredu ar ôl ymgysylltu gan ddefnyddio astudiaeth achos bywyd go iawn.
Fe wnaeth cyfranogwyr canfod arferion gorau mewn datblygu cynlluniau gweithredu, datblygu gweithredu o ddata ymgysylltu gan ddefnyddio technegau cyfranogol a chlustnodi prif gydrannau cynllun gweithredu er mwyn sicrhau darpariaeth.
Dr. Totti Könnölä from Impetu Solutions waas invited to give a keynote speech on 'Opening Horizons: What kind of new approaches are available?' in the COST Foresight on Future Demand for Forest-based Products and Services: Dissemination Conference on September 13, 2011, in Sekocin Stary (Near Warsaw)/Poland.
This presentation was made at a large pharmaceutical company's R&D and corporate affairs campus - going a little more indepth than the one from the prior Science of Team Science Conference
Similar to Using data for impact_Pelletier_5.1.12 (20)
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
1. Using Data for Impact: A Critical Examination
Through the Lens of Implementation Science
David Pelletier
Division of Nutritional Sciences
Cornell University
Spring CORE Group Meeting, Wilmington, DE
May 1, 2012
2. Outline
1. Why implementation science
2. Definition and state of the field
3. Broadening the field
4. A Consolidated Framework
5. An Example: Training frontline workers
6. An Example: Infant feeding and HIV
3. Why Implementation Science?
p2
• Efficacy-to-Effectiveness
• Knowledge-to-Action
• Evidence-Based Interventions
• Evidence-Based Decisions
• Evidence-Based Policy Making
• Scaling Up
• Etc.
4. Why Implementation Science?
Fixsen et al., p74
U5 Deaths Preventable Through:
Achieving 100% Coverage of Existing Interventions 62%
Discovering and Delivering New Interventions 21%
NIH/BMGF Research Funds (2000-04) Focused on:
Improving delivery and utilization 3%
Mechanistic and discovery research 97%
Source: Leroy et al., AJPH 97(2), 2007
5. Some Overall Observations from the Literature
1. New: Implementation science is a new and still-emerging
field with little consistency in terms, concepts and methods
2. Complex: There are ~40 categories of factors (and hundreds
of variations on these) that affect the quality and impact of
intervention delivery
3. Contextual: The importance and changeability of these
factors varies widely across countries, organizations and
communities. Context is King.
4. Conclusion: The focus of our research must shift from
“technical interventions” to “implementation interventions”
6. What is Implementation Science?
Definition of Implementation (or Delivery) Science
(from NIH Fogarty International Center)
“Implementation science is the study of methods to promote the integration of
research findings and evidence into healthcare policy and practice.
It seeks to understand the behavior of healthcare professionals and other
stakeholders as a key variable in the sustainable uptake, adoption, and
implementation of evidence-based interventions. […]
The intent of implementation science and related research is to
• investigate and address major bottlenecks ,
• test new approaches to prevent, detect and/or resolve bottlenecks
• determine a causal relationship between the intervention and its impact”
(at scale)
9. Broadening the Definition
1. Beyond “health care”
– To community and prevention
– To other sectors (ag, livelihoods, social protection, etc)
2. Beyond “evidence-based interventions”
– To include IIGPP (next slide)
3. Beyond “research findings and evidence” in the
usual (privileged scientific) sense
– To include practice-based and local knowledge and
experience
10. Beyond “Evidence-Based Interventions”
The Narrow View: Implementation refers to efforts to introduce
evidence-based interventions into the practices of organizations
and professionals (NIH, WHO, etc)
A Broader View: Implementation refers to efforts to fulfill a goal or
the intent of a policy, even when the evidence is lacking
concerning how to do so (European Journal of Social Work 13(1):109, 2010)
An Inclusive View: Implementation refers to efforts to introduce
interventions, innovations, guidelines, practices or policies (IIGPP)
into organizations, systems or communities
11. Beyond “Scientific” Knowledge
Detached,
Body of
Highly-
Generalizable Formal
Structured or
Principles/ M&E
Experimental
Scientific/
Research
Theoretical
Knowledge Integration
Reflection, Application of
Learning, Knowledge in Improved
Documentation, Program Design Action
Codification & Implementation
Contextual
Knowledge Systematized
Practice-Based & Tacit Experience &
Experience & Knowledge Feedback
Engaged During
Research Implementation
12. Opening the Black Box
Toward a Comprehensive Framework for
Implementation Science
New
Intervention Contexts
Proven in Outcomes
A Few Contexts At-Scale
(RCTs) Dissemination &
Implementation
Processes
13. A Consolidated Framework of Implementation
(factors operate at multiple levels, from provider to organization and country)
Context
D. Outer Setting: Participant needs &
resources, govt and donor policies &
regulations, peer/ network influences
, societal & cultural influences, etc.
A. Intervention/ Implementing Organization
Innovation /
E.
Guideline/ Implementation
B. Inner Setting: org
Practice /
size, structure, maturity, manage
Processes:
Policy (IIGPP) •Formative research
(unadapted) ment, informal Implementation
networks, culture, climate •Planning
•Core components •Implem Strategy Outcomes
•Peripheral (tension, compatibility, priority, in
centives, goal clarity, learning •Change Theory Acceptability
components Service
climate), readiness •Engaging 1. Fit Client
Outcomes
(leadership, resources, access to -opinion leaders 2. Feasibility Outcomes
Perceived and
knowledge & info) -formal leaders 3. Costs 1. Efficiency -Health
Actual:
source, IIGPP (adapted) -champions 2. Effectiveness - Function
Application
evidence, advant •Core components -facilitators 3. Equity -Symptoms
age, adaptability, • Execution 1. Adoption 4. Safety -Satisfaction
trialability, compl •Peripheral -components 2. Adaptation 5. Patient-
exity, design components -sequence 3. Fidelity/Quality centered
quality and -intensity 4. Penetration 6. Timeliness
packaging, cost C. Individuals (providers -duration 5. Sustainability
and managers): knowledge -quality
& beliefs, self-efficacy, stage of •Feedback
change, identification with •Evaluation
organization, motivation, values, •Reflection Adapted from:
•Decisions Damschroeder et al., Implem Science 4:50, 2009;
Proctor et al., Admin Pol Mental Hlth 38:65-76, 2011
intellect, competence, capacity, l •Adjustments
14. Do We Need a Framework?
A Simple (Probably Painful) Example
Which of the following best describes the training approach
typically used with frontline workers in your programs?
1. Lectures and Discussion
2. Lectures and Discussion + demonstrations
3. Lectures and Discussion + demos + hands-on practice
and feedback
15. Effectiveness of Training Methods:
Results of a Meta-Analysis
Outcomes for Assessing Effectiveness
Teacher’s Teacher’s Teacher’s
Training Knowledge Skill Use of New
Method Practices
Lectures and 10% 5% 0
Discussion
Why?
+ Demonstrations 30% 20% 0
+ Practice and 60% 60% 5
Feedback
+ Coaching in the 95% 95% 95%
Classroom
Fixsen, D.L., et al., Implementation research: A synthesis of the literature. 2005,
National Implementation Research Network: Tampa, FL.
16. A Consolidated Framework of Implementation
(factors operate at multiple levels, from provider to organization and country)
Context
D. Outer Setting: Participant needs &
resources, govt and donor policies &
regulations, peer/ network influences
, societal & cultural influences, etc.
A. Intervention/ Implementing Organization
Innovation /
E.
Guideline/ Implementation
B. Inner Setting: org
Practice /
size, structure, maturity, manage
Processes:
Policy (IIGPP) •Formative research
(unadapted) ment, informal Implementation
networks, culture, climate •Planning
•Core components •Implem Strategy Outcomes
•Peripheral (tension, compatibility, priority, in
centives, goal clarity, learning •Change Theory Acceptability
components Service
climate), readiness •Engaging 1. Fit Client
Outcomes
(leadership, resources, access to -opinion leaders 2. Feasibility Outcomes
Perceived and
knowledge & info) -formal leaders 3. Costs 1. Efficiency -Health
Actual:
source, IIGPP (adapted) -champions 2. Effectiveness - Function
Application
evidence, advant •Core components -facilitators 3. Equity -Symptoms
age, adaptability, • Execution 1. Adoption 4. Safety -Satisfaction
trialability, compl •Peripheral -components 2. Adaptation 5. Patient-
exity, design components -sequence 3. Fidelity/Quality centered
quality and -intensity 4. Penetration 6. Timeliness
packaging, cost C. Individuals (providers -duration 5. Sustainability
and managers): knowledge -quality
& beliefs, self-efficacy, stage of •Feedback
change, identification with •Evaluation
organization, motivation, values, •Reflection Adapted from:
•Decisions Damschroeder et al., Implem Science 4:50, 2009;
Proctor et al., Admin Pol Mental Hlth 38:65-76, 2011
intellect, competence, capacity, l •Adjustments
17. An Example for Group Work:
The 2010 WHO Guidelines on Infant
Feeding in the Context of HIV
19. Policy Choice
ARV+Breastfeeding No Breastfeeding
Basic a. Widespread HIV testing a. Safe water and sanitation are assured
Requirements b. Reliable ARV supplies at household and community level
if child survival is c. Full ARV adherence b. Sufficient infant formula is assured
to be maximized d. Proper EBF adherence c. Can prepare it cleanly and frequently
and transition to mixed d. Exclusive formula for first six months is
feeding possible
e. Family is supportive of this practice
f. Access to health care that offers
comprehensive child health services
•What factors in the framework will affect the policy choice of national policy makers?
•What factors in the framework will affect the policy choice of regional and district managers?
•What factors in the framework will affect the counseling practices of front-line staff?
Note: Factors affecting practices of mothers not included here
20. Group Instructions (30 mins)
1. Each table has been assigned one of the following domains:
A. The intervention, innovation, guideline, practice or policy (IIGPP)
B. Individuals (providers and managers)
C. The Inner Setting (the implementing organization)
D. The Outer Setting (actors and conditions outside the organization
that affect implementation)
E. Implementation processes (activities and practices for “rolling out”
the guideline)
2. Identify some of the characteristics of your domain that may
positively or negatively affect the implementation of the guideline
(“implementation” here refers to adoption, adaptation, penetration to
all clinics, and quality of delivery)
3. How would you collect data or information before implementation in
order to plan your implementation strategy?
4. Chose one example to report out.
21. Further work…
– Does the framework identify “hidden bottlenecks?”
– Are any factors missing from the framework?
– How can the framework be made more user-friendly?
– How can we be innovative in assessing and re-assessing the factors?
– Who needs to be assessing and acting on various ones?
23. • Title: Data for Impact: A Critical Examination Through the Lens of Implementation
Science
• Implementation science seeks to improve the effectiveness of large-scale programs
by strengthening the frameworks, tools and evidence base for identifying and
minimizing implementation bottlenecks. Implementers can make major
contributions to this field because of their extensive knowledge, experience and
influence in the implementation process. This session provides an overview of
this emerging field and introduces one of the many conceptual frameworks in the
literature for guiding the assessment and improvement of the implementation
process. It also seeks participants’ views on the forms and meaning of “data” in
the context of real-world implementation by engaging participants in a rapid
application of this framework, using as a case study the WHO Guidelines on infant
feeding in the context of HIV.
24. Assuming that “Breastfeed + ARVs” is the “National Policy”
What factors will influence the counseling practices of health workers
and the feeding practices of mothers?
CFIR Domain CFIR Element
Characteristics of the intervention Perceived strength of evidence
Perceived advantage
Complexity
Characteristics of the individuals Knowledge and beliefs
Identification with the organization
Characteristics of the inner setting Goal clarity
Compatibility
Characteristics of the outer setting Perceived social, cultural and economic
situation of the mother/caretaker
Donor influences on MOH policy
Characteristics of the Implementation strategy (train and hope?)
implementation process Evaluation
Adjustments
Editor's Notes
The literature on implementation science has exploded in the last ten years or so but most of it is outside of nutrition. There now are some good frameworks to build upon, for studying implementation processes and for trying to improve them. For instance it now is clear that certain factors are important early in the implementation process and others are important later, and that there is an imbalance in what has been studied (adoption versus implementation).
The literature has clearly identified some approaches that do NOT work: guideline dissemination and training (by themselves), which is sobering considering how much we seem to rely on them.
It is useful to have a common framework in mind in prioritizing research topics – in order to get on the same page as soon as possible and in order to make informed judgments about priority topics. At the most general level many of the existing frameworks identify these three factors as being crucial: characteristics of the interventions, the new contexts and the implementation processes. The central notion is that an intervention that has been shown to be efficacious in a few contexts, via RCTs, may or may not be effective in new contexts. Much depends on how those contexts differ from the original and the quality of the implementation processes. I will elaborate on each of these in the following slides.
Bottom lines: The black box is quite complex.The interactions and importance of Interventions, Context and Processes are clear.There is an almost infinite numberof reductionistic studies that could be done to: a) document the influence of each of these alone or in combination; and b) to test various ways to change some of these factors for the better. But this would take decades and would not necessarily help us in the end because these factors are all part of an interactive system so we need to understand the system, not the parts in isolation.A more productive use of this framework is: a) to help us design implementation strategies with our eyes wide open (anticipating and addressing various barriers and enablers in advance); b) appreciate the importance of “Implementation Strategies and Processes” as THE pivotal factor for later outcomes; and c) provide some intermediate indicators that should be measured and monitored during implementation so that we can learn how they change under different circumstances.
Bottom lines: The black box is quite complex.The interactions and importance of Interventions, Context and Processes are clear.There is an almost infinite numberof reductionistic studies that could be done to: a) document the influence of each of these alone or in combination; and b) to test various ways to change some of these factors for the better. But this would take decades and would not necessarily help us in the end because these factors are all part of an interactive system so we need to understand the system, not the parts in isolation.A more productive use of this framework is: a) to help us design implementation strategies with our eyes wide open (anticipating and addressing various barriers and enablers in advance); b) appreciate the importance of “Implementation Strategies and Processes” as THE pivotal factor for later outcomes; and c) provide some intermediate indicators that should be measured and monitored during implementation so that we can learn how they change under different circumstances.