Abstract:
BACKGROUND:The World Health Organization recommends that nations implement evidence-based nutritional guidelines and policies in settings such as schools and childcare services to improve public health nutrition. Understanding the causal mechanism by which implementation strategies exert their effects could enhance guideline implementation. The aim of this study was to assess the mechanisms by which implementation strategies improved schools and childcare services' adherence to nutrition guidelines. METHODS:We conducted a mechanism evaluation of an aggregated dataset generated from three randomised controlled trials conducted in schools and childcare services in New South Wales, Australia. Each trial examined the impact of implementation strategies that targeted Theoretical Domains Framework constructs including knowledge, skills, professional role and identity, environmental context and resources. We pooled aggregated organisation level data from each trial, including quantitative assessments of the Theoretical Domains Framework constructs, as well as measures of school or childcare nutrition guideline compliance, the primary implementation outcome. We used causal mediation analysis to estimate the average indirect and direct effects of the implementation strategies and assessed the robustness of our findings to varying levels of unmeasured and unknown confounding. RESULTS:We included 121 schools or childcare services in the pooled analysis: 79 allocated to receive guideline and policy implementation strategies and 42 to usual practice. Overall, the interventions improved compliance (odds ratio = 6.64; 95% CI [2.58 to 19.09]); however, the intervention effect was not mediated by any of the four targeted Theoretical Domains Framework constructs (average causal mediation effects through knowledge = - 0.00 [- 0.05 to 0.04], skills = 0.01 [- 0.02 to 0.07], professional role and identity = 0.00 [- 0.03 to 0.03] and environmental context and resources = 0.00 [- 0.02 to 0.06]). The intervention had no significant effect on the four targeted Theoretical Domains Framework constructs, and the constructs were not associated with school or childcare nutrition guideline compliance. Potentially, this lack of effect could be explained by imprecise measurement of the mediators. Alternatively, it is likely that that the interventions were operating via alternative mechanisms that were not captured by the four Theoretical Domains Framework constructs we explored. CONCLUSIONS:Even though public health implementation strategies led to meaningful improvements in school or childcare nutrition guideline compliance, these effects were not mediated by key targeted constructs of the Theoretical Domains Framework. Future research should explore the mechanistic role of other Theoretical Domains Framework constructs and evaluate system-level mechanisms informed by an ecological framework. TRIAL REGISTRATION:All trials were prospectively registered with the Australian New Zealand Clinical Trials Registry ( ACTRN12613000543785 . Registered 15/05/2013; ACTRN12614001148662 . Registered 30/10/2014; ACTRN12615001032549 . Registered 1/10/2015).
journal_name
Implement Scijournal_title
Implementation science : ISauthors
Lee H,Hall A,Nathan N,Reilly KL,Seward K,Williams CM,Yoong S,Finch M,Wiggers J,Wolfenden Ldoi
10.1186/s13012-018-0734-9subject
Has Abstractpub_date
2018-03-12 00:00:00pages
42issue
1issn
1748-5908pii
10.1186/s13012-018-0734-9journal_volume
13pub_type
杂志文章abstract:BACKGROUND:Uterine fibroids are non-cancerous overgrowths of the smooth muscle in the uterus. As they grow, some cause problems such as heavy menstrual bleeding, pelvic pain, discomfort during sexual intercourse, and rarely pregnancy complications or difficulty becoming pregnant. Multiple treatment options are availabl...
journal_title:Implementation science : IS
pub_type: 杂志文章,随机对照试验
doi:10.1186/s13012-019-0933-z
更新日期:2019-09-02 00:00:00
abstract:BACKGROUND:The effectiveness of many interventions to promote health and prevent disease has been well established. The imperative has therefore shifted from amassing evidence about efficacy to scale-up to maximise population-level health gains. Electronic implementation monitoring, or 'e-monitoring', systems have been...
journal_title:Implementation science : IS
pub_type: 杂志文章,多中心研究
doi:10.1186/s13012-017-0686-5
更新日期:2017-12-06 00:00:00
abstract:BACKGROUND:Practice guidelines (PGs) are systematically developed statements intended to assist in patient and practitioner decisions. The AGREE II is the revised tool for PG development, reporting, and evaluation, comprised of 23 items, two global rating scores, and a new User's Manual. In this study, we sought to dev...
journal_title:Implementation science : IS
pub_type: 杂志文章,随机对照试验
doi:10.1186/1748-5908-6-81
更新日期:2011-07-26 00:00:00
abstract:BACKGROUND:There is little information about the functions and behavior change techniques (BCTs) needed to implement shared decision making (SDM) in clinical practice. To guide future implementation initiatives, we sought to develop a BCT taxonomy for SDM implementation interventions. METHODS:This study is a secondary...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-020-01015-w
更新日期:2020-08-20 00:00:00
abstract:BACKGROUND:Translation of evidence-based interventions into hospital systems can provide immediate and substantial benefits to patient care and outcomes, but successful implementation is often not achieved. Existing literature describes a range of barriers and facilitators to the implementation process. This systematic...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-018-0726-9
更新日期:2018-02-23 00:00:00
abstract::Economic evaluations can inform decisions about the efficiency and allocation of resources to implementation strategies-strategies explicitly designed to inform care providers and patients about the best available research evidence and to enhance its use in their practices. These strategies are increasingly popular in...
journal_title:Implementation science : IS
pub_type: 社论
doi:10.1186/s13012-014-0168-y
更新日期:2014-12-18 00:00:00
abstract:BACKGROUND:Improved quality of care is a policy objective of health care systems around the world. Implementation research is the scientific study of methods to promote the systematic uptake of clinical research findings into routine clinical practice, and hence to reduce inappropriate care. It includes the study of in...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-3-52
更新日期:2008-12-17 00:00:00
abstract:BACKGROUND:Priority setting for artemisinin-based antimalarial drugs has become an integral part of malaria treatment policy change in malaria-endemic countries. Although these drugs are more efficacious, they are also more costly than the failing drugs. When Tanzania changed its National Malaria Treatment Policy in 20...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-7-18
更新日期:2012-03-18 00:00:00
abstract:BACKGROUND:In addition to their more traditional clinical role, midwives are expected to perform various health promotion practice behaviours (HePPBes) such as informing pregnant women about the benefits of physical activity during pregnancy and asking women about their alcohol consumption. There is evidence to suggest...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-019-0913-3
更新日期:2019-06-18 00:00:00
abstract:BACKGROUND:Varenicline and bupropion, efficacious smoking cessation medications, have had suboptimal impact due to barriers at the patient, practitioner and system level. This study explored the feasibility of a web-assisted tobacco intervention offering free prescription smoking cessation medication by mail if the smo...
journal_title:Implementation science : IS
pub_type: 临床试验,杂志文章
doi:10.1186/s13012-015-0329-7
更新日期:2015-10-01 00:00:00
abstract:BACKGROUND:Scientific knowledge is in constant change. The flow of new information requires a frequent re-evaluation of the available research results. Clinical practice guidelines (CPGs) are not exempted from this phenomenon and need to be kept updated to maintain the validity of their recommendations. The objective o...
journal_title:Implementation science : IS
pub_type: 杂志文章,评审
doi:10.1186/1748-5908-7-109
更新日期:2012-11-19 00:00:00
abstract:BACKGROUND:How humans think and make decisions is important in understanding behaviour. Hence an understanding of cognitive processes among physicians may inform our understanding of behaviour in relation to evidence implementation strategies. A personality theory, Cognitive-Experiential Self Theory (CEST) proposes a r...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-3-23
更新日期:2008-04-25 00:00:00
abstract:BACKGROUND:Services to treat tobacco dependence are not readily available to smokers in low-middle income countries (LMICs) where smoking prevalence remains high. We are conducting a cluster randomized controlled trial comparing the effectiveness of two strategies for implementing tobacco use treatment guidelines in 26...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-017-0558-z
更新日期:2017-02-28 00:00:00
abstract:BACKGROUND:The GRADE-CERQual (Confidence in Evidence from Reviews of Qualitative research) approach has been developed by the GRADE (Grading of Recommendations Assessment, Development and Evaluation) Working Group. The approach has been developed to support the use of findings from qualitative evidence syntheses in dec...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-017-0693-6
更新日期:2018-01-25 00:00:00
abstract:BACKGROUND:Denmark has inferior cancer survival rates compared with many European countries. The main reason for this is suggested to be late diagnosis at advanced cancer stages. Cancer diagnostic work-up begins in general practice in 85% of all cancer cases. Thus, general practitioners (GPs) play a key role in the dia...
journal_title:Implementation science : IS
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1186/s13012-014-0159-z
更新日期:2014-11-07 00:00:00
abstract:BACKGROUND:The translation of research into policy and practice is enhanced by policymakers who can recognise and articulate their information needs and researchers that understand the policymakers' environment. As researchers, we sought to understand the policymaking process and how research evidence may contribute in...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-015-0315-0
更新日期:2015-09-03 00:00:00
abstract:BACKGROUND:Over the past years, implementation science has gained more and more importance in German-speaking countries. Reliable and valid questionnaires are needed for evaluating the implementation of evidence-based practices. On an international level, several initiatives focused on the identification of questionnai...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-018-0837-3
更新日期:2018-12-12 00:00:00
abstract:BACKGROUND:There is substantial evidence about the effectiveness of audit with feedback, but none that we know have been conducted in home care settings. The primary purpose of the Data for Improvement and Clinical Excellence - Home Care (DICE-HC) project was to evaluate the effects of an audit and feedback delivered t...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-017-0600-1
更新日期:2017-05-18 00:00:00
abstract:BACKGROUND:The rate of avoidable caesarean sections (CS) could be reduced through multifaceted strategies focusing on the involvement of health professionals and compliance with clinical practice guidelines (CPGs). Quality improvements for CS (QICS) programmes (QICS) based on this approach, have been implemented in Can...
journal_title:Implementation science : IS
pub_type: 杂志文章,多中心研究
doi:10.1186/s13012-014-0182-0
更新日期:2014-12-11 00:00:00
abstract:BACKGROUND:Counselling on health-related lifestyles is key to the prevention and management of chronic diseases. After comprehensive study of determinants of its delivery in general practice and strategies to improve, we composed a tailored improvement program, which included communication skills training, online patie...
journal_title:Implementation science : IS
pub_type: 杂志文章,随机对照试验
doi:10.1186/s13012-016-0460-0
更新日期:2016-08-11 00:00:00
abstract:BACKGROUND:Implementing new practices, such as health information technology (HIT), is often difficult due to the disruption of the highly coordinated, interdependent processes (e.g., information exchange, communication, relationships) of providing care in hospitals. Thus, HIT implementation may occur slowly as staff m...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-5-95
更新日期:2010-11-29 00:00:00
abstract:BACKGROUND:Organizational factors are considered to be an important influence on health workers' uptake of interventions that improve their practices. These are additionally influenced by factors operating at individual and broader health system levels. We sought to explore contextual influences on worker motivation, a...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-4-43
更新日期:2009-07-23 00:00:00
abstract:BACKGROUND:One of the fastest growing risk groups for early onset of diabetes is women with a recent pregnancy complicated by gestational diabetes, and for this group, Latinas are the largest at-risk group in the USA. Although evidence-based interventions, such as the Diabetes Prevention Program (DPP), which focuses on...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-016-0426-2
更新日期:2016-05-18 00:00:00
abstract:BACKGROUND:Fecal incontinence has a high prevalence in the nursing home population which cannot be explained by co-morbidity or anatomic and physiological changes of aging alone. Our hypothesis is that fecal incontinence can be prevented, cured, or ameliorated by offering care staff knowledge of best practice. However,...
journal_title:Implementation science : IS
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1186/s13012-015-0263-8
更新日期:2015-05-23 00:00:00
abstract:OBJECTIVE:To quantify the extent to which clinicians use clinically-efficacious decision aids as intended during implementation in practice and how fidelity to usage instructions correlates with shared decision making (SDM) outcomes. METHODS:Participant-level meta-analysis including six practice-based randomized contr...
journal_title:Implementation science : IS
pub_type: 杂志文章,meta分析
doi:10.1186/1748-5908-9-26
更新日期:2014-02-22 00:00:00
abstract::Implementing research findings into healthcare practice and policy is a complex process occurring in diverse contexts; it invariably depends on changing human behaviour in many parts of an intricate implementation system. Questions asked with the aim of improving implementation are multifarious variants of 'What works...
journal_title:Implementation science : IS
pub_type: 社论
doi:10.1186/s13012-017-0660-2
更新日期:2017-11-14 00:00:00
abstract:BACKGROUND:Integrated knowledge translation (IKT) refers to collaboration between researchers and decision-makers. While advocated as an approach for enhancing the relevance and use of research, IKT is challenging and inconsistently applied. This study sought to inform future IKT practice and research by synthesizing s...
journal_title:Implementation science : IS
pub_type: 杂志文章,评审
doi:10.1186/s13012-016-0399-1
更新日期:2016-03-17 00:00:00
abstract:BACKGROUND:Countries in sub-Saharan Africa (SSA) are experiencing an epidemic of cardiovascular disease (CVD) propelled by rapidly increasing rates of hypertension. Barriers to hypertension control in SSA include poor access to care and high out-of-pocket costs. Although SSA bears 24% of the global disease burden, it h...
journal_title:Implementation science : IS
pub_type: 杂志文章,随机对照试验
doi:10.1186/1748-5908-9-73
更新日期:2014-06-12 00:00:00
abstract:BACKGROUND:The Department of Veterans Affairs (VA) has led the industry in measuring facility performance as a critical element in improving quality of care, investing substantial resources to develop and maintain valid and cost-effective measures. The External Peer Review Program (EPRP) of the VA is the official data ...
journal_title:Implementation science : IS
pub_type: 杂志文章,多中心研究
doi:10.1186/1748-5908-7-45
更新日期:2012-05-18 00:00:00
abstract:BACKGROUND:The current syphilis epidemic among urban men who have sex with men (MSM) has serious implications for those co-infected with human immunodeficiency virus (HIV). Routine and frequent syphilis screening has the potential to ensure early detection and treatment, minimize disease burden, and help control the on...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-016-0371-0
更新日期:2016-01-16 00:00:00