School of Medicine; Division of Pulmonary Medicine, Department of Pediatrics; Department of Population and Quantitative Health Sciences; Department of Psychiatry; UMass Worcester Prevention Research Center
Community Health and Preventive Medicine | Health Services Administration | Health Services Research | Pediatrics | Preventive Medicine | Public Health | Pulmonology | Respiratory Tract Diseases
BACKGROUND: Implementation science frameworks advise the engagement of multi-level partners (at the patient, provider, and systems level) to adapt and increase the uptake of evidence-based practices (EBPs). However, there is little guidance to ensure that systems-level adaptations reflect the voices of providers who deliver and patients/caregivers who receive EBPs.
METHODS: We present a novel methodology, grounded in the Consolidated Framework for Implementation Research (CFIR), which anchors the engagement of multi-level partners to the voices of individuals who deliver and receive EBPs. Using the CFIR domains: intervention adaptation, individuals involved, inner/outer setting, and process, we illustrate our 4-step methodology through a case example of Asthma Link, a school-supervised asthma management intervention. In step 1, we interviewed "individuals involved" in the intervention (providers/caregivers/patients of Asthma Link) to identify implementation barriers. In step 2, we selected systems-level partners in the "inner and outer setting" that could assist with addressing these barriers. In step 3, we presented the barriers to these systems-level partners and conducted semi-structured interviews to elicit their recommended solutions (process). Interviews were audio-recorded, transcribed, and open-coded. A theoretical sampling model and deductive reasoning were used to identify solutions to implementation barriers. In step 4, we utilized multi-level input to adapt the Asthma Link intervention.
RESULTS: Identified barriers included inability to obtain two inhalers for home and school use, inconsistent delivery of the inhaler to school by families, and challenges when schools did not have a nurse. Interviews conducted with school/clinic leaders, pharmacists, payors, legislators, and policymakers (n=22) elicited solutions to address provider and patient/caregiver-identified barriers, including (1) establishing a Medicaid-specific pharmacy policy to allow dispensation of two inhalers, (2) utilizing pharmacy-school delivery services to ensure medication reaches schools, and (3) identifying alternate (non-nurse) officials to supervise medication administration. The iterative process of engaging multi-level partners helped to create an adapted Asthma Link intervention, primed for effective implementation.
CONCLUSIONS: This novel methodology, grounded in the CFIR, ensures that systems-level changes that require the engagement of multi-level partners reflect the voices of individuals who deliver and receive EBPs. This methodology demonstrates the dynamic interplay of CFIR domains to advance the field of implementation science.
Asthma, Deliverer, Evidence-based interventions, Implementation, Multi-level partner engagement, Patient-centered, Recipient, Schools, Stakeholder engagement, Systems-level
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DOI of Published Version
Trivedi M, Hoque S, Shillan H, Seay H, Spano M, Gaffin J, Phipatanakul W, Rosal MC, Garg A, Gerald LB, Broder-Fingert S, Byatt N, Lemon S, Pbert L. CENTER-IT: a novel methodology for adapting multi-level interventions using the Consolidated Framework for Implementation Research-a case example of a school-supervised asthma intervention. Implement Sci Commun. 2022 Mar 26;3(1):33. doi: 10.1186/s43058-022-00283-5. PMID: 35346393; PMCID: PMC8962032. Link to article on publisher's site
Implementation science communications
Trivedi M, Hoque S, Shillan HN, Seay HL, Spano MA, Gaffin J, Phipatanakul W, Rosal MC, Garg A, Gerald LB, Broder-Fingert S, Byatt N, Lemon SC, Pbert L. (2022). CENTER-IT: a novel methodology for adapting multi-level interventions using the Consolidated Framework for Implementation Research-a case example of a school-supervised asthma intervention. UMass Worcester PRC Publications. https://doi.org/10.1186/s43058-022-00283-5. Retrieved from https://escholarship.umassmed.edu/prc_pubs/176
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This work is licensed under a Creative Commons Attribution 4.0 License.
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