Is implementation research out of step with implementation practice? Pathways to effective implementation support over the last decade

Background: There is growing interest in the lived experience of professionals who provide implementation support (i.e., implementation support practitioners). However, there remains limited knowledge about their experiences and how those experiences can contribute to the knowledge base on what constitutes successful and sustainable implementation support models. This study aimed to examine pathways of implementation support practice, as described by experienced professionals actively supporting systems’ uptake and sustainment of evidence to benefit children and families. Methods: Seventeen individuals with extensive experience providing implementation support in various settings participated in semi-structured interviews. Data were analyzed using qualitative content analysis and episode profile analysis approaches. Iterative diagramming was used to visualize the various pathways of implementation support practitioners’ role reflection and transformation evidenced by the interview data. Results: Findings highlighted rich pathways of implementation support practitioners’ role reflection and transformation. Participants described their roots in providing implementation support as it relates to implementing and expanding the use of evidence-based programs and practices in child and family services. Almost all participants reflected on the early stages of their careers providing implementation support and described a trajectory starting with the use of “push models,” which evolved into “pull models” and eventually “co-creation or exchange models” of implementation support involving both technical and relational skills. Conclusions: Developing an implementation support workforce will require a deeper understanding of this lived experience to prevent repeated use of strategies observed to be unsuccessful by those most proximal to the work. The pathways for implementation practice in this study highlight impressive leaps forward in the field of implementation over the last 15 years and speaks to the importance of the professionals leading change efforts in this growth. Plain Language Summary Over the past few years, professionals in the field of implementation science have identified a growing gap between implementation research and implementation practice. While this issue has been highlighted informally, the field is lacking a shared understanding and clear way forward to reconcile this gap. In this paper, the authors describe how professionals providing implementation support have shifted their implementation practice over time through systematic observations of what works (and what does not work) for supporting and sustaining evidence use in service systems to improve population outcomes. The authors share the impressive leaps forward made in the field of implementation practice – from didactic training to responsive and tailored implementation strategies to co-created and relationship-based implementation solutions. The paper concludes with a call to action to the field for the creation of a virtuous learning cycle between professionals conducting implementation research and professionals providing implementation support to change practice as a way to produce a more robust and relevant science of implementation

Comparison of Chimpanzee (Pan Troglodytes) Behavior on Tour and Non-Tour Days at Chimpanzee Sanctuary Northwest

In this study, I investigated the potential effect of a visitor program on captive chimpanzees’ (Pan troglodytes) behaviors at Chimpanzee Sanctuary Northwest (CSNW) in Cle Elum, Washington. I used focal animal sampling to score behaviors from an ethogram of affiliative, aggressive and abnormal chimpanzee behaviors, as well as foraging and vigilance. During each sample, I recorded the focal’s location within the enclosure and whether he or she was situated in locations that would be in view of visitors (present or not). I analyzed 720 minutes of data from each of the seven CSNW chimpanzees. I tested the hypothesis that the chimpanzee’s behaviors would be different on tour and non-tour days. I predicted that on tour days the chimpanzees would have shorter foraging durations and longer durations of vigilant, aggressive and abnormal behaviors. I predicted that tour days would show changes (increase or decrease) in durations of social behaviors such as affiliation and inter-chimpanzee proximity compared to non-tour days. I also hypothesized that location preference would differ on tour and non-tour days. I observed significant differences for durations of vigilant, affiliative, aggressive, and abnormal behaviors and inter-chimpanzee proximity (P values0.05). Generalizations cannot be made about the potential effects of the tours because each chimpanzee varied with respect to some behaviors on tour and non-tour days. My results will aid sanctuary staff in their decisions to halt, alter, or retain this visitor program. My data may also serve as a case study for other sanctuaries

Developing a practice-driven research agenda in implementation science: Perspectives from experienced implementation support practitioners

Background Attention is being placed on the “ironic gap” or “secondary” research-to-practice gap in the field of implementation science. Among several challenges posited to exacerbate this research-to-practice gap, we call attention to one challenge in particular—the relative dearth of implementation research that is tethered intimately to the lived experiences of implementation support practitioners (ISPs). The purpose of this study is to feature a qualitative approach to engaging with highly experienced ISPs to inform the development of a practice-driven research agenda in implementation science. In general, we aim to encourage ongoing empirical inquiry that foregrounds practice-driven implementation research questions. Method Our analytic sample was comprised of 17 professionals in different child and family service systems, each with long-term experience using implementation science frameworks to support change efforts. Data were collected via in-depth, semi-structured interviews. Our analysis followed a qualitative content analysis approach. Our focal conceptual category centered on the desired areas of future research highlighted by respondents, with subcategories reflecting subsets of related research question ideas. Results Interviews yielded varying responses that could help shape a practice-driven research agenda for the field of implementation science. The following subcategories regarding desired areas for future research were identified in respondents’ answers: (a) stakeholder engagement and developing trusting relationships, (b) evidence use, (c) workforce development, and (d) cost-effective implementation. Conclusions There is significant promise in bringing implementation research and implementation practice together more closely and building a practice-informed research agenda to shape implementation science. Our findings point not only to valuable practice-informed gaps in the literature that could be filled by implementation researchers, but also topics for which dissemination and translation efforts may not have yielded optimal reach. We also highlight the value in ISPs bolstering their own capacity for engaging with the implementation science literature to the fullest extent possible.Plain Language Summary In the field of implementation science, increasing attention is being placed on the “ironic gap” or “secondary” research-to-practice gap. This gap reflects a general lag or disconnect between implementation research and implementation practice, often stemming from knowledge generated by implementation research not being accessible to or applied by professionals who support implementation efforts in various service-delivery systems. Several explanations for the research-to-practice gap in implementation science have been offered in recent years; the authors highlight one notable challenge that may be exacerbating the research-to-practice gap in this field, namely that implementation research often remains disconnected from the lived experiences of implementation support practitioners. In this paper, the authors demonstrate the promise of developing a practice-drive research agenda in implementation science, with specific research question ideas offered by highly experienced implementation support practitioners. The paper concludes by expressing enthusiasm for future efforts to bring implementation research and implementation practice together more closely, empirically foreground practice-driven implementation research questions, translate and disseminate existing implementation research findings more widely, and build the capacity of implementation support practitioners to fully engage with the implementation science literature

The iconisation of yeast spreads—love them or hate them

The production of beer yields a number of by-product streams, with spent brewers’ yeast being the second most abundant in volume. The high nutritional value of spent yeast has seen a large proportion of spent brewers’ yeast being used for both food and feed purposes. One of the uses of spent brewers’ yeast for human consumption has been the production of yeast spreads, which came onto the market in the early 20th century, first in the United Kingdom and shortly thereafter in the commonwealth dominions, especially Australia and New Zealand. In this research we investigated the national status of yeast spreads in the UK, Australia and New Zealand. We show that a brewery by-product such as spent brewers’ yeast is more than a mere novel utilisation of a waste stream but have become inherently associated with national identities of these countries to such an extent that some brands have become iconicised. Furthermore, some yeast spread brands have become a symbol of (inter)national polarisation, purely based on its initial sensorial characterisation

"Meet people where they are": a qualitative study of community barriers and facilitators to HIV testing and HIV self-testing among African Americans in urban and rural areas in North Carolina.

BACKGROUND: HIV testing programs in the United States aim to reach ethnic minority populations who experience high incidence of HIV, yet 40% of African Americans have never been tested for HIV. The objective of this study is to identify community-based strategies to increase testing among African Americans in both urban and rural areas. METHODS: This study conducted focus group discussions (FGDs) informed by community-based participatory research principles to examine African American's concerns and ideas around HIV testing and HIV self-testing. Participants included highly affected (i.e., PLWH, MSM, PWID, low-income, teens and young adults) populations from African American communities in North Carolina, aged 15 years and older. We digitally transcribed and analyzed qualitative data using MAXQDA and axial coding to identify emergent themes. RESULTS: Fifty-two men and women between 15 to 60 years old living in urban (n=41) and rural (n=11) areas of North Carolina participated in focus group discussions. HIV testing barriers differed by HIV testing setting: facility-based, community-based, and HIV self-testing. In community-based settings, barriers included confidentiality concerns. In facility-based settings (e.g., clinics), barriers included negative treatment by healthcare workers. With HIV self-testing, barriers included improper use of self-testing kits and lack of post-test support. HIV testing facilitators included partnering with community leaders, decentralizing testing beyond facility-based sites, and protecting confidentiality. CONCLUSIONS: Findings suggest that HIV testing concerns among African Americans vary by HIV testing setting. African Americans may be willing to test for HIV at community events in public locations if client confidentiality is preserved and use HIV self-testing kits in private if post-test social support and services are provided. These community-identified facilitators may improve African American testing rates and uptake of HIV self-testing kits

Senior Sway: Using a Mobile Application to Measure Fall Risk

Background and Purpose: The Senior Sway mobile application uses the iPhone/iPad gyroscope to assess postural sway and motion reaction time. Impairment in postural sway and motion reaction time have the potential to increase risk for future falls. Senior Sway thereby has the potential to provide a quick, easy to use, objective measure for predicting falls in older adults. The purpose of this study was to evaluate the feasibility of the Senior Sway mobile application and its associations with fall risk in community-dwelling older adults. Methods: Adults older than 62 years were recruited from senior centers and community events. Descriptive and bivariate statistics were used to examine feasibility on the basis of enrollment, time required, satisfaction with application, and association with fall risk. Results and Discussion: Fifty-seven adults were recruited. Use of the Senior Sway mobile application was feasible. Ninety-one percent said that they liked the application and reported length of time of assessment was “just right.” The average Senior Sway score was 64.0 (range: 47.8-84.0), which was signifi cantly associated with the 30-second sit-to-stand test. In addition, the motor reaction time score was associated with the Timed Up and Go. Conclusions: Senior Sway is a promising application to improve identifi cation of adults at risk for falls and need for rehabilitation but warrants further research

Risk Factors for Pediatric Invasive Group A Streptococcal Disease

Invasive group A Streptococcus (GAS) infections can be fatal and can occur in healthy children. A case-control study identified factors associated with pediatric disease. Case-patients were identified when Streptococcus pyogenes was isolated from a normally sterile site, and matched controls (≥2) were identified by using sequential-digit dialing. All participants were noninstitutionalized surveillance-area residents <18 years of age. Conditional regression identified factors associated with invasive disease: other children living in the home (odds ratio [OR] = 16.85, p = 0.0002) and new use of nonsteroidal antiinflammatory drugs (OR = 10.64, p = 0.005) were associated with increased risk. More rooms in the home (OR = 0.67, p = 0.03) and household member(s) with runny nose (OR = 0.09, p = 0.002) were associated with decreased risk. Among children, household-level characteristics that influence exposure to GAS most affect development of invasive disease

Building trusting relationships to support implementation: A proposed theoretical model.

This paper presents a theory of change that articulates (a) proposed strategies for building trust among implementation stakeholders and (b) the theoretical linkages between trusting relationships and implementation outcomes. The theory of change describes how trusting relationships cultivate increases in motivation, capability, and opportunity for supporting implementation among implementation stakeholders, with implications for commitment and resilience for sustained implementation, and ultimately, positive implementation outcomes. Recommendations related to the measurement of key constructs in the theory of change are provided. The paper highlights how the development of a testable causal model on trusting relationships and implementation outcomes can provide a bridge between implementation research and implementation practice

Building trusting relationships to support implementation: A proposed theoretical model

This paper presents a theory of change that articulates (a) proposed strategies for building trust among implementation stakeholders and (b) the theoretical linkages between trusting relationships and implementation outcomes. The theory of change describes how trusting relationships cultivate increases in motivation, capability, and opportunity for supporting implementation among implementation stakeholders, with implications for commitment and resilience for sustained implementation, and ultimately, positive implementation outcomes. Recommendations related to the measurement of key constructs in the theory of change are provided. The paper highlights how the development of a testable causal model on trusting relationships and implementation outcomes can provide a bridge between implementation research and implementation practice