The Mechanisms of Implementation Support - Findings from a Systematic Integrative Review

Purpose: Mechanisms of Change (MoC) explain how strategies used to enhance the uptake of evidence in social and human services enable change in the behaviors of individual practitioners, organizational leaders or entire organizations, and systems. One such strategy is the use of implementation support practitioner (ISPs). This study examines the mechanisms through which ISPs facilitate behavior supportive of the implementation of research-supported interventions. Methods: A systematic, integrative review was conducted. The conceptualization of MoCs built on a model by Dalkin and colleagues. Results: Based on a unique combination of knowledge, skills, and attitudes, ISPs install trust in and among their stakeholders and utilize this trust to promote meaningful and relevant learning; provide ongoing opportunities for learning, reflection, and support; help to span boundaries; and positively motivate stakeholders. Discussion: ISPs do not represent a short cut to better implementation. They represent an additional implementation challenge that requires dedicated attention and resources

The Mechanisms of Implementation Support - Findings from a Systematic Integrative Review

Purpose: Mechanisms of Change (MoC) explain how strategies used to enhance the uptake of evidence in social and human services enable change in the behaviors of individual practitioners, organizational leaders or entire organizations, and systems. One such strategy is the use of implementation support practitioner (ISPs). This study examines the mechanisms through which ISPs facilitate behavior supportive of the implementation of research-supported interventions. Methods: A systematic, integrative review was conducted. The conceptualization of MoCs built on a model by Dalkin and colleagues. Results: Based on a unique combination of knowledge, skills, and attitudes, ISPs install trust in and among their stakeholders and utilize this trust to promote meaningful and relevant learning; provide ongoing opportunities for learning, reflection, and support; help to span boundaries; and positively motivate stakeholders. Discussion: ISPs do not represent a short cut to better implementation. They represent an additional implementation challenge that requires dedicated attention and resources

Knowledge and attitudes of Implementation Support Practitioners—Findings from a systematic integrative review

Background: It requires thoughtful planning and work to successfully apply and sustain research-supported interventions like healthcare treatments, social support, or preventive programs in practice. Implementation support practitioners (ISPs) such as facilitators, technical assistance providers, knowledge brokers, coaches or consultants may be involved to actively support the implementation process. This article presents knowledge and attitudes ISPs bring to their work. Methods: Building on a previously developed program logic, a systematic integrative review was conducted. Literature was sourced by searching nine electronic data bases, organizational websites, and by launching a call for publications among selected experts and social media. Article screening was performed independently by two researchers, and data from included studies were extracted by members of the research team and quality-assured by the lead researcher. The quality of included RCTs was assessed based on a framework by Hodder and colleagues. Thematic Analysis was used to capture information on knowledge and attitudes of ISPs across the included studies. Euler diagrams and heatmaps were used to present the results. Results: Results are based on 79 included studies. ISPs reportedly displayed knowledge about the clinical practice they work with, implementation / improvement practice, the local context, supporting change processes, and facilitating evidence-based practice in general. In particular, knowledge about the intervention to be implemented and its target population, specific improvement / implementation methods and approaches, organizational structures and sensitivities, training, and characteristics of (good) research was described in the literature. Seven themes describing ISPs’ attitudes were identified: 1) professional, 2) motivated / motivating / encouraging / empowering, 3) empathetic / respectful / sensitive, 4) collaborative / inclusive, 5) authentic, 6) creative / flexible / innovative / adaptive, and 7) frank / direct / honest. Pertaining to a professional attitude, being responsive and focused were the most prevalent indicators across included publications. Conclusion: The wide range and complexity of knowledge and attitudes found in the literature calls for a comprehensive and systematic approach to collaboratively develop a professional role for ISPs across disciplines. Embedding the ISP role in different health and social welfare settings will enhance implementation capacities considerably

Implementation and evaluation of a multi-level mental health promotion intervention for the workplace (MENTUPP): study protocol for a cluster randomised controlled trial

Background Well-organised and managed workplaces can be a source of wellbeing. The construction, healthcare and information and communication technology sectors are characterised by work-related stressors (e.g. high workloads, tight deadlines) which are associated with poorer mental health and wellbeing. The MENTUPP intervention is a flexibly delivered, multi-level approach to supporting small- and medium-sized enterprises (SMEs) in creating mentally healthy workplaces. The online intervention is tailored to each sector and designed to support employees and leaders dealing with mental health difficulties (e.g. stress), clinical level anxiety and depression, and combatting mental health-related stigma. This paper presents the protocol for the cluster randomised controlled trial (cRCT) of the MENTUPP intervention in eight European countries and Australia. Methods Each intervention country will aim to recruit at least two SMEs in each of the three sectors. The design of the cRCT is based on the experiences of a pilot study and guided by a Theory of Change process that describes how the intervention is assumed to work. SMEs will be randomly assigned to the intervention or control conditions. The aim of the cRCT is to assess whether the MENTUPP intervention is effective in improving mental health and wellbeing (primary outcome) and reducing stigma, depression and suicidal behaviour (secondary outcome) in employees. The study will also involve a process and economic evaluation. Conclusions At present, there is no known multi-level, tailored, flexible and accessible workplace-based intervention for the prevention of non-clinical and clinical symptoms of depression, anxiety and burnout, and the promotion of mental wellbeing. The results of this study will provide a comprehensive overview of the implementation and effectiveness of such an intervention in a variety of contexts, languages and cultures leading to the overall goal of delivering an evidence-based intervention for mental health in the workplace

How is tailored implementation undertaken using a self-guided toolkit? Qualitative study of the ItFits-toolkit in the ImpleMentAll project

BackgroundThe process of tailored implementation is ill-defined and under-explored. The ItFits-toolkit was developed and subsequently tested as a self-guided online platform to facilitate implementation of tailored strategies for internet-based cognitive behavioural therapy (iCBT) services. In ImpleMentAll, ItFits-toolkit had a small but positive effect on the primary outcome of iCBT normalisation. This paper investigates, from a qualitative perspective, how implementation teams developed and undertook tailored implementation using the toolkit within the trial.MethodsImplementation teams in thirteen sites from nine countries (Europe and Australia) used the ItFits-toolkit for six months minimum, consistent with the trial protocol. A qualitative process evaluation was conducted. Descriptive data regarding goals, barriers, strategies, and implementation plans collected within the toolkit informed qualitative data collection in real time. Qualitative data included remote longitudinal interviews (n = 55) with implementation team members (n = 30) and observations of support calls (n = 19) with study sites. Qualitative data were analysed thematically, using a team-based approach.ResultsImplementation teams developed and executed tailored implementation projects across all steps in the toolkit process. Working in a structured way but with room for flexibility, decisions were shaped by team members' ideas and goals, iterative stakeholder engagement, internal and external influences, and the context of the ImpleMentAll project. Although teams reported some positive impacts of their projects, 'time', both for undertaking the work, and for seeing project impacts, was described as a key factor in decisions about implementation strategies and assessments of success.ConclusionThis study responds directly to McHugh et al.'s (2022) call for empirical description of what implementation tailoring looks like in action, in service settings. Self-guided facilitation of tailored implementation enables implementers in service settings to undertake tailoring within their organisations. Implementation tailoring takes considerable time and involves detailed work but can be supported through the provision of implementation science informed guidance and materials, iterative and ongoing stakeholder engagement, and working reflectively in response to external influencing factors. Directions for advancement of tailored implementation are suggested

Electronic Results Addendum (ERA 2): The Mechanisms and Determinants of Implementation Support – Findings from a Systematic Integrative Review

This Electronic Results Addendum (ERA 2) provides a detailed overview of data extraction and analysis across included studies

Knowledge and attitudes of Implementation Support Practitioners—Findings from a systematic integrative review

Background It requires thoughtful planning and work to successfully apply and sustain research-supported interventions like healthcare treatments, social support, or preventive programs in practice. Implementation support practitioners (ISPs) such as facilitators, technical assistance providers, knowledge brokers, coaches or consultants may be involved to actively support the implementation process. This article presents knowledge and attitudes ISPs bring to their work. Methods Building on a previously developed program logic, a systematic integrative review was conducted. Literature was sourced by searching nine electronic data bases, organizational websites, and by launching a call for publications among selected experts and social media. Article screening was performed independently by two researchers, and data from included studies were extracted by members of the research team and quality-assured by the lead researcher. The quality of included RCTs was assessed based on a framework by Hodder and colleagues. Thematic Analysis was used to capture information on knowledge and attitudes of ISPs across the included studies. Euler diagrams and heatmaps were used to present the results. Results Results are based on 79 included studies. ISPs reportedly displayed knowledge about the clinical practice they work with, implementation / improvement practice, the local context, supporting change processes, and facilitating evidence-based practice in general. In particular, knowledge about the intervention to be implemented and its target population, specific improvement / implementation methods and approaches, organizational structures and sensitivities, training, and characteristics of (good) research was described in the literature. Seven themes describing ISPs’ attitudes were identified: 1) professional, 2) motivated / motivating / encouraging / empowering, 3) empathetic / respectful / sensitive, 4) collaborative / inclusive, 5) authentic, 6) creative / flexible / innovative / adaptive, and 7) frank / direct / honest. Pertaining to a professional attitude, being responsive and focused were the most prevalent indicators across included publications. Conclusion The wide range and complexity of knowledge and attitudes found in the literature calls for a comprehensive and systematic approach to collaboratively develop a professional role for ISPs across disciplines. Embedding the ISP role in different health and social welfare settings will enhance implementation capacities considerably

Implementation Support Skills: Findings From a Systematic Integrative Review

Purpose: Skills in selecting and designing strategies for implementing research-supported interventions (RSIs) within specific local contexts are important for progressing a wider RSI adoption and application in human and social services. This also applies to a particular role in implementation, the implementation support practitioner (ISP). This study examines which strategies have been reported as being used by ISPs across multiple bodies of research on implementation support and how these strategies were applied in concrete practice settings. Methods: A systematic integrative review was conducted. Data analysis utilized the Expert Recommendations for Implementing Change compilation of implementation strategies. Results: Studies reported on 18 implementation strategies commonly used by different ISPs, who require mastery in selecting, operationalizing, and detailing these. Two further strategies not included in the ERIC compilation could be identified. Discussion: Given the use of primarily more feasible implementation support strategies among ISPs, their potential as agents of change may be underutilized

Increased attempts to suppress negative and positive emotions in Borderline Personality Disorder

Beblo T, Fernando S, Kamper P, et al. Increased attempts to suppress negative and positive emotions in Borderline Personality Disorder. Psychiatry Research. 2013;210(2):505-509.Patients with Borderline Personality Disorder (BPD) show evidence of disturbed emotion regulation. In particular, patients may try to suppress their emotions with possibly negative effects on mental health. We investigated the suppression of both negative and positive emotions in BPD patients and healthy participants. Thirty BPD patients and 30 matched healthy controls were assessed for emotion suppression using the Emotion Acceptance Questionnaire (EAQ). In addition, we administered additional questionnaires to validate emotion suppression findings. BPD patients reported increased attempts to suppress both negative and positive emotions. These findings indicate that BPD patients are not simply acting out negative emotions. Therapeutic approaches that focus on emotion acceptance of emotions are supported by our study data. Apart from negative emotions, treatment programs should consider positive emotions as well. (C) 2013 Elsevier Ireland Ltd. All rights reserved