Stakeholder and Equity Data-Driven Implementation: a Mixed Methods Pilot Feasibility Study

Kelly A Aschbrenner, Gina Kruse, Karen M Emmons, Deepinder Singh, Marjanna E Barber-Dubois, Angela M Miller, Annette N Thomas, Stephen J Bartels, Kelly A Aschbrenner, Gina Kruse, Karen M Emmons, Deepinder Singh, Marjanna E Barber-Dubois, Angela M Miller, Annette N Thomas, Stephen J Bartels

Abstract

We conducted a mixed methods pilot feasibility study of a Stakeholder and Equity Data-Driven Implementation (SEDDI) process to facilitate using healthcare data to identify patient groups experiencing gaps in the use of evidence-based interventions (EBIs) and rapidly adapt EBIs to achieve greater access and equitable outcomes. We evaluated the feasibility and acceptability of SEDDI in a pilot hybrid type 2 effectiveness-implementation trial of a paired colorectal cancer (CRC) and social needs screening intervention at four federally qualified community health centers (CHCs). An external facilitator partnered with CHC teams to support initial implementation, followed by the SEDDI phase focused on advancing health equity. Facilitation sessions were delivered over 8 months. Preliminary evaluation of SEDDI involved convergent mixed methods with quantitative survey and focus group data. CHCs used data to identify gaps in outreach and completion of CRC screening with respect to race/ethnicity, gender, age, and language. Adaptations to improve access and use of the intervention included cultural, linguistic, and health literacy tailoring. CHC teams reported that facilitation and systematic review of data were helpful in identifying and prioritizing gaps. None of the four CHCs completed rapid cycle testing of adaptations largely due to competing priorities during the COVID-19 response. SEDDI has the potential for advancing chronic disease prevention and management by providing a stakeholder and data-driven approach to identify and prioritize health equity targets and guide adaptations to improve health equity. ClinicalTrials.gov Identifier: NCT04585919.

Keywords: Adaptations; Health equity; Implementation; Mixed methods.

Conflict of interest statement

The authors declare no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
The SEDDI Process embedded in the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework

References

    1. Aarons GA, Green AE, Palinkas LA, Self-Brown S, Whitaker DJ, Lutzker JR, Silovsky JF, Hecht DB, Chaffin MJ. Dynamic adaptation process to implement an evidence-based child maltreatment intervention. Implementation Science. 2012;7:32. doi: 10.1186/1748-5908-7-32.
    1. Baumann AA, Cabassa LJ. Reframing implementation science to address inequities in healthcare delivery. BMC Health Services Research. 2020;20:190–190. doi: 10.1186/s12913-020-4975-3.
    1. Braveman, P. (2014). What are health disparities and health equity? We need to be clear. Public health reports (Washington, D.C. : 1974), 129 Suppl 2, 5–8. 10.1177/00333549141291S203
    1. Brownson RC, Kumanyika SK, Kreuter MW, Haire-Joshu D. Implementation science should give higher priority to health equity. Implementation Science. 2021;16:28. doi: 10.1186/s13012-021-01097-0.
    1. Bryman A. Integrating quantitative and qualitative research: How is it done? Qualitative Research. 2006;6:97–113. doi: 10.1177/1468794106058877.
    1. Chambers DA, Feero WG, Khoury MJ. Convergence of implementation science, precision medicine, and the learning health care system: A new model for biomedical research. Journal of the American Medical Association. 2016;315:1941–1942. doi: 10.1001/jama.2016.3867.
    1. Check DK, Zullig LL, Davis MM, Davies L, Chambers D, Fleisher L, Kaplan SJ, Proctor E, Ramanadhan S, Schroeck FR, Stover AM, Koczwara B. Improvement science and implementation science in cancer care: Identifying areas of synergy and opportunities for further integration. Journal of General Internal Medicine. 2021;36:186–195. doi: 10.1007/s11606-020-06138-w.
    1. Chin MH. Advancing health equity in patient safety: A reckoning, challenge and opportunity. BMJ Quality and Safety. 2020 doi: 10.1136/bmjqs-2020-012599.
    1. Creswell, J. W., & Clark, V. L. P. (2017). Designing and conducting mixed methods research. Sage publications.
    1. Dougherty MK, Brenner AT, Crockett SD, Gupta S, Wheeler SB, Coker-Schwimmer M, Cubillos L, Malo T, Reuland DS. Evaluation of interventions intended to increase colorectal cancer screening rates in the United States: A systematic review and meta-analysis. JAMA Internal Medicine. 2018;178:1645–1658. doi: 10.1001/jamainternmed.2018.4637.
    1. Fetters MD, Curry LA, Creswell JW. Achieving integration in mixed methods designs-principles and practices. Health Services Research. 2013;48:2134–2156. doi: 10.1111/1475-6773.12117.
    1. Fortney JC, Pyne JM, Ward-Jones S, Bennett IM, Diehl J, Farris K, Cerimele JM, Curran GM. Implementation of evidence-based practices for complex mood disorders in primary care safety net clinics. Families, Systems & Health : The Journal of Collaborative Family Healthcare. 2018;36:267–280. doi: 10.1037/fsh0000357.
    1. Gadke, D. L., Kratochwill, T. R., & Gettinger, M. (2021). Incorporating feasibility protocols in intervention research. Journal of School Psychology, 84, 1–18. 10.1016/j.jsp.2020.11.004
    1. Glasgow, R. E., Battaglia, C., McCreight, M., Ayele, R. A., Rabin, B. A. (2020). Making implementation science more rapid: Use of the RE-AIM framework for mid-course adaptations across five health services research projects in the veterans health administration. Frontiers in Public Health, 8.10.3389/fpubh.2020.00194
    1. Harvey G, Kitson A. PARIHS revisited: From heuristic to integrated framework for the successful implementation of knowledge into practice. Implementation Science. 2016;11:33. doi: 10.1186/s13012-016-0398-2.
    1. Issaka RB, Avila P, Whitaker E, Bent S, Somsouk M. Population health interventions to improve colorectal cancer screening by fecal immunochemical tests: A systematic review. Preventive Medicine. 2019;118:113–121. doi: 10.1016/j.ypmed.2018.10.021.
    1. Kerkhoff AD, Farrand E, Marquez C, Cattamanchi A, Handley MA. Addressing health disparities through implementation science—A need to integrate an equity lens from the outset. Implementation Science. 2022;17:13. doi: 10.1186/s13012-022-01189-5.
    1. Kirchner, J. E., Ritchie, M. J., Pitcock, J. A., Parker, L. E., Curran, G. M., & Fortney, J. C. (2014). Outcomes of a partnered facilitation strategy to implement primary care-mental health.Journal of General Internal Medicine, 29 Suppl 4, 904–912. 10.1007/s11606-014-3027-2
    1. Kreuter MW, Lukwago SN, Bucholtz RD, Clark EM, Sanders-Thompson V. Achieving cultural appropriateness in health promotion programs: Targeted and tailored approaches. Health Education & Behavior. 2003;30:133–146. doi: 10.1177/1090198102251021.
    1. Lane-Fall MB, Fleisher LA. Quality improvement and implementation science. Anesthesiology Clinics. 2018;36:i. doi: 10.1016/S1932-2275(17)30126-X.
    1. Langley, G. J., Moen, R. D., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. (2009). The improvement guide: A practical approach to enhancing organizational performance. John Wiley & Sons.
    1. Leeman J, Askelson N, Ko LK, Rohweder CL, Avelis J, Best A, Friedman D, Glanz K, Seegmiller L, Stradtman L, Vanderpool RC. Understanding the processes that Federally Qualified Health Centers use to select and implement colorectal cancer screening interventions: A qualitative study. Translation Behavioral Medicine. 2019;10:394–403. doi: 10.1093/tbm/ibz023.
    1. Leeman J, Rohweder C, Lee M, Brenner A, Dwyer A, Ko LK, O’Leary MC, Ryan G, Vu T, Ramanadhan S. Aligning implementation science with improvement practice: A call to action. Implementation Science Communications. 2021;2:99. doi: 10.1186/s43058-021-00201-1.
    1. Perry CK, Damschroder LJ, Hemler JR, Woodson TT, Ono SS, Cohen DJ. Specifying and comparing implementation strategies across seven large implementation interventions: A practical application of theory. Implementation Science. 2019;14:32. doi: 10.1186/s13012-019-0876-4.
    1. Peters DH, Bhuiya A, Ghaffar A. Engaging stakeholders in implementation research: Lessons from the Future Health Systems Research Programme experience. Health Research Policy and Systems. 2017;15:104. doi: 10.1186/s12961-017-0269-6.
    1. Pope C, Ziebland S, Mays N. Qualitative research in health care. Analysing Qualitative Data. Bmj. 2000;320:114–116. doi: 10.1136/bmj.320.7227.114.
    1. Resnicow, K., Braithwaite, R. L., Dilorio, C., & Glanz, K. (2002). Applying theory to culturally diverse and unique populations. Health behavior and health education: Theory, research, and practice, 485–509.
    1. Ritchie MJ, Parker LE, Kirchner JE. From novice to expert: A qualitative study of implementation facilitation skills. Implementation Science Communications. 2020;1:25. doi: 10.1186/s43058-020-00006-8.
    1. Schapira MM, Swartz S, Ganschow PS, Jacobs EA, Neuner JM, Walker CM, Fletcher KE. Tailoring educational and behavioral interventions to level of health literacy: A systematic review. MDM Policy & Practice. 2017;2:2381468317714474–2381468317714474. doi: 10.1177/2381468317714474.
    1. Shelton, R. C., Chambers, D. A., & Glasgow, R. E. (2020). An extension of RE-AIM to enhance sustainability: Addressing dynamic context and promoting health equity over time. Front Public Health, 8(134). 10.3389/fpubh.2020.00134
    1. Smith, S. N., Liebrecht, C. M., Bauer, M. S., & Kilbourne, A. M. (2020). Comparative effectiveness of external vs blended facilitation on collaborative care model implementation in slow-implementer community practices. Health services research, 55(6), 954–965. 10.1111/1475-6773.13583
    1. Weiner BJ, Lewis CC, Stanick C, Powell BJ, Dorsey CN, Clary AS, Boynton MH, Halko H. Psychometric assessment of three newly developed implementation outcome measures. Implementation Science. 2017;12:108. doi: 10.1186/s13012-017-0635-3.
    1. Wiltsey Stirman S, Baumann AA, Miller CJ. The FRAME: An expanded framework for reporting adaptations and modifications to evidence-based interventions. Implementation Science. 2019;14:58. doi: 10.1186/s13012-019-0898-y.
    1. Woodward EN, Singh RS, Ndebele-Ngwenya P, Melgar Castillo A, Dickson KS, Kirchner JE. A more practical guide to incorporating health equity domains in implementation determinant frameworks. Implementation Science Communications. 2021;2:61. doi: 10.1186/s43058-021-00146-5.

Source: PubMed

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