Dr. Heather McKay Professor Faculty of Medicine, University of - - PowerPoint PPT Presentation
Shining a light on implementation to scale-up continuum : How does it apply t o healt h promot ing innovat ions? Dr. Heather McKay Professor Faculty of Medicine, University of British Columbia Friday, February 28 #ktconnects @
#ktconnects @ ActiveAgingRT
Professor Faculty of Medicine, University of British Columbia
Friday, February 28
Shining a light on implementation to scale-up continuum: How does it apply t o healt h promot ing innovat ions?
@ActiveAgingRT
www.activeagingrt.ca www.choosetomove.info
Ho w do e s it a pply to he a lth pro mo ting I nno va tio ns?
Pro f He a the r Mc K a y F a c ulty o f Me dic ine , UBC he a the r.mc ka y@ UBC.c a
Will it work in a ‘real world’ setting? How will benefits reach the whole population?
Effectiveness
Efficacy
Scale-up
Will it work in a controlled setting?
Adapted from Milat AJ et. al. BMC Public Health 2011
Re se ar c h- to- Pr ac tic e gap
Wha t is kno wn is no t wha t is a do pte d
Re se a rc h (kno wle dg e ) Pra c tic e Po pula tio n le ve l
Imple me ntation gap
No t use d a s inte nde d, no t susta ina b le , no t a t sc a le
I mple me nta tio n Sc a le -up I mple me nta tio n
14%
17 years
Ba la s E A, Bo re n SA. Ma na g ing c linic a l kno wle dg e fo r he a lth c a re impro ve me nt. In: Be mme l J, Mc Cra y AT , e ds. Ye a rb o o k o f me dic a l info rma tic s. Stutt g a rt: Sc ha tt a ue r; 2000:65–70. F ixse n & Bla se , 2012. http:/ / 2012.b lue printsc o nfe re nc e .c o m/ pre se nta tio ns/ De a nF ixse n.pdf
By the e nd o f my pre se nta tio n le a rne rs will b e a b le to :
sc a la b ility;
fra me wo rks in he a lth pro mo tio n;
e va lua tio n;
he use o f stra te g ie s to a do pt a nd inte g ra te e vide nc e - b a se d inte rve ntio ns a nd c ha ng e pra c tic e within spe c ific se tting s. Natio nal I nstitute s o f He alth
he pro c e ss o f putting to use o r inte g ra ting e vide nc e -b a se d inte rve ntio ns within a se tting . Rab in e t al.
“T he sc ie ntific study o f me tho ds to pro mo te the syste ma tic upta ke o f re se a rc h finding s a nd o the r e vide nc e -b a se d pra c tic e s into ro utine pra c tic e s, a nd he nc e , to impro ve the q ua lity a nd e ffe c tive ne ss o f he a lth se rvic e (he a lth pro mo tio n inte rve ntio ns).”
So urc e : Re se a rc h Disse mina tio n a nd Imple me nta tio n (R18) Gra nts. https:/ / www.nhlb i.nih.g o v/ g ra nts-a nd-tra ining / po lic ie s-a nd- g uide line s/ re se a rc h-disse mina tio n-a nd-imple me nta tio n-r18-g ra nts Durla k a nd DuPre . Ame ric a n Jo urna l o f Co mmunity Psyc ho lo g y 2008, 41:327-350 Ra b in e t a l. Jo urna l o f Pub lic He a lth Ma na g e me nt a nd Pra c tic e . 2008 Ma r-Apr;14(2):117-23.
…a fo c us o n de ve lo ping a nd te sting me tho ds to b ro a dly spre a d suc c e ssful imple me nta tio n a c ro ss dive rse se tting s
Damsc hro de rL J 2019 Clarity o ut o f c hao s. Psyc hiatry Re se arc h
inte rve ntio n Mang ham & Hanso n. He alth Po lic y Plan. 2010, 25(2):85-96.
inno va tio ns suc c e ssfully te ste d in pilo t o r e xpe rime nta l pro je c ts to b e ne fit mo re pe o ple a nd to fo ste r po lic y a nd pro g ra m de ve lo pme nt o n a la sting b a sis. E
xpandNe t: http:// e xpa ndne t.ne t
T he po te ntia l suita b ility o f a n inte rve ntio n fo r sc a ling up.
Milat A, King L , Bauman A and Re dman S. T he c o nc e pt o f sc alab ility: inc re asing the sc ale and po te ntial ado ptio n o f he alth pro mo tio n inte rve ntio ns into po lic y and prac tic e . He alth Pro mo tio n I nte rnatio nal, Vo l. 28 No . 3
Ba se d o n its e ffe c tive ne ss a nd c o st-e ffe c tive ne ss a nd ‘ filte r c rite ria ’ suc h a s po litic a l a c c e pta b ility a nd fe a sib ility.
Vo s e t. al. 2010
12
Mo re tha n 60 he a lth pro mo tio n, he a lth se rvic e s imple me nta tio n mo de ls (fra me wo rks)
T ab ak e t.al. Am J Prev Med 2012;43(3):337–350
T hre e ro unds o f
McKay HA et al. Implementation and scale-up of physical activity and behavioural nutrition interventions: an evaluation roadmap. International Journal of Behavioral Nutrition and Physical Activity (2019)16:102
ra me wo rk fo r E ffe c tive I mple me nta tio n
Durlak and DuPre . Am J Co mmunity Psyc ho l. 2008 41(3-4):327-50
ra me wo rk fo r I mple me nta tio n Re se a rc h (CF I R)
Da msc hro de re t a l. I mple me nt Sc i. 2009 4:50
ra me wo rk
Chamb e rs e t al. I mple me nt Sc i. 2013;8:117
Damschroder LJ et. al. Implementation Science 2009
Inner setting
Outer setting Individual Innovation
Implementation
Community F ac tor s Pr
c har ac te r istic s Innovation c har ac te r istic s (inte r ac tive Syste m F r ame wor k)
Pre ve ntion De live ry Syste m Pre ve ntion Suppor t Syste m
E ffe c tive Imple me ntation
Durlak and DuPre . Am J Co mmunity Psyc ho l, 2008
Knowle dg e synthe sis a nd tra nsla tion syste m
nno va tio ns - A F ra me wo rk fo r Ac tio n. Simmo ns e t al. WHO; 2007
nte ra c tive Syste ms F ra me wo rk fo r Disse mina tio n a nd I mple me nta tio n
Wande rsman e t al. Am J Co mmunity Psyc . 2008;41:171-81
ra me wo rk fo r Suc c e ss
Yame y. PL
WHO, E XPANDNE T , 2010
ra me wo rk fo r Sc a ling Up Physic a l Ac tivity I nte rve ntio ns
Re is e t al. T he L anc e t. 2016; 388 (10051):1337-48
nte rve ntio ns
Milat e t al. He alth Re s Po lic y Syst. 2014;12:18; Milat e t al. Pub lic He alth Re s Prac t. 2016;26(1)
A to o l fo r po lic y ma ke rs, pra c titio ne rs a nd pro g ra m ma na g e rs to he lp the m de te rmine ‘ sc a la b ility’ o f a disc re te he a lth pro g ra m o r inte rve ntio n.
A Guide to Sc a ling Up Po pula tio n He a lth I nte rve ntio ns Milat e t al. He alth Re s Po lic y Syst. 2014;12:18; Milat e t al. Pub lic He alth Re s Prac t. 2016;26(1)
Naylo r e t. al. and Mc Kay 2006
T HE I NNOVAT I ON Ada pta b le
F e a sib le Affo rda b le PROVIDER CHARACTERISTICS
Pa rtne rships T ra ining a nd te c hnic a l suppo rt Co mmunic a tio n a c ro ss multiple a udie nc e s Cha mpio ns L e a de rship E va lua tio n a nd fe e db a c k COMMUNI T Y L E VE L So und the o ry a nd re se a rc h Po litic a l will F unding Po lic y
Imple me nta tion Studie s
Ada pta tio n I mple me nta tio n Susta ina b ility Pre inte rve ntio n (pilo t tria ls) E ffic a c y (RCT ) E ffe c tive ne ss (q ua si-e xp. tria ls) Sc a le a nd Re a c h o f the inte rve ntio n
Scale-up is a process
Sc a le - up
Not an end-point
Imple me nta tion Studie s
Ada pta tio n I mple me nta tio n Susta ina b ility Pre inte rve ntio n (pilo t tria ls) E ffic a c y (RCT ) E ffe c tive ne ss (q ua si-e xp. tria ls)
F
Sc a le - up
So urc e : a da pte d fro m Mila t e t a l. BMC Pub lic He a lth, 2011, 11:934 Pinno c k e t a l. BMJ 2017;356:i6795
No sta nda rd
Stirman et al., 2013; Castro et al., 2004; Harden et al., 2017
Imple me nta tion Inte r ve ntion
Mo tiva tio na l Gro up Me e ting s (x4) T e le pho ne Che c k-ins (x10) One -o n-o ne Co nsulta tio n (x1)
x2
3 mo nths 6 mo nths Ac tive Pha se Ma inte na nc e Pha se
x2 x3 Baseline
Pha se 1 & 2: 26 urb a n a nd sub - urb a n c o mmunitie s in BC, 540 pa rtic ipa nts Pha se 3: 175 pro g ra ms a c ro ss BC (urb a n, rura l a nd re mo te ), >2000 pa rtic ipa nts
Pr e ve ntion Synthe sis a nd T r a nsla tion Syste m Ac tive Ag ing Re se a rc h T e a m Pr e ve ntion Suppor t Syste m CT M pro je c t te a m: two princ ipa l inve stig a to rs, pro g ra m ma na g e r a nd RAs Pr e ve ntion De live r y Syste m Pa rtne r 1: Cha rita b le c o mmunity o rg a niza tio n
Co mmunity o rg a niza tio ns Pro vinc ia l c o o rdina to r Re c re a tio n ma na g e r/ c o o rdina to r Ac tivity c o a c he s
Wa nde rsma n e t a l. (2008) Am J Co mmunity Psyc ho l, 41(3-4):171-81
▪ Type 2 hybrid effectiveness-implementation study design ▪ Mixed methods (surveys, interviews and audits) ▪ Measurement at 0, 3 and 6 months
x2 Baseline 0 months Mid-intervention 3 months Post-intervention 6 months
Motivational Group Meetings One-on-one consultation In-person/phone check-ins
Active Phase Maintenance Phase x2 x3
Re a c h
Re c ruitme nt
F ide lity
T ra ining
Ada pta tio n
INDIVIDUAL SUPPORT SYST E M DE L IVE RY SYST E M
I mpa c t
Cha ng e : mo b ility, so c ia l iso la tio n, lo ne line ss, physic a l a c tivity
Co nte xtua l fa c to rs
M (e .g . fe a sib ility, a ppro pria te ne ss, a c c e pta b ility, po lic y)
Pa rtne rships
Susta ina b ility
Ce ntra l suppo rt
; suppo rt re c e ive d
E c o no mic e va lua tio n
Co st, c o st e ffe c tive ne ss, re turn o n inve stme nt
LEVEL INDICATOR DESCRIPTION
I MPL E ME NT AT I ON E VAL UAT I ON
mple me nting and E valuating an Olde r Adult Physic al Ac tivity Mo de l at Sc ale : F rame wo rk fo r Ac tio n. T ra nsla tio na l Jo urna l o f the Ame ric a n Co lle g e o f Spo rts Me dic ine .
Ac tivity I nve stme nts that wo rk: Cho o se to Mo ve – Sc aling -up a physic al ac tivity mo de l fo r o lde r adults. British Jo urna l o f Spo rts Me dic ine .
ac to rs that influe nc e imple me ntatio n o f a c o mmunity-b ase d he alth pro mo tio n inte rve ntio n fo r o lde r adults. BMC Pub lic He a lth.
sc ale -up o f an e ffe c tive o lde r adult physic al ac tivity inte rve ntio n: Charac te rizing the adaptatio n pro c e ss to ac hie ve ‘ b e st fit’ . Pre ve ntio n Sc ie nc e .
c o mmunitie s
c o a c he s tra ine d
pro g ra ms
[I n my] 12 ye a rs in the fitne ss industry, b e ing a CT M Ac tivity Co a c h is fa r a nd a b o ve the
most r e war ding thing I’ve done .
— CT
M Ac tivity Co a c h
De live r y pa r tne r s’ pe r c e ption
McKay HA et.al. (2018) Implementation of a Co- Designed Physical Activity Program for Older Adults: Positive Impact When Delivered at Scale. BMC Public Health.
Mc K a y e t a l. (2018) BMC Pub lic He a lth, 18:1289
T ar ge ts
(urb a n, sma ll urb a n, rura l, re mo te )
@ActiveAgingRT
Active Aging Research Team
Principal Scientists: Heather McKay, PhD Joanie Sims-Gould, PhD Team Members: Rebecca Collett Samantha Gray Christa Hoy Erica Lau Sarah Lusina-Furst Douglas Race Avery MacKenzie Venessa Wong Caroline McLennan Chariisa Yu Lindsay Nettlefold Callista Ottoni
Funding
www.activeagingrt.ca www.choosetomove.info
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