Background: First responders (firefighters, paramedics, and police officers) are often exposed to potentially psychologically traumatic events. When combined with insufficient social support and reduced help-seeking behaviours, such exposures may increase the risk of mental health challenges, particularly among paramedics who report the highest rates of mental disorders. Objective: The current study used the Theoretical Domains Framework (TDF) and the Consolidated Framework for Implementation Research (CFIR) to identify critical barriers and facilitators to help-seeking and accessing mental health care, and the feasibility and sustainability of a first responder clinic. Methods: Semi-structured qualitative interviews included 11 paramedics (frontline, mid-and-senior management, and union), recruited using purposive and snowball sampling. Interviews were analyzed using content and thematic analyses. The TDF and CFIR guided study design, interview content, data collection, and analysis. Results: Barriers included the complexities of stigma, confidentiality, cultural competency, and trust. Conclusions: The findings will be instrumental in developing evidence-based approaches to mental health care for paramedics.

Foodborne illness is a serious and preventable public health problem affecting 1 in 6 Americans with cost estimates over $50 billion annually. Local health departments license and inspect restaurants to ensure food safety and respond to reports of suspected foodborne illness. The City of St. Louis Department of Health adopted the HealthMap Foodborne Dashboard (Dashboard), a tool that monitors Twitter for tweets about food poisoning in a geographic area and allows the health department to respond. We evaluated the implementation by interviewing employees of the City of St. Louis Department of Health involved in food safety. We interviewed epidemiologists, environmental health specialists, health services specialists, food inspectors, and public information officers. Participants viewed engaging innovation participants and executing the innovation as challenges while they felt the Dashboard had relative advantage over existing reporting methods and was not complex once in place. This study is the first to examine practitioner perceptions of the implementation of a new technology in a local health department. Similar implementation projects should focus more on process by developing clear and comprehensive plans to educate and involve stakeholders prior to implementation.

Despite the phenomenal innovations and huge investments in healthcare, it is evident that some digital transformation innovations in the healthcare context fail to meet their desired outcomes. Whilst some researchers argue that this is partly due to ineffective implementation, others argue otherwise. Essentially, there is an outspoken need to evaluate implementation processes, and one way to do so is through the use of an implementation framework, where one such framework showing great potential is the Consolidated Framework for Implementation Research (CFIR). By using a qualitative case study through the lenses of the CFIR, the study carries out a summative evaluation and examination of a previously conducted implementation process in a region in the north of Sweden, with the purpose of developing a greater understanding of implementation processes in order to improve patient care, as well as experiences and outcomes of digital transformation implementations. The study successfully identifies factors of both success and challenge in relation to implementation processes, where some of the success factors include the involvement of caregivers in the process and competition of private healthcare providers, whilst some of the challenges include deficient involvement of end-users as well as lack of structure. The study unearths some lessons which can be used as a guide for future implementations within the healthcare context, but also other contexts as well.

Additive manufacturing (AM) has enabled the possibility for the hospitals to become their own implant producers developing implants that are tailored to patient’s anatomy. Despite the enormous potential of custom-made implants there are challenges that complicate the implementation of them into clinical practice. The aim of this research is to (1) identify the main driving forces and barriers for the delivery of custom-made implants; (2) explore staff stakeholder views and practices related to the implementation of AM in surgery for the development of custom-made implants; (3) formulate recommendations on how to cope with the implementation challenges. The research method was an explorative qualitative study consisted of a literature review on the challenges of custom-made implants in clinical applications coupled with the collection and inductive analysis of empirical data. The empirical study was based on ten semi-structured interviews conducted among both domestic and international hospital managers medical doctors and research engineers. The consolidated framework for implementation research (CFIR) was utilized for data collection. Using the five domains of CFIR, the following results were obtained: (1) Characteristics of individuals: Most research participants indicated a positive attitude towards the innovation expressing self-efficacy to its use; (2) Intervention characteristics: Custom-made implants were perceived to have a relative advantage in surgical practice due to their high degree of observability and geometrical adaptability providing increased surgical quality, perfect patient fit and better understanding of pathologies. However, high implementation costs, low degree of trialability and high degree of complexity in the development process were regarded as drawbacks of the innovation; (3) Outer setting: the regulatory uncertainty and lack of reimbursement limit the accessibility of custom-made implants to low income populations; (4) Inner setting: scarcity of resources, staff resistance to change, insufficient management support, communication difficulties, limited access to educational materials and training opportunities as well as lack of time and innovative capacity were regarded by the majority of participants as implementation barriers; (5) Process: central for the success of implementation is the need for a coherent implementation plan and evaluation process as well as the engagement of key stakeholders such as hospital managers, payers, regulatory and implementation advisors. This dissertation proffers a deeper understanding of the implementation issues related to custom-made implants and offers preliminary recommendations on how to cope with implementation impediments through the use of Rogers diffusion of innovation coupled with concepts from the field of organizational change and innovation management including Clayton’s disruptive innovation.