There is a higher rate of recidivism for U.S. veterans compared to the general population of offenders. To address the unique needs of veterans, separate housing units for veterans (VSUs) are now operating within correctional facilities in 29 U.S. states. Despite reports that VSUs are having a positive impact on recidivism, little is known of the experiences of correctional administrators who have implemented a VSU. The purpose of this qualitative phenomenological study was to explore the lived experiences of several individuals who have implemented a VSU in their correctional facility. Guided by the quality implementation framework (QIF), data collected through semistructured interviews conducted with 7 U.S. correctional administrators were analyzed by reducing the information to significant statements, when combined into themes provided a descriptive analysis. Results from this study affirm that implementing a VSU is a feasible option for many correctional administrators with the desire to address the needs of veteran offenders. Key findings indicate most steps taken to implement a VSU align with quality implementation. Additional results indicate that presently there may be less consideration for VSU implementation processes associated with quality in the areas of ensuring staff training to work with the veterans, and in conducting process evaluations including outcomes tracking. VSUs have a profound and nearly immediate, effect on veteran inmate behaviors and reducing recidivism. This examination of the phenomenon of VSU implementation may offer implementers with evidenced-based practices to advance understanding of VSU implementation in the future, ultimately to benefit veteran offenders and the communities in which they reintegrate.

As a response to the need for efficiency and innovation that modern society hasplaced over healthcare organizations, they are constantly looking for more efficientand innovative tools that facilitate the daily practices for providers. In this context,the use of digital solutions or eHealth arises as an alternative for healthcare.Despite the potential benefits of eHealth solutions, healthcare leaders experiencedifficulties implementing them. For that reason, health services researchersacknowledge the critical role of implementation science in the sector. Seeking tomotivate organizations to embrace eHealth solutions and their benefits, thisresearch identifies the barriers and facilitators experienced by project managersduring the implementation projects of innovations in healthcare. Moreover, itproposes the clarification of concrete criteria to assess success derived from theoutcomes of an implementation project. Starting with a literature review, followedby qualitative research and a data collection through a total of ten semi-structuredinterviews with project managers. Moreover, the data analysis is made based onthematic analysis. The results identify three main facilitators for innovation: 1)maintaining a balanced level of understanding for all stakeholders, 2) to have opencommunication, and 3) to have a high involvement of the top management with theproject. Moreover, the most relevant barrier faced by managers is the lack of skilledand competent people within the organization. Regarding the success ofimplementation projects, the most relevant criteria are: 1) delivering in the righttime, budget, scope and quality (reach the project goals), 2) maintaining thecustomer and user satisfaction, and 3) increase in work efficiency in the healthcareorganizations. To some extent, the mentioned factors contribute to facilitating theimplementation of innovations in healthcare. The role of managers inimplementation is highly valuable since they represent the bridge between topmanagement and front-line employees. This research summarizes the experienceof the managers -from a consultancy company- while working in theimplementation of digital tools in healthcare. Therefore, the research provides abetter understanding regarding the barriers, facilitators and success criteria forimplementation.

Background: Shared decision-making (SDM) counseling for lung cancer screening is recommended by multiple professional societies and mandated by the Center for Medicare and Medicaid Services since lung cancer screening has both benefits and risks. However, uptake of SDM counseling as well as lung cancer screening itself remain low. We sought to develop educational text messages about lung cancer screening as an innovative implementation intervention tool to promote patient-provider discussion about lung cancer screening. Methods: After the study team drafted educational text messages about lung cancer screening, informed by existing decision aids, participants who had had lung cancer screening were recruited and asked to review and edit text messages. After that, participants eligible for lung cancer screening without the previous screening experience were recruited and were asked to select the messages to be included in this text message intervention. The final set of 14 text messages were delivered to the participants both with and without the previous lung cancer screening over a period of 14 days. Participants completed a telephone survey assessing their reactions to the messages after receiving the last message. Results: We successfully involved twelve participants with lung cancer screening experience and eleven lung cancer screening eligible participants without previous screening experience in the development of educational text messages about lung cancer screening. After one participant withdrew, 22 participants received text messages and completed the survey regarding the messages. Most participants (18 of 22) reported reading all 14 text messages, however most recommended sending fewer messages (median recommended number of messages = 10). Participants found the educational text messages informative. Only four participants reported the text messages triggered anxiety and two reported text messages disrupted their daily activities. Participants perceived the text messages would empower patients to discuss lung cancer screening with their providers. Conclusion: Participants generally supported the use of educational text messages about lung cancer screening to increase patients’ awareness and promote patient-provider discussion. Engaging patients in the development and evaluation of text messages elicited helpful feedback that will inform the content of the messages to be delivered via this lung cancer screening text messages intervention.

After cancer patients have completed active cancer treatment, they have specific follow-up care needs. These needs include ongoing surveillance for new and recurring cancers, managing the side effects of cancer treatment, and psychosocial concerns (Rushton et al., 2015). In the past, cancer centres and oncology specialists provided follow-up care; however, new models of care are needed because cancer centres can no longer provide treatment and follow-up care to all cancer survivors (Jefford et al., 2022). To allocate health care resources, low risk cancer survivors (i.e., breast and colorectal cancer survivors) are being discharged from cancer centres after primary treatment back to their primary care provider (PCP) for follow-up care. Survivorship care plans (SCPs) have been identified as a tool to help survivors and their PCPs with this transition (Rushton et al., 2015). SCPs generally consist of a treatment summary, a schedule for follow-up and surveillance tests, and general health recommendations (i.e., diet and exercise; Howell et al., 2011; Ruston et al., 2015). While SCPs are widely accepted, research on their effectiveness as transition tools has been inconclusive (Hill et al., 2019; Jacobsen et al., 2018). Some studies show positive, neutral, and negative impacts of SCP use, and there are three potential reasons for these mixed findings: 1) there is wide variety in the content, format, delivery, and timing of SCPs which adds considerable variance when studying the impact of SCPs; 2) the use of outcomes to measure the usefulness of SCPs as transition tools that are beyond the scope that information about treatment history and follow-up guidelines could impact and; 3) that SCPs are not effective as transition tools (Hill et al., 2019; Jacobsen et al., 2018). An important first step in clarifying whether SCPs are effective transition tools is to understand how SCPs are being used in real world practice (Hill et al., 2019; Jacobsen et al., 2018). The overall purpose of this study was to develop best practice recommendations for implementing SCPs. This was achieved through three study objectives: 1) to comprehensively identify barriers and facilitators perceived to influence SCP use among cancer survivors and primary care providers (PCPs); 2) to identify evidence-based approaches to address barriers and enhance facilitators of SCP use; and 3) to develop best practice recommendations that can be used by implementors of SCPs that are adaptable across different contexts. Article 1 presents the results of semi-structured interviews with breast and colorectal cancer survivors who had received a SCP at least 12 months prior to the interview. The interviews were based on the Theoretical Domains Framework, version two (TDF-2; Cane et al., 2012) and comprehensively identified barriers and facilitators of SCP use amongst breast and colorectal cancer survivors. Thirty cancer survivors (17 female, 13 male) participated in the 30–45-minute interviews, which were then analyzed using content and thematic analysis. Survivors who had received education about the purpose of SCPs and how to use them reported finding their SCP helpful and that they used it to schedule appointments and communicate with their healthcare providers. Barriers to SCP use that were reported by cancer survivors included having lost or not remembering receiving a SCP, not understanding the importance of their SCP, and wanting information about additional supports to be able to follow the SCP (e.g., regular contact from the cancer centre, avenues for peer support). Overall, study 1 found that in order to SCPs to be used as intended transition tools, survivors benefit from receiving education about how to use them and be informed of the expectation that they be actively involved in their follow-up care. Article 2 presents the TDF-based semi-structured interviews with primary care providers (PCPs). Thirteen PCPs completed 15-20 minute interviews, and content and thematic analysis was conducted. PCPs reported finding SCPs helpful and that they contained relevant information to provide follow-up care. A key facilitator of using the SCP was the table of follow-up tasks (e.g., mammography, colonoscopy) and their frequencies included in the SCP. Two significant barriers for PCPs using SCPs were: a) logistical issues with ordering follow-up tests and receiving results; and b) a lack of clear avenues to consult with oncology specialists (e.g., managing side effects of medications, actions that need to be taken when follow-up tests are abnormal). Overall, article 2 showed that PCPs appreciate and readily use SCPs, and contextual changes to facilitate clear avenues of communication between primary and tertiary care may be beneficial when implementing SCPs. Article 3 is a methodology article that presents a detailed explanation and rationale for the implementation science frameworks used and the data analysis chosen. The TDF-2 and Behaviour Change Techniques Taxonomy (BCTTv1; Michie, et al., 2008; Michie et al., 2013). The Human Behaviour Change Project researchers have empirically linked the 14 TDF domains to behaviour change techniques (BCTs), which allowed for multiple options to be developed to address barriers (and promote facilitators) of SCP use among breast and colorectal cancer survivors and PCPs (https://theoryandtechniquetool.humanbehaviourchange.org/tool; Michie et al., 2021). Using the TDF and BCTTv1 showed a dynamic between oncology specialists (e.g., oncologists, oncology nurses), cancer survivors, and PCPs that is involved in ensuring SCPs are implemented in an optimal way. A logic model was used to organize the barriers and enablers into different phases of SCP development, content, delivery, and use by PCPs and cancer survivors in their follow-up care (Mills et al., 2019). A flowchart organizing the recommendations of implementing SCPs was developed, and comprised 10 steps representing interrelationships between cancer centers, PCPs, and cancer survivors. The detailed methodology article also includes lessons learned and suggestions for implementation science researchers using the TDF and BCTTv1. Finally, article 4 is written for anyone looking for guidance implementing SCPs or improving upon how SCPs have been implemented already. It differs from article 3 in that it provides practical solutions for implementers. Because this work generated many recommendations, article 4 provides a worked example of how to use the results of this study. It is written in a way that outlines who would benefit from using the recommendations, and how to use the flow chart to narrow down the recommendation to those most relevant to implementors. The recommendations are organized into one of the 10 relationships in the flow chart, along with the purpose of the recommendations, how to implement it, to whom the recommendation targets, and those responsible for enacting the recommendations. The core factors associated with facilitating SCP use by PCPs and cancer survivors were: a) a treatment summary and follow-up guidelines included in the SCP; b) SCP provided to both cancer survivors and their PCP; and c) educating cancer survivors about their role as self-managers of their own care and the expectation that they participate in their follow-up cancer care. Future research on the usefulness of SCPs in follow-up care should include detailed information about the content, format, and receivers of SCPs and the outcomes most realistically influenced by the information included in SCPs. Before throwing the proverbial baby out with the bathwater, the implementation of SCPs requires additional standardization before meaningful investigation of their effectiveness as transition tools can be conducted.

Yes / Few whole-school physical activity programmes integrate implementation science frameworks within the design, delivery, and evaluation. As a result, knowledge of the key factors that support implementation at scale is lacking. The Creating Active Schools (CAS) programme was co-designed and is underpinned by the Capability, Opportunity, Motivation and Behaviour (COM-B) model and the Consolidated Framework for Implementation Research (CFIR). The study aims to understand the initial impact and implementation of CAS in Bradford over 9 months using McKay's et al.'s (2019) implementation evaluation roadmap. Focus groups and interviews were conducted with school staff (n = 30, schools = 25), CAS Champions (n = 9), and the CAS strategic lead (n = 1). Qualitative data were analysed both inductively and deductively. The deductive analysis involved coding data into a priori themes based on McKay et al's implementation evaluation roadmap, using a codebook approach to thematic analysis. The inductive analysis included producing initial codes and reviewing themes before finalising. Identified themes aligned into three categories: (i) key ingredients for successful adoption and implementation of CAS, (ii) CAS implementation: challenges and solutions, and (iv) the perceived effectiveness of CAS at the school level. This included the willingness of schools to adopt and implement whole-school approaches when they are perceived as high quality and aligned with current school values. The programme implementation processes were seen as supportive; schools identified and valued the step-change approach to implementing CAS long-term. Formal and informal communities of practice provided "safe spaces" for cross-school support. Conversely, challenges persisted with gaining broader reach within schools, school staff's self-competence and shifting school culture around physical activity. This resulted in varied uptake between and within schools. This study provides novel insights into the implementation of CAS, with outcomes aligning to the adoption, reach, and sustainability. Successful implementation of CAS was underpinned by determinants including acceptability, intervention complexity, school culture and school stakeholders' perceived self-efficacy. The combination of McKay's evaluation roadmap and CFIR establishes a rigorous approach for evaluating activity promotion programmes underpinned by behavioural and implementation science. Resultantly this study offers originality and progression in understanding the implementation and effectiveness of whole-school approaches to physical activity. / Higher Education Innovation Fund (UKRI), Sport England’s Local Delivery Pilot in Bradford, Bradford District Metropolitan Council via the Living Well Programme / Research Development Fund Publication Prize Award winner, Jun 2023.

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<p dir="ltr"><b>Background</b></p><p dir="ltr">Recent developments in cancer therapeutics have allowed increased use of Oral Anticancer Medications (OAMs), including in the treatment of breast cancer. Breast cancer is the most common cancer among women in the United States. Patients with breast cancer may face key barriers in managing their OAMs at home. These challenges can lead to sub-optimal adherence and lower the overall quality of life. Designing interventions that enhance the patient experience with use of OAMs requires a deeper understanding of barriers faced by patients as they navigate their cancer care journey. The objective of this study was to identify the unmet medication management needs of patients with breast cancer who are receiving OAMs and co-design an early prototype intervention with patients to support medication management needs of patients with breast cancer.</p><p dir="ltr"><b>Methods</b></p><p dir="ltr">Two phases comprise this study. Phase 1 involved patient-journey mapping to characterize the longitudinal experience of OAMs use among patients diagnosed with breast cancer. In phase 2, we conducted participatory design (PD) workshops to develop a prototype tool to address OAM needs identified in phase 1. All participants were recruited from an outpatient breast cancer clinic in Indianapolis. Eligible participants were: 18 years of age or older, diagnosed with breast cancer, and currently receiving an OAM. All participants completed a brief sociodemographic and health information questionnaire. In phase 1, enrolled persons participated in a journey mapping exercise through semi-structured interviews. Interviews were conducted either in-person or remotely via Zoom, based on participant preference. For each interview, two researchers and the participant collaborated to create individual patient journey maps to generate a concise visual storyboard focused on medication use experiences related to OAMs. The journey maps helped capture treatment timelines, key markers of medication use, and specific barriers faced by patients. Individual journey maps were consolidated to generate personas representing groups of patients with related characteristics, treatment types, goals, and unmet needs. In phase 2, three rounds of PD workshops were conducted using the focus group format to develop an early prototype intervention. In round one (inspiration stage), participants defined the problem space and prioritized a list of challenges amenable to solutions; in round two (ideation stage), participants generated multiple possible solutions and design ideas; and in round three (convergence stage), two design concepts were selected and evaluated by participants.</p><p dir="ltr"><b>Results</b></p><p dir="ltr">In phase 1, 12 interviews (11 females and 1 male) were completed. The median age of participants was 65.5 years (range, 37-75). Participants were divided into two groups based on their prescribed medication types: (1) specialty medication (palbociclib or ribociclib; n=4 patients) and (2) traditional medication (tamoxifen, anastrozole, or exemestane; n=8 patients). We defined ‘Specialty’ medications as those that require specialty pharmacies and ‘traditional’ medications as those obtainable in local community pharmacies. To represent participants across these two broad categories of medications, two personas were created. Participants who had been prescribed specialty medication reported difficulty navigating the insurance process during medication fills, while participants who prescribed traditional medication did not. Notably, the word “prior authorization” was not used by participants to explain the issues they experienced. While all participants reported having side effects from their medications, sub-optimal adherence (n=2) was reported among the traditional medication group only. Other participants taking traditional medications either found their own ways to manage side effects or simply reported: “dealing with side effects as I don’t want cancer.” Participants expressed coping with side effects by enduring them. Participants had few strategies to manage their side effects, often stating that “they didn’t think of reaching out to the doctor,” when asked. Additionally, participants mentioned needing more financial and emotional support during their treatment journey. In phase 2, each PD session was conducted with 4-5 participants and 2 researchers (the design panel). Participants identified key challenges including difficulties navigating resources and information as well as managing medication side effects. The design panel prioritized two design concepts, which were subsequently developed into two prototypes: 1) a physical breast cancer handbook; and 2) an interactive treatment navigation app for use on tablet and smartphone devices. Our team plans to consolidate, further develop, and evaluate these prototypes in subsequent work as a follow up to this pilot study.</p><p dir="ltr"><b>Conclusion</b></p><p dir="ltr">This study provides insight into the patient experience with OAMs. The personas created can be applied in designing interventions tailored to breast cancer patients’ needs and goals, while the consolidated journey maps identify potential areas for improvement. Adequate patient education and enhanced tools and processes are necessary to manage medication side effects effectively, ultimately leading to improved medication outcomes and assisting patients in navigating their treatment. The two design concepts require further revision prior to implementation and pilot testing.</p>

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Background: The World Health Organization recommends early breastfeeding initiation, within the first hour of life. Ugandan mothers with no formal schooling appear superior in fulfilling this recommendation compared to mothers with primary, secondary, or higher education. Aim: This secondary analysis of Ugandan Demographic and Health Survey data from 2016 aimed to statistically analyze the association between maternal education and early breastfeeding initiation, to find socio-economic and health care determinants that promote the behavior. Methods: Ugandan mothers (n=9,209, 15 to 49 years) were included in statistical analysis. Chi-squared testing and logistic regression were used to assess associations between maternal education (exposure) and fulfillment of early breastfeeding initiation less than 1 hour after birth (outcome). Results: Out of the eligible mothers in a weighted sample, 68% (n=6,281) fulfilled early breastfeeding initiation and 32% (n=2,928) did not meet the criteria. Maternal primary education significantly predicted the outcome of early breastfeeding initiation (p ≤ 0.05, AOR: 0.80, with 95% CI 0.67-0.95) in a negative direction, compared to uneducated mothers. This result was adjusted for maternal residence, education, occupation, and parity, along with the husband/partner's education. Moreover, educational attainment beyond the primary level indicated a non-significant association to the criteria fulfillment when compared to uneducated mothers. Conclusions: Ugandan maternal education does not seem to significantly promote early BFI behavior. Primary level education only indicated a significantly negative association compared to uneducated Ugandan mothers. Traditional lifestyle factors (lower level education, and corresponding level of occupation, and larger families) appeared to be associated with the desired behavior.