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 @ ActiveAgingRT

Shining a lig ht o n the imple me nta tio n to sc a le - up c o ntinuum: Pro f He a the r Mc K a y Ho w do e s it a pply to he a lth F a c ulty o f Me dic ine , UBC pro mo ting I nno va tio ns? he a the r.mc ka y@ UBC.c a www.activeagingrt.ca @ActiveAgingRT www.choosetomove.info

T RANSL AT I ON T O POPUL AT I ONS 65% Institutionalization Descriptive 23% Efficacy 3% 13% Effectiveness Scale-up How will benefits reach Will it work in a Will it work in a the whole population? ‘real world’ setting? controlled setting? Adapted from Milat AJ et. al. BMC Public Health 2011

Why study imple me nta tio n a nd sc a le -up? Imple me ntation gap Re se ar c h- to- Pr ac tic e gap No t use d a s inte nde d, Wha t is kno wn is no t susta ina b le , no t wha t is a do pte d no t a t sc a le Po pula tio n Re se a rc h I mple me nta tio n I mple me nta tio n Pra c tic e le ve l (kno wle dg e ) Sc a le -up o utc o me s 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 : • de fine imple me nta tio n, imple me nta tio n sc ie nc e , sc a le -up a nd sc a la b ility; • de sc rib e the c e ntra l te ne ts o f imple me nta tio n a nd sc a le up fra me wo rks in he a lth pro mo tio n; • de sc rib e c e ntra l te ne ts o f imple me nta tio n a nd sc a le -up e va lua tio n; • a pply the ir le a rning to a re a l wo rld se tting (? )

Wha t is imple me nta tio n pra c tic e ? • T 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 • T 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.

I mple me nta tio n sc ie nc e “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.

Wha t is imple me nta tio n sc ie nc e ? …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

Wha t is sc a le -up? • Pro c e ss o f e xpa nding the c o ve ra g e o f he a lth inte rve ntio n Mang ham & Hanso n. He alth Po lic y Plan. 2010, 25(2):85-96 . • De lib e ra te e ffo rts to inc re a se the impa c t o f 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 e xpa ndne t.ne t xpandNe t: http://

Wha t is sc a la b ility? 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

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F ra me wo rks 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 rk s) ab ak e t.al. Am J Prev Med 2012;43(3):337–350 T

Mo difie d De lphi pro c e ss T hre e ro unds o f o nline surve ys Two rounds of expert group meetings 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

I mple me nta tio n fra me wo rks & mo de ls • F 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 • Co nso lida te d F 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 • Dyna mic Susta ina b ility F ra me wo rk Chamb e rs e t al. I mple me nt Sc i. 2013;8:117

F ra me wo rks CF I R- 5 F ACT ORS Outer setting Innovation Inner setting Individual Implementation Damschroder LJ et. al. Implementation Science 2009

ra me wo rk fo r e ffe c tive imple me nta tio n F Community F ac tor s Pr ovide r 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 Knowle dg e Pre ve ntion E ffe c tive synthe sis a nd Suppor t De live ry Imple me ntation tra nsla tion syste m Syste m Syste m Durlak and DuPre . Am J Co mmunity Psyc ho l, 2008

Sc a le -up fra me wo rks • Sc a ling Up He a lth Se rvic e I nno va tio ns - A F ra me wo rk fo r Ac tio n. Simmo ns e t al. WHO; 2007 • I 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 • Sc a ling -Up: A F ra me wo rk fo r Suc c e ss Yame y. PL o SMe d. 2011;8(6):e 1001049.)

Pro c e ss mo de ls & the o rie s • Ste ps to De ve lo ping a Sc a le -Up Stra te g y WHO, E XPANDNE T , 2010 • Re vie w o f Sc a le -Up/ F 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 • 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)

I nte rve ntio n Sc a la b ility Asse ssme nt T o o l 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)

K e y E le me nts o f Suc c e ssful Sc a le -Up T HE I NNOVAT I ON Ada pta b le PROVIDER CHARACTERISTICS F e a sib le Pa rtne rships COMMUNI T Y L E VE L T ra ining a nd te c hnic a l suppo rt Affo rda b le So und the o ry a nd Co mmunic a tio n a c ro ss multiple re se a rc h a udie nc e s Po litic a l will Cha mpio ns F unding L e a de rship Po lic y E va lua tio n a nd fe e db a c k Naylo r e t. al. and Mc Kay 2006

Sc a le -up WHE RE DOE S SCAL E -UP BE GI N?

Sc a le a nd Re a c h o f the inte rve ntio n Sc a le - up Scale-up is a process Imple me nta tion Susta ina b ility Studie s I mple me nta tio n Ada pta tio n E ffe c tive ne ss Not an end-point (q ua si-e xp. tria ls) E ffic a c y (RCT ) Pre inte rve ntio n (pilo t tria ls)

F oc us of the e va lua tion shifts Sc a le - up Imple me nta tion Susta ina b ility Studie s I mple me nta tio n No Ada pta tio n sta nda rd E ffe c tive ne ss o rde r (q ua si-e xp. tria ls) E ffic a c y (RCT ) So urc e : a da pte d fro m Pre inte rve ntio n Mila t e t a l. BMC Pub lic He a lth, 2011, 11:934 (pilo t tria ls) Pinno c k e t a l. BMJ 2017;356:i6795

F ide lity Ada pta tio n Imple me nta tion Inte r ve ntion Stirman et al., 2013; Castro et al., 2004; Harden et al., 2017

A CASE ST UDY

One -o n-o ne Co nsulta tio n (x1) Mo tiva tio na l Gro up Me e ting s (x4) T e le pho ne Che c k-ins (x10) x3 x2 x2 Ma inte na nc e Ac tive Pha se Pha se Baseline 3 mo nths 6 mo nths

Cho o se to Mo ve Pha se s 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