School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, USA.
RTI International, Durham, USA.
Implement Sci. 2018 Mar 20;13(1):48. doi: 10.1186/s13012-018-0738-5.
The U.S. Centers for Disease Control and Prevention (CDC) develops tools to support implementation of evidence-based interventions for school health. To advance understanding of factors influencing the use of these implementation tools, we conducted an evaluation of state, school district, and local school staffs' use of four CDC tools to support implementation of physical activity, nutrition, health education, and parent engagement. Two frameworks guided the evaluation: Interactive Systems Framework (ISF) for Dissemination and Implementation and Consolidated Framework for Implementation Research (CFIR).
The evaluation applied a mixed methods, cross-sectional design that included online surveys (n = 69 state staff from 43 states), phone interviews (n = 13 state staff from 6 states), and in-person interviews (n = 90 district and school staff from 8 districts in 5 states). Descriptive analyses were applied to surveys and content analysis to interviews.
The survey found that the majority of state staff surveyed was aware of three of the CDC tools but most were knowledgeable and confident in their ability to use only two. These same two tools were the ones for which states were most likely to have provided training and technical assistance in the past year. Interviews provided insight into how tools were used and why use varied, with themes organized within the ISF domain "support strategies" (e.g., training, technical assistance) and four CFIR domains: (1) characteristics of tools, (2) inner setting, (3) outer setting, and (4) individuals. Overall, tools were valued for the credibility of their source (CDC) and evidence strength and quality. Respondents reported that tools were too complex for use by school staff. However, if tools were adaptable and compatible with inner and outer setting factors, state and district staff were willing and able to adapt tools for school use.
Implementation tools are essential to supporting broad-scale implementation of evidence-based interventions. This study illustrates how CFIR and ISF might be applied to evaluate factors influencing tools' use and provides recommendations for designing tools to fit within the multi-tiered systems involved in promoting, supporting, and implementing evidence-based interventions in schools. Findings have relevance for the design of implementation tools for use by other multi-tiered systems.
美国疾病控制与预防中心（CDC）开发工具，以支持学校卫生循证干预措施的实施。为了深入了解影响这些实施工具使用的因素，我们对州、学区和地方学校工作人员使用 CDC 四项工具来支持体育活动、营养、健康教育和家长参与的情况进行了评估。两个框架指导了评估：传播和实施的互动系统框架（ISF）和实施研究的综合框架（CFIR）。
该评估采用了混合方法、横断面设计，包括在线调查（来自 43 个州的 69 名州工作人员）、电话访谈（来自 6 个州的 13 名州工作人员）和现场访谈（来自 5 个州的 8 个学区和 90 名工作人员）。对调查进行了描述性分析，对访谈进行了内容分析。
调查发现，大多数接受调查的州工作人员都知道 CDC 的三项工具，但大多数人只了解并对使用其中两项工具的能力有信心。这些也是过去一年各州最有可能提供培训和技术援助的工具。访谈提供了有关工具使用方式和使用差异原因的深入了解，主题组织在 ISF 领域“支持策略”（例如培训、技术援助）和 CFIR 的四个领域内：（1）工具的特征，（2）内部环境，（3）外部环境，和（4）个人。总体而言，工具因其来源（CDC）的可信度和证据的强度和质量而受到重视。受访者报告称，工具对学校工作人员来说过于复杂。然而，如果工具具有适应性并且与内部和外部环境因素相兼容，州和地区工作人员愿意并且能够根据学校的需求调整工具。
实施工具对于支持循证干预措施的广泛实施至关重要。本研究说明了如何应用 CFIR 和 ISF 来评估影响工具使用的因素，并为设计适合在促进、支持和实施学校循证干预措施的多层次系统中使用的工具提供了建议。研究结果对设计用于其他多层次系统的实施工具具有重要意义。
