Ashcraft Laura Ellen, Moon Deborah J, Merlin Jessica S, Eack Shaun M, Rogal Shari S
Center for Health Equity Research and Promotion, Corporal Michael Crescenz VA Medical Center, Philadelphia, PA, USA.
School of Social Work, University of Pittsburgh, Pittsburgh, PA, USA.
Implement Sci Commun. 2022 Dec 9;3(1):128. doi: 10.1186/s43058-022-00378-z.
Precision implementation science requires methods to evaluate and select implementation strategies. This study developed and evaluated a novel measure of concordance between current and preferred dissemination channels (DC) and implementation strategies (IS) to guide efforts to improve the adoption of evidence-based management strategies for chronic pain.
We conducted a one-time electronic survey of Pennsylvania primary care practitioners (PCPs) about current vs. preferred chronic pain management DC and IS use. Survey items were selected based on preliminary data, the Model for Dissemination of Research, and the Evidence-Based Recommendations for Implementing Change taxonomy of implementation strategies. We used Cohen's kappa (κ) to assess the agreement between participant-level current and preferred DC/IS. We calculated % preferred minus % experienced for each DC/IS and assessed the equality of proportions to determine whether this difference significantly departed from zero. We categorized DC and IS based on the degree of use and preference, to evaluate alignment.
The current sample included 101 Pennsylvania PCPs primarily in urban (94.06%), non-academic (90.10%) settings who self-identified as mostly female (66.34%) and white (85.15%). The greatest difference between preferred and experienced DCs, or "need," was identified by participants as workshops, clinical experts, seminars, and researchers. Similarly, participants reported the greatest IS gaps as multidisciplinary chronic pain workgroups, targeted support for clinicians, and a chronic pain clinical champion. Participating PCPs had moderate DC concordance (kappa = 0.45, 95% CI = 0.38-0.52) and low IS concordance (kappa = 0.18, 95% CI = 0.13-0.23). DC and IS concordance were both greater than that expected by chance. We further identified well-aligned DC and IS, including professional organizations, briefs, and guidelines.
We identified a novel implementer-reported outcome of dissemination channel and implementation strategy concordance that allows implementation scientists to quantify the magnitude of the gap between the current and preferred experience of implementers. This quantitative measure can help with the selection and evaluation of dissemination channels and implementation strategies. Future research should leverage this measure to understand the degree to which preference concordance influences clinical outcomes and performance.
精准实施科学需要评估和选择实施策略的方法。本研究开发并评估了一种衡量当前与首选传播渠道（DC）及实施策略（IS）之间一致性的新方法，以指导改善慢性疼痛循证管理策略采用情况的工作。
我们对宾夕法尼亚州的初级保健从业者（PCP）进行了一次电子调查，内容涉及当前与首选的慢性疼痛管理DC及IS的使用情况。调查项目是根据初步数据、研究传播模型以及实施策略的循证变革建议分类法选定的。我们使用科恩kappa系数（κ）来评估参与者层面当前与首选DC/IS之间的一致性。我们计算了每个DC/IS的首选百分比减去体验百分比，并评估比例的相等性，以确定这种差异是否显著偏离零。我们根据使用程度和偏好对DC和IS进行分类，以评估一致性。
当前样本包括101名宾夕法尼亚州的PCP，主要来自城市（94.06%）、非学术机构（90.10%），他们自我认定大多为女性（66.34%）和白人（85.15%）。参与者认为首选与体验到的DC之间最大的差异，即“需求”，在于研讨会、临床专家、研讨会和研究人员。同样，参与者报告的IS差距最大的是多学科慢性疼痛工作组、针对临床医生的定向支持以及慢性疼痛临床倡导者。参与的PCP在DC方面具有中等一致性（kappa = 0.45，95% CI = 0.38 - 0.52），在IS方面具有低一致性（kappa = 0.18，95% CI = 0.13 - 0.23）。DC和IS的一致性均高于随机预期。我们进一步确定了一致性良好的DC和IS，包括专业组织、简报和指南。
我们确定了一种新的由实施者报告的传播渠道和实施策略一致性结果，这使实施科学家能够量化实施者当前与首选体验之间差距的大小。这种定量测量有助于传播渠道和实施策略的选择与评估。未来的研究应利用这一测量方法来了解偏好一致性对临床结果和绩效的影响程度。
