Children's Participation in Environment Research Lab, College of Applied Health Sciences, University of Illinois Chicago, Chicago, Illinois, United States.
Department of Occupational Therapy, University of Illinois Chicago, Chicago, Illinois, United States.
Appl Clin Inform. 2023 Jan;14(1):91-107. doi: 10.1055/s-0042-1760631. Epub 2023 Feb 1.
The aim of the study is to identify and prioritize early intervention (EI) stakeholders' perspectives of supports and barriers to implementing the Young Children's Participation and Environment Measure (YC-PEM), an electronic patient-reported outcome (e-PRO) tool, for scaling its implementation across multiple local and state EI programs.
An explanatory sequential (quan > QUAL) mixed-methods study was conducted with EI families ( = 6), service coordinators ( = 9), and program leadership ( = 7). Semi-structured interviews and focus groups were used to share select quantitative pragmatic trial results (e.g., percentages for perceived helpfulness of implementation strategies) and elicit stakeholder perspectives to contextualize these results. Three study staff deductively coded transcripts to constructs in the Consolidated Framework for Implementation Research (CFIR). Data within CFIR constructs were inductively analyzed to generate themes that were rated by national early childhood advisors for their relevance to longer term implementation.
All three stakeholder groups (i.e., families, service coordinators, program leadership) identified thematic supports and barriers across multiple constructs within each of four CFIR domains: (1) Six themes for "intervention characteristics," (2) Six themes for "process," (3) three themes for "inner setting," and (4) four themes for "outer setting." For example, all stakeholder groups described the value of the YC-PEM e-PRO in forging connections and eliciting meaningful information about family priorities for efficient service plan development ("intervention characteristics"). Stakeholders prioritized reaching families with diverse linguistic preferences and user navigation needs, further tailoring its interface with automated data capture and exchange processes ("process"); and fostering a positive implementation climate ("inner setting"). Service coordinators and program leadership further articulated the value of YC-PEM e-PRO results for improving EI access ("outer setting").
Results demonstrate the YC-PEM e-PRO is an evidence-based intervention that is viable for implementation. Optimizations to its interface are needed before undertaking hybrid type-2 and 3 multisite trials to test these implementation strategies across state and local EI programs with electronic data capture capabilities and diverse levels of organizational readiness and resources for implementation.
本研究旨在确定并优先考虑早期干预（EI）利益相关者对实施《幼儿参与和环境测量表》（YC-PEM）的支持和障碍的观点，YC-PEM 是一种电子患者报告结局（e-PRO）工具，旨在将其在多个地方和州 EI 计划中进行推广。
采用解释性顺序（quan > QUAL）混合方法研究，涉及 EI 家庭（ = 6）、服务协调员（ = 9）和项目领导（ = 7）。使用半结构化访谈和焦点小组分享了部分定量实用试验结果（例如，对实施策略的有用性的感知百分比），并引出了利益相关者的观点，以对这些结果进行背景化。三名研究人员对转录本进行了演绎编码，以构建实施研究综合框架（CFIR）中的结构。在 CFIR 结构内对数据进行了归纳分析，以生成主题，并由国家幼儿顾问对其与长期实施的相关性进行评分。
所有三个利益相关者群体（即家庭、服务协调员、项目领导）都在 CFIR 四个领域的多个结构中确定了主题支持和障碍：（1）“干预特征”有六个主题，（2）“过程”有六个主题，（3）“内部环境”有三个主题，（4）“外部环境”有四个主题。例如，所有利益相关者群体都描述了 YC-PEM e-PRO 在建立联系和引出有关家庭服务计划制定优先级的有意义信息方面的价值（“干预特征”）。利益相关者优先考虑满足具有不同语言偏好和用户导航需求的家庭，进一步调整其与自动化数据捕获和交换流程的接口（“过程”），并营造积极的实施氛围（“内部环境”）。服务协调员和项目领导进一步阐述了 YC-PEM e-PRO 结果在改善 EI 可及性方面的价值（“外部环境”）。
结果表明，YC-PEM e-PRO 是一种可行的基于证据的干预措施。在进行混合类型 2 和 3 多地点试验以在具有电子数据捕获能力和不同水平的组织准备和实施资源的州和地方 EI 计划中测试这些实施策略之前，需要对其接口进行优化。
