Egeland Karina Myhren, Borge Randi Hovden, Peters Nadina, Bækkelund Harald, Braathu Nora, Sklar Marisa, Aarons Gregory A, Skar Ane-Marthe Solheim
Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Gullhaugveien 1, 0484, Oslo, Norway.
National Institute of Occupational Health, Gydas vei 8, 0363, Oslo, Norway.
Implement Sci Commun. 2023 Jul 11;4(1):75. doi: 10.1186/s43058-023-00459-7.
Leaders can improve implementation outcomes by developing an organizational climate conducive to the implementation of evidence-based practices (EBP). This study tested the lagged associations between individual-level perceptions of implementation leadership, implementation climate, and three anticipated implementation outcomes, that is EBP acceptability, appropriateness, and feasibility.
Screening tools and treatment methods for posttraumatic stress disorder were implemented in 43 Norwegian mental health services. A sample of 494 child and adult mental health care professionals (M = 43 years, 78% female) completed surveys addressing perceptions of first-level leaders' (n = 47) implementation leadership and their clinics' implementation climate. Single-level structural equation models estimating both direct, indirect, and total effects were used to investigate whether perceived implementation climate mediated the association between perceived implementation leadership and perceived acceptability, appropriateness, and feasibility of screening tools and treatment methods.
Regarding the treatment methods, implementation leadership was associated with therapists' perceptions of acceptability, appropriateness, and feasibility. Implementation climate also mediated between implementation leadership and the outcomes. Regarding the screening tools, implementation leadership was not associated with the outcomes. However, implementation climate mediated between implementation leadership and therapists' perceptions of acceptability and feasibility, but not appropriateness. Analyses with the implementation climate subscales showed stronger associations for therapists' perceptions of the treatment methods than of screening tools.
Leaders may promote positive implementation outcomes, both directly and through implementation climate. With regard to the effect sizes and explained variance, results indicated that both implementation leadership and implementation climate were more strongly associated with the therapists' perceptions of the treatment methods, implemented by one group of therapists, than the screening tools, implemented by all therapists. This may imply that implementation leadership and climate may have stronger effects for smaller implementation teams within a larger system than for system-wide implementations or when the clinical interventions being implemented are more complex rather than simple ones.
ClinicalTrials NCT03719651, 25 October 2018.
领导者可以通过营造有利于实施循证实践（EBP）的组织氛围来改善实施效果。本研究检验了个体层面的实施领导力认知、实施氛围与三种预期的实施效果（即EBP的可接受性、适宜性和可行性）之间的滞后关联。
在43家挪威心理健康服务机构中实施创伤后应激障碍的筛查工具和治疗方法。494名儿童和成人心理健康护理专业人员（平均年龄43岁，78%为女性）参与了调查，内容涉及对一级领导者（共47人）实施领导力的认知以及其所在诊所的实施氛围。采用单水平结构方程模型估计直接、间接和总体效应，以研究感知到的实施氛围是否介导了感知到的实施领导力与筛查工具和治疗方法的感知可接受性、适宜性和可行性之间的关联。
对于治疗方法，实施领导力与治疗师对可接受性、适宜性和可行性的认知相关。实施氛围也在实施领导力与这些结果之间起中介作用。对于筛查工具，实施领导力与这些结果无关。然而，实施氛围在实施领导力与治疗师对可接受性和可行性的认知之间起中介作用，但在适宜性方面不起中介作用。对实施氛围子量表的分析表明，治疗师对治疗方法的认知关联强于对筛查工具的认知关联。
领导者可以直接或通过实施氛围促进积极的实施效果。就效应大小和解释方差而言，结果表明，与所有治疗师都实施的筛查工具相比，实施领导力和实施氛围与一组治疗师实施的治疗方法的治疗师认知关联更强。这可能意味着，在更大系统中，实施领导力和氛围对较小的实施团队可能比对全系统实施有更强的影响，或者当所实施的临床干预更复杂而非简单时也是如此。
ClinicalTrials NCT03719651，2018年10月25日。
