Adjognon Omonyêlé L, Brady Julianne E, Iverson Katherine M, Stolzmann Kelly, Dichter Melissa E, Lew Robert A, Gerber Megan R, Portnoy Galina A, Iqbal Samina, Haskell Sally G, Bruce Le Ann E, Miller Christopher J
Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA.
Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA.
Implement Sci Commun. 2023 Nov 21;4(1):145. doi: 10.1186/s43058-023-00528-x.
Intimate partner violence (IPV) is a prevalent social determinant of health. The US Preventive Services Task Force recommends routine IPV screening of women, but uptake remains variable. The Veterans Health Administration (VHA) initiated implementation facilitation (IF) to support integration of IPV screening programs into primary care clinics. An evaluation of IF efforts showed variability in IPV screening rates across sites. The follow-up study presented here used a Matrixed Multiple Case Study (MMCS) approach to examine the multilevel factors impacting IPV screening program implementation across sites with varying levels of implementation success.
This mixed methods study is part of a larger cluster randomized stepped wedge Hybrid-II program evaluation. In the larger trial, participating sites received 6 months of IF consisting of an external facilitator from VHA's Office of Women's Health working closely with an internal facilitator and key site personnel. Recognizing the heterogeneity in implementation outcomes across sites, the MMCS approach was used to enable interpretation of qualitative and quantitative data within and across sites to help contextualize the primary findings from the larger study. Qualitative data collection was guided by the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework and included interviews with key informants involved in IPV screening implementation at eight sites. Quantitative data on IPV screening uptake was derived from medical records and surveys completed by key personnel at the same eight sites to understand implementation facilitation activities.
Fifteen factors influencing IPV screening implementation spanning all four i-PARIHS domains were identified and categorized into three distinct categories: (1) factors with enabling influence across all sites, (2) factors deemed important to implementation success, and (3) factors differentiating sites with high/medium versus low implementation success.
Understanding the influencing factors across multi-level domains contributing to variable success of IPV screening implementation can inform the tailoring of IF efforts to promote spread and quality of screening. Implementation of IPV screening programs in primary care with IF should consider consistent engagement of internal facilitators with clinic staff involved in implementation, the resourcefulness of external facilitators, and appending resources to IPV screening tools to help key personnel address positive screens.
ClinicalTrials.gov NCT04106193. Registered on September 26, 2019.
亲密伴侣暴力（IPV）是一种普遍存在的健康社会决定因素。美国预防服务工作组建议对女性进行常规的IPV筛查，但筛查的接受程度仍然存在差异。退伍军人健康管理局（VHA）启动了实施促进（IF）工作，以支持将IPV筛查项目纳入初级保健诊所。对IF工作的一项评估显示，各地点的IPV筛查率存在差异。本文介绍的后续研究采用矩阵式多案例研究（MMCS）方法，以检查在实施成功程度不同的各地点影响IPV筛查项目实施的多层次因素。
这项混合方法研究是一项更大规模的整群随机阶梯楔形混合II项目评估的一部分。在更大规模的试验中，参与的地点接受了为期6个月的IF，由VHA妇女健康办公室的一名外部促进者与一名内部促进者及关键地点人员密切合作。认识到各地点实施结果的异质性，采用MMCS方法来解释各地点内部和之间的定性和定量数据，以帮助将更大规模研究的主要结果置于具体背景中。定性数据收集以卫生服务研究实施促进综合框架（i-PARIHS）为指导，包括对八个地点参与IPV筛查实施的关键信息提供者进行访谈。关于IPV筛查接受情况的定量数据来自相同八个地点的关键人员完成的病历和调查，以了解实施促进活动。
确定了影响IPV筛查实施的15个因素，涵盖i-PARIHS的所有四个领域，并分为三个不同类别：（1）对所有地点都有促进影响的因素；（2）对实施成功至关重要的因素；（3）区分实施成功程度高/中等与低的地点的因素。
了解跨多层次领域导致IPV筛查实施成功程度不同的影响因素，可以为调整IF工作以促进筛查的推广和质量提供参考。在初级保健中通过IF实施IPV筛查项目应考虑让内部促进者持续与参与实施的诊所工作人员互动、外部促进者的应变能力，以及为IPV筛查工具增加资源，以帮助关键人员处理阳性筛查结果。
ClinicalTrials.gov NCT04106193。于2019年9月26日注册。
