Kepper Maura M, Gierbolini-Rivera Raúl D, Weaver Kathryn E, Foraker Randi E, Dressler Emily V, Nightingale Chandylen L, Aguilar Aylin A, Wiseman Kimberly D, Hanna Jenny, Throckmorton Alyssa D, Craddock Lee Simon
Prevention Research Center, Washington University in St. Louis, St. Louis, MO, USA.
Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
Transl Behav Med. 2025 Jan 16;15(1). doi: 10.1093/tbm/ibae058.
Digital health tools are positive for delivering evidence-based care. However, few studies have applied rigorous frameworks to understand their use in community settings. This study aimed to identify implementation determinants of the Automated Heart-Health Assessment (AH-HA) tool within outpatient oncology settings as part of a hybrid effectiveness-implementation trial. A mixed-methods approach informed by the Consolidated Framework for Implementation Research (CFIR) examined barriers and facilitators to AH-HA implementation in four NCI Community Oncology Research Program (NCORP) practices participating in the WF-1804CD AH-HA trial. Provider surveys were analyzed using descriptive statistics. Interviews with providers (n = 15) were coded using deductive (CFIR) and inductive codes by trained analysts. The CFIR rating tool was used to rate each quote for (i) valence, defined as a positive (+) or negative (-) influence, and (ii) strength, defined as a neutral (0), weak (1), or strong (2) influence on implementation. All providers considered discussing cardiovascular health with patients as important (61.5%, n = 8/13) or somewhat important (38.5%, n = 5/13). The tool was well-received by providers and was feasible to use in routine care among cancer survivors. Providers felt the tool was acceptable and usable, had a relative advantage over routine care, and had the potential to generate benefits for patients. Common reasons clinicians reported not using AH-HA were (i) insufficient time and (ii) the tool interfering with workflow. Systematically identifying implementation determinants from this study will guide the broader dissemination of the AH-HA tool across clinical settings and inform implementation strategies for future scale-up hybrid trials.
数字健康工具对于提供循证护理具有积极意义。然而，很少有研究应用严谨的框架来了解其在社区环境中的使用情况。本研究旨在确定门诊肿瘤环境中自动心脏健康评估（AH-HA）工具的实施决定因素，作为一项混合效果-实施试验的一部分。采用以实施研究综合框架（CFIR）为指导的混合方法，研究了参与WF-1804CD AH-HA试验的四个美国国立癌症研究所社区肿瘤研究项目（NCORP）机构中AH-HA实施的障碍和促进因素。使用描述性统计分析提供者调查。由训练有素的分析人员对与提供者进行的访谈（n = 15）使用演绎（CFIR）和归纳编码进行编码。CFIR评分工具用于对每条引述进行评分，包括（i）效价，定义为积极（+）或消极（-）影响，以及（ii）强度，定义为对实施的中性（0）、弱（1）或强（2）影响。所有提供者都认为与患者讨论心血管健康很重要（61.5%，n = 8/13）或有些重要（38.5%，n = 5/13）。该工具受到提供者的好评，并且在癌症幸存者的常规护理中使用是可行的。提供者认为该工具是可接受且可用的，相对于常规护理具有相对优势，并且有可能为患者带来益处。临床医生报告不使用AH-HA的常见原因是（i）时间不足和（ii）该工具干扰工作流程。从本研究中系统地确定实施决定因素将指导AH-HA工具在更广泛的临床环境中的传播，并为未来扩大规模的混合试验的实施策略提供信息。
