scholarly journals Increases in Secondhand Smoke After Going Smoke-Free: An Assessment of the Impact of a Mandated Smoke-Free Housing Policy

2020 ◽  
Vol 22 (12) ◽  
pp. 2254-2256 ◽  
Author(s):  
Andrew D Plunk ◽  
Vaughan W Rees ◽  
Anna Jeng ◽  
Jasilyn A Wray ◽  
Richard A Grucza
Keyword(s):  
Public Housing ◽  
Secondhand Smoke ◽  
Implementation Strategies ◽  
Successful Implementation ◽  
Community Agencies ◽  
Smoking Policy ◽  
Multi Level ◽  
Support Housing ◽  
The Impact

Abstract Objective The 12-month impact of federally mandated smoke-free housing (SFH) policy adoption (July 2018) was assessed using two markers of ambient secondhand smoke (SHS): airborne nicotine and particulate matter at the 2.5-micrometer threshold (PM2.5). Methods We measured markers of SHS in Norfolk, VA from December 2017 to December 2018 in six federally subsidized multi-unit public housing buildings. Multi-level regression was used to model the following comparisons: (1) the month immediately before SFH implementation versus the month immediately after, and (2) December 2017 versus December 2018. Results There was a 27% reduction in indoor PM2.5 and a 32% reduction in airborne nicotine in the first month after SFH adoption, compared to the month prior to adoption. However, there was a 33% increase in PM2.5 and a 25% increase in airborne nicotine after 12 months. Conclusions US Department of Housing and Urban Development (HUD)-mandated SFH can reduce SHS in multi-unit housing. However, SFH could also plausibly increase indoor smoking. Policy approaches adopted by individual properties or housing authorities—for example, property-wide bans versus allowing designated smoking areas—could be driving this potential unintended consequence. Implications Successful implementation of SFH by public housing authorities in response to the HUD rule requires ongoing attention to implementation strategies. In this sense, SFH likely differs from other policies that might be seen as less intrusive. Long-term success of SFH will depend on careful policy implementation, including plans to educate and support housing authority staff, inform and engage residents, and build effective partnerships with community agencies.

scholarly journals Evaluating the implementation of a primary care intervention to reduce prescriptions of benzodiazepines (BENZORED IV)

2021 ◽  
Author(s):  
Isabel Socias ◽  
Alfonso Leiva ◽  
Haizea Pombo-Ramos ◽  
Ferran Bejarano ◽  
Ermengol Sempere-Verdú ◽  
...  
Keyword(s):  
Primary Care ◽  
Traffic Accidents ◽  
Implementation Strategies ◽  
Developed Countries ◽  
Successful Implementation ◽  
Implementation Climate ◽  
Primary Care Settings ◽  
The Individual

Abstract Background: General practitioners (GPs) in developed countries widely prescribe benzodiazepines (BZDs) for their anxiolytic, hypnotic, and muscle-relaxant effects. Treatment duration, however, is rarely limited and this results in a significant number of chronic users. Long-term BZD use is associated with cognitive impairment, falls with hip fractures, traffic accidents, and increased mortality. The BENZORED IV trial was a hybrid type 1 trial conducted to evaluate the effectiveness and implementation of an intervention to reduce BZD prescription in primary care. The purpose of this qualitative study was to analyze facilitator and barriers to implement the intervention to primary care settings.Methods: Focus group meetings with GPs from the intervention arm of the BENZORED IV trial were held at primary healthcare centers in the three districts. For sampling purposes, the GPs were classified as high or low implementers according to the success of the intervention measured at 12 months. The Consolidated Framework for Implementation Research (CFIR) was used to conduct the meetings and to code, rate and analyze the dataResults: Three of the 41 CFIR constructs strongly distinguished between high and low implementers: The complexity in the intervention, the individual Stage of Change and the key stakeholder’s engagement. Seven constructs weakly discriminated between the two groups: the adaptability in the intervention, the external policy and incentives, the implementation climate, the relative priority, the self-efficacy and formally appointed implementation leader engaging. Fourteen constructs did not discriminate between the two groups, six had insufficient data for evaluation, and eleven had no data for evaluation.Conclusion: We identified constructs that could explain the variation in the implementation of the intervention, this information is relevant to design successful implementation strategies to implement the intervention.

Abstract P146: The PATIENT Study: Lessons Learned During the Development of a Multi-Site, Pragmatic Randomized Control Trial in a Large Health Maintenance Organization

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Ashli Owen-Smith ◽  
Suma Vupputuri ◽  
Cynthia Rand ◽  
Jeffrey Tom ◽  
Andrew Williams ◽  
...  
Keyword(s):  
Disease Management ◽  
Health Plan ◽  
Randomized Control Trial ◽  
Patient Adherence ◽  
Lessons Learned ◽  
Successful Implementation ◽  
Health Maintenance ◽  
Randomized Control ◽  
The Impact

Introduction: Patient adherence to chronic therapy is the necessary link between effective treatments and improved patient outcomes. However, the frequent failure of patients to adhere to long-term medication regimens is a challenge in chronic disease management. Though many prior interventions aimed at improving patient medication adherence have been successful, they are often costly and have limited disseminability. Methods: The PATIENT ( P romoting A dherence T o I mprove the E ffective n ess of CVD T herapies) study is a randomized control trial to compare the impact of two low-cost, low-intensity health information technology-based interventions (which include automated prescription refill reminder calls and mailed education materials) on patient adherence to selected chronic CVD medications. The primary goal throughout the development of this intervention was for it to be disseminable at the end of the grant period. We implemented several strategies aimed at increasing the likelihood of long-term implementation and dissemination of the intervention. These strategies included establishing an advisory board that included a diverse group of health plan clinicians and staff, conducting stakeholder interviews and participant focus groups, presenting at health plan meetings and carrying out a pilot of the intervention prior to the start of the main trial. Results: Our efforts in prioritizing the disseminability of the intervention highlighted several important lessons. First, it was important to develop all aspects of the intervention in partnership with health plan stakeholders, as their feedback was critical in the development of a protocol that would be ultimately congruent with local policies. Second, conversations with stakeholders highlighted the ways in which each of the sites were similar to and different from one another, thereby identifying which components of the intervention should be consistent across sites but also underscoring the need for there to be some regional customization. Preliminary results from the pilot of the intervention indicate that these efforts have been worthwhile: 62% of participants reported that the automated phone calls were helpful and the majority (80%) are willing to take a similar call in the future; similarly, the majority of participants reported that the mailed health education materials were useful (∼64%) and easy to understand (∼71%). Conclusions: The PATIENT intervention, if successful, could have significant public health applications as flexible and generalizable components of disease management programs. Understanding the barriers to and facilitators of successful implementation is critical to the widespread implementation of the intervention. Lessons learned from the developing and implementing the present study may aid others in similar efforts and in different settings.

scholarly journals Realtors as Partners in Tobacco Control: Results from a Pennsylvania Survey

2020 ◽  
Vol 6 (6) ◽  
pp. 392-404
Author(s):  
Ann C. Klassen ◽  
Nora Lee ◽  
Jessica P. Lopez ◽  
Chloe Bernardin ◽  
Ryan Coffman ◽  
...  
Keyword(s):  
Tobacco Control ◽  
Tobacco Use ◽  
Indoor Air ◽  
Secondhand Smoke ◽  
Mandatory Disclosure ◽  
Health Concerns ◽  
Home Sales ◽  
On Line ◽  
The Impact

Objectives: Despite success of clean indoor air efforts, home smoking exposes residents to secondhand smoke (SHS) and thirdhand smoke (THS). Home sales offer sellers opportunity to establish smoke-free homes, to improve salability, and promote both exposure reduction and cessation. We explored realtor experiences with smoking-permitted home sales, views on SHS and THS, and attitudes towards mandatory disclosure of in-home smoking in sales. Methods: In 2019, 329 realtors in four Philadelphia-area counties completed on-line surveys capturing both closed-ended and open text responses, regarding the impact of smoking on sales. Results: Virtually all (96%) of respondents reported greater difficulty selling smoking-permitted homes, and buyers with young children or health concerns least likely to consider such properties. Although 65% saw client concerns as primarily aesthetic, 30% felt health concerns played a role. Only 20% saw mandatory disclosure of tobacco use history as negative, with 27% viewing this as positive, and 53% predicting mixed impact. Conclusions: In-home smoking negatively impacts realtors. Tobacco control should consider disclosure as one policy strategy. Advocates and realtors should help sellers establish smoke-free properties and address tobacco-related residue, with long-term goals of maintaining smoke-free homes to support cessation.

scholarly journals General practice referral of ‘at risk’ populations to community leisure services: applying the RE-AIM framework to evaluate the impact of a community-based physical activity programme for inactive adults with long-term conditions

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
E. L. Bird ◽  
M. S. Y. Biddle ◽  
J. E. Powell
Keyword(s):  
Physical Activity ◽  
At Risk ◽  
General Practice ◽  
Successful Implementation ◽  
Community Based ◽  
Long Term Conditions ◽  
The Impact ◽  
Recruitment Target

Abstract Background In the UK a high proportion of adults with long-term conditions do not engage in regular physical activity. General practice (GP) referral to community-based physical activity is one strategy that has gained traction in recent years. However, evidence for the real-world effectiveness and translation of such programmes is limited. This study aimed to evaluate the individual and organisational impacts of the ‘CLICK into Activity’ programme - GP referral of inactive adults living with (or at risk of) long-term conditions to community-based physical activity. Methods A mixed methods evaluation using the RE-AIM framework was conducted with data obtained from a range of sources: follow-up questionnaires, qualitative interviews, and programme-related documentation, including programme cost data. Triangulation methods were used to analyse data, with findings synthesised across each dimension of the RE-AIM framework. Results A total of 602 individuals were referred to CLICK into Activity physical activity sessions. Of those referred, 326 individuals participated in at least one session; the programme therefore reached 30.2% of the 1080 recruitment target. A range of individual-, social-, and environmental-level factors contributed to initial physical activity participation. Positive changes over time in physical activity and other outcomes assessed were observed among participants. Programme adoption at GP surgeries was successful, but the GP referral process was not consistently implemented across sites. Physical activity sessions were successfully implemented, with programme deliverers and group-based delivery identified as having an influential effect on programme outcomes. Changes to physical activity session content were made in response to participant feedback. CLICK into Activity cost £175,000 over 3 years, with an average cost per person attending at least one programme session of £535. Conclusions Despite not reaching its recruitment target, CLICK into Activity was successfully adopted. Positive outcomes were associated with participation, although low 6- and 12-month follow-up response rates limit understanding of longer-term programme effects. Contextual and individual factors, which may facilitate successful implementation with the target population, were identified. Findings highlight strategies to be explored in future development and implementation of GP referral to community-based physical activity programmes targeting inactive adults living with (or at risk of) long-term conditions.

scholarly journals How to foster successful implementation of a patient reported experience measurement in the disability sector: an example of developing strategies in co-creation

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Marjolein van Rooijen ◽  
Anneke van Dijk-de Vries ◽  
Stephanie Lenzen ◽  
Ruth Dalemans ◽  
Albine Moser ◽  
...  
Keyword(s):  
Implementation Strategies ◽  
Implementation Process ◽  
Successful Implementation ◽  
Participatory Action ◽  
Policy And Practice ◽  
Link Type ◽  
Tailored Implementation ◽  
Patient Reported ◽  
Strategy Changes ◽  
The Impact

Abstract Background The integrated uptake of patient-reported experience measures, using outcomes for the micro, meso and macro level, calls for a successful implementation process which depends on how stakeholders are involved in this process. Currently, the impact of stakeholders on strategies to improve the integrated use is rarely reported, and information about how stakeholders can be engaged, including care-users who are communication vulnerable, is limited. This study illustrates the impact of all stakeholders on developing tailored implementation strategies and provides insights into supportive conditions to involve care-users who are communication vulnerable. Methods With the use of participatory action research, implementation strategies were co-created by care-users who are communication vulnerable (n = 8), professionals (n = 12), management (n = 6) and researchers (n = 5) over 9 months. Data collection consisted of audiotapes, reports, and researchers’ notes. Conventional content analysis was performed. Results The impact of care-users concerned the strategies’ look and feel, understandability and relevance. Professionals influenced impact on how to use strategies and terminology. The impact of management was on showing the gap between policy and practice, and learning from previous improvement failures. Researchers showed impact on analysis, direction of strategy changes and translating academic and development experience into practice. The engagement of care-users who are communication vulnerable was supported, taking into account organisational issues and the presentation of information. Conclusions The impact of all engaged stakeholders was identified over the different levels strategies focused on. Care-users who are communication vulnerable were valuable engaged in co-creation implementation strategies by equipping them to their needs and routines, which requires adaptation in communication, delimited meetings and a safe group environment. Trial registration Reviewed by the Medical Ethics Committee of Zuyderland-Zuyd (METCZ20190006). NL7594 registred at https://www.trialregister.nl/.

scholarly journals Implementing an enhanced recovery after thoracic surgery programme in the Netherlands: a qualitative study investigating facilitators and barriers for implementation

BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e051513
Author(s):  
Erik M. von Meyenfeldt ◽  
Femke van Nassau ◽  
Carlijn T I de Betue ◽  
L Barberio ◽  
Wilhelmina H Schreurs ◽  
...  
Keyword(s):  
Lung Cancer ◽  
The Netherlands ◽  
Thoracic Surgery ◽  
Perioperative Care ◽  
Enhanced Recovery ◽  
Implementation Strategies ◽  
Audit And Feedback ◽  
Successful Implementation ◽  
Hospital To Home ◽  
The Impact

ObjectivesThis study aims to elucidate determinants for succesful implementation of the Enhanced Recovery After Thoracic Surgery (ERATS) protocol for perioperative care for surgical lung cancer patients in the Netherlands.SettingLung cancer operations are performed in both academic and regional hospitals, either by cardiothoracic or general thoracic surgeons. Limiting the impact of these operations by optimising and standardising perioperative care with the ERATS protocol is thought to enable reduction in length of stay, complications and costs.ParticipantsA broad spectrum of stakeholders in perioperative care for patients with lung resection participated in this study, ranging from patient representatives, healthcare professionals to an insurance company representative.InterventionsSemistructured interviews (N=14) were conducted with the stakeholders (N=18). The interviews were conducted one on one by telephone and two times, face to face, in small groups. Verbatim transcriptions of these interviews were coded for the purpose of thematic analysis.Outcome measuresDeterminants for successful implementation of the ERATS protocol in the Netherlands.ResultsSeveral determinants correspond with previous publications: having a multidisciplinary team, leadership from a senior clinician and support from an ERAS-coordinator as facilitators; lack of feedback on performance and absence of management support as barriers. Our study underscores the potential detrimental effect of inconsistent communication, the lack of support in the transition from hospital to home and the barrier posed by lack of accessible audit data.ConclusionsBased on a structured problem analysis among a wide selection of stakeholders, this study provides a solid basis for choosing adequate implementation strategies to introduce the ERATS protocol in the Netherlands. Emphasis on consistent and sufficient communication, support in the transition from hospital to home and adequate audit and feedback data, in addition to established implementation strategies for ERAS-type programmes, will enable a tailored approach to implementation of ERATS in the Dutch context.

scholarly journals Evaluation of the Impact of the EU Structural Support on the Competitiveness of Lithuanian Economics

2016 ◽  
Vol 10 (1) ◽  
pp. 1-11 ◽  
Author(s):  
Rita Remeikiene ◽  
Ligita Gaspareniene
Keyword(s):  
Positive Impact ◽  
Research Problem ◽  
Necessary Condition ◽  
Successful Implementation ◽  
The European Union ◽  
Structural Support ◽  
Knowledge Based Economy ◽  
The Impact ◽  
The Eu

Abstract The topic of competitiveness is becoming increasingly significant in the context of modern economics. Considering intensive processes of globalisation alongside with competitive pressure amongst the countries, competitiveness has become a necessary condition for successful economic and social development of any country. Only by creating, enforcing and maintaining international competitiveness of the country, rapid economic growth during the long term is achievable. Amongst the other urgent issues, the European Union (further the EU) public policies are also focused on competitiveness. After the failure to implement the Lisbon strategy and become “the most dynamic and competitive knowledge-based economy”, the EU declared its new competitiveness aims in the long-term strategy Europe 2020. Promotion of competitiveness is one of the fundamental aims and priority directions of the EU structural policy. The EU structural support is engaged as one of the public policy measures to promote the competitiveness of the member-states. In this context, it is purposeful to research whether the structural support is used efficiently and whether it actually contributes to the implementation of the defined aims. Under the order of various Lithuanian institutions, numerous studies on the efficiency of the EU structural support have been carried out. Nevertheless, by analysing the impact of the EU structural support, insufficient attention has been paid to the aspect of competitiveness. Considering the fact that Lithuania has entered the third programming period 2014-2020, evaluation of the EU structural investment in the country has become even more topical - for successful implementation of the aims raised for this new period, the analysis of the previous results is relevant. This determined formulation of the research problem: what impact does the EU structural support have on the competitiveness of Lithuanian economics? The empirical research has revealed that the EU structural support has a positive impact on Lithuanian gross domestic product growth, promotes foreign direct investment, research and development expenditure and increases the number of operating entities during 2004-2014 period.

scholarly journals Barriers and facilitators to implementing community-based physical activity interventions: a qualitative systematic review

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Jemima Cooper ◽  
Joey Murphy ◽  
Catherine Woods ◽  
Femke Van Nassau ◽  
Aisling McGrath ◽  
...  
Keyword(s):  
Physical Activity ◽  
Implementation Strategies ◽  
Outcome Data ◽  
Barriers And Facilitators ◽  
Successful Implementation ◽  
Community Based Interventions ◽  
Community Based ◽  
Physical Activity Interventions ◽  
The Impact ◽  
Implementation Factors

Abstract Background Over the past decade several physical activity (PA) interventions have been shown to be efficacious in a controlled research setting, however there is a continued lack of evidence for how to successfully implement these PA interventions in real-world settings such as the community. This review aims to explore the barriers and facilitators that affect the implementation of community-based PA interventions and make recommendations to improve implementation from the included studies. Methods A systematic literature search of EBSCOhost, Scopus, PUBMED and Web of Science was conducted to identify articles that reported qualitative data on the implementation factors of community-based interventions where PA was a primary outcome. Data were extracted using the Consolidated Framework for Implementation Research (CFIR) as a guide. Implementation factors and recommendations were then mapped onto the 5 domains of the CFIR and synthesised thematically. Results From 495 articles, a total of 13 eligible studies were identified, with 6 studies using a mixed methods approach, and 7 reporting qualitative methods only. There were 82 implementation factors identified, including 37 barriers and 45 facilitators, and a further 26 recommendations from the papers across all 5 domains of the CFIR. More barriers than facilitators were identified within the CFIR domain inner setting, in contrast to all other domains where facilitator numbers outweighed barriers. Conclusions This review identified many facilitators and barriers of implementing physical activity interventions in the community. A key finding of this review was the impact of implementation strategies on successful implementation of community PA interventions. From the evidence, it was clear that many barriers to implementation could have been negated or reduced by an implementation plan in which several strategies are embedded. The findings of this review also suggest more attention to individual’ skills and involvement is needed to improve self-efficacy and knowledge. The role of individuals across all organisational levels, from providers to leaders, can impact on the implementation of an intervention and its success. Trial registration PROSPERO - CRD42020153821.

scholarly journals Cultural Influence on e‑Government Development

2020 ◽  
Vol 23 (1) ◽  
Author(s):  
Sushant Kumar ◽  
Kuldeep Baishya ◽  
Pradip H Sadarangani ◽  
Harsh V Samalia
Keyword(s):  
National Culture ◽  
Power Distance ◽  
Gdp Per Capita ◽  
Economic Prosperity ◽  
Multi Level ◽  
Per Capita ◽  
The Impact ◽  
Government Development

E‑government development varies across countries. This study aims to examine the impact of national culture on e‑government development across 78 countries. The dimensions of national culture are power distance, individualism, masculinity, long‑term orientation, uncertainty avoidance, and indulgence. The paper also examines the role of GDP per capita on e‑government development. The result shows that individualism and long‑term orientation are positively related to e‑government development, whereas power distance is negatively related to e‑government development. Also, GDP per capita is found to be significantly impacting e‑government development. Multi‑level interaction effect of GDP per capita and culture on e‑government development is discussed. The paper outlines the implications of results and strategies to design culturally acceptable e‑government policies. The paper argues that growth in economic prosperity cannot guarantee e‑government development, and national culture must be included in a holistic discussion of the development.

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