The first purpose of this review was to assess the impact of implementation on program outcomes, and the second purpose was to identify factors affecting the implementation process. Results from over quantitative 500 studies offered strong empirical support to the conclusion that the level of implementation affects the outcomes obtained in promotion and prevention programs. Findings from 81 additional reports indicate there are at least 23 contextual factors that influence implementation. The implementation process is affected by variables related to communities, providers and innovations, and aspects of the prevention delivery system (i.e., organizational functioning) and the prevention support system (i.e., training and technical assistance). The collection of implementation data is an essential feature of program evaluations, and more information is needed on which and how various factors influence implementation in different community settings.

/pdf/implementation-matters-a-review-of-research-on-the-influence-1wt0xfs3gm.pdf

Implementation Matters: A Review of Research on the Influence of Implementation on Program Outcomes and the Factors Affecting Implementation

Implementation fidelity refers to the degree to which an intervention or programme is delivered as intended. Only by understanding and measuring whether an intervention has been implemented with fidelity can researchers and practitioners gain a better understanding of how and why an intervention works, and the extent to which outcomes can be improved. The authors undertook a critical review of existing conceptualisations of implementation fidelity and developed a new conceptual framework for understanding and measuring the process. The resulting theoretical framework requires testing by empirical research. Implementation fidelity is an important source of variation affecting the credibility and utility of research. The conceptual framework presented here offers a means for measuring this variable and understanding its place in the process of intervention implementation.

/pdf/a-conceptual-framework-for-implementation-fidelity-544khkva0e.pdf

A conceptual framework for implementation fidelity

A dynamic tension has developed in prevention science regarding two imperatives: (a) fidelity of implementation—the delivery of a manualized prevention intervention program as prescribed by the program developer, and (b) program adaptation—the modification of program content to accommodate the needs of a specific consumer group. This paper examines this complex programmatic issue from a community-based participatory research approach for program adaptation that emphasizes motivating community participation to enhance program outcomes. Several issues, key concepts, and implementation strategies are presented under a strategic approach to address issues of fidelity and adaptation. Despite the noted tension between fidelity and adaptation, both are essential elements of prevention intervention program design and they are best addressed by a planned, organized, and systematic approach. Towards this aim, an innovative program design strategy is to develop hybrid prevention programs that “build in” adaptation to enhance program fit while also maximizing fidelity of implementation and program effectiveness.

The cultural adaptation of prevention interventions: resolving tensions between fidelity and fit.

Child physical abuse is an important cause of pediatric morbidity and mortality and is associated with major physical and mental health problems that can extend into adulthood. Pediatricians are in a unique position to identify and prevent child abuse, and this clinical report provides guidance to the practitioner regarding indicators and evaluation of suspected physical abuse of children. The role of the physician may include identifying abused children with suspicious injuries who present for care, reporting suspected abuse to the child protection agency for investigation, supporting families who are affected by child abuse, coordinating with other professionals and community agencies to provide immediate and long-term treatment to victimized children, providing court testimony when necessary, providing preventive care and anticipatory guidance in the office, and advocating for policies and programs that support families and protect vulnerable children.

/pdf/evaluation-of-suspected-child-physical-abuse-45mr1g1ib6.pdf

Evaluation of Suspected Child Physical Abuse

Increased availability of research-supported, school-based prevention programs, coupled with the growing national policy emphasis on use of evidence-based practices, has contributed to a shift in research priorities from efficacy to implementation and dissemination. A critical issue in moving research to practice is ensuring high-quality implementation of both the intervention model and the support system for sustaining it. The paper describes a three-level framework for considering the implementation quality of school-based interventions. Future directions for research on implementation are discussed.

Maximizing the Implementation Quality of Evidence-Based Preventive Interventions in Schools: A Conceptual Framework

Attention to child maltreatment within military families has grown in recent decades in response to the increasing numbers of children in military families, the broader evolution of child maltreatment policy and services, and the development of military policy on issues such as domestic violence. This chapter summarizes current understanding of child maltreatment in the military. Several characteristics of military populations and military life are likely protective with respect to child maltreatment. However, three aspects of military life may increase risks for child maltreatment: elevated rates of domestic violence among military families, increased prevalence of alcohol among service members, and deployment of service member parents.

/pdf/child-maltreatment-within-military-families-4da72lf9mh.pdf

Child Maltreatment within Military Families

The US Department of Education's Principles of Effectiveness require recipients of Safe and Drug-Free Schools and Community Act funds to: a) base drug and violence prevention programs on needs assessment data, b) develop measurable program goals and objectives, c) implement programs with research evidence of effectiveness, and d) periodically evaluate programs relative to their goals and objectives. This paper reports the extent of awareness of the Principles of Effectiveness and plans for their implementation among public school districts and schools in the United States in the year following their announcement. Results showed a greater percentage of public school districts than individual schools knew about the principles and planned for implementation, but baseline levels of awareness for both districts and schools were relatively low. Schools were more likely to know about the principles when their associated school district also knew. Results suggest a need for greater communication about the principles to school districts, and in turn, a need for greater communication between district and school-level substance use prevention staff.

The principles of effectiveness: early awareness and plans for implementation in a national sample of public schools and their districts.

What is the effect of dementia on hospitalization and emergency department use in residential care facilities

Residential care facilities, known by a variety of names such as assisted living or group homes, offer assistance to people who find it difficult to live alone but who do not need or wish to enter a nursing home. There is substantial variation in the amount that residents are charged each month. Data from the 2010 National Survey of Residential Care Facilities were used to identify factors that affect the total monthly charges to residents. These findings can inform an individual's search for an appropriate, affordable option.

Factors Affecting Residential Care Facility Charges

Purpose To identify key daily activities in which persons working as radiologic technologists spend the majority of time outdoors. The findings will be used to design improved questionnaires to estimate retrospective UV exposure for future case-control studies of skin cancer and other malignancies to be undertaken within a large cohort of these medical radiation workers. Methods We evaluated the self-reported activities undertaken during time spent outdoors between 9 AM and 5 PM for 125 individuals (ages 40–59 and 60+ years old) who filled out a 7–day daily activity diary in September 2004. Daily UV measurements were also recorded for each individual. We initially classified activities into 37 groupings of similar activities before determining the 7 activities that accounted for the majority of time spent outdoors. We evaluated differences by age, gender, and geographic location of the individual in addition to whether these activities were carried out on a weekday or weekend day. Results Of a possible 13,953 daily diary entries, we ascertained that 4697 entries (totaling 1408 hours) were associated with time spent outdoors. The 7 major categories, which accounted for over 93% of the total time spent outdoors, included driving, yard work, home maintenance, walking or doing errands, recreational activities or sports, water activities, and leisure activities or relaxing outside. Differences in time spent outdoors were noted for age, gender, and weekend versus weekday. Conclusion The results of this analysis, in conjunction with UV measurements, will be useful in developing questionnaires that more accurately estimate UV exposure in relation to cancer risks in future case-control studies.

/pdf/assessing-activities-associated-with-time-spent-outdoors-in-3yl6ucb0l2.pdf

Assessing Activities Associated with Time Spent Outdoors in an Occupational Cohort of Radiologic Technologists

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