Although classic models of implementation emphasized the importance of innovation characteristics in their adoption and sustained use, contemporary implementation research and practice have ...deprioritized these variables. Human-centered design (HCD) is an approach that grounds product development in information collected about the people and settings that will ultimately use those products. HCD has strong roots in psychological theory, but its application is typically limited to the development of digital technologies. HCD is rarely applied to the design of psychosocial innovations-including both service-recipient-facing interventions and implementation strategies-within the applied psychological disciplines. The current article reviews the psychological origins of HCD and details pathways through which HCD theories and methods can be leveraged to advance the "core tasks" of contemporary implementation research and practice in psychology. These include (a) identification of multilevel implementation determinants through specification of user needs and contexts; (b) tailoring of implementation strategies, such as contextually driven intervention redesign; and (c) evaluating implementation mechanisms and outcomes, including disentangling how the core HCD focus on usability relates to closely associated implementation variables such as acceptability, feasibility, and appropriateness. Collectively, these applications provide directions through which to leverage the mature field of HCD, maximize psychology's return on its early theoretical investment, and promote the large-scale impact of findings from across the applied fields of psychology.
Public Significance Statement
Most effective innovations from psychological science are used rarely in routine practice, greatly reducing their public health impact. Human-centered design provides methods and tools through which innovations-and the implementation processes that support them-can be developed or redesigned to ensure public health impact.
IntroductionMechanisms explain how implementation strategies work. Implementation research requires careful operationalisation and empirical study of the causal pathway(s) by which strategies effect ...change, and factors that may amplify or weaken their effects. Understanding mechanisms is critically important to replicate findings, learn from negative studies or adapt an implementation strategy developed in one setting to another. Without understanding implementation mechanisms, it is difficult to design strategies to produce expected effects across contexts, which may have disproportionate effects on settings in which priority populations receive care. This manuscript outlines the protocol for an Agency for Healthcare Research and Quality-funded initiative to: (1) establish priorities for an agenda to guide research on implementation mechanisms in health and public health, and (2) disseminate the agenda to research, policy and practice audiences.Methods and analysisA network of scientific experts will convene in ‘Deep Dive’ meetings across 3 years. A research agenda will be generated through analysis and synthesis of information from six sources: (1) systematic reviews, (2) network members’ approaches to studying mechanisms, (3) new proposals presented in implementation proposal feedback sessions, (4) working group sessions conducted in a leading implementation research training institute, (5) breakout sessions at the Society for Implementation Research Collaboration’s (SIRC) 2019 conference and (6) SIRC conference abstracts. Two members will extract mechanism-relevant text segments from each data source and a third member will generate statements as an input for concept mapping. Concept mapping will generate unique clusters of challenges, and the network will engage in a nominal group process to identify priorities for the research agenda.Ethics and disseminationThis initiative will yield an actionable research agenda to guide research to identify and test mechanisms of change for implementation strategies. The agenda will be disseminated via multiple channels to solicit feedback and promote rigorous research on implementation mechanisms.
Individual-level implementation determinants, such as clinician attitudes, commonly influence the successful adoption of evidence-based practices, but few explicit strategies have been tested with ...regard to their ability to impact these key mechanisms of change. This paper reports on an initial test of a blended, theoretically informed pre-implementation strategy designed to target malleable individual-level determinants of behavior change. Beliefs and Attitudes for Successful Implementation in Schools (BASIS) is a brief and pragmatic pre-implementation strategy that uses strategic education, social influence techniques, and group-based motivational interviewing to target implementation attitudes, perceived social norms, perceived behavioral control, and behavioral intentions to implement among mental health clinicians working in the education sector.
As part of a pilot trial, 25 school mental health clinicians were randomized to BASIS (n = 12) or an attention control placebo (n = 13), with both conditions receiving training and consultation in an evidence-based intervention for youth experiencing trauma (the Cognitive Behavioral Intervention for Trauma in Schools). Theorized mechanisms of change (attitudes, perceived social norms, perceived behavioral control, and behavioral intentions) were assessed at baseline, post-training, and 4-month follow-up. Clinician participation in post-training consultation and intervention adoption were also tracked.
A series of regression models and independent sample t tests indicated that BASIS had significant, medium to large effects on the majority of its proximal mechanisms from baseline to post-training. BASIS was also associated with a greater latency between initial training in the intervention and discontinuation of participation in post-training consultation, with clinicians in the BASIS condition persisting in consultation for an average of 134 days versus 32 days for controls, but this difference was not statistically significant. At 4-month follow-up, most differences in the theorized mechanisms had attenuated, and approximately the same small number of BASIS clinicians adopted the trauma intervention as controls.
Findings suggest that the brief BASIS pre-implementation strategy had a significant influence on its proximal mechanisms of change, but that these changes did not persist over time or translate into adoption of the trauma intervention. Implications for theory refinement, revisions to the BASIS protocol, and next steps for research surrounding individual-level implementation strategies are discussed.
ClinicalTrials.gov Identifier: NCT03791281 . Registered 31 December 2018-Retrospectively registered.
Proctor et al.'s (2021) comment "Division 21 Has Been Devoted to Human-Centered Design Since the 1950s" on our article (Lyon et al., 2020) is a welcome addition and useful touchpoint surrounding the ...historical and current relationship between human-centered design and psychological science. "Siloing" in psychology inhibits the progress of the discipline. We offer a set of recommendations for reducing silos and increasing the integration of engineering psychology with implementation science to advance human-centered design and the use of research evidence in practice.
The current study examines whether daily coping moderates the effects of daily stress on same‐day mood and next‐day mood among 58 Latino adolescents (Mage = 13.31; 53% male). The daily diary design ...capitalized on repeated measurements, boosting power to detect effects and allowing for a robust understanding of the day‐to‐day experiences of Latino adolescents. Hierarchical linear modeling revealed that on days when youth reported higher levels of peer and academic stress, they also reported more negative moods. However, only poverty‐related stress predicted mood the following day. Engagement coping buffered the effect of poverty‐related stress on next‐day negative and positive mood, while disengagement exacerbated the effects of academic and peer stress. The need for interventions promoting balanced coping repertoires is discussed.
More than two-thirds of youth experience trauma during childhood, and up to 1 in 5 of these youth develops posttraumatic stress symptoms that significantly impair their functioning. Although ...trauma-focused cognitive behavior therapy (TF-CBT) has a strong evidence base, it is rarely adopted, delivered with adequate fidelity, or evaluated in the most common setting where youth access mental health services-schools. Given that individual behavior change is ultimately required for successful implementation, even when organizational factors are firmly in place, focusing on individual-level processes represents a potentially parsimonious approach. Beliefs and Attitudes for Successful Implementation in Schools (BASIS) is a pragmatic, motivationally focused multifaceted strategy that augments training and consultation and is designed to target precise mechanisms of behavior change to produce enhanced implementation and youth clinical outcomes. This study protocol describes a hybrid type 2 effectiveness-implementation trial designed to concurrently evaluate the main effects, mediators, and moderators of both the BASIS implementation strategy on implementation outcomes and TF-CBT on youth mental health outcomes.
Using a cluster randomized controlled design, this trial will assign school-based mental health (SMH) clinicians and schools to one of three study arms: (a) enhanced treatment-as-usual (TAU), (b) attention control plus TF-CBT, or (c) BASIS+TF-CBT. With a proposed sample of 120 SMH clinicians who will each recruit 4-6 youth with a history of trauma (480 children), this project will gather data across 12 different time points to address two project aims. Aim 1 will evaluate, relative to an enhanced TAU condition, the effects of TF-CBT on identified mechanisms of change, youth mental health outcomes, and intervention costs and cost-effectiveness. Aim 2 will compare the effects of BASIS against an attention control plus TF-CBT condition on theoretical mechanisms of clinician behavior change and implementation outcomes, as well as examine costs and cost-effectiveness.
This study will generate critical knowledge about the effectiveness and cost-effectiveness of BASIS-a pragmatic, theory-driven, and generalizable implementation strategy designed to enhance motivation-to increase the yield of evidence-based practice training and consultation, as well as the effectiveness of TF-CBT in a novel service setting.
ClinicalTrials.gov registration number NCT04451161 . Registered on June 30, 2020.
This study used daily diary methodology to examine associations between cultural factors and daily coping and responses to stress among predominantly low‐income Latino adolescents. A total of 58 ...middle school students (53% male, mean age = 13.31, 95% Latino) completed baseline measures assessing demographic characteristics, familism, ethnic identity, and family ethnic socialization. They subsequently completed 7 consecutive daily diaries assessing daily stress, coping, and involuntary stress responses. Results yielded main effects of stress, gender, familism, and ethnic identity on adolescents’ coping and involuntary stress responses. In addition, interactions between stress and familism, ethnic identity, and family ethnic socialization emerged. Results suggest that familism may promote adaptive responses to stress, while adolescents who report more family ethnic socialization may rely more on maladaptive responses at high levels of stress. Findings related to ethnic identity were mixed and varied depending on levels of ethnic identity exploration versus commitment.
There has been an increase in school mental health research aimed at producing generalizable knowledge to address longstanding science-to-practice gaps to increase children's access to evidence-based ...mental health services. Successful dissemination and implementation are both important pieces to address science-to-practice gaps, but there is conceptual and semantic imprecision that creates confusion regarding where dissemination ends and implementation begins, as well as an imbalanced focus in research on implementation relative to dissemination. In this paper, we provide an enhanced operational definition of dissemination; offer a conceptual model that outlines elements of effective dissemination that can produce changes in awareness, knowledge, perceptions, and motivation across different stakeholder groups; and delineate guiding principles that can inform dissemination science and practice. The overarching goal of this paper is to stimulate future research that aims to advance dissemination science and practice in school mental health.
Emotion regulation, or the ways people modify their emotional responses, impacts mental health in important ways. This longitudinal study assessed how cognitive reappraisal and expressive ...suppression, two specific emotion-regulation strategies, predict (a) emerging adults' later membership in latent classes determined by psychosocial adjustment, using person-centered analyses, and (b) their subsequent psychosocial adjustment outcomes, using variable-centered analyses. Results of latent transition analysis indicated that one's use of emotion-regulation strategies predicts future profiles of psychosocial functioning, even while adjusting for profile status eight months earlier. Further, in regression analyses, reappraisal and suppression predicted subsequent levels of several components of psychosocial adjustment, also above and beyond baseline levels of these outcomes. Both of these findings highlight the strong influence of cognitive reappraisal and expressive suppression on emerging adults' future psychosocial adjustment. Programs promoting mental health during this formative developmental period should target emotion regulation as a key skill predicting future outcomes.
•Emerging adults fell into four latent classes of psychosocial adjustment.•Use of emotion-regulation strategies predicted subsequent class membership.•Cognitive reappraisal and expressive suppression predicted psychosocial outcomes.•Emotion regulation significantly impacts emerging adults' psychosocial functioning.
Training and consultation are core implementation strategies used to support the adoption and delivery of evidence-based prevention programs (EBPPs), but are often insufficient alone to effect ...teacher behavior change. Motivational interviewing (MI) and related behavior change techniques (e.g., strategic education, social influence, implementation planning) delivered in a group format offer promising supplements to training and consultation to improve EBPP implementation. Beliefs and Attitudes for Successful Implementation in Schools for Teachers (BASIS-T) is a theoretically informed, motivational implementation strategy delivered in a group format prior to and immediately after EBPP training. The purpose of this study was to examine the proximal effects of BASIS-T on hypothesized mechanisms of behavior change (e.g., attitudes, subjective norms, intentions to implement) in the context of teachers receiving training and consultation to implement the Good Behavior Game. As part of a pilot trial, 83 elementary school teachers from 9 public elementary schools were randomly assigned (at the school-level to reduce contamination across participants) to a BASIS-T (
n
= 44) or active comparison control (
n
= 39) condition, with both conditions receiving Good Behavior Game (GBG) training and consultation. A series of mixed effects models revealed meaningful effects favoring BASIS-T on a number of hypothesized mechanisms of behavior change leading to increased motivation to implement GBG. The implications, limitations, and directions for future research on the use of MI with groups of individuals and other behavior change techniques to increase the yield of training and consultation are discussed.
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