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      We have the program, what now? Development of an implementation plan to bridge the research-practice gap prevalent in exercise oncology

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          Abstract

          Background

          Exercise has emerged as a promising therapy for people with cancer. Novel programs have been developed to translate research into practice; however, implementation barriers have limited their success in part because successful translation of exercise oncology research into practice requires context-specific implementation plans. The aim of this study was to employ the implementation mapping protocol to develop an implementation plan to support programming of a co-located exercise clinic and cancer treatment center.

          Methods

          The Implementation Mapping protocol, which consists of five specific iterative tasks, was used. A stakeholder advisory group advised throughout the process.

          Results

          A comprehensive needs assessment was used to identify the organization’s general manager as the program adopter; oncologists, center leaders, and various administrative staff as program implementers; and the operations manager as the program maintainer. Twenty performance objectives were identified. The theoretical domains framework was used to identify likely determinants of change, which informed the selection of eight individual implementation strategies across the individual and organizational levels. Finally, an evaluation plan was developed which will be used to measure the success of the implementation plan in the project’s next phase.

          Conclusion

          The Implementation Mapping protocol provided a roadmap to guide development of a comprehensive implementation plan that considered all ecological domains, was informed by theory, and demonstrated an extensive understanding of the implementation context. Strong research-practitioner partnerships and effective stakeholder engagement were critical to development of the plan.

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          Most cited references35

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          Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science

          Background Many interventions found to be effective in health services research studies fail to translate into meaningful patient care outcomes across multiple contexts. Health services researchers recognize the need to evaluate not only summative outcomes but also formative outcomes to assess the extent to which implementation is effective in a specific setting, prolongs sustainability, and promotes dissemination into other settings. Many implementation theories have been published to help promote effective implementation. However, they overlap considerably in the constructs included in individual theories, and a comparison of theories reveals that each is missing important constructs included in other theories. In addition, terminology and definitions are not consistent across theories. We describe the Consolidated Framework For Implementation Research (CFIR) that offers an overarching typology to promote implementation theory development and verification about what works where and why across multiple contexts. Methods We used a snowball sampling approach to identify published theories that were evaluated to identify constructs based on strength of conceptual or empirical support for influence on implementation, consistency in definitions, alignment with our own findings, and potential for measurement. We combined constructs across published theories that had different labels but were redundant or overlapping in definition, and we parsed apart constructs that conflated underlying concepts. Results The CFIR is composed of five major domains: intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation. Eight constructs were identified related to the intervention (e.g., evidence strength and quality), four constructs were identified related to outer setting (e.g., patient needs and resources), 12 constructs were identified related to inner setting (e.g., culture, leadership engagement), five constructs were identified related to individual characteristics, and eight constructs were identified related to process (e.g., plan, evaluate, and reflect). We present explicit definitions for each construct. Conclusion The CFIR provides a pragmatic structure for approaching complex, interacting, multi-level, and transient states of constructs in the real world by embracing, consolidating, and unifying key constructs from published implementation theories. It can be used to guide formative evaluations and build the implementation knowledge base across multiple studies and settings.
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            The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions.

            CONSORT guidelines call for precise reporting of behavior change interventions: we need rigorous methods of characterizing active content of interventions with precision and specificity. The objective of this study is to develop an extensive, consensually agreed hierarchically structured taxonomy of techniques [behavior change techniques (BCTs)] used in behavior change interventions. In a Delphi-type exercise, 14 experts rated labels and definitions of 124 BCTs from six published classification systems. Another 18 experts grouped BCTs according to similarity of active ingredients in an open-sort task. Inter-rater agreement amongst six researchers coding 85 intervention descriptions by BCTs was assessed. This resulted in 93 BCTs clustered into 16 groups. Of the 26 BCTs occurring at least five times, 23 had adjusted kappas of 0.60 or above. "BCT taxonomy v1," an extensive taxonomy of 93 consensually agreed, distinct BCTs, offers a step change as a method for specifying interventions, but we anticipate further development and evaluation based on international, interdisciplinary consensus.
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              Outcomes for Implementation Research: Conceptual Distinctions, Measurement Challenges, and Research Agenda

              An unresolved issue in the field of implementation research is how to conceptualize and evaluate successful implementation. This paper advances the concept of “implementation outcomes” distinct from service system and clinical treatment outcomes. This paper proposes a heuristic, working “taxonomy” of eight conceptually distinct implementation outcomes—acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability—along with their nominal definitions. We propose a two-pronged agenda for research on implementation outcomes. Conceptualizing and measuring implementation outcomes will advance understanding of implementation processes, enhance efficiency in implementation research, and pave the way for studies of the comparative effectiveness of implementation strategies.
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                Author and article information

                Contributors
                m.kennedy@ecu.edu.au
                Journal
                Int J Behav Nutr Phys Act
                Int J Behav Nutr Phys Act
                The International Journal of Behavioral Nutrition and Physical Activity
                BioMed Central (London )
                1479-5868
                9 October 2020
                9 October 2020
                2020
                : 17
                : 128
                Affiliations
                [1 ]GRID grid.1038.a, ISNI 0000 0004 0389 4302, Exercise Medicine Research Institute, Edith Cowan University, ; 270 Joondalup Drive, JOONDALUP, Perth, WA 6027 Australia
                [2 ]GRID grid.1038.a, ISNI 0000 0004 0389 4302, School of Medical and Health Sciences, , Edith Cowan University, ; Perth, WA Australia
                [3 ]GRID grid.411958.0, ISNI 0000 0001 2194 1270, School of Nursing, Midwifery and Paramedicine, , Australian Catholic University, ; Fitzroy, VIC Australia
                [4 ]GRID grid.1038.a, ISNI 0000 0004 0389 4302, School of Nursing and Midwifery, , Edith Cowan University, ; Perth, WA Australia
                [5 ]GRID grid.1003.2, ISNI 0000 0000 9320 7537, School of Human Movement and Nutrition Sciences, , University of Queensland, ; Brisbane, QLD Australia
                [6 ]GenesisCare, Perth, WA Australia
                [7 ]GRID grid.1012.2, ISNI 0000 0004 1936 7910, Faculty of Medicine, University of Western Australia, ; Perth, WA Australia
                [8 ]GRID grid.266886.4, ISNI 0000 0004 0402 6494, Institute for Health Research, University of Notre Dame Australia, ; Fremantle, WA Australia
                [9 ]GRID grid.1024.7, ISNI 0000000089150953, Cancer and Palliative Care Outcomes Centre, , Queensland University of Technology, ; Brisbane, QLD Australia
                Author information
                https://orcid.org/0000-0002-1411-539X
                https://orcid.org/0000-0001-7121-9593
                https://orcid.org/0000-0003-0302-6129
                https://orcid.org/0000-0001-8659-5065
                https://orcid.org/0000-0001-6381-1597
                https://orcid.org/0000-0003-2794-0193
                https://orcid.org/0000-0002-8209-2281
                Article
                1032
                10.1186/s12966-020-01032-4
                7545878
                33036627
                6f0b4de8-d969-4eed-894d-37aaf803f689
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 4 July 2020
                : 30 September 2020
                Categories
                Research
                Custom metadata
                © The Author(s) 2020

                Nutrition & Dietetics
                cancer,physical activity,knowledge translation,organizational change,chemotherapy,radiotherapy

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