Implementation

WHO Collaborating Centers are designated by the Director-General, WHO, as part of an inter-institutional collaborative network of centers worldwide. They are established to provide concrete activities at the national, regional, and global levels, in support of the strategic plans of specific WHO areas of work.

All WHO Collaborating Centers in the Region of the Americas are known as PAHO/WHO Collaborating Centers since the Pan American Health Organization also serves as a WHO regional office.  Currently there are over 180 Centers in 15 countries in the Americas.

Lead:

Valaitis, R.

Research Funding:

More Information:

• PAHO Advanced Practice Nursing Webinar Series 2016 English with Spanish translation
• PAHO Website

The objective of this study is to evaluate the implementation and effectiveness of the Health Teams Advancing Patient Experience: Strengthening Quality (Health TAPESTRY) approach in older adults.

In our program, trained volunteers visit people where they live . In these visits, they learn about what matters most to that person and their health. They also learn more about a person’s health needs. The stories people tell our volunteers are recorded and sent to their health care team using special technology. This helps the team learn more about that person’s life, health needs, goals and how they can better work together to achieve goals and meet needs.

Co-author:

Dolovich, L., Oliver, D., Lamarche, L., Agarwal, G., Carr, T., Chan, D., Cleghorn, L., Griffith, L., Javadi, D., Kastner, M., Longaphy, J., Mangin, D., Richardson, J., Papaioannou, A., Ploeg, J., Raina, P., Risdon, C., Santaguida, P.L., Straus, S., Thabane, L., Valaitis, R., Price, D.

Research Funding:

• TAPESTRY: Teams Advancing Patient Experience: Strengthening Quality

More Information:

• Publication
• Health Tapestry Website

This article reports on a usability study of remote noninvasive cardiac testing in homes. We studied the Vitaphone 3100BT (Bluetooth®) event loop recorder (Vitaphone GmbH, Mannheim, Germany) and paired BlackBerry® Curve™ 8520 smartphone (Research In Motion, Ltd., Waterloo, ON, Canada).

This application requires independent device set-up by patients in their own homes following receipt by mail out of the kit (instructions plus the event loop recorder and smartphone). The case studies of five participants, each with varying experience with technology, were documented as they interacted with the devices. Participants were videotaped following written instructions as they performed a "think aloud" procedure while completing 20 device set-up tasks. Interviews provided insight into how the independent device set-up and processes could be improved. This study concluded that gender, age, and familiarity with technology seemed to influence the participants' abilities to successfully set up these devices and that sending the kit by mail appeared to be an acceptable strategy to provide remote noninvasive cardiacdiagnostic services. This study provides a foundation for future research assessing usability of mobile healthcare technology.

Co-author:

Sparkes, J., Valaitis, R., McKibbon, A.

Students:

1. Jane Sparkes

Research Funding:

More Information:

• Publication

The purpose of this study was to conduct a scoping review of current practices and recommendations for designing, implementing, and evaluating mHealth technologies to support the management of chronic conditions in community-dwelling older adults.

There is limited yet increasing use of mHealth technologies in home health care for older adults. A user-centered, collaborative, interdisciplinary approach to enhance feasibility, acceptability, and usability of mHealth innovations is imperative. Creating teams with the required pools of expertise and insight regarding needs is critical. The cyclical, iterative process of developing mHealth innovations needs to be viewed as a whole with supportive theoretical frameworks. Many barriers to implementation and sustainability have limited the number of successful, evidence-based mHealth solutions beyond the pilot or feasibility stage. The science of implementation of mHealth technologies in home-based care for older adults and self-management of chronic conditions are important areas for further research. Additionally, changing needs as cohorts and technologies advance are important considerations. Lessons learned from the data and important implications for practice, policy, and research are discussed to inform the future development of innovations.

Co-author:

Matthew-Maich, N., Harris, L., Ploeg, J., Markle-Reid, M., Valaitis, R., Ibrahim, S., Gafni, A., & Isaacs, S.

Students:

1. Sandra Isaacs

Research Funding:

• Centre for Research in Community Interventions to Promote Optimal Aging at Home

More Information:

• Publication
• Ontario Ministry of Health and Long-Term Care, Health System Research Fund ($445,194)

This scoping review was conducted in advance of our design and build of a mobile health app to support an interprofessional nurse-led team approach in the delivery of community-based stroke rehabilitation in home care.

We systematically mapped the breadth of research related to three topic areas: mobile and electronic devices, technology based healthcare delivery, and aging populations and/or chronic conditions. From the research question “What are the current practices and recommendations for designing, implementing and evaluating mHealth solutions to support older adults living in their homes?” we identified 42 studies. Report to the Ministry of Health and Long-Term Care, February 2016. To ensure success, a user-centered, collaborative, interdisciplinary and iterative approach is imperative to enhance feasibility, acceptability and usability of mHealth innovations. Implementation within systems or organizations requires a thorough understanding of culture, values and context readiness from researchers.

First Author:

Valaitis, R., Markle-Reid, M., Kelly Stradiotto, C., Archer, N., Bender, D., Brown, P., Chambers, T., Chang, K., Hillmer, M., Karimi, R., Kennedy, L., Magwood-Tye, R., Matthew-Maich, N., Murray, N., Ploeg, J., Taberner, C.

Students:

1. Kristina Chang
2. Rojin Karimi

Research Funding:

• Centre for Research in Community Interventions to Promote Optimal Aging at Home

Advanced practice nursing (APN) is a term used to describe a variety of possible nursing roles operating at an advanced level of practice. The introduction of APN roles is expected to advance primary health care throughout Latin America and the Caribbean, where few such roles exist. The purpose of the paper is to outline an implementation strategy to guide and support the introduction of primary health care APN roles in Latin America and the Caribbean.

This paper outlined an implementation strategy to help guide implementation of APN roles in Latin America and the Caribbean, based on an existing framework that strategically organizes the key points identified by nursing leaders at the April 2015 summit. Countries can use this strategy as a tool to guide the implementation of APN roles that are relevant to their unique health care needs and system contexts. The ultimate aim is to contribute to the advancement of universal health by strengthening the contribution of nursing through the introduction of advanced practice nursing.

Co-author:

Oldenburger, D., Cassiani, S., Bryant-Lukosius, D., Valaitis, R., Baumann, A., Pulcini, J., & Martin-Misener, R.

Research Funding:

More Information:

• Link to paper

This paper explores policy implementation in two exemplar public health programs -chronic disease prevention and sexually-transmitted infection prevention - in Ontario, Canada. It examines public health service providers’, managers’ and senior managements’ perspectives on the process of implementation of the Ontario Public Health Standards 2008 and factors influencing implementation.

Multiple factors influenced public health policy implementation. Results provide empirical support for components of Greenhalgh et al’s framework and suggest two additional components – the role of external organizational collaborations and partnerships as well as planning processes in influencing implementation. These are important to consider by government and public health organizations when promoting new or revised public health policies as they evolve over time. A successful policy implementation process in Ontario has helped to move public health towards the new vision.

First author:

Valaitis, R., MacDonald, M., Kothari, A., O’Mara, L., Regan, S., Garcia, J., Murray, N., Manson, H., Peroff-Johnston, N., Bursey, G., Boyko, J.

Research Funding:

• Supporting Successful Implementation of Public Health Interventions: A Realist Synthesis

More Information:

• Publication
• CIHR Team in Public Health Services Renewal. Canadian Institutes for Health Research ($1,471,250)

There is a growing emphasis in public health on the importance of evidence-based interventions to improve population health and reduce health inequities.

A gap remains between the development of evidence-based public health interventions and their successful implementation. Conventional systematic reviews have been conducted on effective implementation in health care, but few in public health, so their relevance to public health is unclear. In most reviews, stringent inclusion criteria have excluded entire bodies of evidence that may be relevant for policy makers, program planners, and practitioners to understand implementation in the unique public health context. Realist synthesis is a theory-driven methodology that draws on diverse data from different study designs to explain how and why observed outcomes occur in different contexts and thus may be more appropriate for public health. Canadian Institutes for Health Research ($100,000) http://www.cihr-irsc.gc.ca/

Co-author:

MacDonald, M., Pauly, B., Wong, G., Schick-Makaroff, K., van Roode, T., Wilson Strosher, H., Kothari, A., Valaitis, R., Manson, H., O’Briain, W., Carroll, S., Lee, V., Tong, S., Dickenson Smith, K., Ward, M.

Research Funding:

• Supporting Successful Implementation of Public Health Interventions: A Realist Synthesis

More Information:

• Publication