Validation of a Causal Model of Implementation

实施因果模型的验证

• 批准号: 10402919
• 负责人: Emily Michele Becker Haimes
• 金额: $ 53.84万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-07 至 2026-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10402919
• 关键词: Address; Attitude; Behavior; Client; Climate; Cognitive; Cognitive Therapy; Data; Development; Evidence based intervention; Evidence based practice; Friction; Funding; Future; Goals; Health system; Incentives; Individual; Intention; Intervention; Interview; Link; Literature; Measures; Mental Health; Mental Health Services; Mental disorders; Methods; Modeling; Motivation; National Institute of Mental Health; Pathway interactions; Pennsylvania; Philadelphia; Policies; Population; Predictive Factor; Psychological Factors; Psychotherapy; Public Health; Quality of Care; Reporting; Research; Resources; Sampling; Self Efficacy; Social Psychology; Special Education; Structure; Surveys; System; Testing; Texas; Time; Training; United States National Institutes of Health; Validation; Work; Workload; autism spectrum disorder; behavior change; behavioral health; causal model; clinical care; community setting; comparative effectiveness; contextual factors; cost; cost effectiveness; design; effective therapy; effectiveness trial; follow-up; implementation determinants; implementation efforts; implementation framework; implementation outcomes; implementation science; implementation strategy; improved; improved outcome; interest; multilevel analysis; prospective; provider behavior; provider factors; psychologic; psychosocial; recruit; teacher; theories

PROJECT SUMMARY Advancing causal implementation theory is critical for designing tailored implementation strategies to facilitate clinician behavior change that target specific mechanisms associated with evidence-based practice (EBP) use. Such strategies may be more successful and more efficient than general implementation strategies. The overall goal of this study is to test the generalizability of a conceptual model that posits the causal relationship among variables from organizational and social psychology to predict clinician evidence-based practice (EBP) use. Broadly, the model proposes that organizational factors like climate and culture influence attitudes, norms and self-efficacy, while other organizational factors like workload, resources and organizational friction moderate the pathway between intentions and the use of an EBP. Our recently completed NIMH-funded R21 demonstrated that this model accounted for up to 75% of variance in implementation of three EBPs in community settings. While promising, we were limited by a small sample, and a focus on special education teachers' use of autism interventions. This R01 will test the generalizability of the causal model in a much larger sample from a new group of practitioners, for a different and more widely-used EBP, cognitive- behavioral therapy (CBT). Successful completion would further validate the model, advancing our understanding of the causal pathways in EBP implementation. We will leverage ongoing CBT implementation efforts to recruit approximately 300 mental health clinicians across 40 organizations in two large public health systems (Philadelphia and Texas). After completing training in CBT, clinicians will complete measures of all constructs delineated in the model. Clinicians also will be observed via audio recording delivering CBT with a client on their caseload on two occasions. Following each observation, data on theorized moderators of the intention to behavior gap will be collected via survey. A subset of clinicians who report high intentions and demonstrate low EBP use will be purposively recruited to complete brief semi-structured interviews further assessing reasons for the intention to behavior gap. Our primary dependent variables and implementation outcomes of interest are clinician intentions to use CBT and direct observation of clinician use of CBT. However, as CBT comprises many discrete components that vary in complexity, each discrete component of CBT use will be measured separately. Data will be analyzed via multilevel modeling to test the extent to which intentions and determinants of intention predict each discrete CBT component (Aim 1) and the extent to which organizational and other contextual factors highlighted in the implementation literature predict factors related to intention formation and moderate the association between intentions and CBT use (Aim 2). Results will inform the development of implementation strategies that target modifiable factors explaining substantial variance in intention and in implementation that can be applied broadly across EBPs.

项目概要 推进因果实施理论对于设计量身定制的实施策略以促进 针对与循证实践（EBP）使用相关的特定机制的临床医生行为改变。 这样的策略可能比一般的实施策略更成功、更有效。这 这项研究的总体目标是测试假设因果关系的概念模型的普遍性 利用组织心理学和社会心理学的变量来预测临床医生循证实践 (EBP) 使用。从广义上讲，该模型提出气候和文化等组织因素会影响态度、规范 和自我效能，而其他组织因素，如工作量、资源和组织摩擦 调节意图和 EBP 使用之间的路径。我们最近完成了 NIMH 资助的 R21 证明该模型在实施三个 EBP 时解释了高达 75% 的方差 社区设置。虽然我们很有希望，但我们受到样本较小和对特殊教育的关注的限制 教师对自闭症干预措施的使用。这个 R01 将以多种方式测试因果模型的普遍性 来自新的从业者群体的更大样本，针对不同且更广泛使用的 EBP、认知- 行为疗法（CBT）。成功完成将进一步验证模型，推进我们的 了解 EBP 实施中的因果路径。我们将利用正在进行的 CBT 实施 努力在两个大型公共卫生机构的 40 个组织中招募约 300 名心理健康临床医生 系统（费城和德克萨斯州）。完成 CBT 培训后，临床医生将完成所有措施 模型中描绘的构造。临床医生还将通过录音进行 CBT 的观察 客户曾两次谈论他们的案件量。每次观察后，理论调节者的数据 意向行为差距将通过调查收集。一部分临床医生报告有很高的意愿并且 证明 EBP 使用率较低的人将被有目的地招募来进一步完成简短的半结构化访谈 评估行为意图差距的原因。我们的主要因变量和实现 感兴趣的结果是临床医生使用 CBT 的意图以及对临床医生使用 CBT 的直接观察。 然而，由于 CBT 由许多复杂程度各异的分立组件组成，因此每个分立组件 CBT 的使用将单独衡量。将通过多级建模来分析数据，以测试其程度 意图和意图的决定因素预测每个离散的 CBT 组成部分（目标 1）以及其程度 实施文献中强调的组织和其他背景因素预测相关因素 意图形成并调节意图与 CBT 使用之间的关联（目标 2）。结果将告知 制定针对可改变因素的实施战略，这些因素可解释重大差异 意图和实施，可以广泛应用于各个 EBP。