Validation of a Causal Model of Implementation

实施因果模型的验证

• 批准号: 10096422
• 负责人: Emily Michele Becker Haimes
• 金额: $ 56.01万
• 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/10096422
• 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; Healthcare; Incentives; Individual; Intention; Intervention; Interview; Link; Literature; Measures; Mental Health; 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.

项目摘要 推进因果实施理论对于设计量身定制的实施策略至关重要 临床医生的行为改变了与循证实践（EBP）使用相关的特定机制。 这些策略可能比一般实施策略更成功，更高效。这 这项研究的总体目标是测试提出因果关系的概念模型的普遍性 在组织和社会心理学的变量中，预测临床医生循证实践（EBP） 使用。从广义上讲，该模型提出，诸如气候和文化之类的组织因素会影响态度，规范 和自我效能感，而其他组织因素，例如工作量，资源和组织摩擦 调节意图和使用EBP之间的路径。我们最近完成的NIMH资助的R21 证明该模型在实施三个EBP的差异中最多占差异的75％ 社区设置。虽然有前途，但我们受到一个少量样本的限制，而专注 教师使用自闭症干预措施。该R01将在多大程度上测试因果模型的普遍性 来自新的一组从业者的较大样本，用于不同，更广泛的EBP，认知 - 行为疗法（CBT）。成功完成将进一步验证模型，推动我们的 了解EBP实施中的因果途径。我们将利用正在进行的CBT实施 在两个大型公共卫生中的40个组织中招募大约300名心理健康临床医生的努力 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 在模型中描述的构造。还将通过音频记录来观察临床医生 客户两次在案件上。按照每个观察结果，有关理论主持人的数据 行为差距的意图将通过调查收集。报告高意见和 证明使用低EBP的使用将有目的地招募，以进一步完成简短的半结构访谈 评估行为差距的意图的原因。我们的主要因变量和实施 感兴趣的结果是临床医生意图使用CBT并直接观察临床医生对CBT的使用。 但是，由于CBT包含许多复杂性各不相同的离散组件，因此 CBT使用将分别测量。数据将通过多级建模分析，以测试 意图的意图和决定因素可以预测每个离散的CBT组件（AIM 1）以及多大程度上 实施文献中强调的组织和其他上下文因素预测了与 意图形成并缓和意图与CBT使用之间的关联（AIM 2）。结果将告知 实施策略的发展，以可修改因素解释了实质性差异 意图和实施，可以在EBP上广泛应用。