Validation of a Causal Model of Implementation

实施因果模型的验证

• 批准号: 10576956
• 负责人: Emily Michele Becker Haimes
• 金额: $ 55.54万
• 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/10576956
• 关键词: Address; Attitude; Behavior; Client; Climate; Cognitive; Cognitive Therapy; Data; Development; Education; Effectiveness; 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; 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.

项目总结 推进因果实施理论对于设计量身定制的实施战略至关重要，以促进 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。 这类战略可能比一般的执行战略更成功、更有效。这个 这项研究的总体目标是测试假设因果关系的概念模型的概括性 在组织和社会心理学变量中预测临床医生循证实践(EBP) 使用。总的来说，该模型提出，气候和文化等组织因素会影响态度、规范 和自我效能感，而其他组织因素，如工作量、资源和组织摩擦 缓和意图和使用EBP之间的途径。我们最近完成的由NIMH资助的R21 证明此模型可解释以下三个EBPS实施过程中高达75%的差异 社区设置。虽然我们很有希望，但由于样本较少以及对特殊教育的关注，我们受到了限制。 教师对自闭症干预措施的使用。R01将在很大程度上检验因果模型的泛化能力 来自一组新从业者的更大样本，对于不同的、更广泛使用的EBP，认知- 行为疗法(CBT)。成功完成将进一步验证该模型，推进我们的 理解EBP实施中的因果路径。我们将利用正在实施的CBT 努力在两个大型公共卫生部门的40个组织中招聘约300名精神卫生临床医生 系统(费城和德克萨斯州)。在完成CBT培训后，临床医生将完成所有测量 模型中描绘的构件。临床医生还将通过提供CBT的音频记录进行观察 委托人在两次案件处理中。在每一次观察之后，关于理论上的 意向与行为差距将通过问卷调查来收集。一组临床医生，他们报告有很高的意图和 展示较低的EBP使用率将被有目的地招募来进一步完成简短的半结构化面试 评估行为意向落差的原因。我们的主要因变量和实施 令人感兴趣的结果是临床医生使用CBT的意图和对临床医生使用CBT的直接观察。 然而，由于CBT由许多复杂程度不同的离散组件组成，因此 CBT使用量将单独测量。数据将通过多层建模进行分析，以测试 意图和意图决定因素预测每个离散的CBT组成部分(目标1)以及在多大程度上 在实施文献中强调的组织和其他背景因素预测与以下方面相关的因素 意图的形成和调节意图与CBT使用之间的关联(目标2)。结果将通知 制定实施战略，以可修改的因素为目标，解释 意向和执行方面，可广泛适用于欧洲方案。