TY - JOUR
T1 - Periodic reflections
T2 - A method of guided discussions for documenting implementation phenomena
AU - Finley, Erin P.
AU - Huynh, Alexis K.
AU - Farmer, Melissa M.
AU - Bean-Mayberry, Bevanne
AU - Moin, Tannaz
AU - Oishi, Sabine M.
AU - Moreau, Jessica L.
AU - Dyer, Karen E.
AU - Lanham, Holly Jordan
AU - Leykum, Luci
AU - Hamilton, Alison B.
N1 - Funding Information:
All views expressed are those of the authors and do not represent the views of the U.S. government or the Department of Veterans Affairs. The EMPOWER study was made possible by VA QUERI funding (QUE 15-272). Tannaz Moin receives support from VA CSP#2002, the CDC/NIDDK (U18DP006128) and NIH/NIDDK (1R18DK105464-01). We would like to extend a special thanks to the EMPOWER Strategy Advisory Group and Lauren Penney, PhD, for their support in developing this work.
Funding Information:
The implementation initiative described was funded through VA’s Quality Enhancement Research Initiative (QUERI), which uses operational funds to support program improvement. QUERI projects are often conducted as quality improvement, and the DPP project described above falls under that category. The CV Toolkit and CCWV projects described above are considered research and are approved by the Central VA Institutional Review Board and local site Research and Development Boards.
Funding Information:
In 2015, the Department of Veterans Affairs (VA) Quality Enhancement and Research Initiative (QUERI) funded a five-year, multi-site program of research aimed at “Enhancing Mental and Physical Health of Women through Engagement and Retention” (EMPOWER) [29]. EMPOWER includes three projects to implement innovative care models in VA women’s health using Replicating Effective Programs (REP), an evidence-based implementation strategy [30–32] enhanced with stakeholder engagement [33] and complexity science [13, 21, 34, 35]. As part of a multi-method assessment strategy, we developed a pragmatic, ethnographically-informed method for guided discussions (“periodic reflections”) to be used across EMPOWER. Periodic reflections aid in documenting and encouraging reflection on key implementation events, actors, and processes, including adaptation, in complex, multi-site, multi-level implementation studies. This paper has three primary goals: (1) to describe periodic reflections as a method for guided discussions and how they have been used as part of EMPOWER’s implementation evaluation; (2) to illustrate, using examples from all three EMPOWER projects, the value of periodic reflections as a low-burden method for capturing time-sensitive data of interest in implementation trials, and for helping to operationalize dynamic context, adaptation, and team sen-semaking in complex interventions and settings; and (3) to consider how periodic reflections may also support effective sensemaking and learning within implementation teams.
PY - 2018/11/27
Y1 - 2018/11/27
N2 - Background: Ethnography has been proposed as a valuable method for understanding how implementation occurs within dynamic healthcare contexts, yet this method can be time-intensive and challenging to operationalize in pragmatic implementation. The current study describes an ethnographically-informed method of guided discussions developed for use by a multi-project national implementation program. Methods: The EMPOWER QUERI is conducting three projects to implement innovative care models in VA women's health for high-priority health concerns - prediabetes, cardiovascular risk, and mental health - utilizing the Replicating Effective Programs (REP) implementation strategy enhanced with stakeholder engagement and complexity science. Drawing on tenets of ethnographic research, we developed a lightly-structured method of guided "periodic reflections" to aid in documenting implementation phenomena over time. Reflections are completed as 30-60 min telephone discussions with implementation team members at monthly or bi-monthly intervals, led by a member of the implementation core. Discussion notes are coded to reflect key domains of interest and emergent themes, and can be analyzed singly or in triangulation with other qualitative and quantitative assessments to inform evaluation and implementation activities. Results: Thirty structured reflections were completed across the three projects during a 15-month period spanning pre-implementation, implementation, and sustainment activities. Reflections provide detailed, near-real-time information on projects' dynamic implementation context, including characteristics of implementation settings and changes in the local or national environment, adaptations to the intervention and implementation plan, and implementation team sensemaking and learning. Reflections also provide an opportunity for implementation teams to engage in recurring reflection and problem-solving. Conclusions: To implement new, complex interventions into dynamic organizations, we must better understand the implementation process as it unfolds in real time. Ethnography is well suited to this task, but few approaches exist to aid in integrating ethnographic insights into implementation research. Periodic reflections show potential as a straightforward and low-burden method for documenting events across the life cycle of an implementation effort. They offer an effective means for capturing information on context, unfolding process and sensemaking, unexpected events, and diverse viewpoints, illustrating their value for use as part of an ethnographically-minded implementation approach. Trial registration: The two implementation research studies described in this article have been registered as required: Facilitating Cardiovascular Risk Screening and Risk Reduction in Women Veterans (NCT02991534); and Implementation of Tailored Collaborative Care for Women Veterans (NCT02950961).
AB - Background: Ethnography has been proposed as a valuable method for understanding how implementation occurs within dynamic healthcare contexts, yet this method can be time-intensive and challenging to operationalize in pragmatic implementation. The current study describes an ethnographically-informed method of guided discussions developed for use by a multi-project national implementation program. Methods: The EMPOWER QUERI is conducting three projects to implement innovative care models in VA women's health for high-priority health concerns - prediabetes, cardiovascular risk, and mental health - utilizing the Replicating Effective Programs (REP) implementation strategy enhanced with stakeholder engagement and complexity science. Drawing on tenets of ethnographic research, we developed a lightly-structured method of guided "periodic reflections" to aid in documenting implementation phenomena over time. Reflections are completed as 30-60 min telephone discussions with implementation team members at monthly or bi-monthly intervals, led by a member of the implementation core. Discussion notes are coded to reflect key domains of interest and emergent themes, and can be analyzed singly or in triangulation with other qualitative and quantitative assessments to inform evaluation and implementation activities. Results: Thirty structured reflections were completed across the three projects during a 15-month period spanning pre-implementation, implementation, and sustainment activities. Reflections provide detailed, near-real-time information on projects' dynamic implementation context, including characteristics of implementation settings and changes in the local or national environment, adaptations to the intervention and implementation plan, and implementation team sensemaking and learning. Reflections also provide an opportunity for implementation teams to engage in recurring reflection and problem-solving. Conclusions: To implement new, complex interventions into dynamic organizations, we must better understand the implementation process as it unfolds in real time. Ethnography is well suited to this task, but few approaches exist to aid in integrating ethnographic insights into implementation research. Periodic reflections show potential as a straightforward and low-burden method for documenting events across the life cycle of an implementation effort. They offer an effective means for capturing information on context, unfolding process and sensemaking, unexpected events, and diverse viewpoints, illustrating their value for use as part of an ethnographically-minded implementation approach. Trial registration: The two implementation research studies described in this article have been registered as required: Facilitating Cardiovascular Risk Screening and Risk Reduction in Women Veterans (NCT02991534); and Implementation of Tailored Collaborative Care for Women Veterans (NCT02950961).
KW - Complexity science
KW - Ethnography
KW - Implementation context
KW - Qualitative methods
KW - Replicating effective programs
KW - Women veterans; adaptation
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U2 - 10.1186/s12874-018-0610-y
DO - 10.1186/s12874-018-0610-y
M3 - Article
C2 - 30482159
AN - SCOPUS:85057282819
VL - 18
JO - BMC Medical Research Methodology
JF - BMC Medical Research Methodology
SN - 1471-2288
IS - 1
M1 - 153
ER -