Sustainability, spread, and scale in trials using audit and feedback: a theory-informed, secondary analysis of a systematic review
Abstract Background Audit and feedback (A&F) is a widely used implementation strategy to influence health professionals’ behavior that is often tested in implementation trials. This study examines how A&F trials describe sustainability, spread, and scale. Methods This is a theory-informed, d...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-10-01
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| Series: | Implementation Science |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13012-023-01312-0 |
| _version_ | 1827781115995226112 |
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| author | Celia Laur Zeenat Ladak Alix Hall Nathan M. Solbak Nicole Nathan Shewit Buzuayne Janet A. Curran Rachel C. Shelton Noah Ivers |
| author_facet | Celia Laur Zeenat Ladak Alix Hall Nathan M. Solbak Nicole Nathan Shewit Buzuayne Janet A. Curran Rachel C. Shelton Noah Ivers |
| author_sort | Celia Laur |
| collection | DOAJ |
| description | Abstract Background Audit and feedback (A&F) is a widely used implementation strategy to influence health professionals’ behavior that is often tested in implementation trials. This study examines how A&F trials describe sustainability, spread, and scale. Methods This is a theory-informed, descriptive, secondary analysis of an update of the Cochrane systematic review of A&F trials, including all trials published since 2011. Keyword searches related to sustainability, spread, and scale were conducted. Trials with at least one keyword, and those identified from a forward citation search, were extracted to examine how they described sustainability, spread, and scale. Results were qualitatively analyzed using the Integrated Sustainability Framework (ISF) and the Framework for Going to Full Scale (FGFS). Results From the larger review, n = 161 studies met eligibility criteria. Seventy-eight percent (n = 126) of trials included at least one keyword on sustainability, and 49% (n = 62) of those studies (39% overall) frequently mentioned sustainability based on inclusion of relevant text in multiple sections of the paper. For spread/scale, 62% (n = 100) of trials included at least one relevant keyword and 51% (n = 51) of those studies (31% overall) frequently mentioned spread/scale. A total of n = 38 studies from the forward citation search were included in the qualitative analysis. Although many studies mentioned the need to consider sustainability, there was limited detail on how this was planned, implemented, or assessed. The most frequent sustainability period duration was 12 months. Qualitative results mapped to the ISF, but not all determinants were represented. Strong alignment was found with the FGFS for phases of scale-up and support systems (infrastructure), but not for adoption mechanisms. New spread/scale themes included (1) aligning affordability and scalability; (2) balancing fidelity and scalability; and (3) balancing effect size and scalability. Conclusion A&F trials should plan for sustainability, spread, and scale so that if the trial is effective, the benefits can continue. A deeper empirical understanding of the factors impacting A&F sustainability is needed. Scalability planning should go beyond cost and infrastructure to consider other adoption mechanisms, such as leadership, policy, and communication, that may support further scalability. Trial registration Registered with Prospero in May 2022. CRD42022332606. |
| first_indexed | 2024-03-11T15:14:19Z |
| format | Article |
| id | doaj.art-f16533d72eb44312aacd505c8d973b1b |
| institution | Directory Open Access Journal |
| issn | 1748-5908 |
| language | English |
| last_indexed | 2024-03-11T15:14:19Z |
| publishDate | 2023-10-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science |
| spelling | doaj.art-f16533d72eb44312aacd505c8d973b1b2023-10-29T12:31:19ZengBMCImplementation Science1748-59082023-10-0118112110.1186/s13012-023-01312-0Sustainability, spread, and scale in trials using audit and feedback: a theory-informed, secondary analysis of a systematic reviewCelia Laur0Zeenat Ladak1Alix Hall2Nathan M. Solbak3Nicole Nathan4Shewit Buzuayne5Janet A. Curran6Rachel C. Shelton7Noah Ivers8Women’s College Hospital Institute for Health System Solutions and Virtual CareWomen’s College Hospital Institute for Health System Solutions and Virtual CareSchool of Medicine and Public Health, The University of NewcastlePhysician Learning Program, Continuing Medical Education and Professional Development, Cumming School of Medicine, University of CalgarySchool of Medicine and Public Health, The University of NewcastleWomen’s College Hospital Institute for Health System Solutions and Virtual CareSchool of Nursing, Faculty of Health, Dalhousie UniversityDepartment of Sociomedical Sciences, Mailman School of Public Health, Columbia UniversityWomen’s College Hospital Institute for Health System Solutions and Virtual CareAbstract Background Audit and feedback (A&F) is a widely used implementation strategy to influence health professionals’ behavior that is often tested in implementation trials. This study examines how A&F trials describe sustainability, spread, and scale. Methods This is a theory-informed, descriptive, secondary analysis of an update of the Cochrane systematic review of A&F trials, including all trials published since 2011. Keyword searches related to sustainability, spread, and scale were conducted. Trials with at least one keyword, and those identified from a forward citation search, were extracted to examine how they described sustainability, spread, and scale. Results were qualitatively analyzed using the Integrated Sustainability Framework (ISF) and the Framework for Going to Full Scale (FGFS). Results From the larger review, n = 161 studies met eligibility criteria. Seventy-eight percent (n = 126) of trials included at least one keyword on sustainability, and 49% (n = 62) of those studies (39% overall) frequently mentioned sustainability based on inclusion of relevant text in multiple sections of the paper. For spread/scale, 62% (n = 100) of trials included at least one relevant keyword and 51% (n = 51) of those studies (31% overall) frequently mentioned spread/scale. A total of n = 38 studies from the forward citation search were included in the qualitative analysis. Although many studies mentioned the need to consider sustainability, there was limited detail on how this was planned, implemented, or assessed. The most frequent sustainability period duration was 12 months. Qualitative results mapped to the ISF, but not all determinants were represented. Strong alignment was found with the FGFS for phases of scale-up and support systems (infrastructure), but not for adoption mechanisms. New spread/scale themes included (1) aligning affordability and scalability; (2) balancing fidelity and scalability; and (3) balancing effect size and scalability. Conclusion A&F trials should plan for sustainability, spread, and scale so that if the trial is effective, the benefits can continue. A deeper empirical understanding of the factors impacting A&F sustainability is needed. Scalability planning should go beyond cost and infrastructure to consider other adoption mechanisms, such as leadership, policy, and communication, that may support further scalability. Trial registration Registered with Prospero in May 2022. CRD42022332606.https://doi.org/10.1186/s13012-023-01312-0Audit and feedbackSustainabilitySpreadScaleImplementationSystematic review |
| spellingShingle | Celia Laur Zeenat Ladak Alix Hall Nathan M. Solbak Nicole Nathan Shewit Buzuayne Janet A. Curran Rachel C. Shelton Noah Ivers Sustainability, spread, and scale in trials using audit and feedback: a theory-informed, secondary analysis of a systematic review Implementation Science Audit and feedback Sustainability Spread Scale Implementation Systematic review |
| title | Sustainability, spread, and scale in trials using audit and feedback: a theory-informed, secondary analysis of a systematic review |
| title_full | Sustainability, spread, and scale in trials using audit and feedback: a theory-informed, secondary analysis of a systematic review |
| title_fullStr | Sustainability, spread, and scale in trials using audit and feedback: a theory-informed, secondary analysis of a systematic review |
| title_full_unstemmed | Sustainability, spread, and scale in trials using audit and feedback: a theory-informed, secondary analysis of a systematic review |
| title_short | Sustainability, spread, and scale in trials using audit and feedback: a theory-informed, secondary analysis of a systematic review |
| title_sort | sustainability spread and scale in trials using audit and feedback a theory informed secondary analysis of a systematic review |
| topic | Audit and feedback Sustainability Spread Scale Implementation Systematic review |
| url | https://doi.org/10.1186/s13012-023-01312-0 |
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