Lorentz Salvesen, Erlend Nuland Valen, Andrew Keith Wills, Elisabet Rudjord Hillesund, Frøydis Nordgård Vik, Dagrun Engeset, Nina Cecilie Øverby, Anine Christine Medin
Developmental origins of health and disease knowledge is associated with diet quality in preconception young adult men and women
Journal of developmental origins of health and disease
tailored implementation approaches touted superior standardized ones reasoning tailored approaches afford opportunities select strategies resolve determinants local context however results implementation trials topic equivocal therefore important explore relevant contextual factors function determinants evaluate improved tailoring subsequently associated changes implementation outcomes ie via statistical mediation better understand tailoring achieves achieve effects present study examined association tailored standardized implementation approach contextual factors might mediate change target implementation outcome initiative implement measurementbased care specifically clinical integration patient health questionnaire phq9 depression community mental health organization using cluster randomized control design twelve communitybased mental health clinics assigned tailored standardized implementation group clinicians completed selfreport battery assessing contextual factors served candidate mediators informed framework dissemination three time points baseline 5 months active implementation support 10 months sustainment monitoring subset clinicians also participated focus groups 5 months routine use phq9 implementation outcome monitored 10month sustainment period multilevel mediation analyses assessed association implementation group contextual factors association contextual factors phq9 completion quantitative results elaborated analyzing qualitative data exemplar sites although tailored clinics outperformed standard clinics terms phq9 completion end active implementation group differences disappeared post sustainment monitoring perhaps related significant mediators emerged quantitative analyses exploratory qualitative analyses focus group content emphasized importance support colleagues supervisors leadership implementing clinical innovations practice although rates phq9 completion improved across study sustained levels roughly equivalent across groups low overall mediators established using quantitative methods however several partial quantitative pathways well themes qualitative data reveal fruitful areas future research standardized versus tailored implementation measurementbased care depression gov nct02266134 first posted october 16 2014