Challenge 3: Developing a D&I Template for Sustainability Across Settings

Mary Daly England, Kelli Gora, Jose Daniel Navarro, Jill Weinstein

NURS 738 – Group 8College of Nursing, University of Arizona

November 11, 2013

Translational Research Template

Problem

Evidence

DevelopmentImplementation

Evaluation

Factors affecting adoption

• Innovations penetrate homophilous groups more readily

Homophilous verses heterophilous groups

• Active dissemination is more effective

Passive dissemination verses active dissemination

• Relative advantage and compatibility

Characteristics of the intervention or innovation

• Norms and attitudes, organizational structure and process, resources

Contextual factors

Methods to measure penetration and adoption

•Individual provider/consumer

•Service providers’ acceptance of EBP aimed at reducing child neglect

SurveysInterviews

Administrative data

•Individual provider

•Organization or setting

SurveysInterviews

Administrative dataObservation

•RE-AIM/Reach

Case audits Checklists

•Change in knowledge, attitude, behavior, quality of life

•Change in organizational policies and practice

Outcome Indicators

sample

POWER TO REDUCE TYPE I

& TYPE II ERRORS

SIGNIFICANCE

LEVEL OF CONFIDENCE

EFFECT SIZEMARGIN OF

RANDOM ERROR

COST

Variability

Factors to be Considered in Determining Sample Size

(Fox, Hunn & Mathers, 2009;Bacchetti, McCullouch & Segal, 2008)

SAMPLE SIZE IS CRITICAL AND SHOULD BE REPRESENTITIVE AND GERNERALIZABLE TO THE WIDER WORLD.

Organization population size 1000Confidence interval 5%Confidence level 95%

n=286

(Israel, 2009)

Criteria for Determining Effectiveness of the Translational Intervention(s)

EFFECTIVENESS

APPROPRIATENESS

Practicability (focus groups)

ADOPTION

Uptake (survey)

ACCEPTABILITYSatisfaction

of the innovation (survey)

FEASIBILITY

Suitable for everyday use

(survey)

FIDELITY

Adherence (check-lists)

SUSTAINABILITY

Continuation (interviews)

PENETRATION

Level of utilization (case audit)

Taxonomy of implementation outcomes (Proctor et al., 2011)

Organizational Sustainability

Sustainability

Culture

Effectiveness

Stakeholders/ Champions

Integration

Dynamic Sustainability Framework

Ecological System

Practice Setting

Intervention

• Other Practice Settings• Policy• Regulations• Market Forces• Population Charateristics

• Staffing• Org Culture• Models• Education

• Components• Practitioners• Outcomes• Delivery Platform

FIT

FIT

FIT

Adapted from Chambers et al, DSF Model (2013)

Sustainability Strategies

SUSTAINABILITY STRATEGIES

Initial Planning

Key Participants

Integration with

Established Systems

ResourcesFinancial

Time Human

Ongoing Evaluation

Integration With EDSS

(Chambers et al., 2013; Shediac-Rizkallah & Bone, 1998; Scheirer, 2005)

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