Table 2 Summary of original studies included in a systematic review of the use of the Practical, Robust Implementation and Sustainability Model (PRISM)

Ameling, J. M., et al. (2014) [35]

Patient-centered behavioral self-management interventions to improve hypertension control among urban African Americans receiving primary care

Use of hybrid methodologies to adapt interventions for populations experiencing health disparities to improve interventions’ translation to real clinical practice settings and enhance interventions’ sustained effectiveness. Focused on PRISM construct of multiple levels of recipients—organizational and patient characteristics and perceptions of the intervention. Their approach resulted in numerous potential participant-driven intervention modifications to improve the potential effectiveness of hypertension self-management interventions for urban African Americans. Investigators planning similar approaches should consider the substantial resources that similar efforts may require to obtain generalizable perspectives. Stakeholders’ input revolved around their: perceived potential for interventions to improve clinical practice, desired features of interventions, suggested ways to enhance interventions’ cultural relevance, and threats to interventions’ sustained effectiveness.

Ayele, R. A., et al. (2017)

[36] (Ayele, R. A., et al. (2019) [37]; McCreight, M. S., et al. (2019) [38])

Transition of care quality improvement

Four major themes emerged where participants consistently discussed that transitions were delayed when they were not able to (1) identify patients as veterans and notify VA primary care of discharge, (2) transfer non-VA hospital medical records to VA primary care, (3) obtain follow-up care appointments with VA primary care, and (4) write VA formulary medications for veterans that they could fill at VA pharmacies. Each theme was attributed in part to external environment and implementation and sustainability infrastructure contextual factors. The initial theme also was attributed in part to recipient (patient-level) characteristics. Participants also discussed factors involved in smooth transition and recommendations to improve care coordination suggesting positive implementation and sustainability infrastructure context factors also existed.

Ekawati, F.M., et al. (2019) [39]

(Ekawati, F.M., et al. (2020) [40])

Hypertension Disorders in Pregnancy management pathways contextualized to Indonesian primary care settings (to be developed)

Even though Indonesian antenatal care and referrals are generally accessible, there are many challenges and fragmentation of HDP management. The most prominent challenge was related to recipient characteristics—the primary care providers’ lack of confidence in performing the management and a program/intervention factor related to the urgent need of practice guidelines in primary care that had not been appropriately described in the literature. Further development of an evidence-based primary care-focused guidance will potentially improve recipient characteristics—primary care providers’ skills to perform optimal HDP management and provide appropriate education to their patients. Protocol paper.

Esses, S. A., et al. (2019) [41]

The survey indicated that all 3 interventions minimally disrupted workflow and all were recognized as useful. To ensure sustainable implementation, the characteristics of the unit should be considered when selecting an educational program. When parents/caregivers of pediatric ICU patients are given targeted education about PICS, their knowledge of the syndrome, its signs and symptoms, how to contact a social worker, self-management techniques, and available resources increases. In general, education about PICS itself, and how a family might receive assistance during their child’s ICU stay, is well supported by PICU nurses and perceived to be both important and not significantly disruptive to daily workflow. Overall, the costs of such a program are relatively low. Therefore, it is feasible for significant PICS-related education and family support to be provided in almost any PICU setting in a locally sustainable fashion.

Gopalan, G, et al. (2016) [42]

(Gopalan, G., et al. (2019) [43]; Hooley, C., et al. (2020) [44])

4 Rs and 2 Ss for Strengthening Families Program: Caregiver engagement and behavioral parent training and family therapy strategies to support family-level influences on disruptive behavior disorders

Advisory board members reported difficulties engaging families, heavy workloads, and conflicting implementation initiatives. While 4R2S was perceived as generally aligned with their organization’s mission, modifications to the intervention and to agency procedures were recommended to promote implementation success. Suggested modifications to the existing 4R2S training and supervision are discussed. Findings underscore the importance of understanding the experiences of CW service providers, which can inform future efforts to implement child mental health EBIs in CW services. (Gopalan, G., et al. [43]).

Recommendations included adjusting curriculum to better fit the culture of recipients and conveying the importance of openness and respect to providers (Hooley, C., et al. [44]).

Gopalan, G, et al. (2014) [45]

4 Rs and 2 Ss for Strengthening Families Program: Caregiver engagement and behavioral parent training and family therapy strategies to support family-level influences on disruptive behavior disorders

Facilitators and directors reported an overall positive experience in implementing the 4 Rs Program. Given that every clinic functions somewhat differently, flexibility in the implementation of the 4 Rs Program is vital. To advance the first statewide implementation of the 4 Rs Program, CTAC staff utilized PRISM to guide model modifications serving to enhance agency-level uptake. A collaborative approach guided model revisions such that the resulting program manual was co-created by family members, providers, and research staff to promote the existing evidence base in “user friendly” language. While the main components of the model based on the evidence-base remain the same, the revised version is streamlined to cut down on complexity, reduce the number of materials, better fit into current clinic structures, and is supported through a learning collaborative process.

Henderson, V., et al. (2020) [46]

Mile Square Accessible Mammogram Outreach and Engagement (Mi-MAMO): Breast cancer screening and navigation program

Between January and December 2017, 103 women received a screening mammogram at Mile Square Health Centers. To increase screening rates, Mi-MAMO was started in August 2017. Between January and December 2018, the number of women who received a screening mammogram increased to 567. Twenty-four percent (n = 185) completed diagnostic services, and 10 women received positive breast cancer diagnoses (mean age, 49.7 years); all successfully navigated to treatment. Deploying an integrated framework for patient navigation programs can increase breast cancer screening utilization and awareness among under-resourced populations at higher risk for breast cancer.

Knudsen, HK., et al. (2020) [47]

Communities That HEAL (CTH) intervention

None reported; study in progress

Leonard, C, et al. (2019) [48]

(Leonard, C., et al. (2017) [49]; McCreight, M. S., et al. (2019) [38])

Transitions nurse program (TNP) is a Veteran-centered intervention carried out with a Transition Nurse (TN) in collaboration with a hospitalist site champion designed to improve transitional care for rural Veterans.

None reported; study in progress

Liles, EG, et al. (2015) [26]

(Feldstein, A. C. & Glasgow, R. E., (2008) [4])

Centralized outreach program for colorectal cancer (CRC) screening

Addressing barriers at multiple levels of a health system by changing the delivery system design to add a centralized outreach program, switching to a more accurate and easier to use fecal test, and providing educational and electronic support saw CRC screening rates improve 10% during program implementation and they continue to rise.

Linke, SE, et al. (2020) [50]

Quality improvement (QI) project that integrates Exercise is Medicine (EIM) into routine clinical practice

None reported; study in progress

Paniagua-Avila, A., et al. (2020) [51]

None reported; study in progress

Pittman, J. O. E., et al. (2020) [52]

Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST), a compensatory cognitive training (CCT) modules designed to target cognitive impairments common in people with Hoarding Disorder (HD).

There were significant changes in hoarding severity and clutter volume. Based on the initial 2 years of the program, funding was provided for expansion to cover additional San Diego County regions and hire more staff clinicians in year three. Preliminary data suggest that the CREST intervention can be successfully implemented in a community setting with positive results for older adults with HD.

Satre, DD, et al. (2019) [53]

A behavioral health specialist-delivered intervention in primary care with computerized screening and treatment for substance use disorder and depression and anxiety among people with HIV.

None reported; study in progress

Schneider, JL, et al. (2016) [54]

Lynch syndrome screening for all newly diagnosed colon cancer patients

They completed 14 interviews with leaders/managers and staff representing involved clinical and health-plan departments. Although stakeholders supported the concept of universal screening, they identified several internal organizational) and external (environment) factors that promote or hinder implementation. Facilitating factors included perceived benefits of screening for patients and organization, collaboration between departments, and availability of organizational resources. Barriers were also identified, including: lack of awareness of guidelines, lack of guideline clarity, staffing and program “ownership” concerns, and cost uncertainties. Analysis also revealed nine important infrastructure-type considerations for successful implementation. Requirements for successful implementation may include interdepartmental collaboration and communication, patient and provider/ staff education, and significant infrastructure and resource support related to laboratory processing and systems for electronic ordering and tracking.

Scholin, L., et al. (2019) [55]

Screening and brief intervention (SBI) consists of a short conversation focused on identifying problem drinking, motivating and facilitating reduction in drinking or abstinence to reduce the risk of harm.

In several health boards, where reported maternal alcohol use was lower than expected, implementation leaders sought to optimize enquires about women’s alcohol use to facilitate honest disclosure. Strategies focused on having positive conversations, exploring pre-pregnancy drinking habits, and building a trusting relationship between pregnant women and midwives. Women's responses were encouraging and disclosure rates appeared improved, though with some unexpected variation over time. Adapting the intervention to the local context was also considered important. This is the first study to explore implementation leaders’ experiences of antenatal SBI delivery and identify possible changes in disclosure rates arising from the approach taken. Systems-informed evaluations of interventions in this setting that include consideration of unintended consequences are vital. A flexible, conversational approach to discussing alcohol with pregnant women was considered superior to formal tools for identifying who might benefit from interventions.

Shields, N., et al. (2020) [56]

FitSkills is a community based physical activity intervention to improve exercise participation among young people with disabilities.

None reported; study in progress

Ssewamala, FM, et al. (2018) [57]

(McKay, M. M., et al. (2020) [58])

The Multiple Family Group. a multi-generational intervention for youth at high contextual risk for behavioral challenges guided by the 4Rs and 2Ss

Study in progress.

Collaboration with global communities and governments plays a critical role in the adaptation, uptake, scalability, and sustainability of EBPs, and that the process of engagement and collaboration can be guided by conceptual frameworks [58].

Stephens, TN, et al. (2014) [59]

4Rs and 2Ss, a clinical intervention for groups of families with children (aged 7-11 years old) who meet the diagnostic criteria for oppositional defiant disorder or conduct disorder.

Clinics that were more proactive evidenced staff with advanced organizational skills were able to take advantage of the trainings and supports offered by the LC and fared better in their ability to adopt the intervention. The ability to adapt the intervention to the specific constraints of the clinics was a strong influence on continued use following the end of the LC. The dedicated service provided by the staff of the learning collaborative appeared to positively impact the rollout of the 4Rs Program. Problem-solving was a key component of the LC process. This translated to practical questions being answered in the sessions about what could be reasonably amended while maintaining fidelity. While success varied across clinics, there were a number of characteristics that were identified that are linked to successful adoption. These included factors related to their use of the program, their response to external environmental pressures, their mobilization of implementation and sustainability infrastructure, and recipient characteristics.

Sullivan, J. L., et al. (2018) [60]

Project Re-Engineered Discharge (RED) is a patient-centered, standardized intervention to improve hospital discharge processes

Progress and adherence to the RED toolkit implementation steps and intervention components varied across study sites. Both higher- and lower-adherence sites were ultimately able to tailor and implement RED, in large part, because of its adaptability and flexibility. A majority of contextual factors identified were positive influences on sites’ implementation, including readiness to change (for example, to reduce high readmission rates), the presence of coordination across departments and specialties, and patient centeredness. However, the burden of undertaking a large intervention can also negatively influence and hinder program implementation.

Woodbridge, M. W., et al. (2014) [61]

First Step to Success is an early intervention program designed to help children in primary grades who are at risk for developing aggressive or antisocial behavior patterns.

A higher dosage of intervention days delivered successfully in the classroom was associated with higher academic engagement. Higher dosage of Home Base sessions was associated with higher academic engaged time. First Step was associated with improvements in students’ pro-social skills and reductions in problem behaviors. Teachers’ higher implementation fidelity was associated with greater student gains, and teachers’ delivery of higher dosage of First Step was associated with students’ greater academic engagement. From the qualitative data the participants did not think the intervention was overly complex or burdensome to implement. Educators advocated for a supportive infrastructure including high-quality, easily accessible training and regular technical assistance in the classroom. Participants recommended that teachers and students have access to the consistent support of a mentor or coach, who can encourage engagement in the EBP, problem solve about daily behavioral issues in the classroom, and provide immediate feedback about participant successes and challenges.

Yakovchenko, V, et al. (2019) [62]

Automated text messaging system (aTS) for patient self-management and allows clinical teams to monitor patient progress between in-person visits for hepatitis C virus (HCV) treatment.

Providers found the aTS appropriate with high potential for scale-up but not without difficulties in startup, patient selection and recruitment, and clinic workflow integration. Patients largely found the aTS easy to use and helpful; however, low perceived need for self-management support contributed to high declination. The aTS is a promising intervention for improving patient self-management; however, augmented approaches to implementation may be needed to support clinician buy-in and patient engagement. Despite positive perceptions of the aTS, patient enrollment was challenging; however, augmented facilitation resulted in the greater sustained engagement of patients once they enrolled. Among patients who used the aTS (texters) there was an indication of improved illness perception, health engagement, and patient activation.

Zhang, R, et al. (2020) [63]

(Li, L., et al. (2020) [64])

Health education (HE) delivered through the community health service (Zhang et al. 2020) and Healthcare management for the aged (HMA) in basic public health service (BPHS) delivered by lay healthcare workers (LHWs) in primary health care (PHC) sectors (Li et al. 2020)

Less than 50% of residents who knew or utilized some item of HE. Distance to PHC sectors was associated with the knowledge of HE, gender and health insurance were associated with utilization of HE. Age, marital status, occupation region, and self-reported health were associated with satisfaction regarding HE. Barriers to HE delivery included defects in HE design, weak capacity in PHC sectors to provide HE, residents’ poor cooperation, lack of multi-sector cooperation, poor equipment and weak health system. Southwest China delivered HE in all PHC sectors. However, our study underlined many barriers to equalization of HE. To address those barriers and achieve HE quality improvement, comprehensive measures to improve capacity of PHC sectors, enhance multi-sector cooperation and strengthen health information systems are all urgent needs [63].

More than 85% of aged individuals had knowledge and utilization of HMA, and over 94% of these respondents were satisfied with HMA. Challenges in HMA delivery included weakness (unmet items and lack of appropriate assessment indicators) in HMA design, low capacity of PHC sectors and competency of LHWs to deliver HMA, poor health literacy of aged individuals, insufficient funds, and a lack of multi-sector cooperation. Though significant achievements in HMA were observed, this study highlighted the challenges in further quality improvement of HMA delivery program in Southwest China. The “older-person-centered and integrated care” model provided a good theory to improve the quality of HMA by reinforcing the needs-based HMA design, building a comprehensive assessment strategy, improving the capacity of PHC sectors and the LHWs’ competency, and strengthening multi-sector cooperation [64].