■坚持干预培训实施策略是忠诚的基础;然而,很少有研究将培训依从性与受训者的态度和领导行为联系起来,以确定采用和传播基于证据的实践实际上重要的是什么。通过开展本杂交3型有效性实施整群随机对照试验,我们收集了探索,准备工作,实施,和可持续性(EPIS)数据,并将其与量身定制的激励面试培训依从性数据合并,为了阐明提供者对循证实践的态度之间的关系,领导行为,和培训实施战略(例如,研讨会出勤和参与一对一辅导)坚持。
■我们的样本包括来自完成基线(干预前)调查的提供者的数据,这些调查捕获了影响实施的内部和外部环境,并参与了量身定制的动机性访谈培训,生成一个数据集,其中包括培训实施策略的依从性和实施障碍以及促进者(N=77)。领导能力由两个量表来评估:主管领导量表和执行领导量表。使用循证实践态度量表(EBPAS-50)测量态度。对训练实施策略的坚持被建模为具有高斯分布的连续结果。在SPSS中进行分析。
■在对循证实践的九种普遍态度中,开放性与训练依从性相关(估计[EST]=0.096,p<.001;95%CI=[0.040,0.151]).提供者一般(EST=0.054,95%CI=[0.007,0.102])和动机性访谈特定(EST=0.044,95%CI=[0.002,0.086])领导行为与培训依从性呈正相关(p<.05)。在四个激励面试特定的领导领域中,知识和毅力与训练依从性相关(p<.05)。随着这些领导行为的增加,知识(EST=0.042,95%CI=[0.001,0.083])和毅力(EST=0.039,95%CI=[0.004,0.075]),提供者坚持培训实施策略也是如此。
■随着实施科学更加强调在通过评估组织气候来提供基于证据的实践之前评估准备情况,资金流,改变文化,还应该考虑领导力的衡量标准。克服阻力的潜在机制是通过实施培训策略,重点是在对感兴趣的循证实践进行培训之前解决领导问题。
研究人员和从业者,他们的目标是提高对循证实践的吸收,继续寻求改善提供者参与培训实施策略的方法。解决提供者脱离接触的持续挑战,在将这种不感兴趣与患者不良预后联系起来的同时,一直在确定如何量化相关的交付考虑因素,例如,提供者的态度和领导行为可能会影响对学习的承诺或对行为改变的冷漠,同时坚持训练。通过本研究的开展,我们收集了两种类型的数据:(1)提供者态度和领导行为;(2)培训依从性结果.我们发现提供商的开放性,一般领导行为,特定于动机面试的领导行为与坚持培训实施策略有关。由于在采用新的循证实践之前,更多的重点是评估临床准备情况,关于包括提供者对循证实践的态度的指标的讨论,创新,具体的干预是有必要的,同时考虑专注于解决领导力的实施培训策略如何在交付创新之前支持支持变革的行为。
UNASSIGNED: Adherence to intervention training implementation strategies is at the foundation of fidelity; however, few studies have linked training adherence to trainee attitudes and leadership behaviors to identify what practically matters for the adoption and dissemination of evidence-based practices. Through the conduct of this hybrid type 3 effectiveness-implementation cluster randomized controlled trial, we collected Exploration, Preparation, Implementation, and Sustainment (
EPIS) data and merged it with tailored motivational interviewing training adherence data, to elucidate the relationship between provider attitudes toward evidence-based practices, leadership behaviors, and training implementation strategy (e.g., workshop attendance and participation in one-on-one coaching) adherence.
UNASSIGNED: Our sample included data from providers who completed baseline (pre-intervention) surveys that captured inner and outer contexts affecting implementation and participated in tailored motivational interviewing training, producing a dataset that included training implementation strategies adherence and barriers and facilitators to implementation (N = 77). Leadership was assessed by two scales: the director leadership scale and implementation leadership scale. Attitudes were measured with the evidence-based practice attitude scale (EBPAS-50). Adherence to training implementation strategies was modeled as a continuous outcome with a Gaussian distribution. Analyses were conducted in SPSS.
UNASSIGNED: Of the nine general attitudes toward evidence-based practice, openness was associated with training adherence (estimate [EST] = 0.096, p < .001; 95% CI = [0.040, 0.151]). Provider general (EST = 0.054, 95% CI = [0.007, 0.102]) and motivational interviewing-specific (EST = 0.044, 95% CI = [0.002, 0.086]) leadership behaviors were positively associated with training adherence (p < .05). Of the four motivational interviewing-specific leadership domains, knowledge and perseverant were associated with training adherence (p < .05). As these leadership behaviors increased, knowledge (EST = 0.042, 95% CI = [0.001, 0.083]) and perseverant (EST = 0.039, 95% CI = [0.004, 0.075]), so did provider adherence to training implementation strategies.
UNASSIGNED: As implementation science places more emphasis on assessing readiness prior to delivering evidence-based practices by evaluating organizational climate, funding streams, and change culture, consideration should also be given to metrics of leadership. A potential mechanism to overcome resistance is via the implementation of training strategies focused on addressing leadership prior to conducting training for the evidence-based practice of interest.
Researchers and practitioners, who aim to improve the uptake of evidence-based practices, continue to seek ways in which to improve provider participation in training implementation strategies. The persistent challenge in addressing provider disengagement, while linking this disinterest to poor patient outcomes, has been ascertaining how to quantify relevant delivery considerations, for example, provider attitudes and leadership behaviors that may influence commitment to learning or apathy to behavior change, concurrently with training adherence. Through the conduct of this study, we collected both types of data: (1) provider attitudes and leadership behaviors and (2) training adherence outcomes. We found that provider openness, general leadership behaviors, and motivational interviewing-specific leadership behaviors were associated with adherence to training implementation strategies. As more emphasis is placed on assessing clinic readiness prior to adopting new evidence-based practices, a discussion on including metrics of provider attitudes to evidence-based practice, innovation, and the specific intervention is warranted, alongside consideration for how implementation training strategies focused on addressing leadership can bolster change-supportive behaviors prior to delivery of innovations.