OBJECTIVE: To assess the effects of an evidence-based family caregiver training program (implementation of Helping Invested Families Improve Veteran Experiences Study [iHI-FIVES]) in the Veterans Affairs healthcare system on Veteran days not at home and family caregiver well-being.
METHODS: Participants included Veterans referred to home- and community-based services with an identified caregiver across 8 medical centers and confirmed family caregivers of eligible Veterans.
METHODS: In a stepped wedge cluster randomized trial, sites were randomized to a 6-month time interval for starting iHI-FIVES and received standardized implementation support. The primary outcome, number of Veteran \"days not at home,\" and secondary outcomes, changes over 3 months in measures of caregiver well-being, were compared between pre- and post-iHI-FIVES intervals using generalized linear models including covariates.
METHODS: Patient data were extracted from the electronic health record. Caregiver data were collected from 2 telephone-based surveys.
RESULTS: Overall, n = 898 eligible Veterans were identified across pre-iHI-FIVES (n = 327) and post-iHI-FIVES intervals (n = 571). Just under one fifth (17%) of Veterans in post-iHI-FIVES intervals had a caregiver enroll in iHI-FIVES. Veteran and caregiver demographics in pre-iHI-FIVES intervals were similar to those in post-iHI-FIVES intervals. In adjusted models, the estimated rate of days not at home over 6-months was 42% lower (rate ratio = 0.58 [95% confidence interval: 0.31-1.09; p = 0.09]) post-iHI-FIVES compared with pre-iHI-FIVES. The estimated mean days not at home over a 6-month period was 13.0 days pre-iHI-FIVES and 7.5 post-iHI-FIVES. There were no differences between pre- and post-iHI-FIVES in change over 3 months in caregiver well-being measures.
CONCLUSIONS: Reducing days not at home is consistent with effectiveness because more time at home increases quality of life. In this study, after adjusting for Veteran characteristics, we did not find evidence that implementation of a caregiver training program yielded a reduction in Veteran\'s days not at home.

OBJECTIVE: We describe the development of an online fidelity questionnaire for early intervention in psychosis (EIP) services, to be used in population-level research, and that can be completed using self-reports from EIP staff.
METHODS: A review of key literature sources on the components of EIP services was used to identify those components eligible for inclusion in the questionnaire. A modified Delphi approach, using experts in EIP services, was used to select the most important components to include in the questionnaire. To pilot test the questionnaire, two EIP staff members completed one fidelity questionnaire each, and a third questionnaire was completed by an external rater. Responses from the three sources were compared and used to revise the fidelity questionnaire.
RESULTS: Twenty-two experts from England and Canada responded to two Delphi rounds, identifying the top 25 most important EIP service components. Some evidence-based components were not rated as highly as some non-evidence-based components. Pilot testing showed that the EIP staff rated fidelity higher than the external rater. Several questions were removed and/or revised based on the pilot study findings.
CONCLUSIONS: Fidelity instruments are limited by the available evidence and the personal experiences of experts used to develop them. As such, fidelity instruments and EIP services should continually be updated to reflect new knowledge. The online fidelity questionnaire was a simple and efficient way to collect data. Future evaluations of the fidelity questionnaire need to ensure that externally collected fidelity data are comprehensive and accurate.

OBJECTIVE: Fast, easy, and cost-effective methods are needed for fidelity assessment, quality improvement initiatives, and population-based studies in Early Intervention for Psychosis (EIP) services. Having an online questionnaire assessing the fidelity of EIP services, completed by staff self-reports, and having evidence of reliability and validity, could fill that gap. We assess the reliability and validity of the Early Intervention for Psychosis Services Fidelity Questionnaire (EIPS-FQ), developed in Part I of this set of papers.
METHODS: A convenience sample of 10 EIP teams in England was used. Two staff members completed online questionnaires assessing recent and past fidelity. An external rater completed the same questionnaire for the two time periods, using a random sample of patient medical records, program documentation, and interviews with staff. The intra-class correlation coefficient (ICC) was calculated to assess inter-rater reliability. Validity was assessed using Bland-Altman plots, absolute mean differences, and the ICC.
RESULTS: The fidelity score measuring recent fidelity ranged from 54.2 to 82.7, out of a possible 100. The ICC assessing reliability of the fidelity score was 0.40 (95% CI: 0.0-0.81). The ICCs for the fidelity sub-category scores ranged from 0 to 0.76. Two sub-categories, comprehensive assessments and family involvement and intervention, had low ICCs, regardless of period examined.
CONCLUSIONS: This first attempt at validating the EIPS-FQ has demonstrated that the reliability of the EIPS-FQ is moderate/low, and therefore requires modification prior to use. The next iteration of the fidelity questionnaire will clarify or remove items which had very low fidelity and add evidence-based components not identified in the Delphi exercise.

Savoring impacts parents\' emotions and parent-child relationship quality. Using data from a randomized controlled trial (N = 164 mothers of 18-27-month-olds, 37 interveners) conducted with a community sample in the United States, this study examined predictors of fidelity and treatment outcomes across two savoring preventative interventions (relational savoring and personal savoring). Treatment outcome indicators were selected from a battery administered immediately post-intervention (maternal closeness to child) and at a 3-month follow-up (maternal sensitivity, reflective functioning). We examined whether intervener education level (bachelor\'s degree/no bachelor\'s degree) predicted fidelity (Research Question 1), whether intervener education level predicted treatment outcomes (Research Question 2), and whether fidelity predicted treatment outcomes (Research Question 3). In many cases, intervener education background was not related to fidelity or treatment outcome; however, interveners without bachelor\'s degrees showed greater adherence to the protocols on some scales (higher positivity, higher secure base, higher calm matching) and sessions with these interveners were associated with greater increases in maternal sensitivity. Regardless of the intervener education level, redirecting attention to the positive and calmly matching participants\' tone were associated with higher maternal reflective functioning, and higher secure base scores were associated with greater closeness. Findings have implications for the training and implementation of prevention programs for parents.
El sentido de disfrute tiene impacto en las emociones de los progenitores y en la calidad de la relación progenitor‐niño. Este estudio examina los factores de predicción de los resultados de fidelidad y tratamiento a través de dos intervenciones preventivas del disfrute (disfrute en la relación y disfrute personal), y para ello se usaron datos de un ensayo controlado al azar (N = 164 madres de niños entre 18 y 27 meses de edad, 37 interventores) llevado a cabo con un grupo muestra comunitario en Estados Unidos. Se seleccionaron los indicadores de resultados del tratamiento a partir de una serie administrada inmediatamente después de la intervención (cercanía materna al niño) y a los 3 meses del seguimiento (sensibilidad materna, funcionamiento con reflexión). Examinamos si el nivel de educación del interventor (con licenciatura universitaria o sin ella) predijo la fidelidad (Pregunta 1 de Investigación), si el nivel de educación del interventor predijo los resultados de tratamiento (Pregunta 2 de Investigación), y si la fidelidad predijo los resultados de tratamiento (Pregunta 3 de Investigación). En muchos casos, el trasfondo educativo del interventor no se relacionó con la fidelidad o el resultado del tratamiento; sin embargo, los interventores sin licenciatura universitaria mostraron mayor adherencia a los protocolos en algunas escalas (nivel más alto de positividad, base de seguridad más alta, más alta calma en el aparejamiento) y las sesiones con estos interventores se asociaron con mayores aumentos en la sensibilidad materna. Sin tomar en cuenta el nivel de educación del interventor, el reenfocar la atención hacia lo positivo y el tono calmado de las participantes aparejadas se asociaron con un más alto nivel de funcionamiento con reflexión materno y los más altos puntajes de una base segura se asociaron con una mayor cercanía. Los resultados tienen implicaciones para el entrenamiento y la implementación de programas de prevención para progenitores.
Genuss wirkt sich auf die Emotionen der Eltern und die Qualität der Eltern‐Kind‐Beziehung aus. Anhand von Daten aus einer randomisiert‐kontrollierten Studie (N = 164 Mütter von 18‐27 Monate alten Kindern, 37 Intervenierende), die in einer Community‐Stichprobe in den USA durchgeführt wurde, untersuchte diese Studie Prädiktoren für die Therapietreue und die Behandlungsergebnisse zweier präventiver Genussinterventionen (relationales Genießen und persönliches Genießen). Indikatoren für die Behandlungsergebnisse wurden aus einer Batterie ausgewählt, die unmittelbar nach der Intervention (mütterliche Nähe zum Kind) und im 3‐Monats‐Follow Up (mütterliche Sensibilität, Reflexionsfähigkeit) erhoben wurde. Wir untersuchten, ob das Ausbildungsniveau der Intervenierenden (Bachelorabschluss/kein Bachelorabschluss) die Therapietreue vorhersagte (Forschungsfrage 1), ob das Ausbildungsniveau der Intervenierenden die Behandlungsergebnisse vorhersagte (Forschungsfrage 2) und ob die Therapietreue die Behandlungsergebnisse vorhersagte (Forschungsfrage 3). In vielen Fällen stand das Ausbildungsniveau der Intervenierenden nicht mit der Therapietreue oder den Behandlungsergebnissen in Zusammenhang; allerdings zeigten Intervenierende ohne Bachelorabschluss in einigen Skalen eine größere Einhaltung der Interventionsprotokolle (höhere Positivität, stärkere sichere Basis, stärkere ruhige Anpassung), und Sitzungen mit diesen Intervenierenden waren mit einer größeren Zunahme der mütterlichen Sensibilität verbunden. Unabhängig vom Ausbildungsniveau der Intervenierenden waren die Umlenkung der Aufmerksamkeit auf das Positive und die ruhige Anpassung des Tons der Teilnehmerinnen mit einer höheren mütterlichen Reflexionsfähigkeit verbunden, und höhere Werte für die sichere Basis waren mit einer größeren Nähe zum Kind verbunden. Die Ergebnisse haben Auswirkungen auf das Training und die Umsetzung von Präventionsprogrammen für Eltern.
サヴォーリング(Savoring)は両親の感情と親子関係の質に影響を与える。この研究は、米国のコミュニティサンプルを使用して実施された無作為化対照試験(N = 164、18‐27ヶ月の子を持つ母親、37人の介入者)のデータを使用して、2つのサヴォーリング予防介入(関係性のサヴォーリングと個人的なサヴォーリング)の忠実性と治療結果の予測因子を検証した。治療結果の指標は、介入直後に実施された(子どもへの母親の親密度)と3ヵ月後のフォローアップ(母親の感受性、省察機能)のバッテリーから選択された。介入者教育レベル(学士号あり/学士号なし)が忠実性を予測したかどうか(研究課題1)、介入者の教育レベルが治療結果を予測したかどうか(研究課題2)、忠実性が治療結果を予測したかどうか(研究課題3)を調べた。 多くの場合、介入者の教育的背景は忠実性や治療結果とは関連がありませんでした。しかし、学士号を持たない介入者は、いくつかの尺度(より高い積極性、より高い安全基地、より高い冷静なマッチング)においてプロトコルへのより高い順守を示し、これらの介入者とのセッションは母親の感受性のより大きな増加と関連していました。介入者の教育レベルに関係なく、参加者の積極的で落ち着いた口調に注意を向け直すことは、母親の省察機能の向上と関連しており、より高い安全基地スコアはより高い親密さと関連していた。これらの知見は、保護者のための予防プログラムのトレーニングや実施に示唆を与えます。.
品味对父母的情感和亲子关系质量有影响。本研究通过对美国社区样本进行的一项随机对照试验数据(N = 164名18‐27个月幼儿的母亲, 37名干预者)进行分析, 考察了两种品味预防干预(关系品味和个人品味)的忠实度和治疗结果的预测因素。治疗结果指标是从干预后立即进行的一系列调查(母亲与孩子的亲近感)和3个月的随访(母亲敏感性、反思功能)中选出的。我们研究了干预者教育水平(学士学位/无学士学位)是否可以预测忠实度(研究问题1)、干预者教育水平是否可以预测治疗结果(研究问题2), 以及忠实度是否可以预测治疗结果(研究问题3)。在许多情况下, 干预者的教育背景与忠实度或治疗结果无关;然而, 没有学士学位的干预者在某些量表上表现出更高的协议遵守度(更高的积极性、更高的安全基础、更高的平静匹配度), 并且母亲敏感性的提高, 与这些干预者一同开展治疗有关。无论干预者的教育水平如何, 将注意力引导到积极方面并平静匹配参与者的语调与更高的母亲反思功能相关, 而更高的安全基础评分与更高的亲近感相关。研究结果对父母预防项目的培训和实施有重要意义。.
يؤثر التلذذ النفسي على مشاعر الوالدين وجودة العلاقة بين الوالدين والطفل. باستخدام بيانات من تجربة عشوائية مضبوطة (العدد = 164 أمًا لأطفال تتراوح أعمارهم بين 18 و27 شهرًا، و37 متدخلًا) أجريت على عينة مجتمعية في الولايات المتحدة، فحصت هذه الدراسة مؤشرات الدقة ونتائج العلاج عبر تدخلين وقائيين للتلذذ (العلائقي والشخصي). اختيرت مؤشرات نتائج العلاج من مجموعة مقاييس تم إدارتها مباشرة بعد التدخل (قرب الأم من طفلها) وعند المتابعة لمدة 3 أشهر (حساسية الأم، والأداء التأملي). قمنا بفحص ما إذا كان مستوى تعليم المتدخلين (درجة البكالوريوس/بدون درجة البكالوريوس) قد تنبأ بدقة النتائج (سؤال البحث 1)، وما إذا كان مستوى تعليم المتدخلين قد تنبأ بنتائج العلاج (سؤال البحث 2)، وما إذا كانت دقة البحث قد تنبأت بنتائج العلاج (سؤال البحث 3). في كثير من الحالات، لم تكن الخلفية التعليمية للمتدخلين مرتبطة بالدقة أو نتائج العلاج؛ ومع ذلك، أظهر المتدخلون الذين لا يحملون درجة البكالوريوس التزامًا أكبر بالبروتوكولات على بعض المقاييس (إيجابية أعلى، وقاعدة آمنة أعلى، ومطابقة أعلى للهدوء) وارتبطت الجلسات مع هؤلاء المتدخلين بزيادة أكبر في حساسية الأمهات. وبغض النظر عن المستوى التعليمي للمتدخلين، ارتبطت إعادة توجيه الانتباه إلى الإيجابية والمطابقة الهادئة لنبرة المشاركين بزيادة الأداء التأملي للأمهات، وارتبطت درجات القاعدة الآمنة الأعلى بزيادة التقارب. النتائج لها تطبيقات في تدريب وتنفيذ برامج الوقاية للآباء والأمهات.

BACKGROUND: This study is a cost-effectiveness study of two implementation strategies designed to train therapists in college and university counseling centers to deliver interpersonal psychotherapy. Costs of implementing a train-the-trainer (TTT) strategy versus an expert consultation strategy were estimated, and their relative effects upon therapist outcomes were calculated and compared.
METHODS: Twenty four counseling centers were recruited across the United States. These centers were randomized to either a TTT (experimental) condition, in which an in-house therapist trained other center therapists, or an expert consultation condition, in which center therapists participated in a workshop and received 12 months of ongoing supervision. The main outcome was therapist fidelity (adherence and competence) to interpersonal psychotherapy, assessed via audio recordings of therapy sessions, and analyzed using linear mixed models. Costs of each condition were quantified using time-driven activity-based costing methods, and involved a costing survey administered to center directors, follow up interviews and validation checks, and comparison of time tracking logs of trainers in the expert condition. Mean costs to produce one therapist were obtained for each condition. The costs to produce equivalent improvements in therapist-level outcomes were then compared between the two conditions.
RESULTS: Mean cost incurred by counseling centers to train one therapist using the TTT strategy was $3,407 (median = $3,077); mean cost to produce one trained therapist in the control condition was $2,055 (median = $1,932). Therapists in the TTT condition, on average, demonstrated a 0.043 higher adherence score compared to therapists in the control condition; however, this difference was not statistically significant. For the competence outcome, effect size for therapists in the TTT condition was in the large range (1.16; 95% CI: 0.85-1.46; p < .001), and therapists in this condition, on average, demonstrated a 0.073 higher competence score compared to those in the expert consultation condition (95% CI, 0.008-0.14; p = .03). Counseling centers that used the TTT model incurred $353 less in training costs to produce equivalent improvements in therapist competence.
CONCLUSIONS: Despite its higher short run costs, the TTT implementation strategy produces greater increases in therapist competence when compared to expert consultation. Expanding resources to support this platform for service delivery can be an effective way to enhance the mental health care of young people seeking care in college and university counseling centers.
BACKGROUND: ClinicalTrials.gov Identifier: NCT02079142.

BACKGROUND: The consumption of alcohol, tobacco, and cannabis is a public health problem that impacts the cognitive, social, and emotional development of adolescents. Prevention strategies such as the \"Unplugged\" program are effective in delaying the progression of daily smoking and episodes of drunkenness among adolescents. \"Yo Se Lo Que Quiero\" (YSLQQ) corresponds to the adaptation of this program to the Chilean context. This study assesses the acceptability and feasibility of implementing this program to the local reality.
METHODS: This was a cluster-randomized controlled pilot study conducted on six public schools. All consented students attending 6th, 7th, and 8th grades (n = 1,180) participated in the study. The schools were randomly assigned to one of two conditions in a 1:1 ratio: (1) the \"YSLQQ\" intervention group (n = 526), and (2) the Control group (n = 654). The program consisted of a 12-hour class-based curriculum based on a comprehensive social-influence approach delivered by a trained facilitator. The acceptability and feasibility were assessed in the intervention group at the end of the intervention using questionnaires answered by students and facilitators. The quality and fidelity of the program were evaluated during the implementation using self-ported surveys answered by the facilitators and the assessment of video-recorded sessions rated by external observers. Finally, a pre-test and a post-test survey assessing past and current substance use and risk and protective factors were conducted before and immediately after the program\'s implementation.
RESULTS: A high proportion of students (49.6%) liked the sessions. 79.2% reported that the YSLQQ helped them learn about the dangers of substances, while 65.8% reported having more skills to avoid substance use in the future. Regarding students\' satisfaction with YSLQQ, 62.9% reported being happy or very happy with the program. Facilitators reported implementing the intervention according to the manual in 73.9% of sessions. Regarding substance use, students who participated in the intervention groups reported a significant reduction in drunkenness in the last year and last 30-day prevalence and also a significant reduction in a lifetime and 30-day prevalence of cannabis use when compared with those students in the control group.
CONCLUSIONS: Our results suggest that YSLQQ has adequate acceptability and feasibility to be implemented in the Chilean context, and there were promising results in reducing drunkenness and cannabis use. Future research should confirm these results in a larger RCT study.
BACKGROUND: The trial was registered in ClinicalTrials.gov, NCT04566627; registration date: 01/03/2019.

BACKGROUND: Iron deficiency anaemia is common among pregnant women in Nigeria. The standard treatment is oral iron therapy, which can be sub-optimal due to side effects. Intravenous ferric carboxymaltose (FCM) is an evidenced-based alternative treatment with a more favourable side effect profile requiring administration according to a standardized protocol. In this study, we assessed the fidelity of administering a single dose of FCM according to protocol and identified factors influencing implementation fidelity.
METHODS: We used a mixed-method approach with a sequential explanatory design nested in a clinical trial across 11 facilities in Lagos and Kano States, Nigeria. Guided by a conceptual framework of implementation fidelity, we quantitatively assessed adherence to protocol by directly observing every alternate FCM administration, using an intervention procedure checklist, and compared median adherence by facility and state. Qualitative fidelity assessment was conducted via in-depth interviews with 14 skilled health personnel (SHP) from nine purposively selected health facilities, using a semi-structured interview guide. We analyzed quantitative data using descriptive and inferential statistics in Stata and used thematic analysis to analyze the transcribed interviews in NVivo.
RESULTS: A total of 254 FCM administrations were observed across the 11 study sites, with the majority in secondary (63%), followed by primary healthcare facilities (PHCs) (30%). Overall, adherence to FCM administration as per protocol was moderate (63%) and varied depending on facility level. The lowest level of adherence was observed in PHCs (36%). Median, adherence level showed significant differences by facility level (p = 0.001) but not by state (p = 0.889). Teamwork and availability of protocols are facilitation strategies that contributed to high fidelity. However, institutional/ logistical barriers are contextual factors that influenced the varied fidelity levels observed in some facilities.
CONCLUSIONS: Collaborative teams and access to operating protocols resulted in high fidelity in some facilities. However, in some PHCs, fidelity to FCM was low due to contextual factors and intervention complexities, thereby influencing the quality of delivery. In Nigeria, scale-up of FCM will require attention to staff strength, teamwork and availability of administration protocols, in order to optimize its impact on anaemia in pregnancy.

BACKGROUND: The Assessment of Burden of Chronic Conditions (ABCC-)tool is developed to facilitate a personalized approach to care in the patient-healthcare provider (HCP) conversation based on shared decision-making and individualized care plans. An effectiveness study highlighted its effect on the perceived quality of care and patient activation. Successful implementation of novel interventions necessitates an understanding of the user\'s actual application, user experiences and an evaluation of implementation outcomes. This study aims to evaluate the implementation of the ABCC-tool by HCPs in Dutch primary care.
METHODS: This study is the process evaluation of a larger type 1 effectiveness-implementation hybrid trial. Semi-structured interviews with HCPs, who were interventionists in the hybrid trial, were held at three and twelve months after they started using the ABCC-tool. The Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) framework was used to evaluate implementation outcomes. The Implementation domain was further strengthened with an evaluation of implementation fidelity using Carroll\'s framework. Inductive coding and thematic analysis were applied to identify relevant participant experiences and implementation outcomes within the RE-AIM framework.
RESULTS: Seventeen HCPs (1 general practitioner, 16 practice nurses) participated in the study, representing 39% of potentially eligible participants. Most HCPs applied the tool after finishing their own routines instead of how it is intended to be used, namely from the beginning of the consultation. HCPs reached 2-6 patients. The ABCC-tool was initially adopted, but twelve HCPs stopped using the tool due to COVID-19 related cancellation of consultations. High fidelity was found for applying the questionnaire and visualization. Low fidelity was present for applying shared decision-making, formulating care goals and monitoring progress. HCPs indicated that maintaning the ABCC-tool depended on accompanying training and implementation support.
CONCLUSIONS: HCPs applied the ABCC-tool critically different from intended, potentially diminishing its benefits and ease of use. This evaluation stresses the need for a tailored implementation plan that includes more detailed training and guidance on how and when to use the ABCC-tool.

Solution-based processes have received considerable attention in the fabrication of electronics and sensors owing to their merits of being low-cost, vacuum-free, and simple in equipment. However, the current solution-based processes either lack patterning capability or have low resolution (tens of micrometers) and low pattern fidelity in terms of line edge roughness (LER, several micrometers). Here, we present a surface energy-directed assembly (SEDA) process to fabricate metal oxide patterns with up to 2 orders of magnitude improvement in resolution (800 nm) and LER (16 nm). Experiment results show that high pattern fidelity can be achieved only at low relative humidities of below 30%. The reason for this phenomenon lies in negligible water condensation on the solution droplet. Employing the SEDA process, all-solution-processed metal oxide thin film transistors (TFTs) are fabricated by using indium oxide as channel layers, indium tin oxide as source/drain electrodes and gate electrodes, and aluminum oxide as gate dielectrics. TFT-based logic gate circuits, including NOT, NOR, NAND, and AND are fabricated as well, demonstrating the applicability of the SEDA process in fabricating large area functional electronics.

Over the last two decades, the analogue report task has become a standard method for measuring the fidelity of visual representations across research domains including perception, attention, and memory. Despite its widespread use, there has been no methodical investigation of the different task parameters that might contribute to response variability. To address this gap, we conducted two experiments manipulating components of a typical analogue report test of memory for colour hue. We found that human response errors were independently affected by changes in storage and maintenance requirements of the task, demonstrated by a strong effect of set size even in the absence of a memory delay. In contrast, response variability remained unaffected by physical size of the colour wheel, implying negligible contribution of motor noise to task performance, or by its chroma radius, highlighting non-uniformity of the standard colour space. Comparing analogue report to a matched forced-choice task, we found variation in adjustment criterion made a limited contribution to analogue report variability, becoming meaningful only with low representational noise. Our findings validate the analogue report task as a robust measure of representational fidelity for most purposes, while also quantifying non-representational sources of noise that would limit its reliability in specialized settings.