Documenting adaptations to an evidence-based intervention in 58 resource-variable pediatric oncology hospitals across implementation phases
Abstract Background Adaptation of evidence-based interventions (EBIs) often occurs when implemented in new local contexts and settings. It is unclear, however, during which phase of implementation adaptations are most frequently made and how these changes may impact the fidelity, effectiveness, and...
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2024-10-01
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| author | Alejandra Catalina Quesada-Stoner Sayeda Islam Amela Siječić Sara Malone Maria F. Puerto-Torres Adolfo Cardenas Kim Prewitt Yvania Alfonso Carreras Shilel Y. Alvarez-Arellano Deiby Argüello-Vargas Gloria I. Ceballo-Batista Rosdali Diaz-Coronado Maria do Céu Diniz Borborema Jacqueline Estefany Toledo Ever Fing Zunilda Garay Cinthia J. Hernández-González Yajaira V. Jimenez-Antolinez María S. Juárez Tobías Laura Lemos de Mendonça e Fontes Norma A. Lopez-Facundo Jose Miguel Mijares Tobias Scheybi T. Miralda-Méndez Erika Montalvo Zairie Niguelie Cawich Carlos Andres Portilla Figueroa Marcela Sahonero María Sánchez-Martín Marcia X. Serrano-Landivar Valeria Soledad García Annie Vasquez Daniela María Velásquez Cabrera Bobbi J. Carothers Rachel C. Shelton Dylan Graetz Carlos Acuña Douglas A. Luke Virginia R. R. McKay Asya Agulnik the INSPIRE Study Group |
| author_facet | Alejandra Catalina Quesada-Stoner Sayeda Islam Amela Siječić Sara Malone Maria F. Puerto-Torres Adolfo Cardenas Kim Prewitt Yvania Alfonso Carreras Shilel Y. Alvarez-Arellano Deiby Argüello-Vargas Gloria I. Ceballo-Batista Rosdali Diaz-Coronado Maria do Céu Diniz Borborema Jacqueline Estefany Toledo Ever Fing Zunilda Garay Cinthia J. Hernández-González Yajaira V. Jimenez-Antolinez María S. Juárez Tobías Laura Lemos de Mendonça e Fontes Norma A. Lopez-Facundo Jose Miguel Mijares Tobias Scheybi T. Miralda-Méndez Erika Montalvo Zairie Niguelie Cawich Carlos Andres Portilla Figueroa Marcela Sahonero María Sánchez-Martín Marcia X. Serrano-Landivar Valeria Soledad García Annie Vasquez Daniela María Velásquez Cabrera Bobbi J. Carothers Rachel C. Shelton Dylan Graetz Carlos Acuña Douglas A. Luke Virginia R. R. McKay Asya Agulnik the INSPIRE Study Group |
| author_sort | Alejandra Catalina Quesada-Stoner |
| collection | DOAJ |
| description | Abstract Background Adaptation of evidence-based interventions (EBIs) often occurs when implemented in new local contexts and settings. It is unclear, however, during which phase of implementation adaptations are most frequently made and how these changes may impact the fidelity, effectiveness, and sustainability of the EBI. Pediatric Early Warning Systems (PEWS) are EBIs for early identification of deterioration in hospitalized children with cancer. This study evaluates adaptations of PEWS made among resource-variable pediatric oncology hospitals in Latin America implementing and sustaining PEWS. Methods We conducted a cross-sectional survey among pediatric oncology centers participating in Proyecto Escala de Valoración de Alerta Temprana (EVAT), a collaborative to implement PEWS. Adaptations to PEWS were assessed via 3 multiple choice and 1 free text question administered as part of a larger study of PEWS sustainability. Descriptive statistics quantitatively described what, when, and why adaptations were made. Qualitative analysis of free text responses applied the Framework for Reporting Adaptations and Modifications Expanded (FRAME) to describe respondent perspectives on PEWS adaptations. Results We analyzed 2,094 responses from 58 pediatric oncology centers across 19 countries in Latin America. Participants were predominantly female (82.5%), consisting of nurses (57.4%) and physicians (38.2%) who were PEWS implementation leaders (22.1%) or clinical staff (69.1%). Respondents described multiple PEWS adaptations across all implementation phases, with most occurring during the planning and piloting of EBIs. Adaptations included changes to PEWS content (algorithm, scoring tool, terminology, and use frequency) and context (personnel delivering or population). Respondents felt adaptations streamlined monitoring, enhanced effectiveness, improved workflow, increased comprehension, and addressed local resource limitations. Qualitative analysis indicated that most adaptations were categorized as fidelity consistent and planned; fidelity inconsistent adaptations were unplanned responses to unanticipated challenges. Conclusion Adaptations made to PEWS across implementation phases demonstrate how EBIs are adapted to fit dynamic, real-world clinical settings. This research advances implementation science by highlighting EBI adaptation as a potential strategy to promote widespread implementation and sustainability in hospitals of all resource levels. |
| format | Article |
| id | doaj-art-80bb345b30ba4b13b974c2e05241b953 |
| institution | OA Journals |
| issn | 2662-2211 |
| language | English |
| publishDate | 2024-10-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science Communications |
| spelling | doaj-art-80bb345b30ba4b13b974c2e05241b9532025-08-20T02:18:35ZengBMCImplementation Science Communications2662-22112024-10-015111610.1186/s43058-024-00664-yDocumenting adaptations to an evidence-based intervention in 58 resource-variable pediatric oncology hospitals across implementation phasesAlejandra Catalina Quesada-Stoner0Sayeda Islam1Amela Siječić2Sara Malone3Maria F. Puerto-Torres4Adolfo Cardenas5Kim Prewitt6Yvania Alfonso Carreras7Shilel Y. Alvarez-Arellano8Deiby Argüello-Vargas9Gloria I. Ceballo-Batista10Rosdali Diaz-Coronado11Maria do Céu Diniz Borborema12Jacqueline Estefany Toledo13Ever Fing14Zunilda Garay15Cinthia J. Hernández-González16Yajaira V. Jimenez-Antolinez17María S. Juárez Tobías18Laura Lemos de Mendonça e Fontes19Norma A. Lopez-Facundo20Jose Miguel Mijares Tobias21Scheybi T. Miralda-Méndez22Erika Montalvo23Zairie Niguelie Cawich24Carlos Andres Portilla Figueroa25Marcela Sahonero26María Sánchez-Martín27Marcia X. Serrano-Landivar28Valeria Soledad García29Annie Vasquez30Daniela María Velásquez Cabrera31Bobbi J. Carothers32Rachel C. Shelton33Dylan Graetz34Carlos Acuña35Douglas A. Luke36Virginia R. R. McKay37Asya Agulnik38the INSPIRE Study GroupDepartment of Global Pediatric Medicine, St. Jude Children’s Research HospitalBrown School, Washington University in St. LouisCollege for Public Health and Social Justice, Saint Louis UniversityDivision of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of MedicineDepartment of Global Pediatric Medicine, St. Jude Children’s Research HospitalDepartment of Global Pediatric Medicine, St. Jude Children’s Research HospitalBrown School, Washington University in St. LouisHospital Saint DamienBenemérito Hospital General Con Especialidades “Juan María de Salvatierra”Hospital Nacional de NiñosHospital del Niño “Jose Renan Esquivel”Instituto Nacional de Enfermedades NeoplasicasInstituto de Medicina Integral Prof. Fernando FigueiraHospital Nacional de Ninos Benjamin BloomHospital General CelayaHospital de Clinicas de La Facultad de Ciencias MédicasHospital Infantil Teleton de OncologiaHospital Universitario Dr. José E. González, Monterrey UniversitarioHospital Central Dr. Ignacio Morones PrietoHospital Martagão GesteiraISSEMYM Materno InfantilHospital de Especialidades del Niño y La Mujer “Dr. Felipe Nuñez Lara”Hospital Escuela UniversitarioSOLCA QuitoUnidad Nacional de Oncologia PediátricaCentro Médico ImbanacoHospital del Nino de La Santísima TrinidadHospital La PazHospital Caja Petrolera de Salud Santa CruzHospital Universitario AustralHospital Nacional Edgardo Rebagliati MartinsHospital Regional De Alta Especialidad Del BajioBrown School, Washington University in St. LouisDepartment of Sociomedical Sciences, Columbia UniversityDepartment of Global Pediatric Medicine, St. Jude Children’s Research HospitalAssociated Department of Pediatrics and Pediatric Surgery, Oriente University of ChileBrown School, Washington University in St. LouisBrown School, Washington University in St. LouisDepartment of Global Pediatric Medicine, St. Jude Children’s Research HospitalAbstract Background Adaptation of evidence-based interventions (EBIs) often occurs when implemented in new local contexts and settings. It is unclear, however, during which phase of implementation adaptations are most frequently made and how these changes may impact the fidelity, effectiveness, and sustainability of the EBI. Pediatric Early Warning Systems (PEWS) are EBIs for early identification of deterioration in hospitalized children with cancer. This study evaluates adaptations of PEWS made among resource-variable pediatric oncology hospitals in Latin America implementing and sustaining PEWS. Methods We conducted a cross-sectional survey among pediatric oncology centers participating in Proyecto Escala de Valoración de Alerta Temprana (EVAT), a collaborative to implement PEWS. Adaptations to PEWS were assessed via 3 multiple choice and 1 free text question administered as part of a larger study of PEWS sustainability. Descriptive statistics quantitatively described what, when, and why adaptations were made. Qualitative analysis of free text responses applied the Framework for Reporting Adaptations and Modifications Expanded (FRAME) to describe respondent perspectives on PEWS adaptations. Results We analyzed 2,094 responses from 58 pediatric oncology centers across 19 countries in Latin America. Participants were predominantly female (82.5%), consisting of nurses (57.4%) and physicians (38.2%) who were PEWS implementation leaders (22.1%) or clinical staff (69.1%). Respondents described multiple PEWS adaptations across all implementation phases, with most occurring during the planning and piloting of EBIs. Adaptations included changes to PEWS content (algorithm, scoring tool, terminology, and use frequency) and context (personnel delivering or population). Respondents felt adaptations streamlined monitoring, enhanced effectiveness, improved workflow, increased comprehension, and addressed local resource limitations. Qualitative analysis indicated that most adaptations were categorized as fidelity consistent and planned; fidelity inconsistent adaptations were unplanned responses to unanticipated challenges. Conclusion Adaptations made to PEWS across implementation phases demonstrate how EBIs are adapted to fit dynamic, real-world clinical settings. This research advances implementation science by highlighting EBI adaptation as a potential strategy to promote widespread implementation and sustainability in hospitals of all resource levels.https://doi.org/10.1186/s43058-024-00664-yPediatric Early Warning Systems (PEWS)SustainabilityAdaptationModificationsLatin AmericaFidelity |
| spellingShingle | Alejandra Catalina Quesada-Stoner Sayeda Islam Amela Siječić Sara Malone Maria F. Puerto-Torres Adolfo Cardenas Kim Prewitt Yvania Alfonso Carreras Shilel Y. Alvarez-Arellano Deiby Argüello-Vargas Gloria I. Ceballo-Batista Rosdali Diaz-Coronado Maria do Céu Diniz Borborema Jacqueline Estefany Toledo Ever Fing Zunilda Garay Cinthia J. Hernández-González Yajaira V. Jimenez-Antolinez María S. Juárez Tobías Laura Lemos de Mendonça e Fontes Norma A. Lopez-Facundo Jose Miguel Mijares Tobias Scheybi T. Miralda-Méndez Erika Montalvo Zairie Niguelie Cawich Carlos Andres Portilla Figueroa Marcela Sahonero María Sánchez-Martín Marcia X. Serrano-Landivar Valeria Soledad García Annie Vasquez Daniela María Velásquez Cabrera Bobbi J. Carothers Rachel C. Shelton Dylan Graetz Carlos Acuña Douglas A. Luke Virginia R. R. McKay Asya Agulnik the INSPIRE Study Group Documenting adaptations to an evidence-based intervention in 58 resource-variable pediatric oncology hospitals across implementation phases Implementation Science Communications Pediatric Early Warning Systems (PEWS) Sustainability Adaptation Modifications Latin America Fidelity |
| title | Documenting adaptations to an evidence-based intervention in 58 resource-variable pediatric oncology hospitals across implementation phases |
| title_full | Documenting adaptations to an evidence-based intervention in 58 resource-variable pediatric oncology hospitals across implementation phases |
| title_fullStr | Documenting adaptations to an evidence-based intervention in 58 resource-variable pediatric oncology hospitals across implementation phases |
| title_full_unstemmed | Documenting adaptations to an evidence-based intervention in 58 resource-variable pediatric oncology hospitals across implementation phases |
| title_short | Documenting adaptations to an evidence-based intervention in 58 resource-variable pediatric oncology hospitals across implementation phases |
| title_sort | documenting adaptations to an evidence based intervention in 58 resource variable pediatric oncology hospitals across implementation phases |
| topic | Pediatric Early Warning Systems (PEWS) Sustainability Adaptation Modifications Latin America Fidelity |
| url | https://doi.org/10.1186/s43058-024-00664-y |
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