The ezParent program is a self-administered tablet-based parent training program designed for low-income and minority parents of children ages 2-5 years old. The program is intended to help parents manage challenging behavior with positive parenting strategies. A randomized clinical trial examining the efficacy of the ezParent program provided a context to evaluate the implementation process with input from the primary care team at four pediatric primary care clinics. The implementation data collected from the randomized clinical trial and a review of the literature on implementation science and toolkits informed the development of an empirically based toolkit for future dissemination in primary care.
Methods:
The RE-AIM (reach, efficacy, adoption, implementation, & maintenance) framework guided the evaluation of implementation in the four pediatric primary care clinics. Implementation data was collected by using tracking forms to determine how frequently providers were incorporating discussion of the ezParent program into practice. Health care providers including residents, attendings, nurses, and medical assistants responded to an end of program implementation survey and were interviewed about their satisfaction with the implementation process and perceptions about the program before and after the study. The quantitative and qualitative evaluation data was interpreted and the major themes identified using the Consolidated Framework for Implementation Research (The Consolidated Framework for Implementation Research, n.d.). Implementation findings were used to inform the development of the toolkit. The toolkit is based on the Active Implementation Frameworks and the Agency for Healthcare Research and Quality toolkit guidelines (Blase, Fixsen, & Sims, 2014). The toolkit was reviewed by two primary care providers for an initial measure of face validity and usability
Results:
The data indicated an overarching factor impeding implementation was providers had very low rates of introducing the study to parents. Factors impeding provider adoption included: challenges with workflow integration, time limitations, and role confusion (Breitenstein et al, in preparation). Specifically, providers endorsed difficulty identifying patients who qualify for the program and feeling inadequately trained. In addition, providers described a need for onsite representatives to support workflow changes. Specific components in the toolkit address these barriers and support implementation in practice. The toolkit is divided into eight sections that cover the main themes identified in the qualitative data including education and training of the interdisciplinary team, defining roles within the care team, practice champions, the ezParent consultant, parent education and advertising, patient inclusion criteria, use of the electronic medical record, and policy and cost perspective. Each section includes data from the RCT and literature, specific strategies for implementation, ideas for local adaptations, and suggestions for advocacy.
Conclusions:
Implementation toolkits are an important component to support successful implementation. They help to address the gap that can occur between research and practice and serve as an effective mechanism for the knowledge translation. The purpose of a toolkit is to provide a guide to support evidence-based practice change (AHRQ, 2013). The goal of this toolkit is to provide specific, empirically based strategies for implementation of the ezParent program in pediatric primary care that can be adapted to fit the unique characteristics and infrastructure of different pediatric primary care practices. Future work will evaluate implementation outcomes in the context of toolkit use.
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