Leader: Paolo Villari (Sapienza); Other collaborator(s): Azzurra Massimi, Erika Renzi, Valentina Baccolini, Corrado De Vito (Sapienza)
The most successful interventions emerging from WP1, WP2 and WP3 will be selected, and will be evaluated in terms of implementation research and to guide future HTA processes.
The staff will be involved in:
- evaluation of organizational aspects: delivery processes and management issues will be identified and classified through systematic review of the literature;
- identification of barriers and facilitating factors: structured interviews will be conducted to barriers and facilitators of multicomponent interventions at different managerial levels;
- assessment of social validity: surveys will be carried out to investigate social significance of goals, social acceptance of procedures, and social importance of effects.
- dissemination of a set of resources for policymakers and health professionals to implement novel interventions that effectively promote healthy ageing in older people
Brief description of the activities and of the intermediate results
- The overview of systematic review is ongoing according to the Cochrane Handbook for Systematic Reviews and Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The review protocol was registered at PROSPERO (identifier CRD42023444113). The search involved six electronic databases: PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Web of Science, PsycINFO, and the Cochrane Library. The main keywords used to search the database included "implementation strategies"; "implementation studies," "implementation research," "implementability", "implementation science", "implementation of evidence", "acceptability", "fidelity", "feasibility", "scalability", "sustainability", "cost-effectiveness", "older adults" and "aging". No restrictions were applied. The search was supplemented by scanning the reference lists of retrieved articles. The main inclusion criteria were (a) systematic reviews with or without meta-analysis and scoping reviews; (b) articles published in English or Italian; and (c) articles that reported a conceptual model or validated framework for evaluating the implementation of health interventions in older adults (>65 years). Duplicate articles were removed and the title and abstract of all retrieved papers were checked. After removal of duplicates, 14,984 papers were considered eligible. Screening by title and abstract returned 125 articles that are being evaluated at full texts.
- The systematic analysis of the practical guidelines related to health implementation research produced by institutional health authorities is ongoing. The search involved the institutional websites of World Health Organization, The Joanna Briggs Institute, United Nations. Additionally, we screened the websites and databased of Ministry of Health of European Countries. Two conceptual model and framework used for the evaluation of implementability of healthcare interventions were found (WHO Implementation Research in Health, a practical guide ISBN 978 92 4 150621 2; The JBI Model of Evidence-Based Healthcare, Jordan Z, Lockwood C, Aromataris E, Munn Z. The updated JBI model for evidence-based healthcare. The Joanna Briggs Institute. 2016).
Main policy, industrial and scientific implications
The identification of the framework for evaluating implementability and its application in the studies foreseen in WP1 - 3 will enable the development and dissemination of tools for evaluating the implementation of multi-component interventions to promote active ageing at national level.
- The overview of systematic review is ongoing. Screening by title and abstract returned 125 articles assessed by full-text analysis, of which eight were included in the overview of evidence of systematic reviews. Five systematic reviews, one systematic review with meta-analysis, and two scoping reviews were included. The reviews included 52 RCTs, 45 quasi-experimental studies, 24 qualitative studies, 16 implementation studies, 12 mixed-methodology studies, ten process evaluation studies, nine cluster randomized controlled trials (CCRTs), five nonrandomized studies, five cohort studies, four observational studies, two study protocols, one case-control study, one cost-effectiveness analysis, one case study, and one diffusion study. Most of the studies included in the reviews were conducted in Canada (8 reviews; 100%), the US (7 reviews; 87.5%), the UK (7 reviews; 87.5%) and Australia (4 reviews; 50%). The sample consisted of 16.727 older adults (> 65 years). The primary health conditions described were frailty, cognitive impairment and dementia. The healthcare settings involved long-term care (6 reviews; 75%), home care (2 reviews; 25%), primary healthcare centers (4 reviews; 50%), and hospitals (1 review; 12.5%). The health interventions evaluated were multi-component in all systematic reviews, including fall prevention programs, psychosocial interventions to prevent cognitive impairment, chronic disease management programs and other specific health issues (e.g., care pathways and inappropriate medication prescribing).
- The drafting of the research protocol for conducting a multi-method study to identify the opinions and experiences of managers, stakeholders, and communities in implementing healthcare interventions aimed at older people and delivered in community-based healthcare organizations is ongoing.
- The overview of the systematic review has been finalized. The review identified seven frameworks for evaluating the implementation of multicomponent interventions to promote the active aging of older people. Four evaluation frameworks, two process models and one implementation theory were identified to validate a framework for evaluating the implementation of multicomponent interventions to promote active aging at the national level. Concerning the implementation outcomes evaluated, implementation cost (1 review; 12.5 %) and feasibility (3 reviews; 37.5 %) seem to be the least represented within the various frameworks; however, acceptability represents the most frequently examined outcome (8 reviews; 100%). The scientific publication (output 2, WP6 - Milestone 8.10, M30) is being drafted in order to disseminate the results of the review of systematic reviews to support the identification of implementation outcomes (implementation costs, appropriateness, acceptability, fidelity, feasibility, scalability, and/or sustainability) of multicomponent interventions in older adults.
- Drafting the research protocol for conducting a multi-method study to identify the opinions and experiences of managers, stakeholders, and communities in implementing healthcare interventions aimed at older adults and delivered in community-based healthcare organizations is finalized. The research protocol is being submitted to the Sapienza Ethics Committee.
- Professional profiles are being established to constitute the expert panel to validate the framework for evaluating the implementation of multicomponent interventions to promote active aging at the national level. The frameworks that will be used to construct and validate the implementability of healthcare interventions at the national level have been identified:
- Jordan Z, Lockwood C, Aromataris E, Munn Z. The updated JBI model for evidence-based health care. Joanna Briggs Institute. 2016.
- Proctor E, Silmere H, Raghavan R, et al. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health. 2011;38(2):65-76. doi:10.1007/s10488-010-0319-7.
- The overview of the systematic review has been finalized. The methodological components and the validated framework for evaluating the implementation of multi-component interventions at the national level have been identified. The scientific publication is currently under revision for submission (Output 2, WP6 - Milestone 8.10, M30).
- The evaluation of the implementation of healthcare interventions following the WHO framework (Proctor et al., 2010) is currently underway for the study protocols developed by WP1 - WP2 - WP3. Additionally, the implementability assessment of multi-component healthcare interventions targeting older adults is in progress for a project focused on chronically ill older individuals, aimed at promoting active aging. This project, which concluded in 2023 within ASL Roma 2, was carried out as a pilot initiative for the Family and Community Health Nurse role. These assessments facilitate the identification of implementation outcomes evaluated within the national context, both in terms of their impact on the Age-IT project and on healthcare initiatives already integrated into the healthcare system.
- Renzi E, Covelli A, Abbatecola G, Innocenzio M, Parrinello E, Baccolini V, De Vito C, Marzuillo C, Villari P, Massimi A. Implementability of multicomponent interventions in Primary Care: an overview of systematic reviews. In: 16th European Public Health Conference. Dublin, Ireland 9 - 11 November 2023. European Journal of Public Health, Volume 33, Issue Supplement 2. Available at: https://academic.oup.com/eurpub/article/33/Supplement_2/ckad160.307/7327205