Contributions to the literature
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In alignment with the nature of pragmatic trials, trial teams should use practical methods to track and evaluate the strategies that help social service staff implement pragmatic trial procedures, namely participant recruitment and intervention delivery.
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Strategies that are intended to develop stakeholder interrelationships may be most appropriate to deploy during trial the Preparation phase, before participant recruitment and intervention delivery activities begin.
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Strategies designed to provide staff with individualized technical assistance support, financial incentives, and routine reminders may help enhance the success of pragmatic trial implementation, particularly within the social service context.
Introduction
Methods
Social service frontline staff and trial partnership
Number of frontline staffa | Geographical region (USA) | Annual number of MOW clients served | |
---|---|---|---|
Agency #1 | 5 | West | 625 |
Agency #2 | 2 | Southeast | 1000 |
Agency #3 | 2 | Southeast | 650 |
Agency #4 | 3 | Southwest | 4525 |
Agency #5 | 2 | Southeast | 1300 |
Agency staff team meetings
Strategy coding procedures
Detailed strategy descriptions
ERIC strategy codes
Strategy clusters
Time of strategy deployment
Repeat and unique strategies
Frontline staff survey
Analysis
Results
Cluster | ERIC strategy example | ERIC strategy defineda | Specific example |
---|---|---|---|
Preparation phase (n = 88) | |||
Develop stakeholder interrelationships (n = 31) | Conduct local consensus discussions | Include stakeholders in discussions about the importance and appropriateness of an innovation | Gather program input on trial eligibility criteria for waitlisted MOW clients |
Use iterative and evaluative approaches (n = 21) | Assess for readiness and identify barriers and facilitators | Determine the degree to which an agency is ready to implement an innovation and potential obstacles and strengths to implementation | Invite staff to share their agency’s typical meal service practices (i.e., meal options, number of meals provided) |
Provide interactive assistance (n = 15) | bShare technical information | Deliver technical assistance focused on implementation issues | Review name of study funder, study hypothesis, and study design with all frontline staff |
Train and educate staff (n = 12) | Distribute educational and preparatory materials | Share manuals, toolkits, and guides in-person, electronically, or by mail | Share PDF documents via email that describe participant eligibility, monthly recruitment targets, and participant information packet |
Support staff (n = 8) | Remind staff | Develop reminder systems to help staff recall information or use an innovation | Remind staff to enter availability for large-group database training with technology experts |
Change infrastructure (n = 1) | Change record systems | Modify records to streamline documentation of the innovation | Change the software system through which staff submitted names of waitlisted clients to the study team |
Implementation phase (n = 199) | |||
Develop stakeholder interrelationships (n = 62) | cCultivate relationships | Foster partnerships with stakeholders involved in the implementation effort | Encourage staff to change names on Zoom to include their respective agency name |
Use iterative and evaluative approaches (n = 36) | Develop and organize quality monitoring systems | Create procedures that monitor the innovation and the quality of its implementation | Request that all staff call potential participants to confirm contact information before submitting client names to study team |
Train and educate staff (n = 34) | Conduct ongoing training | Routinely provide training to stakeholders | Hold live Zoom demonstration (with screen-sharing) for how staff should terminate service in database system |
Provide interactive assistance (n = 31) | Centralize technical assistance | Use a standard system or approach to deliver information about how to best implement the innovation | Appoint technology support experts to respond to questions about documenting start and end date for meal services |
Support staff (n = 24) | Create new implementation teams | Convene diverse stakeholders to identify approaches to improve implementation of the innovation | Recruit volunteer staff members to participate in workgroup and select preferred formats for enrollment reports |
Use financial approaches (n = 5) | Alter incentive structures | Identify opportunities to provide rewards for innovation implementation | Hold monthly gift card drawings for agencies who submitted names of waitlisted clients by deadline |
Change infrastructure (n = 4) | Mandate change | Have leadership declare elements of the innovation that are required to be implemented | Require staff to document which waitlisted clients lived with one another before submitting names to study team |
Adapt and tailor to context (n = 2) | Promote adaptability | Identify ways an innovation can be tailored to meet local needs while still preserving fidelity | Change monthly due date for waitlisted client names to be submitted to the study team as to not conflict with standard end-of-month tasks |
Engage consumers (n = 1) | Use mass media | Leverage mailings, websites, social media, television, etc. to spread information | Encourage staff to share trial press kits with their agency administrators, board of director members, and communications teams |