Evaluating the national implementation of Bright IDEAS in clinical settings: applying the RE-AIM framework to characterize the clinical perspective

Abstract

\n Background Bright IDEAS: Problem-Solving Skills Training (Bright IDEAS), a psychosocial intervention, has shown to improve problem-solving skills and reduce emotional distress in caregivers of children recently diagnosed with cancer. Though efforts have been made to scale up cancer control interventions, there are limited data assessing the adoption of Evidence-Based Cancer Control Programs (EBCCP) into clinical practice. This study describes the barriers and facilitators to implementation experienced by practitioners trained to use Bright IDEAS in their clinical settings.Methods A total of 209 Pediatric psychosocial oncology practitioners were trained through 10 workshops. Adaptations were made to the training agenda and curriculum based on practitioner feedback following implementation in local institutions. Practitioners were interviewed to understand their training experience and gain their perspective on the effectiveness of delivering Bright IDEAS in the clinical setting. The RE-AIM framework was used to guide the evaluation process we employed to assess the effectiveness of this national effort to disseminate Bright IDEAS.Results Interviews were conducted with 47 practitioners. Practitioners in the pre-adaptation group reported the identification of a particular profile of a client as a facilitator to intervention use. Additionally, perceived rigidity of the protocol, lack of consistency in intervention use with clients, feelings of being overwhelmed by the client as rationale for lack of interest, and lack of multiple trained practitioners at institutions were identified as barriers to intervention use. Practitioners in the post-adaptation group reported similar identification of a profile for an appropriate client for the intervention, more usage of Bright IDEAS materials, implementation across multiple clinical settings, and expressed continued commitment to intervention use as well as discussion of internal training for colleagues.Conclusions This study provides insight into how psychosocial practitioners adopt, implement, and maintain Bright IDEAS in the clinical setting and identified important considerations and needs for both practitioners and larger health care systems. It also provides some cautions to those who wish to promulgate evidence-based interventions.