Tracking implementation determinants over time using the IFASIS: multi-site analysis of opioid treatment programs...

Area of Science:

• Addiction treatment research
• Digital health implementation science
• Healthcare organizational behavior

Background:

• Contingency management (CM) is highly effective for stimulant use disorder but often underutilized due to implementation difficulties.
• Digital CM platforms offer potential solutions to implementation barriers, yet factors influencing their sustained delivery require further investigation.
• Understanding longitudinal changes in implementation determinants is crucial for optimizing digital CM platform uptake in opioid treatment programs (OTPs).

Purpose of the Study:

• To longitudinally measure changes in implementation determinants affecting the uptake of a digital CM platform in OTPs serving stimulant users.
• To assess how external context, internal context, intervention factors, and recipient factors evolve over a 6-month implementation period.
• To identify key barriers and facilitators impacting the sustained delivery of digital CM in real-world clinical settings.

Main Methods:

• A longitudinal study involving five OTPs in Rhode Island implementing a digital CM platform.
• Utilized the Inventory of Factors Affecting Successful Implementation and Sustainment (IFASIS) tool, assessing 27 items rated for impact and importance at baseline and 6 months.
• Employed mixed methods, combining quantitative ratings from OTP staff with qualitative analysis of transcribed interview rationales.

Main Results:

• Internal organizational factors, including leadership commitment and policies, were increasingly perceived as barriers over the 6-month period.
• Staff capacity remained a stable facilitator despite staff turnover, while recipient and intervention factors shifted from perceived facilitators to neutral or barrier perceptions.
• Unanticipated challenges in patient referral and engagement significantly contributed to the observed shifts in implementation determinant ratings.

Conclusions:

• Implementation determinants for digital CM platforms are dynamic and complex, necessitating ongoing monitoring.
• Recipient and intervention factors require particular attention during digital CM implementation, as initial perceptions may not reflect long-term realities.
• OTP staff need support in setting realistic expectations regarding patient identification and engagement processes for digital CM.