Examining Interrelationships Between Implementation Outcomes in the Context of Traumatic Brain Injury Screening in...

Traumatic brain injury (TBI) is common among individuals seeking treatment for substance use disorders in behavioral healthcare settings, but evidence-based TBI screening methods are underutilized. We investigated provider perceptions of the acceptability, feasibility, and appropriateness of TBI screening, and whether these perceptions influenced the relationships between screening intentions and behaviors. Understanding how these implementation outcomes are interrelated can help clarify the temporal sequencing of implementation processes and lead to more precise and cost-effective dissemination and implementation (D&I) strategies.

In Phase 1 of this explanatory sequential mixed methods study, 215 behavioral healthcare providers completed an electronic survey assessing their intentions to screen for TBI using the Ohio State University TBI Identification Method (OSU TBI-ID). After 1-month, a second survey assessed the number of screens conducted, and perceptions of the acceptability, feasibility, and appropriateness of the OSU TBI-ID. Binary logistic regressions were used to examine whether acceptability, feasibility, and appropriateness moderated the relationship between screening intentions and behaviors. In Phase 2, 20 providers participated in an interview to contextualize the quantitative results. Qualitative data were analyzed thematically and integrated with the quantitative results.

The mean acceptability, feasibility, and appropriateness scores were 4.12, 4.02, and 3.69, respectively. Acceptability (OR = 0.80, p = .29), feasibility (OR = 0.93, p = .88), and appropriateness (OR = 0.97, p = .65) of TBI screening did not moderate the relationship between intentions and behaviors. Providers endorsed the OSU TBI-ID as easy to use and integrate into practice, relevant to clients, and helpful in guiding referrals and treatment decision-making.

Positive perceptions of an intervention are important but insufficient for shaping the transition from intentions to behavior. This study begins to disentangle interrelationships between early-phase implementation outcomes, which can help guide more precise D&I strategy development to enhance implementation efficiency and effectiveness.