"A case study of the development of a valid and pragmatic implementatio" by Lawrence H. Yang, Judy K. Bass et al.
 

A case study of the development of a valid and pragmatic implementation science measure: the Barriers and Facilitators in Implementation of Task-Sharing Mental Health interventions (BeFITS-MH) measure

Lawrence H. Yang, Department of Social and Behavioral Sciences, New York University School of Global Public Health, 708 Broadway, New York, NY, 10003, USA. ly1067@nyu.edu.
Judy K. Bass, Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room W1114, Baltimore, MD, 21205, USA.
PhuongThao D. Le, Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Suite 431, Massachusetts, 02118, Boston, USA.
Ritika Singh, Center for Global Mental Health Equity, Department of Psychiatry and Behavioral Health, George Washington University, 2120 L St NW, Washington DC, 20037, USA.
Dristy Gurung, Transcultural Psychosocial Organization (TPO) Nepal, Anek Marg, Kathmandu, 44600, Nepal.
Paola R. Velasco, Universidad O'Higgins, Avenida Bernardo O'Higgins 1058, Santiago, Chile.
Margaux M. Grivel, Department of Social and Behavioral Sciences, New York University School of Global Public Health, 708 Broadway, New York, NY, 10003, USA.
Ezra Susser, Columbia University Mailman School of Public Health, 722 west 168th, New York, NY, 10027, USA.
Charles M. Cleland, Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA.
Rubén Alvarado, Universidad de Valparaíso, Faculty of Medicine, School of Medicine, Department of Public Health, Center for Interdisciplinary Health Studies (CIESAL), Angamos 655, Viña del Mar, Chile.
Brandon A. Kohrt, Center for Global Mental Health Equity, Department of Psychiatry and Behavioral Health, George Washington University, 2120 L St NW, Washington DC, 20037, USA.
Arvin Bhana, University of KwaZulu-Natal, Centre for Rural Health, Howard College campus, Mazisi Kunene Road, Glenwood, Durban, South Africa.

Document Type

Journal Article

Publication Date

11-6-2024

Journal

BMC health services research

Volume

24

Issue

1

DOI

10.1186/s12913-024-11783-6

Keywords

Implementation science; Measure adaptation; Measure development; Measure validation; Case Study; Mental Health Services; Task-sharing

Abstract

BACKGROUND: Few implementation science (IS) measures have been evaluated for validity, reliability and utility - the latter referring to whether a measure captures meaningful aspects of implementation contexts. We present a real-world case study of rigorous measure development in IS that assesses Barriers and Facilitators in Implementation of Task-Sharing in Mental Health services (BeFITS-MH), with the objective of offering lessons-learned and a framework to enhance measurement utility. METHODS: We summarize conceptual and empirical work that informed the development of the BeFITS-MH measure, including a description of the Delphi process, detailed translation and local adaptation procedures, and concurrent pilot testing. As validity and reliability are key aspects of measure development, we also report on our process of assessing the measure's construct validity and utility for the implementation outcomes of acceptability, appropriateness, and feasibility. RESULTS: Continuous stakeholder involvement and concurrent pilot testing resulted in several adaptations of the BeFITS-MH measure's structure, scaling, and format to enhance contextual relevance and utility. Adaptations of broad terms such as "program," "provider type," and "type of service" were necessary due to the heterogeneous nature of interventions, type of task-sharing providers employed, and clients served across the three global sites. Item selection benefited from the iterative process, enabling identification of relevance of key aspects of identified barriers and facilitators, and what aspects were common across sites. Program implementers' conceptions of utility regarding the measure's acceptability, appropriateness, and feasibility clustered across several common categories. CONCLUSIONS: This case study provides a rigorous, multi-step process for developing a pragmatic IS measure. The process and lessons learned will aid in the teaching, practice and research of IS measurement development. The importance of including experiences and knowledge from different types of stakeholders in different global settings was reinforced and resulted in a more globally useful measure while allowing for locally-relevant adaptation. To increase the relevance of the measure it is important to target actionable domains that predict markers of utility (e.g., successful uptake) per program implementers' preferences. With this case study, we provide a detailed roadmap for others seeking to develop and validate IS measures that maximize local utility and impact.

Department

Psychiatry and Behavioral Sciences

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