Bianca Albers is a co-founder and the chair of the European Implementation Collaborative (EIC). She is a seasoned organizational leader, investigator, and project manager with extensive experience in promoting the use of evidence in policy and practice in child, youth, and family services in multiple Western countries. In her work, she focuses on the development, implementation, and evaluation of research-supported programs, practices, and service models and on building the capacity within organizations and services to establish and maintain evidence-based practice and policy cultures. A key element in this work is the identification, selection, and translation of current best and relevant evidence.

Implementation 3.0: Entering a new decade of science and practice

Implementation Science is “the scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice”. Its distinct goal is to “improve the quality and effectiveness of health services and care” (Eccles & Mittman, 2006). This still relatively new discipline has now been around for about two decades, characterized by intense levels of productivity. During this time, an abundance of concepts has been developed, with “implementation determinants”, “implementation strategies”, and “implementation outcomes” being among the most referenced and debated ones. What is it that we can say about them at this stage? What are they, and how can they benefit implementation researchers as well as practitioners? Furthermore, where will we be heading with them, standing at the entrance to a new decade of implementation science? This presentation will introduce symposia participants to the field of implementation science. The focus will be on key terminology, arguments and concepts as well as on current debates – the latter of which will point towards central “constructions sites” that the field is expected to focus on in the decade ahead.  

 

Fabiana Lorencatto is the Research Lead at the University College London Centre for Behaviour Change. Her research focuses on implementation science in the healthcare context. Much of her work involves the application of behavioural science theories, frameworks and methods to understand individual, socio-cultural and environmental factors influencing the behaviour of healthcare professionals, as a basis for designing implementation interventions. She is involved in a number of multidisciplinary programme grants aiming to improve implementation and change professional practice on topics ranging from antimicrobial resistance and infection prevention control to blood transfusion. Fabiana also has a methodological interest in conducting process evaluations of complex interventions, particularly the assessment of intervention fidelity and mechanisms of change. 

Applying behavioural science theories and frameworks in implementation research

Implementing a new initiative, evidence-based practice or policy will likely require one or more groups of individuals to act or do something differently. That is, implementation will inevitably require changing behaviours. Yet, researchers, practitioners and policy makers often do not approach the challenge of implementation in terms of behaviour change; which may in part explain why some implementation initiatives achieve modest and variable success. This talk will explore how we can apply theories, frameworks, and principles of behaviour change in implementation science. There are numerous such theories and frameworks available, but this talk will focus on the Behaviour Change Wheel approach- a set of integrated behavioural science theories and tools. This talk will illustrate how these tools can be applied to: 1) define the implementation problem in behavioural terms; 2) explore factors influencing the behaviour(s) of interest and  facilitating or hindering implementation (i.e. barriers and enablers); 3) and using this to systematically design implementation interventions. Examples of how these tools have been applied to address implementation gaps in healthcare (e.g. reducing inappropriate antibiotic use) will be presented throughout. 

 

Pilvikki Absetz is a behavioral and implementation scientist, an Adjunct Professor of Health Promotion at the Tampere University, a visiting researcher at the University of Eastern Finland, the Head of Research and Development at Provention Ltd, and the CEO and sole owner of Collaborative Care Systems Finland. Pilvikki has over 20 years of experience in designing, implementing and evaluating behavioral interventions for prevention and control of chronic non-communicable diseases through lifestyle changes in different real-world settings in Finland and internationally.  Her currently ongoing projects include implementation of e-health interventions to support healthy lifestyle and implementation and scale-up of community-based peer support interventions. Pilvikki teaches implementation science courses in Finland and in the Global Alliance for Chronic Diseases’ Implementation Science Research Training Schools and Workshops. 

Crossing the implementation gap in public health

Lifestyle change has been proven an effective method in preventing or postponing major non-communicable diseases and their complications. Programs supporting lifestyle change have been designed and often successfully tested in efficacy and effectiveness trials, but maintenance and scaling up these programs through policies and health care professionals’ practices is still a challenge. Systematic implementation and adoption of these programs would require actions on multiple levels – policy makers, professionals, as well as patients and citizens. However, adequate situational analysis including identification of barriers and enabling factors including adoption mechanisms and support systems for implementation, as well as development of feasible, contextualized strategies for addressing these at all appropriate levels are often lacking.

Arja Rimpelä, Professor of Public Health Tampere University, Faculty of Social Sciences, Unit of Health Sciences, has experience of leading and participating in national and international projects. She has around 400 publications in international peer reviewed journals, and in national ones intended for professionals. The main research topics are adolescent and school health, health inequalities, and tobacco-control.

Legislation in changing adolescent behaviour – the Finnish Tobacco Act since 1977

Finland was one of the first countries to start a comprehensive health-oriented tobacco policy by legislative measures in 1977. It aimed at reducing health hazards caused by smoking, by reducing smoking in the population. In the 1970’s, smoking was a widespread habit in the population, a moral issue more than a health issue, a symbol of female emancipation, a rite for adulthood, highly addictive substance and heavily advertised and marketed.

Legislative measures were health education, total ban of advertising and sales promotion, sale prohibitions to minors, modifying tobacco product (less hazardous for health), reducing involuntary smoking (environmental tobacco smoke), and planning, monitoring and research. There was a strong belief that the Tobacco Act will solve the smoking problem.

But something went wrong: up to 2000 girls’ smoking had slightly increased while boys’ smoking had only slightly decreased. Endgame: during the last 20 years, there has been a remarkable decrease in adolescent smoking.

The presentation will analyse factors behind the unsuccessful and successful periods concentrating on underaged youth.

Christina Salmivalli, professor of psychology at the University of Turku, Finland, has done school-based research on bullying and its prevention since 1990’s. Her team developed the KiVa® antibullying program, which is widely used in Finland and beyond. Salmivalli has published widely on children’s peer relations and school bullying. She has been in charge for numerous large-scale projects, and supported thousands of teachers in their antibullying work. Her work has been awarded both nationally and internationally. Salmivalli is the deputy head of INVEST research flagship which aims at increasing wellbeing of Finnish society during childhood, youth and early adulthood and preventing psychosocial risks compromising such development through innovative interventions.

Implementation and sustainability of the KiVa antibullying program in Finland 

After the randomized controlled trial evaluating the efficacy of the KiVa antibullying program (www.kivaprogram.net), the program was made available for all basic education schools (grades 1-9) in Finland since 2009. Only three years later, more than 90% of Finnish basic education schools had adopted the program. As program developers, we continued collecting data in these schools via annual online surveys. There are separate surveys for students and for teachers, both including questions related to the implementation of various program elements. Thus, we have been able to follow the implementation of the program across the years and associate implementation with the outcomes achieved. The presentation describes some of the approaches taken and findings obtained so far, as well as our strategies to enhance the quality of implementation. It will also discuss the challenges faced when trying to find the optimal way to quantify implementation fidelity. 

Screening for fetal malformations: Evidence and public discussion

Tomi Mäki-Opas works as a research director in the House of Effectiveness at the University of Eastern Finland. House of Effectiveness is a multidisciplinary forum that brings the University of Eastern Finland’s effectiveness research and education relating to welfare and health under one, virtual roof. He has a background in social policy (PhD) and health policy (title of docent) with special interest in health and wellbeing inequalities, effectiveness, theoretical perspectives and methodologies in health and wellbeing promotion among socially disadvantaged groups. His research aims to provide new understanding on the mechanisms of social inequalities in health and wellbeing.

Coproduction of effective wellbeing promotion and stakeholder involvement

The social inclusion of disadvantaged groups together with key stakeholders in the co-production of social and health services and programs is a wicked societal problem encountered across the globe. The evidence of social inequalities in health and wellbeing is overwhelmingly convincing, but effective solutions as how to address social inequalities remains thin in the air.  Recent Finnish population surveys emphasize that health and social policies in Finland are failing to reach the most disadvantaged groups in the society: youth not in education, training or employed (NEETS), long-term unemployed, refugees in early stage of resettlement, and older people with multiple care needs and living alone at home.

Inclusive promotion of health and wellbeing (PROMEQ) study employed of social marketing methods to promote both individual and structural change: co-design, co-creation co-production, and common value creation. The PROMEQ study applied a comprehensive theoretical framework in combining Social Quality and Quality of Life to collect new scientific information on disadvantaged groups, and to test and develop inclusive and effective health and wellbeing promotion methods for disadvantaged groups.

In this presentation, I will shortly describe the comprehensive framework and the inclusive social marketing processes applied and present the key results and experiences from the tailored experiments and challenges of working with these stakeholders.   

Kirsi Peltonen is a senior researcher and lecturer at the Faculty of Social Sciences, Psychology, Tampere University, Finland. Her research has focused on mental health of violence exposed children and adolescents as well as on interventions targeted to them. She has special expertise in interventions among severely traumatized refugee children.

Implementation of a new intervention for children with multiple psychological traumas – Experiences and evidence of effectiveness within healthcare system 

Millions of children and adolescents worldwide suffer from post-traumatic stress disorder (PTSD) and other problems due to prolonged exposure to traumatizing events. Forms of cognitive-behavioural therapy are the most commonly used treatment for PTSD, but evidence from sophisticated studies in clinical settings among children is limited. We conducted a multicentre, pragmatic randomized controlled trial assessing the effectiveness of narrative exposure therapy (NET) in traumatized children and adolescents. Fifty 9–17-year-old participants, who had experienced prolonged traumatic conditions in the form of refugeedom or family violence and suffered from PTSD symptoms, were randomized into NET (n = 29) and treatment as usual (TAU; n = 21) active control groups. The objective was to determine whether NET can be feasibly implemented within the existing healthcare system of a high-income country and whether it would reduce mental health problems, especially PTSD, and increase resilience more effectively than TAU. Results revealed that PTSD and psychological distress, but not depression symptoms, decreased regardless of treatment group. Resilience increased in both groups. Within-group analyses showed that the decrease in PTSD symptoms was significant in the NET group only and the reduction in the share of participants with clinical-level PTSD was significant in the NET group only. Despite its shortcomings, this study gives preliminary support for the safety, effectiveness, and usefulness of NET among multiply traumatized children and adolescents in clinical settings.

Mirja Kälviäinen, Ph.D (Arts and Culture) is a principal lecturer and course leader for the MA level design and media studies at the Lahti University of Applied Sciences, Institute of Design. She also carries docentships in East-Finland and Jyväskylä universities in user driven design and in design thinking as an innovation tool. Her research work has included methods for user driven design, design thinking and service design with front end innovation process and co-design applications. The last seven years her research interest has concentrated on design for environmentally sustainable behaviour change.

Behavioural tools and solutions as design applications

Design work is about creating good, context based and for the purpose suitable solutions and experiences. Design for sustainable behaviour change involves evidence based tools to create a difference in consumer lifestyle choices and to make it easy for consumers to notice and adopt environmentally low impact solutions. The design community has developed and applies a variety of tools that help designers to come up with general themes and processes to create and promote sustainable lifestyle offerings. In addition, designers use tools and design techniques that help to design detailed interactions with the sustainable lifestyle service processes.

Nils Sandman is a post-doctoral researcher in psychology working with University of Helsinki and University of Turku. His research interest include sleep and sleep disorders from the perspective of population health as well as different methods for promoting better sleep. At the moment he is working on projects related to sleep problems of young adults as well as feasibility of choice architecture interventions in promoting sleep.

Do people approve of nudging? Public acceptability of choice architecture interventions

Psychological research has illustrated that much of human decision making is not based on maximising utility nor does it follow deductive logic. Instead when making decisions under uncertainty people often rely on heuristics and rules-of-thumb, that enable us to make quick decisions at the cost of accuracy.

These heuristic decisions are prominently affected by the context in which the choice is being made called choice architecture. Nudges are interventions that make changes to a choice architecture based on results from behavioural sciences to steer people towards certain choices. For being classified as a nudge, in addition to modifying choice architecture, the intervention should not limit freedom of the person being nudged to choose differently and the nudge should point the person towards a goal she or he would deem beneficial. Nudges have potential to be a cost-effective method for promoting health lifestyle and protecting environment among other uses. Utilization of nudges raises ethical questions however, as they can be seen as psychological manipulation.

In this presentation I will introduce key concepts related to ethics of choice architecture interventions and describe a series of studies that have investigated acceptability of these kind of techniques among general population in 14 different countries.

Ms. Kouvonen work as Director of Development at the Finnish Children´s Foundation, subordinate to the Finnish Parliament. She has been responsible for the establishment of the Early intervention -Brokering Knowledge for the Support of Children work in Finland since 2014 onwards. The work includes evaluation, dissemination and implementation of evidence- based psycho-social support for children and families. Currently Dr. Kouvonen is involved in the national and regional development and research of implementation of evidence -based support. She has been the co -writer of the recently published Early intervention handbook https://www.kasvuntuki.fi/en/manuals/, synthesising obstacles and possibilities of implementation. 

Supporting children’s growth by evidence- based practices – how to manage implementation?

Today, we know more than ever about effective interventions aiming at improving children’s psycho-social health. What still is less well-known, is the role different actors and structures plays for the implementation process, when moving interventions into the local level. In reality, the implementation of evidence-informed policies and practices across systems is often complex and multifaceted, needing coordinated actions between the local and national level, research and practice as well as policymaking (Kania & Kramer, 2011). Much can however be done by intermediaries in order to facilitate the process of implementation (Bullock, 2019). In business terms intermediaries is used of individuals or organizations that undertake the role of mediators or linkage between two parties. In this presentation the role local policymakers, innovation developers and service delivery organizations as well as necessary processes and tools are explored as crucial actors in the light of an intermediary process where EB psycho-social interventions were moved into practice nationwide in Finland 2017-2018. The interventions implemented were the ones that had scored well in the evaluation process by Brokering Knowledge for the Support of Children (kasvuntuki.fi). The implementation was carried out within the framework of the the governmental programme to address child and family services (LAPE).  

 

Improving the effectiveness of a digital lifestyle counselling app with data-driven user activity segmentation

Dr Elaine Toomey is Associate Director of Cochrane Ireland and Research Fellow within Evidence Synthesis Ireland, and a member of the Health Behaviour Change Research Group based in the National University of Ireland Galway. Elaine’s research primarily focuses on methods used in the development, evaluation and implementation of health behaviour change interventions, particularly in relation to chronic disease treatment and prevention. She has specific expertise in process evaluation and exploring and addressing fidelity and adaptation within behaviour change interventions. Elaine has provided consultation on a number of interdisciplinary research projects in relation to intervention fidelity and process evaluation, and has been an invited speaker on this topic on several occasions. 

Fidelity and adaptation within implementation research 

Intervention fidelity refers to the degree to which interventions are put into practice as intended, and is of paramount importance for behaviour change research. Without adequate assessment and evaluation of intervention fidelity, one cannot be certain that any effects observed in trials are due to the intervention being investigated and not due to variability in how it was actually put into practice. Fidelity is particularly relevant for complex behaviour change interventions which have numerous interacting components all with the potential to affect or influence outcomes. However, the need for balancing intervention fidelity with adaptation is a recurring theme within implementation research. Previous research has debated the concept of fidelity versus adaptation, with the case made for both strict intervention fidelity and for allowing and encouraging adaptation. This presentation will introduce symposia participants to the fidelity and adaptation literature, exploring key concepts, debates and application to behaviour change research.

Jaana Junnila is Government Counselor at the Ministry of the Environment. Her job is to prepare and write legislative proposals for the Government and further for the Parliament in Finland.

Lakien valmistelu ja lakien hyväksyttävyys - valmistelijan näkökulma (presentation in Finnish)

Have you ever thought about the nature of law? What is law for you? Why do you want laws to exist? What would be a good law for you? And finally what are the rules that govern your behavior - is law one of these rules? Neither have I, except lately.

Law drafting is a pragmatic exercise and a project. In order to be successful in law writing, one must have an adequate understanding of the problem itself, of society and of the legal system. One must also know how to put an idea on paper. Law drafting is a regular job.

Lawyers are taught that justification comes from the form of lawmaking. People, on the other hand, assess the justice of law through their experiences when laws are enforced. In politics, laws are a means to an end: One seeks to guide people's behavior with law for the benefit of the people (voters). Highlighting these different approaches during the process of law making could increase common understanding and result in better laws.

Marjo Kurki is a senior researcher at the University of Turku, Centre for Child Psychiatry in Finland. She works as Chief Scientific Editor at Itla Children’s Foundation. She has been  a researcher in Voimaperheet study group which has focused on the topics of digitally delivered psychosocial interventions for children and the implementation of evidence-based early interventions at the national level. 

Vahvan tutkimusnäytön Voimaperheet vanhempainohjausohjelma osaksi neuvolan toimivia käytäntöjä​  - implementaatiotutkimustuloksia (presentation in Finnish)

Parent training is the most effective approach to the psychosocial treatment of disruptive behavioral problems in childhood. Voimaperheet parent training model is unique because it is based on screening children from the general population during routine child health clinic checkups at the age of 4 years. Voimaperheet parent training program consists of 2 components: the interactive website and the telephone coaching. Based on Voimaperheet RCT study (Sourander et al. 2016, 2018) treatment effects were maintained until the 24-month follow-up study. Since 2015 Voimaperheet parent training program has been implemented successfully into primary health care including more than one third of target population in Finland. In this presentation will be described the implementation plan of Voimaperheet parent training program when the intervention make the transition from the research setting to implementation in primary health care.