Enhancing infant pain assessment and treatment: investigating barriers, facilitators, and implementation outcomes with the ImPaC Resource
Year: 2026
Type: article
Abstract: INTRODUCTION: The Implementation of Infant Pain Practice Change (ImPaC) Resource is a 7-step, multifaceted, web-based implementation strategy to improve pain assessment and treatment in Neonatal Intensive Care Units (NICUs). We explored facilitators and barriers to implementing ImPaC and their relationship to implementation outcomes. METHOD: A hybrid type 1 effectiveness-implementation study was conducted using a cluster randomized controlled trial (reported elsewhere) and a mixed-method exploratory study design. Level 2 and 3 Canadian NICUs with >15 beds were invited to participate and were randomized to intervention (INT, n=12) or usual care (UC, n=11) groups. INT NICUs recruited a change team who accessed ImPaC for 6 months; UC NICUs were waitlisted for 6 months and then offered ImPaC. Focus groups were conducted with all change teams following ImPaC completion. The Consolidated Framework for Implementation Research (CFIR) guided interview questions and analyses. Professionally transcribed interview data were coded and analysed using directed content analysis. Valence (+/-) and strength (-2, -1, 0, +1, +2) were assigned for each CFIR construct/subconstruct. Inductive codes were identified. Relationships between CFIR constructs/subconstructs and ImPaC implementation outcomes (feasibility and fidelity) were determined. RESULTS: 83 NICU change team members (median 4/site) participated in focus groups; 1,105 discrete codes relating to 31 CFIR constructs/subconstructs were identified. The most frequent facilitator constructs were Design Quality and Packaging, Compatibility, Available Resources, Champions, Implementation Climate, and Engaging Key Stakeholders. Complexity and Reflecting and Evaluating were salient in 21 transcripts, and Patient Needs and Resources was identified in 20 NICUs. Available Resources and Relative Priority were barriers. A positive association existed between the feasibility of implementing ImPaC and Engaging Key Stakeholders (0.46, p=0.041), Champions (0.82, p=0.001), Relative Priority (0.75, p=0.001) and Networks and Communication (0.60, p=0.023). There was a positive relationship between Engaging Key Stakeholders (0.42, p=0.048), Relative Priority (0.85, p=0.002), Patient Needs and Resources (0.46, p=0.049) and Fidelity. CONCLUSION: Site-specific tailoring to enhance facilitators (e.g., champions, implementation climate) and mitigate local barriers (e.g., resources, relative priority) will provide a viable influence on optimizing implementation outcomes.
Authors: Mariana Bueno, Kate Pearson, Melanie A. Barwick, Marsha Campbell-Yeo, Christine Chambers, Carole Estabrooks, Rachel Flynn, Sharyn Gibbins, Denise Harrison, Wanrudee Isaranuwatchai, Sylvie LeMay, Melanie Noel, Jennifer Stinson, Anne Synnes, Charles Victor, Janet Yamada, Shirine Riahi, Bonnie Stevens
Institutions: University of Toronto, Hospital for Sick Children, Dalhousie University, Izaak Walton Killam Health Centre, University of Alberta, University College Cork, Trillium Health Centre, University of Ottawa, The University of Melbourne, Murdoch Children's Research Institute, Health Intervention and Technology Assessment Program, Institut universitaire en santé mentale de Montréal, CHU Sainte-Justine Research Center, TransMedTech Institute, Université de Montréal, University of Calgary, University of British Columbia, B.C. Women's Hospital & Health Centre, BC Children's Hospital Research Institute, Institute for Clinical Evaluative Sciences, Toronto Metropolitan University
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,290
Award: G8345925566
OpenAlex ID: W7119678261