Paterson et al. Systematic Reviews (2021) 10:41 https://doi.org/10.1186/s13643-020-01570-9 PROTOCOL Open Access Evidence for implementation of interventions to promote mental health in the workplace: a systematic scoping review protocol Charlotte Paterson1* , Caleb Leduc2,3, Margaret Maxwell1, Birgit Aust4, Benedikt L. Amann5, Arlinda Cerga-Pashoja6, Evelien Coppens7, Chrisje Couwenbergh8, Cliodhna O’Connor2,3, Ella Arensman2,3,9,10 and Birgit A. Greiner2 Abstract Background: Mental health problems are common in the working population and represent a growing concern internationally, with potential impacts on workers, organisations, workplace health and compensation authorities, labour markets and social policies. Workplace interventions that create workplaces supportive of mental health, promote mental health awareness, destigmatise mental illness and support those with mental disorders are likely to improve health and economical outcomes for employees and organisations. Identifying factors associated with successful implementation of these interventions can improve intervention quality and evaluation, and facilitate the uptake and expansion. Therefore, we aim to review research reporting on the implementation of mental health promotion interventions delivered in workplace settings, in order to increase understanding of factors influencing successful delivery. Methods and analysis: A scoping review will be conducted incorporating a stepwise methodology to identify relevant literature reviews, primary research and grey literature. This review is registered with Research Registry (reviewregistry897). One reviewer will conduct the search to identify English language studies in the following electronic databases from 2008 through to July 1, 2020: Scopus, PROSPERO, Health Technology Assessments, PubMed, Campbell Collaboration, Joanna Briggs Library, PsycINFO, Web of Science Core Collection, CINAHL and Institute of Occupational Safety and Health (IOSH). Reference searching, Google Scholar, Grey Matters, IOSH and expert contacts will be used to identify grey literature. Two reviewers will screen title and abstracts, aiming for 95% agreement, and then independently screen full texts for inclusion. Two reviewers will assess methodological quality of included studies using the Mixed Methods Appraisal Tool and extract and synthesize data in line with the RE-AIM framework, Nielson and Randall’s model of organisational-level interventions and Moore’s sustainability criteria, if the data allows. We will recruit and consult with international experts in the field to ensure engagement, reach and relevance of the main findings. (Continued on next page) * Correspondence: charlotte.paterson@stir.ac.uk 1 NMAHP-RU, University of Stirling, https://www.nmahp-ru.ac.uk/ Full list of author information is available at the end of the article © The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Paterson et al. Systematic Reviews (2021) 10:41 Page 2 of 8 (Continued from previous page) Discussion: This will be the first systematic scoping review to identify and synthesise evidence of barriers and facilitators to implementing mental health promotion interventions in workplace settings. Our results will inform future evaluation studies and randomised controlled trials and highlight gaps in the evidence base. Systematic review registration: Research Registry (reviewregistry897) Keywords: Barriers and facilitators, RE-AIM, Workplace, Mental health promotion, Implementation science, Scoping review, Organisational interventions, Workplace interventions, Process evaluation, Wellbeing promotion Background technology (ICT), is likely to prevent the development of Mental health problems are common in the working severe depressive disorders and comorbidities, and sub- population and represent a growing concern, with po- sequent suicidal behaviour [13]. tential impacts on workers’ wellbeing, health and dis- Although high-quality evaluations underpin evidence- crimination; organisations through lost productivity; based interventions (EBI), implementation research can workplace health and compensation authorities due to improve the quality of such evaluations and facilitate the growing job stress-related claims; and social welfare sys- uptake and reach of EBIs and other research findings tems owing to increased working age disability pensions into practice [14]. One effective way to do this is to for mental disorders [1]. Mental health refers to ‘a state identify factors that influence the delivery and uptake of of wellbeing in which the individual realizes his or her interventions during development, feasibility, evaluation own abilities, can cope with normal stresses of life, can and implementation stages [15]. work productively and fruitfully, and is able to make a So far, research into specific mechanisms and contribution to his or her community’ [2]. Mental health process factors associated with the successful delivery problems therefore include daily worries, stress, burnout of mental health promotion interventions in the and poor wellbeing, as well as mental health conditions workplace is limited [16, 17]. This review aims to such as depression or anxiety [3]. Psychosocial stresses identify and analyse research on the implementation in the workplace, such as job uncertainty, low job con- of workplace mental health promotion interventions; trol, poor management, harassment and bullying, poor specifically, to understand the barriers and facilitators communication and long hours, have been shown to that influence their delivery in order to provide in- undermine mental wellbeing [4]. A negative working en- sights and inform future intervention, evaluation and vironment may lead to physical and mental health prob- implementation efforts. This work represents a direct lems, harmful use of substances or alcohol, absenteeism, response to recent calls within intervention research presenteeism and lost productivity [5]. Although it is ac- to examine the mechanisms through which interven- knowledged that mental health problems exist in the tions bring about change and the documentation of workplace, stigma and the social exclusion of people contextual and procedural considerations that either with mental health problems may be leading to under- facilitate or limit implementation [16, 17]. recognition of such problems and the subsequent low treatment rate of mental health problems [6–8]. Aims and objectives Under-treatment has been shown to increase the in- This review is part of a wider project intending to de- direct cost of mental disorders, physical morbidity velop, evaluate and implement a multi-level intervention and mortality [9, 10]. (Mental Health Promotion and Intervention in Occupa- Several studies have evaluated workplace interventions tional Settings, MENTUPP) [18], which aims to improve targeting mental wellbeing [11]. Workplace interventions mental health and wellbeing in the workplace involving that support mental health and wellbeing have been 15 European and Australian partners, with a particular shown to help reduce sickness absence [12]. In addition, focus on small to medium sized enterprises (SMEs) in workplaces that promote mental health awareness, des- three sectors with high prevalence rates of mental health tigmatise mental illness and support people with mental problems and suicidal behaviour, namely ICT, healthcare disorders are more likely to reduce levels of depression and construction sectors. More broadly, the purpose of and absenteeism while increasing productivity as well as this review is to collate and critically appraise workplace benefiting from associated economic gains [13]. Improv- mental health intervention implementation literature to ing access to evidence-based interventions for minor understand how and why certain interventions are more stress-related depressive symptoms in occupational sec- effectively implemented than others and inform MEN- tors associated with high suicide rates, e.g. construction, TUPP and future programmes. The objectives of the re- healthcare and information communication and view are to: Paterson et al. Systematic Reviews (2021) 10:41 Page 3 of 8 1. Systematically identify and document research expli- Analyses (PRISMA) Protocol checklist (PRISMA-P) [26] citly reporting on the quality of delivery and implemen- (see Additional file 1). The present protocol has been tation of mental health promotion interventions in registered within the Research Registry (reviewregis- workplaces (e.g. reporting the quality of implementation, try897). The results of our scoping review will be re- a process evaluation or realist evaluation) and, if the evi- ported in accordance with PRISMA-ScR [27]. dence allows, specifically in ICT, construction and Operationally, the current review will systematically healthcare settings and SMEs. conduct the searches based on the following definition of 2. Identify the barriers and facilitators associated with key terms: the quality of implementation of mental health promo- ● Implementation: The results of this review will in- tion interventions in workplace settings and, if the evi- form the design of a feasibility and definitive trial of dence allows, specifically in ICT, construction or mental health promotion in the workplace. As such, im- healthcare settings and within SMEs, as it relates to the plementation refers to interventions being delivered at MENTUPP programme of work. feasibility and piloting, evaluation and implementation Based on these objectives, our research questions are: stages of the Medical Research Council (MRC) frame- work (15). i. What is the scope of research with explicit analysis ● Mental health promotion refers to interventions or of implementation aspects of mental health programmes that aim to treat (intervene to improve promotion interventions in the workplace? mental health), prevent (inhibit the escalation of subclin- ii. What are the barriers and facilitators to ical symptoms to clinical severity or prevent the onset of implementing mental health promotion mental health problems) and promote (improve mental interventions in the workplace? health by targeting positive components of mental iii. What are the barriers and facilitators to health) mental health and wellbeing [28]. implementing mental health promotion ● Barriers are defined as any variable or condition that interventions in SMEs and in the ICT, construction impedes the implementation or delivery of mental health and healthcare sectors? promotion interventions. ● Facilitators are defined as any variable or condition Methods/design that facilitates or improves the implementation or deliv- Study design ery of mental health promotion interventions. We will conduct a systematic scoping review using the ● Workplace settings include any organisation operat- 6-stage scoping review framework [19, 20] to systematic- ing with paid employees. Therefore, mental health pro- ally identify the implementation evidence and factors as- motion interventions must be delivered through, or be sociated with successful implementation of mental associated with, the workplace. Sector-specific defini- health promotion in workplace settings. Scoping reviews tions from the European Commission were used [29]. aim to map a broad field of literature and to summarise The ICT sector will include telecommunications activ- and disseminate research findings [19, 21], rather than ities, information technology activities and other infor- address very focussed questions. This approach is in line mation service activities (divisions 61–63); the with the aims of this review, given the wide range of po- healthcare sector will include healthcare provided by tential successful and failed interventions, contexts and medical professionals in hospitals or other facilities and implementation factors. We will comprehensively ex- residential activities, but not social work activities (divi- plore the relevant research, using iterative methods to sions 86–87); and the construction sector will include develop a rigorous and systematic search of the existing construction of buildings, civil engineering and specia- literature [20]. We will recruit and consult with inter- lised construction activities (divisions 41–43). Small- to national experts in the field according to both applied medium-sized enterprises include those employing < organisational and research experience at key stages of 250 employees [30]. the review process and subsequently to ensure engage- ment, reach and relevance of the process and main find- Information sources and search strategy ings. The active involvement of people affected by a We will use iterative methods to develop and apply a research topic has been argued to be beneficial to the rigorous and comprehensive search strategy, combining quality, relevance and impact of research [22, 23], and it a series of free text terms and Medical Subject Headings enhances the perceived usefulness of systematic review (MeSH) terms for key concepts: (a) workplace AND (b) evidence and addresses barriers to the uptake of synthe- mental health, AND (c) interventions, AND (d) imple- sised research evidence [24, 25]. mentation. A preliminary search strategy (see Additional Our protocol was developed using the Preferred file 2) has been developed for PsycINFO, using estab- Reporting Items for Systematic Reviews and Meta- lished search terms (from Cochrane and other previous Paterson et al. Systematic Reviews (2021) 10:41 Page 4 of 8 search strategies [31–33], peer-reviewed in accordance on feasibility and process studies or realist evaluations. with PRESS guidelines [34]. Boolean operators will be Although we will look at the relation between imple- used to maximise the penetration of terms searched, and mentation and effects, the main aim of the review is to appropriate “wild cards” will be employed to account for identify factors associated with implementation, specific- plurals, variations in databases, and spelling. ally barriers and facilitators. The focus of this review will We will use a stepwise methodology [35] to identify be cognisant of outcomes indicating successful imple- the highest quality evidence in a systematic way and cap- mentation, including programme uptake, retention and ture grey literature. Grey literature will be included be- impact. cause it is likely that due to publication bias some unsuccessful interventions have not been published in Study designs peer-reviewed journals. A number of contingency plans We will include any paper, regardless of study design, have been built into the methods to allow an iterative using either quantitative, qualitative or mixed-methods, approach to the search and selection of evidence for the which explicitly investigates, reports or discusses, in the review (Additional file 3). We will use established search title or abstract, any aspect of implementation of specific terms and adapt searches for each of the following major mental health promotion interventions (i.e. quality of electronic databases outlined below. implementation, a process evaluation including rich data In step 1, we will search the following electronic data- or a realist evaluation) delivered in the workplace. This bases for systematic reviews: includes literature reviews (systematic reviews, scoping ●Scopus reviews, meta-analyses) and primary research studies ● PROSPERO published either in the peer-reviewed scientific literature ● Health Technology Assessments or in the grey literature. We will exclude opinion pieces, ● PubMed commentaries, website discussions, blogs and magazine ● Campbell Collaboration and newspaper articles. ● Joanna Briggs Library ● Web of Science Core Collection Population In step 2, we will look for primary studies reporting We will include studies with adult participants (aged implementation of mental health promotion interven- 16–65) who are in formal employment, including those tions in the following electronic databases: on sickness absence leave and are expected to return to ● PsychINFO work. ● Scopus ● PubMed Interventions ● Web of Science Core Collection Interventions, whose implementation is of interest, are ● CINAHL purposefully applied strategies delivered in the work- ● Institute of Occupational Safety and Health place, targeting either workers, supervisors, managers, (IOSH) research database. occupational health professionals, owners/executives or Step 3 will involve supplementary searches involv- entire organisations. Included interventions will aim to ing a thorough review of relevant study references, (i) help protect mental health by reducing work-related grey literature and personal contacts using a system- risk factors (e.g. job strain, poor working conditions and atic approach (Additional file 3). This will include job stressors such as job insecurity, psychological harass- searching: ment (e.g. due to stigma), low social support at work, or- ● Reference searching: relevant studies included in pub- ganisational injustice, and effort-reward imbalance); (ii) lished guidelines, relevant systematic reviews and listed in promote workplace mental health wellbeing by creating the included studies’ reference lists and bibliographies. positive aspects of work, and develop employees’ ● Grey literature: Google Scholar (25 pages relevant), strengths (e.g. satisfaction, wellbeing, psychological cap- Grey Matters and the Institute of Occupational Safety ital, positive mental health, resilience and positive organ- and Health (IOSH) research database. isational attributes such as authentic leadership, ● Personal contacts: we will contact international experts supportive workplace culture and workplace social cap- and authors of papers reporting trials (from 2008) on work- ital); and (iii) respond to mental health problems when place interventions to address mental health promotion. they occur (e.g. interventions targeting burnout, stress, anxiety, depression or return to work) [36]. We will ex- Criteria for considering studies for inclusion clude studies that evaluate the implementation of gen- Overview eral mental health interventions that are not specifically The scoping review will address factors associated with associated with workplace factors or delivered in work successful implementation and therefore focus primarily contexts (e.g. healthy eating or exercise at home), mental Paterson et al. Systematic Reviews (2021) 10:41 Page 5 of 8 health interventions that are not formally implemented of all titles (CP, CL), removing any clearly irrelevant pa- in the workplace (e.g. online work-related mental health pers. To ensure reliability between reviewers, 15% of the interventions freely available online without association study titles will be reviewed blindly by both reviewers in- to an organisation) and one-off events (e.g. distribution dependently, aiming for 95% agreement. Where 95% of mental health educational material or one-off infor- agreement is not reached, a further 15% will be reviewed mation sessions through guest lecturers). Interventions by both reviewers independently. Any discrepancy be- not directly targeting psychological wellbeing or mental tween reviewers will be discussed and, if necessary, will health will be included if the primary outcome is related involve a third reviewer to resolve. The remaining study to psychological wellbeing or mental health (e.g. a phys- titles will be screened for abstract review by a single re- ical activity programmes delivered in the workplace with viewer. Two reviewers will then be involved in screening a primary outcome for improving mental health). Inter- the remaining potential abstracts (CP, CL) and rate them ventions that target a wide range of health and wellbeing as relevant, irrelevant or unsure. To ensure consistency outcomes, e.g. physical activity, obesity, smoking cessa- between reviewers, 15% will be checked independently, tion and stress, will be excluded. and where agreement does not reach 95%, a further 15% will be reviewed by both reviewers. Studies that are Outcomes of interest ranked as irrelevant will be excluded. We will obtain the We will only include studies reporting rich data on any full papers for the remaining studies. Two reviewers implementation outcomes and will categorise outcomes (CP, CL) will then independently assess each of these within our data charting. We anticipate that identified against the selection criteria. We will resolve any dis- outcomes may include fidelity, reach, dose delivered, agreement through discussion and will involve a third dose received, adoption, penetration, feasibility, accept- independent reviewer if needed. ability, context factors, process factors, sustainability fac- tors, programme theories, theories of change and failure Charting the data theories. We will exclude studies focusing on only the Data extraction impact of interventions on disease end points, i.e. which We will pilot a data extraction template on the first four do not evaluate implementation quality. included studies and amend as required. We will extract key study details (e.g. study design, country, sample size, Types of settings sector, intervention characteristics, impact on primary We will include studies conducted in any geographical outcome, etc.) and implementation data (e.g. direct location, and we will categorise the location based on quotes, page numbers) will be structured using an relevance to Europe and Australia during data charting. adapted version of the RE-AIM framework [40] which The intervention must be delivered in, or in association has been complemented using selected categories from with, a workplace setting and be implemented in the Nielson and Randall’s model of organisational-level in- work schedule, work systems or administrative terventions [16] and Moore’s sustainability criteria [41]. structures. To ensure reliability, data from 15% of included papers will be coded by two reviewers (CP and CL) independ- Language ently. Any ambiguity identified will be resolved through Studies published in English will be included in steps 1 discussion with other members of the review team. and 2. Studies published in English, French and German Study authors will be contacted via email where data are will be included in step 3. missing or unclearly reported. Publication date Studies published in the last 13 years will be included. Data coding The World Health Organization’s (WHO) Global Plan Data will be coded as follows: of Action on Work’s Health (2008–2017) [37] and the ● Stage of intervention development/evaluation will be Mental Health Action Plan (2013–2020) [38] highlight coded according to the MRC framework (i.e. feasibility, the importance of promoting good mental health in the evaluation or implementation) [15]. workplace. Furthermore, the field of implementation sci- ● Countries will be coded using the World Bank clas- ence is fairly new; therefore, literature published after sification [42] to identify countries of relevance to future 2008 is deemed to be most relevant to this review. research, e.g. Europe and Australia. ● Implementation evidence will be mapped using a Study selection modified version of the RE-AIM framework [40], which Rayyan will be used for the study selection process [39]. is organised into five categories: reach, effectiveness, Two reviewers will be utilised for a provisional screening adoption, implementation and maintenance. This Paterson et al. Systematic Reviews (2021) 10:41 Page 6 of 8 framework also allows evaluation of implementation at delivered in workplace settings, and to specifically an individual and organisational level. understand the factors (barriers and facilitators) that in- ● Nielson and Randall’s model of organisational-level fluence the successful delivery of mental health promo- interventions [16] will supplement the RE-AIM frame- tion interventions in the workplace. This review is part work for this review allowing for extraction based on the of the MENTUPP project [18] which aims to develop, intervention itself, the context in which it was delivered evaluate and implement mental health promotion inter- and participants’ mental models. ventions for the workplace, particularly in SMEs in the ● Intervention sustainability will be coded using construction, healthcare and ICT sectors. As such, our Moore’s definitions of sustainability [41], e.g. continued review will aim to focus on intervention implementation delivery, behaviour change, evolution/adaptation and barriers and facilitators in SMEs and in the construction, continued benefits. healthcare and ICT sectors. This work addresses recent calls within intervention research to examine the mecha- Quality appraisal nisms through which interventions bring about change In line with previous systematic and scoping reviews that and the documentation of contextual and procedural include mixed methods literature [32, 43], the methodo- considerations that either facilitate or limit implementa- logical quality of included studies will be assessed using tion [16, 17]. Additionally, this timely review responds to the Mixed Methods Appraisal Tool (MMAT) [44] for international policy regarding mental health in the work- quantitative, qualitative and mixed methods research de- place [8]. In an effort to maintain quality and identify all signs. Each study will receive a methodological rating be- relevant information, we have presented a rigorous and tween 0 and 100 (with 100 being the highest quality), systematic approach to this scoping review. We have based on the evaluation of study selection bias, study de- maintained a broad search strategy in order to capture sign, data collection methods, sample size, intervention the variety of implementation research that may be integrity and analysis. Where studies integrate the available, and we will consult with stakeholders to en- process evaluation into the study design, the quality of sure the main findings are useful and relevant. The re- the entire study will be assessed. Methodological quality sults of this review will identify barriers and facilitators will be rated by two reviewers (CL and CP). To ensure to implementation of mental health promotion interven- consistency between reviewers, 15% will be rated inde- tions in the workplace and inform future pilot and de- pendently, and if agreement is reached, one reviewer will finitive RCTs within the MENTUPP project [18]. This rate the remaining papers. Any ambiguity identified will will help inform future interventions, and the evaluation be resolved through discussion with other members of and implementation efforts of such interventions, which the review team. will subsequently improve outcomes for employees and organisations through improved mental wellbeing; re- Collating, summarising and reporting duced symptoms of depression, anxiety and stress; and Descriptive characteristics of included studies will be tabu- reduced presenteeism and absenteeism. In addition, this lated and brought together using a narrative synthesis. To review will contribute to implementation science related answer question one, we will summarise the type of evi- to workplace mental health promotion. dence relating to the implementation of the interventions in workplace settings. To answer questions two and three, barriers and facilitators will be categorised according to Supplementary Information The online version contains supplementary material available at https://doi. the RE-AIM framework [40], modified using Nielson & org/10.1186/s13643-020-01570-9. Randall’s (2013) model for evaluation organisational-level interventions [16] and Moore’s sustainability criteria [45]. Additional file 1. PRISMA-P checklist. We will present tabulated data by sector and then occupa- Additional file 2. Draft Search Strategy. tional level (i.e. organisational, managerial, etc.) and inter- Additional file 3. Outline of the step-wise review methodology. vention type. If the evidence allows, to further answer research question three, we will present tabulated data from included studies focusing specifically on SMEs using Abbreviations the same format. Key findings will be brought together ICT: Information and communication technology; IOSH: Institution of within a narrative synthesis [46, 47]. occupational safety and health; MRC: Medical research council; MeSH: Medical subject heading; MMAT: Mixed methods appraisal tool; PRIS MA: Preferred reporting items for systematic reviews and meta-analyses; PRIS Discussion MA-P: Preferred reporting items for systematic reviews and meta-analyses; The aim of this systematic scoping review is to identify PRISMA-ScR: Preferred reporting items for systematic reviews and meta- analyses extension for scoping reviews; RCT: Randomized controlled trial; RE- research that reports on the feasibility and implementa- AIM: Reach, effectiveness, adoption, implementation and maintenance; tion of mental health promotion interventions that are SMEs: Small-to-medium sized enterprises; WHO: World health Organization Paterson et al. Systematic Reviews (2021) 10:41 Page 7 of 8 Acknowledgements 6. Brohan E, Thornicroft G. Stigma and discrimination of mental health The authors express their gratitude to Pauline Campbell, Glasgow problems workplace implications. Occup Med. [Internet] 2010;60(6):414–5. Caledonian University, for her guidance and support with the search Available from: https://doi.org/10.1093/occmed/kqq048. [cited 2020 July 27]. strategy, and to Donna O’Doibhlin, University College Cork, for her 7. Mental Health Foundation Scotland. Mental Health in the Workplace agreement to review the final search strategy. The authors would also like to Seminar Report. 2018. express appreciation to all other MENTUPP partners [18]. 8. WHO. Mental health in the workplace [Internet]. WHO. World Health Organization; 2019 [cited 2020 Jul 27]. Available from: http://www.who.int/ Authors’ contributions mental_health/in_the_workplace/en/. The protocol was conceptualised, designed, reviewed and approved by all 9. Rugulies R, Aust B, Madsen IEH. Effort–reward imbalance at work and risk of authors. MM and CP contributed to the writing of the protocol. The depressive disorders. A systematic review and meta-analysis of prospective subsequent study, review of abstracts, full studies and synthesis will be cohort studies. Scand J Work Environ Health. 2017;43:294–306. conducted by CP and CL and supported by MM, BG and BA. 10. Theorell T, Hammarström A, Aronsson G, Träskman Bendz L, Grape T, Hogstedt C, et al. A systematic review including meta-analysis of work environment and depressive symptoms [Internet]. Vol. 15, BMC Public Health; 2015. p. 738. [cited Funding 2020 May 7] Available from: http://bmcpublichealth.biomedcentral.com/ This study is funded by the European Union’s Horizon 2020 research and articles/https://doi.org/10.1186/s12889-015-1954-4. innovation programme under grant agreement No 848137. The material 11. Graveling R, Crawford J, Cowrie H, Amati C, Vohra S. 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Male suicide among construction workers in Australia: a qualitative analysis of the major stressors Ethics approval and consent to participate precipitating death. BMC Public Health. 2017;17(1):584 [cited 2020 May 7] Not applicable. Available from: http://bmcpublichealth.biomedcentral.com/articles/10.1186/ s12889-017-4500-8. 14. Wensing M. Implementation science in healthcare: introduction and perspective. Consent for publication Z Evid Fortbild Qual Gesundhwes. 2015;109(2):97–102. [cited 2017 Aug 2] Not applicable. Available from: http://dx.doi.org/https://doi.org/10.1016/j.zefq.2015.02.014. 15. Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M, et al. Competing interests Developing and evaluating complex interventions: the new Medical The authors have no competing interests. Research Council guidance. 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