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Implementation Science at UW

Keywords: Assessment

Developing and implementing a process improvement intervention to expand evidence-based psychotherapy in the Department of Defense

Authors:

Jeffrey Cook, Melissa Mistretta, Carmen P. McLean, Jeffrey Mann, Erin Frick, Alan L. Peterson, Stacey Young-McCaughan, Elisa V. Borah, Katherine Anne Comtois, Katherine A. Dondanville, Allison M. Conforte, Jeremy Jinkerson, Zachary K. Jones
81st Medical Group, Keesler Air Force Base, Biloxi, Mississippi, United States
Hana J. Kim, Jared S. Link, Debra Nofziger, Erik N. Ringdahl, John Waggoner, Craig Woodworth, Craig S. Rosen, & David S. Riggs

University of Washington affiliated authors are displayed in bold.

Subscription Required for Full Text Access

Published: April 2025

Read the full text in the subscription access journal Psychological Services

✪ Lessons learnt from the 2021 Pacific Northwest heat dome: a qualitative study of western Washington’s healthcare community response

Authors:

Matias Korfmacher, Cat Hartwell, Kelly Hill, Nathaniel Matthews-Trigg, Jeremy Hess, Amruta Nori-Sarma, & Gregory Wellenius

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: April 2025

Read the full text in the open access journal BMJ Open

Abstract:

Objective

The 2021 Pacific Northwest heat dome was Washington state’s deadliest recorded weather event and presented unprecedented response challenges to the state’s health sector. Understanding the impacts of this extreme heat event (EHE) on the sector as well as the barriers to and facilitators of implementing effective heat response is critical to preparing for future events, which are happening more frequently in the region due to climate change.

Design

Guided by an implementation science framework, we convened listening sessions and focus groups of the health sector in western Washington to reflect on regional response efforts.

Setting

Health sector organisations in 15 counties in western Washington State, USA: Clallam, Grays Harbor, Island, Jefferson, King, Kitsap, Lewis, Mason, Pacific, Pierce, San Juan, Skagit, Snohomish, Thurston and Whatcom.

Participants

A convenience sample of 109 listening group participants was recruited through the professional networks of the Northwest Healthcare Response Network, a regional healthcare coalition. 27 of the health sector professionals were recruited using purposive sampling to participate in seven focus groups organised by organisation type.

Results

The co-presence of the COVID-19 pandemic, limited staff capacity, resource acquisition challenges and inadequate regional collaboration emerged as key barriers, while advanced planning, indoor cooling capabilities, adapting strategies to local needs, robust internal relationships and strong external partnerships were reported to facilitate effective response. Establishing centralised coordination ahead of heat events, making improvements to the cooling capabilities of the built environment, developing plans and policies for EHEs that have co-benefits for other events, adopting evidence-informed response strategies, institutionalising the knowledge and relationships developed through prior events and improving evaluative processes (such as developing real-time monitoring capacity) will enable more effective response to future EHEs.

Conclusions

Western Washington’s health sector implemented EHE response activities that enabled essential service continuity, despite limited resources, unfamiliarity with EHEs and other systemic challenges. The recency of the heat dome presents an opportunity to incorporate lessons learnt into practice, policies, plans and built environment; these are necessary improvements ahead of future large-scale events the region may experience in the coming decades.

**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**

✪ Community-Engaged Research in HIV Implementation Science: Characterizing Academic and Community Partnerships in the “Ending the HIV Epidemic” Supplement Awards

Authors:

Reva Datar, Sheree Schwartz, Wilson Gomez, David A Katz, Gustavo Morales, Debbie Humphries, April Pettit, Audrey Harkness, Pedro Alonso Serrano, Robin Gaines Lanzi, Jessica M Sales, Christopher Archiopoli, Stefan Baral, Laura K Beres

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: April 2025

Read the full text open access in the journal JAIDS: Journal of Acquired Immune Deficiency Syndrome

✪ Building the Road to End the HIV Epidemic Through Coordinating and Capacity-Building Hubs to Enhance the Science of HIV Implementation REsearch (CHESHIRE): Reflections and Directions

Authors:

Debbie L Humphries, Carolyn M Audet, Bijal A Balasubramanian, Nanette Benbow, Christopher G Kemp, Robin Gaines Lanzi, Sung-Jae Lee, Hannah Mestel, Alexandra B Morshed, Brian Mustanski, April Pettit, Borsika A Rabin, Olivia Sadler, Alison B Hamilton, Mary-Louise E Millett, Sheree Schwartz, Kenneth Sherr, Nicole A Stadnick, & Dennis H Li

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: April 2025

Read the full text open access in the journal JAIDS: Journal of Acquired Immune Deficiency Syndrome

✪ Developing Implementation Science Capacity Within Health Departments Located in Ending the HIV Epidemic Priority Areas

Authors:

Christine M Khosropour, Arianna Rubin Means, Roxanne P Kerani, Emma M Murphy, Krupa Mehta, Kristina Santana, Kenneth Sherr, & Matthew R Golden.

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: April 2025

Read the full text open access in the journal JAIDS: Journal of Acquired Immune Deficiency Syndrome

✪ Methods for community-engaged data collection and analysis in implementation research

Authors:

Lawrence A. Palinkas, Benjamin Springgate, Leopoldo J. Cabassa, Michelle Shin, Samantha Garcia, Benjamin F. Crabtree & Jennifer Tsui

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: April 2025

Read the full text in the open access journal Implementation Science Communications

Abstract:

Background

Community engagement is widely recognized as critical to successful and equitable implementation of evidence-based practices, programs, and policies. However, there are no clear guidelines for community involvement in data collection and analysis in implementation research.

Methods

We describe three specific methods for engaging community members in data collection and analysis: concept mapping, rapid ethnographic assessment, and Photovoice. Common elements are identified from a case study of each method: 1) selection and adaptation of evidence-based strategies for improving adolescent HPV vaccine initiation rates in disadvantaged communities, 2) strategies for implementing medication for opioid use disorders among low-income Medicaid enrollees during natural disasters, and 3) interventions to improve the physical health of adults with severe mental illness living in supportive housing.

Results

In all three cases, community members assisted in participant recruitment, provided data, and validated preliminary findings created by researchers. In the Photovoice case study, community members participated in both data collection and analysis, while in the concept mapping, community members also participated in the initial phase of organizing and prioritizing evidence-based strategies during the data analysis.

Conclusions

Community involvement in implementation research data collection and analysis contributes to greater engagement and empowerment of community members and validation of study findings. Use of methods that exhibit both scientific rigor and community relevance of implementation research also contributes to greater community investment in successful implementation outcomes. Nevertheless, the case studies point to the importance and efficiency of the division of labor embedded in community-engaged implementation research. Building capacity for community members to assume greater roles in obtaining and organizing data for preliminary analysis prior to interpretation is recommended.

Contributions to the literature

  • Guidelines exist for conducting community engaged research but provide no clear instructions for community involvement in data collection and analysis.
  • This paper examines the potential of community engaged data collection and analysis in implementation research through case studies of concept mapping, rapid ethnographic methods, and Photovoice.
  • Community involvement in implementation research data collection and analysis contributes to greater engagement and empowerment of community members, validation of study findings, and commitment to successful implementation outcomes.

**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**

✪ Practical considerations for engaging staff in resource-constrained healthcare settings in implementation research: A qualitative focus group and consensus building study

Authors:

Kelly A. Aschbrenner, Callie Walsh-Bailey, Meagan C. Brown, Tanveer Khan, Travis P. Baggett, Salene M.W. Jones, Douglas E. Levy, Lydia E. Pace, and Jonathan P. Winickoff

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: March 2025

Read the full text open access in the Journal of Clinical and Translational Science

Abstract:

Background

The primary purpose of this study was to assess perceived burdens and benefits of participating in implementation research among staff employed in resource-constrained healthcare settings. Another objective was to use findings to generate considerations for engaging staff in research across different phases of implementation research.

Methods

This qualitative focus group and consensus building study involved researchers affiliated with the National Cancer Institute Implementation Science Centers in Cancer Control program and nine Community Health Centers (CHCs) in Massachusetts. Six focus groups (n = 3 with CHC staff; n = 3 with researchers) assessed barriers and facilitators to staff participation in implementation research. During consensus discussions, we used findings to develop considerations for engaging staff as participants and partners throughout phases of implementation research.

Results

Sixteen researchers and 14 staff participated in separate focus groups; nine researchers and seven staff participated in separate consensus discussions. Themes emerged across participant groups in three domains: (1) influences on research participation; (2) research burdens and benefits; and (3) ways to facilitate staff participation in research. Practical considerations included: (a) aligning research with organizational and staff values and priorities; (b) applying user-centered design to research methods; (c) building organizational and individual research capacity; and (d) offering equitable incentives for staff participation.

Conclusions

Engaging staff as participants and partners across different phases of implementation research requires knowledge about what contributes to research burden and benefits and addressing context-specific burdens and benefits.

**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**

✪ Usability, Acceptability, and Barriers to Implementation of a Collaborative Agenda-Setting Intervention (CASI) to Promote Person-Centered Ovarian Cancer Care: Development Study

Authors:

Rachel A Pozzar, James A Tulsky, Donna L Berry, Jeidy Batista, Paige Barwick, Charlotta J Lindvall, Patricia C Dykes, Michael Manni, Ursula A Matulonis, Nadine J McCleary, and Alexi A Wright

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: March 2025

Read the full text in the open access journal JMIR Cancer

Abstract:

Background

People with advanced ovarian cancer and their caregivers report unmet supportive care needs. We developed a Collaborative Agenda-Setting Intervention (CASI) to elicit patients’ and caregivers’ needs through the patient portal before a clinic visit and to communicate these needs to clinicians using the electronic health record.

Objective

We aimed to assess the usability and acceptability of the CASI and identify barriers to and facilitators of its implementation.

Methods

We recruited English- and Spanish-speaking patients, caregivers, and clinicians from the gynecologic oncology program at a comprehensive cancer center. Participants used the CASI prototype and then completed individual cognitive interviews and surveys. We assessed usability with the System Usability Scale (scores range 0‐100, scores ≥70 indicate acceptable usability) and acceptability with the Acceptability of Intervention Measure and Intervention Appropriateness Measure (scores for both measures range from 1 to 5, higher scores indicate greater acceptability). Interviews were audio recorded, transcribed, and analyzed using directed content analysis. Domains and constructs from the Consolidated Framework for Implementation Research comprised the initial codebook. We analyzed survey data using descriptive statistics and compared usability and acceptability scores across patients, caregivers, and clinicians using analyses of variance.

Results

We enrolled 15 participants (5 patients, 5 caregivers, and 5 clinicians). The mean System Usability Scale score was 72 (SD 16). The mean Acceptability of Intervention Measure and Intervention Appropriateness Measure scores were 3.9 (SD 1.0) and 4.1 (SD 0.8), respectively. Participants viewed the CASI content and format positively overall. Several participants appreciated the CASI’s integration into the clinical workflow and its potential to increase attention to psychosocial concerns. Suggestions to refine the CASI included removing redundant items, simplifying item language, and adding options to request a conversation or opt out of supportive care referrals. Key barriers to implementing the CASI include its complexity and limited resources available to address patients’ and caregivers’ needs.

Conclusions

The CASI is usable and acceptable to patients with advanced ovarian cancer, caregivers, and clinicians. We identified several barriers to and facilitators of implementing the CASI. In future research, we will apply these insights to a pilot randomized controlled trial to assess the feasibility of comparing the CASI to usual care in a parallel group-randomized efficacy trial.

**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**

✪ Health Care Professional Adherence to Breast Cancer Management Guidelines in Nigeria

Authors:

Anya Romanoff, Olalekan Olasehinde, Kathleen Lynch, Sharif Folorunso, Oluwatosin Omoyiola, Betiku Omolade, Adeleye Omisore, Chukwuma Eze Okereke, Olayide Agodirin, Abubakar Bala Muhammad, Nuhu Ali, Omorodion Irowa, Nneka Sunday Nweke, Uchechukwu Emmanuel Nwokwu, Adewale Aderounmu, Funmilola Wuraola, Hannah L Kalvin, Rivka Kahn, Grace Fitzgerald, Cristina Olcese, Alexia Iasonos, Victoria L Mango, Jamie S Ostroff, Rachel Vreeman, Benjamin O Anderson, T Peter Kingha, and Olusegun Isaac Alatise

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: February 2025

Read the full text in the open access journal JAMA Network Open

Abstract:

Importance

In Nigeria, 80% of breast cancer is diagnosed at an advanced stage, when clinical management is complex and necessitates multidisciplinary collaboration. The Nigerian Federal Ministry of Health promotes multidisciplinary tumor board (MDT) discussions and endorses the National Comprehensive Cancer Network Harmonized Guidelines for Sub-Saharan Africa (Harmonized Guidelines) to standardize breast cancer care, but the extent of their clinical utilization is not well understood.

Objective

To identify barriers to and facilitators of the standardization of breast cancer care in Nigeria as reflected by awareness and consultation of resource-adapted guidelines.

Design, Setting, and Participants

For this survey study, health care professionals (HCPs) involved in breast cancer care in Nigeria were recruited electronically through medical societies and snowball sampling from November 1, 2023, to January 31, 2024.

Exposure

Breast cancer care guidelines.

Main Outcomes and Measures

Current breast cancer guideline awareness, adherence among specialties, and multidisciplinary management in Nigeria were evaluated. A multinational, multidisciplinary team developed and distributed an HCP questionnaire. Cochran-Armitage trend tests and logistic regression assessed associations with guideline awareness and use.

Results

A total of 277 HCPs (median [IQR] age, 42 [38-48] years; 211 of 275 [77%] male), including 124 surgeons (45%), 59 radiologists (21%), 49 clinical oncologists (18%), and 45 pathologists (16%), responded to the survey. Of 274 HCPs, 253 (92%) believed that breast cancer guidelines contribute to better patient outcomes, and 100 of 195 (51%) routinely consulted guidelines. Of 273 HCPs, 103 (38%) had regular engagement in breast cancer MDT discussions. Only 93 of 277 HCPs (34%) were aware of resource-adapted Harmonized Guidelines; both guideline awareness and consultation increased with the frequency of MDT participation. Completing a cancer-related fellowship (OR, 14.56; 95% CI, 6.24-40.00; P < .001), clinical oncology specialization (OR vs surgery, 0.20 [95% CI, 0.09-0.42]; OR vs pathology, 0.05 [95% CI, 0.02-0.14]; OR vs radiology, 0.02 [95% CI, 0.01-0.06]; P < .001), devoting more time to breast health care delivery (OR, 1.04; 95% CI, 1.02-1.05; P < .001), and regular MDT engagement (OR for weekly vs none, 5.13; 95% CI, 1.69-17.35; P = .04) were associated with consulting guidelines regularly on univariable analysis. To improve guideline adherence, 230 of 277 HCPs (83%) reported needing regular MDT discussions.

Conclusions and Relevance

In this survey of HCPs across Nigeria, half reported routinely consulting guidelines and only one-third were aware of the Harmonized Guidelines, which are resource adapted and endorsed by the Nigerian Federal Ministry of Health. Approximately one-third of HCPs reported engaging in regular breast cancer MDT discussions; guideline awareness and consultation increased as frequency of MDT participation increased. Opportunities for disseminating knowledge, such as MDT discussions and fellowship training, are essential to standardize breast cancer care delivery in Nigeria.

**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**

✪ Development of learning health system competency items related to health and healthcare equity and justice for rehabilitation researchers

Authors:

Pamela M. Dunlap, Kathleen M. Poploski, Catherine A. Anderson, Thiru M. Annaswamy, Melissa A. Clark, Peter C. Coyle, Natalie F. Douglas, Ann Marie Flores, Janet K. Freburger, Brian J. Hafner, Kenneth J. Harwood, Jeanne M. Hoffman, Adam R. Kinney, Linda Resnik, Kristin Ressel, Margarite J. Whitten, and Christine M. McDonough

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: January 2025

Read the full text in the open access journal Learning Health Systems

Abstract:

Introduction

In 2021, the Learning Health Systems Rehabilitation Research Network (LeaRRn) developed and administered a needs assessment survey, based on the Agency on Healthcare Research and Quality's (AHRQ's) original seven domains of learning health systems (LHS) researcher core competencies, to identify knowledge and interest in LHS research competencies among rehabilitation researchers. In 2022, the AHRQ added a new health and healthcare equity and justice (HE) domain to the existing seven domains for LHS researcher core competencies.

Methods

LeaRRn utilized methods similar to those employed in the development of their original needs assessment survey to generate and refine competency items for the HE domain. In this report, we describe the methods used to develop these HE competency items.

Results & Conclusions

Other training programs and LHS researchers may use the competency items developed for this needs assessment survey to identify training opportunities in the HE domain.

**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**