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Implementation Science at UW

Keywords: C. Bradley Kramer

✪ Pilot randomized controlled trial to assess the effectiveness of a heat risk reduction decision support platform and barriers and facilitators of its implementation

Authors:

Jeremy Hess, Marci Burden, Tania M. Busch Isaksen, Kristie L. Ebi, Nicole A. Errett, Chelsea Gridley-Smith, C. Bradley Kramer, Clare McCarthy, Oma McLaughlin, Resham Patel, Anna Reed, Mary Hannah Smith, Stefan Wheat & Kenneth Sherr

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: November 2025

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

Abstract:

Background

Climate-sensitive hazards such as extreme heat are increasing in frequency and severity. Protecting population health requires hazard-specific risk assessment, selection of potential interventions, and support for intervention implementation. This process typically takes several years, constraining health adaptation to climate-sensitive hazards. The investigators have developed an online decision support platform, CHaRT, that links evidence-based, location-specific heat-health risk assessment with transparent analyses of risk drivers and evidence-based risk reduction guidance for use in local health departments (LHDs). CHaRT’s effectiveness in supporting delivery of effective health interventions has not been evaluated.

Methods

LHDs are the organizational unit being studied. In this pilot randomized controlled trial, LHDs from the conterminous US will be recruited in coordination with the National Association of City and County Health Officials (NACCHO). Thirty LHDs will be selected at random from interested participants. Fifteen will be randomized to receive the intervention, a facilitated engagement with CHaRT, and 15 will receive the control, a package with information on heat vulnerability assessment and potential interventions. Intervention and control packages will be delivered simultaneously. Facilitated engagement will include an introduction to the tool, user exploration of the tool, elective inclusion of site-specific data into the tool, follow-up sessions to address additional questions, and discussion with investigators regarding planning and implementation needs. Pre- and post-study surveys will be used to assess CHaRT’s effectiveness using the RE-AIM (Reach, Effectiveness, Acceptability, Implementation, Maintenance) framework and by comparing each site’s intentions to implement specific interventions. After the trial, barriers and facilitators of the CHaRT platform’s implementation will be assessed through key informant interviews with the intervention group and analyzed using the Consolidated Framework for Implementation Research (CFIR).

Discussion

This study will allow investigators to evaluate the public health impact of a decision support platform and to identify barriers and facilitators of its implementation. The results will guide future research into strategies for increasing public health adaptation to climate change at the speed and breadth required.

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

✪ Environmental sustainability, an essential outcome for implementation scientists to improve health

Authors:

Virginia Mckay, Emmanuel Tetteh, Nicholas Wong, C Bradley Kramer & Jason Burnham

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: October 2025

Read the full text in the open access journal Frontiers in Health Services

Abstract:

While there is evidence of humans' harmful impact on the environment, translating such evidence into changes is challenging. Implementation science can facilitate a shift from a reactive to proactive approach in tackling environmental sustainability. This article aims to spur further discussion among implementation scientists to incorporate environmental sustainability within their research, while also offering concepts relevant to environmental science researchers seeking to apply implementation science principles.

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

✪ “Veteran to Veteran, there’s automatically a trust”: A qualitative study of Veterans’ experiences in a peer health coaching program for hypertension

Authors:

C. Bradley Kramer, Karin M. Nelson, George Sayre, Jennifer L Williams, Leon Spruill, Tiffanie Fennell, Kristen E. Gray, Bryan J. Weiner, Vincent Fan, Jessica Jones-Smith, & Mayuree Rao

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: July 2024

Read the full text open access in the journal AJPM Focus

✪ Development of an Asthma Home-Visit Training Program for Community Health Workers and Their Supervisors in Washington State

Authors:

Nuha Elkugia, Mary E. Crocker, James W. Stout, Kaylin Bolt, Bryan J. Weiner, and C. Bradley Kramer

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: June 2021

Read the full text in the open access journal Frontiers in Public Health
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Abstract:

The community health worker (CHW) asthma home-visiting model developed by Public Health-Seattle & King County (PHSKC) is an evidence-based approach proven to improve health outcomes and quality of life. In addition, it has been shown to be an effective and culturally appropriate approach to helping people with asthma understand the environmental and behavioral causes of uncontrolled asthma, while acquiring the skills they need to control their asthma.

This paper describes the development and implementation of training curricula for CHWs and supervisors in the asthma home visiting program. To facilitate dissemination, this program took advantage of the current healthcare landscape in Washington State resulting from Centers for Medicare & Medicaid Services (CMS) approval of the 1115 Medicaid Waiver project. Key aspects of the training program development included: (1) Engagement: forming a Community Advisory Board with multiple stakeholders to help prioritize training content; (2) Curriculum Development: building the training on evidence-based home-visit protocols previously developed at PHSKC; (3) Implementation of the training program; (4) Evaluation of the training; and (5) Adaptation of the training based on lessons learned.

We describe key factors in the training program's improvement including the use of a community-based participatory approach to engage stakeholders at multiple phases of the project and ensure regional adaption; combining in-person and online modules for delivery; and holding learning collaboratives for post-training and technical support. We also outline our training program evaluation plan and the planned evaluation of the home visit program which the trainees will deliver, both of which follow the RE-AIM framework. However, because the COVID-19 pandemic has curtailed training activities and prohibited the trainees from implementation of these CHW home visit practices, our evaluation is currently incomplete. Therefore, this case study provides insight into the adaptation of the training program, but not the delivery of the home visit program, the outcomes of which remain to be seen.