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Implementation Science at UW

Keywords: Debate

✪ Adjunctive interventions: Change methods directed at recipients that support uptake and use of health innovations

Authors:

Justin D. Smith, Dennis H. Li, James L. Merle, Brennan Keiser, Brian Mustanski & Nanette D. Benbow

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: February 2024

Read the full text in the open access journal Implementation Science

Abstract:

Background

Implementation science groups change methods into two categories: (1) clinical, behavioral, or biomedical intervention targeting recipient’s health outcomes and (2) implementation strategies targeting the delivery system. Differentiating interventions from strategies based on their intended functions is critical to accurately attributing their effects to health or implementation outcomes. However, in coordinating 200+ HIV implementation research projects and conducting systematic reviews, we identified change methods that had characteristics of both interventions and strategies that were inconsistently categorized. To alleviate confusion and improve change method specification, we propose that implementation science should adopt an extant but rarely used term—adjunctive interventions—to classify change methods that are distinct from the common intervention/strategy taxonomy

Main text

Adjunctive interventions as change methods that target recipients (e.g., patients, participants) of a health intervention but are designed to increase recipients’ motivation, self-efficacy, or capacity for initiating, adhering to, complying with, or engaging with the health intervention over time. In two of our published reviews on implementation of HIV interventions, 25 out of 45 coded change methods fell into this gray area between strategy and intervention. We also noted instances in which the same change method was labelled as the intervention (“the thing”), as an adjunctive intervention, or an implementation strategy in different studies—further muddying the waters. Adjunctive interventions are distinguished from other change methods by their intended targets, desired outcomes, and theory of action and causal processes. Whereas health interventions target recipients and have a direct, causal effect on the health outcome, adjunctive interventions enhance recipients’ attitudes and behaviors to engage with the intervention and have an indirect causal link to the health outcome via increasing the probability of recipients’ utilization and adherence to the intervention. Adjunctive interventions are incapable of directly producing the health outcome and will themselves require implementation strategies to effectively impact sustained uptake, utilization, and adherence. Case examples, logic modeling, and considerations (e.g., relationship to consumer engagement strategies) for adjunctive intervention research are provided

Conclusion

Conceptualizing adjunctive interventions as a separate type of change method will advance implementation research by improving tests of effectiveness, and the specification of mechanisms and outcomes.

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

✪ Grounding implementation science in health equity for cancer prevention and control

Authors:

Prajakta Adsul, David Chambers, Heather M. Brandt, Maria E. Fernandez, Shoba Ramanadhan, Essie Torres, Jennifer Leeman, Barbara Baquero, Linda Fleischer, Cam Escoffery, Karen Emmons, Montserrat Soler, April Oh, Ariella R. Korn, Stephanie Wheeler & Rachel C. Shelton

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: June 2022

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

Abstract:

Background

The past decade of research has seen theoretical and methodological advances in both implementation science and health equity research, opening a window of opportunity for facilitating and accelerating cross-disciplinary exchanges across these fields that have largely operated in siloes. In 2019 and 2020, the National Cancer Institute’s Consortium for Cancer Implementation Science convened an action group focused on ‘health equity and context’ to identify opportunities to advance implementation science. In this paper, we present a narrative review and synthesis of the relevant literature at the intersection of health equity and implementation science, highlight identified opportunities (i.e., public goods) by the action group for advancing implementation science in cancer prevention and control, and integrate the two by providing key recommendations for future directions.

Discussion

In the review and synthesis of the literature, we highlight recent advances in implementation science, relevant to promoting health equity (e.g., theories/models/frameworks, adaptations, implementation strategies, study designs, implementation determinants, and outcomes). We acknowledge the contributions from the broader field of health equity research and discuss opportunities for integration and synergy with implementation science, which include (1) articulating an explicit focus on health equity for conducting and reviewing implementation science; (2) promoting an explicit focus on health equity in the theories, models, and frameworks guiding implementation science; and (3) identifying methods for understanding and documenting influences on the context of implementation that incorporate a focus on equity.

Summary

To advance the science of implementation with a focus on health equity, we reflect on the essential groundwork needed to promote bi-directional learning between the fields of implementation science and health equity research and recommend (1) building capacity among researchers and research institutions for health equity-focused and community-engaged implementation science; (2) incorporating health equity considerations across all key implementation focus areas (e.g., adaptations, implementation strategies, study design, determinants, and outcomes); and (3) continuing a focus on transdisciplinary opportunities in health equity research and implementation science. We believe that these recommendations can help advance implementation science by incorporating an explicit focus on health equity in the context of cancer prevention and control and beyond.

Contributions to the literature
  • This paper presents a narrative review and synthesis of the conceptual and empirical literature at the intersection of implementation science and health equity research.
  • We highlight opportunities identified at the health equity and context working group at the Consortium for Cancer Implementation Science to make a focus on health equity in IS foundational and explicit.
  • Informed by the narrative review and identified opportunities by the action group, we offer recommendations that reflect the essential groundwork needed to promote bi-directional learning and synergy between the fields of implementation science and health equity research.

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