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Implementation Science at UW

Keywords: Judith N. Wasserheit

✪ Design and method considerations for equity-centered implementation science and practice: A PEDALs approach

Authors:

Run (Sherry) Wang, Wenjun He PhD, Lijing Yan, Rohit Ramaswamy, Judith N. Wasserheit, Mosoka P. Fallah, Ntuli Kapologwe, Malabika Sarker, Yiyuan Cai, Blandina Theophil Mmbaga, Dan Wu, Donna Spiegelman, Jia Bainga Kangbai, Easmon Otupiri, Mathuros Tipayamongkholgul, Dong (Roman) Xu

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: June 2026

Read the full text in the open access journal Global Health Research and Policy

Abstract:

The persistent "know-do gap"—the lag between the development of evidence-based practices (EBPs) and their routine use in health systems—remains a barrier to achieving global health equity. Implementation science offers a pathway to bridge this gap, but without an explicit equity focus, it risks reinforcing existing disparities. In this perspective, we propose an equity-centered adaptation of the PEDALs model (Problem, Evidence-based practice, Determinants, Action, Long-term use, and scale) to guide more just and context-sensitive implementation efforts in global health.

We describe how each stage of PEDALs can be used to embed equity considerations in implementation research and practice. These include identifying root causes of inequity-linked health problems (P), using both scientific and practice-based evidence while adapting or de-implementing interventions (E), engaging marginalized voices when analyzing barriers and facilitators (D), co-designing contextually grounded implementation strategies (A), and measuring long-term implementation outcomes through an equity lens (L), including attention to scalability, iterative learning, and proper design and methods (s). We highlight methodological considerations—such as hybrid designs, embedded and workflow-based research, and rapid and participatory methods—that support timely, relevant, and equitable implementation. Our model builds on the concept of “radical incrementalism” to emphasize steady, equity-driven change that is responsive to diverse settings, especially in low- and middle-income countries. This modified PEDALs-based approach offers a practical structure for design and methodological considerations in advancing equity-centered implementation science.

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

✪ Advancing Adolescent HIV Prevention and Care Through Implementation Science: An Agenda for Combating the Global AIDS Epidemic in Sub-Saharan Africa

Authors:

Eric Goosby, Judith N Wasserheit, Roger Glass & Peter Kilmarx

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: March 2023

Read the full text in the open access journal Prevention Science

Abstract:

AIDS continues to be a major driver of adolescent mortality in Sub-Saharan Africa. Despite evidence of efficacy in this population, many efforts to address adolescent HIV have had limited impact across the region because of difficulty with implementation. The field of implementation science holds promise for addressing these challenges. The Fogarty-led Adolescent HIV Prevention and Treatment Implementation Science Alliance (AHISA) creates a platform for bidirectional learning between researchers and the users of research evidence that promotes the use of implementation science to strengthen adolescent HIV prevention and care across Africa. The unique contributions of AHISA are reflected in this supplement’s articles which represent the collective learning of the Alliance; illustrate the value of implementation science in the context of adolescent HIV; and identify critical research gaps that should be addressed by implementation science in the future.

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

✪ Evaluating and optimizing the consolidated framework for implementation research (CFIR) for use in low- and middle-income countries: a systematic review

Authors:

Arianna Rubin Means, Christopher G. Kemp, Marie-Claire Gwayi-Chore, Sarah Gimbel, Caroline Soi, Kenneth Sherr, Bradley H. Wagenaar, Judith N. Wasserheit, & Bryan J. Weiner

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: March 2020

Read the full text in the open access journal Implementation Science

Abstract:

Background

The Consolidated Framework for Implementation Research (CFIR) is a determinants framework that may require adaptation or contextualization to fit the needs of implementation scientists in low- and middle-income countries (LMICs). The purpose of this review is to characterize how the CFIR has been applied in LMIC contexts, to evaluate the utility of specific constructs to global implementation science research, and to identify opportunities to refine the CFIR to optimize utility in LMIC settings.

Methods

A systematic literature review was performed to evaluate the use of the CFIR in LMICs. Citation searches were conducted in Medline, CINAHL, PsycINFO, CINAHL, SCOPUS, and Web of Science. Data abstraction included study location, study design, phase of implementation, manner of implementation (ex., data analysis), domains and constructs used, and justifications for use, among other variables. A standardized questionnaire was sent to the corresponding authors of included studies to determine which CFIR domains and constructs authors found to be compatible with use in LMICs and to solicit feedback regarding ways in which CFIR performance could be improved for use in LMICs.

Results

Our database search yielded 504 articles, of which 34 met final inclusion criteria. The studies took place across 21 countries and focused on 18 different health topics. The studies primarily used qualitative study designs (68%). Over half (59%) of the studies applied the CFIR at study endline, primarily to guide data analysis or to contextualize study findings. Nineteen (59%) of the contacted authors participated in the survey. Authors unanimously identified culture and engaging as compatible with use in global implementation research. Only two constructs, patient needs and resources and individual stages of change were commonly identified as incompatible with use. Author feedback centered on team level influences on implementation, as well as systems characteristics, such as health system architecture. We propose a “Characteristics of Systems” domain and eleven novel constructs be added to the CFIR to increase its compatibility for use in LMICs.

Conclusions

These additions provide global implementation science practitioners opportunities to account for systems-level determinants operating independently of the implementing organization. Newly proposed constructs require further reliability and validity assessments.

Trial registration

PROSPERO, CRD42018095762

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

Health facility factors and quality of services to prevent mother-to-child HIV transmission in Côte d’Ivoire, Kenya, and Mozambique

Authors:

Alison S Rustagi, Sarah Gimbel, Ruth Nduati, Maria de Fatima Cuembelo, Judith N Wasserheit, Carey Farquhar, Stephen Gloyd, Kenneth Sherr, with input from the SAIA Study Team

University of Washington affiliated authors are displayed in bold.

Subscription Required for Full Text Access

Published: September 2016

Read the full text in the subscription access International Journal of STD & AIDS