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Implementation Science at UW

Keywords: Michelle Shin

✪ 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**

✪ Use of concept mapping to inform a participatory engagement approach for implementation of evidence-based HPV vaccination strategies in safety-net clinics

Authors:

Jennifer Tsui, Michelle Shin, Kylie Sloan, Thomas I. Mackie, Samantha Garcia, Anne E. Fehrenbacher, Benjamin F. Crabtree & Lawrence A. Palinkas

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: June 2024

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

Abstract:

Background

Multiple evidence-based strategies (EBS) for promoting HPV vaccination exist. However, adolescent HPV vaccination rates remain below target levels in communities at high risk for HPV-associated cancers and served by safety-net clinics. Participatory engaged approaches are needed to leverage the expertise of community and clinical partners in selecting EBS relevant to their local context. We engaged concept mapping as a method to inform the adoption and adaptation of EBS that seeks to empower implementation partners to prioritize, select, and ultimately implement context-relevant EBS for HPV vaccination.

Methods

Using 38 EBS statements generated from qualitative interviews and national HPV vaccine advocacy sources, we conducted a modified concept mapping activity with partners internal to safety-net clinics and external community members in two study sites of a larger implementation study (Greater Los Angeles and New Jersey), to sort EBS into clusters and rate each EBS by importance and feasibility for increasing HPV vaccination within safety-net clinics. Concept mapping findings (EBS statement ratings, ladder graphs and go-zones) were shared with leaders from a large federally qualified health center (FQHC) system (focusing on three clinic sites), to select and implement EBS over 12 months.

Results

Concept mapping participants (n=23) sorted and rated statements, resulting in an eight-cluster solution: 1) Community education and outreach; 2) Advocacy and policy; 3) Data access/quality improvement monitoring; 4) Provider tracking/audit and feedback; 5) Provider recommendation/communication; 6) Expanding vaccine access; 7) Reducing missed opportunities; and 8) Nurse/staff workflow and training. The FQHC partner then selected to intervene on eight of 17 EBS statements in the “go-zone” for action, with three from “reducing missed opportunities,” two from “nurse/staff workflow and training,” and one each from “provider tracking/audit and feedback,” “provider recommendation/communication,” and “expanding vaccine access,” which the research team addressed through the implementation of three multi-level intervention strategies (e.g., physician communication training, staff training and workflow assessment, audit and feedback of clinic processes).

Conclusions

Concept mapping provided a powerful participatory approach to identify multilevel EBS for HPV vaccination relevant to the local safety-net clinic context, particularly when several strategies exist, and prioritization is necessary. This study demonstrates how a clinic system benefited directly from the ratings and prioritization of EBS by multilevel clinic and community partners within the broader safety-net clinic context to identify and adapt prioritized solutions needed to advance HPV vaccine equity.

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

✪ Disruptions to and Innovations in HPV Vaccination Strategies within Safety-Net Healthcare Settings Resulting from the COVID-19 Pandemic

Authors:

Samantha Garcia, Michelle Shin, Kylie Sloan, Emily Dang, Carlos Orellana Garcia, Lourdes Baezconde-Garbanati, Lawrence A. Palinkas, Benjamin F. Crabtree, and Jennifer Tsui

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published:August 2023

Read the full text in the open access journal Healthcare

Abstract:

Abstract

The COVID-19 pandemic disrupted healthcare delivery within safety-net settings. Barriers to and facilitators of human papillomavirus (HPV) vaccination during the pandemic can inform future HPV vaccine strategies for underserved communities. Qualitative interviews (n = 52) between December 2020 and January 2022 in Los Angeles and New Jersey were conducted with providers, clinic leaders, clinic staff, advocates, payers, and policy-level representatives involved in the HPV vaccine process. Using the updated Consolidated Framework for Implementation Research we identified (1) outer setting barriers (i.e., vaccine hesitancy driven by social media, political views during the pandemic) and facilitators (e.g., partnerships); (2) inner setting clinic facilitators (i.e., motivation-driven clinic metrics, patient outreach, vaccine outreach events); (3) individual characteristics such as patient barriers (i.e., less likely to utilize clinic services during the pandemic and therefore, additional outreach to address missed vaccine doses are needed); (4) innovations in HPV vaccination strategies (i.e., clinic workflow changes to minimize exposure to COVID-19, leveraging new community partnerships (e.g., with local schools)); and (5) implementation strategies (i.e., multisectoral commitment to HPV goals). Pandemic setbacks forced safety-net settings to develop new vaccine approaches and partnerships that may translate to new implementation strategies for HPV vaccination within local contexts and communities.

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

✪ Understanding Clinic and Community Member Experiences with Implementation of Evidence-Based Strategies for HPV Vaccination in Safety-Net Primary Care Settings

Authors:

Jennifer Tsui, Michelle Shin, Kylie Sloan, Bibiana Martinez, Lawrence A. Palinkas, Lourdes Baezconde-Garbanati, Joel C. Cantor, Shawna V. Hudson & Benjamin F. Crabtree

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: June 2023

Read the full text in the open access journal Prevention Science

Abstract:

HPV vaccination rates remain below target levels among adolescents in the United States, which is particularly concerning in safety-net populations with persistent disparities in HPV-associated cancer burden. Perspectives on evidence-based strategies (EBS) for HPV vaccination among key implementation participants, internal and external to clinics, can provide a better understanding of why these disparities persist. We conducted virtual interviews and focus groups, guided by the Practice Change Model, with clinic members (providers, clinic leaders, and clinic staff) and community members (advocates, parents, policy-level, and payers) in Los Angeles and New Jersey to understand common and divergent perspectives on and experiences with HPV vaccination in safety-net primary care settings. Fifty-eight interviews and seven focus groups were conducted (n = 65 total). Clinic members (clinic leaders n = 7, providers n = 12, and clinic staff n = 6) revealed conflicting HPV vaccine messaging, lack of shared motivation to reduce missed opportunities and improve workflows, and non-operability between clinic electronic health records and state immunization registries created barriers for implementing effective strategies. Community members (advocates n = 8, policy n = 11, payers n = 8, and parents n = 13) described lack of HPV vaccine prioritization among payers, a reliance on advocates to lead national agenda setting and facilitate local implementation, and opportunities to support and engage schools in HPV vaccine messaging and adolescents in HPV vaccine decision-making. Participants indicated the COVID-19 pandemic complicated prioritization of HPV vaccination but also created opportunities for change. These findings highlight design and selection criteria for identifying and implementing EBS (changing the intervention itself, or practice-level resources versus external motivators) that bring internal and external clinic partners together for targeted approaches that account for local needs in improving HPV vaccine uptake within safety-net settings.

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