Open Access Archives - Implementation Science at UW

✪ Strengthening primary care facility management: a systematic review of management interventions, implementation strategies, and outcomes in six sub-Saharan African countries

Abstract:

Background

Although primary health care (PHC) is central to health system performance, effective facility-level management is a critical determinant of service quality, resource use, and improved health outcomes. We conducted a systematic review to synthesize evidence on interventions, implementation strategies, and outcomes aimed at strengthening PHC facility management in Sub-Saharan Africa (SSA).

Methods

We conducted a systematic review using thematic synthesis. Eight electronic databases were searched for peer-reviewed studies and grey literature published between 2012 and 2022, focusing on interventions targeting PHC facility management in SSA. Implementation strategies were mapped to the thematic cluster areas of the Expert Recommendations for Implementing Change (ERIC) framework. Implementation outcomes were classified using Proctor’s Implementation Outcome Framework, and management effectiveness domains were identified through thematic analysis.

Results

Of 3,752 studies screened, nine met the inclusion criteria. These studies represented six SSA countries: Botswana, Ethiopia, Kenya, South Africa, Tanzania, and Zambia. Four categories of intervention were identified: (1) training and capacity building programs, (2) peer-to-peer learning, (3) audit and feedback-based quality management systems, and (4) supportive supervision. These interventions were delivered through multiple implementation strategies, including training and education, coaching and mentoring, learning collaboratives, interactive continuous learning, and routine data monitoring. Acceptability was the most consistently reported implementation outcome. Improvements in management effectiveness were identified across four domains: financial management, organizational climate and culture, resource management and utilization, and human resource management. Five studies also reported intermediate service-level outcomes including improvements in maternal and child health indicators.

Conclusion

Interventions aimed at strengthening PHC facility management in SSA primarily emphasize skill development, collaboration, and ongoing managerial support, typically delivered through multiple strategies. However, few studies have evaluated these interventions using rigorous experimental or pragmatic study designs. More robust implementation research is needed to identify effective strategies for strengthening PHC facility management and supporting the consistent implementation of national PHC guidelines.

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

✪ Implementation science frameworks and strategies to promote adoption of and adherence to oncology clinical practice guidelines in low- and middle-income countries: a scoping review

Authors:

Anya Romanoff, Kathleen Lynch, Lily Martin, Olayide Agodirin, Shilpa Murthy, Olalekan Olasehinde, Chukwuma Okereke, Julia M. Jackman, Betel Yibrehu, William E. Rosa, Catherine Zivanov, Erica Mann, Joy O. Ogunmuyiwa, Colleen E. Witty, Victoria L. Mango, Olusegun Isaac Alatise, T. Peter Kingham, Rachel Vreeman, Benjamin O. Anderson & Jamie S. Ostroff

^{University of Washington affiliated authors are displayed in bold.}

✪ Open Access

Published: July 2026

Read the full text in the open access journal BMC Global Public Health

Abstract:

Background

Clinical practice guidelines (CPGs) were developed to standardize and optimize cancer care delivery in low- and middle-income countries (LMICs). The aim of this scoping review is to identify implementation science (IS) frameworks and strategies to promote CPG adoption and adherence in LMICs.

Methods

We identified studies that describe, develop, reference, or utilize IS frameworks or strategies to deliver or evaluate adoption of oncology CPGs in LMICs. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), we searched Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), African Journals Online, Latin American and Caribbean Health Sciences Literature, Scopus, Web of Science, and PsycINFO on 3/21/2022, 12/20/2022, 01/26/2024, and 10/03/2025. Publications in all languages and of all study types were eligible for inclusion. Titles, abstracts, and full text were screened by two reviewers with conflicts resolved by a third reviewer. Excluded studies did not use an IS framework or strategy, did not focus on cancer care, or were conducted in a high-income country.

Results

Searches identified 17,806 unique publications for title/abstract screening. 182 studies met criteria for full-text review; 35 were included. Twenty-four studies were country-specific, most commonly India (n = 5) and Nigeria (n = 5). The most frequent CPGs referenced were national/country-specific guidelines (n = 13) and Breast Health Global Initiative (BHGI) guidelines (n = 9). Only 16 full-text publications described original research to promote or evaluate evidence-based CPG interventions in LMICs. Established IS frameworks used in more than one study were the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework (n = 2) and Consolidated Framework for Implementation Research (CFIR) (n = 2).

Conclusions

There is limited research utilizing IS frameworks and strategies to promote CPG adoption and adherence in LMICs and substantial heterogeneity in reporting. Greater utilization of IS frameworks, strengthening implementation capacity and improving consistency in reporting, are needed to improve CPG uptake in LMICs.

Systematic review registration

Open Science Framework (https://osf.io/nb75s).

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

✪ Rigorous projects and grants integrating human-centered design and implementation science: 8 tips for success

Abstract:

Background

Researchers and funders increasingly see potential for integrating human-centered design (HCD) and implementation science (IS) approaches to enhance the design and uptake of health interventions and implementation strategies. These approaches offer complementary strengths. HCD prioritizes developing compelling, intuitive, and adoptable innovations grounded in user and contextual needs; IS focuses on ensuring evidence-based practices reach and work for their intended populations. Integrating HCD and IS creates challenges that existing IS proposal writing guidelines do not address. HCD’s inherent uncertainty–since final designs are developed through iteration rather than pre-determined–can unsettle researchers and funders accustomed to more defined endpoints. Variation in how HCD is understood adds further difficulty when collaborating across disciplines or communicating with funders. There are currently no published recommendations to help researchers design strong studies integrating HCD and IS and communicate them effectively to funders.

Discussion

We present tips to support both rigorous study design and effective proposal writing that integrate HCD and IS. This draws from our experiences leading, supporting, and reviewing both funded and unfunded projects. Our considerations are informed primarily by experiences with teams in the United States in the mental health and behavioral health domains; however, we have found our findings also apply to projects globally and in other health sectors. Our intent is that this guide will advance good research that leverages both approaches and is viable for funding. We also hope that the tips will support funders in developing solicitations and evaluating proposals.

Conclusion

There is untapped potential for innovative health research integrating HCD and IS, but realizing it requires both rigorous study design and an ability to attract funding. We offer practice guidance to help researchers and funders develop quality projects and proposals, and we encourage others to build on these recommendations.

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

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

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**}

✪ Acceptability and Feasibility of Remote PrEP Visits for Adolescent Girls and Young Women in South Africa

Abstract:

The World Health Organization recommends differentiated service delivery (DSD) models for HIV prevention, including alternatives to clinic-based PrEP services. This study assessed the acceptability and feasibility of remote PrEP delivery—including HIV and pregnancy self-testing, and phone-based adherence counselling—among adolescent girls and young women (AGYW) in Johannesburg. The research was nested within the PrEP SMART trial (2019–2022), which evaluated scalable adherence support strategies for AGYW aged 18–25. During COVID-19 lockdowns, PrEP refills and testing kits were delivered to participants’ homes, and counselling was provided by phone. Using a phenomenological qualitative method, we conducted in-depth interviews with AGYW (n = 14) who had the option to complete remote PrEP visits (accepting or declining), study staff (n = 12), and key informants (n = 10) involved in PrEP programming. Thematic analysis explored experiences of remote delivery, focusing on acceptability and feasibility.

AGYW found remote PrEP visits convenient, empowering, and time-saving. Procedures such as self-testing and phone counselling were generally acceptable, though some expressed anxiety about performing tests incorrectly and concerns over privacy, stigma, and unintentional disclosure of PrEP use at home. About half still preferred clinic-based visits. Staff and key informants recognized benefits, but highlighted challenges related to cost, sustainability, and provider workload. Suggestions for improvement included integrating contraception and partnering with community organizations. In conclusion, remote PrEP delivery is acceptable and feasible for many AGYW but not universally suitable. These findings support the inclusion of remote PrEP options in DSD models, with attention to privacy concerns and support for self-testing in this age group.

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

✪ Targeted social and behavior change communication (SBCC) in a high adolescent pregnancy setting of Bangladesh: a cluster-randomized study protocol engaging key family members

Abstract:

Background

Maternal health service utilization remains low in Bangladesh, while maternal health outcomes are poor and adolescent pregnancy rates are high. In this context, targeted social and behavior change communication (SBCC) can be an effective approach. This targeted SBCC research was participatorily designed in collaboration with Bangladesh local partners and was funded as part of the 2023–27 KOICA Strategic Partnership Program (SPP)- Strengthening Maternal and Neonatal Health System in Rangpur, Bangladesh (No. 2023–0515). The study was informed by implementation and behavior change theories, engaging key family members in the intervention.

Methods

A hybrid effectiveness-implementation type II cluster-randomized study was designed to measure key maternal health service utilization outcomes as well as implementation outcomes. A total of 750 participants classified into four targeted groups-1) adolescent pregnant women, 2) adult pregnant women, 3) husbands and 4) mothers-in-law, will be invited to participate in group-based interactive community courtyard sessions. These 5-month curriculum targeted SBCC sessions cover maternal and newborn health topics such as antenatal care (ANC), safe delivery, postnatal care (PNC), and neonatal care. The primary outcomes include four or more ANC visits, facility delivery, Postnatal Care (PNC) and neonatal care within 48 h after delivery. Secondary outcomes are perceptions on early marriage, maternal health-seeking behaviors, family support, decision making, and satisfaction with the information gained from the targeted SBCC sessions. To assess the effectiveness, baseline and endline surveys, along with endline focus group discussions (FGDs) will be conducted before and after the 5-month curriculum. Additionally, implementation outcomes such as adoption, penetration, acceptability, coverage, feasibility, fidelity, and sustainability will be measured.

Discussion

This study engages key decision-makers such as pregnant women, their husbands, and mothers-in-law, to enhance maternal health service utilization. As Bangladesh is a patriarchal society, men within households are often the primary decision-makers regarding marriage and reproductive matters. Moreover, the child marriage and adolescent pregnancy rates remain high, contributing to persistently elevated maternal and neonatal mortality. By applying implementation science frameworks and behavior change theories, this study aims to generate evidence to inform future scale-up efforts in similar contexts.

Trial registration

The protocol was registered with ISRCTN registry under registration ISRCTN12515877.

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

✪ An integrative review of implementation science in climate change and health adaptation research

Abstract:

Introduction

As climate change accelerates, reducing associated health risks requires uptake of effective approaches to adaptation at scale. However, translating climate change and health adaptation (CCHA) interventions into practice remains a persistent challenge for both researchers and practitioners. Implementation science provides tools to study methods and strategies that facilitate the adoption and sustainability of interventions into practice, but its application in the CCHA domain has not yet been examined.

Methods

In response, this integrative literature review identifies how implementation science has been applied to assess determinants, strategies, and outcomes of CCHA interventions, and to evaluate gaps, strengths, and limitations in the existing literature. Nineteen articles were identified through systematic searches of four databases and expert recommendations. Discrete data domains, defined a priori, were extracted and synthesized across articles.

Results

Findings demonstrated wide variability in the use of implementation frameworks, the identification and assessment of implementation strategies and outcomes, and the overall conceptualization of CCHA interventions. Findings highlight a critical opportunity to leverage implementation science as a tool to strengthen the assessment and uptake of CCHA efforts in public health practice.

Conclusion

In the face of the accelerating climate crisis, there is an urgent need for implementation science and climate change and health experts to work together to overcome conceptual and operational challenges to the use of implementation science frameworks and methods to advance the field.

Highlights

The formal use of implementation science in published CCHA research is limited.
Opportunities exist to adapt implementation science frameworks to CCHA research.
Investing in these opportunities can improve uptake of CCHA interventions.

View graphical abstract

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

✪ A cross-consortium, stakeholder-driven model for implementing a modern electronic data capture and submission system across the Alzheimer’s Disease Research Centers Program

Authors:

Sarah Biber, Sarah Gothard, Charles F Murchison, Laura McLeod, Kathryn Gauthreaux, Chandima HewaNadungodage, Emily Cheng, Jessica Welsch, Jessica E. Culhane, Sarah Yasuda, Hannah Stockwell, Shilpa Allimatti, Mark Bauer, Jonathan M. Reader, Walter Kukull, Meredith Zozus & Sudeshna Das

^{University of Washington affiliated authors are displayed in bold.}

✪ Open Access

Published: March 2026

Read the full text in the open access Alzheimer's & Dementia: The Journal of the Alzheimer's Association

Abstract:

INTRODUCTION

The National Alzheimer's Coordinating Center (NACC) and Alzheimer's Disease Research Center (ADRC) Program advances dementia research by collecting and sharing standardized, longitudinal data, including the Uniform Data Set with the global research community. To modernize workflow and accelerate the availability of analyzable data, we co-developed a consortium-wide Electronic Data Capture and Submission system.

METHODS

A cross-disciplinary workgroup of ADRC and NACC members co-developed the system using a stakeholder-centered sociotechnical implementation model. Subgroups focused on requirements, development, and training. Surveys and pilot testing across centers guided design and priorities.

RESULTS

Research Electronic Data Capture was selected as the foundational platform. Deliverables included modular UDS version 4 instruments, embedded logic and automated quality checks, dynamic training resources, and an API-based submission pipeline to NACC. The platform was adopted across all 36 ADRCs and surveys indicated high user satisfaction.

DISCUSSION

Beyond infrastructure, this initiative provides a scalable, stakeholder-driven implementation model that supports higher-quality, more timely multicenter data submission, accelerating biomarker validation, early detection studies, and precision-medicine analyses.

Highlights

A cross-disciplinary workgroup of ADRC and NACC members designed a stakeholder-centric sociotechnical implementation model.
The workgroup drove the adoption of a modernized data infrastructure across a national consortium.
Deployed a modern electronic data capture and submission system for the ADRC program.
Leveraged REDCap as a flexible, scalable tool for a large-scale EDCS system.

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

✪ A framework policy analysis of single-dose HPV vaccination adoption in East Africa: a rapid review

Abstract:

Cervical cancer is a global public health problem. While HPV vaccination effectively prevents cervical cancer, vaccination coverage remains low in low -and middle-income countries (LMICs) where around 94% of cervical cancer-related deaths occur. To improve coverage and accelerate progress toward achieving cervical cancer elimination, the World Health Organization (WHO) recommended that countries switch to a single-dose HPV vaccination schedule in 2022. Despite strong evidence of the health and economic benefits of a single-dose HPV vaccination schedule, its adoption has varied across countries.

We sought to rapidly review existing evidence to assess the “how” of policy reform on HPV vaccination, leveraging a policy analysis of single-dose HPV vaccination adoption in three East African countries. We used the Health Policy Triangle Framework (HPF) to compile key considerations that led to the adoption of single-dose HPV vaccination in Ethiopia, Uganda, and Tanzania. Relevant articles from peer-reviewed journals and grey literature published up to December 2024 were selected using pre-set inclusion and exclusion criteria. Data were extracted and summarized using a rapid qualitative analysis approach guided by the HPF. Twenty-four articles from academic and grey literature were examined.

Beyond context-specific aspects, a few common themes emerged across the three countries. Political will focused on addressing cervical cancer as a public health problem, and it was crucial to prioritize the revision of the HPV vaccination policy. The policy revision on the HPV vaccination schedule was undertaken, building on existing evidence and the WHO endorsement. Additionally, the availability of key evidence on the magnitude of this public health problem (eg: burden of the disease), the potential benefit of a single-dose schedule (efficacy, and the economic impact) played an important role in the policy revision process. At the national level, National Immunization Technical Advisory Groups (NITAGs) that provided evidence-based guidance to policy-makers were central to the single-dose decision-making process. Our findings highlighted key considerations for the policy revision process in three East African countries, which could inform strategic policy decisions in these countries and comparable settings.

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

✪ Reciprocal innovation in implementation science and global health: reflections from the EXTRA-CVD (extending the HIV treatment cascade for cardiovascular disease prevention) study

Abstract:

Reciprocal innovation, a model of sustained, multidirectional exchange in which health strategies are adapted, revisited, and refined across contexts, offers a compelling framework to rethink how implementation science can support global health equity by enabling dynamic, multidirectional learning across different contexts. Drawing on the EXTRA-CVD trial, a nurse-led cardiovascular disease prevention intervention designed to extend the HIV treatment cascade in United States (U.S.) HIV clinics, which adapted strategies informed by implementation research in Kenya and the U.S. Veterans Affairs health system, this perspective examines how reciprocal innovation can begin to emerge within existing research structures, as well as where opportunities for deeper exchange remain limited. We identify four operational domains of reciprocal innovation: care delivery strategies, end-user engagement, research methodologies, and research leadership and partnership. Across these domains, we describe how cross-context learning shaped intervention adaptation and site-level implementation in EXTRA-CVD, as well as missed opportunities where more intentional feedback, shared leadership, and methodological exchange could have strengthened multidirectional learning. Taken together, this work highlights both the potential and the practical challenges of reciprocal innovation in implementation research, emphasizing its role in moving beyond unidirectional knowledge transfer toward iterative, context-responsive learning. By embedding structures for iterative feedback, equity-centered governance, and multidirectional learning systems within research and implementation systems, future global partnerships can foster more inclusive, responsive, and sustainable health interventions.

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

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✪ Open Access

Read the full text in the open access journal BMC Primary Care

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Background

Methods

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✪ Open Access

Read the full text in the open access journal BMC Global Public Health

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Background

Methods

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Systematic review registration

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✪ Open Access

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

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Background

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✪ Open Access

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

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✪ Open Access

Read the full text in the open access journal AIDS and Behavior

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✪ Open Access

Read the full text in the open access journal Implementation Science

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Background

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Trial registration

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✪ Open Access

Read the full text in the open access Journal of Climate Change and Health

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Introduction

Methods

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Conclusion

Highlights

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✪ Open Access

Read the full text in the open access Alzheimer's & Dementia: The Journal of the Alzheimer's Association

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INTRODUCTION

METHODS

RESULTS

DISCUSSION

Highlights

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✪ Open Access

Read the full text in the open access journal BMC Health Services Research

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✪ Open Access

Read the full text in the open access journal BMC Global Public Health

Abstract: