Open Access Archives - Page 2 of 35 - Implementation Science at UW

✪ Identifying Community-Sourced Implementation Strategies for Delivering a Task-Shared Mental Health Intervention for Fathers in Kenya

Abstract:

Background

To design accessible interventions, understanding how best to implement them in context is essential. Strategies that reflect community perspectives may be most relevant and impactful. This study aimed to identify and specify community-sourced implementation strategies for delivering a mental health and alcohol use intervention for fathers in Kenya and to map them to the Expert Recommendations for Implementing Change (ERIC) taxonomy.

Method

In Eldoret, Kenya, focus groups (seven groups; 31 participants) and key informant interviews (n = 18) were conducted with hospital leaders, policymakers, mental health providers, community leaders, fathers, lay providers, patients, and men currently experiencing mental health and alcohol use challenges. Data were analyzed using the framework method to generate high-level codes, followed by a second phase to extract, specify, and review implementation strategies.

Results

Community members identified lay providers recruited from the community as a promising delivery approach, with professional providers contributing to linkage to care and support for more acute needs. Engagement of community leaders and leveraging existing infrastructure were seen as key to enhancing implementation and reach, particularly among men. Multiple delivery settings (e.g., church, hospital, school) were considered acceptable depending on patient preference. A total of 25 unique community-sourced strategies were identified: three directly matched ERIC strategies, 19 were adapted, and two were unique to the community context.

Conclusions

This study identified locally grounded implementation strategies to guide early-stage intervention delivery for fathers in Kenya. Findings contribute to the growing body of implementation science in non-Western contexts and highlight a participatory approach for identifying and specifying strategies relevant to local systems and populations.

Plain Language Summary

This study explored how to deliver mental health and alcohol use treatment to Kenyan fathers based on community and father input. Key strategies included using local helpers, familiar spaces, and engaging leaders. Findings emphasize co-design and context-based delivery to make interventions more accessible, relevant, and ready for testing.

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

✪ Cost of an Audit and Feedback intervention to increase uptake of maternal and child health services in Mozambique’s Primary health care

Abstract:

Introduction

Despite high coverage of facility-based maternal and child health (MCH) services in Mozambique, preventable maternal and neonatal deaths remain among the highest globally. To address this, the Integrated District Evidence-to-Action (IDEAs) program was implemented from 2016 to 2020 in central Mozambique as a facility-level Audit and Feedback (A&F) strategy. IDEAs adapted traditional A&F into three components: 1) biannual facility readiness assessments, 2) A&F meetings to develop action plans, and 3) supportive supervision with funding for implementation. This study estimates total and component-specific implementation costs of IDEAs and compares them to average district health budgets.

Methods

Costs were estimated from a payer perspective following CHEERS guidelines, using both Gross and Microcosting methods. Costs were annualized over five years (2016–2020) with a 3% discount rate and are reported in 2020 USD. Staff time estimates were based on program staff consultations and national salary data. Outcomes include average cost per district and total annual cost by intervention component. We conducted a deterministic sensitivity analysis to identify cost drivers with the most significant impact on the overall cost.

Results

The IDEAs programs total (2016–2020) incurred total costs were $2,224,341 (2020 USD), with $1,702,648 (76.5%) for recurrent expenses and $495,323 (22.3%) for Capital expenses. Average annual district-level costs were $41,967, including A&F meetings ($10,893; 26.0%), Capital expenditures ($8255; 19.7%), targeted support ($9323; 22.2%) which includes $5700 (13.6%) for district-level cash transfers and $3623 (8.6%) for facility supervision, and readiness assessments ($6351; 15.1%).Per diems accounted for 52.0% of A&F meeting costs. IDEAs represented approximately 6.6% of the average district health budget. Implementation involved 33 participants with 2560 h yearly per district. Capital expenses were highly sensitive to when applying a standard 25% increase or decrease compared to other cost categories.

Conclusion

Our findings offer practical guidance for district-level planners to adapt and scale IDEAs. Policymakers and donors should integrate recurring costs into budgets and explore cost-saving strategies like virtual tools or streamlined meetings to improve sustainability. Future research must assess long-term integration into government programs and test alternative approaches across diverse low-resource settings to guide scaling.

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

✪ Towards a decolonising implementation science: principles from Indigenous leadership

Abstract:

Summary

Implementation science is a diverse and evolving field that draws on multiple epistemologies and methods. However, the dominant foundations of implementation science remain settler colonial, biomedical, and positivist. In Indigenous and other marginalised settings, these foundations can result in poor epistemological, ethical, and practical fit. We argue that a paradigm shift that is grounded in Indigenous values, sovereignty, relationality, and epistemologies is needed. We propose seven guiding principles for a decolonising implementation science. Drawing from emerging scholarship and innovative Indigenous-led frameworks from the USA, Aotearoa New Zealand, and Australia, these principles centre sovereignty, strengths-based approaches, and relational accountability. These principles also offer a roadmap to redefine rigour, expand what counts as evidence, and ensure genuine community control over the research process. Although born from Indigenous experience, these principles provide a framework for transforming implementation science to be more just, equitable, and effective for marginalised communities globally.

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

✪ Advancing global pediatric cancer survivorship care: barriers, facilitators, and implementation strategies

Abstract:

Background

As more children with cancer experience improved treatment outcomes across the world, challenges arise with ongoing care needs due to a higher risk of mortality and chronic health conditions compared to the general population. Addressing global pediatric cancer survivorship care, especially in low- and middle-income countries (LMICs), is of growing importance. The current study used the Consolidated Framework for Implementation Research (CFIR) and the Expert Recommendations for Implementing Change (ERIC) to examine the barriers, facilitators, and strategies for implementing childhood cancer survivorship care in LMICs.

Methods

Using a larger review (PROSPERO registration CRD42021242548), a total of 8,456 articles were considered. The search identified nine eligible articles mentioning determinants of survivorship care across LMICs. Data were extracted from these articles using the CFIR domains of outer setting, inner setting, and individuals. Assigned CFIR constructs were then paired with ERIC strategies using the CFIR–ERIC matching tool.

Results

The nine studies were published between 2003 and 2020, representing the following countries: India, Brazil, Turkey, China, and Thailand. Inner setting barriers included lack of available resources—funding, space, materials, and guidelines. Outer setting barriers were related to financing, policies, and laws. Individual patient barriers reported were low health literacy, distance to care centers, and low prioritization of follow-up. No common facilitators were noted. The most feasible ERIC strategies for the barriers identified were accessing new funding, developing and distributing educational materials, developing resource-sharing agreements, and conducting local survivorship care needs assessments.

Conclusions

There are limited existing data evaluating childhood cancer survivorship care barriers in LMICs. Of the studies we identified, low resource availability was a frequently reported barrier. As accessing funding can be difficult, resource sharing of contextually adapted guidelines and educational materials can serve as an implementation strategy to improve survivorship care globally.

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

✪ Getting to Implementation: applying data-driven implementation strategies to improve guideline concordant surveillance for hepatocellular carcinoma

Authors:

Vera Yakovchenko, Chaeryon Kang, Brittney Neely, Carolyn Lamorte, Heather McCurdy, Dawn Scott, Anna Nobbe, Gwen Robins, Nsikak R. Ekanem, Monica Merante, Sandra Gibson, Patrick Spoutz, Linda Chia, Rachel I. Gonzalez, Matthew J. Chinman, David Ross, Maggie Chartier, Lauren A. Beste, Jasmohan S. Bajaj, Tamar Taddei, Timothy R. Morgan & Shari S. Rogal

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

✪ Open Access

Published: December 2025

Read the full text in the open access journal Implementation Science

Abstract:

Background

While guidelines recommend twice-yearly liver cancer (hepatocellular carcinoma, HCC) surveillance for people with cirrhosis, adherence to these guidelines remains variable. We aimed to empirically identify and apply successful implementation strategies through Getting to Implementation (GTI), a manualized facilitation approach.

Method

A hybrid type III, stepped-wedge, cluster-randomized trial was conducted at 12 underperforming Veterans Health Administration (VA) sites between October 2020 and October 2022. GTI included a stepwise approach to guide sites to detail their current state, set implementation goals, identify implementation barriers, select implementation strategies, make a work plan, conduct an evaluation, and sustain their work. Outcomes were defined using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.

Results

Facilitators supported site teams with an average of 20±6 facilitation hours over a 12-month period. Ten of 12 sites (83%) adopted GTI and applied a median of five strategies (e.g., dashboard use, small tests of change, direct patient outreach). Reach, the primary outcome, increased from mean 29.1% to mean 38.8% at-risk Veterans receiving HCC surveillance from pre- to post-intervention, and further increasing to 41.3% in the sustainment period. In both unadjusted and adjusted models, the odds of HCC surveillance were significantly higher during intervention (adjusted odds ratio, aOR=1.67, 95% CI:1.59, 1.75) and during sustainment (aOR=1.69, 95% CI:1.60, 1.78) compared with baseline, and with difference between active and sustainment periods, indicating sustained improvement after active facilitation ended.

Conclusions

GTI sustainably improved HCC surveillance, suggesting that applying data-driven implementation strategies within a manualized facilitation approach can improve care.

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

✪ Feasibility and Implementation of INTERVAL-GAP4: A Global Randomised Controlled Trial of Intense Hybrid-supervised/Self-managed Versus Self-directed Exercise for Metastatic Prostate Cancer

Authors:

Stacey A Kenfield, Nicolas H Hart, Kerry S Courneya, Rosemary Greenwood , June M Chan, Jennette Sison, Li Zhang, Sarah RudmaN, Leah Ung, Moritz Schumann, Erin L Van Blarigan, Sam McKeown, Charles J Ryan, James Catto, Daniel A Galvão, Robert U Newton, Fred Saad; INTERVAL-GAP4 Site Investigators and INTERVAL-GAP4 Steering and Management Committees (Stephen R. Plymate, Committee Member

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

✪ Open Access

Published: December 2025

Read the full text in the open access journal European Urology Open Science

Abstract:

Background and objective

Physical activity is associated with a lower risk of mortality in men with prostate cancer (PC); yet, randomised controlled trials with survival endpoints are nonexistent. INTense ExeRcise for surviVAL-Global Action Plan 4 (INTERVAL-GAP4) was a global phase 3 trial designed to test whether structured, hybrid-supervised/self-managed exercise improves survival in men with metastatic PC. The trial was stopped early due to poor accrual. This paper reports feasibility and implementation outcomes.

Methods

Men with metastatic PC were randomised (1:1) to a supervised/self-managed moderate- to high-intensity resistance and aerobic programme (three sessions per week for 2 yr) or to self-directed exercise. We evaluated site activation, recruitment, year 1 adherence, adverse events, and barriers to global trial feasibility. Efficacy outcomes—including survival, physical fitness, and biomarker results—will be reported separately.

Key findings and limitations

Of 21 activated sites across seven countries, 13 (62%) randomised patients. Of 938 patients approached, 232 (25%) consented and 145 (15%) were randomised (75 in the intervention and 70 in the control group) between April 2016 and February 2023. The median age was 70 yr (range: 44–89 yr). The study closed early after reaching 17% of the intended target. The median adherence in the intervention arm was 84% (interquartile range: 61–95%), with no difference between metastatic castrate-resistant and hormone-sensitive PC. At 12 mo, 58% of intervention participants met exercise guidelines versus 24% of controls. In year 1, 162 adverse events occurred in the intervention group and 109 in the control group; 19 adverse events were study related, all in the intervention arm. The major feasibility challenges included administrative burden, infrastructure limitations, logistics of supervised exercise delivery, and coronavirus disease 2019 disruptions.

Conclusions and clinical implications

While high adherence to a demanding exercise programme was achieved in selected metastatic PC patients, global recruitment proved difficult. Future large-scale exercise-oncology trials require streamlined protocols, realistic timelines, and greater alignment with site resources. Implementation science research is needed to support integration of exercise into routine advanced cancer care. A forthcoming paper will present the trial’s survival and physical fitness efficacy outcomes.

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

✪ HIV Prevention for People Releasing from Incarceration: A Qualitative Pre-implementation Study

Abstract:

Background

Release from prison or jail is a high-risk time for HIV acquisition, yet prior efforts to expand access to pre-exposure prophylaxis (PrEP) and other HIV prevention services for people releasing from jail or prison have faced substantial implementation barriers.

Objective

Characterize the implementation landscape for HIV prevention for people releasing from prison or jail in Washington State, gathering input from staff at carceral institutions and community-based organizations to inform implementation of evidence-based HIV prevention strategies.

Design

Qualitative study.

Participants

Healthcare and reentry staff in prisons and jails (n = 15) and staff at community-based organizations that may serve people releasing from jail or prison (n = 20), selected through chain referral sampling.

Approach

Semi-structured qualitative interviews were conducted to theoretical saturation, then coded using a mixed inductive-deductive approach, based on the Consolidated Framework for Implementation Research.

Key Results

Carceral institutions had few programs aimed specifically at HIV prevention. Carceral institutions had PrEP available but did not offer it widely, focusing on behavioral health or acute medical needs. Some community-based organizations offered PrEP or other forms of HIV prevention, but many focused on meeting basic needs or building community. Five themes characterized the implementation landscape for HIV prevention: 1) primacy of basic needs means HIV prevention is lower priority, 2) adding HIV prevention programming would require new funding, 3) differences in culture and philosophy influence interest in providing PrEP, 4) disconnection between carceral institutions and providers in the community limits linkage to care, 5) organizations balance protecting confidentiality while coordinating care.

Conclusion

Rather than directly focusing on HIV prevention, carceral institutions and community-based organizations often focused on substance use disorder treatment, and there are opportunities to integrate additional HIV prevention education and interventions into substance use care. Closer relationships between carceral institutions and community organizations may improve care coordination but would require staff capacity.

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

✪ Exploring implementation strategies in evidence-based open streets programs for promoting physical activity in the Americas: a scoping review

Abstract:

Background

Chronic diseases are a leading public health concern in the Americas, and physical inactivity contributes significantly to their burden. Open streets program—community initiatives that temporarily close urban streets to vehicles—promote physical activity and community engagement, demonstrating positive health and social impacts. Effective implementation depends on identifying suitable strategies and frameworks. The Expert Recommendations for Implementing Change (ERIC) taxonomy, developed for clinical/healthcare contexts, has not been widely assessed for community-based interventions such as Open Streets. Implementation strategies could lead to specific outcomes (e.g., adoption, sustainability) that differ from program outcomes (e.g., PA levels, chronic disease prevalence). This scoping review focuses on the strategies that influence implementation outcomes. The primary aims of this review were to (1) identify implementation strategies for Open Streets programs and (2) identify opportunities for Open Streets programs to promote chronic disease prevention and physical activity, specifically in the Americas.

Methods

A scoping review was conducted using Joanna Briggs Institute methodology and PRISMA-ScR guidelines. Six databases (PubMed, Scopus, Scielo, Web of Science, TRIS, and LILACS) were searched for studies on Open Streets programs in the Americas (January 2004–April 2024). Three reviewers independently screened studies in Rayyan. Strategies were extracted and coded according to the 73 ERIC taxonomy strategies. Quality appraisal used MMAT for empirical studies, AMSTAR-2 for reviews, and AACODS for gray literature.

Results

Fifty-nine studies met the inclusion criteria, yielding 63 distinct implementation strategies for Open Streets programs. All 63 strategies were classified within the ERIC taxonomy. Frequently aligned ERIC strategies included building coalitions, capturing local knowledge, conducting needs assessments, and fostering stakeholder engagement. Open Streets strategies emphasized multisectoral collaboration, cultural adaptation, equity, and sustainability.

Discussion

Among the 63 identified Open Streets strategies, many aligned with ERIC, providing a foundation in stakeholder engagement, coalition building, and flexible, context-sensitive implementation. However, several ERIC strategies were not relevant to Open Streets, underscoring that while many ERIC strategies were applicable, not all suited this setting. Open Streets programs may require supplemental approaches to address equity, cultural competence, and multisectoral collaboration. Findings present opportunities to tailor, test, and scale strategies that maximize the population health impact of Open Streets and similar community-based programs.

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

✪ Protocol for the process evaluation of a randomised clinical trial of incremental-start versus conventional haemodialysis: the TwoPlus study

Authors:

Mariana Murea, Kristie L Foley, Samir C Gautam, Jennifer E Flythe , Jochen G Raimann, Emaad Abdel-Rahman, Alaa S Awad, Vandana Dua Niyyar, Cassandra Kovach, Glenda V Roberts, Nicole M Jefferson, Paul T Conway, Laura M Rosales, Jobira Woldemichael, Hiba I Sheikh, Gaurav Raman, Anne M Huml, Daphne H Knicely, Irtiza Hasan, Bhaktidevi Makadia , Janice Lea, John T Daugirdas, Nihan Gencerliler, Jasmin Divers, Peter Kotanko, TwoPlus Research Consortium & Ucheoma C Nwaozuru

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

✪ Open Access

Published: November 2025

Read the full text in the open access journal BMJ Open

Abstract:

Introduction

Process evaluation provides insight into how interventions are delivered across varying contexts and why interventions work in some contexts and not in others. This manuscript outlines the protocol for a process evaluation embedded in a hybrid type 1 effectiveness-implementation randomised clinical trial of incremental-start haemodialysis (HD) versus conventional HD delivered to patients starting chronic dialysis (the TwoPlus Study). The trial will simultaneously assess the effectiveness of incremental-start HD in real-world settings and the implementation strategies needed to successfully integrate this intervention into routine practice. This manuscript describes the rationale and methods used to capture how incremental-start HD is implemented across settings and the factors influencing its implementation success or failure within this trial.

Methods and analysis

We will use the Consolidated Framework for Implementation Research (CFIR) and the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) frameworks to inform process evaluation. Mixed methods include surveys conducted with treating providers (physicians) and dialysis personnel (nurses and dialysis administrators); semi-structured interviews with patient participants, caregivers of patient participants, treating providers (physicians and advanced practice practitioners), dialysis personnel (nurses, dieticians and social workers); and focus group meetings with study investigators and stakeholder partners. Data will be collected on the following implementation determinants: (a) organisational readiness to change, intervention acceptability and appropriateness; (b) inner setting characteristics underlying barriers and facilitators to the adoption of HD intervention at the enrollment centres; (c) external factors that mediate implementation; (d) adoption; (e) reach; (f) fidelity, to assess adherence to serial timed urine collection and HD treatment schedule; and (g) sustainability, to assess barriers and facilitators to maintaining intervention. Qualitative and quantitative data will be analysed iteratively and triangulated following a convergent parallel and pragmatic approach. Mixed methods analysis will use qualitative data to lend insight to quantitative findings. Process evaluation is important to understand factors influencing trial outcomes and identify potential contextual barriers and facilitators for the potential implementation of incremental-start HD into usual workflows in varied outpatient dialysis clinics and clinical practices. The process evaluation will help interpret and contextualise the trial clinical outcomes’ findings.

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

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

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**}

Authors:

✪ Open Access

Read the full text in the open access journal Implementation Research and Practice

Abstract:

Background

Method

Results

Conclusions

Plain Language Summary

Authors:

✪ Open Access

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

Abstract:

Introduction

Methods

Results

Conclusion

Authors:

✪ Open Access

Read the full text in the open access journal Lancet Global Health

Abstract:

Summary

Authors:

✪ Open Access

Read the full text in the open access journal Journal of Cancer Survivorship: Research and Practice

Abstract:

Background

Methods

Results

Conclusions

Authors:

✪ Open Access

Read the full text in the open access journal Implementation Science

Abstract:

Background

Method

Results

Conclusions

Authors:

✪ Open Access

Read the full text in the open access journal European Urology Open Science

Abstract:

Background and objective

Methods

Key findings and limitations

Conclusions and clinical implications

Authors:

✪ Open Access

Read the full text in the open access journal Journal of General Internal Medicine

Abstract:

Background

Objective

Design

Participants

Approach

Key Results

Conclusion

Authors:

✪ Open Access

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

Abstract:

Background

Methods

Results

Discussion

Authors:

✪ Open Access

Read the full text in the open access journal BMJ Open

Abstract:

Introduction

Methods and analysis

Authors:

✪ Open Access

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

Abstract:

Background

Methods

Discussion