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Implementation Science at UW

Keywords: Perspective

✪ Implementation Science to Respond to the COVID-19 Pandemic

Authors:

Arianna Rubin Means, Anjuli D. Wagner, Eli Kern, Laura P. Newman, and Bryan J. Weiner

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: September 2020

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

Abstract:

The COVID-19 pandemic continues to expand globally, requiring massive public health responses from national and local governments. These bodies have taken heterogeneous approaches to their responses, including when and how to introduce and enforce evidence-based interventions—such as social distancing, hand-washing, personal protective equipment (PPE), and testing. In this commentary, we reflect on opportunities for implementation science to contribute meaningfully to the COVID-19 pandemic response. We reflect backwards on missed opportunities in emergency preparedness planning, using the example of PPE stockpiling and supply management; this planning could have been strengthened through process mapping with consensus-building, microplanning with simulation, and stakeholder engagement.

We propose current opportunities for action, focusing on enhancing the adoption, fidelity, and sustainment of hand washing and social distancing; we can combine qualitative data, policy analysis, and dissemination science to inform agile and rapid adjustment to social marketing strategies to enhance their penetration. We look to future opportunities to enhance the integration of new evidence in decision-making, focusing on serologic and virologic testing systems; we can leverage simulation and other systems engineering modeling to identify ideal system structures. Finally, we discuss the ways in which the COVID-19 pandemic challenges implementation science to become more rapid, rigorous, and nimble in its approach, and integrate with public health practice. In summary, we articulate the ways in which implementation science can inform, and be informed by, the COVID-19 pandemic, looking backwards, proposing actions for the moment, and approaches for the future.

Contributions to the Literature
  • The COVID-19 pandemic response has illuminated gaps in emergency preparedness planning that could be addressed by implementation scientists working in coordination with public health practitioners.
  • Classical implementation science tools and measures can be operationalized within the context of the COVID-19 pandemic, and at each stage of the pandemic. Doing so empowers implementation scientists to apply their skillsets toward optimizing uptake of evidence-based interventions such as such as social distancing, hand washing, and personal protective equipment.
  • To be more responsive to public health emergencies, implementation science as a discipline must evolve to be more rapid, nimble, and policy-oriented in its approaches.

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

✪ Research translation for military and veteran health: research, practice, policy

Authors:

Jeffrey P. Haibach, Katherine D. Hoerster, Lindsey Dorflinger, Lisa M. McAndrew, Daniel G. Cassidy, David E. Goodrich, Jill E. Bormann, Julie Lowery, Steven M. Asch, Susan D. Raffa, Tannaz Moin, Alan L. Peterson, Michael G. Goldstein, Tracy Neal-Walden, Gerald W. Talcott, Christopher L. Hunter, & Sara J. Knight

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: February 2020

Read the full text in the journal Translational Behavioral Medicine

✪ Expanding Hybrid Studies for Implementation Research: Intervention, Implementation Strategy, and Context

Authors:

Christopher G. Kemp, Bradley H. Wagenaar, and Emily E. Haroz

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: November 2019

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

Abstract:

Successful implementation reflects the interplay between intervention, implementation strategy, and context. Hybrid effectiveness-implementation studies allow investigators to assess the effects of both intervention and implementation strategy, though the role of context as a third independent variable (IV) is incompletely specified. Our objective is to expand the hybrid typology to include mixtures of all three types of IVs: intervention, implementation strategy, and context.

We propose to use I to represent the IV of intervention, IS to represent implementation strategy, and C to represent context. Primary IVs are written first and in upper case. Secondary IVs are written after a forward slash and in lower case; co-primary IVs are written after a dash and in upper case. The expanded framework specifies nine two-variable hybrid types: I/is, I-IS, IS/i, IS/c, IS-C, C/is, C/i, I-C, and I/c. We describe four in detail: I/is, IS/c, IS-C, and C/is. We also specify seven three-variable hybrid types. We argue that many studies already meet our definitions of two- or three-variable hybrids.

Our proposal builds from the typology proposed by Curran et al. (1), but offers a more complete specification of hybrid study types. We need studies that measure the implementation-related effects of variations in contextual determinants, both to advance the science and to optimize intervention delivery in the real world. Prototypical implementation studies that evaluate the effectiveness of an implementation strategy, in isolation from its context, risk perpetuating the gap between evidence and practice, as they will not generate context-specific knowledge around implementation, scale-up, and de-implementation.

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

✪ From Classification to Causality: Advancing Understanding of Mechanisms of Change in Implementation Science

Authors:

Cara C. Lewis, Predrag Klasnja, Byron J. Powell, Aaron R. Lyon, Leah Tuzzio, Salene Jones, Callie Walsh-Bailey and Bryan J. Weiner

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: May 2018

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

Abstract:

Background

The science of implementation has offered little toward understanding how different implementation strategies work. To improve outcomes of implementation efforts, the field needs precise, testable theories that describe the causal pathways through which implementation strategies function. In this perspective piece, we describe a four-step approach to developing causal pathway models for implementation strategies.

Building causal models

First, it is important to ensure that implementation strategies are appropriately specified. Some strategies in published compilations are well defined but may not be specified in terms of its core component that can have a reliable and measureable impact. Second, linkages between strategies and mechanisms need to be generated. Existing compilations do not offer mechanisms by which strategies act, or the processes or events through which an implementation strategy operates to affect desired implementation outcomes. Third, it is critical to identify proximal and distal outcomes the strategy is theorized to impact, with the former being direct, measurable products of the strategy and the latter being one of eight implementation outcomes (1). Finally, articulating effect modifiers, like preconditions and moderators, allow for an understanding of where, when, and why strategies have an effect on outcomes of interest.

Future directions

We argue for greater precision in use of terms for factors implicated in implementation processes; development of guidelines for selecting research design and study plans that account for practical constructs and allow for the study of mechanisms; psychometrically strong and pragmatic measures of mechanisms; and more robust curation of evidence for knowledge transfer and use.

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