Review Archives - Implementation Science at UW

✪ 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.

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✪ 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.

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✪ 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.

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✪ 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.

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A quality appraisal of cultural adaptation of caregiver-implemented interventions for young autistic children

✪ Up-front alternative donor HCT in severe aplastic anemia: gaps and opportunities to translate evidence into practice

Abstract:

Severe aplastic anemia (SAA) is a rare and life-threatening bone marrow failure disorder. Immunosuppressive therapy (IST) with antithymocyte globulin and cyclosporine has long been a frontline treatment option in SAA; however, its limited durability and risk of long-term complications such as secondary malignancies remain a drawback in this treatment modality. Allogeneic hematopoietic cell transplantation (HCT) is a potentially curative option with significantly improved outcomes over the long term, particularly with HLA-matched related donors. However, the use of alternative donors, such as haploidentical, mismatched, or matched unrelated donors, has previously been limited due to increased transplant-related morbidity, particularly graft-versus-host disease (GVHD). HCTs have therefore been limited to young recipients and those with HLA-matched related donors, creating significant disparity for older adults and those who lack matched donor options. Nevertheless, more recent advances in HCT, such as posttransplant cyclophosphamide for GVHD prophylaxis, have led to improved outcomes of HCT with alternative donors; however, alternative donor HCT remains underused as up-front therapy, in part because of limited multicenter trial data. This review discusses current SAA treatment approaches, including both IST and HCT, and highlights remaining gaps. It also discusses how ongoing clinical trials such as CureAA and TransIT could help address these gaps. Furthermore, we discuss the importance of stakeholder engagement and implementation science in the integration of research-based evidence into clinical practice. Bridging these gaps is necessary for achieving equitable access for patients historically excluded from frontline HCT, including older adults and racially or ethnically diverse populations.

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✪ Evaluating behavioral intervention technologies: Integrating human-centered design and implementation science outcomes

Abstract:

Background

Behavioral intervention technologies (BITs) offer scalable, cost-effective healthcare solutions but often show reduced impacts in community settings and are rarely sustained. Human-centered design (HCD) enhances usability by tailoring BITs to stakeholder needs, while implementation science (IS) identifies contextual barriers and strategies to promote uptake and sustainability. Both HCD and IS aim to improve BIT usability and implementation through iterative, user-focused processes but are rarely integrated.

Objective

We introduced the user-centered and sustainable implementation science (USIS) model, a novel and systematic framework that combines HCD and IS principles to enhance BIT effectiveness and sustainability. We aimed to (1) synthesize the HCD and IS outcomes and integrate them into a USIS framework; (2) apply USIS to a case study: the sleep shared-management intervention for children with juvenile idiopathic arthritis and their parents (SLEEPSMART).

Methods

We conducted a narrative literature review on HCD and IS outcomes for BITs from the PubMed, CINAHL, and Web of Science databases. Articles were selected based on their focus on usability, implementation outcomes, and evidence-based healthcare practices. This synthesis informed the development of the USIS model.

Results

The USIS model incorporates five domains: (1) user-centeredness (empathy, engagement, and equity), (2) efficiency (cost, timeliness, and rapidity), (3) feasibility (learnability, memorability, error reduction, and low cognitive load), (4) satisfaction (acceptability and appropriateness), and (5) fidelity (adoption, penetration, and sustainability). We applied the USIS model to evaluate the SLEEPSMART project to demonstrate the application of the USIS model in guiding BIT design and refinement. Insights from the review informed the design principles applied during the development and testing stages of SLEEPSMART.

Conclusion

The USIS model serves as a practical and theoretical guide to improve BIT design and evaluation. By emphasizing implementation considerations early and centering user needs, USIS provides a pathway to bridge HCD and IS approaches to enhance the real-world impact and sustainability of digital health innovations.

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✪ Can audit and feedback improve health service readiness and delivery outcomes in a low-resource setting? Effectiveness results of the IDEAs strategy from central Mozambique

Abstract:

Limited evidence exists on audit and feedback (A&F) in low-resource contexts. We tested the Integrated District Evidence-to-Action (IDEAs), a multicomponent A&F strategy in Mozambique’s maternal and child health (MCH) services. IDEAs include A&F meetings, readiness assessments, and facility support. We report the effectiveness results. IDEAs were implemented in 2016–2020 across two provinces, 12 districts, and 154 primary health facilities in Mozambique. We assessed 1) ten service delivery outcomes across antenatal, maternity, postpartum, childcare, and reproductive health services and 2) five service readiness outcomes (medicines, infrastructure, equipment, care, and staffing availability). We used propensity score matching to minimize bias and a controlled interrupted time series with a negative binomial mixed effects model for service delivery analysis, presenting incidence rate ratios (IRR) with 95% confidence intervals (95% CI). For service readiness outcomes, we created composite scores for each domain and a difference-in-difference analysis using an ordinal mixed effects model, reporting odds ratios (OR) and 95% CI. Significant associations were found with first at-risk child appointments (IRR = 1.06 [1.04, 1.07]), first polymerase chain reaction tests for HIV-exposed children (IRR = 1.02 [1.01, 1.03]), new contraceptive users (IRR = 0.95 [0.94, 0.96]), women starting long-lasting contraceptives (IRR = 0.94 [0.93, 0.95]), availability of infrastructure (OR = 5.84 [1.32, 25.88]) and essential care (OR = 0.13 [0.03, 0.54]). No significant associations were found between IDEAs and six of 10 service delivery outcomes (women with a fourth dose of preventive malaria treatment; women protected with tetanus vaccine; women with four+ antenatal visits; deliveries with active management of the third stage of labor; first postpartum consultations and fully vaccinated children) and on medicine, equipment, and staffing availability. We observed mixed effectiveness in implementing IDEAs, with null and sub-optimal effects suggesting the need to refine and adapt strategy components to more effectively address clinical and readiness outcomes.

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✪ Partnering with Policymakers to Design Suicide Care Research: Maximizing Impact in Adolescent Mental Health Policy

Abstract:

Outpatient medical settings are a critical source of mental health care for adolescents and young adults. This is due to the familiarity and accessibility of those settings and challenges accessing mental health care elsewhere. Adolescents and young adults who die by suicide are more likely to have seen a medical provider in the prior month than a mental health specialist, but few suicide care interventions have been developed to specifically address the challenges of working in these outpatient medical settings. This paper provides the perspective of the University of Washington Suicide Care Research Center on the importance of incorporating evidence into public policy decisions regarding workforce development and standards of care for adolescents and young adults experiencing suicidal thoughts and behaviors, their families, and their outpatient medical setting providers; and the equal importance of integrating policy and funding perspectives in clinical services and implementation science. The paper will review the trends in suicide care policy and funding structures as relevant to adolescents and young adults in outpatient medical settings, provide recommendations to advance the translation of research into evidence-based policy decisions for adolescents and young adults at risk of suicide, and recommendations for researchers on incorporating policy perspectives in the development and evaluation of evidence-based interventions. We will share how the University of Washington Suicide Care Research Center is operationalizing these recommendations.

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✪ A mapping review and critique of the literature on translation, dissemination, and implementation capacity building initiatives for different audiences

Abstract:

Background

Capacity building is critical for research and practice as the fields of dissemination, implementation and translation science continue to grow. Some scholars state that capacity building should be grounded in competencies. However, the fields are unclear in determining which competencies are relevant for whom, including the content and appropriate level of information and skills for different roles. The goal of this study was to catalogue competencies across current D&I capacity building initiatives.

Methods

We conducted a mapping review to examine to what extent are theories or frameworks used to guide capacity building, who is being trained, to what extent do capacity building initiatives include a health equity focus, which competencies are being outlined or suggested, how are they being defined, and whether the competencies can be organized along different roles of participants. As a mapping review, we broadly searched for papers using the keywords “training D&I” OR “training implementation” OR “training translation” OR “training dissemination” and included debate and empirical papers about capacity building initiatives in the sample.

Results

A total of 42 articles (from 2011 to 2024) were reviewed, including training development and/or evaluation (n = 25) and conceptual (n = 17) articles. Of the training articles, 13 (52%) specified a framework that guided training. Participants in training included graduate students, researchers, practitioners, and mixed audiences. Fourteen (56%) of the trainings were conducted in the USA, seven (28%) in Canada and other countries. The length of training ranged from two days to two years. Four trainings had an explicit focus on equity. A total of 307 unique competencies were identified and divided into themes: Knowledge, Skills, Engagement with Other Disciplines, Equity, Attitude and Relational Aspects, Capacity Building, Quality Improvement, and Mentorship.

Conclusions

While there are many D&I capacity building initiatives, we found little consistency in competencies that guided training activities for diverse audiences. Few training activities explicitly identified guiding theories or frameworks or tailored competencies toward different levels of interest in D&I research. Even fewer had an explicit focus on health equity. As the fields continue to foster capacity building programs, it will be important to think critically about the types of competencies we are developing for whom, how, and why.

Contributions to the literature

This study provides a critical step in the dissemination, implementation and translation capacity building literatures by cataloging competencies related to these sciences, and by offering suggestions for capacity building initiatives.

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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

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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 Journal of Cancer Survivorship: Research and Practice

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✪ Open Access

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

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Read the full text in the subscription access journal Transcultural Psychiatry

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✪ Open Access

Read the full text in the open access journal Blood Advances

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✪ Open Access

Read the full text in the open access journal Digital Health

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✪ Open Access

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

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Read the full text in the open access journal Evidence-Based Practice in Child and Adolescent Mental Health

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✪ Open Access

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

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