Cyrus Mugo, Irene Njuguna, Margaret Nduati, Vincent Omondi, Verlinda Otieno, Florence Nyapara, Elizabeth Mabele, Hellen Moraa, Kenneth Sherr, Irene Inwani, Elizabeth Maleche-Obimbo, Dalton Wamalwa, Grace John-Stewart, Jennifer Slyker, Anjuli D Wagner
University of Washington affiliated authors are displayed in bold.
Published: September 2020
Anne F. Rositch, Karla Unger‐Saldaña, Rebecca J. DeBoer, Anne Ng’ang’a, & Bryan J. Weiner
University of Washington affiliated authors are displayed in bold.
Published: April 2020
Global disparities in breast cancer outcomes are attributable to a sizable gap between evidence and practice in breast cancer control and management. Dissemination and implementation science (D&IS) seeks to understand how to promote the systematic uptake of evidence‐based interventions and/or practices into real‐world contexts. D&IS methods are useful for selecting strategies to implement evidence‐based interventions, adapting their implementation to new settings, and evaluating the implementation process as well as its outcomes to determine success and failure, and adjust accordingly.
Process models, explanatory theories, and evaluation frameworks are used in D&IS to develop implementation strategies, identify implementation outcomes, and design studies to evaluate these outcomes. In breast cancer control and management, research has been translated into evidence‐based, resource‐stratified guidelines by the Breast Health Global Initiative and others. D&IS should be leveraged to optimize the implementation of these guidelines, and other evidence‐based interventions, into practice across the breast cancer care continuum, from optimizing public education to promoting early detection, increasing guideline‐concordant clinical practice among providers, and analyzing and addressing barriers and facilitators in health care systems. Stakeholder engagement through processes such as co‐creation is critical.
In this article, the authors have provided a primer on the contribution of D&IS to phased implementation of global breast cancer control programs, provided 2 case examples of ongoing D&IS research projects in Tanzania, and concluded with recommendations for best practices for researchers undertaking this work.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Alex R. Dopp, Kathryn E. Parisi, Sean A. Munson, & Aaron R. Lyon
University of Washington affiliated authors are displayed in bold.
Published: February 2020
Innovative approaches are needed to maximize fit between the characteristics of evidence-based practices (EBPs), implementation strategies that support EBP use, and contexts in which EBPs are implemented. Standard approaches to implementation offer few ways to address such issues of fit. We characterized the potential for collaboration with experts from a relevant complementary approach, user-centered design (UCD), to increase successful implementation.
Using purposive and snowball sampling, we recruited 56 experts in implementation (n = 34) or UCD (n = 22). Participants had 5+ years of professional experience (M = 10.31), worked across many settings (e.g., healthcare, education, human services), and were mostly female (59%) and white (73%). Each participant completed a web-based concept mapping structured conceptualization task. They sorted strategies from established compilations for implementation (36 strategies) and UCD (30 strategies) into distinct clusters, then rated the importance and feasibility of each strategy.
We used multidimensional scaling techniques to examine patterns in the sorting of strategies. Based on conceptual clarity and fit with established implementation frameworks, we selected a final set of 10 clusters (i.e., groups of strategies), with five implementation-only clusters, two UCD-only clusters, and three trans-discipline clusters. The highest-priority activities (i.e., above-average importance and feasibility) were the trans-discipline clusters plus facilitate change and monitor change. Implementation and UCD experts sorted strategies into similar clusters, but each gave higher importance and feasibility ratings to strategies/clusters from their own discipline.
In this concept mapping study, experts in implementation and UCD had perspectives that both converged (e.g., trans-discipline clusters, which were all rated as high-priority) and diverged (e.g., in importance/feasibility ratings). The results provide a shared understanding of the alignment between implementation science and UCD, which can increase the impact and sustainability of EBP implementation efforts. Implications for improved collaboration among implementation and UCD experts are discussed.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Laura-Mae Baldwin, Jennifer L. Schneider, Malaika Schwartz, Jennifer S. Rivelli, Beverly B. Green, Amanda F. Petrik & Gloria D. Coronado
University of Washington affiliated authors are displayed in bold.
Published: February 2020
Colorectal cancer screening rates remain low, especially among certain racial and ethnic groups and the uninsured and Medicaid insured. Clinics and health care systems have adopted population-based mailed fecal immunochemical testing (FIT) programs to increase screening, and now health insurance plans are beginning to implement mailed FIT programs. We report on challenges to and successes of mailed FIT programs during their first year of implementation in two health plans serving Medicaid and dual eligible Medicaid/Medicare enrollees.
This qualitative descriptive study gathered data through in-depth interviews with staff and leaders at each health plan (n = 10). The Consolidated Framework for Implementation Research, field notes from program planning meetings between the research team and the health plans, and internal research team debriefs informed interview guide development. Qualitative research staff used Atlas.ti to code the health plan interviews and develop summary themes through an iterative content analysis approach.
We identified first-year implementation challenges in five thematic areas: 1) program design, 2) vendor experience, 3) engagement/communication, 4) reaction/satisfaction of stakeholders, and 5) processing/returning of mailed kits. Commonly experienced challenges by both health plans related to the time-consuming nature of the programs to set up, and complexities and delays in working with vendors. We found implementation successes in the same five thematic areas as well as four additional areas of: 1) leadership support, 2) compatibility with the health plan, 3) broader impacts, and 4) collaboration with researchers. Commonly experienced successes included the ability to adapt the mailed FIT program to the individual health plan culture and needs, and the synchronicity between the programs and their organizational missions and goals.
Both health plans successfully adapted mailed FIT programs to their own culture and resources and used their strong quality management resources to maximize success in overcoming the time demands of setting up the program and working with their vendors. Mailed FIT programs administered by health plans, especially those serving Medicaid- and dual eligible Medicaid/Medicare-insured populations, may be an important resource to support closing gaps in colorectal cancer screening among traditionally underserved populations.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
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.
Published: February 2020
Cameo F. Stanick, Heather M. Halko, Caitlin N. Dorsey, Bryan J. Weiner, Byron J. Powell, Lawrence A. Palinkas & Cara C. Lewis
University of Washington affiliated authors are displayed in bold.
Published: November 2018
Implementation science measures are rarely used by stakeholders to inform and enhance clinical program change. Little is known about what makes implementation measures pragmatic (i.e., practical) for use in community settings; thus, the present study’s objective was to generate a clinical stakeholder-driven operationalization of a pragmatic measures construct.
The pragmatic measures construct was defined using: 1) a systematic literature review to identify dimensions of the construct using PsycINFO and PubMed databases, and 2) interviews with an international stakeholder panel (N = 7) who were asked about their perspectives of pragmatic measures.
Combined results from the systematic literature review and stakeholder interviews revealed a final list of 47 short statements (e.g., feasible, low cost, brief) describing pragmatic measures, which will allow for the development of a rigorous, stakeholder-driven conceptualization of the pragmatic measures construct.
Results revealed significant overlap between terms related to the pragmatic construct in the existing literature and stakeholder interviews. However, a number of terms were unique to each methodology. This underscores the importance of understanding stakeholder perspectives of criteria measuring the pragmatic construct. These results will be used to inform future phases of the project where stakeholders will determine the relative importance and clarity of each dimension of the pragmatic construct, as well as their priorities for the pragmatic dimensions. Taken together, these results will be incorporated into a pragmatic rating system for existing implementation science measures to support implementation science and practice.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Adam Drewnowski, Benjamin Caballero, Jai K Das, Jeff French, Andrew M Prentice, Lisa R Fries, Tessa M van Koperen, Petra Klassen-Wigger, & Barbara J Rolls
University of Washington affiliated authors are displayed in bold.
Published: September 2018
Shoba Ramanadhan, Melinda M. Davis, Rebecca Armstrong, Barbara Baquero, Linda K. Ko, Jennifer C. Leng, Ramzi G. Salloum, Nicole A. Vaughn, & Ross C. Brownson
University of Washington affiliated authors are displayed in bold.
Published: February 2018
Bradley H. Wagenaar, Lisa R. Hirschhorn, Catherine Henley, Artur Gremu, Ntazana Sindano, Roma Chilengi and the AHI PHIT Partnership Collaborative
University of Washington affiliated authors are displayed in bold.
Published: December 2017
Well-functioning health systems need to utilize data at all levels, from the provider, to local and national-level decision makers, in order to make evidence-based and needed adjustments to improve the quality of care provided. Over the last 7 years, the Doris Duke Charitable Foundation’s African Health Initiative funded health systems strengthening projects at the facility, district, and/or provincial level to improve population health. Increasing data-driven decision making was a common strategy in Mozambique, Rwanda and Zambia. This paper describes the similar and divergent approaches to increase data-driven quality of care improvements (QI) and implementation challenge and opportunities encountered in these three countries.
Eight semi-structured in-depth interviews (IDIs) were administered to program staff working in each country. IDIs for this paper included principal investigators of each project, key program implementers (medically-trained support staff, data managers and statisticians, and country directors), as well as Ministry of Health counterparts. IDI data were collected through field notes; interviews were not audio recorded. Data were analyzed using thematic analysis but no systematic coding was conducted. IDIs were supplemented through donor report abstractions, a structured questionnaire, one-on-one phone calls, and email exchanges with country program leaders to clarify and expand on key themes emerging from IDIs.
Project successes ranged from over 450 collaborative action-plans developed, implemented, and evaluated in Mozambique, to an increase from <10% to >80% of basic clinical protocols followed in intervention facilities in rural Zambia, and a shift from a lack of awareness of health data among health system staff to collaborative ownership of data and using data to drive change in Rwanda.
Based on common successes across the country experiences, we recommend future data-driven QI interventions begin with data quality assessments to promote that rapid health system improvement is possible, ensure confidence in available data, serve as the first step in data-driven targeted improvements, and improve staff data analysis and visualization skills. Explicit Ministry of Health collaborative engagement can ensure performance review is collaborative and internally-driven rather than viewed as an external “audit.”
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Felix Cyamatare Rwabukwisi, Ayaga A. Bawah, Sarah Gimbel, James F. Phillips, Wilbroad Mutale, Peter Drobac and the AHI PHIT Partnership Collaborative
University of Washington affiliated authors are displayed in bold.
Published: December 2017
Achieving the United Nations Sustainable Development Goals in sub-Saharan Africa will require substantial improvements in the coverage and performance of primary health care delivery systems. Projects supported by the Doris Duke Charitable Foundation’s (DDCF) African Health Initiative (AHI) created public-private-academic and community partnerships in five African countries to implement and evaluate district-level health system strengthening interventions. In this study, we captured common implementation experiences and lessons learned to understand core elements of successful health systems interventions.
We used qualitative data from key informant interviews and annual progress reports from the five Population Health Implementation and Training (PHIT) partnership projects funded through AHI in Ghana, Mozambique, Rwanda, Tanzania, and Zambia.
Four major overarching lessons were highlighted. First, variety and inclusiveness of concerned key players (public, academic and private) are necessary to address complex health system issues at all levels. Second, a learning culture that promotes evidence creation and ability to efficiently adapt were key in order to meet changing contextual needs. Third, inclusion of strong implementation science tools and strategies allowed informed and measured learning processes and efficient dissemination of best practices. Fourth, five to seven years was the minimum time frame necessary to effectively implement complex health system strengthening interventions and generate the evidence base needed to advocate for sustainable change for the PHIT partnership projects.
The AHI experience has raised remaining, if not overlooked, challenges and potential solutions to address complex health systems strengthening intervention designs and implementation issues, while aiming to measurably accomplish sustainable positive change in dynamic, learning, and varied contexts.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**