Theories and Frameworks (General) Archives - Implementation Science at UW

✪ 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**}

✪ 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**}

Effectiveness of the Systems Analysis and Improvement Approach to optimise outpatient mental, neurological, and substance-use disorder treatment cascades in Mozambique: a cluster-randomised trial

✪ 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**}

✪ “Though there are some challenges, we try our best to follow the guidelines”: a qualitative study exploring determinants of providing guideline-adherent care to hospitalized children in Kenya

Abstract:

Background

Clinical treatment guidelines are designed to improve quality of care by offering clear recommendations for health workers; however, across many settings, implementing guidelines is a challenge. For over 20 years, comprehensive World Health Organization guidelines for care of hospitalized children have provided guidance for treating the primary causes of childhood death. These recommendations were adapted in Kenya and codified in the Basic Paediatric Protocol; however, adherence to these evidence-based interventions remains suboptimal.

Methods

This qualitative study identified the barriers and facilitators of providing guideline-adherent care to children admitted to two hospitals in Kenya. The semi-structured question guide was informed by the Theoretical Domains Framework (TDF). Three focus group discussions and 16 in-depth interviews were conducted with 35 health workers. Participants were nurses, doctors, clinical officers, or nutritionists (including in-charges and clinical supervisors). Interviews were audio recorded and transcribed. Transcripts were coded using a TDF-based codebook, validated, and analyzed for themes.

Results

TDF domains with the greatest influence on the thematic findings were environmental context and resources, social influences, beliefs about consequences, and beliefs about capabilities. Health workers were knowledgeable about guidelines and felt strongly that adherence to them was beneficial; however, they also faced barriers implementing them. Challenges related to the environmental context were pervasive, including shortages of staff and supplies. Participants praised the simplicity of guidelines but also noted that simplified diagnostic criteria don’t align with complex patient presentations. While guidelines empowered some nurses to make clinical decisions, respondents reported that strict professional roles sometimes delayed diagnosis and treatment. Further, health workers reported some deviations were intentional (ex. when guidelines were not aligned to their beliefs) and other times they were unintentional (ex. when complex patient presentations make guideline adherence difficult).

Conclusions

Knowledge of guidelines and motivation to use them were not major determinants in this analysis. Rather, human and material resource shortages presented the greatest barrier to guideline adherence in this setting. Improving guidelines by involving health workers in participatory development of guidelines would improve both clarity and feasibility. Health workers are well-versed in guideline recommendations, so educational strategies should focus on knowledge gaps or changes in the latest version of guidelines.

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

✪ Testing Three Alternate Methods to Direct Observation in Measuring Use of Discrete Youth Cognitive Behavioral Techniques: A Secondary Analysis

Abstract:

Background

Cognitive behavioral therapy (CBT), an umbrella term for therapeutic techniques guided by cognitive behavioral theory, is an evidence-based approach for many psychiatric conditions in youth. A stronger dose of CBT delivery is thought to improve youth clinical outcomes. While a critical indicator of care quality, measuring the use of CBT techniques feasibly and affordably is challenging. Certain CBT techniques (e.g., more concrete and observable) may be easier to measure than others using low-cost methods, such as clinician self-report; however, this has not been studied.

Method

To assess the concordance of three methods of measuring CBT technique use with direct observation (DO), clinicians from 27 community agencies (n = 126; Mage = 37.7 years, SD = 12.8; 76% female) were randomized 1:1:1 to a self-report, chart-stimulated recall (CSR; semistructured interviews with the chart available), or behavioral rehearsal (BR; simulated role-plays) condition. In previous work using a global score aggregating 12 CBT techniques, only BR produced scores that did not differ from DO. This secondary analysis examined the concordance of these alternate methods with DO for each discrete CBT technique, testing for differential concordance across cognitive techniques (e.g., cognitive education) compared to behavioral techniques (e.g., behavioral activation).

Results

Results of three-level mixed effects regression models indicated that BR scores did not differ significantly from DO for any techniques, and for nine techniques, neither did CSR (all ps > .05). Contrastingly, self-report scores differed from DO for all but one technique, with greater concordance for behavioral than cognitive techniques (z = −3.29, p < .001).

Conclusions

Unlike previous findings using an aggregate score, we found that both BR and CSR did not differ significantly from DO for most techniques tested. These findings have implications within implementation research and usual care settings; they support multiple viable measurement methods that are less resource-intensive than DO.

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

✪ “When he is around, I’ll take the PrEP, but when he is not, I will not take PrEP”: key influences on PrEP use decisions among women attending family planning clinics in Kenya

Abstract:

Background

Women of childbearing age in sub-Saharan Africa (SSA) face a disproportionately high risk of HIV acquisition. Although oral PrEP has been universally scaled up for individuals at significant risk of HIV, its uptake and sustained use remain suboptimal. Understanding PrEP use decisions offers insights into context-specific barriers and facilitators to its utilization.

Methods

From September to November 2023, we conducted a qualitative study nested in a larger prospective, open-label clinical trial (FP-Plus). We conducted in-depth interviews (IDIs) with younger women (ages 15–24) and older women (ages ≥25) who declined, delayed, discontinued, or restarted PrEP during the study. IDIs were conducted at two FP clinics by trained Kenyan social scientists and were audio recorded, translated, and transcribed. We analyzed data using inductive and deductive thematic analysis through the lens of the theory of planned behavior (TPB) to explore experiences, beliefs, and rationale among women who made various PrEP decisions.

Results

We interviewed 64 women, including 40 younger women and 24 older women, all of whom declined, delayed, discontinued, or restarted PrEP (n = 16 women/category). The median age of these women was 24 years (IQR, 23–30). The majority of participants (86%, 55/64) were using family planning methods, primarily injectables (42%, 23/64). PrEP discontinuation or restart was primarily influenced by changes in HIV risk dynamics. Agency and perceived HIV risk were pivotal factors in PrEP use decisions, shaping participants’ ability to practice effective prevention adherence (TPB: perceived behavioral control). Women who declined PrEP cited a lack of autonomy, partner influence, and insufficient information (TPB: social and subjective norms). Low self-efficacy influenced decisions to delay or decline PrEP (TPB: behavioral beliefs and attitudes). In addition, challenges with PrEP pill size, taste, and texture were perceived as barriers to swallowing pills among all groups of women. Participants expressed a preference for alternative PrEP formulations, such as injectable PrEP, due to perceived ease of use, privacy, and potential to support adherence.

Conclusions

PrEP discontinuation and restart cycles largely reflected changes in HIV risk. Women who decline or delay PrEP may benefit from personalized support to improve their autonomy, recognizing that HIV risk persists during periods of PrEP delay.

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

✪ Methods for community-engaged data collection and analysis in implementation research

Abstract:

Background

Community engagement is widely recognized as critical to successful and equitable implementation of evidence-based practices, programs, and policies. However, there are no clear guidelines for community involvement in data collection and analysis in implementation research.

Methods

We describe three specific methods for engaging community members in data collection and analysis: concept mapping, rapid ethnographic assessment, and Photovoice. Common elements are identified from a case study of each method: 1) selection and adaptation of evidence-based strategies for improving adolescent HPV vaccine initiation rates in disadvantaged communities, 2) strategies for implementing medication for opioid use disorders among low-income Medicaid enrollees during natural disasters, and 3) interventions to improve the physical health of adults with severe mental illness living in supportive housing.

Results

In all three cases, community members assisted in participant recruitment, provided data, and validated preliminary findings created by researchers. In the Photovoice case study, community members participated in both data collection and analysis, while in the concept mapping, community members also participated in the initial phase of organizing and prioritizing evidence-based strategies during the data analysis.

Conclusions

Community involvement in implementation research data collection and analysis contributes to greater engagement and empowerment of community members and validation of study findings. Use of methods that exhibit both scientific rigor and community relevance of implementation research also contributes to greater community investment in successful implementation outcomes. Nevertheless, the case studies point to the importance and efficiency of the division of labor embedded in community-engaged implementation research. Building capacity for community members to assume greater roles in obtaining and organizing data for preliminary analysis prior to interpretation is recommended.

Contributions to the literature

Guidelines exist for conducting community engaged research but provide no clear instructions for community involvement in data collection and analysis.
This paper examines the potential of community engaged data collection and analysis in implementation research through case studies of concept mapping, rapid ethnographic methods, and Photovoice.
Community involvement in implementation research data collection and analysis contributes to greater engagement and empowerment of community members, validation of study findings, and commitment to successful implementation outcomes.

^{**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 BMC Global Public Health

Abstract:

Background

Methods

Results

Conclusions

Systematic review registration

Authors:

✪ Open Access

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

Abstract:

Introduction

Methods

Results

Conclusion

Highlights

Authors:

✪ Open Access

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

Abstract:

INTRODUCTION

METHODS

RESULTS

DISCUSSION

Highlights

Authors:

✪ Open Access

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

Abstract:

Authors:

Subscription Required for Full Text Access

Read the full text in the subscription access journal The Lancet: Psychiatry

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 Implementation Science Communication

Abstract:

Background

Methods

Results

Conclusions

Authors:

✪ Open Access

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

Abstract:

Background

Method

Results

Conclusions

Authors:

✪ Open Access

Read the full text in the open access journal Frontiers in Medicine

Abstract:

Background

Methods

Results

Conclusions

Authors:

✪ Open Access

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

Abstract:

Background

Methods

Results

Conclusions

Contributions to the literature