Vasco F J Cumbe, Alberto Muanido, Morgan Turner, João Nhalimue Jala Jr, Ernesto Eusébio Armando, Flávia Faduque, Ernesto Rodrigo Xerinda, Kenneth Sherr, Brian P Flaherty, Monisha Sharma & Bradley H Wagenaar
University of Washington affiliated authors are displayed in bold.
Published: March 2026
Claudia L. Leung, Hayden B. Bosworth, Allison R. Webel, Angela Aifah, Constantine Akwanalo, Gerald S. Bloomfield, Emily W. Choi, Barbara M. Gripshover, Corrilynn O. Hileman, Jemima Kamano, Virginie Lopez-Kidwell, Charles Muiruri, Benson Njuguna, Nwora Lance Okeke, Christopher T. Longenecker, & Rajesh Vedanthan
University of Washington affiliated authors are displayed in bold.
Published: March 2026
Reciprocal innovation, a model of sustained, multidirectional exchange in which health strategies are adapted, revisited, and refined across contexts, offers a compelling framework to rethink how implementation science can support global health equity by enabling dynamic, multidirectional learning across different contexts. Drawing on the EXTRA-CVD trial, a nurse-led cardiovascular disease prevention intervention designed to extend the HIV treatment cascade in United States (U.S.) HIV clinics, which adapted strategies informed by implementation research in Kenya and the U.S. Veterans Affairs health system, this perspective examines how reciprocal innovation can begin to emerge within existing research structures, as well as where opportunities for deeper exchange remain limited. We identify four operational domains of reciprocal innovation: care delivery strategies, end-user engagement, research methodologies, and research leadership and partnership. Across these domains, we describe how cross-context learning shaped intervention adaptation and site-level implementation in EXTRA-CVD, as well as missed opportunities where more intentional feedback, shared leadership, and methodological exchange could have strengthened multidirectional learning. Taken together, this work highlights both the potential and the practical challenges of reciprocal innovation in implementation research, emphasizing its role in moving beyond unidirectional knowledge transfer toward iterative, context-responsive learning. By embedding structures for iterative feedback, equity-centered governance, and multidirectional learning systems within research and implementation systems, future global partnerships can foster more inclusive, responsive, and sustainable health interventions.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Ali Giusto, Florence Jaguga, Michaela Greenlee, Noah Triplett, Wilter Rono, Hani Rukh-E-Qamar, Mercy Korir, Dan Aburi, Milton Wainberg
University of Washington affiliated authors are displayed in bold.
Published: March 2026
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.
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.
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.
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.
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**
Ermyas Birru, Aneth Dinis, Jonny Crocker, Quinhas Fernandes, Sarah Gimbel, Steve Gloyd, Artur Gremu, Lisa R. Hirschhorn, Isaías Ramiro, Stelio Tembe, Orvalho Augusto & Kenneth Sherr
University of Washington affiliated authors are displayed in bold.
Published: March 2026
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.
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.
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.
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**
Christopher G Kemp, Lauren White, Emily E HaroZ & Prof Donald Warne
University of Washington affiliated authors are displayed in bold.
Published: December 2026
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**
Nicholas B. George, Sara Malone, Amela Sijecic, Grace Cross, Melissa Martos, David Noyd, Lisa M. Force, Nickhill Bhakta, Matthew J. Ehrhardt & Maura M. Kepper
University of Washington affiliated authors are displayed in bold.
Published: January 2026
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.
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.
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.
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**
Wentrell Bing, Ian Rodriguez, Anne Dudley, Emily Durkin, Nicolas Fernandez, Julia Finkelstein, Gwen Grimsby, Leslie McQuiston, Hans Pohl, Puneeta Ramachandra, Erica Traxel, Carmen Tong, Briony Varda, Jill Whitehouse & Jonathan S. Ellison
University of Washington affiliated authors are displayed in bold.
Published: December 2025
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.
Published: December 2025
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.
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.
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.
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**
Aneth Dinis, Quinhas Fernandes, Orvalho Augusto, Bryan J. Weiner, Sarah Gimbel, Ermyas Birru, Dorlim Uetela, Grace John-Stewart, Stephen Gloyd, Isaias Ramiro & Kenneth Sherr
University of Washington affiliated authors are displayed in bold.
Published: December 2025
Assessing implementation fidelity—the degree to which a program is implemented as intended—is essential to understand whether poor outcomes are due to implementation problems or the design of an intervention. Few studies in health research have documented the association between implementation fidelity and effectiveness. The Integrated District Evidence-to-Action (IDEAs) is a multicomponent audit and feedback strategy designed to improve the implementation of maternal and child clinical guidelines in Mozambique. In a previous study, we found mixed results of IDEAs effectiveness. The objective of the present study is to understand how implementation fidelity may have influenced the effectiveness of the strategy.
IDEAs was implemented in 154 health facilities across 12 districts in Manica and Sofala provinces in Mozambique between 2016 and 2020. We used the conceptual framework for implementation fidelity to guide descriptive analysis of IDEAs adherence. Regression modeling was used to study patterns of the direction of association between measures of fidelity and effectiveness for ten service delivery outcomes and five service readiness outcomes.
We describe adherence on 15 measures of fidelity, of which 12 had high fidelity. Poor fidelity was found in conducting facility service readiness assessments and completing micro-interventions from action plans. Service delivery measures tended to be positively associated with participation and degree of micro-intervention completion and negatively associated with a higher number of action plans elaborated by participating teams. For the service readiness outcomes, delivery of essential care was positively associated with participation and micro-intervention completion, and staff availability was negatively associated with supervision.
Participation in audit and feedback meetings, the number of action plans elaborated, and the degree of completion of micro-interventions seem to be related to the effectiveness results. IDEAs should be adapted to reduce the number of action plans elaborated and promote better micro-intervention completion. Additionally, combining audit and feedback strategies with other strategies might enhance effectiveness in service outcomes. This study examines how to analyze the link between fidelity and effectiveness of a strategy to inform better design and recommend context-specific improvements.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Elizabeth Manafò, Elyette Lugo, Amit Jain, Lisa Petermann, Benjamin Davies, Olesja Hazenbiller, Janneke I. Loomans, Muzahem M. Taha, Klaus John Schnake, Michael P. Kelly, Asdrubal Falavigna, Anne Versteeg, Richard Bransford, Riccardo Cecchinato, Charles Fisher & AO Knowledge Translation Steering Committee
University of Washington affiliated authors are displayed in bold.
Published: December 2025
Knowledge translation (KT) interventions are essential for implementing evidence-based practices in healthcare. However, despite their proven effectiveness in addressing global health challenges, KT strategies in surgery remain challenging to apply. This scoping review examines KT strategies in surgery, their effectiveness, and key barriers and enablers to their implementation.
This scoping review followed the Arksey and O’Malley and Levac et al. frameworks, integrating the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) and the PRISM (Practical Robust Implementation Sustainability Model) models to evaluate the effectiveness of knowledge translation interventions in surgical practice change and associated contextual barriers and facilitators. A systematic search was conducted across MEDLINE (PubMed, OVID), CINAHL (EBSCO), and PsycINFO (ProQuest). Articles were screened using predefined selection criteria, emphasizing experimental and quasi-experimental studies. Data extraction categorized KT interventions: knowledge diffusion, dissemination, and implementation approaches.
A total of 34 studies met the inclusion criteria. Most were hospital-based (88%) and focused on guideline adherence. The review identified three primary KT strategies: (i) educational materials and educational outreach, (ii) reminders and prompts, and (iii) audit and feedback systems. The most effective KT strategies used a combination of these interventions to maximize impact. Barriers included physician resistance, limited leadership support, financial constraints, and workflow disruptions, while enablers included institutional leadership, structured training programs, financial incentives, and interdisciplinary collaboration. A notable finding was the lack of standardized validation processes for adopting changes in the surgical setting, which often burdens individual surgeons and their institutions, thereby constraining both capacity and motivation for practice change.
Findings suggest that layered, interdisciplinary KT strategies are the most effective for driving surgical practice change and overcoming institutional barriers. The integrated application of RE-AIM and PRISM frameworks proved valuable in assessing the interventions’ sustainability and real-world effectiveness. This comprehensive analysis contributes to the growing body of knowledge on effective implementation strategies in surgical settings and provides a foundation for future practice improvement initiatives. Future research should focus on refining KT methodologies, expanding implementation frameworks, and addressing barriers to sustainability across diverse surgical settings.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**