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Implementation Science at UW

Archives: UW Articles

Breast Cancer Knowledge, Behaviors, and Preferences in Malawi: Implications for Early Detection Interventions From a Discrete Choice Experiment

Authors:

Racquel E. Kohler, Satish Gopal, Clara N. Lee, Bryan J. Weiner, Bryce B. Reeve, and Stephanie B. Wheeler

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: April 2017

Read the full text in the open access Journal of Global Oncology

Abstract:

Purpose

Breast cancer is the most common female cancer in Africa and leading cause of death resulting from cancer; however, many countries lack early detection services. In Malawi, women are frequently diagnosed with large tumors after long symptomatic periods. Little is known about local cancer knowledge.

Methods

We administered a cross-sectional survey with a discrete choice experiment to a random sample in urban and rural areas of Lilongwe district. Bivariable and multivariable analyses determined factors associated with knowledge. Preference utilities for early detection interventions were estimated using a hierarchical Bayesian model in Sawtooth software.

Results

Of 213 women recruited, fewer than half were aware of breast cancer. In multivariable analysis, electricity at home and knowing someone with cancer increased the odds of awareness. Women were more knowledgeable about symptoms than treatment or risk factors; more than 60% erroneously believed local misconceptions. Seventeen percent were aware of breast self-examination, and 20% were aware of clinical breast examination (CBE); few reported either behavior. Common barriers included not knowing where to access CBE and transportation difficulties. Discrete choice experiment results indicated the detection strategy (breast health awareness, CBE, or both) was the most important attribute of an intervention, followed by the encounter setting and travel time.

Conclusion

Addressing misconceptions in health messages and engaging survivors to promote early detection may help improve breast cancer knowledge in Malawi. Program designs accounting for women’s preferences should provide breast health education and CBEs in convenient settings to address transportation barriers, particularly for women with low socioeconomic position.

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

✪ Enhance®Fitness Dissemination and Implementation: 2010–2015: A Scoping Review

Authors:

Miruna G. Petrescu-Prahova, Thomas J. Eagen, Sarah L. Fishleder, Basia Belza

University of Washington affiliated authors are displayed in bold.

Published: February 2017

Read the full text in the open access journal American Journal of Preventive Medicine

Abstract:

Introduction

Physical activity has many benefits for older adult physical and mental health. Enhance®Fitness (EF) is an evidence-based group exercise program delivered by community-based organizations. The purpose of this study was to review recent evidence on the dissemination and implementation of EF.

Methods

A scoping review of qualitative and quantitative studies with EF as main focus was conducted. CINAHL, PubMed, PubMed Central, SCOPUS, Web of Science, PsycINFO, and Google Scholar were searched between October and November 2015 for data-based studies on EF published in 2010–2015. Two team members abstracted each paper independently using a data abstraction tool. Results were summarized using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.

Results

Seventeen publications met inclusion criteria. EF has reached and is effective across a broad population base, including individuals with low SES and diverse ethnic/racial backgrounds. EF participation may be associated with reduced risk for falls requiring medical care, and is associated with fewer hospital admissions. Analyses of medical cost savings from EF participation and program implementation costs suggest economic benefits of EF implementation for communities. Organization-level maintenance is facilitated by program-specific and organizational factors, such as instructor training and funding. Individual-level maintenance is facilitated by program structure, absence of pain, and increased quality of life.

Conclusions

More-rigorous evidence is needed about the association between participation in EF and conditions such as falls. Evaluation of program fidelity, adaptations, and sustainability is limited; more-systematic examination across population groups and types of organizations would help ensure older adults continue to benefit from EF participation.

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

Impact of the Cancer Prevention and Control Research Network: Accelerating the Translation of Research Into Practice

Authors:

Kurt M. Ribisl, Maria E.Fernandez, Daniela B.Friedman, Peggy A. Hannon, Jennifer Leeman, Alexis Moore, Lindsay Olson, Marcia Ory, Betsy Risendal, Laura Sheble, Vicky M. Taylor, Rebecca S. Williams, Bryan J.Weiner

University of Washington affiliated authors are displayed in bold.

Subscription Required for Full Text Access

Published: March 2017

Read the full text open access in the subscription access American Journal of Preventive Medicine

Combined use of the Consolidated Framework for Implementation Research (CFIR) and the Theoretical Domains Framework (TDF): a systematic review

Authors:

Sarah A. Birken, Byron J. Powell, Justin Presseau, M. Alexis Kirk, Fabiana Lorencatto, Natalie J. Gould, Christopher M. Shea, Bryan J. Weiner, Jill J. Francis, Yan Yu, Emily Haines and Laura J. Damschroder

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: January 2017

Read the full text in the open access journal Implementation Science

Abstract:

Background

Over 60 implementation frameworks exist. Using multiple frameworks may help researchers to address multiple study purposes, levels, and degrees of theoretical heritage and operationalizability; however, using multiple frameworks may result in unnecessary complexity and redundancy if doing so does not address study needs. The Consolidated Framework for Implementation Research (CFIR) and the Theoretical Domains Framework (TDF) are both well-operationalized, multi-level implementation determinant frameworks derived from theory. As such, the rationale for using the frameworks in combination (i.e., CFIR + TDF) is unclear. The objective of this systematic review was to elucidate the rationale for using CFIR + TDF by (1) describing studies that have used CFIR + TDF, (2) how they used CFIR + TDF, and (2) their stated rationale for using CFIR + TDF.

Methods

We undertook a systematic review to identify studies that mentioned both the CFIR and the TDF, were written in English, were peer-reviewed, and reported either a protocol or results of an empirical study in MEDLINE/PubMed, PsycInfo, Web of Science, or Google Scholar. We then abstracted data into a matrix and analyzed it qualitatively, identifying salient themes.

Findings

We identified five protocols and seven completed studies that used CFIR + TDF. CFIR + TDF was applied to studies in several countries, to a range of healthcare interventions, and at multiple intervention phases; used many designs, methods, and units of analysis; and assessed a variety of outcomes. Three studies indicated that using CFIR + TDF addressed multiple study purposes. Six studies indicated that using CFIR + TDF addressed multiple conceptual levels. Four studies did not explicitly state their rationale for using CFIR + TDF.

Conclusions

Differences in the purposes that authors of the CFIR (e.g., comprehensive set of implementation determinants) and the TDF (e.g., intervention development) propose help to justify the use of CFIR + TDF. Given that the CFIR and the TDF are both multi-level frameworks, the rationale that using CFIR + TDF is needed to address multiple conceptual levels may reflect potentially misleading conventional wisdom. On the other hand, using CFIR + TDF may more fully define the multi-level nature of implementation. To avoid concerns about unnecessary complexity and redundancy, scholars who use CFIR + TDF and combinations of other frameworks should specify how the frameworks contribute to their study.

Trial registration

PROSPERO CRD42015027615

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

The role of implementation science training in global health: from the perspective of graduates of the field’s first dedicated doctoral program

Authors:

Arianna R. Means, David E. Phillips, Grégoire Lurton, Anne Njoroge, Sabine M. Furere, Rong Liu, Wisal M. Hassan, Xiaochen Dai, Orvalho Augusto, Peter Cherutich, Gloria Ikilezi, Caroline Soi, Dong (Roman) Xu & Christopher G. Kemp

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: November 2016

Read the full text in the open access journal Implementation Science

Abstract:

Bridging the ‘know-do gap’ is an enormous challenge for global health practitioners. They must be able to understand local health dynamics within the operational and social contexts that engender them, test and adjust approaches to implementation in collaboration with communities and stakeholders, interpret data to inform policy decisions, and design adaptive and resilient health systems at scale. These skills and methods have been formalized within the nascent field of Implementation Science (IS). As graduates of the world's first PhD program dedicated explicitly to IS, we have a unique perspective on the value of IS and the training, knowledge, and skills essential to bridging the ‘know-do gap’. In this article, we describe the philosophy and curricula at the core of our program, outline the methods vital to IS in a global health context, and detail the role that we believe IS will increasingly play in global health practice. At this junction of enormous challenges and opportunities, we believe that IS offers the necessary tools for global health professionals to address complex problems in context and raises the bar of success for the global health programs of the future.

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

Participatory System Dynamics Modeling: Increasing Stakeholder Engagement and Precision to Improve Implementation Planning in Systems

Authors:

Lindsey Zimmerman, David W. Lounsbury, Craig S. Rosen, Rachel Kimerling, Jodie A. Trafton, & Steven E. Lindley
University of Washington affiliated authors are displayed in bold.

Subscription Required for Full Text Access

Published: August 2016

Read the full text open access in the subscription access journal Administration and Policy in Mental Health and Mental Health Services Research

Costs of integrating cervical cancer screening at an HIV clinic in Kenya

Authors:

Elisabeth L. Vodicka, Joseph B. Babigumira, Marita R. Mann, Rose J. Kosgei, Fan Lee, Nelly R. Mugo, Timothy C. Okech, Samah R. Sakr, Louis P. Garrison Jr., Michael H. Chung

University of Washington affiliated authors are displayed in bold.

Subscription Required for Full Text Access

Published: October 2016

Read the full text in the subscription access International Journal of Gynecology & Obstetrics

Health Information Technologies — Academic and Commercial Evaluation (HIT-ACE) methodology: Description and application to clinical feedback systems

Authors:

Aaron R. Lyon, Cara C. Lewis, Abigail Melvin, Meredith Boyd, Semret Nicodimos, Freda F. Liu, Nathaniel Jungbluth

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: September 2016

Read the full text in the open access journal Implementation Science

Abstract:

Background

Health information technologies (HIT) have become nearly ubiquitous in the contemporary healthcare landscape, but information about HIT development, functionality, and implementation readiness is frequently siloed. Theory-driven methods of compiling, evaluating, and integrating information from the academic and commercial sectors are necessary to guide stakeholder decision-making surrounding HIT adoption and to develop pragmatic HIT research agendas. This article presents the Health Information Technologies—Academic and Commercial Evaluation (HIT-ACE) methodology, a structured, theory-driven method for compiling and evaluating information from multiple sectors. As an example demonstration of the methodology, we apply HIT-ACE to mental and behavioral health measurement feedback systems (MFS). MFS are a specific class of HIT that support the implementation of routine outcome monitoring, an evidence-based practice.

Results

HIT-ACE is guided by theories and frameworks related to user-centered design and implementation science. The methodology involves four phases: (1) coding academic and commercial materials, (2) developer/purveyor interviews, (3) linking putative implementation mechanisms to hit capabilities, and (4) experimental testing of capabilities and mechanisms. In the current demonstration, phase 1 included a systematic process to identify MFS in mental and behavioral health using academic literature and commercial websites. Using user-centered design, implementation science, and feedback frameworks, the HIT-ACE coding system was developed, piloted, and used to review each identified system for the presence of 38 capabilities and 18 additional characteristics via a consensus coding process. Bibliometic data were also collected to examine the representation of the systems in the scientific literature. As an example, results are presented for the application of HIT-ACE phase 1 to MFS wherein 49 separate MFS were identified, reflecting a diverse array of characteristics and capabilities.

Conclusions

Preliminary findings demonstrate the utility of HIT-ACE to represent the scope and diversity of a given class of HIT beyond what can be identified in the academic literature. Phase 2 data collection is expected to confirm and expand the information presented and phases 3 and 4 will provide more nuanced information about the impact of specific HIT capabilities. In all, HIT-ACE is expected to support adoption decisions and additional HIT development and implementation research.

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