Hannah E. Frank, Nima Sarani, Jacqueline F. Hayes, Ruben G. Martinez, Jessyca Goldstein, Laura Evans, Gary Phillips, R. Phillip Dellinger, David Portelli, Christa Schorr, Kathleen M. Terry, Lori Harmon, Sean Townsend & Mitchell M. Levy
University of Washington affiliated authors are displayed in bold.
Published: May 2026
Alexandra L. Rose, Shaina Coogan, Jess Indresano, Steven B. Zeliadt & Jessica A. Chen
University of Washington affiliated authors are displayed in bold.
Published: May 2025
The high prevalence and significant morbidity and mortality associated with chronic pain among veterans has made expansion of pain services within the Veterans Health Administration (VHA) a key priority. TelePain, in which services are provided via telehealth from central “hub” sites to patients at decentralized “spoke” sites, is one such model with positive implementation findings to date. However, the staff effort and cost of implementation have yet to be examined when considering TelePain or similar virtual hub-and spoke models of specialty pain care, information that is critical for expansion of services.
Using an established time-based activity tracker designed for implementation facilitation, study staff tracked minutes spent on implementation activities at 11 spoke sites. Annual salaries were extracted to calculate an average cost per minute for each personnel type. Costs per personnel minute were combined with activity data to calculate costs of implementation activities at spoke sites. Implementation reach outcomes for the first 36 months of implementation were extracted from the electronic health record. Service utilization data was combined with cost data to calculate cost per patient reached and per clinical encounter achieved at each site.
Total facilitation costs (range: $1,746-$7,978) and unique patients reached (range: 2–46) varied considerably across spoke sites and greater staff implementation efforts (measured in time or cost) were not associated with greater numbers of patients reached. Therefore, costs per patient reached also varied widely (range: $120–2,569) across spoke sites. Key challenges included high rurality and small clinic size; insufficient engagement of frontline providers; lack of referral options for high acuity patients; and lack of existing programming within which to situate pain services.
At spoke sites where patients were consistently referred and reached, costs were relatively modest, particularly compared to the high cost of untreated chronic pain, suggesting the potential impact of this model at scale. However, in spoke sites where referrals and encounters were low during initial implementation, cost per patient was high. Findings highlight the need for better methods for tailoring of facilitation interventions to spoke site’s individual needs to maximize impact.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Danielle M. Wesolowicz, William C. Becker, Margarita Alegria , Lia Chin-Purcell, Joseph E. Glass, Hannah K. Knudsen, Patience M. Dow, Karen H. Seal & Emma B. McGinty
University of Washington affiliated authors are displayed in bold.
Published: April 2025
Geoffrey Setswe, Sarah Day, Felex Ndebele, Jacqueline Pienaar, Vuyolwethu Ncube, & Caryl Feldacker
University of Washington affiliated authors are displayed in bold.
Published: April 2025
To document adaptations that were made to the implementation of the two-way texting (2wT) randomised controlled trial (RCT) for voluntary medical male circumcision (VMMC) in South Africa and to provide a nuanced discussion on the differences between adaptations and fidelity in this context.
We conducted a qualitative study using the Framework for Reporting Adaptations and Modifications in Evidence-based Implementation Strategies (FRAME-IS) to examine 2wT adaptations. We reported adaptations to the 2wT intervention using two steps. First, we categorised adaptations in a shared study-specific Google Docs that documented participant engagement with the 2wT system, tracked daily RCT implementation notes, reported software bugs and noted reminder emails about adaptations for the research team. Second, we conducted a qualitative assessment of the influence of adaptations on project outcomes via 10 periodic reflection meetings with VMMC implementers. Reflection documentation included notes from field observations, meeting minutes and informal partner check-ins to complete adaptation documentation. Using the FRAME-IS as a codebook, adaptations were categorised.
The RCT was conducted in rural and urban VMMC clinics in the North West and Gauteng districts of South Africa.
Implementation scientists and VMMC implementers who implemented the 2wT pragmatic randomised controlled trial (pRCT) were participants for the adaptation study.
The primary outcome measure was the adaptations that were made during the implementation of the 2wT pRCT. The secondary outcome measures were fidelity and rigour of implementing adaptations to the 2wT pRCT.
Between June 2021 and February 2022, 13 adaptations were identified in three phases during the implementation of the 2wT pRCT. The first phase of adaptations aimed to augment study recruitment, including conducting weekend VMMC recruitment camps, using mobile outreach services in the rural site, adding two urban sites to increase recruitment, using weekly WhatsApp calls for updates with all implementing teams, using virtual meetings to implement the 2wT strategy remotely during COVID-19 restrictions and allocating one clinician to work outside of normal working hours. The second phase of adaptations further enhanced enrolments, including adding two local language translations in the usability survey for 2wT men and contributing a portion towards the salary of the implementing staff by the research partner. The third phase included the exclusion of two rural clinics as recruitment sites due to inconsistent mobile phone networks, adding another layer of data quality checks to ensure data quality, training non-clinical counsellors to help with enrolling clients, retraining of staff in the rural site with high staff turnover and using both primary and alternative phone numbers for enrolment to reduce loss to follow-up.
This study made adaptations to the 2wT pRCT without compromising the fidelity of the study. The 2wT pRCT balances rigour (fidelity) and relevance (adaptation). Adaptations should not be confined by rigour but should also not go unchallenged or unverified. We conclude that fidelity can be maintained with adaptations that are implemented to close the gap between research in the laboratory and practice.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Sadhvi Krishnamoorthy, Gregory Armstrong, Victoria Ross, Lennart Reifels, Hayley Purdon, Jillian Francis, Jacinta Hawgood, Sharna Mathieu, Alexandr Kasal, Allison Crawford, Allison M. Gustavson, András Székely, Anna Baran, Annette Erlangsen, Ashley Nemiro, Chez Curnow, Daniel Reidenberg, Daria Biechowska, Ella Arensman, Emmanuel Nii-Boye Quarshie, Fiona Shand, Caroline Mae Ramirez, Isabel Zbukvic, Jorgen Gullestrup, Katherine McGill, Kylie King, Lakshmi Vijayakumar, Lauren White, Loraine Barnaby, Mark Sinyor, Marlena Sokół-Szawłowska, Maryke Van Zyl, Merike Sisask, Michael Phillips, Mohsen Rezaeian, Naohiro Yonemoto, Nathaniel Pollock, Nikhil Jain, Paul Siu Fai Yip, Ping Qin, Piotr Toczyski, Rakhi Dandona, Ricardo Gusmão, Samah Jabr, Sarah Spafford, Tae-Yeon Hwang, Thomas Niederkrotenthaler, Ulrich Hegerl, Vita Poštuvan, Yutaka Motohashi, Kairi Kõlves
University of Washington affiliated authors are displayed in bold.
Published: April 2025
Suicide research and prevention are complex. Many practical, methodological and ethical challenges must be overcome to implement effective suicide prevention interventions. Implementation science can offer insights into what works, why and in what context. Yet, there are limited real-world examples of the application of implementation science in suicide prevention. This study aimed to identify approaches to employ principles of implementation science to tackle important challenges in suicide prevention.
A questionnaire about promoting implementation science for suicide prevention was developed through thematic analysis of stakeholder narratives. Statements were categorised into six domains: research priorities, practical considerations, approach to intervention design and delivery, lived experience engagement, dissemination and the way forward. The questionnaire (n=52 statements—round 1; n=44 statements—round 2; n=9 statements—round 3) was administered electronically to a panel (n=62—round 1, n=48—round 2; n=45—round 3) of international experts (suicide researchers, leaders, project team members, lived experience advocates). Statements were rated on a Likert scale based on an understanding of importance and priority of each item. Statements endorsed by at least 85% of the panel would be included in the final guidelines.
Eighty-two of the 90 statements were endorsed. Recommendations included broadening research inquiries to understand overall programme impact; accounting for resources in the translation of evidence into practice; embedding implementation science in intervention delivery and design; meaningfully engaging lived experience; considering channels for dissemination of implementation-related findings and focusing on next steps needed to routinely harness the strengths of implementation science in suicide prevention research, practice and training.
An interdisciplinary panel of suicide prevention experts reached a consensus on optimal strategies for using implementation science to enhance the effectiveness of policies and programmes aimed at reducing suicide.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Jill Locke, Nathaniel J. Williams, Aksheya Sridhar, Mark G. Ehrhart, Alex Dopp, Marissa Thirion, Christine Espeland, Brandon Riddle, Kelcey Schmitz, Kurt Hatch, Lindsey Buehler & Aaron R. Lyon
University of Washington affiliated authors are displayed in bold.
Published: April 2025
Schools need to implement universal student supports that prevent social, emotional, and behavioral difficulties; minimize associated risks; and promote social, emotional, and behavioral competencies. The purpose of this study is to examine the efficacy of the Helping Educational Leaders Mobilize Evidence (HELM) implementation strategy for promoting school-level implementation leadership, implementation climate, and high-fidelity delivery of an evidence-based practice. We will test HELM with an exemplar EBP, Positive Behavioral Interventions and Supports (PBIS). The specific aims of the study are to: 1) experimentally evaluate the effects of HELM versus PBIS training and technical assistance only (control condition); and 2) explore for whom, under what conditions, how equitably, and through which processes HELM works to improve outcomes, as well as its cost-effectiveness.
This study will use a hybrid type 3 effectiveness-implementation trial to provide a rigorous test of the effects of HELM in elementary schools. Schools will be randomly assigned to HELM + PBIS training and technical assistance (n = 21 schools; n = 210 educators) or PBIS training and technical assistance only (n = 21 schools; n = 210 educators) in a 1:1 ratio within cohorts using covariate constrained randomization that accounts for degree of prior PBIS exposure (measured using the Tiered Fidelity Inventory at baseline) and school size. A series of mixed effects models (time within educator, educator within school) will test within-subject/between-subject interactions across three timepoints (12 months total) to examine whether HELM will show steeper gains than the control on implementation leadership (primary outcome), implementation climate, PBIS fidelity, and student outcomes. Mediational analyses will test hypothesized mechanisms of change (i.e., implementation leadership and climate) of HELM on PBIS fidelity. Sequential mixed-methods data collection and analyses will further explore how organizational mechanisms are linked to implementation outcomes. Cost-effectiveness analyses will compare costs and outcomes of PBIS training and technical assistance only versus PBIS implementation with HELM.
The nature of leadership support in schools can make the difference between successful and unsuccessful EBP implementation. Testing HELM within the context of PBIS implementation will provide rigorous evidence about whether and how HELM can equitably address important EBP and student outcomes.
Clinical Trials ID: NCT06586723. Date of Registration: August 27, 2024. Prospectively registered. URL of Trial Registry Record: https://clinicaltrials.gov/study/NCT06586723?intr=helm&rank=1
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Name of the registry
clinicaltrials.gov.
Peer Review reports
Jeffrey Cook, Melissa Mistretta, Carmen P. McLean, Jeffrey Mann, Erin Frick, Alan L. Peterson, Stacey Young-McCaughan, Elisa V. Borah, Katherine Anne Comtois, Katherine A. Dondanville, Allison M. Conforte, Jeremy Jinkerson, Zachary K. Jones
81st Medical Group, Keesler Air Force Base, Biloxi, Mississippi, United States
Hana J. Kim, Jared S. Link, Debra Nofziger, Erik N. Ringdahl, John Waggoner, Craig Woodworth, Craig S. Rosen, & David S. Riggs
University of Washington affiliated authors are displayed in bold.
Published: April 2025
Matias Korfmacher, Cat Hartwell, Kelly Hill, Nathaniel Matthews-Trigg, Jeremy Hess, Amruta Nori-Sarma, & Gregory Wellenius
University of Washington affiliated authors are displayed in bold.
Published: April 2025
The 2021 Pacific Northwest heat dome was Washington state’s deadliest recorded weather event and presented unprecedented response challenges to the state’s health sector. Understanding the impacts of this extreme heat event (EHE) on the sector as well as the barriers to and facilitators of implementing effective heat response is critical to preparing for future events, which are happening more frequently in the region due to climate change.
Guided by an implementation science framework, we convened listening sessions and focus groups of the health sector in western Washington to reflect on regional response efforts.
Health sector organisations in 15 counties in western Washington State, USA: Clallam, Grays Harbor, Island, Jefferson, King, Kitsap, Lewis, Mason, Pacific, Pierce, San Juan, Skagit, Snohomish, Thurston and Whatcom.
A convenience sample of 109 listening group participants was recruited through the professional networks of the Northwest Healthcare Response Network, a regional healthcare coalition. 27 of the health sector professionals were recruited using purposive sampling to participate in seven focus groups organised by organisation type.
The co-presence of the COVID-19 pandemic, limited staff capacity, resource acquisition challenges and inadequate regional collaboration emerged as key barriers, while advanced planning, indoor cooling capabilities, adapting strategies to local needs, robust internal relationships and strong external partnerships were reported to facilitate effective response. Establishing centralised coordination ahead of heat events, making improvements to the cooling capabilities of the built environment, developing plans and policies for EHEs that have co-benefits for other events, adopting evidence-informed response strategies, institutionalising the knowledge and relationships developed through prior events and improving evaluative processes (such as developing real-time monitoring capacity) will enable more effective response to future EHEs.
Western Washington’s health sector implemented EHE response activities that enabled essential service continuity, despite limited resources, unfamiliarity with EHEs and other systemic challenges. The recency of the heat dome presents an opportunity to incorporate lessons learnt into practice, policies, plans and built environment; these are necessary improvements ahead of future large-scale events the region may experience in the coming decades.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Phillip L Marotta, Debbie Humphries, Daniel Escudero, David A Katz, Joseph G Rosen, Samantha Veronica Hill, Jennifer L Glick, Dennis H Li, Latosha Elopre, Fatemeh Ghadimi, Rinad S Beidas, Jose Bauermeister, Stephen Bonett, Drew B Cameron, LaRon E Nelson, Serena Rajabiun, Larry R Hearld, Mansoorah Kermani, Sarah Stoltman, Darjai Payne, Tobeya Ibitayo, Faiad Alam, Amanda Williams, Corilyn Ott, Emma Kay, Sarah Chrestman, Scott Batey, Laramie R Smith, Robin Gaines Lanzi, Karen Musgrove, Mayra Malagon, Jeannette Bailey-Webb, Florence Momplaisir, Robert Gross, Gregory Gross, Taylor Kaser, Tawnya Brown, Chelsey R Carter, Michael Mugavero , Tequetta Valeriano, Sarah Shaw, Anjuli D Wagner, Bakari Atiba, & Russell A Brewer
University of Washington affiliated authors are displayed in bold.
Published: April 2025
Reva Datar, Sheree Schwartz, Wilson Gomez, David A Katz, Gustavo Morales, Debbie Humphries, April Pettit, Audrey Harkness, Pedro Alonso Serrano, Robin Gaines Lanzi, Jessica M Sales, Christopher Archiopoli, Stefan Baral, Laura K Beres
University of Washington affiliated authors are displayed in bold.
Published: April 2025