Search

Globally, there has been an increasing call for dissemination and implementation science to improve the health equity of older adults. However, improving the health equity of older adults requires methods that allow for an in-depth understanding of the existing research. While the value of review articles is widely recognized, the value of publishing review protocols is an emerging paradigm with great potential to advance implementation science and aging research. In this article, we propose that prior to review articles, review protocols are necessary as they provide a clear and comprehensive search strategy, which greatly enhances the quality and rigor of reviews. More specifically, we argue that review protocols are indispensable because they support: (1) a clearly defined and comprehensive search methodology; (2) reviewer feedback to mitigate potential issues; and (3) registration to reduce risk of research replication. Additionally, we propose three strategies to accelerate review protocols in implementation science to support older adults’ health equity.

BackgroundThere is a large number of research studies about the prevention of non-communicable diseases (NCD), with findings taking several years to be translated into practice. One reason for this lack of translation is a limited understanding of how to best disseminate NCD research findings to user-groups in a way that is salient and useful. An understanding of barriers and facilitators to dissemination is key to informing the development of strategies to increase dissemination. Therefore, this review aims to identify and synthesise the barriers and facilitators to dissemination of NCD research findings.MethodsA mixed studies systematic review was performed following JBI (formerly known as Joanna Briggs Institute) methodology. The search included articles from January 2000 until May 2021. We conducted a comprehensive search of bibliographic and grey literature of five databases to identify eligible studies. Studies were included if they involved end-users of public health research that were decision-makers in their setting and examined barriers/facilitators to disseminating research findings. Two pairs of reviewers mapped data from included studies against the Framework of Knowledge Translation (FKT) and used a convergent approach to synthesise the data.ResultsThe database search yielded 27,192 reports. Following screening and full text review, 15 studies (ten qualitative, one quantitative and four mixed methods) were included. Studies were conducted in 12 mostly high-income countries, with a total of 871 participants. We identified 12 barriers and 14 facilitators mapped to five elements of the FKT. Barriers related to: (i) the user-group (n = 3) such as not perceiving health as important and (ii) the dissemination strategies (n = 3) such as lack of understanding of content of guidelines. Several facilitators related to dissemination strategies (n = 5) such as using different channels of communication. Facilitators also related to the user-group (n = 4) such as the user-groups’ interest in health and research.ConclusionResearchers and government organisations should consider these factors when identifying ways to disseminate research findings to decision-maker audiences. Future research should aim to build the evidence base on different strategies to overcome these barriers.Systematic review registrationThe protocol of this review was deposited in Open Science Framework (https://doi.org/10.17605/OSF.IO/5QSGD).

BackgroundEquity is fundamental to health promotion programmes. However, unintentional or unseen barriers may exist for some underserved groups. We aimed to identify how to ensure equitable access and engagement for diverse parent carers of disabled children to benefit from health promotion programmes.MethodsWe purposively sampled parent carers with potentially intersecting characteristics including those who self-identified as from ethnic groups, whose children were educated other than at school, with sensory impairments, or neurodiversity, and fathers. Participants were recruited through local and national organisations and parent carer networks. Data collection involved semi-structured individual interviews, which were transcribed verbatim and analysed thematically and iteratively alongside data collection. Core researchers performed early analysis independently, followed by research team and advisory group cross-validation.ResultsThirty-six parent carers with intersecting characteristics across the sampled backgrounds participated. We identified various perceived barriers around finding out about, attending and engaging with health programmes. We organised the findings into five themes focused on concepts capturing challenges and potential solutions to contextual barriers to access and participation in health programmes. (i) Reach—judiciously using targeted and universal strategies to ensure equitable distribution; (ii) Credibility—demonstrating trustworthiness of those advertising and/or delivering the programme; (iii) Opportunity—ensuring that the programme is seen as fulfilling a relevant need; (iv) Reservations—addressing barriers of readiness to participate; and (v) Optimisation—tailoring to improve the inclusivity of the programme delivery.ConclusionWe identified modifiable factors that impede members of some social groups from engaging with, and benefiting from, health promotion programmes, and potential solutions. We advocate a multifaceted approach is required from outreach to delivery, tailored to be mindful of extant diverse needs of parent carers in underserved communities. We catalogue key considerations to inform implementation strategies to optimise equity in health programmes for parent carers. The implications are likely transferable to other interventions and contexts.

IntroductionRacial/ethnic disparities in maternal mortality rates represent one of the most significant areas of disparities amongst all conventional population perinatal health measures in the U.S. The alarming trends and persistent disparities of outcomes by race/ethnicity and geographic location reinforce the need to focus on ensuring quality and safety of maternity care for all women. Despite complex multilevel factors impacting maternal mortality and morbidity, there are evidence-based interventions that, when facilitated consistently and properly, are known to improve the health of mothers before, during and after pregnancy. The objective of this project is to test implementation of pre-conception counseling with father involvement in community-based settings to improve cardiovascular health outcomes before and during pregnancy in southeastern United States.Methods and analysisThis study has two components: a comprehensive needs and assets assessment and a small-scale pilot study. We will conduct a community informed needs and assets assessment with our diverse stakeholders to identify opportunities and barriers to preconception counseling as well as develop a stakeholder-informed implementation plan. Next, we will use the implementation plan to pilot preconception counseling with father involvement in community-based settings. Finally, we will critically assess the context, identify potential barriers and facilitators, and iteratively adapt the way preconception counseling can be implemented in diverse settings. Results of this research will support future research focused on identifying barriers and opportunities for scalable and sustainable public health approaches to implementing evidence-based strategies that reduce maternal morbidity and mortality in the southeastern United States’ vulnerable communities.DiscussionFindings will demonstrate that preconception counseling can be implemented in community health settings in the southeastern United States. Furthermore, this study will build the capacity of community-based organizations in addressing the preconception health of their clients. We plan for this pilot to inform a larger scaled-up clinical trial across community health settings in multiple southeastern states.

PurposeCurrent evidence supports the use of integrative oncology (IO) interventions in cancer supportive care. The demand for outpatient IO services in Hong Kong is expected to soar following the surge in cancer incidence due to population ageing. This study identified the factors influencing the delivery and utilisation of outpatient IO from local stakeholders’ perspectives and developed corresponding implementation strategies.MethodsThis study involved two sequential stages. First, with individual semi-structured interviews guided by the Theoretical Domains Framework (TDF), we explored stakeholders’ views on the barriers to and facilitators for implementing IO. Second, guided by a TDF-based qualitative data analysis of interview transcripts, we performed intervention mapping to develop Behaviour Change Wheel-based implementation strategies that may overcome the barriers and strengthen the facilitators.ResultsWe interviewed 31 stakeholders, including traditional Chinese medicine (TCM) practitioners (n = 8), biomedically-trained doctors (n = 7), nurses (n = 6), administrators (n = 4), caregivers (n = 4), and pharmacists (n = 2). The key local factors influencing outpatient IO are (1) lacking nursing and administrative workforce supporting IO service delivery, (2) lacking awareness of IO services among healthcare professionals, administrators, patients, and caregivers, and (3) lacking knowledge among healthcare professionals of herb–drug interaction and herbal toxicities.ConclusionWe recommended a multi-faceted implementation strategies package that included arranging funding to train, recruit, and retain nursing and administrative staff, devolving resources into promoting interprofessional collaborations and evidence on IO effectiveness and safety, integrating evidence on herb–drug interactions and herbal toxicities into automated electronic health record systems monitored by pharmacists with dual qualifications in TCM and conventional pharmacy.

Many public health challenges are characterized by complexity that reflects the dynamic systems in which they occur. Such systems involve multiple interdependent factors, actors, and sectors that influence health, and are a primary driver of challenges of insufficient implementation, sustainment, and scale of evidence-based public health interventions. Implementation science frameworks have been developed to help embed evidence-based interventions in diverse settings and identify key factors that facilitate or hinder implementation. These frameworks are largely static in that they do not explain the nature and dynamics of interrelationships among the identified determinants, nor how those determinants might change over time. Furthermore, most implementation science frameworks are top-down, deterministic, and linear, leaving critical gaps in understanding of both how to intervene on determinants of successful implementation and how to scale evidence-based solutions. Design thinking and systems science offer methods for transforming this problem-oriented paradigm into one that is solution-oriented. This article describes these two approaches and how they can be integrated into implementation science strategies to promote implementation, sustainment, and scaling of public health innovation, ultimately resulting in transformative systems changes that improve population health.

BackgroundChronic disease risk factors are increasing amongst adolescents, globally. Digital health prevention programs, which provide education and information to reduce chronic disease risk factors need to be equitable and accessible for all. For their success, multiple highly engaged stakeholders should be involved in development and implementation. This study aimed to evaluate stakeholders’ support for, and perspectives on potential public health impact of digital health prevention programs for adolescents and potential pathways for future implementation.MethodsQualitative semi-structured online interviews with stakeholders. Stakeholder mapping identified key individuals, groups and organizations across Australia that may influence the implementation of digital health prevention programs for adolescents. Recorded and transcribed interviews were analyzed within the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) Framework, using deductive content analysis.FindingsNineteen interviews were conducted in 2023 with stakeholders from government, health, non-government organizations, youth services, education, community settings and others. Four overarching themes were identified: (i) existing digital health initiatives are not fit for purpose; (ii) the co-creation of digital health prevention programs is critical for successful implementation; (iii) digital health prevention programs must address equity and the unique challenges raised by technology and; (iv) system level factors must be addressed.InterpretationStakeholders broadly supported digital health prevention programs, yet raised unique insights to ensure that future programs create public health impact by improving chronic disease risk factors among adolescents. These insights can be applied in future development of digital health prevention programs for adolescents to strengthen widespread implementation.

IntroductionRecent cash-value benefit (CVB) increases are a positive development to help increase WIC participant fruits and vegetables (FV) access. Little is known about the impacts of the CVB changes on FV redemptions or about implementation successes and challenges among WIC State and local agencies. This mixed method study aimed to evaluate (a) the CVB changes’ impact on FV access among WIC child participants measured by CVB redemption rates, (b) facilitators and barriers to CVB changes’ implementation, and (c) differences in FV redemption and facilitators and barriers by race/ethnicity.MethodsWe requested redemption data from all 89 State agencies for April 2020 to September 2022 and utilized descriptive statistics, interrupted time series analysis (ITS), and generalized linear regression analysis. Additionally, we recruited State agencies, local agencies, and caregivers across the U.S. for interviews and used rapid qualitative analysis to find emerging themes anchored in policy evaluation and implementation science frameworks.ResultsWe received redemption data from 27 State agencies and interviewed 23 State agencies, 61 local agencies, and 76 caregivers of child WIC participants. CVB monthly redemptions increased at $35/child/month compared to $9/child/month; however, adjusted ITS analyses found a decrease in redemption rates at $35/child/month. The decrease was not significant when the transition/first implementation month was excluded with rates progressively increasing over time. Differences were found among racial/ethnic groups, with lower redemption rates observed for non-Hispanic Black caregivers. Overall, WIC caregivers reported high satisfaction and utilization at the $35/child/month. The frequent and quick turnaround CVB changes strained WIC agency resources with agencies serving higher caseloads of diverse racial and ethnic populations experiencing greater issues with implementing the CVB changes.ConclusionDespite implementation challenges, the increased CVB shows promise to improve WIC participant FV access and satisfaction with WIC. WIC agencies need adequate lead time to update the CVB amounts, and resources and support to help ensure equitable distribution and utilization of the FV benefits.

Potent partnerships among researchers, policymakers, and community members have potential to produce positive changes in communities on a range of topics, including behavioral health. The paper provides a brief illustrative review of such partnerships and then describes the development and evolution of one partnership in particular in Virginia. The origin of the partnership is traced, along with its founding vision, mission, and values. Some of its several projects are described, including (a) needs assessment for implementation of evidence-based programs (EBPs) pursuant to the Family First Prevention Services Act; (b) statewide fidelity monitoring of key EBPs; and (c) projects to synergize state investments in specific EBPs, like multisystemic therapy, functional family therapy, and high fidelity wraparound. The paper concludes with some themes around which the center has evolved to serve the state and its citizens more effectively.

This manuscript undertakes a disciplinary self-critique of the field of implementation science, a field which attempts to bridge the gap between evidence-based interventions and their practical application. Despite the heightened emphasis on health equity and racial disparities, the field’s current discourse is limited by key epistemic shortcomings. First, even though prevalence of implementation gaps between racialized groups in the United States necessitates a comprehensive understanding of the systems perpetuating these disparities, the field does not operate with a general explanation for disparities not as a failure of systems, but a system historically and structural designed to produce disparities. Second, the field has attempted to address disparities without adequate dialog with a broad tradition of anti-racist and anti-colonial sociology, history and epistemology, and therefore risks a decontextualized analysis of disparities and under-informed approaches to achieving equity. Fortunately, scholarship from the Black radical tradition (BRT), such as the Public Health Critical Race Praxis (PHCRP), Critical Race Theory (CRT), and more broadly conceptual frameworks from post-modern, anti-colonial, Black feminist studies and social epistemology can offer to implementation science frameworks that center power dynamics and racialized oppression. This epistemic re-alignment of implementation research to “center at the margins” can enable the field of implementation science to more critically examine and dismantle systems that perpetuate racial inequalities in access to and utilization of health interventions. For example, normalization and dynamic fit, which are thought to be key mechanisms of implementation, are revealed in the light of this tradition of scholarship to be potentially problematic acquiescence to oppressive systems. Drawing from the concept of resistance anchored in the scholarship of the Black radical tradition as well as contemporary social epistemology such as the work of José Medina and Maria Fricker about epistemic justice, the authors further advance that implementation science could make more substantial contributions to the dismantling of racialized systems and actively work toward health justice through the transdisciplinary lens of resistance. This is a call to action for integrating implementation science with critical philosophical and theoretical perspectives rooted in Black studies and related insights, which have been acquired through the struggle for social justice, to inform the design of implementation strategies and research projects that improve health services and health outcomes for health disparity populations.

Background“Data to Care” (D2C) is a strategy which relies on a combination of public health surveillance data supplemented by clinic data to support continuity of HIV care. The Cooperative Re-Engagement Controlled Trial (CoRECT) was a CDC-sponsored randomized controlled trial of a D2C model, which provided an opportunity to examine the process of implementing an intervention for people with HIV (PWH) who are out-of-care across three public health department jurisdictions. Using the EPIS (Exploration, Preparation, Implementation, Sustainment) framework, we aimed to retrospectively describe the implementation process for each site to provide insights and guidance to inform future D2C activities implemented by public health agencies and their clinical and community partners.MethodsAfter completion of CoRECT, the three (Connecticut, Massachusetts, Philadelphia) trial sites reviewed study protocols and held iterative discussions to describe and compare their processes regarding case identification, interactions with partnering clinics and patients, and sustainability. The EPIS framework provided a structure for comparing key organizational and operational practices and was applied to the entire implementation process.ResultsThe trial sites varied in their implementation processes and the specific elements of the intervention. Factors including prior D2C experience, data management and analytic infrastructure, staff capacity, and relationships with clinic partners informed intervention development and implementation. Additionally, this review identified key lessons learned including to: (1) explore new supplemental sources for public health surveillance data; (2) work with stakeholders representing core functions/components in the early stages of the intervention design process; (3) build flexibility into all components of the follow-up activities; and (4) integrate data sharing, project management, and follow-up activities within existing DPH organizational structure.ConclusionThe CoRECT study provides a general blueprint and lessons learned for implementing a D2C intervention for re-engagement in HIV care. Interventions should be tailored to local operational and structural factors, and responsive to evolving clinical and public health practices.

IntroductionIn developing countries such as Pakistan, program and policies underperform in providing public good as weak institutions lead to decisions that are unresponsive to citizens and are driven by personal motivations of the incumbents. We describe the decision-making processes in the health sector through the framework of “Public Choice” theory which posits how individual motives shape institutional performance and direction.MethodsWe conducted 84 qualitative interviews with five types of stakeholders: politicians, senior and mid-level bureaucrats, donors, public health experts and media personnel spanning 2 periods over a decade. The initial interviews were conducted during 2013–2015 period and a case study on decision-making during the COVID-19 response was added in 2020–2022 period.FindingsMost new ideas originate from top political leadership, guided by personal agendas or political expediency. Senior bureaucrats implement politicians’ agenda and mid-level officials maintain the status quo and follow established “authority.” Since officials’ performance, promotions, transfers, and the rare dismissals are based on tenure deviations rather than work performance, individuals and institutions are reluctant to take initiative without “consensus” among their colleagues often leading to inaction or delays that obviate initiative and reform. The public sector lacks institutional memory, formal information gathering, and citizen engagement, impacting public goods, health services, and policies. Media and donor personnel are important influencers. However, media mostly report only “hot issues” in health, with short publication and reader attention cycles. Donor personnel are the most likely to follow evidence for decision making, albeit while following their institutional priorities determined centrally. The COVID-19 response is presented as a contrast from usual practices, where evidence was used to guide decisions, as the pandemic was perceived as a national threat by the highest leadership.ConclusionAbsence of citizen feedback and formal systems for evidence gathering and processing leads to decisions that neglect the needs of those they serve, prioritizing personal or political gains and perpetuating the status quo. However, the COVID-19 pandemic emphasized the importance of evidence-based decision-making and offers valuable lessons for reforming decision-making processes.

IntroductionThe widespread HIV epidemic in Ukraine is concentrated among people who inject drugs (PWID), making access to sterile injection paraphernalia (SIP) like sterile needles and syringes a critical method of HIV/AIDS prevention; however, the Russian invasion has threatened to disrupt the operations of syringe services programs (SSPs), creating a risk of HIV outbreaks among PWID.MethodsWe conducted 10 semi-structured interviews with outreach workers from SSPs. Interviews were purposively sampled to cover three prototypic regions of Ukraine: temporarily Russian-controlled, frontline, and destination. Qualitative results from interviews were then compared against a standardized, nationwide harm reduction database.ResultsWe found that the Russian invasion triggered both supply and demand challenges for SSPs. Demand increased for all regions due to client transitions from pharmacies that closed to SSPs, increases in illicit drug use, greater client openness to NGO support, and displacement of clients to destination regions. Supply decreased for all areas (except for remote destination regions) due to battle-related barriers like curfews, roadblocks, and Internet disruptions; diminished deliveries of SIP and funding; and staff displacement. Time series plots of the number of unique clients accessing harm reduction services showed that an initial decrease in service provision occurred at the start of the war but that most regions recovered within several months except for Russian-controlled regions, which continued to provide services to fewer clients relative to previous years.ConclusionTo ensure continued scale-up of SIP and other HIV prevention services, the SyrEx database should be leveraged to serve as a streamlined harm reduction locator that can inform workers and clients of open site locations and other pertinent information.

ObjectiveThis portfolio analysis aims to describe the scope of NIH-funded extramural research grants at the intersection of nutrition research and implementation science (IS) from 2011 to 2022 and to offer insights into future research opportunities relevant to the Strategic Plan for NIH Nutrition Research 2020–2030.MethodsA portfolio analysis of funded grants using NIH reporting systems was conducted to identify nutrition research and IS awarded between fiscal years 2011 and 2022. The authors screened the titles and abstracts for inclusion criteria: research and career development awards involved a nutrition and/or dietary intervention and measured a stated implementation outcome or used an IS theory, model, or framework.ResultsIn total, 33 NIH-funded awards met the inclusion criteria. Almost half of the awards (48.5%) were investigator-initiated research projects compared to research career awards and cooperative agreements. While studies were predominantly conducted in the United States, 15.2% were conducted in low- and middle-income countries in Africa, Latin America, and Asia. Adults aged 19–64 years and children aged 2–11 years represented most of the study populations (45.5 and 15.2%, respectively). Studies provided nutrition/dietary guidelines and created culturally tailored interventions, which were then adapted in collaboration with community partners in schools, hospitals, and religious settings. The most cited IS outcomes were feasibility, costs, adoption, and acceptability. Sixteen awards (48.5%) used an IS theory, model, or framework to guide their work.DiscussionThe findings show the breadth of NIH-funded nutrition and implementation research and highlight potential research opportunities.

BackgroundChildhood obesity is highly prevalent in the United States and disproportionately impacts communities of color and low-income populations; these disparities have worsened during the COVID-19 pandemic. Adoption of effective pediatric weight management interventions (PWMIs) that have been evaluated among low-income diverse populations is needed. The Healthy Weight Clinic PWMI, a package co-developed by the American Academy of Pediatrics and Massachusetts General Hospital, helps health centers establish multidisciplinary Healthy Weight Clinics based on previous randomized controlled trials which demonstrated effectiveness. We sought to identify the factors influencing successful adoption of this PWMI and understand adaptations needed prior to implementation in new sites.MethodsWe interviewed 20 stakeholders, 10 from two health centers in Mississippi where the Healthy Weight Clinic PWMI will be piloted (pre-implementation sites) and 10 from health centers that have previously implemented it (sites in maintenance stages). Separate interview guides informed by the Consolidated Framework for Implementation Research (CFIR) were developed for the pre-implementation sites and those in maintenance stages, including questions related to adaptations of the PWMI in response to the COVID-19 pandemic. Qualitative data analysis was conducted using directed content analysis based on CFIR constructs. Adaptations in response to the pandemic were categorized using Framework for Reporting Adaptations and Modifications-Expanded (FRAME).ResultsIn pre-implementation sites, an inner setting facilitator mentioned was a positive learning climate. Characteristics of individuals that can facilitate adoption include staff willingness to learn, valuing evidence-based care for childhood obesity, and culturally and weight-sensitive staff. In terms of patient needs and resources (outer setting), social drivers of health are barriers to adoption, but creative solutions were suggested to mitigate these. Other facilitators related to the intervention included its multidisciplinary model and adaptability. Similar themes were elicited from sites in maintenance stages; adaptations brought on by the pandemic, such as telehealth visits and content modification to align with distancing guidelines and the effects of social isolation were also described.ConclusionUnderstanding the factors influencing adoption of an evidence-based PWMI informs necessary adaptations and implementation strategies required to facilitate nationwide dissemination of PWMIs, with the goal of reaching the populations most at-risk.

IntroductionMental health promotion and screenings are recommended as part of standard preventive care. Mexican immigrants in the U.S. are at high risk for mental health illness especially after the COVID-19 pandemic, however access to mental health prevention for this population has been limited, which results in important implementation and equity gaps. The Ventanilla de Salud (VDS) program provides preventive services through Mexican consulates in the U.S.ObjectiveThe objective of this study was to assess capability, opportunity, and motivation for promotores to implement mental health programming through the VDS, leveraging early experiences of ongoing mental health prevention efforts.MethodsThis was a qualitative study using the Capability, Opportunity, and Motivation for Behavior Change model (COM-B). We conducted 9 focus groups with 40 VDS promotores and 6 semi-structured interviews with program stakeholders. Data were analyzed using inductive and deductive coding.ResultsWe found high levels of interest from the leadership, partners, and promotores to provide mental health services through the VDS. Early implementation of a mental health strategy that included training sessions for promotores and mental health promotion, screenings and referrals for VDS users was ongoing. We identified facilitators and barriers that could affect capability, opportunity, and motivation to provide mental health services. Facilitators included promotores’ extensive knowledge about the importance of mental health, promotores service mindset and commitment to provide services to VDS users, and general support from the VDS network and partners. Barriers included promotores’ turnover, need for additional economic compensation, burnout, competing priorities, and lack of mental health professionals to provide clinical services or supervision. Additional investments are recommended to support promotores’ well-being.ConclusionThe main lesson learned from this study was that investing in VDS promotores’ training, resources, and well-being is key to their capability, opportunity and motivation to provide mental health services for Mexican immigrants in the US. Results from this study can be applied to improve the ongoing VDS mental health strategy and increase its impact on the mental health of Mexican immigrants.

Sustainability and health inequities are key challenges in public health and healthcare. Research suggests that only about half of evidence-based interventions (EBIs) are sustained over time, and settings and populations experiencing systemic and structural barriers to health (e.g., poverty, racism, stigma, and discrimination) experience even greater challenges to sustainability. In this article, we argue that an enhanced focus on sustainability in the field of implementation science is critical in order to maximize the long-term health benefits and broader societal impacts of EBIs for all populations and settings. From an equity perspective, a focus on sustainability is particularly critical to prioritize among population sub-groups that have not historically received the benefits of health-related EBIs. We discuss how a health equity framing is essential to sustaining EBIs in under-resourced communities, and requires moving away from a deficit mindset that focuses on why EBIs are challenging to sustain, to one that focuses more on identifying and nurturing existing assets within individuals and communities to increase the likelihood that EBIs are sustained. We conclude with a discussion of future directions as well as recommendations and resources (e.g., frameworks, tools) to advance and make progress toward sustainability from a health equity mindset, including: (1) Actively planning early for sustainability alongside key partners; (2) Tracking progress toward enhancing sustainability and being accountable in doing so equitably for all settings and populations; and (3) Focusing on both equity and engagement early and often throughout the research process and all implementation phases.

RationaleThe host-pathogen relationship is inherently dynamic and constantly evolving. Applying an implementation science lens to policy evaluation suggests that policy impacts are variable depending upon key implementation outcomes (feasibility, acceptability, appropriateness costs) and conditions and contexts.COVID-19 case studyExperiences with non-pharmaceutical interventions (NPIs) including masking, testing, and social distancing/business and school closures during the COVID-19 pandemic response highlight the importance of considering public health policy impacts through an implementation science lens of constantly evolving contexts, conditions, evidence, and public perceptions. As implementation outcomes (feasibility, acceptability) changed, the effectiveness of these interventions changed thereby altering public health policy impact. Sustainment of behavioral change may be a key factor determining the duration of effectiveness and ultimate impact of pandemic policy recommendations, particularly for interventions that require ongoing compliance at the level of the individual.Practical framework for assessing and evaluating pandemic policyUpdating public health policy recommendations as more data and alternative interventions become available is the evidence-based policy approach and grounded in principles of implementation science and dynamic sustainability. Achieving the ideal of real-time policy updates requires improvements in public health data collection and analysis infrastructure and a shift in public health messaging to incorporate uncertainty and the necessity of ongoing changes. In this review, the Dynamic Infectious Diseases Public Health Response Framework is presented as a model with a practical tool for iteratively incorporating implementation outcomes into public health policy design with the aim of sustaining benefits and identifying when policies are no longer functioning as intended and need to be adapted or de-implemented.Conclusions and implicationsReal-time decision making requires sensitivity to conditions on the ground and adaptation of interventions at all levels. When asking about the public health effectiveness and impact of non-pharmaceutical interventions, the focus should be on when, how, and for how long they can achieve public health impact. In the future, rather than focusing on models of public health intervention effectiveness that assume static impacts, policy impacts should be considered as dynamic with ongoing re-evaluation as conditions change to meet the ongoing needs of the ultimate end-user of the intervention: the public.

Early intervention (EI) researchers (i.e., those focused on children birth to age 3 and their families who experience early vulnerabilities) often engage in translational research and implementation science at the intersection of public health, pediatrics, and EI. There is currently a significant research-to-practice gap in EI despite ongoing efforts to close it. Translational research and implementation science are promising approaches to promote transdisciplinary collaborations among researchers and to move EI research into practice, thus supporting positive outcomes for young children and families. This commentary proposes a contemporary alignment of translational research phases for EI. Two literature reviews served to inform development of this alignment: (1) a narrative literature review identified existing applications of translational phases to EI; and (2) a rapid review identified examples of existing behavior-focused translational models across disciplines. Several case examples of current translational research being conducted in EI are discussed and classified according to their respective translational phase. The proposed alignment and case examples provide a basis for transdisciplinary conversations among those working across the various fields and disciplines relevant to EI research. A shift in EI research to reflect a translational and implementation focus will help bridge the research-to-practice gap and, most importantly, speed the movement of scientific evidence into real-world contexts to positively impact young children and families.

BackgroundGender-based violence (GBV) and violence against children (VAC) are two prevalent and highly interconnected global health challenges, yet data and research capacities to study these forms of violence and to generate evidence-based policies and programs remain limited. To address critical shortages in research capacity in Vietnam and to establish a model for other Low- and Middle-Income Countries (LMICs), we are establishing CONVERGE—the Consortium for Violence Prevention Research, Implementation, and Leadership Training for Excellence.MethodsBased on a needs assessment with partners in Vietnam, CONVERGE will provide a comprehensive research training program supporting 15 long-term, postdoctoral trainees with multi-disciplinary research training in GBV and VAC. We also will offer in-country trainings and short-courses to 40 short-term mid-career academic trainees and 60 short-term practitioner/stakeholder trainees over 5 years to build productive GBV and VAC academic, scientific, and practitioner networks. The CONVERGE training program has four components: (1) 14 h of virtual/in-person annual mentorship training to prepare research mentors and to create a pipeline of future mentors in Vietnam; (2) a one-month intensive research training for long-term postdoctoral fellows at Emory University; (3) a structured 17-month, in-country mentored research project for long-term trainees that results in a peer-reviewed manuscript and a subsequent grant submission; and, (4) week-long in-country intensive translational trainings on implementation science, advanced topics in leadership, and advanced topics in science dissemination. Opportunities for on-going virtual training and professional networking will be provided for CONVERGE trainees and mentors in Vietnam with other trainees and mentors of D43s focused on injury/violence prevention, D43s housed at Emory, and D43s with other institutions in Southeast Asia. To assess the reach, implementation, fidelity, and effectiveness of these four components, we will implement a rigorous, mixed-methods, multi-level evaluation strategy using process and outcome measures. Findings from the evaluation will be used to refine program components for future trainee and mentor cohorts and to assess long-term program impact.DiscussionLed by Emory University in the US and Hanoi Medical University in Vietnam, CONVERGE represents leading institutions and experts from around the world, with a goal of providing mentorship opportunities for early-career scientists with an interest in violence prevention.

IntroductionThe purpose of this study is to evaluate two recruitment strategies on schools and participant participation rates and representativeness (reach) within a pediatric obesity treatment trial tailored for families who live in rural areas.MethodsRecruitment of schools was evaluated based on their progress toward enrolling participants. Recruitment and reach of participants were evaluated using (1) participation rates and (2) representativeness of demographics and weight status of participants compared to eligible participants (who did not consent and enroll) and all students (regardless of eligibility). School recruitment, as well as participant recruitment and reach, were evaluated across recruitment methods comparing opt-in (i.e., caregivers agreed to allow their child to be screened for eligibility) vs. screen-first (i.e., all children screened for eligibility).ResultsOf the 395 schools contacted, 34 schools (8.6%) expressed initial interest; of these, 27 (79%) proceeded to recruit participants, and 18 (53%) ultimately participated in the program. Of schools who initiated recruitment, 75% of schools using the opt-in method and 60% of schools using the screen-first method continued participation and were able to recruit a sufficient number of participants. The average participation rate (number of enrolled individuals divided by those who were eligible) from all 18 schools was 21.6%. This percentage was higher in schools using the screen-first method (average of 29.7%) compared to schools using the opt-in method (13.5%). Study participants were representative of the student population based on sex (female), race (White), and eligibility for free and reduced-price lunch. Study participants had higher body mass index (BMI) metrics (BMI, BMIz, and BMI%) than eligible non-participants.ConclusionsSchools using the opt-in recruitment were more likely to enroll at least 5 families and administer the intervention. However, the participation rate was higher in screen-first schools. The overall study sample was representative of the school demographics.

BackgroundRestaurants are an emerging yet underutilized setting to facilitate healthier eating, particularly among minoritized communities that disproportionately experience health inequities. The present study aimed to examine outcomes from interventions co-developed using Human-Centered Design (HCD) in two Latin American restaurants, including sales of healthier menu items (HMI) and the consumer nutrition environment. In addition, we aimed to assess implementation outcomes (acceptability, fidelity, and sustainability) and elucidate the determinants for implementation using the Consolidated Framework for Implementation Research.MethodsThis study used a mixed-methods, longitudinal design. Data were collected pre-, during, and post-intervention testing. Intervention outcomes were examined through daily sales data and the Nutrition Environment Measures Survey for Restaurants (NEMS-R). Changes in HMI sales were analyzed using interrupted time series. Implementation outcomes and determinants were assessed through site visits [observations, interviews with staff (n = 19) and customers (n = 31)], social media monitoring, and post-implementation key informant interviews with owners and staff. Qualitative data were analyzed iteratively by two independent researchers using codes developed a priori based on CFIR.ResultsThe HCD-tailored interventions had different outcomes. In restaurant one (R1), where new HMI were introduced, we found an increase in HMI sales and improvements in NEMS-R scores. In restaurant two, where existing HMI were promoted, we found no significant changes in HMI sales and NEMS-R scores. Acceptance was high among customers and staff, but fidelity and sustainability differed by restaurant (high in R1, low in R2). Barriers and facilitators for implementation were found across all CFIR constructs, varying by restaurant and intervention. Most relevant constructs were found in the inner setting (restaurant structure, implementation climate), individual characteristics, and process (HCD application). The influence of outer setting constructs (policy, peer pressure) was limited due to lack of awareness.ConclusionOur findings provide insights for interventions developed in challenging and constantly changing settings, as in the case of restaurants. This research expands the application of CFIR to complex and dynamic community-based settings and interventions developed using HCD. This is a significant innovation for the field of public health nutrition and informs future interventions in similarly dynamic and understudied settings.

IntroductionThe purpose of developing and adopting regulatory science (RS) for drug regulatory authorities (DRAs) is to enhance regulatory capacity by advancing the scientific approach for the evaluation of health-related products. While many DRAs around the world advocate the concept of RS, the implementation approaches of RS vary according to local needs and have not been systemically examined. This study aimed to systematically identify the evidence about how RS was developed, adopted, and advanced by the selected DRAs, and analyzed and compared the implementation experiences of RS development under the guidance of an implementation science framework.MethodsDocumentary analysis of government documents and a scoping literature review were conducted, and data analysis was performed under the guidance of the PRECEDE-PROCEED Model (PPM). DRAs in the United States, the European Union, Japan, and China had officially launched RS initiatives and were therefore selected as the target countries in this study.ResultsThere is no common consensus on the definition of RS among the DRAs. However, these DRAs shared the same goal of developing and adopting RS, which was used to develop new tools, standards, and guidelines that could improve the effectiveness and efficiency of the risk and benefit assessment of the regulated products. Each DRA had decided its own priority areas for RS development and thus set specific objectives that might be technology-based (e.g., toxicology and clinical evaluation), process-based (e.g., partnership with healthcare systems and high-quality review/consultation services), or product-based (e.g., drug-device combination products and innovative emerging technologies). To advance RS, considerable resources had been allocated for staff training, advancing information technology and laboratory infrastructure, and funding research projects. DRAs also took multifaceted approaches to expand scientific collaborations through public–private partnerships, research funding mechanisms, and innovation networks. Cross-DRA communications were also reinforced through horizon scanning systems and consortiums to better inform and assist the regulatory decision-making process. The output measurements might be scientific publications, funded projects, DRAs interactions, and evaluation methods and guidelines. Improved regulatory efficiency and transparency leading to benefits to public health, patient outcomes, and translation of drug research and development as the key primary outcomes of RS development were anticipated but not yet clearly defined.ConclusionThe application of the implementation science framework is useful for conceptualizing and planning the development and adoption of RS for evidence-based regulatory decision-making. Continuous commitment to the RS development and regular review of the RS goals by the decision-makers are important for DRAs to meet the ever-changing scientific challenges in their regulatory decision-making process.

BackgroundOnline pharmacies in Kenya provide sexual and reproductive health products (e.g., HIV self-testing, contraception) and could be leveraged to increase the reach of HIV pre-exposure and post-exposure prophylaxis (PrEP/PEP) to populations who do not frequently attend health facilities. To date, evidence is limited for operationalizing online PrEP/PEP delivery and the type of populations reached with this differential service delivery model.MethodsThe ePrEP Kenya Pilot will deliver daily oral PrEP and PEP via MYDAWA, a private online pharmacy retailer, to clients in Nairobi for 18 months. Potential clients will obtain information about PrEP/PEP on MYDAWA's sexual wellness page and self-screen for HIV risk. Individuals ≥18 years, identified as at HIV risk, and willing to pay for a blood-based HIV self-test and PrEP/PEP delivery will be eligible for enrollment. To continue with online PrEP/PEP initiation, eligible clients will purchase a blood-based HIV self-test for 250 KES (~USD 2) [delivered to their setting of choice for 99 KES (~USD 1)], upload an image of their self-test result, and attend a telemedicine visit with a MYDAWA provider. During the telemedicine visit, providers will screen clients for PrEP/PEP eligibility, including clinical concerns (e.g., kidney disease), discuss self-test results, and complete counseling on PrEP/PEP use and safety. Providers will refer clients who self-test HIV positive or report any existing medical conditions to the appropriate services at healthcare facilities that meet their preferences. Eligible clients will be prescribed PrEP (30-day PrEP supply at initiation; 90-day PrEP supply at follow-up visits) or PEP (28-day supply) for free and have it delivered for 99 KES (~USD 1). We will measure PrEP and PEP initiation among eligible clients, PEP-to-PrEP transition, PrEP continuation, and implementation outcomes (e.g., feasibility, acceptability, and costs).DiscussionEstablishing pathways to increase PrEP and PEP access is crucial to help curb new HIV infections in settings with high HIV prevalence. The findings from this study will provide evidence on the implementation of online pharmacy PrEP and PEP service delivery that can help inform guidelines in Kenya and similar settings.

BackgroundWhile depression is a leading cause of poor health, less than half of older adults receive adequate care. Inequities in both access and outcomes are even more pronounced for socially disadvantaged older adults. The collaborative care model (CCM) has potential to reduce this burden through community-based organizations (CBOs) who serve these populations. However, CCM has been understudied in diverse cultural and resource-constrained contexts. We evaluated the implementation and effectiveness of PEARLS, a home-based CCM adapted with and for community health workers/promotores (CHWs/Ps).MethodsWe used an instrumental case study design. Our case definition is a community-academic partnership to build CHW/P capacity for evidence-based depression care for older U.S. Latino adults in the Inland Empire region of California (2017–2020). We aimed to understand adaptations to fit local context; acceptability, feasibility, and fidelity; clinical effectiveness; and contextual determinants of implementation success or failure. Data sources included quantitative and qualitative administrative and evaluation data from participants and providers. We used descriptive statistics and paired t-tests to characterize care delivery and evaluate effectiveness post-intervention, and deductive thematic analysis to answer other aims.FindingsThis case study included 152 PEARLS participants and nine data sources (N = 67 documents). The CBO including their CHWs/Ps partnered with the external implementation team made adaptations to PEARLS content, context, and implementation strategies to support CHWs/Ps and older adults. PEARLS was acceptable, feasible and delivered with fidelity. Participants showed significant reductions in depression severity at 5 months (98% clinical response rate [mean (SD), 13.7 (3.9) drop in pre/post PHQ-9; p < 0.001] and received support for 2.6 social needs on average. PEARLS delivery was facilitated by its relative advantage, adaptability, and trialability; the team's collective efficacy, buy-in, alignment with organization mission, and ongoing reflection and evaluation during implementation. Delivery was challenged by weak partnerships with clinics for participant referral, engagement, reimbursement, and sustainability post-grant funding.DiscussionThis case study used existing data to learn how home-based CCM was adapted by and for CHWs/Ps to reduce health inequities in late-life depression and depression care among older Latino immigrants. The CBOs and CHWs/Ps strong trust and rapport, addressing social and health needs alongside depression care, and regular internal and external coaching and consultation, appeared to drive successful implementation and effectiveness.

IntroductionFrailty is a complex condition that is highly associated with health decline and the loss of independence. Home-delivered meal programs are designed to provide older adults with health and nutritional support that can attenuate the risk of frailty. However, home-delivered meal agencies do not routinely assess frailty using standardized instruments, leading to uncertainty over the longitudinal impact of home-delivered meals on frailty levels. Considering this knowledge gap, this study aimed to facilitate home-delivered meal staff's implementation of a standardized frailty instrument with meal clients as part of routine programming. This article (a) describes the use of Implementation Mapping principles to develop strategies supporting frailty instrument implementation in one home-delivered meal agency and (b) examines the degree to which a combination of strategies influenced the feasibility of frailty instrument use by home-delivered meal staff at multiple time points.Methods and materialsThis retrospective observational study evaluated staff's implementation of the interRAI Home Care Frailty Scale (HCFS) with newly enrolled home-delivered meal clients at baseline-, 3-months, and 6-months. The process of implementing the HCFS was supported by five implementation strategies that were developed based on tenets of Implementation Mapping. Rates of implementation and reasons clients were lost to 3- and 6-month follow-up were evaluated using univariate analyses. Client-level data were also examined to identify demographic factors associated with attrition at both follow-up time points.ResultsStaff implemented the HCFS with 94.8% (n = 561) of eligible home-delivered meal clients at baseline. Of those clients with baseline HCFS data, staff implemented the follow-up HCFS with 43% of clients (n = 241) at 3-months and 18.0% of clients (n = 101) at 6-months. Insufficient client tracking and documentation procedures complicated staff's ability to complete the HCFS at follow-up time points.DiscussionWhile the HCFS assesses important frailty domains that are relevant to home-delivered meal clients, its longitudinal implementation was complicated by several agency- and client-level factors that limited the extent to which the HCFS could be feasibly implemented over multiple time points. Future empirical studies are needed to design and test theoretically derived implementation strategies to support frailty instrument use in the home- and community-based service setting.

IntroductionImplementation strategies supporting the translation of evidence into practice need to be tailored and adapted for maximum effectiveness, yet the field of adapting implementation strategies remains nascent. We aimed to adapt “Getting To Outcomes”® (GTO), a 10-step implementation playbook designed to help community-based organizations plan and evaluate behavioral health programs, into “Getting To Implementation” (GTI) to support the selection, tailoring, and use of implementation strategies in health care settings.MethodsOur embedded evaluation team partnered with operations, external facilitators, and site implementers to employ participatory methods to co-design and adapt GTO for Veterans Health Administration (VA) outpatient cirrhosis care improvement. The Framework for Reporting Adaptations and Modifications to Evidenced-based Implementation Strategies (FRAME-IS) guided documentation and analysis of changes made pre- and post-implementation of GTI at 12 VA medical centers. Data from multiple sources (interviews, observation, content analysis, and fidelity tracking) were triangulated and analyzed using rapid techniques over a 3-year period.ResultsAdaptations during pre-implementation were planned, proactive, and focused on context and content to improve acceptability, appropriateness, and feasibility of the GTI playbook. Modifications during and after implementation were unplanned and reactive, concentrating on adoption, fidelity, and sustainability. All changes were collaboratively developed, fidelity consistent at the level of the facilitator and/or implementer.ConclusionGTO was initially adapted to GTI to support health care teams' selection and use of implementation strategies for improving guideline-concordant medical care. GTI required ongoing modification, particularly in steps regarding team building, context assessment, strategy selection, and sustainability due to difficulties with step clarity and progression. This work also highlights the challenges in pragmatic approaches to collecting and synthesizing implementation, fidelity, and adaptation data.Trial registrationThis study was registered on ClinicalTrials.gov (Identifier: NCT04178096).

BackgroundIt takes decades and millions of dollars for a new scientific discovery to become part of clinical practice. In 2015, the Center for Health Innovation & Implementation Science (CHIIS) launched a Professional Certificate Program in Innovation and Implementation Sciences aimed at transforming healthcare professionals into Agile Change Conductors capable of designing, implementing, and diffusing evidence-based healthcare solutions.MethodIn 2022, the authors surveyed alumni from the 2016–2021 cohorts of the Certificate Program as part of an educational quality improvement inquiry and to evaluate the effectiveness of the program.ResultsOf the 60 alumni contacted, 52 completed the survey (87% response rate) with 60% of graduates being female while 30% were an under-represented minority. On a scale from 1 to 5, the graduates agreed that the certificate benefited their careers (4.308 with a standard deviation (SD) of 0.612); expanded their professional network (4.615, SD of 0.530); and had a large impact on the effectiveness of their leadership (4.288, SD of 0.667), their change management (4.365, SD of 0.742), and their communication (4.392, SD of 0.666). Graduates claimed to use Agile Processes (Innovation, Implementation, or Diffusion), storytelling, and nudging weekly. On a scale from 0 to 10 where 10 indicates reaching a mastery, the average score for different Agile competencies ranged from 5.37 (SD of 2.80) for drafting business proposals to 7.77 (SD of 1.96) for self-awareness. For the 2020 and 2021 cohorts with existing pre and post training competency data, 22 of the 26 competencies saw a statistically significant increase.ConclusionThe Graduate Certificate has been able to create a network of Agile Change Conductors competent to design, implement, and diffuse evidence-based care within the healthcare delivery system. Further improvements in building dissemination mastery and program expansion initiatives are advised.

Getting the science right for implementation is critical for making the processes for improving outcomes more predictable and effective in global public health. Unfortunately, "implementation science" has become a catchphrase for ideas, assumptions, and findings concerning the science to service gap and how to close it. The purpose of this paper is to explore the dimensions of a "science of implementation" that meets the definitions of a science and is focused on implementation variables (i.e., purposeful processes to put innovations into effect so that intended benefits can be realized). A science of implementation is important for accomplishing the goals related to improving the health and well-being of populations around the world. Much of public health involves interaction-based interventions. In a typology of science, interaction-based interventions are created by specifying the nature of certain exchanges between and among individual people or groups. The complexity of developing interaction-based independent variables requires meeting benchmarks for fidelity to assure the presence and strength of implementation independent variables. The paper presents information related to the following tenets: (1) A science of implementation is based on if-then predictions. Science is cumulative. As predictions are made, tested, and elaborated, the facts accumulate to form the knowledge base for science and practice. (2) Implementation variables are interaction-based inventions and, therefore, must be created and established so the specific set of activities related to implementation can be studied. (3) A science of implementation is based on theory that organizes facts, leads to testable predictions, and is modified or discarded based on outcomes. (4) A science of interaction-based implementation depends on frequent measures of independent and dependent variables specific to implementation methods and outcomes. Two examples illustrate the implications for theory, research, and practice. The paper advocates a paradigm shift to a new mental model that values fidelity over tailoring, has one size fits all as a goal, and is concerned with the function of evidence rather than the form of evidence based on RCTs. Global health fundamentally requires scaling implementation capacity so that effective innovations can be used as intended and with good effect to achieve population benefits., Competing Interests: DF, MD, and KB were employed by Active Implementation Research Network, Inc., (Copyright © 2024 Fixsen, Van Dyke and Blase.)

Globally, there has been an increasing call for dissemination and implementation science to improve the health equity of older adults. However, improving the health equity of older adults requires methods that allow for an in-depth understanding of the existing research. While the value of review articles is widely recognized, the value of publishing review protocols is an emerging paradigm with great potential to advance implementation science and aging research. In this article, we propose that prior to review articles, review protocols are necessary as they provide a clear and comprehensive search strategy, which greatly enhances the quality and rigor of reviews. More specifically, we argue that review protocols are indispensable because they support: (1) a clearly defined and comprehensive search methodology; (2) reviewer feedback to mitigate potential issues; and (3) registration to reduce risk of research replication. Additionally, we propose three strategies to accelerate review protocols in implementation science to support older adults' health equity., Competing Interests: The authors declare that the article was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Bacsu, Pottle, Fehr, Funk and Smith.)

Background: There is a large number of research studies about the prevention of non-communicable diseases (NCD), with findings taking several years to be translated into practice. One reason for this lack of translation is a limited understanding of how to best disseminate NCD research findings to user-groups in a way that is salient and useful. An understanding of barriers and facilitators to dissemination is key to informing the development of strategies to increase dissemination. Therefore, this review aims to identify and synthesise the barriers and facilitators to dissemination of NCD research findings., Methods: A mixed studies systematic review was performed following JBI (formerly known as Joanna Briggs Institute) methodology. The search included articles from January 2000 until May 2021. We conducted a comprehensive search of bibliographic and grey literature of five databases to identify eligible studies. Studies were included if they involved end-users of public health research that were decision-makers in their setting and examined barriers/facilitators to disseminating research findings. Two pairs of reviewers mapped data from included studies against the Framework of Knowledge Translation (FKT) and used a convergent approach to synthesise the data., Results: The database search yielded 27,192 reports. Following screening and full text review, 15 studies (ten qualitative, one quantitative and four mixed methods) were included. Studies were conducted in 12 mostly high-income countries, with a total of 871 participants. We identified 12 barriers and 14 facilitators mapped to five elements of the FKT. Barriers related to: (i) the user-group ( n  = 3) such as not perceiving health as important and (ii) the dissemination strategies ( n  = 3) such as lack of understanding of content of guidelines. Several facilitators related to dissemination strategies ( n  = 5) such as using different channels of communication. Facilitators also related to the user-group ( n  = 4) such as the user-groups' interest in health and research., Conclusion: Researchers and government organisations should consider these factors when identifying ways to disseminate research findings to decision-maker audiences. Future research should aim to build the evidence base on different strategies to overcome these barriers., Systematic Review Registration: The protocol of this review was deposited in Open Science Framework (https://doi.org/10.17605/OSF.IO/5QSGD)., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Renda, Turon, Lim, Wolfenden, McCrabb, O’Connor, Finch, Smith, Goraya, Harrison, Naughton, Grady, Hodder, Reilly and Yoong.)

Background: Equity is fundamental to health promotion programmes. However, unintentional or unseen barriers may exist for some underserved groups. We aimed to identify how to ensure equitable access and engagement for diverse parent carers of disabled children to benefit from health promotion programmes., Methods: We purposively sampled parent carers with potentially intersecting characteristics including those who self-identified as from ethnic groups, whose children were educated other than at school, with sensory impairments, or neurodiversity, and fathers. Participants were recruited through local and national organisations and parent carer networks. Data collection involved semi-structured individual interviews, which were transcribed verbatim and analysed thematically and iteratively alongside data collection. Core researchers performed early analysis independently, followed by research team and advisory group cross-validation., Results: Thirty-six parent carers with intersecting characteristics across the sampled backgrounds participated. We identified various perceived barriers around finding out about, attending and engaging with health programmes. We organised the findings into five themes focused on concepts capturing challenges and potential solutions to contextual barriers to access and participation in health programmes. (i) Reach-judiciously using targeted and universal strategies to ensure equitable distribution; (ii) Credibility-demonstrating trustworthiness of those advertising and/or delivering the programme; (iii) Opportunity-ensuring that the programme is seen as fulfilling a relevant need; (iv) Reservations-addressing barriers of readiness to participate; and (v) Optimisation-tailoring to improve the inclusivity of the programme delivery., Conclusion: We identified modifiable factors that impede members of some social groups from engaging with, and benefiting from, health promotion programmes, and potential solutions. We advocate a multifaceted approach is required from outreach to delivery, tailored to be mindful of extant diverse needs of parent carers in underserved communities. We catalogue key considerations to inform implementation strategies to optimise equity in health programmes for parent carers. The implications are likely transferable to other interventions and contexts., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Harniess, McGlinchey, McDonald, Boyle, Garrood, Logan, Morris and Borek.)

Introduction: Racial/ethnic disparities in maternal mortality rates represent one of the most significant areas of disparities amongst all conventional population perinatal health measures in the U.S. The alarming trends and persistent disparities of outcomes by race/ethnicity and geographic location reinforce the need to focus on ensuring quality and safety of maternity care for all women. Despite complex multilevel factors impacting maternal mortality and morbidity, there are evidence-based interventions that, when facilitated consistently and properly, are known to improve the health of mothers before, during and after pregnancy. The objective of this project is to test implementation of pre-conception counseling with father involvement in community-based settings to improve cardiovascular health outcomes before and during pregnancy in southeastern United States., Methods and Analysis: This study has two components: a comprehensive needs and assets assessment and a small-scale pilot study. We will conduct a community informed needs and assets assessment with our diverse stakeholders to identify opportunities and barriers to preconception counseling as well as develop a stakeholder-informed implementation plan. Next, we will use the implementation plan to pilot preconception counseling with father involvement in community-based settings. Finally, we will critically assess the context, identify potential barriers and facilitators, and iteratively adapt the way preconception counseling can be implemented in diverse settings. Results of this research will support future research focused on identifying barriers and opportunities for scalable and sustainable public health approaches to implementing evidence-based strategies that reduce maternal morbidity and mortality in the southeastern United States' vulnerable communities., Discussion: Findings will demonstrate that preconception counseling can be implemented in community health settings in the southeastern United States. Furthermore, this study will build the capacity of community-based organizations in addressing the preconception health of their clients. We plan for this pilot to inform a larger scaled-up clinical trial across community health settings in multiple southeastern states., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Hernandez-Green, Haiman, McDonald, Rollins, Franklin, Farinu, Clarke, Huebshmann, Fort, Chandler, Brocke, McLaurin-Glass, Harris, Berry, Suarez and Williams.)

IntroductionClinical trials in sub-Saharan Africa support that HIV self-testing (HIVST) can increase testing rates in difficult-to-reach populations. However, trials mostly evaluate oral fluid HIVST only. We describe preferences for oral fluid vs. blood-based HIVST to elucidate prior trial results and inform testing programs.MethodsParticipants were recruited from a HIVST randomized controlled trial in Nakuru County, Kenya, which aimed to test the effect of choice between oral HIVST and facility-based testing compared to standard-of-care on HIV testing among truck drivers. We conducted in-depth interviews (IDIs) with purposively sampled trial participants who declined HIV testing at baseline or who were offered access to oral fluid HIVST and chose not to pick up the kit during follow-up. IDIs were conducted with all consenting participants. We first describe IDI participants compared to the other study participants, assessing the statistical significance of differences in characteristics between the two samples and then describe preferences, beliefs, and attitudes about HIVST biospecimen type expressed in the IDIs.ResultsThe final sample consisted of 16 men who refused HIV testing at baseline and 8 men who did not test during follow-up. All IDI participants had tested prior to study participation; mean number of years since last HIV test was 1.55, vs. 0.98 among non-IDI participants (p = 0.093). Of the 14 participants who answered the question about preferred type of HIVST, nine preferred blood-based HIVST, and five, oral HIVST. Preference varied by study arm with four of five participants who answered this question in the Choice arm and five of nine in the SOC arm preferring blood-based HIVST. Six key themes characterized truckers' views about test type: (1) Rapidity of return of test results. (2) Pain and fear associated with finger prick. (3) Ease of use. (4) Trust in test results; (5) fear of infection by contamination; and (6) Concerns about HIVST kit storage and disposal.ConclusionWe found no general pattern in the themes for preference for oral or blood-based HIVST, but if blood-based HIVST had been offered, some participants in the Choice arm might have chosen to self-test. Offering choices for HIVST could increase testing uptake.

BackgroundPolicies addressing food insecurity are only effective if they are implemented successfully, serving those most at risk. Universal school meals provide a key intervention to schools that serve predominantly low-income families by providing free school breakfast and lunch to all. Unfortunately, low uptake of such provisions among students is concerning especially regarding school breakfast, warranting key implementation support for schools to ensure student nutrition needs are met. Thus, the purpose of this study was to evaluate the determinants of implementing two different school breakfast programs and pragmatic strategies for serving breakfast in ways that maximize student participation.MethodsA qualitative study was conducted between 2018 and 2020 within the School District of Philadelphia (SDP) comprising surveys, interviews, and observations to assess contextual determinants of two distinctive breakfast models: Breakfast in the Classroom (BIC) and Cafeteria after the Bell (CAB). Principals and lead kitchen staff completed surveys to assess determinants of breakfast model adoption. Principals, lead kitchen staff, classroom teachers, climate (i.e., social emotional wellbeing), and facilities staff subsequently participated in interviews to discuss implementation determinants (i.e., facilitators and challenges) and strategies for maximizing student participation. Observations provided rich data to triangulate interviews and survey data. Survey data were analyzed using frequency analysis, and observation and interview data were analyzed through thematic analysis. Presentation of themes was framed by the Consolidated Framework for Implementation Research.ResultsResults highlighted several positive determinants to participation including addressing student and family needs, making data-informed decisions, and providing hot meals and fruit based on student tastes. Negative determinants to implementation comprised challenges to SNAP-Ed-funded policy changes to promote student breakfast participation, lack of communication between administration, and staff and turnover among food service staff. Strategies included modifying school entrance procedures and combining breakfast with other education-related tasks to minimize instructional time lost through breakfast after the bell schedules.DiscussionData highlight the need to include implementation partner expertise when designing interventions for increasing reach and effectiveness of school meal programs. Future research that directly tests implementation strategies and key outcomes of reach/participation, among others, is critical to bridging the policy to practice gap in school nutrition programs.

IntroductionWorkplace programs to prevent non-communicable diseases (NCDs) in the workplace can help prevent the incidence of chronic diseases among employees, provide health benefits, and reduce the risk of financial loss. Nevertheless, these programs are not fully implemented, particularly in small- and medium-sized enterprises (SMEs). The purpose of this study was to develop implementation strategies for health promotion activities to prevent NCDs in Japanese SMEs using Implementation Mapping (IM) to present the process in a systematic, transparent, and replicable manner.MethodsQualitative methods using interviews and focus group discussions with 15 SMEs and 20 public health nurses were conducted in a previous study. This study applied the Consolidated Framework for Implementation Research and IM to analyze this dataset to develop implementation strategies suitable for SMEs in Japan.ResultsIn task 2 of the IM, we identified performance objectives, determinants, and change objectives for each implementation stage: adoption, implementation, and maintenance; to identify the required actors and actions necessary to enhance implementation effectiveness. Twenty-two performance objectives were identified in each implementation stage. In task 3 of the IM, the planning group matched behavioral change methods (e.g., modeling and setting of graded tasks, framing, self-re-evaluation, and environmental re-evaluation) with determinants to address the performance objectives. We used a consolidated framework for implementation research to select the optimal behavioral change technique for performance objectives and determinants and designed a practical application. The planning team agreed on the inclusion of sixteen strategies from the final strategies list compiled and presented to it for consensus, for the overall implementation plan design.DiscussionThis paper provides the implementation strategies for NCDs prevention for SMEs in Japan following an IM protocol. Although the identified implementation strategies might not be generalizable to all SMEs planning implementation of health promotion activities, because they were tailored to contextual factors identified in a formative research. However, identified performance objectives and implementation strategies can help direct the next steps in launching preventive programs against NCDs in SMEs.

IntroductionThe effective translation of evidence-based interventions has contributed to implementing actions that impact public policies and the population's health. However, there is a gap in the literature regarding the factors associated with the successful implementation of these interventions. The Active Life Improving Health Behavior Change Program (BCP-VAMOS) uses behavioral strategies to promote an active and healthy lifestyle in the community. Characterized as a health innovation, it also provides health professionals with online training to implement the program in Primary Health Care (PHC). Our study describes a pragmatic trial that aims to evaluate the implementation of BCP-VAMOS, version 3.0, in PHC in southern Brazil.Methods and analysisA pragmatic randomized controlled trial (PRCT) of two arms comparing a group of PHC professionals who will participate in a traditional didactic approach (control group) vs. a group that will receive ongoing support (intervention group) for the implementation of BCP-VAMOS. The intervention will be available to adults (≥18 years old) registered at PHC. Program recipient's will be assessed at baseline and post-intervention (9 months after) to measure markers of physical activity and eating behavior (primary outcomes). Program's implementation process will be monitored for 12 months and will be evaluated using the RE-AIM and Consolidated Framework for Implementation Research (CFIR) frameworks.DiscussionsThe survey findings can be used widely throughout Brazil, guiding the work of health professionals, service planners and policy-makers. Also, the results may help to inform the national health promotion policy to plan interventions and improve the implementation of programs in PHC. This research results will provide practical guidance for researchers to develop similar protocols to implement and adapt public health interventions.Ethics and disseminationEthics approval has been granted by the Human Research Ethics Committee of the Federal University of Santa Catarina (UFSC), Brazil, under no. 1394492. Results will be published in full as open access in the UFSC library and main trial results and associated papers in high-impact peer-reviewed journals.Trial registration numberRBR-2vw77q—Brazilian Registry of Clinical Trials – ReBEC (http://www.ensaiosclinicos.gov.br).

Responding rapidly to emerging public health crises is vital to reducing their escalation, spread, and impact on population health. These responses, however, are challenging and disparate processes for researchers and practitioners. Researchers often develop new interventions that take significant time and resources, with little exportability. In contrast, community-serving systems are often poorly equipped to properly adopt new interventions or adapt existing ones in a data-driven way during crises' onset and escalation. This results in significant delays in deploying evidence-based interventions (EBIs) with notable public health consequences. This prolonged timeline for EBI development and implementation results in significant morbidity and mortality that is costly and preventable. As public health emergencies have demonstrated (e.g., COVID-19 pandemic), the negative consequences often exacerbate existing health disparities. Implementation science has the potential to bridge the extant gap between research and practice, and enhance equity in rapid public health responses, but is underutilized. For the field to have a greater “real-world” impact, it needs to be more rapid, iterative, participatory, and work within the timeframes of community-serving systems. This paper focuses on rapid adaptation as a developing implementation science area to facilitate system responses during public health crises. We highlight frameworks to guide rapid adaptation for optimizing existing EBIs when responding to urgent public health issues. We also explore the economic implications of rapid adaptation. Resource limitations are frequently a central reason for implementation failure; thus, we consider the economic impacts of rapid adaptation. Finally, we provide examples and propose directions for future research and application.

BackgroundImplementation mapping is a systematic, collaborative, and contextually-attentive method for developing implementation strategies. As an exemplar, we applied this method to strategy development for Managed Problem Solving Plus (MAPS+), an adapted evidence-based intervention for HIV medication adherence and care retention that will be delivered by community health workers and tested in an upcoming trial.MethodsIn Step 1: Conduct Needs Assessment, we interviewed 31 stakeholders to identify determinants of MAPS+ implementation in 13 clinics serving people with HIV in Philadelphia County. In Step 2: Develop Logic Model, we used these determinants as inputs for a working logic model guided by the Consolidated Framework for Implementation Research. In Step 3: Operationalize Implementation Strategies, our team held a virtual stakeholder meeting to confirm determinants. We synthesized stakeholder feedback, then identified implementation strategies that conceptually matched to determinants using the Expert Recommendations for Implementing Change taxonomy. Next, we operationalized implementation strategies with specific examples for clinic settings. We linked strategies to behavior change theories to allow for a mechanistic understanding. We then held a second virtual stakeholder meeting to present the implementation menu for feedback and glean generalizable insights for how these strategies could be operationalized in each stakeholder's clinic. In Step 4: Protocolize Strategies, we incorporated stakeholder feedback and finalized the implementation strategy menu.FindingsImplementation mapping produced a menu of 39 strategies including revise professional roles, identify and prepare champions, use warm handoffs, and change record systems. The process of implementation mapping generated key challenges for implementation strategy development: lack of implementation strategies targeting the outer setting (i.e., sociopolitical context); tension between a one-size-fits-all and individualized approach for all clinics; conceptual confusion between facilitators and strategies; and challenges in translating the implementation science lexicon for partners.ImplicationsThis case exemplar advances both MAPS+ implementation and implementation science methods by furthering our understanding of the use of implementation mapping to develop strategies that enhance uptake of evidence-based interventions. The implementation menu will inform MAPS+ deployment across Philadelphia in an upcoming hybrid trial. We will carry out Step 5: Test Strategies to test the effectiveness and implementation of MAPS+.

BackgroundMulti-sector stakeholder engagement is essential in the successful implementation, dissemination, and sustainability of pediatric weight management interventions (PWMI), particularly in low-income settings where sustainability relies on external policies and reimbursement. The objective of this study was to engage stakeholders (1) to inform the creation of the intervention with adaptations needed for a successful PWMI in a primary care and community setting and (2) to identify barriers and facilitators to implementation and dissemination.MethodsWe sought to examine the perspectives of local, state, and national clinic and community stakeholders during the pre-implementation period of a two-arm, randomized trial of a Health Weight Clinic PWMI conducted in two health centers and a modified—Healthy Weight and Your Child PWMI at two local YMCAs that serve a predominantly lower income, Hispanic community. The Consolidated Framework for Implementation Research interview guide served as a template for the study but was modified to fit the PWMIs and the various professional roles. Interviews were transcribed and analyzed using the framework analysis approach and themes were linked to the CFIR domains and constructs.ResultsTwenty-six stakeholders perceived the following as needed components of a PWMI: a formal curriculum with illustrative examples, a patient- and family-centered program, group visits, and high-quality multidisciplinary personnel. These findings led to the creation of a group visit curriculum, implementation trainings and cross-site collaborative technical assistance. Additionally, creating partnerships between community and clinical organizations, and addressing patient barriers and unmet social needs (i.e., transportation, food) were identified as facilitators to successful implementation. These results led to the creation of community resource guides, connections to community organizations, and screening and referring for unmet social needs. Perceived facilitators of dissemination included proving cost-effectiveness of the PWMI to inform insurance reimbursement for long-term sustainability. Therefore, we collected cost data and engaged with Medicaid officials to discuss reimbursement.ConclusionFindings highlight the importance of engaging multi-sector stakeholders pre-implementation to ensure the components valued are included, ensuring the program minimizes barriers to participation, considering how staff training can improve implementation and how collected outcomes can inform sustainability and dissemination of PWMIs in clinic and community settings.

BackgroundCoach2Move is a person-centered physical therapy intervention that has demonstrated success in changing physical activity behaviors among older adults in the Netherlands. In this manuscript, we describe how we developed an implementation plan for Coach2move in a U.S. population and healthcare system using Implementation Mapping.MethodsWe established an implementation planning team of researchers, patients, and clinicians. The Consolidated Framework for Implementation Research provided an overall structure for consideration of the context for implementation. Implementation Mapping guided the planning process. The implementation planning team worked sequentially through the five tasks of Implementation Mapping (1) Identify needs, program adopters and implementers; (2) Identify adoption and implementation outcomes, performance objectives, determinants, and matrices of change; (3) Choose theoretical models and implementation strategies; (4) Produce implementation protocols; (5) Evaluate implementation outcomes. In this manuscript, we identify our evaluation plan but not results as data collection is ongoing.ResultsClinic managers and physical therapists were identified as program adopters and implementors. Performance objectives necessary steps to achieving implementation outcomes were linked to Coach2Move fidelity indicators with implementation by the physical therapist. These included delivery of person-centered care, motivational interviewing, meaningful goal setting, shared decision-making in planning, and systematic monitoring and follow-up. Determinants linked to these performance objectives included knowledge, outcome expectations, skills and self-efficacy, and perceived norms. Implementation strategies were selected based on a review of methods effective for influencing these determinants. This resulted in four primary strategies (1) educational meetings and dynamic training, (2) peer-assessment meetings, (3) changing the electronic health record template, and (4) reminders and prompts. Measures of intervention acceptability, appropriateness, and feasibility will be collected after training and early in implementation. Fidelity and effectiveness measures will be collected over the next 12-months.ConclusionImplementation mapping provided a systematic process for identifying what physical therapists would need to implement Coach2Move with fidelity. The result was a matrix linking behavioral determinants and performance objectives. These matrices of change allowed for systematic identification and tailoring of implementation strategies to the needs of our population and setting. The process was acceptable to diverse stakeholders, facilitated communication across stakeholders.

Mental wellness is a critical component of healthy development in emerging adulthood and serves to protect against stress and promote resilience against psychopathology. Emotion regulation is a key mechanism for effective prevention because of its role in socio-emotional competence and its transdiagnostic significance for psychopathology. In this feasibility study, a brief, time and cost-effective emotion regulation training program for emerging adults (BERT) was developed and tested using the RE-AIM framework. Importantly, building interventions within the context of an implementation framework, such as the RE-AIM framework, enhances the chances that an intervention will be able to scale out and scale up. First, the brainwriting premortem method was utilized to refine program content, conducting focus groups a priori to identify potential program failures prior to program implementation. Undergraduate students (n = 12) attended four focus groups presenting initial program content. Four clinicians were also interviewed to determine program barriers. Qualitative analyses aggregated participant feedback to identify compliments, changes, and concerns about BERT and critical feedback was immediately implemented prior to initial testing. BERT was rooted in cognitive-behavioral practices and informed by the Gross model of emotion regulation. The 5-week program was then examined in a college sample (N = 42) to evaluate implementation (low attrition, high content engagement, favorable attitudes, low incidence of technical errors, costs), reach (enrollment and completion demographics comparable to the population in which recruitment took place), and efficacy (positive change in emotion regulation pre- to post-program). Of the recruited participants, 36 remained in the study where 27 completed at least 80% of program content. Repeated-measures ANOVAs exhibited significant improvements in emotion regulation, psychological distress, and negative affectivity, suggesting promising initial efficacy. Initial data provide support for feasibility and a future randomized control trial. BERT has potential significance for promoting healthy development as its brief electronic format reduced barriers and the program development process incorporated stakeholder feedback at multiple levels to inform better implementation and dissemination.

AimsThis study aims to identify implementation determinants, mechanisms of action, implementation strategies, and implementation outcome evaluation plans for a new theory-based rehabilitation goal setting and goal management intervention system, called MyGoals, using Implementation Mapping with community-based participatory research principles.MethodsWe completed Implementation Mapping tasks 1 to 4 as a planning team consisting of MyGoals target implementers (occupational therapists (OTs), MyGoals intervention target clients (adults with chronic conditions), and the research team. We are currently conducting mapping task 5. These processes were guided by the Consolidated Framework for Implementation Research, social cognitive theory, the taxonomy of behavior change methods, and Proctor's implementation research framework.ResultsWe identified intervention-level determinants (MyGoals' evidence strength & quality, relative advantages) and OT-level determinants (knowledge, awareness, skills, self-efficacy, outcome expectancy). We selected the MyGoals implementation outcome (OTs will deliver MyGoals completely and competently), outcome variables (acceptability, appropriateness, feasibility, fidelity), and process outcomes. We also determined three performance objectives (e.g., OTs will deliver all MyGoals intervention components) and 15 change objectives (e.g., OTs will demonstrate skills for delivering all MyGoals intervention components). Based on the identified outcomes, objectives, and determinants, we specified the mechanisms of change (e.g., active learning). To address these determinants and achieve the implementation outcomes, we produced two tailored MyGoals implementation strategies: MyGoals Clinician Education and MyGoals Clinician Audit & Feedback. We developed evaluation plans to explore and evaluate how these two MyGoals implementation strategies perform using a mixed-methods study of OT-client dyads.ConclusionWe produced tailored implementation strategies for a rehabilitation goal setting and goal management intervention by using Implementation Mapping with community-based participatory research principles. The MyGoals implementation strategies may help OTs implement high-quality goal setting and goal management practice and thus contribute to bridging current research-practice gaps. Our findings can provide insight on how to apply implementation science in rehabilitation to improve the development and translation of evidence-based interventions to enhance health in adults with chronic conditions.

Organizational readiness is essential for high-quality implementation of innovations (programs, policies, practices, or processes). The R = MC2 heuristic describes three readiness components necessary for implementation—the general functioning of the organization (general capacities), the ability to deliver a particular innovation (innovation-specific capacities), and the motivation to implement the innovation. In this article, we describe how we used the Readiness Building System (RBS) for assessing, prioritizing, and improving readiness and Implementation Mapping (IM), a systematic process for planning implementation strategies, to build organizational readiness for implementation of sexual assault prevention evidence-based interventions (EBIs). While RBS provides an overarching approach for assessing and prioritizing readiness constructs (according to the R = MC2 heuristic; Readiness = Motivation x general Capacity × innovation specific Capacity), it does not provide specific guidance on the development and/or selection and tailoring of strategies to improve readiness. We used the five IM tasks to identify and prioritize specific readiness goals and develop readiness-building strategies to improve subcomponents described in the R = MC2 heuristic. This article illustrates how IM can be used synergistically with the RBS in applied contexts to plan implementation strategies that will improve organizational readiness and implementation outcomes. Specifically, we provide an example of using these two frameworks as part of the process of building organizational readiness for implementation of sexual assault prevention EBIs.

Translation of developmental science discoveries is impeded by numerous barriers at different stages of the research-to-practice pipeline. Actualization of the vast potential of the developmental sciences to improve children's health and development in the real world is imperative but has not yet been fully realized. In this commentary, we argue that an integrated developmental-implementation sciences framework will result in a translational mindset essential for accelerating real world impact. We delineate key principles and methods of implementation science of salience to the developmental science audience, lay out a potential synthesis between implementation and developmental sciences, provide an illustration of the Mental Health, Earlier Partnership (MHE-P), and set actionable steps for realization. Blending these approaches along with wide-spread adoption of the translational mindset has transformative potential for population-level impact of developmental science discovery.