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Hoskins K, Linn KA, Ahmedani BK, Boggs JM, Johnson C, Heintz J, Marcus SC, Kaminer I, Zabel C, Wright L, Quintana LM, Buttenheim AM, Daley MF, Elias ME, Jager-Hyman S, Lieberman A, Lyons J, Maye M, McArdle B, Ritzwoller DP, Small DS, Westphal J, Wolk CB, Zhang S, Shelton RC, Beidas RS. Equitable implementation of S.A.F.E. Firearm: A multi-method pilot study. Prev Med 2022; 165:107281. [PMID: 36191653 PMCID: PMC10013361 DOI: 10.1016/j.ypmed.2022.107281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/23/2022] [Accepted: 09/24/2022] [Indexed: 02/08/2023]
Abstract
Attention to health equity is critical in the implementation of firearm safety efforts. We present our operationalization of equity-oriented recommendations in preparation for launch of a hybrid effectiveness-implementation trial focused on firearm safety promotion in pediatric primary care as a universal suicide prevention strategy. In Step 1 of our process, pre-trial engagement with clinican partners and literature review alerted us that delivery of a firearm safety program may vary by patients' medical complexity, race, and ethnicity. In Step 2, we selected the Health Equity Implementation Framework to inform our understanding of contextual determinants (i.e., barriers and facilitators). In Step 3, we leveraged an implementation pilot across 5 pediatric primary care clinics in 2 health system sites to study signals of inequities. Eligible well-child visits for 694 patients and 47 clinicians were included. Our results suggested that medical complexity was not associated with program delivery. We did see potential signals of inequities by race and ethnicity but must interpret with caution. Though we did not initially plan to examine differences by sex assigned at birth, we discovered that clinicians may be more likely to deliver the program to parents of male than female patients. Seven qualitative interviews with clinicians provided additional context. In Step 4, we interrogated equity considerations (e.g., why and how do these inequities exist). In Step 5, we will develop a plan to probe potential inequities related to race, ethnicity, and sex in the fully powered trial. Our process highlights that prospective, rigorous, exploratory work is vital for equity-informed implementation trials.
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Affiliation(s)
- Katelin Hoskins
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Kristin A Linn
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Brian K Ahmedani
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, MI, USA
| | - Jennifer M Boggs
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Christina Johnson
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jonathan Heintz
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Steven C Marcus
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA
| | - Isabelle Kaminer
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Celeste Zabel
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, MI, USA
| | - Leslie Wright
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - LeeAnn M Quintana
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | | | - Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Marisa E Elias
- Department of Pediatrics, Henry Ford Health, Detroit, MI, USA
| | - Shari Jager-Hyman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Adina Lieberman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jason Lyons
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Melissa Maye
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, MI, USA
| | - Bridget McArdle
- Department of Pediatrics, Henry Ford Health, Detroit, MI, USA
| | - Debra P Ritzwoller
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Dylan S Small
- Wharton School of Business, University of Pennsylvania, Philadelphia, PA, USA
| | - Joslyn Westphal
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, MI, USA
| | | | - Shiling Zhang
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, MI, USA
| | - Rachel C Shelton
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Rinad S Beidas
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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152
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Giusto A, Friis-Healy EA, Kaiser BN, Ayuku D, Rono W, Puffer ES. Mechanisms of change for a family intervention in Kenya: An Integrated Clinical and Implementation Mapping approach. Behav Res Ther 2022; 159:104219. [PMID: 36283239 PMCID: PMC10155602 DOI: 10.1016/j.brat.2022.104219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/02/2022] [Accepted: 10/14/2022] [Indexed: 12/14/2022]
Abstract
To increase cultural relevance and maximize access for historically underserved populations, there is a need to explore mechanisms underlying treatment outcomes during piloting. We developed a mixed-method approach, Integrated Clinical and Implementation Mapping (ICIM), to explore clinical and implementation mechanisms to inform improvements in content and delivery. We applied ICIM in a pilot of Tuko Pamoja, a lay counselor-delivered family intervention in Kenya (10 families with adolescents ages 12-17). ICIM is a 3-phase process to triangulate data sources to analyze how and why change occurs within individual cases and across cases. We synthesized data from session and supervision transcripts, fidelity and clinical skills ratings, surveys, and interviews. Outputs included a comprehensive narrative and visual map depicting how content and implementation factors influenced change. For Tuko Pamoja, ICIM results showed common presenting problems, including financial strain and caregivers' distress, triggering negative interactions and adolescent distress. ICIM demonstrated that active treatment ingredients included communication skills and facilitated, prescribed time together. Families improved communication, empathy, and hope, facilitated improved family functioning and mental health. Key implementation mechanisms included provider clinical competencies, alliance-building, treatment-aligned adaptations, and consistent attendance. Results guided manual and training refinements and generated hypotheses about mechanisms to test in larger trials.
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Affiliation(s)
- Ali Giusto
- New York State Psychiatric Institute, Columbia University, Department of Psychiatry, New York, NY, 10032, USA; Duke Global Health Institute, Durham, NC, USA.
| | - Elsa A Friis-Healy
- Duke Global Health Institute, Durham, NC, USA; Department of Psychiatry Duke University School of Medicine, Durham, NC, USA.
| | - Bonnie N Kaiser
- Duke Global Health Institute, Durham, NC, USA; University of California San Diego, Anthropology Department and Global Health Program, La Jolla, CA, USA.
| | - David Ayuku
- Moi University, Academic Highway, Eldoret, Usain Gishu County, Kenya.
| | - Wilter Rono
- Moi Teaching & Referral Hospital, Eldoret, Rift Valley, Kenya.
| | - Eve S Puffer
- Duke Global Health Institute, Durham, NC, USA; Department of Neuroscience and Psychology, Duke University, Durham, NC, USA.
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153
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Moise N, Cené CW, Tabak RG, Young DR, Mills KT, Essien UR, Anderson CAM, Lopez-Jimenez F. Leveraging Implementation Science for Cardiovascular Health Equity: A Scientific Statement From the American Heart Association. Circulation 2022; 146:e260-e278. [PMID: 36214131 DOI: 10.1161/cir.0000000000001096] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Reducing cardiovascular disease disparities will require a concerted, focused effort to better adopt evidence-based interventions, in particular, those that address social determinants of health, in historically marginalized populations (ie, communities excluded on the basis of social identifiers like race, ethnicity, and social class and subject to inequitable distribution of social, economic, physical, and psychological resources). Implementation science is centered around stakeholder engagement and, by virtue of its reliance on theoretical frameworks, is custom built for addressing research-to-practice gaps. However, little guidance exists for how best to leverage implementation science to promote cardiovascular health equity. This American Heart Association scientific statement was commissioned to define implementation science with a cardiovascular health equity lens and to evaluate implementation research that targets cardiovascular inequities. We provide a 4-step roadmap and checklist with critical equity considerations for selecting/adapting evidence-based practices, assessing barriers and facilitators to implementation, selecting/using/adapting implementation strategies, and evaluating implementation success. Informed by our roadmap, we examine several organizational, community, policy, and multisetting interventions and implementation strategies developed to reduce cardiovascular disparities. We highlight gaps in implementation science research to date aimed at achieving cardiovascular health equity, including lack of stakeholder engagement, rigorous mixed methods, and equity-informed theoretical frameworks. We provide several key suggestions, including the need for improved conceptualization and inclusion of social and structural determinants of health in implementation science, and the use of adaptive, hybrid effectiveness designs. In addition, we call for more rigorous examination of multilevel interventions and implementation strategies with the greatest potential for reducing both primary and secondary cardiovascular disparities.
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154
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Schoenberg NE, Sherman D, Pfammatter AF, Roberts MK, Chih MY, Vos SC, Spring B. Adaptation and study protocol of the evidence-based Make Better Choices (MBC2) multiple diet and activity change intervention for a rural Appalachian population. BMC Public Health 2022; 22:2043. [PMID: 36348358 PMCID: PMC9643925 DOI: 10.1186/s12889-022-14475-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 10/26/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Rural Appalachian residents experience among the highest prevalence of chronic disease, premature mortality, and decreased life expectancy in the nation. Addressing these growing inequities while avoiding duplicating existing programming necessitates the development of appropriate adaptations of evidence-based lifestyle interventions. Yet few published articles explicate how to accomplish such contextual and cultural adaptation. METHODS In this paper, we describe the process of adapting the Make Better Choices 2 (MBC2) mHealth diet and activity randomized trial and the revised protocol for intervention implementation in rural Appalachia. Deploying the NIH's Cultural Framework on Health and Aaron's Adaptation framework, the iterative adaptation process included convening focus groups (N = 4, 38 participants), conducting key informant interviews (N = 16), verifying findings with our Community Advisory Board (N = 9), and deploying usability surveys (N = 8), wireframing (N = 8), and pilot testing (N = 9. This intense process resulted in a comprehensive revision of recruitment, retention, assessment, and intervention components. For the main trial, 350 participants will be randomized to receive either the multicomponent MBC2 diet and activity intervention or an active control condition (stress and sleep management). The main outcome is a composite score of four behavioral outcomes: two outcomes related to diet (increased fruits and vegetables and decreased saturated fat intake) and two related to activity (increased moderate vigorous physical activity [MVPA] and decreased time spent on sedentary activities). Secondary outcomes include change in biomarkers, including blood pressure, lipids, A1C, waist circumference, and BMI. DISCUSSION Adaptation and implementation of evidence-based interventions is necessary to ensure efficacious contextually and culturally appropriate health services and programs, particularly for underserved and vulnerable populations. This article describes the development process of an adapted, community-embedded health intervention and the final protocol created to improve health behavior and, ultimately, advance health equity. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT04309461. The trial was registered on 6/3/2020.
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Affiliation(s)
- Nancy E Schoenberg
- Department of Behavioral Science, University of Kentucky, 760 Press Avenue, 468 Healthy Kentucky Research Building, Lexington, KY, 40536, USA.
| | - Deanna Sherman
- Department of Behavioral Science, University of Kentucky, 760 Press Avenue, 468 Healthy Kentucky Research Building, Lexington, KY, 40536, USA
| | - Angela Fidler Pfammatter
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Ming-Yuan Chih
- Department of Health & Clinical Sciences, University of Kentucky, Lexington, KY, USA
| | - Sarah C Vos
- Department of Health Management and Policy, University of Kentucky, Lexington, KY, USA
| | - Bonnie Spring
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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155
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Quanbeck A, Hennessy RG, Park L. Applying concepts from "rapid" and "agile" implementation to advance implementation research. Implement Sci Commun 2022; 3:118. [PMID: 36335373 PMCID: PMC9636827 DOI: 10.1186/s43058-022-00366-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 11/08/2022] Open
Abstract
Background The translation of research findings into practice can be improved to maximize benefits more quickly and with greater flexibility. To expedite translation, researchers have developed innovative approaches to implementation branded as “rapid” and “agile” implementation. Rapid implementation has roots in precision medicine and agile implementation has roots in systems engineering and software design. Research has shown that innovation often derives from learning and applying ideas that have impacted other fields. Implications for implementation researchers This commentary examines “rapid” and “agile” approaches to implementation and provides recommendations to implementation researchers stemming from these approaches. Four key ideas are synthesized that may be broadly applicable to implementation research, including (1) adopting a problem orientation, (2) applying lessons from behavioral economics, (3) using adaptive study designs and adaptive interventions, and (4) using multi-level models to guide implementation. Examples are highlighted from the field where researchers are applying these key ideas to illustrate their potential impact. Conclusions “Rapid” and “agile” implementation approaches to implementation stem from diverse fields. Elements of these approaches show potential for advancing implementation research, although adopting them may entail shifting scientific norms in the field.
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Affiliation(s)
- Andrew Quanbeck
- Department of Family Medicine and Community Health, University of Wisconsin-Madison, 800 University Bay Drive, Madison, WI, 53705, USA.
| | - Rose Garza Hennessy
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, P.O. Box 413, Milwaukee, WI, 53205, USA
| | - Linda Park
- Department of Family Medicine and Community Health, University of Wisconsin-Madison, 800 University Bay Drive, Madison, WI, 53705, USA
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156
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Siegel L, Asada Y, Lin S, Fitzgibbon ML, Kong A. Perceived factors that influence adoption, implementation and sustainability of an evidence-based intervention promoting healthful eating and physical activity in childcare centers in an urban area in the United States serving children from low-income, racially/ethnically diverse families. FRONTIERS IN HEALTH SERVICES 2022; 2:980827. [PMID: 36925814 PMCID: PMC10012626 DOI: 10.3389/frhs.2022.980827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
Introduction Early childcare centers offer optimal settings to provide healthy built environments where preschool age children spend a majority of their week. Many evidence-based interventions (EBIs) promoting healthful eating and physical activity for early childcare settings exist, but there is a limited understanding of how best to support adoption, implementation and sustainability in community settings. This study examined how early childcare teachers and administrators from Chicago-area childcare centers serving children from low-income, racially/ethnically diverse communities viewed an EBI called Hip to Health (H3), and the factors they perceived as relevant for EBI adoption, implementation, and sustainability. Methods A multiple methods study including key informant interviews and a brief survey was conducted. Key informant interviews with teachers and administrators from childcare centers located in Chicago, IL were completed between December 2020 and May 2021. An interview guide and coding guide based on the Consolidated Framework for Implementation Research (CFIR) was developed. Interview transcripts were team coded in MAXQDA Qualitative Data Analysis software. Thematic analysis was used to identify findings specific to adoption, implementation, and sustainability. Participants were also asked to respond to survey measures about the acceptability, feasibility, and appropriateness of H3. Results Overall, teachers (n = 20) and administrators (n = 16) agreed that H3 was acceptable, appropriate, and feasible. Low start-up costs, ease-of-use, adaptability, trialability, compatibility, and leadership engagement were important to EBI adoption. Timely and flexible training was critical to implementation. Participants noted sustainability was tied to low ongoing costs, access to ongoing support, and positive observable benefits for children and positive feedback from parents. Conclusions These findings suggest that EBIs suitable for adoption, implementation, and sustainment in childcare centers serving racially/ethnically diverse, low-income families should be adaptable, easy to use, and low-cost (initial and ongoing). There is also some evidence from these findings of the heterogeneity that exists among childcare centers serving low-income families in that smaller, less resourced centers are often less aware of EBIs, and the preparation needed to implement EBIs. Future research should examine how to better support EBI dissemination and implementation to these settings.
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Affiliation(s)
- Leilah Siegel
- 4-H Youth Development, University of Illinois Extension, St. Charles, IL, United States
| | - Yuka Asada
- Community Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, IL, United States
| | - Shuhao Lin
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, United States
| | - Marian L. Fitzgibbon
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL, United States
| | - Angela Kong
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago, College of Pharmacy, Chicago, IL, United States
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157
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Nathan N, Powell BJ, Shelton RC, Laur CV, Wolfenden L, Hailemariam M, Yoong SL, Sutherland R, Kingsland M, Waltz TJ, Hall A. Do the Expert Recommendations for Implementing Change (ERIC) strategies adequately address sustainment? FRONTIERS IN HEALTH SERVICES 2022; 2:905909. [PMID: 36925827 PMCID: PMC10012683 DOI: 10.3389/frhs.2022.905909] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022]
Abstract
Background Sustainability science is an emerging area within implementation science. There is limited evidence regarding strategies to best support the continued delivery and sustained impact of evidence-based interventions (EBIs). To build such evidence, clear definitions, and ways to operationalize strategies specific and/or relevant to sustainment are required. Taxonomies and compilations such as the Expert Recommendations for Implementing Change (ERIC) were developed to describe and organize implementation strategies. This study aimed to adapt, refine, and extend the ERIC compilation to incorporate an explicit focus on sustainment. We also sought to classify the specific phase(s) of implementation when the ERIC strategies could be considered and applied. Methods We used a two-phase iterative approach to adapt the ERIC. This involved: (1) adapting through consensus (ERIC strategies were mapped against barriers to sustainment as identified via the literature to identify if existing implementation strategies were sufficient to address sustainment, needed wording changes, or if new strategies were required) and; (2) preliminary application of this sustainment-explicit ERIC glossary (strategies described in published sustainment interventions were coded against the glossary to identify if any further amendments were needed). All team members independently reviewed changes and provided feedback for subsequent iterations until consensus was reached. Following this, and utilizing the same consensus process, the Exploration, Preparation, Implementation and Sustainment (EPIS) Framework was applied to identify when each strategy may be best employed across phases. Results Surface level changes were made to the definitions of 41 of the 73 ERIC strategies to explicitly address sustainment. Four additional strategies received deeper changes in their definitions. One new strategy was identified: Communicate with stakeholders the continued impact of the evidence-based practice. Application of the EPIS identified that at least three-quarters of strategies should be considered during preparation and implementation phases as they are likely to impact sustainment. Conclusion A sustainment-explicit ERIC glossary is provided to help researchers and practitioners develop, test, or apply strategies to improve the sustainment of EBIs in real-world settings. Whilst most ERIC strategies only needed minor changes, their impact on sustainment needs to be tested empirically which may require significant refinement or additions in the future.
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Affiliation(s)
- Nicole Nathan
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW, Australia
| | - Byron J. Powell
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, St. Louis, MO, United States
- Division of Infectious Diseases, John T. Milliken Department of Medicine, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
- Center for Dissemination and Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, MO, United States
| | - Rachel C. Shelton
- Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health, New York, NY, United States
| | - Celia V. Laur
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW, Australia
| | - Maji Hailemariam
- Department of Obstetrics, Gynaecology and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, MI, United States
| | - Sze Lin Yoong
- School of Health Science, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Rachel Sutherland
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW, Australia
| | - Melanie Kingsland
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW, Australia
| | - Thomas J. Waltz
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI, United States
| | - Alix Hall
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW, Australia
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Koorts H, Bauman A, Edwards N, Bellew W, Brown WJ, Duncan MJ, Lubans DR, Milat AJ, Morgan PJ, Nathan N, Searles A, Lee K, Plotnikoff RC. Tensions and Paradoxes of Scaling Up: A Critical Reflection on Physical Activity Promotion. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192114284. [PMID: 36361159 PMCID: PMC9657872 DOI: 10.3390/ijerph192114284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/20/2022] [Accepted: 10/27/2022] [Indexed: 05/21/2023]
Abstract
Achieving system-level, sustainable 'scale-up' of interventions is the epitome of successful translation of evidence-based approaches in population health. In physical activity promotion, few evidence-based interventions reach implementation at scale or become embedded within systems for sustainable health impact. This is despite the vast published literature describing efficacy studies of small-scale physical activity interventions. Research into physical activity scale-up (through case-study analysis; evaluations of scale-up processes in implementation trials; and mapping the processes, strategies, and principles for scale-up) has identified barriers and facilitators to intervention expansion. Many interventions are implemented at scale by governments but have not been evaluated or have unpublished evaluation information. Further, few public health interventions have evaluations that reveal the costs and benefits of scaled-up implementation. This lack of economic information introduces an additional element of risk for decision makers when deciding which physical activity interventions should be supported with scarce funding resources. Decision-makers face many other challenges when scaling interventions which do not relate to formal research trials of scale-up; Methods: To explore these issues, a multidisciplinary two-day workshop involving experts in physical activity scale-up was convened by the University of Newcastle, Australia, and the University of Ottawa, Canada (February 2019); Results: In this paper we discuss some of the scale-up tensions (challenges and conflicts) and paradoxes (things that are contrary to expectations) that emerged from this workshop in the context of the current literature and our own experiences in this field. We frame scale-up tensions according to epistemology, methodology, time, and partnerships; and paradoxes as 'reach without scale', 'planned serendipity' and 'simple complexity'. We reflect on the implications of these scale-up tensions and paradoxes, providing considerations for future scale-up research and practice moving forward; Conclusions: In this paper, we delve deeper into stakeholders' assumptions, processes and expectations of scaling up, and challenge in what ways as stakeholders, we all contribute to desired or undesired outcomes. Through a lens of 'tensions' and 'paradoxes', we make an original contribution to the scale-up literature that might influence current perspectives of scaling-up, provide future approaches for physical activity promotion, and contribute to understanding of dynamic of research-practice partnerships.
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Affiliation(s)
- Harriet Koorts
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC 3220, Australia
| | - Adrian Bauman
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, NSW 2037, Australia
| | - Nancy Edwards
- School of Nursing, University of Ottawa, Ottawa, ON K1H 8M5, Canada
| | - William Bellew
- Sydney Medical School & Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Wendy J. Brown
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, QLD 4072, Australia
| | - Mitch J. Duncan
- School of Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
| | - David R. Lubans
- Centre for Active Living and Learning, College of Human and Social Futures, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Faculty of Sport and Health Sciences, University of Jyväskylä, 40014 Jyvaskyla, Finland
| | - Andrew J. Milat
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia
- Centre for Epidemiology and Evidence, NSW Ministry of Health, 1 Reserve Rd., St Leonards, NSW 2065, Australia
| | - Philip J. Morgan
- Centre for Active Living and Learning, College of Human and Social Futures, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Nicole Nathan
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW 2287, Australia
| | - Andrew Searles
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Karen Lee
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, NSW 2037, Australia
| | - Ronald C. Plotnikoff
- Centre for Active Living and Learning, College of Human and Social Futures, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Correspondence: ; Tel.: +61-(02)-49854465
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Pérez Jolles M, Willging CE, Stadnick NA, Crable EL, Lengnick-Hall R, Hawkins J, Aarons GA. Understanding implementation research collaborations from a co-creation lens: Recommendations for a path forward. FRONTIERS IN HEALTH SERVICES 2022; 2:942658. [PMID: 36908715 PMCID: PMC10003830 DOI: 10.3389/frhs.2022.942658] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/26/2022] [Indexed: 01/18/2023]
Abstract
Increasing calls within the field of implementation science (IS) research seek to promote active engagement of diverse and often disenfranchised stakeholder voices to increase buy-in, fidelity, outcome relevance, and sustainment of evidence-based practices (EBPs). Including such voices requires cultural humility and the integration of multiple perspectives and values among organizations, groups, and individuals. However, the IS field lacks guidance for researchers on structuring collaborative approaches to promote a co-created process (i.e., synergistic approach to goal attainment). We contend that improved operationalization of co-created implementation collaborations is critical to sparking synergy and addressing differentials based on power, privilege, knowledge, and access to resources among stakeholders. These differentials can undermine future implementation and sustainment efforts if not addressed early in the research effort. An insufficient understanding of the guiding principles of co-created implementation collaborations may limit the scientific value of evaluation processes, and researchers' ability to replicate outcomes. We propose a perspective foregrounded in the concept of co-creation to guide the structuring of implementation collaboratives through five principles. We offer three case examples informed by the Exploration, Preparation, Implementation, Sustainment (EPIS) Framework to illustrate the application of these co-creation principles. Lastly, we offer recommendations for promoting co-creation in IS research moving forward.
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Affiliation(s)
- Mónica Pérez Jolles
- ACCORDS Dissemination and Implementation Science Program, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Cathleen E. Willging
- Pacific Institute for Research and Evaluation—Southwest Center, Beltsville, MD, United States
| | - Nicole A. Stadnick
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
- Child and Adolescent Services Research Center, San Diego, CA, United States
- University of California San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, La Jolla, CA, United States
| | - Erika L. Crable
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
- Child and Adolescent Services Research Center, San Diego, CA, United States
- University of California San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, La Jolla, CA, United States
| | | | - Jemma Hawkins
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - Gregory A. Aarons
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
- Child and Adolescent Services Research Center, San Diego, CA, United States
- University of California San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, La Jolla, CA, United States
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160
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Alcaraz KI, Yanez BR. Interventions to promote health equity: implications for implementation science in behavioral medicine. Transl Behav Med 2022; 12:885-888. [PMID: 36205475 PMCID: PMC9540972 DOI: 10.1093/tbm/ibac062] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Disparities in health persist despite the development of innovative and effective behavioral interventions. Both behavioral medicine and implementation science are vital to improving health care and health outcomes, and both can play a critical role in advancing health equity. However, to eliminate health disparities, more research in these areas is needed to ensure disparity-reducing behavioral interventions are continually developed and implemented. This special issue on interventions to promote health equity presents a diverse set of articles focused on implementing behavioral interventions to reduce health disparities. The current article summarizes the special issue and identifies key themes and future considerations. Articles in this special issue report on behavioral medicine intervention studies (including those examining aspects of implementation) as well as implementation science studies with implications for behavioral medicine. Articles discuss community-, provider-, and system-level interventions; implementation processes; and barriers and facilitators to implementation. Also included are commentaries calling for greater prioritization of behavioral medicine and implementation research. As evidenced in this special issue, behavioral medicine is primed to lead the implementation of behavioral interventions in historically marginalized and minoritized populations to advance health equity and improve overall population health.
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Affiliation(s)
- Kassandra I Alcaraz
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Betina R Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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161
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Hasson RE, Eisman AB, Wassmann A, Martin S, Pugh P, Winkelseth K, Zernicke R, Rabaut L. Rapid cycle adaptation of a classroom-based intervention to promote equity in access to youth physical activity. Transl Behav Med 2022; 12:945-955. [PMID: 36205474 PMCID: PMC9540976 DOI: 10.1093/tbm/ibac049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Our objective was to systematically adapt Interrupting Prolonged sitting with ACTivity (InPACT), a classroom-based physical activity intervention, for home delivery to equitably increase access to structured youth physical activity opportunities during the COVID-19 pandemic. Key steps in the rapid-cycle research adaptation process included: (Step 1) identifying partner organizations; (Steps 2 and 3) engaging in problem and knowledge exploration to examine the problem from different perspectives; (Steps 4 and 5) initiating solution development and testing by selecting an intervention and adapting the format and content for home delivery. Using Rapid RE-AIM to guide online assessment and refinement of InPACT at Home; and (Step 6) utilizing dissemination strategies to extend the reach of the program. Core elements of the InPACT program that were retained included: the use of exercise videos, maintenance of the intervention dose, and teacher-led physical activities. Key adaptations included: utilization of physical education specialists to develop the exercise videos, incorporation of health messaging in videos, and utilization of dissemination strategies (intervention website) to reach K-12 students across the state. Intervention website reach included all 83 counties in Michigan, but goals were not met for website pageviews (5,147; 85% of goal) and video view duration (7 min 19 sec; 37% of goal). Accordingly, dissemination was expanded to include public television broadcasting (monthly viewers: 500,000) and videos were shortened to 8 minutes. Dissemination and implementation science frameworks guided the rapid adaptation of an existing intervention, InPACT, to equitably increase access to structured youth physical activity opportunities at home during the pandemic.
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Affiliation(s)
- Rebecca E Hasson
- University of Michigan, School of Kinesiology, Ann Arbor, MI, USA
- University of Michigan, Exercise & Sport Science Initiative, Ann Arbor, MI, USA
| | - Andria B Eisman
- Wayne State University, College of Education, Detroit, MI, USA
- Wayne State University, Center for Health and Community Impact, Detroit, MI, USA
| | - Amy Wassmann
- Saginaw Intermediate School District, Saginaw, MI, USA
| | - Scott Martin
- Michigan Department of Education, Lansing, MI, USA
| | - Pamela Pugh
- Michigan State Board of Education Vice President, Lansing, MI, USA
| | - Kerry Winkelseth
- University of Michigan, School of Kinesiology, Ann Arbor, MI, USA
| | - Ronald Zernicke
- University of Michigan, Exercise & Sport Science Initiative, Ann Arbor, MI, USA
- University of Michigan Department of Orthopaedic Surgery, Ann Arbor, MI, USA
| | - Lisa Rabaut
- University of Michigan, Exercise & Sport Science Initiative, Ann Arbor, MI, USA
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162
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Kamath CC, Kelpin SS, Patten CA, Rummans TA, Kremers HM, Oesterle TS, Williams MD, Breitinger SA. Shaping the Screening, Behavioral Intervention, and Referral to Treatment (SBIRT) Model for Treatment of Alcohol Use Disorder in the COVID-19 Era. Mayo Clin Proc 2022; 97:1774-1779. [PMID: 36202491 PMCID: PMC9293785 DOI: 10.1016/j.mayocp.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/15/2022] [Accepted: 07/13/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Celia C Kamath
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, MN; Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
| | - Sydney S Kelpin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Christi A Patten
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN; Center for Clinical and Translational Science
| | - Teresa A Rummans
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Hilal Maradit Kremers
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN; Department of Orthopedic Surgery (H.M.K.), Mayo Clinic, Rochester, MN
| | - Tyler S Oesterle
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Mark D Williams
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
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Rabin BA, Cakici J, Golden CA, Estabrooks PA, Glasgow RE, Gaglio B. A citation analysis and scoping systematic review of the operationalization of the Practical, Robust Implementation and Sustainability Model (PRISM). Implement Sci 2022; 17:62. [PMID: 36153628 PMCID: PMC9509575 DOI: 10.1186/s13012-022-01234-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/30/2022] [Indexed: 11/23/2022] Open
Abstract
Background The Practical, Robust Implementation and Sustainability Model (PRISM) was developed in 2008 as a contextually expanded version of the broadly used Reach, Adoption, Effectiveness, Implementation, and Maintenance (RE-AIM) framework. PRISM provides researchers a pragmatic and intuitive model to improve translation of research interventions into clinical and community practice. Since 2008, the use of PRISM increased across diverse topics, populations, and settings. This citation analysis and scoping systematic review aimed to assess the use of the PRISM framework and to make recommendations for future research. Methods A literature search was conducted using three databases (PubMed, Web of Science, Scopus) for the period of 2008 and September 2020. After exclusion, reverse citation searches and invitations to experts in the field were used to identify and obtain recommendations for additional articles not identified in the original search. Studies that integrated PRISM into their study design were selected for full abstraction. Unique research studies were abstracted for information on study characteristics (e.g., setting/population, design), PRISM contextual domains, and RE-AIM outcomes. Results A total of 180 articles were identified to include PRISM to some degree. Thirty-two articles representing 23 unique studies integrated PRISM within their study design. Study characteristics varied widely and included studies conducted in diverse contexts, but predominately in high-income countries and in clinical out-patient settings. With regards to use, 19 used PRISM for evaluation, 10 for planning/development, 10 for implementation, four for sustainment, and one for dissemination. There was substantial variation across studies in how and to what degree PRISM contextual domains and RE-AIM outcomes were operationalized and connected. Only two studies directly connected individual PRISM context domains with RE-AIM outcomes, and another four included RE-AIM outcomes without direct connection to PRISM domains. Conclusions This is the first systematic review of the use of PRISM in various contexts. While there were low levels of ‘integrated’ use of PRISM and few reports on linkage to RE-AIM outcomes, most studies included important context domains of implementation and sustainability infrastructure and external environment. Recommendations are provided for more consistent and comprehensive use of and reporting on PRISM to inform both research and practice on contextual factors in implementation. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-022-01234-3.
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164
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Binagwaho A, Hirwe D, Mathewos K. Health System Resilience: Withstanding Shocks and Maintaining Progress. GLOBAL HEALTH, SCIENCE AND PRACTICE 2022; 10:e2200076. [PMID: 36109051 PMCID: PMC9476489 DOI: 10.9745/ghsp-d-22-00076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/15/2022] [Indexed: 12/03/2022]
Abstract
Building a resilient system capable of responding to health threats while maintaining essential health service delivery requires health systems to embed implementation research capacity to create the knowledge needed, ensure the affordability and accessibility of health care services at all levels of delivery, and provide the range of services needed to meet the population’s needs.
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Affiliation(s)
| | - Dennis Hirwe
- University of Global Health Equity, Kigali, Rwanda
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165
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Abstract
PURPOSE Implementation science aims to facilitate the use of evidence-based programs, practices, and policies in routine care settings. In audiology, as in other health disciplines, there is a persistent research-to-practice gap. Improving the adoption, reach, implementation, and sustainment of effective interventions in audiology would increase their public health impact, ensuring that all individuals needing hearing health care services could benefit from innovations and evidence-based best practices. This tutorial provides an introductory overview of implementation science relevant to the field of audiology, including Internet-based practices and interventions. METHOD Major concepts and themes of implementation science are presented, including implementation outcomes, implementation science frameworks, implementation strategies, current topics in implementation science, and study design considerations. Recent publications in audiology are highlighted to illustrate implementation science concepts and themes. The relevance of each topic to the use of evidence-based programs, practices, and policies in audiology is highlighted with reference to recent research in the field. CONCLUSIONS Challenges in the widespread delivery of evidence-based audiological practices and interventions limit their public health impact. The application of implementation science principles and methods in audiology research, as demonstrated in other areas of health research, can increase our focus on ensuring that effective practices are widely available, accessible, equitable, and sustainable to improve the lives of those who need them.
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Affiliation(s)
- Christina R. Studts
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora
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166
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Price MA, Hollinsaid NL. Future Directions in Mental Health Treatment with Stigmatized Youth. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2022; 51:810-825. [PMID: 36007234 PMCID: PMC9835015 DOI: 10.1080/15374416.2022.2109652] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Stigma refers to societally-deemed inferiority associated with a circumstance, behavior, status, or identity. It manifests internally, interpersonally, and structurally. Decades of research indicate that all forms of stigma are associated with heightened risk for mental health problems (e.g., depression, PTSD, suicidality) in stigmatized youth (i.e., children, adolescents, and young adults with one or more stigmatized identities, such as youth of Color and transgender youth). Notably, studies find that stigmatized youth living in places with high structural stigma - defined as laws/policies and norms/attitudes that hurt stigmatized people - have a harder time accessing mental health treatment and are less able to benefit from it. In order to reduce youth mental health inequities, it is imperative for our field to better understand, and ultimately address, stigma at each of these levels. To facilitate this endeavor, we briefly review research on stigma and youth mental health treatment, with an emphasis on structural stigma, and present three future directions for research in this area: (1) directly addressing stigma in treatment, (2) training therapists in culturally responsive care, and (3) structural interventions. We conclude with recommendations for best practices in broader mental health treatment research.
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Affiliation(s)
- Maggi A. Price
- School of Social Work, Boston College, Boston, MA
- Department of Psychology, Harvard University, Cambridge, MA
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167
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Kuo GM, Trinkley KE, Rabin B. Research and Scholarly Methods: Implementation Science Studies. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022; 5:995-1004. [PMID: 36212610 PMCID: PMC9534307 DOI: 10.1002/jac5.1673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/14/2022] [Indexed: 11/08/2022]
Abstract
Traditional research focuses on efficacy or effectiveness of interventions but lacks evaluation of strategies needed for equitable uptake, scalable implementation, and sustainable evidence-based practice transformation. The purpose of this introductory review is to describe key implementation science (IS) concepts as they apply to medication management and pharmacy practice, and to provide guidance on literature review with an IS lens. There are five key ingredients of IS, including: (1) evidence-based intervention; (2) implementation strategies; (3) IS theory, model, or framework; (4) IS outcomes and measures; and (5) stakeholder engagement, which is key to a successful implementation. These key ingredients apply across the three stages of IS research: (1) pre-implementation; (2) implementation; and (3) sustainment. A case example using a combination of IS models, PRISM (Practical, Robust Implementation and Sustainability model) and RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance), is included to describe how an IS study is designed and conducted. This case is a cluster randomized trial comparing two clinical decision support tools to improve guideline-concordant prescribing for patients with heart failure and reduced ejection fraction. The review also includes information on the Standards for Reporting Implementation Studies (StaRI), which is used for literature review and reporting of IS studies,as well as IS-related learning resources.
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Affiliation(s)
- Grace M Kuo
- Texas Tech University Health Sciences Center and Professor Emerita at University of California San Diego; Address: 1300 S. Coulter Street, Suite 104, Amarillo, TX 79106
| | - Katy E Trinkley
- University of Colorado Skaggs Schools of Medicine and Pharmacy and Pharmaceutical Sciences at the Anschutz Medical Campus; Aurora, Colorado
| | - Borsika Rabin
- Herbert Wertheim School of Public Health and Human Longevity Science and Co-Director of the UC San Diego ACTRI Dissemination and Implementation Science Center at University of California San Diego; La Jolla, California
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168
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Astorino JA, Kerch S, Pratt-Chapman ML. Building implementation science capacity among practitioners of cancer control: development of a pilot training curriculum. Cancer Causes Control 2022; 33:1181-1191. [PMID: 35842850 PMCID: PMC9534372 DOI: 10.1007/s10552-022-01604-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 06/23/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Cancer control interventions are difficult to implement with fidelity, while tailoring to fit contexts. Engaged approaches are suggested to advance equity. On-the-ground practitioners are needed to serve as collaborators in the implementation process with research teams, but few trainings are designed with them in mind. METHODS The Cancer Control Implementation Science Base Camp (CCISBC) was created to improve capacity among cancer control practitioners when implementing evidence-based cancer screening programs in specific contexts. Development of the curriculum included the following: (1) performing a literature review assessing extant curricula, (2) comparing competencies of these curricula, (3) user-centered design, (4) producing learning materials, (5) recruiting two teams to test a pilot, (6) running the pilot, and (7) evaluating results. RESULTS Nine competencies overlapped between four of the curricula scanned in this study, all of which served as the basis for learning objectives. Principles that emerged from design sessions included staying clear about terminology, supporting the brokerage of knowledge, reframing theories, models, and frameworks as tools, and including equity in everything. Pilot testing showed that the average learner increased 74.5% in knowledge and 75% in confidence regarding implementing evidence-based cancer screening. Evidence suggests that the training increased the skill of implementing evidence-based interventions (EBIs) with a health equity lens. CONCLUSION In order to scale practice-based evidence, practitioners will need to be engaged. This engagement is optimized when practitioners are trained to collaborate on implementation research. The CCISBC is a feasible program to develop capacity among practitioners in comprehensive cancer control in order to optimize EBIs tailored to context.
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Affiliation(s)
- Joseph A Astorino
- The George Washington University Cancer Center, School of Medicine and Health Sciences, George Washington University, Washington, D.C, United States of America.
| | - Sarah Kerch
- The George Washington University Cancer Center, School of Medicine and Health Sciences, George Washington University, Washington, D.C, United States of America
| | - Mandi L Pratt-Chapman
- The George Washington University Cancer Center, School of Medicine and Health Sciences, George Washington University, Washington, D.C, United States of America
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169
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Eisman AB, Kim B, Salloum RG, Shuman CJ, Glasgow RE. Advancing rapid adaptation for urgent public health crises: Using implementation science to facilitate effective and efficient responses. Front Public Health 2022; 10:959567. [PMID: 36091566 PMCID: PMC9448975 DOI: 10.3389/fpubh.2022.959567] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/08/2022] [Indexed: 01/24/2023] Open
Abstract
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.
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Affiliation(s)
- Andria B. Eisman
- Community Health, Division of Kinesiology, Health and Sport Studies, College of Education, Wayne State University, Detroit, MI, United States,Center for Health and Community Impact (CHCI), Wayne State University, Detroit, MI, United States,*Correspondence: Andria B. Eisman
| | - Bo Kim
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, United States,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Ramzi G. Salloum
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, United States
| | - Clayton J. Shuman
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, United States
| | - Russell E. Glasgow
- Dissemination and Implementation Science Program of ACCORDS (Adult and Child Consortium for Health Outcomes Research and Delivery Science), University of Colorado School of Medicine, Aurora, CO, United States
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170
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Abstract
Population-based solutions are needed to stabilize and then reverse the continued upward trends in obesity prevalence in the US population and worldwide. This review focuses on the related, urgent issue of disparities in obesity prevalence affecting US racial/ethnic minority and other socially marginalized populations. The review provides background on these disparities from a health equity perspective and highlights evidence of progress in equity-focused obesity efforts. Five recommendations for advancing equity efforts are offered as potential approaches to build on progress to date: (a) give equity issues higher priority, (b) adopt a health equity lens, (c) strengthen approaches by using health equity frameworks, (d) broaden the types of policies considered, and (e) emphasize implementation science concepts and tools. Potential challenges and opportunities are identified, including the prospect of longer-term, transformative solutions that integrate global and national initiatives to address obesity, undernutrition, and climate change.
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Affiliation(s)
- Shiriki K Kumanyika
- Dornsife School of Public Health, Drexel University, and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;
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171
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Beidas RS, Dorsey S, Lewis CC, Lyon AR, Powell BJ, Purtle J, Saldana L, Shelton RC, Stirman SW, Lane-Fall MB. Promises and pitfalls in implementation science from the perspective of US-based researchers: learning from a pre-mortem. Implement Sci 2022; 17:55. [PMID: 35964095 PMCID: PMC9375077 DOI: 10.1186/s13012-022-01226-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 07/20/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Implementation science is at a sufficiently advanced stage that it is appropriate for the field to reflect on progress thus far in achieving its vision, with a goal of charting a path forward. In this debate, we offer such reflections and report on potential threats that might stymie progress, as well as opportunities to enhance the success and impact of the field, from the perspective of a group of US-based researchers. MAIN BODY Ten mid-career extramurally funded US-based researchers completed a "pre-mortem" or a group brainstorming exercise that leverages prospective hindsight to imagine that an event has already occurred and to generate an explanation for it - to reduce the likelihood of a poor outcome. We came to consensus on six key themes related to threats and opportunities for the field: (1) insufficient impact, (2) too much emphasis on being a "legitimate science," (3) re-creation of the evidence-to-practice gap, (4) difficulty balancing accessibility and field coherence, (5) inability to align timelines and priorities with partners, and (6) overly complex implementation strategies and approaches. CONCLUSION We submit this debate piece to generate further discussion with other implementation partners as our field continues to develop and evolve. We hope the key opportunities identified will enhance the future of implementation research in the USA and spark discussion across international groups. We will continue to learn with humility about how best to implement with the goal of achieving equitable population health impact at scale.
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172
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Presseau J, Kasperavicius D, Rodrigues IB, Braimoh J, Chambers A, Etherington C, Giangregorio L, Gibbs JC, Giguere A, Graham ID, Hankivsky O, Hoens AM, Holroyd-Leduc J, Kelly C, Moore JE, Ponzano M, Sharma M, Sibley KM, Straus S. Selecting implementation models, theories, and frameworks in which to integrate intersectional approaches. BMC Med Res Methodol 2022; 22:212. [PMID: 35927615 PMCID: PMC9351159 DOI: 10.1186/s12874-022-01682-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/13/2022] [Indexed: 11/20/2022] Open
Abstract
Background Models, theories, and frameworks (MTFs) provide the foundation for a cumulative science of implementation, reflecting a shared, evolving understanding of various facets of implementation. One under-represented aspect in implementation MTFs is how intersecting social factors and systems of power and oppression can shape implementation. There is value in enhancing how MTFs in implementation research and practice account for these intersecting factors. Given the large number of MTFs, we sought to identify exemplar MTFs that represent key implementation phases within which to embed an intersectional perspective. Methods We used a five-step process to prioritize MTFs for enhancement with an intersectional lens. We mapped 160 MTFs to three previously prioritized phases of the Knowledge-to-Action (KTA) framework. Next, 17 implementation researchers/practitioners, MTF experts, and intersectionality experts agreed on criteria for prioritizing MTFs within each KTA phase. The experts used a modified Delphi process to agree on an exemplar MTF for each of the three prioritized KTA framework phases. Finally, we reached consensus on the final MTFs and contacted the original MTF developers to confirm MTF versions and explore additional insights. Results We agreed on three criteria when prioritizing MTFs: acceptability (mean = 3.20, SD = 0.75), applicability (mean = 3.82, SD = 0.72), and usability (median = 4.00, mean = 3.89, SD = 0.31) of the MTF. The top-rated MTFs were the Iowa Model of Evidence-Based Practice to Promote Quality Care for the ‘Identify the problem’ phase (mean = 4.57, SD = 2.31), the Consolidated Framework for Implementation Research for the ‘Assess barriers/facilitators to knowledge use’ phase (mean = 5.79, SD = 1.12), and the Behaviour Change Wheel for the ‘Select, tailor, implement interventions’ phase (mean = 6.36, SD = 1.08). Conclusions Our interdisciplinary team engaged in a rigorous process to reach consensus on MTFs reflecting specific phases of the implementation process and prioritized each to serve as an exemplar in which to embed intersectional approaches. The resulting MTFs correspond with specific phases of the KTA framework, which itself may be useful for those seeking particular MTFs for particular KTA phases. This approach also provides a template for how other implementation MTFs could be similarly considered in the future. Trial registration Open Science Framework Registration: osf.io/qgh64. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01682-x.
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Affiliation(s)
- Justin Presseau
- Clinical Epidemiology, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada. .,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada. .,School of Psychology, University of Ottawa, Ottawa, Canada.
| | - Danielle Kasperavicius
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | | | - Jessica Braimoh
- Department of Social Science, York University, Toronto, ON, Canada
| | | | - Cole Etherington
- Clinical Epidemiology, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.,Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Lora Giangregorio
- Department of Kinesiology and Health Sciences, and Schlegel Research Institute for Aging, University of Waterloo, Waterloo, ON, Canada
| | - Jenna C Gibbs
- Department of Kinesiology and Physical Education, McGill University, Montreal, QC, Canada
| | - Anik Giguere
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, QC, Canada
| | - Ian D Graham
- Clinical Epidemiology, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Olena Hankivsky
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Alison M Hoens
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Jayna Holroyd-Leduc
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Christine Kelly
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | | | - Matteo Ponzano
- Department of Kinesiology and Health Sciences, and Schlegel Research Institute for Aging, University of Waterloo, Waterloo, ON, Canada
| | - Malika Sharma
- Division of Infectious Diseases, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kathryn M Sibley
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada
| | - Sharon Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
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Hoskins K, Sanchez AL, Hoffacker C, Momplaisir F, Gross R, Brady KA, Pettit AR, Zentgraf K, Mills C, Coley D, Beidas RS. Implementation mapping to plan for a hybrid trial testing the effectiveness and implementation of a behavioral intervention for HIV medication adherence and care retention. Front Public Health 2022; 10:872746. [PMID: 35983357 PMCID: PMC9379308 DOI: 10.3389/fpubh.2022.872746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 07/01/2022] [Indexed: 11/24/2022] Open
Abstract
Background Implementation 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. Methods In 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. Findings Implementation 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. Implications This 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+.
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Affiliation(s)
- Katelin Hoskins
- Penn Medicine Nudge Unit, University of Pennsylvania Health System, Philadelphia, PA, United States,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, United States,*Correspondence: Katelin Hoskins
| | - Amanda L. Sanchez
- Penn Medicine Nudge Unit, University of Pennsylvania Health System, Philadelphia, PA, United States,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, United States
| | - Carlin Hoffacker
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States,Department of Counseling and Educational Psychology, Indiana University, Bloomington, IN, United States
| | - Florence Momplaisir
- Department of Medicine (Infectious Diseases), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Robert Gross
- Department of Medicine (Infectious Diseases), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Kathleen A. Brady
- AIDS Activities Coordinating Office, Philadelphia Department of Public Health, Philadelphia, PA, United States
| | | | - Kelly Zentgraf
- Penn Medicine Nudge Unit, University of Pennsylvania Health System, Philadelphia, PA, United States
| | - Chynna Mills
- Penn Medicine Nudge Unit, University of Pennsylvania Health System, Philadelphia, PA, United States
| | - DeAuj'Zhane Coley
- Penn Medicine Nudge Unit, University of Pennsylvania Health System, Philadelphia, PA, United States
| | - Rinad S. Beidas
- Penn Medicine Nudge Unit, University of Pennsylvania Health System, Philadelphia, PA, United States,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, United States,Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States,Center for Health Incentives and Behavioral Economics (CHIBE), University of Pennsylvania, Philadelphia, PA, United States
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174
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Guerin R, Glasgow R, Tyler A, Rabin B, Huebschmann A. Methods to improve the translation of evidence-based interventions: A primer on dissemination and implementation science for occupational safety and health researchers and practitioners. SAFETY SCIENCE 2022; 152:105763. [PMID: 37854304 PMCID: PMC10583726 DOI: 10.1016/j.ssci.2022.105763] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
Objective A limited focus on dissemination and implementation (D&I) science has hindered the uptake of evidence-based interventions (EBIs) that reduce workplace morbidity and mortality. D&I science methods can be used in the occupational safety and health (OSH) field to advance the adoption, implementation, and sustainment of EBIs for complex workplaces. These approaches should be responsive to contextual factors, including the needs of partners and beneficiaries (such as employers, employees, and intermediaries). Methods By synthesizing seminal literature and texts and leveraging our collective knowledge as D&I science and/or OSH researchers, we developed a D&I science primer for OSH. First, we provide an overview of common D&I terminology and concepts. Second, we describe several key and evolving issues in D&I science: balancing adaptation with intervention fidelity and specifying implementation outcomes and strategies. Next, we review D&I theories, models, and frameworks and offer examples for applying these to OSH research. We also discuss widely used D&I research designs, methods, and measures. Finally, we discuss future directions for D&I science application to OSH and provide resources for further exploration. Results We compiled a D&I science primer for OSH appropriate for practitioners and evaluators, especially those newer to the field. Conclusion This article fills a gap in the OSH research by providing an overview of D&I science to enhance understanding of key concepts, issues, models, designs, methods and measures for the translation into practice of effective OSH interventions to advance the safety, health and well-being of workers.
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Affiliation(s)
- R.J. Guerin
- Division of Science Integration, National Institute for
Occupational Safety and Health, Centers for Disease Control and Prevention, 1090
Tusculum Ave., MS C-10, Cincinnati, OH 45226, USA
| | - R.E. Glasgow
- Dissemination and Implementation Science Program,
University of Colorado Adult and Child Center for Outcomes Research and Delivery
Science, Anschutz Medical Campus, Aurora, CO 80045, USA
- University of Colorado Department of Family Medicine,
Anschutz Medical Campus, Aurora, CO 80045, USA
| | - A. Tyler
- Dissemination and Implementation Science Program,
University of Colorado Adult and Child Center for Outcomes Research and Delivery
Science, Anschutz Medical Campus, Aurora, CO 80045, USA
- University of Colorado Department of Pediatrics, Section
of Hospital Medicine, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - B.A. Rabin
- Herbert Wertheim School of Public Health and Human
Longevity Science, University of California San Diego, La Jolla, CA 92037, USA
- UC San Diego Altman Clinical and Translational Research
Institute Dissemination and Implementation Science Center, University of California
San Diego, La Jolla, CA 92037, USA
| | - A.G. Huebschmann
- Dissemination and Implementation Science Program,
University of Colorado Adult and Child Center for Outcomes Research and Delivery
Science, Anschutz Medical Campus, Aurora, CO 80045, USA
- University of Colorado Division of General Internal
Medicine, Anschutz Medical Campus, Aurora, CO 80045, USA
- University of Colorado Ludeman Family Center for
Women’s Health Research, Anschutz Medical Campus, Aurora, CO 80045, USA
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175
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Haynes SC, Marcin JP. Pediatric Telemedicine: Lessons Learned During the Coronavirus Disease 2019 Pandemic and Opportunities for Growth. Adv Pediatr 2022; 69:1-11. [PMID: 35985702 PMCID: PMC8979775 DOI: 10.1016/j.yapd.2022.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The accelerated uptake of telemedicine during the coronavirus disease 2019 pandemic has resulted in valuable experience and evidence on the delivery of telemedicine for pediatric patients. The pandemic has also highlighted inequities and opportunities for improvement. This review discusses lessons learned during the pandemic, focusing on provider-to-patient virtual encounters. Recent evidence on education and training, developing and adapting clinical workflows, patient assessment and treatment, and family-centered care is reviewed. Opportunities for future research in pediatric telemedicine are discussed, specifically with regard to engaging pediatric patients, improving and measuring access to care, addressing health equity, and expanding the evidence base.
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Affiliation(s)
- Sarah C Haynes
- Department of Pediatrics, UC Davis School of Medicine, UC Davis Center for Health and Technology, 4610 X Street, Suite 2300, Sacramento, CA 95817, USA.
| | - James P Marcin
- Department of Pediatrics, UC Davis School of Medicine, UC Davis Center for Health and Technology, 4610 X Street, Suite 2300, Sacramento, CA 95817, USA
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176
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Thompson HM, Clement AM, Ortiz R, Preston TM, Quantrell ALW, Enfield M, King AJ, Klosinski L, Reback CJ, Hamilton A, Milburn N. Community engagement to improve access to healthcare: a comparative case study to advance implementation science for transgender health equity. Int J Equity Health 2022; 21:104. [PMID: 35907962 PMCID: PMC9339189 DOI: 10.1186/s12939-022-01702-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 06/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recent calls to action have been made for Implementation Science to attend to health inequities at the intersections of race, gender, and social injustice in the United States. Transgender people, particularly Black and Latina transgender women, experience a range of health inequities and social injustices. In this study, we compared two processes of transgender community engagement in Los Angeles and in Chicago as an implementation strategy to address inequitable access to care; we adapted and extended the Exploration Planning Implementation and Sustainment (EPIS) framework for transgender health equity. METHODS A comparative case method and the EPIS framework were used to examine parallel implementation strategies of transgender community engagement to expand access to care. To foster conceptual development and adaptation of EPIS for trans health equity, the comparative case method required detailed description, exploration, and analyses of the community-engagement processes that led to different interventions to expand access. In both cities, the unit of analysis was a steering committee made up of local transgender and cisgender stakeholders. RESULTS Both steering committees initiated their exploration processes with World Café-style, transgender community-engaged events in order to assess community needs and structural barriers to healthcare. The steering committees curated activities that amplified the voices of transgender community members among stakeholders, encouraging more effective and collaborative ways to advance transgender health equity. Based on analysis and findings from the Los Angeles town hall, the steering committee worked with a local medical school, extending the transgender medicine curriculum, and incorporating elements of transgender community-engagement. The Chicago steering committee determined from their findings that the most impactful intervention on structural racism and barriers to healthcare access would be to design and pilot an employment program for Black and Latina transgender women. CONCLUSION In Los Angeles and Chicago, transgender community engagement guided implementation processes and led to critical insights regarding specific, local barriers to healthcare. The steering committee itself represented an important vehicle for individual-, organizational-, and community-level relationship and capacity building. This comparative case study highlights key adaptations of EPIS toward the formation of an implementation science framework for transgender health equity.
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Affiliation(s)
- Hale M Thompson
- Rush University Medical Center, 1645 W. Jackson Blvd., Suite 302, Chicago, IL, 60612, USA.
| | - Allison M Clement
- University of California-Los Angeles, 760 Westwood Plaza A8-159A, Los Angeles, CA, 90095, USA
| | - Reyna Ortiz
- TaskForce Prevention & Community Services, 9 N. Cicero, Chicago, IL, 60644, USA
| | - Toni Marie Preston
- Howard Brown Health Center, 4025 N. Sheridan Road, Chicago, IL, 60613, USA
| | | | - Michelle Enfield
- AIDS Project Los Angeles, 5901 W. Olympic Blvd., Suite 310, Los Angeles, CA, 90036, USA
| | - A J King
- Center for AIDS Research, University of California-Los Angeles, 11075 Santa Monica Blvd, Suite 100, Los Angeles, CA, 90025, USA
| | - Lee Klosinski
- University of California-Los Angeles, 760 Westwood PlazaA8-159A, Los Angeles, CA, 90095, USA
| | - Cathy J Reback
- Friends Research Institute, 6910 Santa Monica Boulevard, Los Angeles, CA, 90038, USA
| | - Alison Hamilton
- University of California-Los Angeles, 760 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Norweeta Milburn
- University of California-Los Angeles, 760 Westwood Plaza A8-159A, Los Angeles, CA, 90095, USA
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177
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Mielke J, De Geest S, Zúñiga F, Brunkert T, Zullig LL, Pfadenhauer LM, Staudacher S. Understanding dynamic complexity in context-Enriching contextual analysis in implementation science from a constructivist perspective. FRONTIERS IN HEALTH SERVICES 2022; 2:953731. [PMID: 36925847 PMCID: PMC10012673 DOI: 10.3389/frhs.2022.953731] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/01/2022] [Indexed: 01/24/2023]
Abstract
Context in implementation science includes not only characteristics of a setting in which an intervention will be delivered, but also social systems (e.g., interrelationships). Context is dynamic and interacts with both, the intervention and its implementation. Therefore, contextual analysis is recognized as an indispensable part of implementation science methodology: it provides the foundation for successful and sustainable implementation projects. Yet, driven by the prevailing post-positivist understanding of context, contextual analysis typically focuses on individual characteristics of context i.e., contextual dynamics and interactions go unnoticed. Conducting contextual analysis from a constructivist perspective promotes a multilayered approach, building a more comprehensive understanding of context, and thus facilitating successful implementation. In this article, we highlight the limitations of prevailing perspectives on context and approaches to contextual analysis. We then describe how contextual analysis can be enriched by working from a constructivist perspective. We finish with a discussion of the methodological and practical implications the proposed changes would entail. Emerging literature attempts to address both the concept of context and methods for contextual analysis. Various theories, models and frameworks consider context, however, many of these are reductionistic and do not acknowledge the dynamic nature of context or interactions within it. To complement recent conceptualizations of context, we suggest consider the following five constructivist concepts: 1) social space; 2) social place; 3) agency; 4) sensation; and 5) embodiment. We demonstrate the value of these concepts using COVID-19 vaccination uptake as an example and integrate the concepts in the Context and Implementation of Complex Interventions (CICI) framework-an implementation science framework that pays ample attention to context. To study context from a constructivist perspective, we also suggest additional considerations in view of methodologies for data collection and analysis, e.g., rapid ethnographic methods. A constructivist perspective contributes to a stronger conceptualization of contextual analysis. Considering the five constructivist concepts helps to overcome contextual analysis' current shortcomings, while revealing complex dynamics that usually go unnoticed. Thus, more comprehensive understanding of context can be developed to inform subsequent phases of an implementation project, thereby maximizing an intervention's uptake and sustainability.
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Affiliation(s)
- Juliane Mielke
- Institute of Nursing Science, Department Public Health, University of Basel, Basel, Switzerland
| | - Sabina De Geest
- Institute of Nursing Science, Department Public Health, University of Basel, Basel, Switzerland
- Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Franziska Zúñiga
- Institute of Nursing Science, Department Public Health, University of Basel, Basel, Switzerland
| | - Thekla Brunkert
- Institute of Nursing Science, Department Public Health, University of Basel, Basel, Switzerland
- University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland
| | - Leah L. Zullig
- Center for Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care, Durham, NC, United States
- System and Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC, United States
| | - Lisa M. Pfadenhauer
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilian University of Munich, Munich, Germany
- Pettenkofer School of Public Health, Ludwig Maximilian University of Munich, Munich, Germany
| | - Sandra Staudacher
- Institute of Nursing Science, Department Public Health, University of Basel, Basel, Switzerland
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
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178
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Tsai E, Allen P, Saliba LF, Brownson RC. The power of partnerships: state public health department multisector collaborations in major chronic disease programme areas in the United States. Health Res Policy Syst 2022; 20:80. [PMID: 35804420 PMCID: PMC9264297 DOI: 10.1186/s12961-021-00765-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multisector collaboration between state public health departments (SHDs) and diverse community partners is increasingly recognized as important for promoting positive public health outcomes, addressing social determinants of health, and reducing health inequalities. This study investigates collaborations between SHDs in the United States and different types of organizations addressing chronic disease in and outside of the health sector. METHODS SHD employees were randomly selected from the National Association of Chronic Disease Directors membership list for participation in an online survey. Participants were asked about their primary chronic disease work unit (cancer, obesity, tobacco, diabetes, cardiovascular disease, and others), as well as their work unit collaborations (exchange of information/cooperation in activities) with organizations in health and non-health sectors. As a measure of the different organizations SHDs collaborated with in health and non-health sectors, a collaboration heterogeneity score for each programme area was calculated. One-way analysis of variance (ANOVA) with Tukey's post hoc tests were used to assess differences in collaborator heterogeneity between programme areas. RESULTS A total of 574 participants were surveyed. Results indicated that the cancer programme area, along with diabetes and cardiovascular disease, had significantly less collaboration heterogeneity with organizations outside of the health sector compared to the obesity and tobacco programme areas. CONCLUSIONS While collaborations with health sector organizations are commonly reported, public health departments can increase collaboration with sectors outside of health to more fully address chronic disease prevention.
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Affiliation(s)
- Edward Tsai
- Division of Public Health Sciences, Department of Surgery, and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, 660 S. Euclid Avenue, Campus Box 8100, St. Louis, MO, 63110, USA.
| | - Peg Allen
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, USA
| | - Louise Farah Saliba
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, USA
| | - Ross C Brownson
- Division of Public Health Sciences, Department of Surgery, and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, 660 S. Euclid Avenue, Campus Box 8100, St. Louis, MO, 63110, USA
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, USA
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Mustanski B, Smith JD, Keiser B, Li DH, Benbow N. Supporting the Growth of Domestic HIV Implementation Research in the United States Through Coordination, Consultation, and Collaboration: How We Got Here and Where We Are Headed. J Acquir Immune Defic Syndr 2022; 90:S1-S8. [PMID: 35703749 PMCID: PMC9643076 DOI: 10.1097/qai.0000000000002959] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 03/18/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Ending the HIV Epidemic (EHE) initiative sets a goal to virtually eliminate new HIV infections in the United States by 2030. The plan is predicated on the fact that tools exist for diagnosis, prevention, and treatment, and the current scientific challenge is how to implement them effectively and with equity. Implementation research (IR) can help identify strategies that support effective implementation of HIV services. SETTING NIH funded the Implementation Science Coordination Initiative (ISCI) to support rigorous and actionable IR by providing technical assistance to NIH-funded projects and supporting local implementation knowledge becoming generalizable knowledge. METHODS We describe the formation of ISCI, the services it provided to the HIV field, and data it collected from 147 NIH-funded studies. We also provide an overview of this supplement issue as a dissemination strategy for HIV IR. CONCLUSION Our ability to reach EHE 2030 goals is strengthened by the knowledge compiled in this supplement, the services of ISCI and connected hubs, and a myriad of investigators and implementation partners collaborating to better understand what is needed to effectively implement the many evidence-based HIV interventions at our disposal.
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Affiliation(s)
- Brian Mustanski
- Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL
- Third Coast Center for AIDS Research, Chicago, IL
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Justin D. Smith
- Department of Population Health Sciences, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT
| | - Brennan Keiser
- Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL
| | - Dennis H. Li
- Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL
- Third Coast Center for AIDS Research, Chicago, IL
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Nanette Benbow
- Third Coast Center for AIDS Research, Chicago, IL
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
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180
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Sanchez AL, Hoskins K, Pettit AR, Momplaisir F, Gross R, Brady KA, Hoffacker C, Zentgraf K, Beidas RS. Stakeholder Perspectives on MAPS. J Acquir Immune Defic Syndr 2022; 90:S190-S196. [PMID: 35703771 PMCID: PMC9473662 DOI: 10.1097/qai.0000000000002979] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Managed problem solving (MAPS) is an evidence-based intervention that can boost HIV medication adherence and increase viral suppression, but it is not widely used in community clinics. Deploying community health workers to deliver MAPS could facilitate broader implementation, in support of the Ending the HIV Epidemic (EHE) initiative's goal of reducing new HIV infections in the US by 90% by 2030. SETTING Ryan White-funded clinics in Philadelphia, 1 of 48 US counties prioritized in the EHE. METHODS Semistructured stakeholder interviews were conducted with 13 clinics and 4 stakeholder groups: prescribing clinicians, nonprescribing clinical team members (eg, medical case managers), clinic administrators, and policymakers. Interviews were based on the Consolidated Framework for Implementation Research and investigated perceived barriers to and facilitators of MAPS delivery by community health workers. Rapid qualitative analytic techniques were used to synthesize interview data and identify key categories along an implementation pathway. Core determinants (ie, barriers and facilitators) of MAPS implementation were grouped within each category. RESULTS Stakeholders were receptive to CHW-delivered MAPS and offered critical information on potential implementation determinants including preferences for identification and referral of patients, and the importance of integration and communication within the care team. CONCLUSIONS This study elucidates insights regarding barriers and facilitators to delivering an evidence-based behavioral intervention in clinics serving people with HIV (PWH) and extends a rapid qualitative approach to HIV care that rigorously incorporates stakeholder data into the development of implementation strategies. It also offers insights for national implementation efforts associated with EHE.
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Affiliation(s)
- Amanda L. Sanchez
- Penn Medicine Nudge Unit, University of Pennsylvania Health System
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA
| | - Katelin Hoskins
- Penn Medicine Nudge Unit, University of Pennsylvania Health System
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA
| | | | - Florence Momplaisir
- Department of Medicine (Infectious Diseases), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, Philadelphia, PA
| | - Robert Gross
- Department of Medicine (Infectious Diseases), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, Philadelphia, PA
| | - Kathleen A. Brady
- AIDS Activities Coordinating Office, Philadelphia Department of Public Health, Philadelphia, PA
| | - Carlin Hoffacker
- Department of Counseling and Educational Psychology, Indiana University, Bloomington, IN
| | - Kelly Zentgraf
- Penn Medicine Nudge Unit, University of Pennsylvania Health System
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Rinad S. Beidas
- Penn Medicine Nudge Unit, University of Pennsylvania Health System
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Center for Health Incentives and Behavioral Economics (CHIBE), University of Pennsylvania, Philadelphia, PA
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181
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Sibley KM, Kasperavicius D, Rodrigues IB, Giangregorio L, Gibbs JC, Graham ID, Hoens AM, Kelly C, Lalonde D, Moore JE, Ponzano M, Presseau J, Straus SE. Development and usability testing of tools to facilitate incorporating intersectionality in knowledge translation. BMC Health Serv Res 2022; 22:830. [PMID: 35761251 PMCID: PMC9238081 DOI: 10.1186/s12913-022-08181-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/07/2022] [Indexed: 11/17/2022] Open
Abstract
Background The field of knowledge translation (KT) has been criticized for neglecting contextual and social considerations that influence health equity. Intersectionality, a concept introduced by Black feminist scholars, emphasizes how human experience is shaped by combinations of social factors (e.g., ethnicity, gender) embedded in systemic power structures. Its use has the potential to advance equity considerations in KT. Our objective was to develop and conduct usability testing of tools to support integrating intersectionality in KT through three key phases of KT: identifying the gap; assessing barriers to knowledge use; and selecting, tailoring, and implementing interventions. Methods We used an integrated KT approach and assembled an interdisciplinary development committee who drafted tools. We used a mixed methods approach for usability testing with KT intervention developers that included semi-structured interviews and the System Usability Scale (SUS). We calculated an average SUS score for each tool. We coded interview data using the framework method focusing on actionable feedback. The development committee used the feedback to revise tools, which were formatted by a graphic designer. Results Nine people working in Canada joined the development committee. They drafted an intersectionality primer and one tool that included recommendations, activities, reflection prompts, and resources for each of the three implementation phases. Thirty-one KT intervention developers from three countries participated in usability testing. They suggested the tools to be shorter, contain more visualizations, and use less jargon. Average SUS scores of the draft tools ranged between 60 and 78/100. The development committee revised and shortened all tools, and added two, one-page summary documents. The final toolkit included six documents. Conclusions We developed and evaluated tools to help embed intersectionality considerations in KT. These tools go beyond recommending the use of intersectionality to providing practical guidance on how to do this. Future work should develop guidance for enhancing social justice in intersectionality-enhanced KT. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08181-1.
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Affiliation(s)
- Kathryn M Sibley
- Department of Community Health Sciences, University of Manitoba, 379 - 753 McDermot Avenue, Winnipeg, MB, R3E 0W3, Canada. .,George and Fay Yee Centre for Healthcare Innovation, 379- 753 McDermot Avenue, Winnipeg, MB, R3E 0W3, Canada.
| | - Danielle Kasperavicius
- Knowledge Translation Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | | | - Lora Giangregorio
- Department of Kinesiology and Health Sciences, and Schlegel-UW Research Institute for Aging, University of Waterloo, Waterloo, ON, Canada
| | - Jenna C Gibbs
- Department of Kinesiology and Physical Education, McGill University, Montreal, QC, Canada
| | - Ian D Graham
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Alison M Hoens
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Christine Kelly
- Department of Community Health Sciences, University of Manitoba, 379 - 753 McDermot Avenue, Winnipeg, MB, R3E 0W3, Canada
| | - Dianne Lalonde
- Learning Network, Centre for Research & Education on Violence Against Women & Children, Western University, London, ON, Canada
| | | | - Matteo Ponzano
- Department of Kinesiology and Health Sciences, and Schlegel-UW Research Institute for Aging, University of Waterloo, Waterloo, ON, Canada
| | - Justin Presseau
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.,School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Sharon E Straus
- Division of Infectious Diseases, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
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182
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Wolfenden L, Hawe P, Rychetnik L, Sutherland R, Barnes C, Yoong S, Giles-Corti B, Mitchell J, Bauman A, Milat AJ, Chai LK, Mayfield S, Mastersson N, Freebairn L, Sacks G, Wilson A, Wright A, Wiggers J. A call to action: More collaborative implementation research is needed to prevent chronic disease. Aust N Z J Public Health 2022; 46:549-553. [PMID: 35735905 DOI: 10.1111/1753-6405.13270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, New South Wales.,Hunter Medical Research Institute, New Lambton, New South Wales.,The Australian Prevention Partnership Centre, Sax Institute, Sydney, New South Wales
| | - Penelope Hawe
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, New South Wales.,Sydney School of Public Health, University of Sydney, Sydney, New South Wales
| | - Lucie Rychetnik
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, New South Wales.,Sydney School of Public Health, University of Sydney, Sydney, New South Wales
| | - Rachel Sutherland
- School of Medicine and Public Health, The University of Newcastle, New South Wales.,Hunter Medical Research Institute, New Lambton, New South Wales
| | - Courtney Barnes
- School of Medicine and Public Health, The University of Newcastle, New South Wales.,Hunter Medical Research Institute, New Lambton, New South Wales
| | - Serene Yoong
- School of Medicine and Public Health, The University of Newcastle, New South Wales.,Hunter Medical Research Institute, New Lambton, New South Wales.,Faculty Health, Arts and Design, Swinburne University of Technology, Victoria
| | - Billie Giles-Corti
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, New South Wales.,Centre for Urban Research, RMIT University, Melbourne, Victoria
| | - Jo Mitchell
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, New South Wales.,Centre for Population Health, New South Wales Ministry of Health, Sydney, New South Wales
| | - Adrian Bauman
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, New South Wales.,Sydney School of Public Health, University of Sydney, Sydney, New South Wales
| | - Andrew J Milat
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, New South Wales.,Centre for Epidemiology and Evidence, NSW Ministry of Health, Sydney, New South Wales
| | - Li Kheng Chai
- School of Exercise and Nutrition Science, Queensland University of Technology at the Centre for Children's Health Research (CCHR), South Brisbane, Queensland.,Health and Wellbeing Queensland, Queensland Government, Milton, Queensland
| | - Sara Mayfield
- Health and Wellbeing Queensland, Queensland Government, Milton, Queensland
| | - Nadia Mastersson
- The Commission on Excellence and Innovation in Health, Government of South Australia, Adelaide, South Australia
| | - Louise Freebairn
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, New South Wales.,Brain and Mind Centre, University of Sydney, Sydney, New South Wales
| | - Gary Sacks
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, New South Wales.,Deakin University, Global Obesity Centre, Institute for Health Transformation, Geelong, Victoria
| | - Andrew Wilson
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, New South Wales.,Sydney School of Public Health, University of Sydney, Sydney, New South Wales
| | - Annemarie Wright
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria.,Victorian Health Promotion Foundation, Melbourne, Victoria
| | - John Wiggers
- School of Medicine and Public Health, The University of Newcastle, New South Wales.,Hunter Medical Research Institute, New Lambton, New South Wales
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183
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Standen EC, Finch LE, Tiongco-Hofschneider L, Schopp E, Lee KM, Parker JE, Bamishigbin ON, Tomiyama AJ. Healthy versus unhealthy comfort eating for psychophysiological stress recovery in low-income Black and Latinx adults. Appetite 2022; 176:106140. [PMID: 35718313 DOI: 10.1016/j.appet.2022.106140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/27/2022] [Accepted: 06/13/2022] [Indexed: 11/02/2022]
Abstract
Low-income Black and Latinx individuals are disproportionately vulnerable to chronic stress and metabolic disease. Evidence suggests that these populations engage in elevated levels of comfort eating (i.e., eating comforting food to alleviate stress), which can harm diet quality. For this reason, many interventions discourage comfort eating. However, if comfort eating does indeed buffer stress, it may be a protective health behavior, particularly if healthy foods (e.g., strawberries) buffer stress as effectively as traditional unhealthy comfort foods (e.g., brownies). By choosing healthy foods, people may be able to simultaneously improve their nutrition and reduce their stress levels, both of which have the potential to reduce health disparities among chronically stressed populations. The present study tested the efficacy of healthy and unhealthy comfort eating for improving psychophysiological stress recovery. A sample of low-income Black and Latinx individuals (N = 129) were randomly assigned to consume a healthy food (e.g., grapes), unhealthy comfort food (e.g., chips), or no food after exposure to a laboratory stressor. Throughout, we measured participants' psychophysiological stress responses, including self-reported stress, rumination, autonomic nervous system activation (i.e., electrodermal activity (EDA), heart rate variability (HRV)) and neuroendocrine responses (i.e., salivary cortisol). We compared participants' stress recovery trajectories by condition and found no significant group differences (p = 0.12 for self-reported stress; p = 0.92 for EDA; p = 0.22 for HRV, p = 1.00 for cortisol). Participants in all conditions showed decreases in self-reported stress and in cortisol post-stressor (ps < 0.01), but rates of decline did not differ by condition (i.e., healthy or unhealthy comfort food, brief no-food waiting period). Although null, these results are important because they challenge the widely-held assumption that comfort foods help people decrease stress.
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Affiliation(s)
- Erin C Standen
- University of Minnesota, Twin Cities, 75 E River Road, Minneapolis, MN, 55455, USA.
| | - Laura E Finch
- NORC at the University of Chicago, 55 East Monroe Street, Chicago, IL, 60603, USA.
| | | | - Emma Schopp
- National Institutes of Health, 31 Center Drive, Bethesda, MD, 20892, USA.
| | - Kristen M Lee
- University of California, 502 Portola Plaza, Los Angeles, CA, 90095, USA.
| | - Jordan E Parker
- University of California, 502 Portola Plaza, Los Angeles, CA, 90095, USA.
| | | | - A Janet Tomiyama
- University of California, 502 Portola Plaza, Los Angeles, CA, 90095, USA.
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184
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Korn AR, Walsh-Bailey C, Pilar M, Sandler B, Bhattacharjee P, Moore WT, Brownson RC, Emmons KM, Oh AY. Social determinants of health and cancer screening implementation and outcomes in the USA: a systematic review protocol. Syst Rev 2022; 11:117. [PMID: 35676720 PMCID: PMC9175338 DOI: 10.1186/s13643-022-01995-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Improving the delivery, uptake, and implementation of cancer screening to meet evidence-based recommendations is needed to reduce persistent cancer health disparities in the USA. Current national public health targets emphasize the role of social determinants of health (SDOH) on cancer screening. However, there remains a need to explicate these linkages, toward the goal of identifying and implementing effective interventions that target and address SDOH to reduce inequities in cancer screening. METHODS We will conduct a systematic review of English language peer-reviewed original research articles published between 2010 and 2021 that describe observational (qualitative and quantitative) and intervention studies conducted in the USA. In alignment with Healthy People 2030, we will include studies of breast, cervical, colorectal, and/or lung cancer screening. Guided by multiple SDOH frameworks, we will broadly define SDOH by five domain areas: economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context. Following systematic literature searches in five databases (Ovid MEDLINE, Embase, CINAHL, Web of Science, Cochrane Library) and piloting of screening procedures, reviewers will independently screen titles/abstracts for potential relevance. Reviewer pairs will then screen full text articles for eligibility criteria. We will extract data items from included articles, including study characteristics, cancer screening intervention information, and coding of SDOH constructs. We will assess study quality using the Mixed Methods Appraisal Tool and synthesize our findings using narrative, descriptive statistics, tables, and figures. Our approach will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) recommendations. DISCUSSION By completing this systematic review, we will summarize recent literature on SDOH and cancer screening, identify research gaps for inclusion of SDOH, and propose future opportunities for advancing equity in cancer screening by integrating SDOH as part of the implementation context to promote uptake, sustainability, and scale-up in the implementation of screening guidelines. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021276582 .
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Affiliation(s)
- Ariella R Korn
- Cancer Prevention Fellowship Program, Implementation Science, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, 20850, USA.
| | - Callie Walsh-Bailey
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Meagan Pilar
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | - Brittney Sandler
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | - Prema Bhattacharjee
- Implementation Science, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - W Todd Moore
- Implementation Science, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA.,University of Kansas Medical Center, Kansas, KS, USA
| | - Ross C Brownson
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, MO, USA.,Department of Surgery, Division of Public Health Sciences, Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MT, USA
| | - Karen M Emmons
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - April Y Oh
- Implementation Science, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
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185
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Dewidar O, Rader T, Waddington H, Nicholls SG, Little J, Hardy BJ, Horsley T, Young T, Cuervo LG, Sharp MK, Chamberlain C, Shea B, Craig P, Lawson DO, Rizvi A, Wiysonge CS, Kredo T, Nguliefem MN, Ghogomu E, Francis D, Kristjansson E, Bhutta Z, Martin AA, Melendez-Torres GJ, Pantoja T, Wang X, Jull J, Roberts JH, Funnell S, White H, Krentel A, Mahande MJ, Ramke J, Wells GA, Petkovic J, Tugwell P, Pottie K, Mbuagbaw L, Welch V. Reporting of health equity considerations in equity-relevant observational studies: Protocol for a systematic assessment. F1000Res 2022. [DOI: 10.12688/f1000research.122185.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: The mitigation of unfair and avoidable differences in health is an increasing global priority. Observational studies including cohort, cross-sectional and case-control studies tend to report social determinants of health which could inform evidence syntheses on health equity and social justice. However, the extent of reporting and analysis of equity in equity-relevant observational studies is unknown. Methods: We define studies which report outcomes for populations at risk of experiencing inequities as “equity-relevant”. Using a random sampling technique we will identify 320 equity-relevant observational studies published between 1 January 2020 to 27 April 2022 by searching the MEDLINE database. We will stratify sampling by 1) studies in high-income countries (HIC) and low- and middle-income countries (LMIC) according to the World Bank classification, 2) studies focused on COVID and those which are not, 3) studies focused on populations at risk of experiencing inequities and those on general populations that stratify their analyses. We will use the PROGRESS framework which stands for place of residence, race or ethnicity, occupation, gender or sex, religion, education, socioeconomic status, social capital, to identify dimensions where inequities may exist. Using a previously developed data extraction form we will pilot-test on eligible studies and revise as applicable. Conclusions: The proposed methodological assessment of reporting will allow us to systematically understand the current reporting and analysis practices for health equity in observational studies. The findings of this study will help inform the development of the equity extension for the STROBE (Strengthening the Reporting of Observational studies in Epidemiology) reporting guidelines.
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186
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Adsul P, Chambers D, Brandt HM, Fernandez ME, Ramanadhan S, Torres E, Leeman J, Baquero B, Fleischer L, Escoffery C, Emmons K, Soler M, Oh A, Korn AR, Wheeler S, Shelton RC. Grounding implementation science in health equity for cancer prevention and control. Implement Sci Commun 2022; 3:56. [PMID: 35659151 PMCID: PMC9164317 DOI: 10.1186/s43058-022-00311-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 05/20/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The past decade of research has seen theoretical and methodological advances in both implementation science and health equity research, opening a window of opportunity for facilitating and accelerating cross-disciplinary exchanges across these fields that have largely operated in siloes. In 2019 and 2020, the National Cancer Institute's Consortium for Cancer Implementation Science convened an action group focused on 'health equity and context' to identify opportunities to advance implementation science. In this paper, we present a narrative review and synthesis of the relevant literature at the intersection of health equity and implementation science, highlight identified opportunities (i.e., public goods) by the action group for advancing implementation science in cancer prevention and control, and integrate the two by providing key recommendations for future directions. DISCUSSION In the review and synthesis of the literature, we highlight recent advances in implementation science, relevant to promoting health equity (e.g., theories/models/frameworks, adaptations, implementation strategies, study designs, implementation determinants, and outcomes). We acknowledge the contributions from the broader field of health equity research and discuss opportunities for integration and synergy with implementation science, which include (1) articulating an explicit focus on health equity for conducting and reviewing implementation science; (2) promoting an explicit focus on health equity in the theories, models, and frameworks guiding implementation science; and (3) identifying methods for understanding and documenting influences on the context of implementation that incorporate a focus on equity. To advance the science of implementation with a focus on health equity, we reflect on the essential groundwork needed to promote bi-directional learning between the fields of implementation science and health equity research and recommend (1) building capacity among researchers and research institutions for health equity-focused and community-engaged implementation science; (2) incorporating health equity considerations across all key implementation focus areas (e.g., adaptations, implementation strategies, study design, determinants, and outcomes); and (3) continuing a focus on transdisciplinary opportunities in health equity research and implementation science. We believe that these recommendations can help advance implementation science by incorporating an explicit focus on health equity in the context of cancer prevention and control and beyond.
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Affiliation(s)
- Prajakta Adsul
- Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM USA
| | - David Chambers
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD USA
| | - Heather M. Brandt
- HPV Cancer Prevention Program, St. Jude Children’s Research Hospital, Memphis, TN USA
| | - Maria E. Fernandez
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, USA
| | | | - Essie Torres
- East Carolina University, 2309 Carol Belk Bldg, Greenville, NC 27858 USA
| | | | - Barbara Baquero
- University of Washington, 3980 15th Ave. NE, Seattle, WA 98195 USA
| | | | - Cam Escoffery
- Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322 USA
| | - Karen Emmons
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115 USA
| | - Montserrat Soler
- Ob/Gyn and Women’s Health Institute, Cleveland Clinic, Cleveland, OH USA
| | - April Oh
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - Ariella R. Korn
- Cancer Prevention Fellowship Program, Implementation Science, Office of the Director, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, USA
| | - Stephanie Wheeler
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB #7411, Chapel Hill, NC 27599 USA
| | - Rachel C. Shelton
- Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health, 722 W 168th Street, New York, NY 10032 USA
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187
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Hamm RF, Moniz MH. From Research to Practice in OBGYN: How to Critically Interpret Studies in Implementation. Clin Obstet Gynecol 2022; 65:277-289. [PMID: 35354160 PMCID: PMC9050823 DOI: 10.1097/grf.0000000000000706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There is a growing body of research that addresses implementation-focused questions within obstetrics and gynecology. With this document, we provide clinicians with the necessary tools to critically read and interpret literature evaluating an implementation endeavor. We describe the process of implementation research, as well as common study designs and outcomes. Furthermore, we detail pitfalls in the design and analysis of implementation studies, using examples within obstetrics and gynecology. Armed with this knowledge, clinicians may better be able to translate a paper on implementation into improvement efforts in their own clinical practice setting.
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Affiliation(s)
- Rebecca F Hamm
- Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine
- Leonard Davis Institute of Health Economics, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Michelle H Moniz
- Department of Obstetrics and Gynecology
- Program for Women's Health Effectiveness Research, Department of Obstetrics & Gynecology
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
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188
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MCLOUGHLIN GABRIELLAM, MARTINEZ OMAR. Dissemination and Implementation Science to Advance Health Equity: An Imperative for Systemic Change. COMMONHEALTH (PHILADELPHIA, PA.) 2022; 3:75-86. [PMID: 35811831 PMCID: PMC9262159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Innovations in public health research and evidence-based interventions targeting chronic and infectious diseases are only effective if they reach their target populations. Individuals from low socioeconomic background, racial and ethnic minorities, and sexual/gender minority communities are most susceptible to chronic diseases such as obesity and cancer, and infectious diseases such as HIV and COVID-19. These disparities are driven by social and structural conditions including stigma and discrimination, housing instability and food insecurity, among others. Accordingly, interventions that aim to improve population health must be targeted toward marginalized communities who are often systematically excluded from decision making processes. This article introduces dissemination and implementation science as a key opportunity to advance health equity through integrating measures and metrics that evaluate if an intervention is successful at improving health outcomes in marginalized populations. Implementation science also provides frameworks to help evaluate the key determinants to implementation success which can inform subsequent health outcomes. Examples of how researchers have engaged with community stakeholders are provided, along with strategies in which dissemination has gone beyond traditional practices. Finally, ways in which universities can build capacity for implementation science as a means to address health disparities are provided with the goal of improving the translation of research to practice.
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Affiliation(s)
- GABRIELLA M. MCLOUGHLIN
- Department of Kinesiology, College of Public Health, Temple University,Implementation Science Center for Cancer Control and Prevention Research Center, Brown School, Washington University in St. Louis
| | - OMAR MARTINEZ
- School of Social Work, College of Public Health, Temple University
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189
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Baumann AA, Woodward EN, Singh RS, Adsul P, Shelton RC. Assessing researchers' capabilities, opportunities, and motivation to conduct equity-oriented dissemination and implementation research, an exploratory cross-sectional study. BMC Health Serv Res 2022; 22:731. [PMID: 35650573 PMCID: PMC9161573 DOI: 10.1186/s12913-022-07882-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 03/30/2022] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND A recent paradigm shift has led to an explicit focus on enhancing health equity through equity-oriented dissemination and implementation (D&I) research. However, the integration and bidirectional learning across these two fields is still in its infancy and siloed. This exploratory study aimed to examine participants' perceived capabilities, opportunities, and motivations to conduct equity-oriented D&I research. METHODS We conducted an exploratory cross-sectional survey distributed online from December 2020 to April 2021. Participants were recruited at either D&I or health disparities-oriented conferences, meetings, through social media, or personal outreach via emails. Informed by the Capability, Opportunity, and Motivation Model (COM-B), the survey queried respondents about different aspects of engaging in and conducting equity-oriented D&I research. All analyses were conducted in SPSS Version 27.0. RESULTS A total of 180 participants responded to the survey. Most participants were women (81.7%), white (66.1%), academics (78.9%), and faculty members (53.9%). Many reported they were advanced (36.7%) or advanced beginners (27.8%) in the D&I field, and a substantial proportion (37.8%) reported being novice in D&I research that focused on health equity. Participants reported high motivation (e.g., 62.8% were motivated to apply theories, models, frameworks for promoting health equity in D&I research), but low capability to conduct equity-oriented D&I research (e.g., 5% had the information needed for promoting health equity in D&I research). Most participants (62.2%) reported not having used measures to examine equity in their D&I projects, and for those who did use measures, they mainly used individual-level measures (vs. organizational- or structural-level measures). When asked about factors that could influence their ability to conduct equity-oriented D&I research, 44.4% reported not having the skills necessary, and 32.2% stated difficulties in receiving funding for equity-oriented D&I research. CONCLUSIONS Study findings provide empirical insight into the perspectives of researchers from different backgrounds on what is needed to conduct equity-oriented D&I research. These data suggest the need for a multi-pronged approach to enhance the capability and opportunities for conducting equity-oriented D&I work, such as: training specifically in equity-oriented D&I, collaboration between D&I researchers with individuals with expertise and lived experience with health equity research, funding for equity-oriented D&I research, and recognition of the value of community engaged research in promotion packages.
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Affiliation(s)
- Ana A. Baumann
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO USA
| | - Eva N. Woodward
- Center for Mental Healthcare and Outcomes Research, U.S. Department of Veterans Affairs, North Little Rock, AR USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR USA
| | - Rajinder Sonia Singh
- South Central Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs, North Little Rock, North Little Rock, AR USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR USA
| | - Prajakta Adsul
- Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM USA
| | - Rachel C. Shelton
- Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health, New York, NY USA
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190
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Pilar M, Elwy AR, Lushniak L, Huang G, McLoughlin GM, Hooley C, Nadesan-Reddy N, Sandler B, Moshabela M, Alonge O, Geng E, Proctor E. A Perspective on Implementation Outcomes and Strategies to Promote the Uptake of COVID-19 Vaccines. FRONTIERS IN HEALTH SERVICES 2022; 2:897227. [PMID: 36925818 PMCID: PMC10012688 DOI: 10.3389/frhs.2022.897227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022]
Abstract
Recent articles have highlighted the importance of incorporating implementation science concepts into pandemic-related research. However, limited research has been documented to date regarding implementation outcomes that may be unique to COVID-19 vaccinations and how to utilize implementation strategies to address vaccine program-related implementation challenges. To address these gaps, we formed a global COVID-19 implementation workgroup of implementation scientists who met weekly for over a year to review the available literature and learn about ongoing research during the pandemic. We developed a hierarchy to prioritize the applicability of "lessons learned" from the vaccination-related implementation literature. We identified applications of existing implementation outcomes as well as identified additional implementation outcomes. We also mapped implementation strategies to those outcomes. Our efforts provide rationale for the utility of using implementation outcomes in pandemic-related research. Furthermore, we identified three additional implementation outcomes: availability, health equity, and scale-up. Results include a list of COVID-19 relevant implementation strategies mapped to the implementation outcomes.
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Affiliation(s)
- Meagan Pilar
- Department of Infectious Diseases, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - A. Rani Elwy
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, United States
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States
| | - Larissa Lushniak
- Department of Infectious Diseases, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Grace Huang
- Department of Infectious Diseases, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Gabriella M. McLoughlin
- College of Public Health, Temple University, Philadelphia, PA, United States
- Implementation Science Center for Cancer Control and Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Cole Hooley
- School of Social Work, Brigham Young University, Provo, UT, United States
| | - Nisha Nadesan-Reddy
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Brittney Sandler
- Bernard Becker Medical Library, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Mosa Moshabela
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Olakunle Alonge
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Elvin Geng
- Department of Infectious Diseases, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Enola Proctor
- Shanti K. Khinduka Distinguished Professor Emerita, Brown School, Washington University in St. Louis, St. Louis, MO, United States
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191
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Davidson MM, Morris MA. Epilogue: Implementation Science in CSD and Starting Where You Are. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:1179-1187. [PMID: 35349780 DOI: 10.1044/2022_ajslp-22-00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In this epilogue for the Clinicians and Researchers Navigating Implementation Science in CSD forum, we begin by summarizing the eight articles in this forum that describe where the field is in terms of published implementation science (IS) articles in communication sciences and disorders (CSD) and how numerous teams have begun incorporating IS into their research programs. We then situate these articles across three themes: (1) levels of analysis and support; (2) research methods, frameworks, and models; and (3) underserved populations. Next, we consider the challenges and opportunities for conducting IS in CSD. Finally, we conclude by offering tangible steps for researchers, department heads, clinicians, patients, organizations/administrators, and funders in doing and supporting IS research in CSD.
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192
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Ramella L, Schaefer AJ, Rokicki S, Adachi J, Thompson AB, Byatt N, Moore Simas TA, Mackie TI. A national survey on adaptations by perinatal psychiatry access programs to promote perinatal mental healthcare equity. Gen Hosp Psychiatry 2022; 76:49-54. [PMID: 35361495 DOI: 10.1016/j.genhosppsych.2022.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 02/24/2022] [Accepted: 03/09/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Perinatal Psychiatry Access Programs ("Access Programs") are system-level interventions that aim to build the capacity of perinatal healthcare professionals to address mental health, and thereby improve access to perinatal mental healthcare. Access Programs are widely implemented and positioned to promote health equity in perinatal mental healthcare, but little is known about the adaptations being made to the model in response to calls to promote health equity. METHODS One respondent from each of the 14 Access Programs (n = 14) completed an online survey that queried on adaptations made to promote perinatal mental healthcare equity. RESULTS Twelve of the 14 Access Program team members (86%) indicated implementation of at least one new equity initiative. The average number of initiatives that a single Access Program implemented was 3.5 (range 0-10). Two Access Programs (14%) implemented 8.5 initiatives (range: 7-10), indicating that a small cohort is leading promotion of equity among Access Programs. CONCLUSION Efforts to further expand the capacity and services of Access Programs to address perinatal mental healthcare inequities are needed. These adaptations may provide a robust opportunity for implementation initiatives to promote health equity through a system-level intervention.
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Affiliation(s)
- Leah Ramella
- School of Public Health, State University of New York, Downstate Health Sciences University, 450 Clarkson Avenue, Mail Stop Code 43, Brooklyn, NY 11203, United States of America.
| | - Ana J Schaefer
- School of Public Health, State University of New York, Downstate Health Sciences University, 450 Clarkson Avenue, Mail Stop Code 43, Brooklyn, NY 11203, United States of America.
| | - Slawa Rokicki
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ 08854, United States of America.
| | - Jamie Adachi
- Maternal-Child Mental Health Program, Department of Psychiatry & Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, United States of America.
| | - Azure B Thompson
- Department of Community Health Sciences, School of Public Health, State University of New York, Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, United States of America.
| | - Nancy Byatt
- Department of Psychiatry, Obstetrics & Gynecology, and Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School/UMass Memorial Health, 222 Maple Ave - Chang Building, Shrewsbury, MA 01545, United States of America.
| | - Tiffany A Moore Simas
- Department of Obstetrics & Gynecology, Pediatrics, Psychiatry, and Population and Quantitative Health Sciences, Memorial Campus, 119 Belmont Street, Worcester, MA 01605, United States of America.
| | - Thomas I Mackie
- Department of Health Policy and Management, School of Public Health, State University of New York, Downstate Health Sciences University, 450 Clarkson Avenue, Mail Stop Code 43, Brooklyn, NY 11203, United States of America.
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193
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Lawrence K. Digital Health Equity. Digit Health 2022. [DOI: 10.36255/exon-publications-digital-health-health-equity] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Mckay V, Vogel M, Combs T, Brossart L, Endrizal A, Andersen S, Poor T, Mahoney M, Luke D. Tailoring dissemination of evidence to preferences of tobacco control partners: results from an academic-community partnership. Subst Abuse Treat Prev Policy 2022; 17:29. [PMID: 35459197 PMCID: PMC9034543 DOI: 10.1186/s13011-022-00450-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tobacco control program leaders and their partners, who often present evidence to policymakers, can increase the use of evidence in program and policy development. However, up-to-date evidence from the scientific community about what works is slow to reach leaders. We describe efforts to understand and utilize tobacco control leaders' preferences for receiving evidence and report on resulting dissemination strategies, translational products, and outcomes. METHODS This work is part of the Advancing Science and Practice in the Retail Environment (ASPiRE) Center, an interdisciplinary research center focused on understanding and evaluating tobacco retail policy. Participants were members of the ASPiRE Community Advisory Board (CAB), comprised of tobacco control leaders from 30 metropolitan areas representing all regions of the US plus nine representatives from leading national tobacco control organizations (N = 39). During meetings in February 2019 and October 2020, all CAB members were invited to participate in live polls consisting of six survey questions each. Questions addressed preferences for receiving scientific evidence and their anticipated use of ASPiRE translational products. Responses were analyzed descriptively and informed translational product development and communications with ASPiRE contact list members (N = 125). ASPiRE email and website interactions were tracked from March 2019 to May 2021 as a complementary indication of content use. RESULTS Response rates for 2019 and 2020 CAB meetings were 66% (n = 26) and 59% (n = 23), respectively. CAB members indicated preferences for email communication (33%) and webinars (31%), communications once per month (46%), and short-format documents (28%). In response, the team developed translational short-format products including case studies, fact sheets, and research briefs. On average, 52% (SD = 14%) of recipients opened the newsletter and 17% (SD = 9%) clicked a link within the newsletter. Overall, 95% of responding CAB members found the products useful and all responding CAB members reported using them to communicate evidence to policymakers, staff, and coalition members. CONCLUSIONS Our successful dissemination approach to making evidence more accessible and useable for tobacco control leaders could be adapted by researchers working with community partners to assess and respond to stakeholders' preferences for receiving evidence in other areas of health policy.
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Affiliation(s)
- Virginia Mckay
- Center for Public Health Systems Science, Brown School, Washington University in St. Louis, 1 Brookings Drive, Campus, Box 1196, St. Louis, MO, 63130, USA.
| | - Mia Vogel
- Center for Public Health Systems Science, Brown School, Washington University in St. Louis, 1 Brookings Drive, Campus, Box 1196, St. Louis, MO, 63130, USA
| | - Todd Combs
- Center for Public Health Systems Science, Brown School, Washington University in St. Louis, 1 Brookings Drive, Campus, Box 1196, St. Louis, MO, 63130, USA
| | - Laura Brossart
- Center for Public Health Systems Science, Brown School, Washington University in St. Louis, 1 Brookings Drive, Campus, Box 1196, St. Louis, MO, 63130, USA
| | - Amy Endrizal
- Center for Public Health Systems Science, Brown School, Washington University in St. Louis, 1 Brookings Drive, Campus, Box 1196, St. Louis, MO, 63130, USA
| | - Stephanie Andersen
- Center for Public Health Systems Science, Brown School, Washington University in St. Louis, 1 Brookings Drive, Campus, Box 1196, St. Louis, MO, 63130, USA
| | - Timothy Poor
- Health Communication Research Laboratory, Brown School, Washington University in St. Louis, 1 Brookings Drive, Campus, Box 1196, St. Louis, MO, 63130, USA
| | | | - Douglas Luke
- Center for Public Health Systems Science, Brown School, Washington University in St. Louis, 1 Brookings Drive, Campus, Box 1196, St. Louis, MO, 63130, USA
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195
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Brownson RC, Shelton RC, Geng EH, Glasgow RE. Revisiting concepts of evidence in implementation science. Implement Sci 2022; 17:26. [PMID: 35413917 PMCID: PMC9004065 DOI: 10.1186/s13012-022-01201-y] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 04/04/2022] [Indexed: 11/20/2022] Open
Abstract
Background Evidence, in multiple forms, is a foundation of implementation science. For public health and clinical practice, evidence includes the following: type 1 evidence on etiology and burden; type 2 evidence on effectiveness of interventions; and type 3: evidence on dissemination and implementation (D&I) within context. To support a vision for development and use of evidence in D&I science that is more comprehensive and equitable (particularly for type 3 evidence), this article aims to clarify concepts of evidence, summarize ongoing debates about evidence, and provide a set of recommendations and tools/resources for addressing the “how-to” in filling evidence gaps most critical to advancing implementation science. Main text Because current conceptualizations of evidence have been relatively narrow and insufficiently characterized in our opinion, we identify and discuss challenges and debates about the uses, usefulness, and gaps in evidence for implementation science. A set of questions is proposed to assist in determining when evidence is sufficient for dissemination and implementation. Intersecting gaps include the need to (1) reconsider how the evidence base is determined, (2) improve understanding of contextual effects on implementation, (3) sharpen the focus on health equity in how we approach and build the evidence-base, (4) conduct more policy implementation research and evaluation, and (5) learn from audience and stakeholder perspectives. We offer 15 recommendations to assist in filling these gaps and describe a set of tools for enhancing the evidence most needed in implementation science. Conclusions To address our recommendations, we see capacity as a necessary ingredient to shift the field’s approach to evidence. Capacity includes the “push” for implementation science where researchers are trained to develop and evaluate evidence which should be useful and feasible for implementers and reflect community or stakeholder priorities. Equally important, there has been inadequate training and too little emphasis on the “pull” for implementation science (e.g., training implementers, practice-based research). We suggest that funders and reviewers of research should adopt and support a more robust definition of evidence. By critically examining the evolving nature of evidence, implementation science can better fulfill its vision of facilitating widespread and equitable adoption, delivery, and sustainment of scientific advances.
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Keating NL, Landrum MB, Samuel-Ryals C, Sinaiko AD, Wright A, Brooks GA, Bai B, Zaslavsky AM. Measuring Racial Inequities In The Quality Of Care Across Oncology Practices In The US. Health Aff (Millwood) 2022; 41:598-606. [PMID: 35377762 DOI: 10.1377/hlthaff.2021.01594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Racial inequities in clinical performance diminish overall health care system performance; however, quality assessments have rarely incorporated reliable measures of racial inequities. We studied care for more than one million Medicare fee-for-service beneficiaries with cancer to assess the feasibility of calculating reliable practice-level measures of racial inequities in chemotherapy-associated emergency department (ED) visits and hospitalizations. Specifically, we used hierarchical models to estimate adjusted practice-level Black-White differences in these events and described differences across practices. We calculated reliable inequity measures for 426 and 322 practices, depending on the measure. These practices reflected fewer than 10 percent of practices treating Medicare beneficiaries with chemotherapy, but they treated approximately half of all White and Black Medicare beneficiaries receiving chemotherapy and two-thirds of Black Medicare beneficiaries receiving chemotherapy. Black patients experienced chemotherapy-associated ED visits and hospitalizations at higher rates (54.2 percent and 35.8 percent, respectively) than White patients (45.7 percent and 31.9 percent, respectively). The median within-practice Black-White difference was 8.1 percentage points for chemotherapy-associated ED visits and 2.7 percentage points for chemotherapy-associated hospitalizations. Additional research is needed to identify other reliable measures of racial inequities in health care quality, measure care inequities in smaller practices, and assess whether providing practice-level feedback could improve equity.
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Affiliation(s)
- Nancy L Keating
- Nancy L. Keating , Harvard University and Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Cleo Samuel-Ryals
- Cleo Samuel-Ryals, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Alexi Wright
- Alexi Wright, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Gabriel A Brooks
- Gabriel A. Brooks, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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197
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Afifi RA, Parker EA, Dino G, Hall DM, Ulin B. Reimagining Rural: Shifting Paradigms About Health and Well-Being in the Rural United States. Annu Rev Public Health 2022; 43:135-154. [PMID: 34910581 PMCID: PMC11295601 DOI: 10.1146/annurev-publhealth-052020-123413] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Rural health disparities have attracted increased national attention, compelling an expanded focus on rural health research. In this article, we deconstruct the definitions and narratives of "rural" communities and suggest that a paradigm shift is needed that centers the complexity and strength of rural places. We discuss the relevance of health equity frameworks, implementation science, and community-engaged approaches to promote rural well-being. Focusing on rural in its own right will lead to intervention innovations and reinvention with implications beyond rural areas. We conclude with suggestions for research and practice to inspire renewed interest in partnering with rural communities to promote health equity.
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Affiliation(s)
- R A Afifi
- Department of Community and Behavioral Health, and Prevention Research Center for Rural Health, College of Public Health, University of Iowa, Iowa City, Iowa, United States; ,
| | - E A Parker
- Department of Community and Behavioral Health, and Prevention Research Center for Rural Health, College of Public Health, University of Iowa, Iowa City, Iowa, United States; ,
| | - G Dino
- Department of Social and Behavioral Sciences, and West Virginia Prevention Research Center, School of Public Health, West Virginia University, Morgantown, West Virginia, United States;
| | - D M Hall
- Office of the Associate Director for Policy and Strategy, Centers for Disease Control and Prevention, Atlanta, Georgia, United States;
| | - B Ulin
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States;
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Wesson P, Hswen Y, Valdes G, Stojanovski K, Handley MA. Risks and Opportunities to Ensure Equity in the Application of Big Data Research in Public Health. Annu Rev Public Health 2022; 43:59-78. [PMID: 34871504 PMCID: PMC8983486 DOI: 10.1146/annurev-publhealth-051920-110928] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The big data revolution presents an exciting frontier to expand public health research, broadening the scope of research and increasing the precision of answers. Despite these advances, scientists must be vigilant against also advancing potential harms toward marginalized communities. In this review, we provide examples in which big data applications have (unintentionally) perpetuated discriminatory practices, while also highlighting opportunities for big data applications to advance equity in public health. Here, big data is framed in the context of the five Vs (volume, velocity, veracity, variety, and value), and we propose a sixth V, virtuosity, which incorporates equity and justice frameworks. Analytic approaches to improving equity are presented using social computational big data, fairness in machine learning algorithms, medical claims data, and data augmentation as illustrations. Throughout, we emphasize the biasing influence of data absenteeism and positionality and conclude with recommendations for incorporating an equity lens into big data research.
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Affiliation(s)
- Paul Wesson
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA;
- Bakar Computational Health Sciences Institute, University of California, San Francisco, California, USA
| | - Yulin Hswen
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA;
- Bakar Computational Health Sciences Institute, University of California, San Francisco, California, USA
| | - Gilmer Valdes
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA;
- Department of Radiation Oncology, University of California, San Francisco, California, USA
| | - Kristefer Stojanovski
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
- Department of Social, Behavioral and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Margaret A Handley
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA;
- Department of Medicine, University of California, San Francisco, California, USA
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA
- Partnerships for Research in Implementation Science for Equity (PRISE), University of California, San Francisco, California, USA
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199
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Kwan BM, Brownson RC, Glasgow RE, Morrato EH, Luke DA. Designing for Dissemination and Sustainability to Promote Equitable Impacts on Health. Annu Rev Public Health 2022; 43:331-353. [PMID: 34982585 PMCID: PMC9260852 DOI: 10.1146/annurev-publhealth-052220-112457] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Designing for dissemination and sustainability (D4DS) refers to principles and methods for enhancing the fit between a health program, policy, or practice and the context in which it is intended to be adopted. In this article we first summarize the historical context of D4DS and justify the need to shift traditional health research and dissemination practices. We present a diverse literature according to a D4DS organizing schema and describe a variety of dissemination products, design processes and outcomes, and approaches to messaging, packaging, and distribution. D4DS design processes include stakeholder engagement, participatory codesign, and context and situation analysis, and leverage methods and frameworks from dissemination and implementation science, marketing and business, communications and visualarts, and systems science. Finally, we present eight recommendations to adopt a D4DS paradigm, reflecting shifts in ways of thinking, skills and approaches, and infrastructure and systems for training and evaluation.
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Affiliation(s)
- Bethany M Kwan
- Department of Family Medicine and Adult & Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA;
| | - Ross C Brownson
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Russell E Glasgow
- Department of Family Medicine and Adult & Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA;
| | - Elaine H Morrato
- Parkinson School of Health Sciences and Public Health and Institute for Translational Medicine, Loyola University Chicago, Maywood, Illinois, USA
| | - Douglas A Luke
- Center for Public Health Systems Science, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
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200
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Swami N, Yamoah K, Mahal BA, Dee EC. The right to be screened: Identifying and addressing inequities in genetic screening. LANCET REGIONAL HEALTH. AMERICAS 2022; 11:100251. [PMID: 36778922 PMCID: PMC9903822 DOI: 10.1016/j.lana.2022.100251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Nishwant Swami
- University of Massachusetts Medical School, Worcester, MA, USA,Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kosj Yamoah
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, University of South Florida, Tampa, FL, USA
| | - Brandon A. Mahal
- Department of Radiation Oncology, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA,Corresponding author.
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