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Terrana A, Viglione C, Rhee K, Rabin B, Godino J, Aarons GA, Chapman J, Melendrez B, Holguin M, Osorio L, Gidwani P, Juarez Nunez C, Firestein G, Hekler E. The core functions and forms paradigm throughout EPIS: designing and implementing an evidence-based practice with function fidelity. FRONTIERS IN HEALTH SERVICES 2024; 3:1281690. [PMID: 38292916 PMCID: PMC10826509 DOI: 10.3389/frhs.2023.1281690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/21/2023] [Indexed: 02/01/2024]
Abstract
There are numerous frameworks for implementing evidence-based practices (EBPs) in novel settings to achieve "fidelity." However, identifying appropriate referents for fidelity poses a challenge. The Core Functions and Forms paradigm offers a model that can inform adaptation decisions throughout all phases of the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. We applied the Core Functions-Forms paradigm throughout the Exploration and Preparation phases of EPIS in the design of two EBPs targeting family protective factors among Latinos in San Diego, as well as describe plans for its use in Implementation and Sustainment. We employed a distinct approach for each intervention element to contrast adaptation decisions that prioritize adherence to either form or function fidelity. We describe our application of the functions-forms paradigm within the EPIS framework, focusing on the Preparation phase. We also provide functions-forms matrices that map out the relationship between individual intervention components (forms) and the essential processes (functions) by which components are theorized to exert their impact. This case study of how the core functions-forms framework can be mapped onto EPIS can support a conceptual shift from prioritizing form fidelity to also focusing on function fidelity. This might allow interventionists to target appropriate fidelity referents when adapting an EBP, rather than defaulting to maintaining fidelity to forms as described in the protocol. We see great promise for using this framework for guiding actions throughout all EPIS phases and informing future applications of this paradigm to foster more robust fidelity to function.
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Affiliation(s)
- Alec Terrana
- School of Medicine, University of California San Diego, San Diego, CA, United States
| | - Clare Viglione
- Altman Clinical and Translational Research Institute, School of Medicine, University of California, San Diego, CA, United States
| | - Kyung Rhee
- School of Medicine, University of California San Diego, San Diego, CA, United States
| | - Borsika Rabin
- Altman Clinical and Translational Research Institute, School of Medicine, University of California, San Diego, CA, United States
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA, United States
| | - Job Godino
- Family Health Centers of San Diego, San Diego, CA, United States
| | - Gregory A. Aarons
- Altman Clinical and Translational Research Institute, School of Medicine, University of California, San Diego, CA, United States
| | - Jessica Chapman
- Altman Clinical and Translational Research Institute, School of Medicine, University of California, San Diego, CA, United States
| | - Blanca Melendrez
- Altman Clinical and Translational Research Institute, School of Medicine, University of California, San Diego, CA, United States
| | | | - Liliana Osorio
- Altman Clinical and Translational Research Institute, School of Medicine, University of California, San Diego, CA, United States
| | | | | | - Gary Firestein
- Altman Clinical and Translational Research Institute, School of Medicine, University of California, San Diego, CA, United States
| | - Eric Hekler
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA, United States
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Villalobos A, Blachman-Demner D, Percy-Laurry A, Belis D, Bhattacharya M. Community and partner engagement in dissemination and implementation research at the National Institutes of Health: an analysis of recently funded studies and opportunities to advance the field. Implement Sci Commun 2023; 4:77. [PMID: 37438834 DOI: 10.1186/s43058-023-00462-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/28/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND As the focus has grown in recent years on both engaged research and dissemination and implementation (D&I) research, so too has federal funding to support these areas. The purpose of this analysis is to provide an overall perspective about the range of practices and approaches being used to engage partners in D&I research, with special attention to disparities-relevant research, and to identify gaps and opportunities in research funded by the US National Institutes of Health (NIH) in this space. METHODS This analysis examined a portfolio of active D&I research grants funded in fiscal years 2020 and 2021 across the NIH. Grant applications were deductively coded and summary statistics were calculated. Cross-tabulations were used to identify trends by engagement and disparities foci. RESULTS There were 103 grants included in the portfolio, of which 87% contained some form of community or partner engagement, and 50% of engaged grants were relevant to health disparities. Engagement was planned across the research continuum with each study engaging on average 2.5 different partner types. Consultation was the most common level of engagement (56%) while partnership was the least common (3%). On average, each study used 2.2 engagement strategies. Only 16% of grants indicated formally measuring engagement. Compared to non-disparities studies, disparities-relevant studies were about twice as likely to engage partners at the higher levels of partnership or collaboration (19% vs. 11%) and were also more likely to be conducted in community settings (26% vs. 5%). CONCLUSIONS Based on this portfolio analysis, D&I research appears to regularly integrate engagement approaches and strategies, though opportunities to deepen engagement and diversify who is engaged remain. This manuscript outlines several gaps in the portfolio and describes opportunities for increasing engagement to improve the quality of D&I research and application to advancing health equity. In addition, opportunities for leveraging the consistent and systematic application of engagement approaches and strategies to advance the science of engagement are discussed.
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Affiliation(s)
- Aubrey Villalobos
- Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Dr, Bethesda, MD, 20892, USA.
| | - Dara Blachman-Demner
- Office of Behavioral and Social Sciences Research, Office of the Director, National Institutes of Health, 31 Center Dr, Bethesda, MD, 20892, USA
| | - Antoinette Percy-Laurry
- Office of Science Policy, Planning, Evaluation and Reporting, National Institute on Minority Health and Health Disparities, 6707 Democracy Blvd, Bethesda, MD, 20817, USA
| | - Deshiree Belis
- Office of Behavioral and Social Sciences Research, Office of the Director, National Institutes of Health, 31 Center Dr, Bethesda, MD, 20892, USA
| | - Manami Bhattacharya
- Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Dr, Bethesda, MD, 20892, USA
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Woodward EN, Ball IA. Perspectives on learning to practice reflexivity while engaging communities in implementation science. FRONTIERS IN HEALTH SERVICES 2023; 2:1070444. [PMID: 36925788 PMCID: PMC10012695 DOI: 10.3389/frhs.2022.1070444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/07/2022] [Indexed: 01/18/2023]
Abstract
Background As implementation scientists and practitioners engage community members and service users, reflexivity rises as a critical approach for managing power imbalances and effective collaborative work to promote equity. Reflexivity is an approach for acknowledging scientists' own positions, including their understanding and limits of how they view their phenomena of inquiry. We describe our perspective practicing reflexivity as an implementation science team new to community engagement. Methods We spent over two years learning principles of Community-Based Participatory Research (CBPR) to inform implementation science and practice, then applied CPBR principles into a new community-academic partnership in August 2020 for and with veterans of the United States Military living in rural Arkansas. We used five methods to practice reflexivity for the first time: identifying positionality, writing fieldnotes, obtaining mentorship on technical aspects, comparing head notes, and consulting reference materials. Discussion We found multiple methods for practicing reflexivity to be feasible, although difficult to stay consistent with busy schedules. Fieldnotes especially required commitment and were important not to minimize. Written fieldnotes enabled us to reflect on successes and missteps, funneling into action planning. Head notes allowed emotional catharsis and to generate insights based on each other's perspectives. Referencing books or course modules reminded us of ideal CBPR principles. Discussion with mentors helped us with technical aspects and balancing real-world challenges with ideal CBPR principles. Our methods to practice reflexivity were valuable and directly impacted process and research outcomes. Future training for implementation science and practice might consider reflexivity practice as a core competency.
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Affiliation(s)
- Eva N. Woodward
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Irenia A. Ball
- VA Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
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Malley J, Bauer A, Boaz A, Kendrick H, Knapp M. Theory-based evaluation of three research-practice partnerships designed to deliver novel, sustainable collaborations between adult social care research and practice in the UK: a research protocol for a 'layered' contributions analysis and realist evaluation. BMJ Open 2022; 12:e068651. [PMID: 36428022 PMCID: PMC9703321 DOI: 10.1136/bmjopen-2022-068651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Research-practice partnerships (RPPs) are long-term collaborations between research and practice that aim to conduct research that can be used to make practice-based improvements. They intentionally bring together diverse experience in decision making and seek to shift power dynamics so that all partners have a say. The Creating Care Partnerships project aims to explore whether the RPP approach developed within the US educational context can be successfully applied to the English care home context. The project involves a programme of codesign, implementation and evaluation within three case study sites. This protocol set outs the aims, research design and governance of the evaluation. METHODS AND ANALYSIS The evaluation takes a theory-based approach to explore how, why and in what circumstances RPPs in the care home context contribute to enhancing research and research use in local care homes and informing wider improvement efforts. A mixed-methods design will be used for each case study, including semistructured interviews, observations of RPP events and meetings, an online survey, activity diary and review of local data and documents. Data collection will proceed in waves, with the theory of change (ToC) being continually refined and used to guide further data collection and analysis. Insights will be drawn using Contribution Analysis, Realist Evaluation and systems perspectives to assess the contribution made by the case study sites to achieving outcomes and the influence of contextual factors. Economic consequences will be identified through the ToC, using a narrative economic analysis to assess costs, consequences and value for money. ETHICS AND DISSEMINATION The study has undergone ethics review by HRA Research Ethics Committee. It does not pose major ethical issues. A final report will be published and articles will be submitted to international journals.
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Affiliation(s)
- Juliette Malley
- Care Policy and Evaluation Centre, The London School of Economics and Political Science, London, UK
| | - Annette Bauer
- Care Policy and Evaluation Centre, The London School of Economics and Political Science, London, UK
| | - Annette Boaz
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Hannah Kendrick
- Care Policy and Evaluation Centre, The London School of Economics and Political Science, London, UK
| | - Martin Knapp
- Care Policy and Evaluation Centre, The London School of Economics and Political Science, London, UK
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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: 19] [Impact Index Per Article: 9.5] [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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Bartley L, Metz A, Fleming WO. What implementation strategies are relational? Using Relational Theory to explore the ERIC implementation strategies. FRONTIERS IN HEALTH SERVICES 2022; 2:913585. [PMID: 36925772 PMCID: PMC10012668 DOI: 10.3389/frhs.2022.913585] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 09/20/2022] [Indexed: 03/18/2023]
Abstract
The identification and use of implementation strategies in implementation research and practice have strengthened our understanding of the implementation process as well as the causal pathways between mechanisms, strategies, and implementation outcomes. Although these contributions have advanced the application of strategies, there is still a need to learn more about how strategies might integrate relational exchanges and interactions. The inclusion of critical perspectives has been limited in implementation science, and theories such as Relational Theory can expand our understanding of the relational nature of implementation and enhance rigor through alternative theoretical applications. This study applied Relational Theory through a qualitative directed content analysis of the 73 Expert Recommendations for Implementation Change (ERIC) implementation strategies and examine relational components in strategy descriptions. Three reviewers used the structured approach to review and categorize the implementation strategies based on the Relational and Transactional Strategy Continuum measure, which operationalizes types of interactions, exchanges and alliances. Relational alliance strategies are those in which there is mutual growth and accountability, frequent interaction, shared power, and potential vulnerability. Operational alliances include forms of working exchanges between parties with balanced transactional and relational features. Operational alliances can be somewhat interactive in nature, with minor exchanges and limited accountability. Transactional alliance strategies are mostly uni-directional, influenced by power differentials, and do not require mutual growth, commitment, or exchange; thus, the power of growth is inherently one-sided. Results from the review suggest more implementation strategies with relational alliance features (highly relational, n = 17, semi-relational, n = 19) compared to transactional (highly transactional, n = 9, semi-transactional, n = 10) and 18 strategies coded as operational alliances. The qualitative review revealed opportunities to further expand how relational exchanges are considered within the implementation strategies descriptions, as well as the role of actors and power dynamics within strategy exchanges. The Relational and Transactional Strategy Continuum measure can help practitioners and researchers consider the sequencing, pairing, and impact on outcomes of different types and combinations of strategies in implementation practice and research. Additionally, the measure can support reflection on strategies that promote positive alliances, frequent connections, bi-directional communication, and power sharing.
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Affiliation(s)
- Leah Bartley
- Kaye Implementation and Evaluation, Tacoma, WA, United States
| | - Allison Metz
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - W. Oscar Fleming
- School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Collier-Meek MA, Kratochwill TR, Luh HJ, Sanetti LMH, Susilo A. Reflections on Consultation: Applying a DisCrit and Equitable Implementation Lens to Help School Psychologists Disrupt Disparities. JOURNAL OF EDUCATIONAL AND PSYCHOLOGICAL CONSULTATION 2022. [DOI: 10.1080/10474412.2022.2131558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2022]
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Shattuck D, Richard BO, Jaramillo ET, Byrd E, Willging CE. Power and resistance in schools: Implementing institutional change to promote health equity for sexual and gender minority youth. FRONTIERS IN HEALTH SERVICES 2022; 2:920790. [PMID: 36873606 PMCID: PMC9979782 DOI: 10.3389/frhs.2022.920790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction Schools in the United States are hierarchical institutions that actively (re)produce the power relations of the wider social world, including those associated with heteronormativity. Structural stigma, informed by heteronormativity and perpetuated through schools, contributes to the production of academic and health disparities among youth who are lesbian, gay, bisexual, transgender, queer, or of other gender and sexual identities (LGBTQ+). We draw upon 5 years of qualitative data from a cluster randomized controlled trial conducted in New Mexico that used implementation science frameworks to promote the uptake and sustainment of evidence-informed practices (EIPs) to examine how power operates to hinder or promote the ability of school staff to change school environments, disrupt structural stigma, and increase safety and support for LGBTQ+ youth. Methods Data sources included annual individual and small group qualitative interviews with school professionals (e.g., administrators, school nurses, teachers, and other staff), several of whom took part in Implementation Resource Teams (IRTs) charged with applying the EIPs. Other data sources included bi-weekly periodic reflections with implementation coaches and technical assistance experts. Data were recorded, transcribed, and analyzed using deductive and inductive coding techniques. Results The IRTs experienced variable success in implementing EIPs. Their efforts were influenced by: (1) constraining school characteristics, including staff turnover and resource scarcity; (2) community-based opposition to change and concerns about community backlash; (3) the presence or absence of supportive school leadership; and (4) variations in school, district, and state policies affecting LGBTQ+ students and attitudes about their importance. Findings illustrate how diverse power structures operated in and across outer and inner contexts to bound, shift, amplify, and otherwise shape how new practices were received and implemented. Conclusion Findings indicate that the efforts of IRTs were often a form of resistant power that operated within and against school hierarchies to leverage epistemic, discursive, and material power toward implementation. To improve health equity, implementation scientists must attend to the multiple real and perceived power structures that shape implementation environments and influence organizational readiness and individual motivation. Implementers must also work to leverage resistant power to counter the institutional structures and social norms that perpetuate inequities, like heteronormativity and structural stigma.
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Affiliation(s)
| | | | | | - Evelyn Byrd
- Pacific Institute for Research and Evaluation
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