The pragmatic, rapid, and iterative dissemination and implementation (PRIDI) cycle: adapting to the dynamic nature of public health emergencies (and beyond)

Digital intervention for public health: searching for implementing characteristics, concepts and recommendations: scoping review

Studying the impact of digital interventions on public health can help ensure that the offered services produce the desired results. In order to address these factors, the subsequent study uses a scope review to evaluate the state of the field while concentrating on ideas and suggestions that represent factors that have been crucial in the management of digital intervention for public health. To shed light on the traits, ideas and suggestions related to public health digital intervention, a scoping review was carried out. Five electronic databases were used to locate pertinent research that were published before February 2022. All texts were examined, and study abstracts were scrutinized to determine their eligibility. The last analysis of this study included fifteen publications; five reviews, four qualitative studies, two quantitative studies, one viewpoint study, one mixed-method study, one perspective study, and one interventional study. The key ideas for digital interventions in population management and health studies are presented in this overview. Many concepts, implementation characteristics and recommendations have been raised which highlight the future role of these interventions to enhance public engagement and health equity.

Rapid-cycle designs to adapt interventions for COVID-19 in safety-net healthcare systems

Racial/ethnic minority, low socioeconomic status, and rural populations are disproportionately affected by COVID-19. Developing and evaluating interventions to address COVID-19 testing and vaccination among these populations are crucial to improving health inequities. The purpose of this paper is to describe the application of a rapid-cycle design and adaptation process from an ongoing trial to address COVID-19 among safety-net healthcare system patients. The rapid-cycle design and adaptation process included: (a) assessing context and determining relevant models/frameworks; (b) determining core and modifiable components of interventions; and (c) conducting iterative adaptations using Plan-Do-Study-Act (PDSA) cycles. PDSA cycles included: Plan. Gather information from potential adopters/implementers (e.g., Community Health Center [CHC] staff/patients) and design initial interventions; Do. Implement interventions in single CHC or patient cohort; Study. Examine process, outcome, and context data (e.g., infection rates); and, Act. If necessary, refine interventions based on process and outcome data, then disseminate interventions to other CHCs and patient cohorts. Seven CHC systems with 26 clinics participated in the trial. Rapid-cycle, PDSA-based adaptations were made to adapt to evolving COVID-19-related needs. Near real-time data used for adaptation included data on infection hot spots, CHC capacity, stakeholder priorities, local/national policies, and testing/vaccine availability. Adaptations included those to study design, intervention content, and intervention cohorts. Decision-making included multiple stakeholders (e.g., State Department of Health, Primary Care Association, CHCs, patients, researchers). Rapid-cycle designs may improve the relevance and timeliness of interventions for CHCs and other settings that provide care to populations experiencing health inequities, and for rapidly evolving healthcare challenges such as COVID-19.

Designing Digital COVID-19 Screening: Insights and Deliberations

Due to the global COVID-19 pandemic, public health control and screening measures have been introduced at healthcare facilities, including those housing our most vulnerable populations. These warning measures situated at hospital entrances are presently labour-intensive, requiring additional staff to conduct manual temperature checks and risk-assessment questionnaires of every individual entering the premises. To make this process more efficient, we present eGate, a digital COVID-19 health-screening smart Internet of Things system deployed at multiple entry points around a children's hospital. This paper reports on design insights based on the experiences of concierge screening staff stationed alongside the eGate system. Our work contributes towards social-technical deliberations on how to improve design and deploy of digital health-screening systems in hospitals. It specifically outlines a series of design recommendations for future health screening interventions, key considerations relevant to digital screening control systems and their implementation, and the plausible effects on the staff who work alongside them.

Addressing COVID-19 vaccine hesitancy in rural communities: A case study in engaging trusted messengers to pivot and plan

The pandemic declaration of COVID-19 in 2020 presented unique challenges, lessons, and opportunities for public health practice in the United States. Despite clear evidence of COVID-19 vaccine effectiveness, vaccine uptake and vaccine confidence remained low in many regions. Vaccine holdouts, or those who are vaccine hesitant, have been an increasingly difficult population to reach. Several factors influence vaccine hesitancy and behavior in rural areas, including health care access challenges, misinformation, political loyalties, and concerns regarding the perceived lack of trustworthy evidence and knowledge of long-term effects. In March 2021, the Finger Lakes Rural Immunization Initiative (FLRII) engaged stakeholders to address vaccine hesitancy in a nine-county region of rural New York known as the Finger Lakes. Driven by data collected from community partners, physicians, and local health departments regarding their biggest barriers and greatest needs, the FLRII team created an interactive program for trusted messengers (TMs) including a stakeholder panel, called the Trusted Messenger Forum (TMF). The TMF met every 2 weeks from August 2021- August 2022 to engage local TMs and disseminate up-to-date knowledge in real time. During forum sessions, TMs shared detailed accounts of their experiences combating vaccine hesitancy in their communities and supported one another in their efforts through positive interaction and reaffirming conversations. Collaborations between community stakeholders can form a scaffolding to support a rapid response to a variety of public health problems and result in impactful change. For researchers implementing community-based research projects, modeling stakeholder panels after trusted messenger forums can be effective for diversifying the scope of the project and reacting to emergent problems in real-time.

Advancing rapid adaptation for urgent public health crises: Using implementation science to facilitate effective and efficient responses

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.

Grounding implementation science in health equity for cancer prevention and control

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.