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Saragosa AC, Flatt JD, Buccini G. Using concept mapping to co-create implementation strategies to address maternal-child food insecurity during the first 1000 days of life. MATERNAL & CHILD NUTRITION 2024:e13739. [PMID: 39400447 DOI: 10.1111/mcn.13739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 09/09/2024] [Accepted: 09/25/2024] [Indexed: 10/15/2024]
Abstract
Food insecurity (FI) has short- and long-term effects on maternal and child health, with persistent inequities within under-resourced communities of colour (e.g., Hispanic and Non-Hispanic Black). Interventions to mitigate maternal-child FI must engage the voices of under-resourced communities of colour to improve implementation and tackle socio-ecological drivers of inequities, leading to positive maternal-child outcomes. This exploratory sequential mixed-methods study aimed to co-create implementation strategies to tailor a culturally sensitive intervention to address FI during the first 1000 days of life in under-resourced communities of colour in Las Vegas. A Community Advisory Board (CAB) engaged in a two-step participatory process. First, through the concept mapping, hierarchical cluster analysis organized 125 strategies into seven thematic areas: policy and advocacy, access to food and resources, built environment, education across systems, social and peer support, cultural congruency and trust, and wellness and mental health. Second, through consensus-building, strategies were combined by similarity (n = 94) and excluded if unrelated to health and nutrition (n = 9). The CAB reached a consensus on 22 strategies classified across three socio-ecological levels. Examples of strategies at the community level (n = 16) included increasing utilization of federal nutrition assistance programmes; at the service level (n = 4), integrating FI screenings and referral coordination systems across services; and at the individual level (n = 2), providing mentorship, education, and support for families and moms. The co-creation of a culturally sensitive intervention to reduce inequities in maternal-child FI during the first 1000 days of life requires multi-level strategies across three socio-ecological levels in under-resourced communities of colour in Las Vegas.
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Affiliation(s)
- Amanda C Saragosa
- Department of Social and Behavioral Health, School of Public Health, University of Nevada, Las Vegas, Las Vegas, Nevada, USA
| | - Jason D Flatt
- Department of Social and Behavioral Health, School of Public Health, University of Nevada, Las Vegas, Las Vegas, Nevada, USA
| | - Gabriela Buccini
- Department of Social and Behavioral Health, School of Public Health, University of Nevada, Las Vegas, Las Vegas, Nevada, USA
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McLoughlin GM, Singleton CR, Walsh-Bailey C, Inman R, Turner L. Bridging the Gap in Policy Implementation through a Health Equity Lens: Insights from a 2-Year Study on Measurement Development. Nutrients 2024; 16:3357. [PMID: 39408323 PMCID: PMC11478687 DOI: 10.3390/nu16193357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Revised: 09/19/2024] [Accepted: 09/27/2024] [Indexed: 10/20/2024] Open
Abstract
Background: Policy implementation measurement lacks an equity focus, which limits understanding of how policies addressing health inequities, such as Universal School Meals (USM) can elicit intended outcomes. We report findings from an equity-focused measurement development study, which had two aims: (1) identify key constructs related to the equitable implementation of school health policies and (2) establish face and content validity of measures assessing key implementation determinants, processes, and outcomes. Methods: To address Aim 1, study participants (i.e., school health policy experts) completed a survey to rate the importance of constructs identified from implementation science and health equity by the research team. To accomplish Aim 2, the research team developed survey instruments to assess the key constructs identified from Aim 1 and conducted cognitive testing of these survey instruments among multiple user groups. The research team iteratively analyzed the data; feedback was categorized into "easy" or "moderate/difficult" to facilitate decision-making. Results: The Aim 1 survey had 122 responses from school health policy experts, including school staff (n = 76), researchers (n = 22), trainees (n = 3), leaders of non-profit organizations (n = 6), and others (n = 15). For Aim 2, cognitive testing feedback from 23 participants was predominantly classified as "easy" revisions (69%) versus "moderate/difficult" revisions (31%). Primary feedback themes comprised (1) comprehension and wording, (2) perceived lack of control over implementation, and (3) unclear descriptions of equity in questions. Conclusions: Through adaptation and careful dissemination, these tools can be shared with implementation researchers and practitioners so they may equitably assess policy implementation in their respective settings.
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Affiliation(s)
- Gabriella M. McLoughlin
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B. Moore Ave., Philadelphia, PA 19122, USA
- Implementation Science Center for Cancer Control, One Brookings Drive, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Chelsea R. Singleton
- Department of Social, Behavioral, and Population Sciences, Tulane School of Public Health & Tropical Medicine, 1440 Canal Street, Suite 2200-20, New Orleans, LA 70112, USA;
| | - Callie Walsh-Bailey
- Department of Medical Social Sciences, Division of Implementation Science, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave., Suite 2100, Chicago, IL 60611, USA;
| | - Rachel Inman
- Department of Nutrition Sciences, College of Nursing and Health Professions, Drexel University, 60 N 36th St., Philadelphia, PA 19104, USA;
| | - Lindsey Turner
- College of Education, Boise State University, 1910 University Drive, Boise, ID 83725, USA;
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L'Huillier JC, Boccardo JD, Stewart M, Wang S, Myneni AA, Bari AA, Nitsche LJ, Taylor HL, Lukan J, Noyes K. Gun violence revictimization in New York State: What increases the risk of being shot again? J Trauma Acute Care Surg 2024; 97:604-613. [PMID: 38689385 DOI: 10.1097/ta.0000000000004370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
BACKGROUND While gun injuries are more likely to occur in urban settings and affect people of color, factors associated with gun violence revictimization-suffering multiple incidents of gun violence-are unknown. We examined victim demographics and environmental factors associated with gun violence revictimization in New York State (NYS). METHODS The 2005 to 2020 NYS hospital discharge database was queried for patients aged 12 years to 65 years with firearm-related hospital encounters. Patient and environmental variables were extracted. Patient home zip code was used to determine the Social Deprivation Index (SDI) for each patient's area of residence. We conducted bivariate and multivariate analyses among patients who suffered a single incident of gun violence or gun violence revictimization. RESULTS We identified 38,974 gun violence victims among whom 2,243 (5.8%) suffered revictimization. The proportion of revictimization rose from 4% in 2008 to 8% in 2020 ( p < 0.01). The median [interquartile range] time from first to second incident among those who suffered revictimization was 359 days [81-1,167 days]. Revictimization was more common among Blacks (75.0% vs. 65.1%, p < 0.01), patients with Medicaid (54.9% vs. 43.2%, p < 0.01), and in areas of higher deprivation (84.8 percentile vs. 82.1 percentile, p < 0.01). CONCLUSION Gun violence revictimization is on the rise. People of color and those residing in areas with high social deprivation are more likely to be re-injured. Our findings emphasize the importance of community-level over individual-level interventions for prevention of gun violence revictimization. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level IV.
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Affiliation(s)
- Joseph C L'Huillier
- From the Department of Surgery, Jacobs School of Medicine and Biomedical Sciences (J.C.L., A.A.M., L.J.N., J.L., K.N.), University at Buffalo, Buffalo, NY; Department of Epidemiology and Environmental Health, Division of Health Services Policy and Practice, School of Public Health and Health Professions (J.C.L., K.N.), University at Buffalo, Buffalo, NY; Department of Biostatistics (J.D.B.), University at Buffalo, Buffalo, NY; School of Architecture and Planning (M.S., A.A.B., H.L.T.), University at Buffalo, Buffalo, NY; and Department of Geography (S.W.), University at Buffalo, Buffalo, NY
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List K, Agamile P, Alia DY, Cherutich P, Danforth K, Kinuthia J, Means AR, Mukui I, Ngumbau N, Su Y, Wagner AD, Weiner BJ, Masyuko S. Reimagining policy implementation science in a global context: a theoretical discussion. FRONTIERS IN HEALTH SERVICES 2024; 4:1292688. [PMID: 39371575 PMCID: PMC11449972 DOI: 10.3389/frhs.2024.1292688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 09/03/2024] [Indexed: 10/08/2024]
Affiliation(s)
- Kellie List
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Peter Agamile
- Daniel J. Evans School of Public Policy & Governance, University of Washington, Seattle, WA, United States
| | - Didier Yélognissè Alia
- Daniel J. Evans School of Public Policy & Governance, University of Washington, Seattle, WA, United States
| | | | - Kristen Danforth
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - John Kinuthia
- Medical Research & Programs Department, Kenyatta National Hospital, Nairobi, Kenya
| | - Arianna Rubin Means
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Irene Mukui
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Nancy Ngumbau
- Medical Research & Programs Department, Kenyatta National Hospital, Nairobi, Kenya
| | - Yanfang Su
- Department of Global Health, University of Washington, Seattle, WA, United States
- Daniel J. Evans School of Public Policy & Governance, University of Washington, Seattle, WA, United States
| | - Anjuli Dawn Wagner
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Bryan J. Weiner
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Sarah Masyuko
- Department of Global Health, University of Washington, Seattle, WA, United States
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Ramadurai D, Shea JA. Leveraging the health equity implementation framework to foster an equity focus in medical education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024; 29:1047-1058. [PMID: 37668934 PMCID: PMC10912357 DOI: 10.1007/s10459-023-10277-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 08/13/2023] [Indexed: 09/06/2023]
Abstract
Teaching equitable clinical practice is of critical importance, yet how best to do so remains unknown. Educators utilize implementation science frameworks to disseminate clinical evidence-based practices (EBP). The Health Equity Implementation Framework (HEIF) is one of these frameworks, and it delineates how health equity may be concomitantly assessed and addressed in planning the implementation of an EBP. The HEIF therefore lays a strong foundation to understand and explain barriers and facilitators to implementation through an equity lens, making it well-suited for use by medical educators. Three equity-focused frames of reference within the model include (1) the clinical encounter, (2) societal context, and (3) culturally relevant factors, herein referred to as domains. The HEIF provides a structure for prospective and retrospective assessment of how EBP are taught and ultimately incorporated into clinical practice by trainees, with specific attention to delivering equitable care. We present three examples of common topics in internal medicine, contextualized by the three equity domains of the HEIF. We additionally acknowledge the limitations of this framework as a research tool with complex features that may not be suitable for brief teaching in the clinical environment. We propose a 360-degree learner assessment to ensure implementation of this framework is successful. By encouraging trainees to explore the narrative experiences of their patients and examine their own implicit biases, the HEIF provides a structure to address gaps in knowledge about delivering equitable care.
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Affiliation(s)
- Deepa Ramadurai
- Division of Pulmonary, Allergy and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
| | - Judy A Shea
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Corcuff M, Lamontagne ME, Routhier F, Morales E. Co-design knowledge mobilization tools for universal accessibility in municipalities. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1331728. [PMID: 39011086 PMCID: PMC11247021 DOI: 10.3389/fresc.2024.1331728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 05/28/2024] [Indexed: 07/17/2024]
Abstract
Introduction Modern research teams are re-evaluating conventional methods with the aim of improving the usefulness of knowledge for users, focusing on the role of knowledge users in shaping innovation. In disability field, encouraging participatory research inherently involves diverse perspectives and inclusion, which aligns with the principles of universal accessibility. By actively involving individuals with various backgrounds, abilities, and needs in the research process, we can better understand and address the challenges faced in adopting universal accessibility. This approach ensures that solutions are more comprehensive, inclusive, and effectively cater to the needs of all individuals, fostering a more equitable and accessible environment for everyone. Despite municipal organizations mandating universal accessibility action plans, they lack tools for efficient implementation. The aim of this study was to develop knowledge mobilization tools tailored to a specific municipal context in Quebec, Canada, to facilitate the implementation of universal accessibility measures by municipal employees. Methods The co-design process employed in this study was organized into four distinct stages, following the Morales model: (1) Exploration (2) Co-Design (3) Validation (4) Development. Results Stages one and two highlighted the employees' lack of awareness about universal accessibility issues and their need to have more information and resources about how universal accessibility is encountered in their work. A steering committee co-designed three video vignettes about universal accessibility, the city's action plan and measures included in it. Discussion The co-design approach used in this study allowed us to observe the non-linear nature of partnership research with an organization as complex as a municipality. Our study shows significant advantages of collaboration between the municipal sector and research.
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Affiliation(s)
- Maëlle Corcuff
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre Intégré Universitaire en Santé et Services Sociaux de la Capitale Nationale, Québec, QC, Canada
- School of Rehabilitation Sciences, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Marie-Eve Lamontagne
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre Intégré Universitaire en Santé et Services Sociaux de la Capitale Nationale, Québec, QC, Canada
- School of Rehabilitation Sciences, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - François Routhier
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre Intégré Universitaire en Santé et Services Sociaux de la Capitale Nationale, Québec, QC, Canada
- School of Rehabilitation Sciences, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Ernesto Morales
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre Intégré Universitaire en Santé et Services Sociaux de la Capitale Nationale, Québec, QC, Canada
- School of Rehabilitation Sciences, Faculty of Medicine, Université Laval, Québec, QC, Canada
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Walker SC, Ahrens KR, Owens MD, Parnes M, Langley J, Ackerley C, Purtle J, Saldana L, Aarons GA, Hogue A, Palinkas LA. Using policy codesign to achieve multi-sector alignment in adolescent behavioral health: a study protocol. Implement Sci Commun 2024; 5:54. [PMID: 38720398 PMCID: PMC11077850 DOI: 10.1186/s43058-024-00583-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 04/06/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Policymaking is quickly gaining focus in the field of implementation science as a potential opportunity for aligning cross-sector systems and introducing incentives to promote population health, including substance use disorders (SUD) and their prevention in adolescents. Policymakers are seen as holding the necessary levers for realigning service infrastructure to more rapidly and effectively address adolescent behavioral health across the continuum of need (prevention through crisis care, mental health, and SUD) and in multiple locations (schools, primary care, community settings). The difficulty of aligning policy intent, policy design, and successful policy implementation is a well-known challenge in the broader public policy and public administration literature that also affects local behavioral health policymaking. This study will examine a blended approach of coproduction and codesign (i.e., Policy Codesign), iteratively developed over multiple years to address problems in policy formation that often lead to poor implementation outcomes. The current study evaluates this scalable approach using reproducible measures to grow the knowledge base in this field of study. METHODS This is a single-arm, longitudinal, staggered implementation study to examine the acceptability and short-term impacts of Policy Codesign in resolving critical challenges in behavioral health policy formation. The aims are to (1) examine the acceptability, feasibility, and reach of Policy Codesign within two geographically distinct counties in Washington state, USA; (2) examine the impact of Policy Codesign on multisector policy development within these counties using social network analysis; and (3) assess the perceived replicability of Policy Codesign among leaders and other staff of policy-oriented state behavioral health intermediary organizations across the USA. DISCUSSION This study will assess the feasibility of a specific approach to collaborative policy development, Policy Codesign, in two diverse regions. Results will inform a subsequent multi-state study measuring the impact and effectiveness of this approach for achieving multi-sector and evidence informed policy development in adolescent SUD prevention and treatment.
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Affiliation(s)
- Sarah Cusworth Walker
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA.
| | - Kym R Ahrens
- Seattle Children's Hospital and Research Institute, Seattle, WA, USA
| | - Mandy D Owens
- Addictions, Drug & Alcohol Institute, University of Washington, Seattle, WA, USA
| | - McKenna Parnes
- Seattle Children's Hospital and Research Institute, Seattle, WA, USA
| | - Joe Langley
- Lab For Living, Sheffield Hallam University, Sheffield, UK
| | - Christine Ackerley
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Jonathan Purtle
- Department of Public Health Policy and Management, Global Center for Implementation Science, New York University, New York City, USA
| | - Lisa Saldana
- Chestnut Health Systems, Lighthouse Institute, Eugene, OR, USA
| | - Gregory A Aarons
- Department of Psychiatry, UC San Diego ACTRI Dissemination and Implementation Science Center, University of California San Diego, La Jolla, CA, USA
| | - Aaron Hogue
- Partnership to End Addiction, New York, NY, USA
| | - Lawrence A Palinkas
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
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Purtle J, Stadnick NA, Wynecoop M, Walker SC, Bruns EJ, Aarons GA. Acceptability and feasibility of policy implementation strategies for taxes earmarked for behavioral health services. FRONTIERS IN HEALTH SERVICES 2024; 4:1304049. [PMID: 38638608 PMCID: PMC11025354 DOI: 10.3389/frhs.2024.1304049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 03/21/2024] [Indexed: 04/20/2024]
Abstract
Background This study's aims are to: (1) Compare the acceptability and feasibility of five types of implementation strategies that could be deployed to increase the reach of evidence-based practices (EBPs) with revenue from policies that earmark taxes for behavioral health services, and (2) Illustrate how definitions of implementation strategies and measures of acceptability and feasibility can be used in policy-focused implementation science research. Methods Web-based surveys of public agency and community organization professionals involved with earmarked tax policy implementation were completed in 2022-2023 (N = 211, response rate = 24.9%). Respondents rated the acceptability and feasibility of five types of implementation strategies (dissemination, implementation process, integration, capacity-building, and scale-up). Aggregate acceptability and feasibility scores were calculated for each type of strategy (scoring range 4-20). Analyses of variance compared scores across strategies and between organizational actor types. Findings For acceptability, capacity-building strategies had the highest rating (M = 16.3, SD = 3.0), significantly higher than each of the four other strategies, p ≤ . 004), and scale-up strategies had the lowest rating (M = 15.6). For feasibility, dissemination strategies had the highest rating (M = 15.3, significantly higher than three of the other strategies, p ≤ .002) and scale-up strategies had the lowest rating (M = 14.4). Conclusions Capacity-building and dissemination strategies may be well-received and readily deployed by policy implementers to support EBPs implementation with revenue from taxes earmarked for behavioral health services. Adapting definitions of implementation strategies for policy-focused topics, and applying established measures of acceptability and feasibility to these strategies, demonstrates utility as an approach to advance research on policy-focused implementation strategies.
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Affiliation(s)
- Jonathan Purtle
- Department of Public Health Policy & Management, Global Center for Implementation Science, New York University School of Global Public Health, New York, NY, United States
| | - Nicole A. Stadnick
- Department of Psychiatry, Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, University of California San Diego, La Jolla, CA, United States
| | - Megan Wynecoop
- Department of Public Health Policy & Management, Global Center for Implementation Science, New York University School of Global Public Health, New York, NY, United States
| | - Sarah C. Walker
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
| | - Eric J. Bruns
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
| | - Gregory A. Aarons
- Department of Psychiatry, Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, University of California San Diego, La Jolla, CA, United States
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McGinty EE, Seewald NJ, Bandara S, Cerdá M, Daumit GL, Eisenberg MD, Griffin BA, Igusa T, Jackson JW, Kennedy-Hendricks A, Marsteller J, Miech EJ, Purtle J, Schmid I, Schuler MS, Yuan CT, Stuart EA. Scaling Interventions to Manage Chronic Disease: Innovative Methods at the Intersection of Health Policy Research and Implementation Science. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:96-108. [PMID: 36048400 PMCID: PMC11042861 DOI: 10.1007/s11121-022-01427-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 10/14/2022]
Abstract
Policy implementation is a key component of scaling effective chronic disease prevention and management interventions. Policy can support scale-up by mandating or incentivizing intervention adoption, but enacting a policy is only the first step. Fully implementing a policy designed to facilitate implementation of health interventions often requires a range of accompanying implementation structures, like health IT systems, and implementation strategies, like training. Decision makers need to know what policies can support intervention adoption and how to implement those policies, but to date research on policy implementation is limited and innovative methodological approaches are needed. In December 2021, the Johns Hopkins ALACRITY Center for Health and Longevity in Mental Illness and the Johns Hopkins Center for Mental Health and Addiction Policy convened a forum of research experts to discuss approaches for studying policy implementation. In this report, we summarize the ideas that came out of the forum. First, we describe a motivating example focused on an Affordable Care Act Medicaid health home waiver policy used by some US states to support scale-up of an evidence-based integrated care model shown in clinical trials to improve cardiovascular care for people with serious mental illness. Second, we define key policy implementation components including structures, strategies, and outcomes. Third, we provide an overview of descriptive, predictive and associational, and causal approaches that can be used to study policy implementation. We conclude with discussion of priorities for methodological innovations in policy implementation research, with three key areas identified by forum experts: effect modification methods for making causal inferences about how policies' effects on outcomes vary based on implementation structures/strategies; causal mediation approaches for studying policy implementation mechanisms; and characterizing uncertainty in systems science models. We conclude with discussion of overarching methods considerations for studying policy implementation, including measurement of policy implementation, strategies for studying the role of context in policy implementation, and the importance of considering when establishing causality is the goal of policy implementation research.
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Affiliation(s)
- Emma E McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Nicholas J Seewald
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sachini Bandara
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Magdalena Cerdá
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Gail L Daumit
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Matthew D Eisenberg
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Tak Igusa
- Department of Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - John W Jackson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alene Kennedy-Hendricks
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jill Marsteller
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Edward J Miech
- Indiana University School of Medicine, Indianapolis, USA
| | - Jonathan Purtle
- Department of Public Health Policy and Management, New York University School of Global Public Health, New York City, New York, USA
| | - Ian Schmid
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Christina T Yuan
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elizabeth A Stuart
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Whitsel LP, Honeycutt S, Radcliffe R, Johnson J, Chase PJ, Noyes P. Policy implementation and outcome evaluation: establishing a framework and expanding capacity for advocacy organizations to assess the impact of their work in public policy. Health Res Policy Syst 2024; 22:27. [PMID: 38378597 PMCID: PMC10877836 DOI: 10.1186/s12961-024-01110-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 01/18/2024] [Indexed: 02/22/2024] Open
Abstract
Advocacy organizations can play a crucial role in evaluating whether legislation or regulation has had its intended effect by supporting robust public policy implementation and outcome evaluation. The American Heart Association, working with expert advisors, has developed a framework for effective evaluation that can be used by advocacy organizations, in partnership with researchers, public health agencies, funders, and policy makers to assess the health and equity impact of legislation and regulation over time. Advocacy organizations can use parts of this framework to evaluate the impact of policies relevant to their own advocacy and public policy efforts and inform policy development and guide their organizational resource allocation. Ultimately, working in partnership, advocacy organizations can help bring capacity, commitment and funding to this important implementation and outcome evaluation work that informs impactful public policy for equitable population health and well-being.
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Affiliation(s)
- Laurie P Whitsel
- American Heart Association, 1150 Connecticut Avenue - Suite 300, Washington, DC, 20036, USA.
| | - Sally Honeycutt
- American Heart Association, 1150 Connecticut Avenue - Suite 300, Washington, DC, 20036, USA
| | - Reyna Radcliffe
- American Heart Association, 1150 Connecticut Avenue - Suite 300, Washington, DC, 20036, USA
| | - Janay Johnson
- American Heart Association, 1150 Connecticut Avenue - Suite 300, Washington, DC, 20036, USA
| | - Paul J Chase
- American Heart Association, 1150 Connecticut Avenue - Suite 300, Washington, DC, 20036, USA
| | - Philip Noyes
- American Heart Association, 1150 Connecticut Avenue - Suite 300, Washington, DC, 20036, USA
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Labbé D, Heider A, Eisenberg Y, Gould R, Jones R. Reflection on the application of the Consolidated Framework for Implementation Research to a national policy to improve inclusion of people with disabilities. EVALUATION AND PROGRAM PLANNING 2024; 102:102367. [PMID: 37708627 DOI: 10.1016/j.evalprogplan.2023.102367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 08/08/2023] [Accepted: 09/05/2023] [Indexed: 09/16/2023]
Abstract
People with disabilities face many barriers in the built environment impacting their mobility, health, and social participation. In the US, under the Americans with Disabilities Act (ADA), municipalities were required to develop and implement barrier-removal plans for pedestrian infrastructure, called ADA transition plans, but very few have done so. Many communities know they need a plan but do not know how to get it done because of a lack of understanding of the many different implementation considerations. Implementation science offers a useful approach for understanding complex policy implementation such as ADA plans. This paper provides a reflection on the adaptation of the Consolidated Framework for Implementation Research (CFIR) to evaluate the implementation of ADA transition planning. To apply the CFIR, we tailored the construct definitions and modified them to fit the specific context of the ADA transition planning process. We documented the constructs that were more challenging to apply, those that were not relevant, and those that were particularly useful. This paper can serve as a valuable example that other researchers can use when considering adapting the CFIR or other implementation frameworks for the evaluation of complex social policy beyond the ADA.
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Affiliation(s)
- Delphine Labbé
- Great Lakes ADA Center, Department of Disability and Human Development, University of Illinois at Chicago, 1640 W. Roosevelt Rd. M/C 626, Chicago, IL 60608, USA.
| | - Amy Heider
- Great Lakes ADA Center, Department of Disability and Human Development, University of Illinois at Chicago, 1640 W. Roosevelt Rd. M/C 626, Chicago, IL 60608, USA
| | - Yochai Eisenberg
- Great Lakes ADA Center, Department of Disability and Human Development, University of Illinois at Chicago, 1640 W. Roosevelt Rd. M/C 626, Chicago, IL 60608, USA
| | - Robert Gould
- Great Lakes ADA Center, Department of Disability and Human Development, University of Illinois at Chicago, 1640 W. Roosevelt Rd. M/C 626, Chicago, IL 60608, USA
| | - Robin Jones
- Great Lakes ADA Center, Department of Disability and Human Development, University of Illinois at Chicago, 1640 W. Roosevelt Rd. M/C 626, Chicago, IL 60608, USA
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Walton L, Skillen E, Mosites E, Bures RM, Amah-Mbah C, Sandoval M, Thigpen Tart K, Berrigan D, Star C, Godette-Greer D, Kowtha B, Vogt E, Liggins C, Lloyd J. The intersection of health and housing: Analysis of the research portfolios of the National Institutes of Health, Centers for Disease Control and Prevention, and U.S. Department of Housing and Urban Development. PLoS One 2024; 19:e0296996. [PMID: 38285706 PMCID: PMC10824422 DOI: 10.1371/journal.pone.0296996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 12/20/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Housing is a major social determinant of health that affects health status and outcomes across the lifespan. OBJECTIVES An interagency portfolio analysis assessed the level of funding invested in "health and housing research" from fiscal years (FY) 2016-2020 across the National Institutes of Health (NIH), the United States Department of Housing and Urban Development (HUD), and the Centers for Disease Control and Prevention (CDC) to characterize the existing health and housing portfolio and identify potential areas for additional research and collaboration. METHODS/RESULTS We identified NIH, HUD, and CDC research projects that were relevant to both health and housing and characterized them by housing theme, health topic, population, and study design. We organized the assessment of the individual housing themes by four overarching housing-to-health pathways. From FY 2016-2020, NIH, HUD, and CDC funded 565 health and housing projects combined. The Neighborhood pathway was most common, followed by studies of the Safety and Quality pathway. Studies of the Affordability and Stability pathways were least common. Health topics such as substance use, mental health, and cardiovascular disease were most often studied. Most studies were observational (66%); only a little over one fourth (27%) were intervention studies. DISCUSSION This review of the research grant portfolios of three major federal funders of health and housing research in the United States describes the diversity and substantial investment in research at the intersection between housing and health. Analysis of the combined portfolio points to gaps in studies on causal pathways linking housing to health outcomes. The findings highlight the need for research to better understand the causal pathways from housing to health and prevention intervention research, including rigorous evaluation of housing interventions and policies to improve health and well-being.
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Affiliation(s)
- Liberty Walton
- Office of Disease Prevention, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Elizabeth Skillen
- Policy Analysis and Engagement Office, Office of Policy, Performance & Evaluation, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Emily Mosites
- Office of the Deputy Director for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Regina M. Bures
- Population Dynamics Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, United States of America
| | - Chino Amah-Mbah
- Public Health and Epidemiology Practice, Westat, Rockville, Maryland, United States of America
| | - Maggie Sandoval
- Public Health and Epidemiology Practice, Westat, Rockville, Maryland, United States of America
| | - Kimberly Thigpen Tart
- Office of Science Coordination, Planning, and Evaluation, National Institute of Environmental Health Sciences, National Institutes of Health, Durham, North Carolina, United States of America
| | - David Berrigan
- Health Behaviors Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland, United States of America
| | - Carol Star
- Office of Policy Development and Research, Program Evaluation Division, U.S. Department of Housing and Urban Development, Washington, DC, United States of America
| | - Dionne Godette-Greer
- Division of Extramural Science Programs, National Institute of Nursing Research, Rockville, Maryland, United States of America
| | - Bramaramba Kowtha
- Office of Disease Prevention, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Elizabeth Vogt
- Office of Disease Prevention, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Charlene Liggins
- Office of Disease Prevention, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Jacqueline Lloyd
- Office of Disease Prevention, National Institutes of Health, Bethesda, Maryland, United States of America
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13
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Baumann AA, Shelton RC, Kumanyika S, Haire‐Joshu D. Advancing healthcare equity through dissemination and implementation science. Health Serv Res 2023; 58 Suppl 3:327-344. [PMID: 37219339 PMCID: PMC10684051 DOI: 10.1111/1475-6773.14175] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
OBJECTIVE To provide guiding principles and recommendations for how approaches from the field of dissemination and implementation (D&I) science can advance healthcare equity. DATA SOURCES AND STUDY SETTING This article, part of a special issue sponsored by the Agency for Healthcare Research and Quality (AHRQ), is based on an outline drafted to support proceedings of the 2022 AHRQ Health Equity Summit and further revised to reflect input from Summit attendees. STUDY DESIGN This is a narrative review of the current and potential applications of D&I approaches for understanding and advancing healthcare equity, followed by discussion and feedback with Summit attendees. DATA COLLECTION/EXTRACTION METHODS We identified major themes in narrative and systematic reviews related to D&I science, healthcare equity, and their intersections. Based on our expertise, and supported by synthesis of published studies, we propose recommendations for how D&I science is relevant for advancing healthcare equity. We used iterative discussions internally and at the Summit to refine preliminary findings and recommendations. PRINCIPAL FINDINGS We identified four guiding principles and three D&I science domains with strong promise for accelerating progress toward healthcare equity. We present eight recommendations and more than 60 opportunities for action by practitioners, healthcare leaders, policy makers, and researchers. CONCLUSIONS Promising areas for D&I science to impact healthcare equity include the following: attention to equity in the development and delivery of evidence-based interventions; the science of adaptation; de-implementation of low-value care; monitoring equity markers; organizational policies for healthcare equity; improving the economic evaluation of implementation; policy and dissemination research; and capacity building.
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Affiliation(s)
- Ana A. Baumann
- Division of Public Health Sciences, Department of SurgeryWashington University School of MedicineSt. LouisMissouriUSA
| | - Rachel C. Shelton
- Department of Sociomedical SciencesColumbia University, Mailman School of Public HealthNew YorkNew YorkUSA
| | - Shiriki Kumanyika
- Drexel Dornsife School of Public HealthDrexel UniversityPhiladelphiaPennsylvaniaUSA
| | - Debra Haire‐Joshu
- Brown School of Public Health and School of MedicineWashington University in St. LouisSt. LouisMissouriUSA
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14
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Smith NR, Hassmiller Lich K, Ng SW, Hall MG, Trogdon JG, Frerichs L. Implementation costs of sugary drink policies in the United States. J Public Health Policy 2023; 44:566-587. [PMID: 37714964 PMCID: PMC10841536 DOI: 10.1057/s41271-023-00435-4] [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] [Accepted: 08/11/2023] [Indexed: 09/17/2023]
Abstract
To support implementation of important public health policies, policymakers need information about implementation costs over time and across stakeholder groups. We assessed implementation costs of two federal sugar-sweetened beverage (SSB) policies of current policy interest and with evidence to support their effects: excise taxes and health warning labels. Our analysis encompassed the entire policy life cycle using the Exploration, Preparation, Implementation, and Sustainment framework. We identified implementation actions using key informant interviews and developed quantitative estimates of implementation costs using published literature and government documents. Results show that implementation costs vary over time and among stakeholders. Explicitly integrating implementation science theory and using mixed methods improved the comprehensiveness of our results. Although this work is specific to federal SSB policies, the process can inform how we understand the costs of many public health policies, providing crucial information for public health policy making.
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Affiliation(s)
- Natalie Riva Smith
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA.
| | - Kristen Hassmiller Lich
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health, Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
| | - Marissa G Hall
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Justin G Trogdon
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Leah Frerichs
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
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15
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Ndumele CE, Rangaswami J, Chow SL, Neeland IJ, Tuttle KR, Khan SS, Coresh J, Mathew RO, Baker-Smith CM, Carnethon MR, Despres JP, Ho JE, Joseph JJ, Kernan WN, Khera A, Kosiborod MN, Lekavich CL, Lewis EF, Lo KB, Ozkan B, Palaniappan LP, Patel SS, Pencina MJ, Powell-Wiley TM, Sperling LS, Virani SS, Wright JT, Rajgopal Singh R, Elkind MSV. Cardiovascular-Kidney-Metabolic Health: A Presidential Advisory From the American Heart Association. Circulation 2023; 148:1606-1635. [PMID: 37807924 DOI: 10.1161/cir.0000000000001184] [Citation(s) in RCA: 121] [Impact Index Per Article: 121.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Cardiovascular-kidney-metabolic health reflects the interplay among metabolic risk factors, chronic kidney disease, and the cardiovascular system and has profound impacts on morbidity and mortality. There are multisystem consequences of poor cardiovascular-kidney-metabolic health, with the most significant clinical impact being the high associated incidence of cardiovascular disease events and cardiovascular mortality. There is a high prevalence of poor cardiovascular-kidney-metabolic health in the population, with a disproportionate burden seen among those with adverse social determinants of health. However, there is also a growing number of therapeutic options that favorably affect metabolic risk factors, kidney function, or both that also have cardioprotective effects. To improve cardiovascular-kidney-metabolic health and related outcomes in the population, there is a critical need for (1) more clarity on the definition of cardiovascular-kidney-metabolic syndrome; (2) an approach to cardiovascular-kidney-metabolic staging that promotes prevention across the life course; (3) prediction algorithms that include the exposures and outcomes most relevant to cardiovascular-kidney-metabolic health; and (4) strategies for the prevention and management of cardiovascular disease in relation to cardiovascular-kidney-metabolic health that reflect harmonization across major subspecialty guidelines and emerging scientific evidence. It is also critical to incorporate considerations of social determinants of health into care models for cardiovascular-kidney-metabolic syndrome and to reduce care fragmentation by facilitating approaches for patient-centered interdisciplinary care. This presidential advisory provides guidance on the definition, staging, prediction paradigms, and holistic approaches to care for patients with cardiovascular-kidney-metabolic syndrome and details a multicomponent vision for effectively and equitably enhancing cardiovascular-kidney-metabolic health in the population.
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Chriqui JF, Asada Y, Smith NR, Kroll-Desrosiers A, Lemon SC. Advancing the science of policy implementation: a call to action for the implementation science field. Transl Behav Med 2023; 13:820-825. [PMID: 37354558 PMCID: PMC10631873 DOI: 10.1093/tbm/ibad034] [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: 06/26/2023] Open
Abstract
Public policies have been essential in addressing many of the most pressing public health problems in the USA and around the world. A large and convincing body of multidisciplinary research has established the impacts or effectiveness of public policies, such as smoke-free air laws and nutrition standards, on improving health outcomes and behaviors. Most of this research assumes that because an evidence-based policy is adopted or takes effect, it is implemented as intended. This assumption, however, is often incorrect. Like with clinical guidelines and other interventions, implementation science has an important role to play in promoting the uptake and implementation of evidence-based public policies that promote public health. To realize this potential, there remains a critical need to first establish a common understanding of what public policy is, the role of specific policies in the context of implementation (i.e., is it the evidence-based intervention or the implementation strategy?), and to establish an appropriate methodological foundation for the field of policy implementation science. We recommend that the field must evolve to (i) include policy experts and actors on policy implementation science study teams; (ii) identify theories, models, and frameworks that are suitable for policy implementation science; (iii) identify policy implementation strategies; (iv) adapt and/or identify study designs best suited for policy implementation science research; and (v) identify appropriate policy implementation outcome measures.
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Affiliation(s)
- Jamie F Chriqui
- Division of Health Policy and Administration and Institute for Health Research and Policy, School of Public Health, University of Illinois Chicago, Chicago, IL, USA
| | - Yuka Asada
- Division of Community Health Sciences and Institute for Health Research and Policy, School of Public Health, University of Illinois Chicago, Chicago, IL, USA
| | - Natalie Riva Smith
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Aimee Kroll-Desrosiers
- Research & Education, VA Central Western Massachusetts Healthcare System, Leeds, MA, USA
- Division of Health Informatics and Implementation Science, UMass Chan Medical School, Worcester, MA, USA
| | - Stephenie C Lemon
- Division of Preventive and Behavioral Medicine, UMass Chan Medical School, Worcester, MA, USA
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17
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Buscemi J, Figueroa R, Bell BM, Dulin A, Shen M, Schneider KL, Pagoto S, Fitzgibbon M. Advocacy efforts of the Society of Behavioral Medicine: a 6-year update. Transl Behav Med 2023; 13:809-816. [PMID: 37432369 DOI: 10.1093/tbm/ibad042] [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: 07/12/2023] Open
Abstract
Six years ago, we published a paper describing the Society of Behavioral Medicine's (SBM) health policy organizational leadership structure and policy initiatives. The purpose of the current paper is to provide an update on changes in the infrastructure and new policy initiatives that have been developed since 2017. We review each of the policy leadership arms of SBM including details of the work of each and goals for the future. The SBM engages in several health policy advocacy efforts through their Advocacy Council and Position Statements Committee. The Advocacy Council launched the Health Policy Ambassador Program in 2020. The Ambassador Program serves to train members to develop longer-term relationships with legislative staff around key policy priority areas. The Position Statements Committee is responsible for overseeing the development and dissemination of health policy position statements. Both groups work together and with partner organizations to increase the impact of our science. Over the last 6 years, developing a stronger infrastructure and implementing metrics for progress such as tracking social media engagement has helped to move SBM's policy agenda forward. The work of the policy-related leadership teams can serve as a model for other organizations who are interested in further developing their policy advocacy efforts.
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Affiliation(s)
| | | | | | | | - Megan Shen
- Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
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18
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Shelton RC, Hailemariam M, Iwelunmor J. Making the connection between health equity and sustainability. Front Public Health 2023; 11:1226175. [PMID: 37822544 PMCID: PMC10562623 DOI: 10.3389/fpubh.2023.1226175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 09/05/2023] [Indexed: 10/13/2023] Open
Abstract
Sustainability and health inequities are key challenges in public health and healthcare. Research suggests that only about half of evidence-based interventions (EBIs) are sustained over time, and settings and populations experiencing systemic and structural barriers to health (e.g., poverty, racism, stigma, and discrimination) experience even greater challenges to sustainability. In this article, we argue that an enhanced focus on sustainability in the field of implementation science is critical in order to maximize the long-term health benefits and broader societal impacts of EBIs for all populations and settings. From an equity perspective, a focus on sustainability is particularly critical to prioritize among population sub-groups that have not historically received the benefits of health-related EBIs. We discuss how a health equity framing is essential to sustaining EBIs in under-resourced communities, and requires moving away from a deficit mindset that focuses on why EBIs are challenging to sustain, to one that focuses more on identifying and nurturing existing assets within individuals and communities to increase the likelihood that EBIs are sustained. We conclude with a discussion of future directions as well as recommendations and resources (e.g., frameworks, tools) to advance and make progress toward sustainability from a health equity mindset, including: (1) Actively planning early for sustainability alongside key partners; (2) Tracking progress toward enhancing sustainability and being accountable in doing so equitably for all settings and populations; and (3) Focusing on both equity and engagement early and often throughout the research process and all implementation phases.
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Affiliation(s)
- Rachel C. Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Maji Hailemariam
- C. S. Mott Department of Public Health and Department of OBGYN and Reproductive Biology, Michigan State University, Flint, MI, United States
| | - Juliet Iwelunmor
- Behavioral Science and Health Education, College for Public Health and Social Justice, St. Louis University, St. Louis, MO, United States
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19
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Cruden G, Crable EL, Lengnick-Hall R, Purtle J. Who's "in the room where it happens"? A taxonomy and five-step methodology for identifying and characterizing policy actors. Implement Sci Commun 2023; 4:113. [PMID: 37723580 PMCID: PMC10506261 DOI: 10.1186/s43058-023-00492-6] [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: 04/04/2023] [Accepted: 08/28/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Engaging policy actors in research design and execution is critical to increasing the practical relevance and real-world impact of policy-focused dissemination and implementation science. Identifying and selecting which policy actors to engage, particularly actors involved in "Big P" public policies such as laws, is distinct from traditional engaged research methods. This current study aimed to develop a transparent, structured method for iteratively identifying policy actors involved in key policy decisions-such as adopting evidence-based interventions at systems-scale-and to guide implementation study sampling and engagement approaches. A flexible policy actor taxonomy was developed to supplement existing methods and help identify policy developers, disseminators, implementers, enforcers, and influencers. METHODS A five-step methodology for identifying policy actors to potentially engage in policy dissemination and implementation research was developed. Leveraging a recent federal policy as a case study-The Family First Prevention Services Act (FFPSA)-publicly available documentation (e.g., websites, reports) were searched, retrieved, and coded using content analysis to characterize the organizations and individual policy actors in the "room" during policy decisions. RESULTS The five steps are as follows: (1) clarify the policy implementation phase(s) of interest, (2) identify relevant proverbial or actual policymaking "rooms," (3) identify and characterize organizations in the room, (4) identify and characterize policy actors in the "room," and (5) quantify (e.g., count actors across groups), summarize, and compare "rooms" to develop or select engagement approaches aligned with the "room" and actors. The use and outcomes of each step are exemplified through the FFPSA case study. CONCLUSIONS The pragmatic and transparent policy actor identification steps presented here can guide researchers' methods for continuous sampling and successful policy actor engagement. Future work should explore the utility of the proposed methods for guiding selection and tailoring of engagement and implementation strategies (e.g., research-policy actor partnerships) to improve both "Big P" and "little p" (administrative guidelines, procedures) policymaking and implementation in global contexts.
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Affiliation(s)
- Gracelyn Cruden
- Chestnut Health System, Lighthouse Institute-Oregon Group, Eugene, OR, 97401, USA.
| | - Erika L Crable
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | | | - Jonathan Purtle
- School of Global Public Health, New York University, New York City, NY, USA
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Purtle J, Moucheraud C, Yang LH, Shelley D. Four very basic ways to think about policy in implementation science. Implement Sci Commun 2023; 4:111. [PMID: 37700360 PMCID: PMC10496363 DOI: 10.1186/s43058-023-00497-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/04/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Policy is receiving increasing attention in the field of implementation science. However, there remains a lack of clear, concise guidance about how policy can be conceptualized in implementation science research. Building on Curran's article "Implementation science made too simple"-which defines "the thing" as the intervention, practice, or innovation in need of implementation support-we offer a typology of four very basic ways to conceptualize policy in implementation science research. We provide examples of studies that have conceptualized policy in these different ways and connect aspects of the typology to established frameworks in the field. The typology simplifies and refines related typologies in the field. Four very basic ways to think about policy in implementation science research. 1) Policy as something to adopt: an evidence-supported policy proposal is conceptualized as "the thing" and the goal of research is to understand how policymaking processes can be modified to increase adoption, and thus reach, of the evidence-supported policy. Policy-focused dissemination research is well-suited to achieve this goal. 2) Policy as something to implement: a policy, evidence-supported or not, is conceptualized as "the thing" and the goal of research is to generate knowledge about how policy rollout (or policy de-implementation) can be optimized to maximize benefits for population health and health equity. Policy-focused implementation research is well-suited to achieve this goal. 3) Policy as context to understand: an evidence-supported intervention is "the thing" and policies are conceptualized as a fixed determinant of implementation outcomes. The goal of research is to understand the mechanisms through which policies affect implementation of the evidence-supported intervention. 4) Policy as strategy to use: an evidence-supported intervention is "the thing" and policy is conceptualized as a strategy to affect implementation outcomes. The goal of research is to understand, and ideally test, how policy strategies affect implementation outcomes related to the evidence-supported intervention. CONCLUSION Policy can be conceptualized in multiple, non-mutually exclusive ways in implementation science. Clear conceptualizations of these distinctions are important to advancing the field of policy-focused implementation science and promoting the integration of policy into the field more broadly.
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Affiliation(s)
- Jonathan Purtle
- Department of Public Health Policy & Management, Global Center for Implementation Science, New York University School of Global Public Health, 708 Broadway, New York, NY, 10003, USA.
| | - Corrina Moucheraud
- Department of Public Health Policy & Management, Global Center for Implementation Science, New York University School of Global Public Health, 708 Broadway, New York, NY, 10003, USA
| | - Lawrence H Yang
- Department of Social and Behavioral Sciences, Global Center for Implementation Science, New York University School of Global Public Health, Global Mental Health and Stigma Program, 708 Broadway, New York, NY, 10003, USA
| | - Donna Shelley
- Department of Public Health Policy & Management, Global Center for Implementation Science, New York University School of Global Public Health, 708 Broadway, New York, NY, 10003, USA
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Asada Y, Kroll-Desrosiers A, Chriqui JF, Curran GM, Emmons KM, Haire-Joshu D, Brownson RC. Applying hybrid effectiveness-implementation studies in equity-centered policy implementation science. FRONTIERS IN HEALTH SERVICES 2023; 3:1220629. [PMID: 37771411 PMCID: PMC10524255 DOI: 10.3389/frhs.2023.1220629] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/21/2023] [Indexed: 09/30/2023]
Abstract
Policy implementation science (IS) is complex, dynamic, and fraught with unique study challenges that set it apart from biomedical or clinical research. One important consideration is the ways in which policy interacts with local contexts, such as power and social disadvantage (e.g., based on ability, race, class, sexual identity, geography). The complex nature of policy IS and the need for more intentional integration of equity principles into study approaches calls for creative adaptations to existing implementation science knowledge and guidance. Effectiveness-implementation hybrid studies were developed to enhance translation of clinical research by addressing research questions around the effectiveness of an intervention and its implementation in the same study. The original work on hybrid designs mainly focused on clinical experimental trials; however, over the last decade, researchers have applied it to a wide range of initiatives and contexts, including more widespread application in community-based studies. This perspectives article demonstrates how effectiveness-implementation hybrid studies can be adapted for and applied to equity-centered policy IS research. We draw upon principles of targeted universalism and Equity in Implementation Research frameworks to guide adaptations to hybrid study typologies, and suggest research and engagement activities to enhance equity considerations; for example, in the design and testing of implementing strategies. We also provide examples of equity-centered policy IS studies. As the field of policy IS rapidly evolves, these adapted hybrid type studies are offered to researchers as a starting guide.
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Affiliation(s)
- Yuka Asada
- Community Health Sciences, School of Public Health, University of Illinois Chicago (UIC), Chicago, IL, United States
| | - Aimee Kroll-Desrosiers
- VA Central Western Massachusetts Health Care System, Leeds, MA, United States
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, United States
- Department of Health Policy and Promotion, School of Public Health and Health Sciences, UMass Amherst, Amherst, MA, United States
| | - Jamie F. Chriqui
- Health Policy Research, Institute for Health Research and Policy, School of Public Health, University of Illinois Chicago, Chicago, IL, United States
- Department of Health Policy and Administration, School of Public Health, University of Illinois Chicago, Chicago, IL, United States
| | - Geoffrey M. Curran
- Departments of Pharmacy Practice and Psychiatry, Center for Implementation Research, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Karen M. Emmons
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Debra Haire-Joshu
- Department is Public Health, Brown School at Washington University in St. Louis, St. Louis, MO, United States
| | - Ross C. Brownson
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, MO, United States
- Division of Public Health Sciences, Department of Surgery, Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
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Heley K, D'Angelo H, Oh A, Vanderpool RC, McQueen A, Kreuter MW, Everson NS. Understanding Associations of Personal Values With Support for Tobacco and Alcohol Control Policies. Am J Prev Med 2023; 65:448-457. [PMID: 36933752 PMCID: PMC10505251 DOI: 10.1016/j.amepre.2023.03.010] [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] [Received: 10/14/2022] [Revised: 03/10/2023] [Accepted: 03/10/2023] [Indexed: 03/20/2023]
Abstract
INTRODUCTION This cross-sectional analysis of the 2020 Health Information National Trends Survey (N=3,604) examines the associations of personal values with tobacco and alcohol control policy support, which may inform policy-related communication efforts. METHODS Respondents selected which of 7 value options they considered most important in their daily life and rated their support for 8 proposed tobacco and alcohol control policies (1=strongly oppose, 5=strongly support). Weighted proportions for each value were described across sociodemographic characteristics, smoking status, and alcohol use. Weighted bivariate and multivariable regressions tested the associations of values with mean policy support (alpha=0.89). Analyses occurred from 2021 to 2022. RESULTS The most frequently selected values were assuring my family is safe and secure (30.2%), being happy (21.1%), and making my own decisions (13.6%). Selected values varied across sociodemographic and behavioral characteristics. For example, people with lower education and incomes were overrepresented among those selecting making my own decisions and keeping myself in good health. After adjusting for sociodemographics, smoking, and alcohol use, people selecting family safety (β=0.20, 95% CI=0.06, 0.33) or religious connection (β=0.34, 95% CI=0.14, 0.54) as most important reported higher policy support than those selecting making their own decisions, the value associated with the lowest mean policy support. Mean policy support did not significantly differ across any other value comparisons. CONCLUSIONS Personal values are associated with support for alcohol and tobacco control policies, with making my own decisions associated with the lowest policy support. Future research and communication efforts may consider aligning tobacco and alcohol control policies with the idea of supporting autonomy.
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Affiliation(s)
- Kathryn Heley
- Health Communication and Informatics Research Branch (HCIRB), Behavioral Research Program, Division of Cancer Control & Population Sciences, National Cancer Institute, Rockville, Maryland.
| | - Heather D'Angelo
- Health Communication and Informatics Research Branch (HCIRB), Behavioral Research Program, Division of Cancer Control & Population Sciences, National Cancer Institute, Rockville, Maryland
| | - April Oh
- Implementation Science, Office of the Director, Division of Cancer Control & Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Robin C Vanderpool
- Health Communication and Informatics Research Branch (HCIRB), Behavioral Research Program, Division of Cancer Control & Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Amy McQueen
- Health Communication Research Laboratory, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Matthew W Kreuter
- Health Communication Research Laboratory, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Nicole Senft Everson
- Health Communication and Informatics Research Branch (HCIRB), Behavioral Research Program, Division of Cancer Control & Population Sciences, National Cancer Institute, Rockville, Maryland
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Chaparro MP, Auchincloss AH, Argibay S, Ruggiero DA, Purtle J, Langellier BA. County- and state-level immigration policies are associated with Supplemental Nutrition Assistance Program (SNAP) participation among Latino households. Soc Sci Med 2023; 333:116141. [PMID: 37572629 PMCID: PMC10530172 DOI: 10.1016/j.socscimed.2023.116141] [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: 02/17/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/14/2023]
Abstract
The purpose of this study was to investigate the association between county- and state-level immigrant criminalizing and integrating policies and Latino household participation in the largest safety net program against food insecurity in the U.S., the Supplemental Nutrition Assistance Program (SNAP). Our outcome, county-level proportion of SNAP-participating Latino households, and county-level covariates were obtained from the American Community Survey 1-year county files (N = 675 counties) for 13 years (2007-2019). Our exposures were county-level presence of sanctuary policies and a state-level immigrant friendliness score, created based on 19 immigrant criminalizing and integrating state-level policies obtained from the Urban Institute's State Immigration Policies Resource. We classified every county in the sample as 1) sanctuary policy + immigrant friendly state, 2) sanctuary policy + immigrant unfriendly state, 3) no sanctuary policy + immigrant friendly state, and 4) no sanctuary policy + immigrant unfriendly state. Using multivariable generalized linear models that adjusted for poverty levels and other social composition characteristics of counties, we found that county-level SNAP participation among Latino households was 1.1 percentage-point higher in counties with sanctuary policies (B = 1.12, 95%CI = 0.26-1.98), compared to counties with no sanctuary policies, and 1.6 percentage-point higher in counties with sanctuary policies in immigrant friendly states (B = 1.59, 95%CI = 0.33-2.84), compared to counties with no sanctuary policy in immigrant unfriendly states. Local and state immigration policy, even when unrelated to SNAP eligibility, may influence SNAP participation among Latino households. Jurisdictions which lack sanctuary policies or have more criminalizing and less integrating policies should consider adopting targeted outreach strategies to increase SNAP enrollment among Latino households.
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Affiliation(s)
- M Pia Chaparro
- Nutritional Sciences Program, Department of Health Systems and Population Health, School of Public Health, University of Washington, Raitt Hall 305, Box 353410, Seattle, WA, 98195, USA.
| | - Amy H Auchincloss
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Nesbitt Hall, 3215 Market St., Philadelphia, PA, 19104, USA.
| | - Sofia Argibay
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Nesbitt Hall, 3215 Market St., Philadelphia, PA, 19104, USA.
| | - Dominic A Ruggiero
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Nesbitt Hall, 3215 Market St., Philadelphia, PA, 19104, USA.
| | - Jonathan Purtle
- Department of Public Health Policy and Management, School of Global Public Health, New York University, 708 Broadway, New York, NY, 10003, USA.
| | - Brent A Langellier
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Nesbitt Hall, 3215 Market St., Philadelphia, PA, 19104, USA.
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24
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Fiscella K, Yousefi Nooraie R. Health first, for all: Envisioning a novel complementary pathway for translational research. J Clin Transl Sci 2023; 7:e186. [PMID: 37706002 PMCID: PMC10495821 DOI: 10.1017/cts.2023.613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 09/15/2023] Open
Affiliation(s)
- Kevin Fiscella
- Department of Family Medicine, University of Rochester, Rochester, NY, USA
| | - Reza Yousefi Nooraie
- Department of Public Health Sciences, University of Rochester, Rochester, NY, USA
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25
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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 PMCID: PMC10339604 DOI: 10.1186/s43058-023-00462-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [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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26
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Almquist L, Walker SC, Purtle J. A landscape assessment of the activities and capacities of evidence-to-policy intermediaries (EPI) in behavioral health. Implement Sci Commun 2023; 4:55. [PMID: 37218006 DOI: 10.1186/s43058-023-00432-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/30/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND A significant gap exists between the production of research evidence and its use in behavioral health policymaking. Organizations providing consulting and support activities for improving policy represent a promising source for strengthening the infrastructure to address this gap. Understanding the characteristics and activities of these evidence-to-policy intermediary (EPI) organizations can inform the development of capacity-building activities, leading to strengthened evidence-to-policy infrastructure and more widespread evidence-based policymaking. METHODS Online surveys were sent to 51 organizations from English-speaking countries involved in evidence-to-policy activities in behavioral health. The survey was grounded in a rapid evidence review of the academic literature regarding strategies used to influence research use in policymaking. The review identified 17 strategies, which were classified into four activity categories. We administered the surveys via Qualtrics and calculated the descriptive statistics, scales, and internal consistency statistics using R. RESULTS A total of 31 individuals completed the surveys from 27 organizations (53% response rate) in four English-speaking countries. EPIs were evenly split between university (49%) and non-university (51%) settings. Nearly all EPIs conducted direct program support (mean = 4.19/5 [sd = 1.25]) and knowledge-building (4.03 [1.17]) activities. However, engagement with traditionally marginalized and non-traditional partners (2.84 [1.39]) and development of evidence reviews using formal critical appraisal methods (2.81 [1.70]) were uncommon. EPIs tend to be specialized, focusing on a group of highly related strategies rather than incorporating multiple evidence-to-policy strategies in their portfolios. Inter-item consistency was moderate to high, with scale α's ranging from 0.67 to 0.85. Ratings of respondents' willingness to pay for training in one of three evidence dissemination strategies revealed high interest in program and policy design. CONCLUSIONS Our results suggest that evidence-to-policy strategies are frequently used by existing EPIs; however, organizations tend to specialize rather than engage in a breadth of strategies. Furthermore, few organizations reported consistently engaging with non-traditional or community partners. Focusing on building capacity for a network of new and existing EPIs could be a promising strategy for growing the infrastructure needed for evidence-informed behavioral health policymaking.
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Affiliation(s)
- Lars Almquist
- Department of Health Systems and Population Health, University of Washington, Seattle, USA.
| | - Sarah Cusworth Walker
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Jonathan Purtle
- Department of Public Health Policy and Management, New York University, New York City, USA
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27
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Walsh-Bailey C, Gilbert A, Shato T, Sandler B, Baumann AA, Bradley CD, McLoughlin GM, McGuire FH, Fort MP, Tabak RG. Protocol for a scoping review of health equity frameworks and models applied in empirical studies of chronic disease prevention and control. Syst Rev 2023; 12:83. [PMID: 37170261 PMCID: PMC10176929 DOI: 10.1186/s13643-023-02240-2] [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] [Received: 05/09/2022] [Accepted: 04/19/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Chronic diseases, such as cancers and cardiovascular diseases, present the greatest burden of morbidity and mortality worldwide. This burden disproportionately affects historically marginalized populations. Health equity is rapidly gaining increased attention in public health, health services, and implementation research, though many health inequities persist. Health equity frameworks and models (FM) have been called upon to guide equity-focused chronic disease and implementation research. However, there is no clear synthesis of the health equity FM used in chronic disease research or how these are applied in empirical studies. This scoping review seeks to fill this gap by identifying and characterizing health equity FM applied in empirical studies along the chronic disease prevention and control continuum, describing how these FM are used, and exploring potential applications to the field of implementation science. METHODS We follow established guidance for conducting scoping reviews, which includes six stages: (1) identify the research question; (2) identify relevant studies; (3) select studies for inclusion; (4) data extraction; (5) collating, summarizing, and reporting the results; and (6) consultation. This protocol presents the iterative, collaborative approach taken to conceptualize this study and develop the search strategy. We describe the criteria for inclusion in this review, methods for conducting two phases of screening (title and abstract, full text), data extraction procedures, and quality assurance approaches taken throughout the project. DISCUSSION The findings from this review will inform health-equity focused chronic disease prevention and control research. FM identified through this review will be added to an existing website summarizing dissemination and implementation science frameworks, and we will offer case examples and recommendations for utilizing a health equity FM in empirical studies. Our search strategy and review methodology may serve as an example for scholars seeking to conduct reviews of health equity FM in other health disciplines. SYSTEMATIC REVIEW REGISTRATION Open Science Framework Registration https://doi.org/10.17605/OSF.IO/SFVE6.
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Affiliation(s)
- Callie Walsh-Bailey
- Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA.
- Implementation Science Center for Cancer Control and Prevention Research Center, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA.
| | - Amanda Gilbert
- Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA
| | - Thembekile Shato
- Implementation Science Center for Cancer Control and Prevention Research Center, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 600 S. Taylor Ave, St. Louis, MO, 63110, USA
| | - Brittney Sandler
- Division of Infectious Diseases, Washington University School of Medicine, 600 S. Taylor Ave, St. Louis, MO, 63110, USA
- Bernard Becker Medical Library, School of Medicine, Washington University in St. Louis, St. Louis, USA
| | - Ana A Baumann
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 600 S. Taylor Ave, St. Louis, MO, 63110, USA
| | - Cory D Bradley
- Division of Infectious Diseases, Washington University School of Medicine, 600 S. Taylor Ave, St. Louis, MO, 63110, USA
| | - Gabriella M McLoughlin
- Implementation Science Center for Cancer Control and Prevention Research Center, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
- College of Public Health, Temple University, 1800 N. Broad St, Philadelphia, PA, 19121, USA
| | - F Hunter McGuire
- Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA
| | - Meredith P Fort
- Department of Health Systems, Management and Policy, Colorado School of Public Health, 13055 E. 17Th Ave, Aurora, CO, 80045, USA
| | - Rachel G Tabak
- Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA
- Implementation Science Center for Cancer Control and Prevention Research Center, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
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28
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Purtle J, Stadnick NA, Wynecoop M, Bruns EJ, Crane ME, Aarons G. A policy implementation study of earmarked taxes for mental health services: study protocol. Implement Sci Commun 2023; 4:37. [PMID: 37004117 PMCID: PMC10067193 DOI: 10.1186/s43058-023-00408-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/05/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Insufficient funding is frequently identified as a critical barrier to the implementation and sustainment of evidence-based practices (EBPs). Thus, increasing access to funding is recognized as an implementation strategy. Policies that create earmarked taxes-defined as taxes for which revenue can only be spent on specific activities-are an increasingly common mental health financing strategy that could improve the reach of EBPs. This project's specific aims are to (1) identify all jurisdictions in the USA that have implemented earmarked taxes for mental health and catalogue information about tax design; (2) characterize experiences implementing earmarked taxes among local (e.g., county, city) mental health agency leaders and other government and community organization officials and assess their perceptions of the acceptability and feasibility of different types of policy implementation strategies; and (3) develop a framework to guide effect earmarked tax designs, inform the selection of implementation strategies, and disseminate the framework to policy audiences. METHODS The project uses the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to inform data collection about the determinants and processes of tax implementation and Leeman's typology of implementation strategies to examine the acceptability and feasibility strategies which could support earmarked tax policy implementation. A legal mapping will be conducted to achieve aim 1. To achieve aim 2, a survey will be conducted of 300 local mental health agency leaders and other government and community organization officials involved with the implementation of earmarked taxes for mental health. The survey will be followed by approximately 50 interviews with these officials. To achieve aim 3, quantitative and qualitative data will be integrated through a systematic framework development and dissemination process. DISCUSSION This exploratory policy implementation process study will build the evidence base for outer-context implementation determinants and strategies by focusing on policies that earmarked taxes for mental health services.
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Affiliation(s)
- Jonathan Purtle
- Department of Public Health Policy & Management, Global Center for Implementation Science, New York University School of Global Public Health, 708, Broadway, New York, NY, 10003, USA.
| | - Nicole A Stadnick
- Department of Psychiatry, Dissemination and Implementation Science Center, Altman Clinical and Translational Research Institute, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Megan Wynecoop
- Department of Public Health Policy & Management, Global Center for Implementation Science, New York University School of Global Public Health, 708, Broadway, New York, NY, 10003, USA
| | - Eric J Bruns
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 6200 NE 74Th St, Building 29, Suite 110, Seattle, WA, 98115, USA
| | - Margaret E Crane
- Department of Psychology, Temple University, Weiss Hall, 1701 N 13Th St, Philadelphia, PA, 19122, USA
- Department of Psychiatry, New York Presbyterian-Weill Cornell Medicine, 425 E 61St St, New York, NY, 10065, USA
| | - Gregory Aarons
- Department of Psychiatry, Dissemination and Implementation Science Center, Altman Clinical and Translational Research Institute, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
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29
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Nicastro HL, Vorkoper S, Sterling R, Korn AR, Brown AGM, Maruvada P, Oh AY. Opportunities to advance implementation science and nutrition research: a commentary on the Strategic Plan for NIH Nutrition Research. Transl Behav Med 2023; 13:1-6. [PMID: 36370119 PMCID: PMC10091491 DOI: 10.1093/tbm/ibac066] [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] [Indexed: 11/13/2022] Open
Abstract
Despite population-wide recommendations by the U.S. Dietary Guidelines for Americans and others to encourage health-promoting dietary patterns, the proportion of Americans following dietary recommendations remains low. The gaps in the adoption and integration of evidence-based dietary interventions, practices, programs, and policies (EBIs) into community and clinical settings signal the need to strengthen efforts in implementation science (IS) in nutrition research to understand and alleviate barriers to adopting and sustaining healthy dietary behaviors and practices. Equally important is the translation of this research into practice in a variety of settings and across the diversity of populations. Recognizing this need, the U.S. National Institutes of Health (NIH) 2020-2030 Strategic Plan for NIH Nutrition Research calls for the expansion of IS as a key opportunity to advancing nutrition research. This commentary highlights three scientific opportunities to stimulate IS in nutrition research and provides examples for each opportunity. These include: (a) Advance consideration of implementation and dissemination early in the design of interventions to facilitate opportunities for equitable scale-up and sustainability of EBIs, (b) Develop and test strategies for equitable implementation of nutrition and diet EBIs in health care and community settings, and (c) Build and strengthen the infrastructure, capacity, and expertise needed to increase use of IS in clinical and community nutrition research to swiftly move the research into practice. By advancing the three opportunities identified in this commentary, the scientific community has the potential to advance the field of nutrition research and IS with the ultimate goal of improving public health.
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Affiliation(s)
- Holly L Nicastro
- Office of Nutrition Research, National Institutes of Health, Bethesda, MD, USA
| | - Susan Vorkoper
- Division of International Science Policy, Planning and Evaluation, Fogarty International Center, Bethesda, MD, USA
| | - Rene Sterling
- Division of Genomics and Society, National Human Genome Research Institute, Bethesda, MD, USA
| | - Ariella R Korn
- Cancer Prevention Fellowship Program, Rockville, MD, USA.,Implementation Science Team, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Alison G M Brown
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Padma Maruvada
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - April Y Oh
- Implementation Science Team, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
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30
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Kokole D, Mercken L, Anderson P, Mejía-Trujillo J, Perez-Gomez A, Bustamante I, Piazza M, Natera Rey G, Arroyo M, Pérez De León A, Bautista Aguilar N, Medina Aguilar PS, Schulte B, O'Donnell A, de Vries H, Jané-Llopis E. Country and policy factors influencing the implementation of primary care-based alcohol screening: A comparison of Colombia, Mexico and Peru. Glob Public Health 2023; 18:2207410. [PMID: 37156224 DOI: 10.1080/17441692.2023.2207410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Researchers and practitioners recognise the importance of context when implementing healthcare interventions, but the influence of wider environment is rarely mapped. This paper identifies the country and policy-related factors potentially explaining the country differences in outcomes of an intervention focused on improving detection and management of heavy alcohol use in primary care in Colombia, Mexico and Peru. Qualitative data obtained through interviews, logbooks and document analysis are used to explain quantitative data on number of alcohol screenings and screening providers in each of the countries. Existing alcohol screening standards in Mexico, and policy prioritisation of primary care and consideration of alcohol as a public health issue in Colombia and Mexico positively contributed to the outcome, while the COVID-19 pandemic had a negative impact. In Peru, the context was unsupportive due to a combination of: political instability amongst regional health authorities; lack of focus on strengthening primary care due to the expansion of community mental health centres; alcohol considered as an addiction rather than a public health issue; and the impact of COVID-19 on healthcare. We found that wider environment-related factors interacted with the intervention implemented and can help explain country differences in outcomes.
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Affiliation(s)
- Daša Kokole
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Liesbeth Mercken
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- Department of Health Psychology, Open University, Heerlen, Netherlands
| | - Peter Anderson
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | | | - Ines Bustamante
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Marina Piazza
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Perú
| | | | - Miriam Arroyo
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | | | | | | | - Bernd Schulte
- Department of Psychiatry and Psychotherapy, Centre for Interdisciplinary Addiction Research (ZIS), University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Amy O'Donnell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Hein de Vries
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Eva Jané-Llopis
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- ESADE, Universitat Ramon Llull, Barcelona, Spain
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31
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Stopka TJ, Rottapel RE, Ferguson WJ, Pivovarova E, Toro-Mejias LD, Friedmann PD, Evans EA. Medication for opioid use disorder treatment continuity post-release from jail: A qualitative study with community-based treatment providers. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 110:103803. [PMID: 35965159 PMCID: PMC10117037 DOI: 10.1016/j.drugpo.2022.103803] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND People released from jail are at elevated opioid overdose risk. Medications for opioid use disorder (MOUD) are effective in reducing overdoses. MOUD treatment was recently mandated in seven Massachusetts jails, but little is known about barriers and facilitators to treatment continuity post-release. We aimed to assess MOUD provider perspectives on treatment continuity among people released from jail. METHODS We conducted qualitative interviews with 36 medical, supervisory, and administrative staff at MOUD programs that serve jail-referred patients. We used the Exploration, Preparation, Implementation, and Sustainment (EPIS) implementation science framework to guide development of instruments, codes, and analyses. We employed deductive and inductive coding, and a grounded theory analytical approach to identify salient themes. RESULTS Inner context findings highlighted necessary adjustments among jail staff to approve MOUD treatment, especially with agonist medications that were previously considered contraband. Participants perceived that some staff within jails favored abstinence-based recovery, viewing agonists as a crutch. Bridging results highlighted the importance of inter-agency communication and coordination to ensure information transfer for seamless treatment continuity in the community post-release. Pre-release planning, release on pre-scheduled dates, medication provision to cover gaps between jail release and intake at community MOUD sites, and exchange of treatment information across agencies were viewed as paramount to success. Unexpected early releases and releases from court were viewed as barriers to treatment coordination. Outer context domains were largely tied to social determinants of health. Substantial barriers to treatment continuity included shelter, food security, employment, transportation, and insurance reactivation. CONCLUSION Through qualitative interviews with community-based MOUD staff, we identified salient barriers and facilitators to treatment continuity post-release from jails. Findings point to needed investments in care coordination, staffing, and funding to strengthen jail-to-community-based MOUD treatment, removing barriers to continuity, and decreasing opioid overdose deaths during this high-risk transition.
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Affiliation(s)
- Thomas J Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 200 Harrison Avenue, Boston, MA, 02111, United States.
| | - Rebecca E Rottapel
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 200 Harrison Avenue, Boston, MA, 02111, United States
| | - Warren J Ferguson
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01655, United States
| | - Ekaterina Pivovarova
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01655, United States
| | - Lizbeth Del Toro-Mejias
- University of Massachusetts Chan Medical School-Baystate, 55 N Lake Ave, Worcester, MA 01655, United States; Baystate Health, 759 Chestnut St, Springfield, MA, 01199, United States
| | - Peter D Friedmann
- University of Massachusetts Chan Medical School-Baystate, 55 N Lake Ave, Worcester, MA 01655, United States; Baystate Health, 759 Chestnut St, Springfield, MA, 01199, United States
| | - Elizabeth A Evans
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 312 Arnold House, 715 North Pleasant Street, Amherst, MA, United States
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McLoughlin GM, Walsh-Bailey C, Singleton CR, Turner L. Investigating implementation of school health policies through a health equity lens: A measures development study protocol. Front Public Health 2022; 10:984130. [PMID: 36530706 PMCID: PMC9747935 DOI: 10.3389/fpubh.2022.984130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/11/2022] [Indexed: 12/05/2022] Open
Abstract
Background School-based policies that ensure provision of nutrition, physical activity, and other health-promoting resources and opportunities are essential in mitigating health disparities among underserved populations. Measuring the implementation of such policies is imperative to bridge the gap between policy and practice. Unfortunately, limited practical, psychometrically strong measures of school policy implementation exist. Few available explicitly focus on the issues of equity and social justice as a key component of implementation, which may result in underassessment of the equity implications of policy implementation. The purpose of this study is to develop equity-focused measures in collaboration with practitioners, researchers, and other key implementation partners that will facilitate evaluation of policy implementation determinants (i.e., barriers and facilitators), processes, and outcomes. Methods We will actively seek engagement from practitioners, researchers, and advocacy partners (i.e., stakeholders) who have expertise in school health policy throughout each phase of this project. We propose a multi-phase, 1-year project comprising the following steps: (1) selection of relevant constructs from guiding frameworks related to health equity and implementation science; (2) initial measure development, including expert feedback on draft items; (3) pilot cognitive testing with representatives from key target populations (i.e., school administrators, teachers, food service staff, and students and parents/guardians); and (4) measure refinement based on testing and assessment of pragmatic properties. These steps will allow us to establish initial face and content validity of a set of instruments that can undergo psychometric testing in future studies to assess their reliability and validity. Discussion Completion of this project will result in several school policy implementation measurement tools which can be readily used by practitioners and researchers to evaluate policy implementation through a health equity lens. This will provide opportunities for better assessment and accountability of policies that aim to advance health equity among school-aged children and their families. Trial registration Open Science Framework Registration doi: 10.17605/OSF.IO/736ZU.
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Affiliation(s)
- 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
| | - Callie Walsh-Bailey
- Implementation Science Center for Cancer Control and Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Chelsea R. Singleton
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Lindsey Turner
- College of Education, Boise State University, Boise, ID, United States
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Fornaro EG, McCrossan E, Hawes P, Erdem E, McLoughlin GM. Key determinants to school breakfast program implementation in Philadelphia public schools: Implications for the role of SNAP-Ed. Front Public Health 2022; 10:987171. [PMID: 36304238 PMCID: PMC9592801 DOI: 10.3389/fpubh.2022.987171] [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: 07/05/2022] [Accepted: 09/15/2022] [Indexed: 01/26/2023] Open
Abstract
Background Policies addressing food insecurity are only effective if they are implemented successfully, serving those most at risk. Universal school meals provide a key intervention to schools that serve predominantly low-income families by providing free school breakfast and lunch to all. Unfortunately, low uptake of such provisions among students is concerning especially regarding school breakfast, warranting key implementation support for schools to ensure student nutrition needs are met. Thus, the purpose of this study was to evaluate the determinants of implementing two different school breakfast programs and pragmatic strategies for serving breakfast in ways that maximize student participation. Methods A qualitative study was conducted between 2018 and 2020 within the School District of Philadelphia (SDP) comprising surveys, interviews, and observations to assess contextual determinants of two distinctive breakfast models: Breakfast in the Classroom (BIC) and Cafeteria after the Bell (CAB). Principals and lead kitchen staff completed surveys to assess determinants of breakfast model adoption. Principals, lead kitchen staff, classroom teachers, climate (i.e., social emotional wellbeing), and facilities staff subsequently participated in interviews to discuss implementation determinants (i.e., facilitators and challenges) and strategies for maximizing student participation. Observations provided rich data to triangulate interviews and survey data. Survey data were analyzed using frequency analysis, and observation and interview data were analyzed through thematic analysis. Presentation of themes was framed by the Consolidated Framework for Implementation Research. Results Results highlighted several positive determinants to participation including addressing student and family needs, making data-informed decisions, and providing hot meals and fruit based on student tastes. Negative determinants to implementation comprised challenges to SNAP-Ed-funded policy changes to promote student breakfast participation, lack of communication between administration, and staff and turnover among food service staff. Strategies included modifying school entrance procedures and combining breakfast with other education-related tasks to minimize instructional time lost through breakfast after the bell schedules. Discussion Data highlight the need to include implementation partner expertise when designing interventions for increasing reach and effectiveness of school meal programs. Future research that directly tests implementation strategies and key outcomes of reach/participation, among others, is critical to bridging the policy to practice gap in school nutrition programs.
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Affiliation(s)
- Elisabeth G. Fornaro
- Office of Research and Evaluation, School District of Philadelphia, Philadelphia, PA, United States
| | - Erin McCrossan
- Office of Research and Evaluation, School District of Philadelphia, Philadelphia, PA, United States
| | - Peter Hawes
- Office of Research and Evaluation, School District of Philadelphia, Philadelphia, PA, United States
| | - Ebru Erdem
- Office of Research and Evaluation, School District of Philadelphia, Philadelphia, PA, United States
| | - Gabriella Maria 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,*Correspondence: Gabriella Maria McLoughlin
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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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Clevenger KA, Lowry M, Perna FM, Berrigan D. Cross-Sectional Association of State Recess Laws With District-Level Policy and School Recess Provision in the United States. THE JOURNAL OF SCHOOL HEALTH 2022; 92:996-1004. [PMID: 35416309 DOI: 10.1111/josh.13189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 02/16/2022] [Accepted: 03/08/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND State recess laws are recommended to encourage adequate and equitable access to recess and its benefits, but the downstream effects of state recess laws are unknown. We examined the association of state recess laws with district-level policy and school recess provision. METHODS This is cross-sectional analysis of the School Health Policies and Practices Survey, a US nationally representative sample of school districts (2016) and schools (2014). State-level recess laws were coded as none, recommend, or require recess. Logistic and linear regression were used to examine the association between state law with district policies and school recess provision, respectively. Data from 2000 are presented to highlight changes in recess policy and provision over time. RESULTS The odds of a district policy requiring recess were 2.22 and 2.34 times greater when state recess law recommended or required recess, respectively, compared to states with no recess policy. There were no significant differences in school-level recess provision by state recess law but point estimates from 2000 indicated states without a law had the largest declines in recess provision over time. CONCLUSIONS State recess laws are positively associated with district-level policy. Effects at the school level are unclear and continued surveillance is needed.
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Affiliation(s)
- Kimberly A Clevenger
- Health Behaviors Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Centre Dr, Rockville, MD, 20850
| | - Mark Lowry
- Health Behaviors Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Centre Dr, Rockville, MD, 20850
| | - Frank M Perna
- Health Behaviors Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Centre Dr, Rockville, MD, 20850
| | - David Berrigan
- Health Behaviors Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Centre Dr, Rockville, MD, 20850
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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: 54] [Impact Index Per Article: 27.0] [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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Drabo EF, Moucheraud C, Nguyen A, Garland WH, Holloway IW, Leibowitz A, Suen SC. Using Microsimulation Modeling to Inform EHE Implementation Strategies in Los Angeles County. J Acquir Immune Defic Syndr 2022; 90:S167-S176. [PMID: 35703769 PMCID: PMC9216245 DOI: 10.1097/qai.0000000000002977] [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: 02/03/2023]
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) is essential to ending HIV. Yet, uptake remains uneven across racial and ethnic groups. We aimed to estimate the impacts of alternative PrEP implementation strategies in Los Angeles County. SETTING Men who have sex with men, residing in Los Angeles County. METHODS We developed a microsimulation model of HIV transmission, with inputs from key local stakeholders. With this model, we estimated the 15-year (2021-2035) health and racial and ethnic equity impacts of 3 PrEP implementation strategies involving coverage with 9000 additional PrEP units annually, above the Status-quo coverage level. Strategies included PrEP allocation equally (strategy 1), proportionally to HIV prevalence (strategy 2), and proportionally to HIV diagnosis rates (strategy 3), across racial and ethnic groups. We measured the degree of relative equalities in the distribution of the health impacts using the Gini index (G) which ranges from 0 (perfect equality, with all individuals across all groups receiving equal health benefits) to 1 (total inequality). RESULTS HIV prevalence was 21.3% in 2021 [Black (BMSM), 31.1%; Latino (LMSM), 18.3%, and White (WMSM), 20.7%] with relatively equal to reasonable distribution across groups (G, 0.28; 95% confidence interval [CI], 0.26 to 0.34). During 2021-2035, cumulative incident infections were highest under Status-quo (n = 24,584) and lowest under strategy 3 (n = 22,080). Status-quo infection risk declined over time among all groups but remained higher in 2035 for BMSM (incidence rate ratio, 4.76; 95% CI: 4.58 to 4.95), and LMSM (incidence rate ratio, 1.74; 95% CI: 1.69 to 1.80), with the health benefits equally to reasonably distributed across groups (G, 0.32; 95% CI: 0.28 to 0.35). Relative to Status-quo, all other strategies reduced BMSM-WMSM and BMSM-LMSM disparities, but none reduced LMSM-WMSM disparities by 2035. Compared to Status-quo, strategy 3 reduced the most both incident infections (% infections averted: overall, 10.2%; BMSM, 32.4%; LMSM, 3.8%; WMSM, 3.5%) and HIV racial inequalities (G reduction, 0.08; 95% CI: 0.02 to 0.14). CONCLUSIONS Microsimulation models developed with early, continuous stakeholder engagement and inputs yield powerful tools to guide policy implementation.
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Affiliation(s)
- Emmanuel F. Drabo
- Department of Health Policy and Management, John Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Corrina Moucheraud
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA
- UCLA Center for HIV Identification, Prevention and Treatment Services, University of Los Angeles, CA
| | - Anthony Nguyen
- Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, CA
| | - Wendy H. Garland
- Los Angeles County Department of Public Health, Division of HIV and STD Programs, Los Angeles, CA
| | - Ian W. Holloway
- UCLA Center for HIV Identification, Prevention and Treatment Services, University of Los Angeles, CA
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, CA
| | - Arleen Leibowitz
- UCLA Center for HIV Identification, Prevention and Treatment Services, University of Los Angeles, CA
- Department of Public Policy, Luskin School of Public Affairs, University of California, Los Angeles, CA
| | - Sze-chuan Suen
- Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, CA
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Purtle J, Nelson KL, Gebrekristos L, Lê-Scherban F, Gollust SE. Partisan differences in the effects of economic evidence and local data on legislator engagement with dissemination materials about behavioral health: a dissemination trial. Implement Sci 2022; 17:38. [PMID: 35729630 PMCID: PMC9213102 DOI: 10.1186/s13012-022-01214-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 06/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND State legislators make policy decisions that influence children's exposure to adverse childhood experiences (ACEs), such as child maltreatment, and their effects on behavioral health. Effective dissemination of scientific research can increase the likelihood that legislators' decisions are aligned with evidence to prevent ACEs and their consequences, and effective dissemination requires legislators to engage with dissemination materials. Informed by the elaboration likelihood model of persuasive communication and Brownson's Model of Dissemination Research, we tested the hypothesis that inclusion of economic evidence and local data would increase legislator engagement with dissemination materials about evidence-supported policies related to ACEs and behavioral health. METHODS A three-arm randomized dissemination trial was conducted. A university researcher e-mailed dissemination materials which contained evidence about ACEs and behavioral health problems to state legislators (two e-mails sent 2 weeks apart, 12,662 e-mails delivered to 6509 legislators). The e-mail subject lines, text, and policy brief content were manipulated across the study arms. The intervention condition received state-tailored data about rates of ACEs and state-tailored economic evidence about the costs of ACEs for public systems, the enhanced control condition received state-tailored data and not economic evidence, and the control condition received national data and not economic evidence. Outcomes were rates of e-mail views, policy brief link clicks, requests for researcher consultation, and mentions of child maltreatment terms in legislators' social media posts. RESULTS For the first e-mail, the e-mail view rate was 42.6% higher in the intervention than in the enhanced control condition (22.8% vs. 14.8%) and 20.8% higher than in the control condition (22.8% vs. 18.5%) (both p < .0001). Similar results were observed for the second e-mail. These differences remained significant after adjustment for demographic differences across study conditions in individual-level models, but not multilevel models. There was a significant interaction between the experimental condition and political party (p < .0001) in which the intervention increased e-mail view rates among Democrats but not Republicans. The intervention had no effect on policy brief link clicks or requests for consultation and a mixed effect on social media posts. CONCLUSIONS Inclusion of state-tailored economic evidence in dissemination materials can increase engagement with research evidence among Democrat, but not Republican, legislators. Dissemination strategies tailored for legislators' political party affiliation may be needed.
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Affiliation(s)
- Jonathan Purtle
- New York University School of Global Public Health, New York City, USA.
| | | | | | | | - Sarah E Gollust
- University of Minnesota School of Public Health, Minneapolis, USA
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McLoughlin GM, Martinez O. 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] [Grants] [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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Determinantes sociales y salud mental en las pandemias: nuevos retos. ENFERMERIA CLINICA 2022. [DOI: 10.1016/j.enfcli.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Lima-Serrano M. Social determinants and mental health in pandemics: new challenges. ENFERMERIA CLINICA (ENGLISH EDITION) 2022; 32:141-142. [PMID: 35690429 PMCID: PMC9179045 DOI: 10.1016/j.enfcle.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 05/09/2022] [Indexed: 10/31/2022]
Affiliation(s)
- Marta Lima-Serrano
- Departamento de Enfermería, Universidad de Sevilla, Grupo CTS-969 "Innovación en cuidados y determinantes sociales en salud", Spain.
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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] [Key Words] [MESH Headings] [Grants] [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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Affiliation(s)
- Ross C. Brownson
- Prevention Research Center, Brown School at Washington University in St. Louis, One Brookings Drive, Campus, Box 1196, St. Louis, MO 63130 USA
- Department of Surgery, Division of Public Health Sciences, and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO 63130 USA
| | - Rachel C. Shelton
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY 10032 USA
| | - Elvin H. Geng
- Division of Infectious Diseases, Department of Medicine and Center for Dissemination and Implementation in the Institute for Public Health, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO 63110 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, CO 80045 USA
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Beidas RS, Hannon PA, James AS, Emmons KM. Advancing gender equity in the academy. SCIENCE ADVANCES 2022; 8:eabq0430. [PMID: 35353578 PMCID: PMC11093218 DOI: 10.1126/sciadv.abq0430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 06/14/2023]
Abstract
Implementation science offers a rigorous set of tools to help mitigate long-standing and worsening gender disparities in academia.
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Childs E, Geller AC, Brooks DR, Davine J, Kane J, Keske R, Anthony J, Rees VW. Assessing Smoke-Free Housing Implementation Approaches to Inform Best Practices: A National Survey of Early-Adopting Public Housing Authorities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3854. [PMID: 35409538 PMCID: PMC8997519 DOI: 10.3390/ijerph19073854] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/20/2022] [Accepted: 03/21/2022] [Indexed: 11/26/2022]
Abstract
Secondhand smoke (SHS) exposure causes chronic illness and occurs at a higher prevalence in low-income communities than the general public. In 2018, the U.S. Department of Housing and Urban Development (HUD) instituted a smoke-free housing rule for Public Housing Authorities (PHAs) to address persistent health inequities. However, the success of smoke-free housing requires evidence to inform effective implementation approaches. A mixed-methods, cross-sectional survey was conducted in a national sample of PHAs. Questions focused on housing officials' use of specific implementation strategies. Adjusted odds ratios were used to assess associations between implementation approaches and variations among PHAs (i.e., region, size, or recency of policy adoption). Qualitative analyses were conducted to assess the perceived effectiveness of implementation strategies. Resident engagement, staff training, and smoking cessation support were the most frequently used implementation strategies. Engagement with local stakeholders was cited less frequently. Enforcement actions were limited with no violations referred to housing court. Support for policy adherence was identified as a sixth implementation strategy. While most PHAs used at least some evidence-informed implementation strategies, a lack of a systematic approach may limit overall effectiveness. Further research is required to resolve implementation barriers experienced disproportionately by a subset of PHAs, and to inform a best practice implementation framework that meets the needs of a heterogeneous population.
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Affiliation(s)
- Ellen Childs
- Division of Health and Environment, Abt Associates, Rockville, MD 20852, USA;
| | - Alan C. Geller
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (A.C.G.); (J.D.)
| | - Daniel R. Brooks
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA;
| | - Jessica Davine
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (A.C.G.); (J.D.)
| | - John Kane
- Boston Housing Authority, Boston, MA 02111, USA;
| | - Robyn Keske
- Football Players Health Study, Harvard Medical School, Boston, MA 02215, USA;
| | | | - Vaughan W. Rees
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (A.C.G.); (J.D.)
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Pyra M, Motley D, Bouris A. Moving toward equity: fostering transdisciplinary research between the social and behavioral sciences and implementation science to end the HIV epidemic. Curr Opin HIV AIDS 2022; 17:89-99. [PMID: 35225249 DOI: 10.1097/coh.0000000000000726] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Since the beginning of the HIV epidemic, social and behavioral scientists have developed interventions to stem the spread of the virus. The dissemination of these interventions has traditionally been a lengthy process; however, implementation science (IS) offers a route toward hastening delivery of effective interventions. A transdisciplinary approach, wherein IS informs and is informed by social and behavioral sciences (SBS) as well as community participation, offers a strategy for more efficiently moving toward health equity and ending the HIV epidemic. RECENT FINDINGS There has been considerable growth in HIV research utilizing IS theories, methods and frameworks. Many of these studies have been multi or interdisciplinary in nature, demonstrating the ways that IS and SBS can strengthen one another. We also find areas for continued progress toward transdisciplinarity. SUMMARY We review literature from 2020 to 2021, exploring the ways IS and SBS have been used in tandem to develop, evaluate and disseminate HIV interventions. We highlight the interplay between disciplines and make a case for moving toward transdisciplinarity, which would yield new, integrated frameworks that can improve prevention and treatment efforts, moving us closer to achieving health equity.
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Affiliation(s)
- Maria Pyra
- Chicago Center for HIV Elimination, Biological Sciences Division, University of Chicago
- Howard Brown Health Center
| | - Darnell Motley
- Chicago Center for HIV Elimination, Biological Sciences Division, University of Chicago
| | - Alida Bouris
- Chicago Center for HIV Elimination, Biological Sciences Division, University of Chicago
- Crown Family School of Social Work, Policy and Practice, University of Chicago, Chicago, IL, USA
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Michaud-Létourneau I, Gayard M, Njoroge B, Agabiirwe CN, Luwangula AK, McGough L, Mwangi A, Pelto G, Tumilowicz A, Pelletier DL. Operationalizing Implementation Science in Nutrition: The Implementation Science Initiative in Kenya and Uganda. Curr Dev Nutr 2022; 6:nzab146. [PMID: 35047720 PMCID: PMC8760423 DOI: 10.1093/cdn/nzab146] [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: 09/06/2021] [Revised: 11/16/2021] [Accepted: 11/23/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Implementation science (IS) has the potential to improve the implementation and impact of policies, programs, and interventions. Most of the training, guidance, and experience has focused on implementation research, which is only 1 part of the broader field of IS. In 2018, the Society for Implementation Science in Nutrition borrowed concepts from IS in health to develop a broader and more integrated conceptual framework, adapted to the particular case of nutrition and with language and concepts more familiar to the nutrition community: it is called the IS in Nutrition (ISN) framework. OBJECTIVE The purpose of this research was to generate knowledge concerning challenges and strategies in operationalizing the ISN framework in low- and middle-income country (LMIC) settings. METHODS The ISN framework was operationalized in partnership with country teams in Kenya and Uganda over a 3-y period as part of the Implementation Science Initiative. An action research methodology (developmental evaluation) was used to provide timely feedback to the country teams, facilitate adaptations and adjustments, and generate the data presented in this article concerning challenges and strategies. RESULTS Operationalization of the ISN framework proceeded by first articulating a set of guiding principles as touchstones for the country teams and further articulating 6 components of an IS system to facilitate development of work streams. Challenges and strategies in implementing these 6 components were then documented. The knowledge gained through this experience led to the development of an IS system operational model to assist the application of IS in other LMIC settings. CONCLUSIONS Future investments in IS should prioritize a system- and capacity-building approach in order to realize its full potential and become institutionalized at country level. The operational model can guide others to improve the implementation of IS within a broad range of programs.
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Affiliation(s)
- Isabelle Michaud-Létourneau
- The Society for Implementation Science in Nutrition,
NY, USA
- Department of Social and Preventive Medicine, School of Public Health, University of Montréal, Montréal, Québec, Canada
| | - Marion Gayard
- The Society for Implementation Science in Nutrition,
NY, USA
| | | | | | | | | | | | - Gretel Pelto
- The Society for Implementation Science in Nutrition,
NY, USA
- Division of Nutritional Sciences, College of Human Ecology, Cornell University, Ithaca, NY, USA
| | | | - David L Pelletier
- The Society for Implementation Science in Nutrition,
NY, USA
- Division of Nutritional Sciences, College of Human Ecology, Cornell University, Ithaca, NY, USA
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Amano T, Hooley C, Strong J, Inoue M. Strategies for implementing music-based interventions for people with dementia in long-term care facilities: A systematic review. Int J Geriatr Psychiatry 2022; 37. [PMID: 34647348 DOI: 10.1002/gps.5641] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 10/11/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Research has found that music-based interventions can decrease behavioral and psychological symptoms of dementia or behaviors that challenge (BPSD/BtC). However, how to effectively implement these interventions is unclear. This study synthesizes available evidence regarding implementation strategies and outcomes of music-based interventions for people with dementia at residential long-term care facilities. METHODS Study registered with PROSPERO (registration number: CRD42020194354). We searched the following databases: PsychInfo, PubMed, MEDLINE, CINAHL, and The Cochrane Library. Inclusion criteria included articles targeting music-based interventions conducted for people with dementia, studies conducted in residential long-term care facilities, and articles that reported implementation strategies and outcomes of the intervention. RESULTS Of the included eight studies, half were studies of music therapy and the other half were on individualized music. 49 implementation strategies were reported. The most frequently reported category of strategies was planning (34.7%), followed by education (24.5%), quality management (24.5%), restructuring (12.2%), and finance (4.1%). No strategies under the category of attending to the policy context were reported. The most frequently reported implementation outcomes were appropriateness (27.3%), followed by adoption (22.7%), fidelity (22.7%), acceptability (9.1%), sustainability (9.1%), and cost (9.1%). No studies measured feasibility or penetration. CONCLUSIONS Although various effective implementation strategies were identified, we were unable to examine the effectiveness of individual implementation strategies due to the designs of the selected studies. Less attention has been paid to strategies that aim at structural changes of intervention delivery systems. Future studies should investigate facilitators and barriers of implementing music-based interventions especially focusing on structural aspects.
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Affiliation(s)
- Takashi Amano
- Rutgers University - Newark, Newark, New Jersey, USA
| | | | - Joe Strong
- University of North Carolina - Greensboro, Greensboro, North Carolina, USA
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Pilar M, Jost E, Walsh-Bailey C, Powell BJ, Mazzucca S, Eyler A, Purtle J, Allen P, Brownson RC. Quantitative measures used in empirical evaluations of mental health policy implementation: A systematic review. IMPLEMENTATION RESEARCH AND PRACTICE 2022; 3:26334895221141116. [PMID: 37091091 PMCID: PMC9924289 DOI: 10.1177/26334895221141116] [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] [Indexed: 12/11/2022] Open
Abstract
Background Mental health is a critical component of wellness. Public policies present an opportunity for large-scale mental health impact, but policy implementation is complex and can vary significantly across contexts, making it crucial to evaluate implementation. The objective of this study was to (1) identify quantitative measurement tools used to evaluate the implementation of public mental health policies; (2) describe implementation determinants and outcomes assessed in the measures; and (3) assess the pragmatic and psychometric quality of identified measures. Method Guided by the Consolidated Framework for Implementation Research, Policy Implementation Determinants Framework, and Implementation Outcomes Framework, we conducted a systematic review of peer-reviewed journal articles published in 1995-2020. Data extracted included study characteristics, measure development and testing, implementation determinants and outcomes, and measure quality using the Psychometric and Pragmatic Evidence Rating Scale. Results We identified 34 tools from 25 articles, which were designed for mental health policies or used to evaluate constructs that impact implementation. Many measures lacked information regarding measurement development and testing. The most assessed implementation determinants were readiness for implementation, which encompassed training (n = 20, 57%) and other resources (n = 12, 34%), actor relationships/networks (n = 15, 43%), and organizational culture and climate (n = 11, 31%). Fidelity was the most prevalent implementation outcome (n = 9, 26%), followed by penetration (n = 8, 23%) and acceptability (n = 7, 20%). Apart from internal consistency and sample norms, psychometric properties were frequently unreported. Most measures were accessible and brief, though minimal information was provided regarding interpreting scores, handling missing data, or training needed to administer tools. Conclusions This work contributes to the nascent field of policy-focused implementation science by providing an overview of existing measurement tools used to evaluate mental health policy implementation and recommendations for measure development and refinement. To advance this field, more valid, reliable, and pragmatic measures are needed to evaluate policy implementation and close the policy-to-practice gap. Plain Language Summary Mental health is a critical component of wellness, and public policies present an opportunity to improve mental health on a large scale. Policy implementation is complex because it involves action by multiple entities at several levels of society. Policy implementation is also challenging because it can be impacted by many factors, such as political will, stakeholder relationships, and resources available for implementation. Because of these factors, implementation can vary between locations, such as states or countries. It is crucial to evaluate policy implementation, thus we conducted a systematic review to identify and evaluate the quality of measurement tools used in mental health policy implementation studies. Our search and screening procedures resulted in 34 measurement tools. We rated their quality to determine if these tools were practical to use and would yield consistent (i.e., reliable) and accurate (i.e., valid) data. These tools most frequently assessed whether implementing organizations complied with policy mandates and whether organizations had the training and other resources required to implement a policy. Though many were relatively brief and available at little-to-no cost, these findings highlight that more reliable, valid, and practical measurement tools are needed to assess and inform mental health policy implementation. Findings from this review can guide future efforts to select or develop policy implementation measures.
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Affiliation(s)
- Meagan Pilar
- Prevention Research Center, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
- Department of Infectious Diseases, Washington University School of Medicine,
Washington University in St. Louis, St. Louis, MO, USA
| | - Eliot Jost
- Prevention Research Center, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
| | - Callie Walsh-Bailey
- Prevention Research Center, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
| | - Byron J. Powell
- Center for Mental Health Services Research, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
- Division of Infectious Diseases, John T. Milliken Department of
Medicine, Washington University School of Medicine, Washington University in St.
Louis, St. Louis, MO, USA
| | - Stephanie Mazzucca
- Prevention Research Center, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
| | - Amy Eyler
- Prevention Research Center, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
| | - Jonathan Purtle
- Department of Public Health Policy & Management, New York
University School of Global Public Health, Global Center for Implementation Science, New York University, New York, NY, USA
| | - Peg Allen
- Prevention Research Center, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
| | - Ross C. Brownson
- Prevention Research Center, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
- Department of Surgery (Division of Public Health Sciences) and Alvin
J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St.
Louis, St. Louis, MO, USA
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The 2019 Conference on Health and Active Transportation: Research Needs and Opportunities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211842. [PMID: 34831599 PMCID: PMC8622688 DOI: 10.3390/ijerph182211842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/03/2021] [Accepted: 11/04/2021] [Indexed: 11/17/2022]
Abstract
Active transportation (AT) is widely viewed as an important target for increasing participation in aerobic physical activity and improving health, while simultaneously addressing pollution and climate change through reductions in motor vehicular emissions. In recent years, progress in increasing AT has stalled in some countries and, furthermore, the coronavirus (COVID-19) pandemic has created new AT opportunities while also exposing the barriers and health inequities related to AT for some populations. This paper describes the results of the December 2019 Conference on Health and Active Transportation (CHAT) which brought together leaders from the transportation and health disciplines. Attendees charted a course for the future around three themes: Reflecting on Innovative Practices, Building Strategic Institutional Relationships, and Identifying Research Needs and Opportunities. This paper focuses on conclusions of the Research Needs and Opportunities theme. We present a conceptual model derived from the conference sessions that considers how economic and systems analysis, evaluation of emerging technologies and policies, efforts to address inclusivity, disparities and equity along with renewed attention to messaging and communication could contribute to overcoming barriers to development and use of AT infrastructure. Specific research gaps concerning these themes are presented. We further discuss the relevance of these themes considering the pandemic. Renewed efforts at research, dissemination and implementation are needed to achieve the potential health and environmental benefits of AT and to preserve positive changes associated with the pandemic while mitigating negative ones.
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McLoughlin GM, Allen P, Walsh-Bailey C, Brownson RC. A systematic review of school health policy measurement tools: implementation determinants and outcomes. Implement Sci Commun 2021; 2:67. [PMID: 34174969 PMCID: PMC8235584 DOI: 10.1186/s43058-021-00169-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/08/2021] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND Governments in some countries or states/provinces mandate school-based policies intended to improve the health and well-being of primary and secondary students and in some cases the health of school staff. Examples include mandating a minimum time spent per week in programmed physical activity, mandating provision of healthy foods and limiting fat content of school meals, and banning tobacco products or use on school campuses. Although school health researchers have studied whether schools, districts, or states/provinces are meeting requirements, it is unclear to what extent implementation processes and determinants are assessed. The purposes of the present systematic review of quantitative measures of school policy implementation were to (1) identify quantitative school health policy measurement tools developed to measure implementation at the school, district, or state/provincial levels; (2) describe the policy implementation outcomes and determinants assessed and identify the trends in measurement; and (3) assess pragmatic and psychometric properties of identified implementation measures to understand their quality and suitability for broader application. METHODS Peer-reviewed journal articles published 1995-2020 were included if they (1) had multiple-item quantitative measures of school policy implementation and (2) addressed overall wellness, tobacco, physical activity, nutrition, obesity prevention, or mental health/bullying/social-emotional learning. The final sample comprised 86 measurement tools from 67 peer-review articles. We extracted study characteristics, such as psychometric and pragmatic measure properties, from included articles based on three frameworks: (1) Implementation Outcomes Framework, (2) Consolidated Framework for Implementation Research, and (3) Policy Implementation Determinants Framework. RESULTS Most implementation tools were developed to measure overall wellness policies which combined multiple policy topics (n = 35, 40%) and were in survey form (n = 75, 87%). Fidelity was the most frequently prevalent implementation outcome (n = 70, 81%), followed by adoption (n = 32, 81%). The implementation determinants most assessed were readiness for implementation, including resources (n = 43, 50%), leadership (n = 42, 49%), and policy communication (n = 41, 48%). Overall, measures were low-cost and had easy readability. However, lengthy tools and lack of reported validity/reliability data indicate low transferability. CONCLUSIONS Implementation science can contribute to more complete and rigorous assessment of school health policy implementation processes, which can improve implementation strategies and ultimately the intended health benefits. Several high-quality measures of implementation determinants and implementation outcomes can be applied to school health policy implementation assessment. Dissemination and implementation science researchers can also benefit from measurement experiences of school health researchers.
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Affiliation(s)
- Gabriella M McLoughlin
- Implementation Science Center for Cancer Control (WU-ISC3) and Prevention Research Center, Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA.
- Division of Public Health Sciences (Department of Surgery), Washington University School of Medicine, Washington University in St. Louis, St. Louis, 63110, USA.
| | - Peg Allen
- Implementation Science Center for Cancer Control (WU-ISC3) and Prevention Research Center, Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Callie Walsh-Bailey
- Implementation Science Center for Cancer Control (WU-ISC3) and Prevention Research Center, Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Ross C Brownson
- Implementation Science Center for Cancer Control (WU-ISC3) and Prevention Research Center, Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
- Division of Public Health Sciences (Department of Surgery), Washington University School of Medicine, Washington University in St. Louis, St. Louis, 63110, USA
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