Development and evaluation of the SPeeding Research-tested INTerventions (SPRINT) training program

The National Cancer Institute established a dissemination and implementation accelerator program called SPeeding Research-tested INTerventions (SPRINT) to improve the uptake of evidence-based interventions. The purpose of this study was to describe the origin, structure, and goals of the SPRINT program, and present evaluation results from the first two cohorts of the program. Qualitative (focus group) and quantitative (survey) data collected from participants were used to evaluate the course and inform program improvement efforts. The majority of the participants (over 90% in both cohorts) rated the course highly, and over 80% would recommend the course to other researchers. Most participants indicated knowing relatively little about business model concepts before SPRINT, but after SPRINT, nearly all respondents felt that they had at least "some" knowledge of each business model component. Participants also indicated that they learned about the product-market fit of their intervention and gained insights from customer discovery interviews that would enable them to make their intervention more "stakeholder focused". Participants also indicated that they plan to use the knowledge and skills they gained during the SPRINT program in their future work. Feedback from participants was used by the management team to implement various program improvements to better serve the next cohort of participants. While behavioral researchers face significant barriers to commercializing their interventions, they recognize the importance of translating their research into practice. Training researchers to consider scale-up, implementation, and commercialization from the outset can help reduce the number of proven interventions that are never used in practice.

Future directions for implementation science at the National Cancer Institute: Implementation Science Centers in Cancer Control

The National Cancer Institute (NCI) Cancer Moonshot initiative seeks to accelerate cancer research for the USA. One of the scientific priorities identified by the Moonshot's Blue Ribbon Panel (BRP) of scientific experts was the implementation of evidence-based approaches. In September 2019, the NCI launched the Implementation Science Centers in Cancer Control (ISC3 or "Centers") initiative to advance this Moonshot priority. The vision of the ISC3 is to promote the development of research centers to build capacity and research in high-priority areas of cancer control implementation science (e.g., scale-up and spread, sustainability and adaptation, and precision implementation), build implementation laboratories within community and clinical settings, improve the state of measurement and methods, and improve the adoption, implementation, and sustainment of evidence-based cancer control interventions. This paper highlights the research agenda, vision, and strategic direction for these Centers and encourages transdisciplinary scientists to learn more about opportunities to collaborate with these Centers.

Customer discovery as a tool for moving behavioral interventions into the marketplace: insights from the NCI SPRINT program

The National Cancer Institute established a dissemination and implementation accelerator program called Speeding Research-tested INTerventions (SPRINT) in order to expedite the translation of behavioral research into practice. The goal of SPRINT is to introduce researchers to a new method for moving their research into practice in order to increase the real-world impact of their evidence-based interventions. The goal of this article is to present case studies on three teams that have completed the SPRINT program to date. Each case study provides a description of the intervention the team came into the program with, the team's motivation for participating in the SPRINT program, the team's experience in the program, lessons learned from "customer discovery" interviews conducted by the team during the course, and the team's future plans for their intervention. The case studies suggest that by focusing on behavioral researchers, SPRINT addresses an unmet need in the commercialization training space; that the definition of "success" can vary across SPRINT projects; that identifying and engaging "payors" for behavioral interventions is an ongoing challenge; and that there are potential "misalignments" between the research process and market demands. Overall, these examples show that customer discovery is a potentially useful method for making interventions more responsive to the needs of stakeholders, and that researchers can benefit from learning the "language" of business and working with individuals who have business experience before trying to move their research from the lab to the real world.

Building capacity: a cross-sectional evaluation of the US Training Institute for Dissemination and Implementation Research in Health

BACKGROUND

In 2011, the National Institute of Health (NIH) initiated the Training in Dissemination and Implementation Research in Health (TIDIRH) program. Over its first 5 years, TIDIRH provided an in-person, week-long training to 197 investigators who were new to the dissemination and implementation (D&I) field. This paper evaluates the long-term impact of TIDIRH on trainees' use of D&I methods, collaborations, and research funding.

METHODS

Trainees were selected to participate through a competitive process. We compared the 197 trainees to 125 unselected applicants (UAs) whose application score was within one standard deviation of the mean for all trainees' scores for the same application year. A portfolio analysis examined electronic applications for NIH peer-reviewed funding submitted by trainees and UAs between 2011 and 2019. A survey of trainees and UAs was conducted in 2016, as was a faculty survey among the 87 individuals who served as TIDIRH instructors.

RESULTS

A major goal of TIDIRH was to build the field, at least in part through networking and collaboration. Thirty-eight percent of trainees indicated they had extensive contact with faculty following the training, and an additional 38% indicated they had at least limited contact. Twenty-four percent of trainees had extensive collaboration with other fellows post-TIDIRH, and 43% had at least limited contact. Collaborative activities included the full range of academic activities, including manuscript development, grant writing, and consultation/collaboration on research studies. The portfolio analysis combining grant mechanisms showed that overall, TIDIRH trainees submitted more peer-reviewed NIH grants per person than UA and had significantly better funding outcomes (25% vs 19% funded, respectively). The greatest difference was for large research project, program/center, and cooperative agreement grants mechanisms.

CONCLUSIONS

Overall, this evaluation found that TIDIRH is achieving its three primary goals: (1) building a pipeline of D&I investigators, (2) creating a network of scholars to build the field, and (3) improving funding outcomes for D&I grants.

Collaborating to conquer cancer: the role of partnerships in comprehensive cancer control

Comprehensive cancer control celebrated its twentieth anniversary in 2018. A dedicated group of national partners formed the Comprehensive Cancer Control National Partnership (CCCNP) at the same time that CDC's National Comprehensive Cancer Control Program was formed. The CCCNP has supported the development and growth of comprehensive cancer control from its inception. The CCCNP mirrors how coalitions function at the state, tribe, territory, and Pacific Island Jurisdiction level. We provide a national example of how 19 leading cancer organizations work together with a unified vision to support cancer control efforts in the United States (U.S.). What follows is an overview of the CCCNP, its vision, mission, and structure and a description of how this partnership has evolved over the past 20 years. The importance of collaboration is highlighted. Two states, South Dakota and Kansas, provide examples of how working with partners through the cancer coalition has advanced their state's cancer control agenda. Closing thoughts on the future work of the CCCNP are provided, including a continued focus on supporting health equity; better engagement and support of CCC coalition leaders; and informing efforts to develop a national cancer control plan for the United States.

Evaluating centralized technical assistance as an implementation strategy to improve cancer prevention and control

PURPOSE

In 2015-2016, the Comprehensive Cancer Control National Partnership provided technical assistance workshops to support 22 cancer coalitions in increasing human papillomavirus (HPV) vaccination uptake and increasing colorectal cancer (CRC) screening in their local communities. As national efforts continue to invest in providing technical assistance, there is a current gap in understanding its use as a strategy to accelerate implementation of evidence-based interventions (EBIs) for cancer prevention. The objective of this study was to evaluate the impact of technical assistance on the participants' knowledge, attitudes, and skills for implementing EBIs in their local context and enhancing state team collaboration.

METHODS

Data were collected August-November 2017 using web-based questionnaires from 44 HPV workshop participants and 66 CRC workshop participants.

RESULTS

Both HPV vaccination and CRC screening workshop participants reported changes in knowledge, attitudes, and skills related to implementing EBIs in their local state context. Several participants reported increased abilities in communicating and coordinating with partners in their states and utilizing additional implementation strategies to increase HPV vaccination uptake and CRC screening rates.

CONCLUSIONS

Findings from this study suggest that providing technical assistance to members of comprehensive cancer control coalitions is useful in promoting collaborations and building capacity for implementing EBIs for cancer prevention and control.

Moving family interventions into the real world: What matters to oncology stakeholders?

BACKGROUND

Family interventions targeting patients and/or informal caregivers are beneficial, but few have been integrated in oncology clinical care. Understanding diverse stakeholder perspectives may inform implementation and dissemination efforts.

METHODS

We are currently conducting a randomized controlled trial of CareSTEPS, a telephone-based intervention for caregivers of advanced lung cancer patients. CareSTEPS seeks to improve caregiver and patient self-care behaviors, quality of life, and satisfaction with care. With an eye toward integrating CareSTEPS into clinical care, semi-structured interviews were conducted with 7 experts in integrated care [practice thought leaders] and 26 individuals representing different oncology stakeholder groups (i.e., potential end users of CareSTEPS including counselors, social workers, nurse specialists, and psychologists) [N = 13], decision-makers, including physicians and administrators [N = 6], and key dissemination partners, including representatives from cancer and caregiving advocacy groups [N = 7]). Questions focused on existing caregiver support services, barriers to integrating care for caregivers in routine patient care, and possible models for clinical uptake and dissemination. Interviews were transcribed and analyzed using directed content analysis.

RESULTS

Stakeholders noted a mismatch between caregiver needs and services offered, and expressed interest in broader service offerings. Barriers for integrating caregiver support into clinical care included inadequate funding, lack of interdisciplinary training among providers, and concern that research-based interventions are often not flexible enough to roll out into clinical practice. To secure buy-in, stakeholders noted the importance of evaluating intervention cost, cost savings, and revenue generation. Possible avenues for dissemination, through bottom-up and top-down (e.g., policy change) approaches, were also discussed.

CONCLUSIONS

Findings highlight the importance of evaluating outcomes important to diverse oncology stakeholder groups to speed translation of research into practice. They also suggest that pragmatic trials are needed that allow for flexibility in the delivery of family interventions and that consider the resource limitations of clinical care.

Lung cancer screening: an emerging cancer control issue presents opportunities for an awareness campaign in rural Michigan

Lung cancer is the leading cause of cancer deaths in the United States representing about 25% of all cancer deaths. The risk from smoking has increased over time with racial/ethnic minorities and disadvantaged populations having higher smoking rates and experiencing greater burden of lung cancer compared to other populations. Rural populations, in particular, experience higher rates of tobacco usage associated with increased incidence of lung cancer. National efforts to identify lung cancer in its early stage would greatly benefit high-risk populations, consequently reducing advanced cancers and potentially decreasing smoking rates. In 2013, lung cancer screening with low-dose computed tomography was recommended by the US Preventive Services Task Force for early detection of lung cancer. These guidelines were developed after the results of the National Lung Screening Trial. The National Lung Screening Trial study showed a 20% reduction in deaths of participants who were current or former heavy smokers who were screened with low-dose computed tomography versus those screened by chest X-ray. In response to this evidence and using state lung cancer burden data and local smoking rates as a guide, Michigan implemented a lung cancer screening awareness campaign in the rural northern, lower peninsula. Awareness of lung cancer screening was increased through the use of a variety of media including gas station/convenience store small media, digital media, radio broadcast media, and the use and marketing of a website that provided lung cancer screening information and resources.

Using concept mapping to develop a conceptual framework for creating virtual communities of practice to translate cancer research into practice

INTRODUCTION

Translating government-funded cancer research into clinical practice can be accomplished via virtual communities of practice that include key players in the process: researchers, health care practitioners, and intermediaries. This study, conducted from November 2012 through January 2013, examined issues that key stakeholders believed should be addressed to create and sustain government-sponsored virtual communities of practice to integrate cancer control research, practice, and policy and demonstrates how concept mapping can be used to present relevant issues.

METHODS

Key stakeholders brainstormed statements describing what is needed to create and sustain virtual communities of practice for moving cancer control research into practice. Participants rated them on importance and feasibility, selected most relevant statements, and sorted them into clusters. I used concept mapping to examine the issues identified and multidimensional scaling analyses to create a 2-dimensional conceptual map of the statement clusters.

RESULTS

Participants selected 70 statements and sorted them into 9 major clusters related to creating and sustaining virtual communities of practice: 1) standardization of best practices, 2) external validity, 3) funding and resources, 4) social learning and collaboration, 5) cooperation, 6) partnerships, 7) inclusiveness, 8) social determinants and cultural competency, and 9) preparing the environment. Researchers, health care practitioners, and intermediaries were in relative agreement regarding issues of importance for creating these communities.

CONCLUSION

Virtual communities of practice can be created to address the needs of researchers, health care practitioners, and intermediaries by using input from these key stakeholders. Increasing linkages between these subgroups can improve the translation of research into practice. Similarities and differences between groups can provide valuable information to assist the government in developing virtual communities of practice.

The U.S. training institute for dissemination and implementation research in health

BACKGROUND

The science of dissemination and implementation (D&I) is advancing the knowledge base for how best to integrate evidence-based interventions within clinical and community settings and how to recast the nature or conduct of the research itself to make it more relevant and actionable in those settings. While the field is growing, there are only a few training programs for D&I research; this is an important avenue to help build the field's capacity. To improve the United States' capacity for D&I research, the National Institutes of Health and Veterans Health Administration collaborated to develop a five-day training institute for postdoctoral level applicants aspiring to advance this science.

METHODS

We describe the background, goals, structure, curriculum, application process, trainee evaluation, and future plans for the Training in Dissemination and Implementation Research in Health (TIDIRH).

RESULTS

The TIDIRH used a five-day residential immersion to maximize opportunities for trainees and faculty to interact. The train-the-trainer-like approach was intended to equip participants with materials that they could readily take back to their home institutions to increase interest and further investment in D&I. The TIDIRH curriculum included a balance of structured large group discussions and interactive small group sessions.Thirty-five of 266 applicants for the first annual training institute were accepted from a variety of disciplines, including psychology (12 trainees); medicine (6 trainees); epidemiology (5 trainees); health behavior/health education (4 trainees); and 1 trainee each from education & human development, health policy and management, health services research, public health studies, public policy and social work, with a maximum of two individuals from any one institution. The institute was rated as very helpful by attendees, and by six months after the institute, a follow-up survey (97% return rate) revealed that 72% had initiated a new grant proposal in D&I research; 28% had received funding, and 77% had used skills from TIDIRH to influence their peers from different disciplines about D&I research through building local research networks, organizing formal presentations and symposia, teaching and by leading interdisciplinary teams to conduct D&I research.

CONCLUSIONS

The initial TIDIRH training was judged successful by trainee evaluation at the conclusion of the week's training and six-month follow-up, and plans are to continue and possibly expand the TIDIRH in coming years. Strengths are seen as the residential format, quality of the faculty and their flexibility in adjusting content to meet trainee needs, and the highlighting of concrete D&I examples by the local host institution, which rotates annually. Lessons learned and plans for future TIDIRH trainings are summarized.

Developing partnerships to reduce disparities in cancer screening

BACKGROUND

Interventions in scientific settings to improve the well-being of women who are not regularly screened for cancer have failed. Consequently, community-based prevention and control efforts are needed.

COMMUNITY CONTEXT

From 2003 through 2007, three federal agencies and 1 nongovernmental agency collaborated with county-level public health counterparts from 6 states to address screening disparities in cervical and breast cancer in counties with the highest prevalence. This case study describes lessons learned from Team Up, a model pilot program.

METHODS

We conducted a descriptive qualitative case study including 5 Southern states and 1 Midwestern state: Alabama, Georgia, Kentucky, Missouri, South Carolina, and Tennessee. The 6 states underwent a 5-step process to adopt, adapt, and implement 1 of 3 evidence-based interventions designed for cervical and breast cancer screening.

OUTCOME

The 6 participating states had various levels of success. Participating states formed and sustained viable interorganizational public health partnerships throughout the pilot program and beyond.

INTERPRETATION

Although this innovative pilot faced many difficulties, participants overcame substantial obstacles and produced many key accomplishments. Team Up brought together 2 challenging public health strategies: the translation of evidence-based approaches to communities and populations, and partnerships among diverse people and organizations. Case study results suggest that using a mix of approaches can promote the transference of evidence from research into practice through local, regional, and national partnerships.

Characterization of elements mediating regulation of phosphoenolpyruvate carboxykinase gene transcription by protein kinase A and insulin. Identification of a distinct complex formed in cells that mediate insulin inhibition

The in vivo pattern of induction of phosphoenolpyruvate carboxykinase (PEPCK) gene transcription by cAMP and its inhibition by insulin is reproduced in H4IIe cells and is mediated by a bipartite cAMP/insulin response unit (C/IRU) consisting of a cAMP response element (-95/-87) and an upstream enhancer, AC (-271/-225). Studies in HepG2 cells showed that binding of AP-1 and CAAT/enhancer-binding protein (C/EBP) to AC is required for induction by cAMP, but insulin did not inhibit cAMP-induced PEPCK expression in HepG2 cells. Binding of H4IIe nuclear proteins to an AC element probe was inhibited by antibodies or a consensus site for C/EBP, but not AP-1. Transfection with dominant negative bZIP factors, which prevent endogenous factors from binding to DNA, showed that elimination of cAMP regulatory element-binding protein CREB or C/EBP activity blocked induction by protein kinase A (PKA), whereas elimination of AP-1 activity had no effect. In addition, promoters with multiple CREB sites, or a single CREB site and multiple C/EBP sites, mediated PKA induction, but this was inhibited to no greater extent than basal activity was by insulin. These results indicate that an AC factor other than C/EBP must mediate insulin inhibition. An A-site probe (-265/-247) or a probe across the middle of the AC element (-256/-237) competed for complexes formed by factors other than AP-1 or C/EBP. However, analysis of competitor oligonucleotides and antibodies for candidate factors failed to identify other factors. Scanning mutations throughout the AC element interfered with induction but allowed us to define five overlapping sites for regulatory factors in AC and to design probes binding just one or two factors. Comparison of the protein-DNA complexes formed on these smaller probes revealed that a specific complex present in rat liver and H4IIe cell nuclear extracts differed from those formed by HepG2 cell nuclear extracts. Our results suggest that multiple factors binding the AC element of the C/IRU interact with each other and CREB to regulate PEPCK induction by cAMP and inhibition by insulin and that the unique factor expressed in H4IIe cells is a candidate for involvement in insulin regulation of PKA-induced PEPCK gene transcription.

Effect of myocardial fibre architecture on the behaviour of the human left ventricle in diastole

Stress and deformation results from finite element analyses are presented for a series of models of the human left ventricle. The myocardium has a complex anisotropic fibre structure, are made on both fibre orientation and on the ratio are made on both fibre orientation and on the ratio of the elastic moduli along and across the fibres. The results show that, at least in diastole, when the left ventricle is considered as a passive structure under the action of the internal blood pressure, the effect of the real fibre arrangement is generally to reduce deformation and also the direct stresses. In spite of fibre angle changing across the wall, the analyses correctly predict the lack of rotation of the left ventricle about the long axis.

Computer modeling of the human left ventricle

A computer graphical technique is described for reconstructing the three-dimensional geometry of the human left ventricle of the heart from biplane cineangiograms. The views used are right and left anterior oblique. The reconstructed shape is intended for three-dimensional mesh generation for finite element stress analysis, but may also be useful for clinical diagnostic purposes and for cavity volume calculation throughout the cardiac cycle.

Analysis of left ventricular behaviour in diastole by means of finite element method

The human left ventricle in diastole can be modelled as a passive structure with incremental internal pressure change being considered as the load. Recent developments in engineering stress analysis provide techniques for predicting the behaviour of structures with complex geometry and material properties, as is the case with the left ventricle. That which is most appropriate is the finite element method which requires the use of a large digital computer. The ventricles of 2 patients have been studied during diastole, the geometries having been derived from cineangiographic data (biplane), and the pressure by means of catheter-tip manometers. Various descriptions of myocardial stress/strain relations have been assumed and applied to the left ventricular wall in order to obtain the best match between the calculated and observed deformation patterns. The manner in which the value and distribution of stiffness in the left ventricle influences the shape change can therefore be determined, and possible clinical implications deduced.