Bridging the Methodological Gap: Integrating Implementation Science With HFACS to Move From Diagnosis to Intervention Design.

The development of cancer care treatment facilities in resource-constrained settings represents a challenge for many reasons. Implementation science-the assessment of how services are set up and delivered; contextual factors that affect delivery, treatment safety, toxicity, and efficacy; and where adaptations are needed-is essential if we are to understand the performance of a treatment program, know where the gaps in care exist, and design interventions in care delivery models to improve outcomes for patients. The field of implementation science in relation to cancer care delivery is reviewed, and the experiences of the integrated implementation science program at the Butaro Cancer Center of Excellence in Rwanda are described as a practical application. Implementation science of HIV and tuberculosis care delivery in similar challenging settings offers some relevant lessons. Integrating effective implementation science into cancer care in resource-constrained settings presents many challenges, which are discussed. However, with carefully designed programs, it is possible to perform this type of research, on regular and ongoing bases, and to use the results to develop interventions to improve quality of care and patient outcomes and provide evidence for effective replication and scale-up. Implementation science is both critical and feasible in evaluating, improving, and supporting effective expansion of cancer care in resource-limited settings. In ideal circumstances, it should be a prospective program, established early in the lifecycle of a new cancer treatment program and should be an integrated and continual process.

Background There is a need to identify why multiple sclerosis exercise research is not translating into real-world participation. To lay the foundations of strong clinical research, considering the translational element of implementation science at the feasibility phase of a trial is vital. Methods Document analysis was used to examine document sources on exercise activity interventions designed for people living with multiple sclerosis. Document sources focused on multiple sclerosis research that incorporated exercise prescription elements and behaviour change and were feasibility studies incorporating aspects of implementation science. Results Implementation science should come much earlier than the efficacy or effectiveness research pipeline. An alternate view is outlined where feasibility and implementation science should meet based on case examples that have not yet shown strong efficacy or effectiveness. Findings from our key themes indicate a need for a cyclical iterative approach to the translational process. Multiple aspects of feasibility and how it can be assessed using an implementation science lens to support more successful interventions are provided. The determination of feasibility in behaviour change should involve implementation science as feasibility is drawn on for theory development, optimising the intervention design and quality of implementation strategies, and identifying those delivering the intervention before conducting efficacy and effectiveness research. Conclusions Document analysis methodology is underused in qualitative research and was appropriate to use as it was a very resource, time-efficient and an unobtrusive process that could track change and development to explore the integration of implementation science at the feasibility phase, with the findings indicating the earlier implementation science is introduced into multiple sclerosis exercise interventions the better.

Challenges and opportunities for implementation of interventions to prevent and control CVD in low-resource settings: a report from CESCAS in Argentina.

Suicide research and prevention are complex. Many practical, methodological and ethical challenges must be overcome to implement effective suicide prevention interventions. Implementation science can offer insights into what works, why and in what context. Yet, there are limited real-world examples of the application of implementation science in suicide prevention. This study aimed to identify approaches to employ principles of implementation science to tackle important challenges in suicide prevention. A questionnaire about promoting implementation science for suicide prevention was developed through thematic analysis of stakeholder narratives. Statements were categorised into six domains: research priorities, practical considerations, approach to intervention design and delivery, lived experience engagement, dissemination and the way forward. The questionnaire (n=52 statements-round 1; n=44 statements-round 2; n=9 statements-round 3) was administered electronically to a panel (n=62-round 1, n=48-round 2; n=45-round 3) of international experts (suicide researchers, leaders, project team members, lived experience advocates). Statements were rated on a Likert scale based on an understanding of importance and priority of each item. Statements endorsed by at least 85% of the panel would be included in the final guidelines. Eighty-two of the 90 statements were endorsed. Recommendations included broadening research inquiries to understand overall programme impact; accounting for resources in the translation of evidence into practice; embedding implementation science in intervention delivery and design; meaningfully engaging lived experience; considering channels for dissemination of implementation-related findings and focusing on next steps needed to routinely harness the strengths of implementation science in suicide prevention research, practice and training. An interdisciplinary panel of suicide prevention experts reached a consensus on optimal strategies for using implementation science to enhance the effectiveness of policies and programmes aimed at reducing suicide.

Neurodevelopmental disorders have become global public health challenges, and early interventions have been proved to be effective in mitigating the problems and promoting the long-term functioning of people facing such challenges. These interventions had long been provided only by health professionals, but parents are now recognized for their capabilities. Parent-implemented early interventions are devised to equip parents with specialized knowledge and skills so that they can offer tailored training for their children. As these community-based interventions are designed to be implemented at home, they inevitably influence and are influenced by the family systems. While the family dynamics play a key role in determining the efficacy of the intervention, still little is known about the familial factors, as the focus on the existing literature is on the changes of the parent-child dyads. This research bridged this knowledge gap in implementation sciences by investigating how the family members who did not partake in the training reacted to the parent-implemented interventions (PIIs) at home. A qualitative study was conducted between August 2023 and July 2024 in Hong Kong, examining the impacts of a localized version of the World Health Organization Caregiver Skills Training. In total, 22 respondents participated in five focus group discussions. Inductive reflexive thematic analysis was applied to construct codes, themes, and frameworks. Four levels of responses-Level 0: Reject, Level 1: Support, Level 2: Attempt, and Level 3: Embrace-were identified, and these themes were on a continuum of families' involvement in the practice of PII. Factors that promoted or discouraged their involvement were discussed. Evidence has confirmed that PII had indirect impacts on family dynamics, and the responses of family members affected the intervention effectiveness and the mental health of the caregiver-participants. This research responded to the call to improve public health evaluations. It moved beyond the linear changing processes in the intervention design, addressed the complexity of the social systems, and explicated the multidimensional changing processes in a family-the immediate context where parent-implemented early intervention was implemented. It contributed to build initial frameworks on the familial influences and support the future development of the intervention and research designs.

The 17-year time span between discovery and application of evidence in practice has become a unifying challenge for implementation science and translational science more broadly. Further, global pandemics and social crises demand timely implementation of rapidly accruing evidence to reduce morbidity and mortality. Yet speed remains an understudied metric in implementation science. Prevailing evaluations of implementation lack a temporal aspect, and current approaches have not yielded rapid implementation. In this paper, we address speed as an important conceptual and methodological gap in implementation science. We aim to untangle the complexities of studying implementation speed, offer a framework to assess speed of translation (FAST), and provide guidance to measure speed in evaluating implementation. To facilitate specification and reporting on metrics of speed, we encourage consideration of stakeholder perspectives (e.g., comparison of varying priorities), referents (e.g., speed in attaining outcomes, transitioning between implementation phases), and observation windows (e.g., time from intervention development to first patient treated) in its measurement. The FAST framework identifies factors that may influence speed of implementation and potential effects of implementation speed. We propose a research agenda to advance understanding of the pace of implementation, including identifying accelerators and inhibitors to speed.

Nonbiomedical factors affecting antibiotic use in the community: authors' response

There is increasing attention being given to opportunities and approaches to advance health equity using implementation science. To reduce disparities in health, it is crucial that an equity lens is integrated from the earliest stages of the implementation process. In this paper, we outline four key pre-implementation steps and associated questions for implementation researchers to consider that may help guide selection and design of interventions and associated implementation strategies that are most likely to reach and be effective in reducing health disparities among vulnerable persons and communities.

The current challenging economic climate demands, more than ever, value for money in service delivery. Every service is required to maximise positive outcomes in the most cost-effective ways. To date, a smorgasbord of interventions have been designed to benefit society. Those worthy of attention have solid foundations in empirical research, offering service providers reassurance that positive outcomes are assured. Many of these programmes lie within the field of education and everyday school practice, yet often even these highly supported programmes yield poor results. Therefore, teachers and school staff cast these valuable materials aside, claiming they are ineffective. The question is why. Why do these interventions, grounded in theory and research, fail to translate into positive outcomes? The answer rests within the study of implementation science. Following a brief definition of key terms and theories, this article will go on to discuss why implementation is not a straightforward process. To do so, this article will draw upon examples of poorly implemented, but evidence-based, school programmes. Having acknowledged how poor implementation affects sustainability, we will then look at the growing amount of frameworks for practice within this field. One such framework, The Core Components Model, (Fixsen, Blase, Naoom, & Wallace, 2009) will be used to facilitate discussion around the processes of successful design and evaluation. This article will continue by illustrating how the quality of implementation has directly affected sustainability of The Incredible Years programmes (Webser-Stratton, 2012) and the Promoting Alternative Thinking Strategies (PATHS) curriculum (Greenberg & Kusche, 1996). Then by analysing implementation science, some of the challenges currently faced within this field will be highlighted and areas for further research discussed. This will then link to the implications for educational psychologists (EPs) and will conclude that implementation science is crucial to the design and evaluation of interventions and the EP is in an ideal position to support sustainable positive change.

BackgroundHistorically, the focus of cost-effectiveness analyses has been on the costs to operate and deliver interventions after their initial design and launch. The costs related to design and implementation of interventions have often been omitted. Ignoring these costs leads to an underestimation of the true price of interventions and biases economic analyses toward favoring new interventions. This is especially true in low- and middle-income countries (LMICs), where implementation may require substantial up-front investment. This scoping review was conducted to explore the topics, depth, and availability of scientific literature on integrating implementation science into economic evaluations of health interventions in LMICs.MethodsWe searched Web of Science and PubMed for papers published between January 1, 2010, and December 31, 2021, that included components of both implementation science and economic evaluation. Studies from LMICs were prioritized for review, but papers from high-income countries were included if their methodology/findings were relevant to LMIC settings.ResultsSix thousand nine hundred eighty-six studies were screened, of which 55 were included in full-text review and 23 selected for inclusion and data extraction. Most papers were theoretical, though some focused on a single disease or disease subset, including: mental health (n = 5), HIV (n = 3), tuberculosis (n = 3), and diabetes (n = 2). Manuscripts included a mix of methodology papers, empirical studies, and other (e.g., narrative) reviews. Authorship of the included literature was skewed toward high-income settings, with 22 of the 23 papers featuring first and senior authors from high-income countries. Of nine empirical studies included, no consistent implementation cost outcomes were measured, and only four could be mapped to an existing costing or implementation framework. There was also substantial heterogeneity across studies in how implementation costs were defined, and the methods used to collect them.ConclusionA sparse but growing literature explores the intersection of implementation science and economic evaluation. Key needs include more research in LMICs, greater consensus on the definition of implementation costs, standardized methods to collect such costs, and identifying outcomes of greatest relevance. Addressing these gaps will result in stronger links between implementation science and economic evaluation and will create more robust and accurate estimates of intervention costs.Trial registrationThe protocol for this manuscript was published on the Open Science Framework. It is available at: https://osf.io/ms5fa/ (DOI: 10.17605/OSF.IO/32EPJ).

BackgroundResearch has generated valuable knowledge in identifying, understanding, and intervening to address inequities in the delivery of healthcare, yet these inequities persist. The best available interventions, programs and policies designed to address inequities in healthcare are not being adopted in routine practice settings. Implementation science can help address this gap by studying the factors, processes, and strategies at multiple levels of a system of care that influence the uptake, use, and the sustainability of these programs for vulnerable populations. We propose that an equity lens can help integrate the fields of implementation science and research that focuses on inequities in healthcare delivery.Main textUsing Proctor et al.’ (12) framework as a case study, we reframed five elements of implementation science to study inequities in healthcare. These elements include: 1) focus on reach from the very beginning; 2) design and select interventions for vulnerable populations and low-resource communities with implementation in mind; 3) implement what works and develop implementation strategies that can help reduce inequities in care; 4) develop the science of adaptations; and 5) use an equity lens for implementation outcomes.ConclusionsThe goal of this paper is to continue the dialogue on how to critically infuse an equity approach in implementation studies to proactively address healthcare inequities in historically underserved populations. Our examples provide ways to operationalize how we can blend implementation science and healthcare inequities research.

Introduction: Nutrition professionals face implementation challenges due to their lack of knowledge to incorporate D&I science into intervention design. To improve intervention outcomes, nutrition professionals must be trained in D&I science, which are currently absent in the field. Aims: To identify and assess nutrition educators and practitioners perceived motivations, self-efficacy, and attitudes in using D&I science to inform the educational design and strategies of a nutrition-specific D&I curriculum for nutrition educators. Then to test feasibility of the nutrition-specific curriculum in increasing knowledge, self-efficacy, and attitudes by a case study approach, pre/post intervention design. Methods: First, scoping review methodology involved the search of six academic databases. Data extraction included intervention type, population, study aim, methods, theoretical approach, outcomes, and results. Secondly, using the Theory of Planned Behavior (perceptions survey), participants recruited from the Society of Nutrition Education and Behavior directory were asked to report perceptions of D&I science through an online survey. Data were analyzed for nonparametric measures (Spearman’s p) and thematic analysis. Third, a content mapping exercise categorized the nutrition-specific D&I training learning objectives to validated D&I course competencies. Then, experts were recruited by a selective sample of practitioners in nutrition implementation science. Experts reported feedback on the curriculum by responding to 7-point Likert scale questions and qualitative responses, which were analyzed for themes. Lastly, the nutrition-specific D&I training was pilot tested under a case study approach. Participants were enrolled in the 8-week intervention and completed a pre/post assessment with an exit interview. Quantitative measures were analyzed for changed over time using a Wilcoxon signed rank test. Qualitative measures were deductively analyzed using the Kirkpatrick Model, Implementation Outcome measures, and the Systems Level Framework. Results: From the scoping review, thirty-four retained articles qualitatively identified benefits (successful planning and organization of complex interventions) and challenges (limited resources, trainings, and lack of knowledge) to utilizing systems science in nutrition D&I research. Further results suggest that an active and mentorship methods for a nutrition-specific D&I curriculum for university nutrition and public health students is likely to perceived behavioral control. From the mixed-methods perceptions survey (n=70), perceived behavioral control (knowledge and learning autonomy) positively influenced behavioral intention to use D&I science (p=0.0119). From the 43 validated competencies, this course covers 22 of the core competencies. 31 experts categorized the learning strategies and syllabus towards the positive Likert scale end (i.e.; helpful, clarifying, effective, useful, encouraging, and important) with scores between 4-7. Participants in the

Proposal for Life Course Intervention Researcher Core Competencies.

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.

Having learnt about the prevalence, behaviours and impacts of Workplace Bullying, the field is currently moving to focus more on interventions that prevent and manage the phenomenon. Rather than presenting evidence on particular interventions, this chapter introduces a framework that outlines the role of academics and practitioners in advancing this area of research, arguing that only collaboration and the sharing of expertise and perspectives will enable us to improve the design, delivery and refinement of interventions or programmes. Collaboration and the need for different perspectives are vital due to the complexity of the phenomenon. By focusing on scientific principles, the logic underpinning action is strengthened and will help inform the development of emergent practice. Fortunately, the field of Workplace Bullying can learn the lessons of academics and practitioners in the fields of Prevention Science and Implementation Science and the disciplines of Public Health and Human Services. Paying attention to these lessons and building upon their principles can assist in advancing how we in the field of Workplace Bullying respond to this phenomenon, either through prevention or management. This chapter presents an approach to intervention research, including concepts and principles from the fields of Prevention Science and Implementation Science that will guide both academics and practitioners as we move into the latest frontier of Workplace Bullying research.