From evidence to delivery: an Implementation-Science blueprint for behavioural policy

Strategies to Sustain Quality Interventions: Case Examples of Chlorhexidine Gluconate Bathing.

IMPACT: Specific recommendations will be suggested in this presentation as to how a health equity lens can be applied to implementation science frameworks. OBJECTIVES/GOALS: This systematic review consolidated literature on how implementation science (IS) frameworks (e.g., RE-AIM) have been used in cancer prevention services (e.g., screening, tobacco cessation programs) to reduce health disparities. METHODS/STUDY POPULATION: The systematic review was conducted in accordance with PRISMA and registered with PROSPERO. Searches were conducted in Ovid MEDLINE, PubMed, PsycINFO, CINAHL, and EMBASE between January-May 2020. Search strategies used the combinations of terms related to implementation science frameworks, cancer prevention and/or intervention, and all search algorithms were validated by a public health librarian. RESULTS/ANTICIPATED RESULTS: A total of 1,025 articles were screened and 84 were deemed eligible for full-text screening. After full-text screening, n=27 articles were included for data abstraction and synthesis. Of the 27 studies that used an implementation science framework, only one-third of studies (N=9, 33.3%) used an IS framework to address cancer-related health disparities. Of those nine studies, six of them used the Consolidated Framework for Implementation Research (CFIR) to guide, inform, and/or adapt the implementation of a cancer prevention intervention to target health disparities. However, the variability in how this framework was applied remains a challenge. DISCUSSION/SIGNIFICANCE OF FINDINGS: Recommendations for how various IS frameworks can be used to address cancer prevention disparities will be presented, such as, guiding principles on how to intentionally select domains within the CFIR that will capture input from key stakeholders in health disparities populations.

Background: RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) and CFIR (Consolidated Framework for Implementation Research) dissemination and implementation frameworks define theory-based domains associated with the adoption, implementation and maintenance of evidence-based interventions. Used together, the two frameworks identify metrics for evaluating implementation success, i.e., high reach and effectiveness resulting in sustained practice change (RE-AIM), and modifiable factors that explain and enhance implementation outcomes (CFIR). We applied both frameworks to study the implementation planning process for a technology-delivered asthma care intervention called Breathewell within an integrated care organization. The goal of the Breathewell intervention is to increase the efficiency of delivering resource-intensive asthma care services.Methods: We reviewed historical documents (i.e., meeting agendas; minutes) from 14 months of planning to evaluate alignment of implementation team priorities with RE-AIM domains. Key content was extracted and analyzed on topics, frequency and amount of discussion within each RE-AIM domain. Implementation team members were interviewed using questions adapted from the CFIR Interview Guide Tool to focus their reflection on the process and contextual factors considered during pre-implementation planning. Documents and transcripts were initially coded using RE-AIM domain definitions, and recoded using CFIR constructs, with intent to help explain how team decisions and actions can contribute to adoption, implementation and maintenance outcomes.Results: Qualitative analysis of team documents and interviews demonstrated strong alignment with the RE-AIM domains: Reach, Effectiveness, and Implementation; and with the CFIR constructs: formal inclusion of provider and staff stakeholders in implementation planning, compatibility of the intervention with workflows and systems, and alignment of the intervention with organizational culture. Focus on these factors likely contributed to RE-AIM outcomes of high implementation fidelity. However, team members expressed low confidence that Breathewell would be adopted and maintained post-trial. A potential explanation was weak alignment with several CFIR constructs, including tension for change, relative priority, and leadership engagement that contribute to organizational receptivity and motivation to sustain change.Conclusions: While RE-AIM provides a practical framework for planning and evaluating practice change interventions to assure their external validity, CFIR explains why implementation succeeded or failed, and when used proactively, identifies relevant modifiable factors that can promote or undermine adoption, implementation, and maintenance.

BackgroundThe concept of intersectionality proposes that demographic and social constructs intersect with larger social structures of oppression and privilege to shape experiences. While intersectionality is a widely accepted concept in feminist and gender studies, there has been little attempt to use this lens in implementation science. We aimed to supplement the Consolidated Framework for Implementation Research (CFIR), a commonly used framework in implementation science, to support the incorporation of intersectionality in implementation science projects by (1) integrating an intersectional lens to the CFIR; and (2) developing a tool for researchers to be used alongside the updated framework.MethodsUsing a nominal group technique, an interdisciplinary framework committee (n = 17) prioritized the CFIR as one of three implementation science models, theories, and frameworks to supplement with intersectionality considerations; the modification of the other two frameworks are described in other papers. The CFIR subgroup (n = 7) reviewed the five domains and 26 constructs in the CFIR and prioritized domains and constructs for supplementation with intersectional considerations. The subgroup then iteratively developed recommendations and prompts for incorporating an intersectional approach within the prioritized domains and constructs. We developed recommendations and prompts to help researchers consider how personal identities and power structures may affect the facilitators and inhibitors of behavior change and the implementation of subsequent interventions.ResultsWe achieved consensus on how to apply an intersectional lens to CFIR after six rounds of meetings. The final intersectionality supplemented CFIR includes the five original domains, and 28 constructs; the outer systems and structures and the outer cultures constructs were added to the outer setting domain. Intersectionality prompts were added to 13 of the 28 constructs.ConclusionThrough an expert-consensus approach, we modified the CFIR to include intersectionality considerations and developed a tool with prompts to help implementation users apply an intersectional lens using the updated framework.

Background: Campus sexual violence interventions must be scalable and effective in real-world settings. However, campus sexual violence interventions have unique implementation contexts that are not fully addressed by the most common implementation science frameworks. Hybrid studies - designs that incorporate effectiveness and implementation outcomes into a single trial - are an important tool to shorten the translation pipeline and enhance the efficacy and effectiveness of these interventions. We conducted a series of case studies to explore the applicability of the Consolidated Framework for Implementation Research (CFIR) to campus sexual violence interventions and to develop an adapted framework and checklist that could be used to advance the implementation science of campus sexual violence intervention research. Methods: We developed four case studies of campus sexual violence interventions from the United States, South Africa, and Eswatini. Two were delivered digitally (United States and Eswatini) and two in person (South Africa and Eswatini). We analyzed these cases using a comparative design guided by CFIR’s theorized constructs, aiming to identify implementation science concerns that are likely unique to CSVI research. These analyses were used to develop a CSVI-specific IS checklist and planning worksheet Results: We identified multiple cross-cutting issues unique to the implementation science of campus sexual violence interventions: The policy and legal framework, team praxis, relationships, context, infrastructure, and people. We situated these within a conceptual framework to reflect their intersections and developed a checklist of considerations at the planning, implementation, and post-project reflection phase. Conclusions: The field of sexual violence will benefit from the integration of implementation science methodologies. We found CFIR to be a useful starting point, however, it requires certain key modifications to fully support sexual violence intervention research. The adapted CFIR framework we developed from a cross-national set of case studies is a key tool to meet the needs of funders, researchers, and practitioners.

Introduction: The use of models and frameworks to design and evaluate strategies to improve delivery of evidence-based interventions is a foundational element of implementation science. To date, however, evaluative implementation science frameworks such as Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) have not been widely employed to examine environmental health interventions. We take advantage of a unique opportunity to utilize and iteratively adapt the RE-AIM framework to guide NIH-funded case studies of the implementation of clean cooking fuel programs in eleven low- and middle-income countries.Methods: We used existing literature and expert consultation to translate and iteratively adapt the RE-AIM framework across several stages of the NIH Clean Cooking Implementation Science case study project. Checklists and templates to guide investigators were developed at each stage.Results: The RE-AIM framework facilitated identification of important emerging issues across this set of case studies, in particular highlighting the fact that data associated with certain important outcomes related to health and welfare are chronically lacking in clean fuel programs. Monitoring of these outcomes should be prioritized in future implementation efforts. As RE-AIM was not originally designed to evaluate household energy interventions, employing the framework required adaptation. Specific adaptations include the broadening of Effectiveness to encompass indicators of success toward any stated programmatic goal, and expansion of Adoption to include household-level uptake of technology.Conclusions: The RE-AIM implementation science framework proved to be a useful organizing schema for 11 case studies of clean fuel cooking programs, in particular highlighting areas requiring emphasis in future research and evaluation efforts. The iterative approach used here to adapt an implementation science framework to a specific programmatic goal may be of value to other multi-country program efforts, such as those led by international development agencies. The checklists and templates developed for this project are publicly available for others to use and/or further modify.

ObjectiveTo identify innovation and implementation determinants of HIV testing, diagnosis, and linkage-to-care in the U.S.Data sources and study settingBetween November 2020 and January 2022, a broad search strategy was employed in three literature databases: Ovid MEDLINE, PsycINFO, and Web of Science.Study designA systematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement.Data collection/extraction methodsA team of master’s and Ph.D.-level researchers screened eligible studies against the inclusion criteria and extracted the data using COVIDENCE software in pairs with consensus performed by a senior member of the team. Barriers and facilitators were extracted and analyzed according to the Consolidated Framework for Implementation Research (CFIR). Frequency of determinants across studies was mapped according to CFIR, valence, study design, delivery setting, unit of analysis, population of interest, region of the U.S., and year.ResultsWe identified 1,739 implementation and innovation determinants from 186 articles. Most determinants were for HIV testing rather than linkage-to-care. Most determinants were identified in the inner setting and individuals domains of CFIR, with the fewest identified in the process and innovations domains. Determinants of providers were only slightly more frequently identified than determinants of recipients. However, determinants of organizations and systems were rarely identified.ConclusionThis review provides a synthesis of innovation and implementation determinants of HIV testing and linkage-to-care using the most-cited implementation science (IS) framework, CFIR. This synthesis enables the larger field of HIV science to utilize IS in efforts to end the HIV epidemic and positions IS to consider the application of IS frameworks to fields like HIV.

Transforming research into practice via implementation science may improve institution-wide implementation success rates for lifestyle medicine (LM). Implementation science (IS) is the study of methods that facilitate the uptake of evidence-based practice and research into regular use by practitioners and policymakers. Multiple IS frameworks, such as the Reach, Effectiveness, Adoption, Implementation, Maintenance/Practical Robust Implementation Strategy Model (RE-AIM/PRISM) model, Exploration, Preparation, Implementation, Sustainment (EPIS) model, and Consolidated Framework for Implementation Research (CFIR) model, have been developed. IS frameworks provide a strong yet adaptable foundation for launching initiatives, minimizing barriers by challenging implementers to identify and address problems that impede implementation, and promoting long-term sustainability and positive outcomes. The trouble-shooting tips provided in this article are strategically aligned with the RE-AIM/PRISM model of IS to maximize the likelihood of implementation success within the LM space. These tips provide guidance on how to effectively implement interventions, sustain their delivery, and avoid or overcome barriers to implementation. This article presents 12 tips intended as a list of options to facilitate the implementation phases of an initiative, as opposed to offering an all-or-nothing approach to implementation strategy. Current IS priorities emphasize system change and sustainability, which are essential components of successful implementation of LM initiatives.

BackgroundA Risk Evaluation and Mitigation Strategy (REMS) is a drug safety program for certain medications with serious safety concerns required by the U.S. Food and Drug Administration (FDA) of manufacturers to implement to help ensure the benefits of the medication outweigh its risks. FDA is encouraging “the research community to develop novel methods for assessing REMS,” conveying the unmet need for a standardized evaluation method of these regulatory-mandated healthcare programs. The objective of this research is to evaluate FDA REMS assessment plans using established implementation science frameworks and identify opportunities for strengthening REMS evaluation.MethodsA content analysis was conducted of publicly available assessment plans for all REMS programs (N = 23) approved 1/1/2014–12/31/2018 for new drug applications (NDAs) and biologics license applications (BLAs) requiring FDA-mandated Elements to Assure Safe Use (ETASU). Blinded reviewers critically appraised REMS assessment measures (n = 674) using three established implementation science frameworks: RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance); PRECEDE-PROCEED (Predisposing, Reinforcing, and Enabling Constructs in Educational/Environmental Diagnosis and Evaluation – Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development); and CFIR (Consolidated Framework for Implementation Research). Framework constructs were mapped to REMS Assessment categories as defined by FDA Guidance for Industry to evaluate congruence.ResultsREMS assessment measures demonstrated strong congruence (> 90% mapping rate) with the evaluative constructs of RE-AIM, PRECEDE-PROCEED, and CFIR. Application of the frameworks revealed that REMS assessment measures heavily emphasize implementation and operations, focus less on health outcomes, and do not evaluate program context and design assumptions.ConclusionsImplementation science frameworks have utility for evaluating FDA-mandated drug safety programs including the selection of primary measures to determine whether REMS goals are being met and of secondary measures to evaluate contextual factors affecting REMS effectiveness in varying organizational settings.

Translational research: The ingredients are only the start of the recipe for better dietetic practice

Long-acting injectable HIV pre-exposure prophylaxis (LAI-PrEP) was approved by the U.S. Food and Drug Administration in December 2021. This initial phase of implementation represents a prime opportunity to ensure equitable LAI-PrEP provision to communities often underrepresented in PrEP care before disparities in access and uptake emerge. Herein, we describe the EquiPrEP Project which utilizes an equity-oriented implementation science framework to optimize LAI-PrEP rollout in an urban safety-net clinic in New York City. The primary objectives of this project are to: (1) increase LAI-PrEP initiation overall; (2) increase uptake among groups disproportionately impacted by the HIV epidemic; (3) preserve high PrEP retention while expanding use; and (4) identify barriers and facilitators to LAI-PrEP use. EquiPrEP will enroll 210 PrEP-eligible participants into LAI-PrEP care with planned follow-up for one year. We will recruit from the following priority populations: Black and/or Latine men who have sex with men, Black and/or Latine cisgender women, and transgender women and nonbinary individuals. To evaluate implementation of LAI-PrEP, we will utilize equity-focused iterations of the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework and the Consolidated Framework for Implementation Research (CFIR), in addition to longitudinal surveys and qualitative interviews. Novel LAI-PrEP formulations carry tremendous potential to revolutionize the field of HIV prevention. Implementation strategies rooted in equity are needed to ensure that marginalized populations have access to LAI-PrEP and to address the structural factors that hinder initiation and retention in care.

Implementation Science in Suicide Prevention.

The delay between establishing evidence-based practice and translating effective practices is well documented. This presentation will focus on the application of implementation science principles to the Department of Veterans Affairs (VA) Hospital-In-Home program using a staged approach. The stages are: 1) assessing current program implementation, 2) measuring organizational readiness with new sites, 3) developing tools and resources to assist new HIH sites, and 4) working with new sites interested in adopting the HIH program using a participatory implementation planning process guided by system dynamics. In this session we will profile our use of theories, models and frameworks including the Consolidated Framework for Implementation Research (CFIR) and Reach Effectiveness Adoption Implementation Maintenance (REAIM) framework. The CFIR Expert Recommendation for Implementing Change (ERIC) Mapping Tool will be introduced as useful to identifying strategies to overcome barriers to implementation. We will apply the participatory approaches for implementation planning, including Implementation Mapping, development of Implementation Logic Models, and Group Model Building to plan for the implementation of HIH in prospective sites. Key implementation science concepts and techniques will be introduced, along with a description of how participatory approaches will facilitate informed planning and stakeholder engagement in future implementation, adaptation, and roll-out of an evidence-based systemic program. Key anticipated outputs include a framework for the core components of HIH intervention, a catalog of important determinants of HIH implementation success, a profile of existing strategies to enhance implementation and sustainability, and a roadmap for the participatory planning of HIH implementation in future contexts.

The field of violence against women and children (VAW/C) prevention has made significant progress in identifying effective strategies to prevent violence. However, there are still gaps in understanding how to sustain and scale evidence-based interventions across diverse settings. At the same time, implementation science offers approaches that could help achieve greater scale, sustainability, and equity. Despite its potential, implementation science approaches have not been fully applied to VAW/C research. To address this gap, a scoping review was conducted to identify the frameworks employed, understand the most frequently studied implementation domains, examine any specific challenges captured within the applied implementation science frameworks related to delivering survivor-centered violence prevention programming, and illuminate the role of practice-based knowledge within implementation science efforts for violence prevention programming. The review, conducted between 2023 and 2024, identified 40 VAW/C evaluation studies that included implementation or process evaluation components, with most studies published after 2020. Commonly used implementation science frameworks included the Consolidated Framework for Implementation Research (CFIR), the Exploration, Preparation, Implementation, and Sustainment (EPIS) model, and the Medical Research Council (MRC) frameworks. Key implementation domains studied were fidelity, acceptability, and feasibility. However, scale and sustainability-critical priorities for practitioners, policymakers, and donors-were only minimally addressed in the literature. In addition, there was limited focus on implementing survivor-centered practices and incorporating practice-based knowledge. The findings highlight the need for long-term collaborations between researchers and practitioners that explicitly integrate implementation science. Such partnerships could help adapt, scale, and sustain evidence-based VAW/C prevention programs more effectively while ensuring they remain survivor-centered.

Background: Ischemic stroke treatment necessitates timely intervention, including intravenous thrombolysis (IVT) and mechanical thrombectomy (MT), to optimize patient outcomes. Increasing patient volumes and staffing challenges have contributed to deviations from acute stroke protocols. This quality improvement initiative evaluated the implementation of an Acute Stroke Nurse (ASN) role at a Comprehensive Stroke Center to enhance stroke alert coordination, post-thrombolytic monitoring, and patient care transitions. Methods: A 12-week pilot program introduced the ASN role, focusing on acute stroke response and monitoring after IVT administration. Guided by implementation science frameworks, including the Consolidated Framework for Implementation Research (CFIR), Expert Recommendations for Implementing Change (ERIC), and the Implementation Research Logic Model (IRLM), the initiative assessed door-to-treatment times, post-thrombolytic monitoring compliance, and staff perceptions of the role. Quantitative metrics, validated scales for acceptability and appropriateness (AIM and IAM), and thematic analysis of feedback informed the evaluation. Results: The ASN role was piloted with partial coverage (median 3.5 days per week). Although door-to-needle times for IVT did not improve, door-to-puncture times for MT decreased by 28.3% (mean 39.4 minutes compared to 55 minutes pre-pilot). Compliance with vital sign and neurologic monitoring improved by 40.4% and 11.1%, respectively, in the critical post-thrombolytic period. Staff surveys (n=45) demonstrated high acceptability (AIM=4.77) and appropriateness (IAM=4.81), with strong support for the role’s expansion. Based on these findings, two full-time equivalent (FTE) positions were approved to sustain and expand the ASN role. Conclusions: The pilot demonstrated the ASN role’s impact on enhancing monitoring compliance, reducing treatment times for mechanical thrombectomy, and improving staff satisfaction. These findings support the role's scalability and highlight the value of structured implementation science approaches in advancing evidence-based stroke care practices.