Implementation science for brain disorders

Abstract

Implementation science is an emerging multidisciplinary field that aims to promote the integration of scientific evidence into health-care policy and clinical practice. It can identify barriers to and enablers of effective policy making, and it can help stakeholders leverage their scientific knowledge for the effective implementation of an intervention. Over the past decade, implementation science has become an increasing priority across the US National Institutes of Health (NIH) and, more specifically, for the Fogarty International Center. Scientists from the Fogarty Global Brain Disorders Research Program1Fogarty International CenterGlobal Brain Disorders Research.https://www.fic.nih.gov/Programs/Pages/brain-disorders.aspxDate: Nov 8, 2019Date accessed: June 17, 2020Google Scholar contend that incorporating implementation science into neurological research can add scientific rigor to an otherwise ad-hoc implementation process by helping stakeholders explore crucial challenges in a more systematic way. The Fogarty International Center's Learning Collaborative for Implementation Science in Global Brain Disorders provides training opportunities as part of the Global Brain Disorders Research Program's network meetings to increase grantees' capacity to conduct global implementation research. The Fogarty International Center and its NIH partners additionally provide funding opportunities to promote implementation research in neurological disorders in low-income and middle-income countries, allowing neuroscientists to expand the reach and effect of their work. Neurological disorders are the leading cause of disability and the second leading cause of death globally.2GBD 2016 Neurology CollaboratorsGlobal, regional, and national burden of neurological disorders, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016.Lancet Neurol. 2019; 18: 459-480Summary Full Text Full Text PDF PubMed Scopus (1203) Google Scholar This burden will only be further exacerbated by the growth of ageing populations worldwide. Thus, scientists must not only pursue new prevention and treatment strategies but also capitalise on existing interventions to make progress in reducing the burden of neurological diseases. For instance, a grantee of the Fogarty International Center at the NIH has created a novel cost-effective treatment for infant hydrocephalus, combining two methods that were previously used individually: endoscopic third ventriculostomy (ETV) and choroid plexus cauterisation (CPC).3Boston Children's HospitalETV/CPC procedure.https://www.childrenshospital.org/conditions-and-treatments/treatments/etv-cpc-procedureDate accessed: June 17, 2020Google Scholar The combined ETV–CPC method was developed in Uganda and is now being utilised in several paediatric neurosurgery centres in North America. By reducing lifetime shunt dependence, this technique is expected to increase cost savings and decrease morbidity and mortality.4Kulkarni AV Schiff SJ Mbabazi-Kabachelor E et al.Endoscopic treatment versus shunting for infant hydrocephalus in Uganda.N Engl J Med. 2017; 377: 2456-2464Crossref PubMed Scopus (72) Google Scholar, 5Zeitvogel K Fogarty-supported research revolutionizes hydrocephalus care.https://www.fic.nih.gov/News/GlobalHealthMatters/september-october-2018/Pages/hydrocephalus-care.aspxDate: September, 2018Date accessed: June 17, 2020Google Scholar This exemplar shows that there is value in adapting an intervention to a new context; however, the process by which this adaption can be successfully done is not always apparent. In fact, evidence-based innovations that are deemed successful in a setting typically do not produce results when scaled up or transferred to new settings, because programme implementers did not study how best to adapt the intervention to suit the unique culture, available resources, and other factors. Implementation science can accelerate the effect of neurological research and enable health systems, providers, and governments to harness and scale proven treatment and prevention strategies and, therefore, help reduce the global burden of neurological disorders. We declare no competing interests.