Implementation Research Research Articles

Background: More women die in Nigeria around the time of childbirth than in any other country in the world and preeclampsia is a leading cause of these deaths. Despite evidence-based guidelines, the uptake of aspirin prophylaxis in high-burden settings like Nigeria remains unclear. This study assessed aspirin use among at-risk pregnant women and explored multi-level barriers and facilitators to implementation. Methods: We conducted an explanatory sequential mixed-methods study across four tertiary hospitals in Nigeria from October 2023 to March 2024. The quantitative phase surveyed 1,200 pregnant women stratified by preeclampsia risk (low, moderate, high) per WHO criteria, with self-reported aspirin use. The qualitative phase included 18 in-depth interviews and 8 focus group discussions, which were analyzed using the updated Consolidated Framework for Implementation Research. Results: Of 1,159 participants with complete risk profiles, 30 (3%) were classified as moderate risk and 329 (28%) as high risk for preeclampsia. Among 313 participants with available aspirin data, 14% of moderate-risk and 20% of high-risk women reported receiving an aspirin prescription. Early antenatal presentation (before 16 weeks) was associated with higher aspirin use (34% vs. 19%, p = 0.008). Participants with a personal history of preeclampsia, chronic hypertension, age >40 years, or a family history of preeclampsia were more likely to receive aspirin than those with diabetes. Lower educational attainment and income levels were associated with reduced odds of aspirin use. Preeclampsia and eclampsia occurred in 21% and 3%, respectively, of the moderate- to high-risk group, compared to 5% and 2% among low-risk participants. Qualitative data revealed barriers including poor dissemination of guidelines, limited provider and patient awareness, delayed antenatal care, and cost. Key facilitators included strong provider motivation and integration with existing antenatal workflows. Conclusion: Aspirin use for preeclampsia prevention remains low among at-risk pregnant women in Nigerian tertiary hospitals. Targeted implementation strategies—focused on provider training, improved guideline dissemination, patient education, and policy measures to enhance access—are urgently needed. Scaling this evidence-based, low-cost intervention could significantly reduce maternal morbidity and mortality in Nigeria and other high-burden settings.

Introduction: Bystander defibrillation remains low throughout the US (1-4%). The REciprocal InnovationS TO ImpRovE Cardiovascular CARE in Rural America (RESTORe-CARE) project is designed to develop and pilot a drone-delivered AED program in two counties. While partners may likely be supportive of a drone-delivered AED program, understanding differences in perceived challenges by organizational role may be critical to future adoption. Objectives: We sought to examine out-of-hospital systems of care perspectives and acceptability of the drone-delivered AED program to inform subsequent implementation. Methods: We developed a multiple methods survey informed by the Consolidated Framework for Implementation Research, which is a conceptual framework that guides the systematic assessment of implementation. Surveys were collected from Forsyth County, NC and James City, VA. We categorized partners by role (Emergency Medical Services (EMS), Sheriff/9-1-1, Medical/9-1-1, Fire/First Responders, and Other) and examined differences in responses by role and location. The survey data were analyzed using Pearson’s Chi-squared test. Qualitative data were reported by top salient themes. Results: From 4/2024-8/2024, 102 surveys were completed; 10% (EMS), 42% (Sheriff/9-1-1), 8% (Medical/9-1-1), 21% (Fire/Fire Responders), and 19% (Other). Experience with drones varied, with individuals expressing no experience with using drones and experience using drones in emergencies (Table 1). When queried about the extent implementing the drone program provided an advantage to their organization, responses varied by primary role (p=0.04; great extent: 22% EMS, 47% Sheriff, 50% Medical 911, 57% Fire, 18% Other) and location (p=0.01; great extent: 48% Forsyth County, 38% James City County). When asked about their expectation of drone-delivered AED program effectiveness, responses varied by primary role (p<0.01; Very effective/effective: 38% EMS, 41% Sheriff, 44% Medical 911, 68% Fire, 30% Other). Participants mentioned uncertainty in drone response times compared to those of traditional law enforcement units and concerns around insufficient staffing/resources and cost (Table 1). Conclusion: Perspectives of the drone-delivered AED intervention differed by organizational partner role. Understanding differences by role may inform future adoption of our developing drone-delivered AED program. This process may generalize to other innovative, emergent cardiac arrest interventions.

Background: Diabetes mellitus represents a critical public health emergency in India, with projections indicating 134 million affected adults by 2045 (Pradeepa et al., 2020). The integration of machine learning with nationally representative survey data offers promising approaches for population-level risk stratification in resource-constrained settings. Methods: Utilizing the National Family Health Survey-5 (NFHS-5) dataset comprising 724,115 women and 101,839 men, this study implemented six machine learning algorithms. Comprehensive preprocessing addressed complex survey design and missing data through multiple imputation techniques (Van Buuren, 2018). Results: Ensemble methods demonstrated superior performance, with Random Forest achieving AUC-ROC 0.891 (95% CI: 0.884-0.898) and XGBoost 0.874 (95% CI: 0.866-0.882). The models identified age (22.3%), BMI (18.7%), and waist-to-hip ratio (15.2%) as primary predictors, consistent with known pathophysiological mechanisms while revealing novel socioeconomic determinants. Conclusion: Machine learning algorithms effectively predict diabetes risk using nationally representative data, potentially enabling cost-effective screening strategies. Implementation research is needed to translate these findings into public health practice..

Mounting evidence supports the use of thermal ablation in women positively screened with high-risk Human Papillomaviruses (hrHPV) but limited data are available on the long-term post-treatment outcomes in women living with HIV (WLHIV). We aimed to estimate the persistence of hrHPV infection amongst WLHIV ≥24 months post treatment in West Africa. From October 2019 to October 2024, a cohort study was conducted amongst WLHIV in two HIV clinics in Burkina Faso and Cote d'Ivoire. All WLHIV with a positive hrHPV test who received thermal ablation were followed up ≥24 months. During follow-up visits, DNA HPV testing, visual inspection and biopsy were systematically performed. Factors associated with ≥24 months hrHPV positivity were assessed through a logistic regression model. A total of 200 WLHIV, aged 42 years [Interquartile range (IQR): 38-45], with a nadir CD4 of 365 [IQR: 168-616] cell/mm3 received thermal ablation and were followed for a median time of 42 [IQR: 29-48] months. A positive hrHPV was detected in 40.5% of women ≥24 months post treatment. WLHIV who had a nadir CD4 count ≤200 cell/mm3 (aOR = 3.06 [95% CI: 1.23-7.59]) or had no or a primary school level (aOR = 2.25 [95% CI: 1.13-4.49]) were more likely to present at ≥24 months with hrHPV infection. Post-therapeutic hrHPV infection remains high beyond 2 years in WLHIV stressing the need for long-term follow-up, especially when diagnosed with advanced HIV disease. Future implementation research should focus on the contribution of additional tools to better track those in need of additional treatment.

IntroductionCommunities of South Asian origin in high-income countries experience a significantly high prevalence of mental health disorders relative to other migrant populations. Emerging evidence highlights socio-cultural and systemic challenges to mental health care access for culturally diverse communities in high-income English speaking countries; however, there is no comprehensive qualitative evidence regarding the opportunities and challenges faced by these communities. To address this knowledge gap, this scoping review aimed to explore the lived experiences of South Asian communities in accessing mental health care across four selected high-income nations (the United Kingdom, Australia, the United States, and Canada).MethodsThis scoping review followed reporting guidelines for scoping reviews outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. A systematic search was conducted to identify qualitative studies and mixed-methods studies published in English between January 2000 - January 2023 in three electronic databases: PubMed, Web of Science, and Scopus. The search strategy included keywords related to South Asian communities, mental health and access to health care in the chosen high-income countries. Extracted qualitative data was analysed using a thematic analysis.ResultsAnalysis of the 25 included studies identified interlinked opportunities and challenges informing the ability of South Asian communities to access mental health care. Findings have been structured according to dimensions of accessibility of services: (1) approachability, (2) acceptability, (3) availability and accommodation, (4) affordability, and (5) appropriateness. Our study identified myriad challenges faced by South Asian communities including inflexible accessibility to diverse mental health care, difficult family dynamics, stigma and acculturative issues hindering mental health care usage and poor mental health care experiences informing perceptions of mental health care and re-engagement.ConclusionThe research finds that access to mental health care for those from South Asian backgrounds requires a comprehensive and nuanced framework that addresses population-specific barriers, systemic inequalities and socio-cultural factors. Recommendations include increasing cultural safety, facilitating flexible models of care and service delivery in practice, alongside policy and funding reflective of systemic mental health care access issues, alongside implementation research to assess the effectiveness of such recommendations.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12889-025-24619-7.

BackgroundTransformEd is an evidence-based program that targets initial teacher education to equip future teachers with innovative strategies that increase the health, wellbeing and education outcomes of school children. Feasibility, effectiveness and implementation research demonstrate that TransformEd significantly enhances pre-service teachers’ confidence and competence to deliver such strategies. However, to date, the program has only been tested in undergraduate teaching degrees. It is important to gather more evidence for the feasibility and efficacy of the program at all levels of initial teacher education, including at postgraduate level.MethodsA feasibility study was conducted to examine the feasibility of embedding TransformEd in a Master of Teaching degree at one Australian university. Preliminary efficacy was measured by pre- and post-program surveys completed by Master of Teaching pre-service teachers who received the 12-week TransformEd program. Implementation was measured by adherence checklists completed by lecturers who delivered TransformEd. Post-program focus groups and interviews with senior academics and lecturers, respectively, explored perceptions of all eight domains of feasibility.ResultsSurvey results demonstrated that the TransformEd program was positively received by pre-service teachers (n = 21), resulting in improvements in several measures of teaching confidence and competence regarding delivering strategies to improve school children’s health, wellbeing and learning. The TransformEd strategies were well adopted by lecturers and implementation increased over time. Both lecturers (n = 3) and senior academics (n = 2) had positive perceptions of the program, highlighting its feasibility in postgraduate initial teacher education.ConclusionThis study supports the feasibility and preliminary efficacy of the TransformEd program in postgraduate initial teacher education and provides a foundation for a future controlled trial to rigorously evaluate its impact, with potential population-level benefits for children's health, wellbeing, and educational outcomes in Australia.Supplementary InformationThe online version contains supplementary material available at 10.1186/s40814-025-01713-6.

Report from the World Health Organization's Immunization and Vaccines-related Implementation Research Advisory Committee (IVIR-AC) meeting, virtual gathering, 1-5 September 2025.

Insights from high and low clinical users of telemedicine: a mixed-methods study of clinician workflows, sentiments, and user experiences.

Challenges in implementing a multidisciplinary integrative oncology intervention for young women with localized breast cancer.

ObjectiveRegular screening can reduce the burden of colorectal cancer (CRC) and general practice involvement has been demonstrated to improve screening uptake and CRC outcomes. Our study explores Australian general practice stakeholders’ current involvement in supporting organised CRC screening through the National Bowel Cancer Screening Program (NBCSP) and their views of the feasibility and applicability of evidence-based intervention components.MethodsA qualitative study was undertaken using focus groups (n = 12) with 45 participants that included General Practitioners (GPs), practice nurses, practice staff and program support staff from across Australia. The Consolidated Framework for Implementation Research (CFIR) was used as a guiding framework for deductive thematic content analysis.ResultsThe findings indicated that proactive GP involvement in the NBCSP is challenged by clinical information system limitations, time constraints, and competing priorities. Participants expressed a willingness to support CRC screening activities, understood the effectiveness of screening, but placed little focus on using the NBCSP as the primary method of CRC screening. An intervention to increase NBCSP participation involving a risk assessment tool, electronic reminder prompt, clinical information system and workflow enhancement, and education was viewed as feasible and applicable to practice if identified implementation challenges in the inner setting and individuals CFIR domains were addressed.ConclusionsGeneral practice stakeholders acknowledge their potential for a more enhanced role in supporting the NBCSP and contributing to reducing the impact of CRC. A multi-component general practice-led intervention to promote an enhanced role was perceived as acceptable. To improve feasibility and applicability, the intervention needs to be integrated, straightforward, time-efficient, and supported by incentives and a whole-of-practice approach.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12875-025-03016-4.

Effectiveness, challenges, and improvement strategies for active tuberculosis case-finding practices by community pharmacy personnel: A scoping review.

BackgroundCommunity-clinical linkage models (CCLM) display significant potential to address the unique, multi-level type 2 diabetes risk factors facing minoritized communities, such as South Asian Americans. However, there lacks a systematic, longitudinal evaluation of how such tailored CCLMs can be better implemented in dynamic, real-world settings. This study aims to leverage multi-partner insights, collected in real time, to explore the barriers and facilitators to implement a South Asian American diabetes management and prevention intervention (the DREAM intervention).MethodsThe DREAM intervention, a two-arm randomized controlled trial, was implemented from 2019–2022; partners involved in its implementation were interviewed annually to understand their experiences of the program. Implementation partners included community health workers (CHWs), participating healthcare providers, community advisory board (CAB) partners, and research staff. The interview guide and subsequent deductive qualitative analysis was informed by the Consolidated Framework for Implementation Research (CFIR).ResultsOverall, 78 interviews were conducted across four waves (2019–2022) with 5 research staff, 8 CHWs, 18 providers/clinic staff, and 12 CAB partners. CHWs adapted intervention characteristics by tailoring curriculum and implementation to patient needs, including personalized goal setting and shifting to remote delivery with COVID-19-related content. At the individual level, participants’ occupations, family dynamics, and technological capacity shaped engagement, while changing social, financial, and health contexts over time required CHWs to continually adjust support. Within the inner setting, partner roles and resource availability fluctuated, yet structured and consistent meetings facilitated communication and problem-solving. Outer setting influences, including shifting government and universities policies and the COVID-19 pandemic, required repeated adaptations, while CAB partnerships expanded community connections and services over time. Process-related findings underscored the evolving role of CHWs and research staff in planning and fidelity, with training shifting toward peer mentorship to build capacity.ConclusionFindings revealed the pivotal role of programmatic adaptability and robust partner engagement in navigating dynamic contexts to support the diabetes needs of minoritized communities. The real-time, longitudinal approach taken for data collection and analysis was crucial in understanding how intervention changes were implemented and experienced, providing a model for similar implementation assessments.Supplementary InformationThe online version contains supplementary material available at 10.1186/s43058-025-00800-2.

Background: There is a pressing need to provide evidence-based treatment for obesity to millions of children. We sought to implement and evaluate the packaged Healthy Weight Clinic (HWC), a primary care-based Family Healthy Weight Program (FHWP) delivering Intensive Health Behavior and Lifestyle Treatment. Methods: We conducted a Type III hybrid effectiveness-implementation study in four health care organizations affiliated with eight primary care clinics. Sites received provider training, technical assistance, and participated in a virtual learning community with quality improvement. Consolidated Framework for Implementation Research (CFIR) and Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) implementation frameworks were used to evaluate implementation via quantitative and qualitative methods. Children with a BMI ≥85th percentile were eligible to participate in the effectiveness trial. A group of 5990 children with a BMI ≥ 95th percentile receiving care at the eight health centers but not participating in the HWC served as the comparison group. Results: The packaged HWC reached 191 children. The HWC was effective in reducing BMI -0.26 (95% confidence interval [CI]: -0.47, -0.04), percentage of the median -1.87 (95% CI: -3.09, -0.64), and %BMIp95 -1.05 (95% CI: -1.97, -0.13) compared with comparisons. Seven of the eight sites were able to adopt all the components of the program except the texting campaign and sustain the program 18 months after training. Qualitative themes contextualized implementation findings, highlighting barriers and facilitators. Conclusions: The HWC is a promising FHWP that can improve health for children with overweight and obesity. The implementation package can facilitate the adoption across diverse primary care settings in the United States.

This study examined human immunodeficiency virus (HIV) -related health literacy and prevention among students at a Southeastern Historical Black College and University (HBCU) using the Integrative Health Literacy Model and the Consolidated Framework for Implementation Research (CFIR). Seven gender-specific focus groups (n = 20) were created between June and October 2023. The discussions explored health and HIV information-seeking behaviors, knowledge, prevention practices, and campus culture. Transcripts were analyzed using the domains of health literacy and CFIR. Participants primarily relied on social media and Google for health information, often passively encountering content rather than actively seeking it. While most have basic knowledge of HIV, misconceptions persist regarding HIV transmission, prevention, and curability. Condom use and testing were endorsed but inconsistently practiced, and knowledge of pre-exposure prophylaxis (PrEP) was minimal. Female groups emphasized relational decision making and negotiation, while male groups raised more factual questions. Campus culture-including gossip, "dirty/clean" narratives, and sexual activity around events like homecoming-shaped both stigma and prevention behaviors. Barriers included comfort concerns regarding condom use, privacy concerns, judgmental staff, and uneven sexual health education before college. The students highlighted the need for private, affordable, and culturally resonant preventive strategies. The CFIR analysis identified opportunities for anonymous and bundled testing, peer-led education based on relationships and pleasure, and co-designed interventions that embed sexual health into campus life. Strengthening media literacy, promoting partner testing, improving awareness of PrEP and Rapid testing improve HIV prevention among HBCU students.

Artificial intelligence holds the potential to enhance the efficiency of clinical research. Yet, like all innovations, its impact is dependent upon target user uptake and adoption. As efforts to leverage artificial intelligence for clinical trial screening become more widespread, it is imperative that implementation science principles be incorporated in both the design and roll-out of user-facing tools. We present and discuss implementation themes considered to be highly relevant by target users of artificial intelligence–enabled clinical trial screening platforms. The identified themes range from design features that optimize usability to collaboration with tool designers to improve transparency and trust. These themes were generally mapped to domains of existing implementation science frameworks such as the Consolidated Framework for Implementation Research. Designers should consider incorporating an implementation science framework early in the development process to not only ensure a user-centered design but to inform how tools are integrated into existing clinical research workflows.

This study examines the implementation of virtual GERAS DANCE in community, hospital, and long-term care (LTC) settings. Using the Consolidated Framework for Implementation Research (CFIR), we conducted surveys and semi-structured interviews. Key CFIR constructs analyzed included innovation characteristics, outer setting, inner setting, individual characteristics, and implementation process. We gathered feedback from 22 healthcare professionals across 11 sites in five practice settings. Virtual GERAS DANCE reached 135 older adults. Implementation was most influenced by innovation characteristics (enjoyable music, socialization, exercise, and evidence-based design) and inner setting factors within participating organizations (cost-effective implementation, experienced staff in virtual programs, and high demand for virtual options). Barriers included technical limitations such as limited Wi-Fi capacity in rural communities. The success of virtual GERAS DANCE was largely driven by its evidence-based design and the organizational readiness for virtual health interventions.

BackgroundNoncommunicable diseases, particularly hypertension, diabetes, hyperlipidemia, and obesity, are on the rise among older adults in Singapore, emphasizing the need for effective screening, monitoring, and educational interventions. The traditional health care model, relying on in-person visits to review patients, poses risks of underreported cases and missed opportunities for early interventions to manage complications. Community-based telemonitoring programs present promising opportunities to extend telehealth services to underserved populations, thereby mitigating the digital divide and addressing health inequalities.ObjectiveThis study aimed to retrospectively evaluate the implementation of a community-based telemonitoring program, the Community Telehealth Service (CTS), developed to reduce digital barriers and raise awareness for regular health screening among older adults in the Singapore community. It also aimed to generate insights for scaling up similar telehealth initiatives in the community.MethodsThis retrospective study used the (1) Implementation Research Logic Model, (2) Reach, Effectiveness, Adoption, Implementation, and Maintenance framework, and the Implementation Outcomes Framework to guide the design and evaluation of CTS’ implementation strategies. Outcomes covered implementation outcomes (reach, adoption, feasibility, and cost), service outcomes (safety and preliminary effectiveness), and user outcomes (satisfaction). Data were collected from operational statistics and structured user feedback surveys across 3 phases of implementation at different community sites.ResultsOver the course of the 3 phases, CTS has reached more than 800 older individuals and 147 health ambassadors, with the participation of community organizations, health care institutions, academic collaborators, corporate sponsors, and government agencies. Operational statistics indicated that CTS was delivered consistently across 3 sites, with improving show-up rates and stable service hours. User feedback was generally positive, citing convenience, perceived value, and appreciation for health ambassador support. However, challenges were noted in referral tracking due to differing workflows across partners and in collecting user feedback, particularly in later phases where the survey was perceived as lengthy and complex for older users. Several areas for improvement were identified, such as incorporating more health assessments, providing more health-related information, and improving the referral process.ConclusionsThis early-stage retrospective study suggests that community-based telehealth programs may be a feasible and acceptable approach to delivering preventive services in community settings. While initial findings are promising, further rigorous research is needed to evaluate long-term outcomes, integration with health systems, and potential for scale-up.

Background Non-communicable diseases (NCDs), particularly hypertension and diabetes, represent a rising public health burden in India, driven by lifestyle changes and complex social determinants. In Karnataka’s Chamarajanagar district, previous research identified a high NCD prevalence alongside systemic gaps in the continuum of care and multisectoral action. The IMPACT NCD project is an implementation research study that aims to strengthen the primary healthcare system's capacity and foster multisectoral collaboration for effective NCD prevention and management. Its primary scientific objective is to conduct a rigorous implementation evaluation. This evaluation examines the causal pathways and contextual factors that influence the success of these real-world interventions to understand what works, for whom, and why. Methodology The study is guided by a theory-driven implementation research design. Interventions, developed using a participatory approach, include two main components: Capacity building and technical support for healthcare workers at Ayushman Arogya Mandirs (AAMs) on NCD screening, follow-up, and the continuum of care. Sensitisation workshops for local elected officials, police personnel, and students in grades 8 to 12. The effectiveness of these strategies will be evaluated using a sequential mixed-methods approach to understand the pathways and mechanisms of change. First, quantitative program data will be analysed using Principal Component Analysis (PCA) and cluster analysis to stratify primary units by performance. Subsequently, a purposive sample of high-performing and low-performing units will be selected for in-depth qualitative analysis through interviews and observations to test and refine the project's Theory of Change. Discussion The project’s strong focus on implementation evaluation is critical. By moving beyond simply measuring outcomes to understanding the underlying processes and contextual factors, the study aims to identify mechanisms that drive implementation success and sustainability mechanisms of change, the study will generate crucial insights into how complex, multisectoral NCD programs can be effectively embedded within existing government systems.

Evaluating the implementation and sustainment potential of a pharmacy-embedded community health worker model.

Barriers and facilitators to implementing pharmacist-driven mobile health clinics: Identification of implementation strategies using the Consolidated Framework for Implementation Research-Expert Recommendations for Implementing Change (CFIR-ERIC) matching tool.