Implementation Science Research Research Articles

Psycho-social stimulation interventions, recommended in the WHO guidelines for severe acute malnutrition (SAM), have been demonstrated to improve neurodevelopment and growth. However, interventions which have proven effective in clinical trials are resource-intensive and may be challenging in many contexts. This study aimed to explore facilitators, barriers and the existing provision of psycho-social stimulation interventions. We undertook a survey targeting practitioners across the globe who are involved in SAM care and/or programme management. We then undertook 12 semi-structured key informant interviews with practitioners from diverse professional contexts. We transcribed and coded interviews using a deductive approach based on the Consolidated Framework for Implementation Science Research (CFIR). We gained 42 responses from 18 countries for our survey with 29 respondents including psycho-social stimulation interventions in their SAM programmes. Our 12 key informant interviews described several barriers (financial, physical, and human resource limitations, prioritisation of life-saving care, and staff beliefs) as well as some potential facilitators (inclusion in guidelines, enjoyment for staff and parents, and emerging evidence of benefits in terms of short and long-term outcomes). This multi-country mixed methods study revealed that there are very heterogeneous patterns around the implementation of psycho-social interventions in children with SAM. Our study has demonstrated the perceived challenges by professionals involved in SAM care of the feasibility of implementing interventions from research trials. Pragmatic studies are needed which also include an assessment of implementation to enhance an understanding of what might drive uptake. Limitations of our study include a potential respondent bias and small sample size.

Deinstitutionalization spawned numerous psychiatric rehabilitation interventions, but only a small number have endured for decades and spread widely. This article identifies a concise set of 10 criteria to examine ethical, scientific, practical, and policy elements of highly successful interventions. Based on 50 years of psychiatric rehabilitation literature, we examined three exemplary, enduring practices-assertive community treatment, Individual Placement and Support, and Housing First-for evidence related to the 10 common criteria. Psychiatric rehabilitation has had a firm grounding in ethics, client-centeredness, implementation science, and outcomes research. Policy and funding have followed. We identified 10 criteria that incorporate these values: recovery, model clarity, fidelity, effectiveness, enduring effects, cost-effectiveness, feasibility, scalability/sustainability, policy/funding, and adaptability. All three practices are guided by validated fidelity scales, have strong evidence for effectiveness, and are feasible to implement, but they vary on other criteria. In varying degrees, assertive community treatment, Individual Placement and Support, and Housing First are practices meeting most of the 10 criteria in a newly developed framework aimed at broadening the criteria for evaluating psychiatric rehabilitation programs to encompass both scientific and pragmatic, real-world considerations. This framework establishes an objective framework to guide the prioritization of services for people with mental health conditions. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

IntroductionImplementation science research increases the uptake of evidence-based interventions, which may improve health equity among racial and ethnic minorities. However, it is unclear how anti-racism and anti-colonialism practices have been integrated into implementation science research. The objectives of this scoping review are to describe the current conceptualisations of racism and colonialism within the USA, examine racism or colonialism-conscious approaches and analyse gaps in the operationalisation of anti-racism or anti-colonialism within implementation science studies.Methods and analysisThis scoping review will be conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping reviews guidelines. The Center for Chronic Disease Reduction and Equity Promotion Across Minnesota conceptual framework and an implementation science anti-racism lens will guide the study design and analysis. To determine study eligibility for the scoping review, articles will undergo abstract and full-text screening by two independent reviewers and discrepancies will be settled together. Data charting will be extracted from included articles by eight independent reviewers. The search strategy will use controlled vocabulary and natural language keywords related to health equity, health disparities and anti-racism/colonialism on six databases. The scoping review will include studies that applied implementation science theories, models or frameworks among US-based populations. Additionally, included studies will report any of the following implementation activities: implementation strategies, implementation outcomes, adaptations to evidence-based interventions, or evaluations of pre-implementation or implementation context.Ethics and disseminationNo ethical approval was required for the scoping review. Dissemination will be through publication in a peer-reviewed journal and conference presentations.

BackgroundOver the past 30 years, Ethiopia has significantly invested in its primary health care (PHC) system, improving access to health services and overall health outcomes. However, gaps persist in delivering comprehensive reproductive, maternal, newborn, and child health (RMNCH) services. Although Ethiopia’s policy framework supports integrated PHC services, RMNCH programs often operate independently, resulting in fragmented care and missed opportunities, especially in rural and pastoral regions with limited access. This study examined current practices in integrated service delivery and the association between integrated service delivery and the adoption of postpartum family planning (PPFP) and immunization services.MethodsFrom July to August 2024, we conducted formative implementation science research utilizing household surveys and facility assessments. A stratified multistage sampling technique recruited 1,922 women with infants ages 0–11 months across agrarian and pastoral regions, along with data from 67 facilities. The study assessed the association between integrated family planning, maternal and newborn health, and immunization service delivery with postpartum family planning and immunization practices in Ethiopia. Data were analyzed using Stata 15.1, employing Pearson’s chi-square test, post-stratification sampling weights, and random-intercept logistic regression models to estimate associations between individual- and community-level variables and the likelihood of adopting PPFP and child vaccination.ResultsOverall, the availability and integration of essential job aids and services varied considerably by setting, with pastoral areas consistently showing lower coverage across RMNCH touchpoints. Approximately 45% of mothers adopted PPFP, with significant regional variations, particularly lower rates in pastoral areas. About one-third received PPFP counseling during antenatal care contacts, and over three-fourths received immunization counseling during childbirth. Women who received counseling about PPFP during childbirth had 2.6 times higher odds of adoption (AOR: 2.60; 95% CI: 1.61–4.20), while those counseled during both antenatal care (ANC) and childbirth had four times higher odds (AOR: 4.06; 95% CI: 2.49–6.63). Counseling on immunization during or after childbirth increased child vaccination odds threefold (AOR: 3.39; 95% CI: 1.80–6.41), while women who did not receive integrated services during childbirth had 78% lower odds of vaccination (AOR: 0.22; 95% CI: 0.14–0.34). Women in agrarian communities and those receiving postpartum care within six weeks also had higher odds of adopting PPFP and vaccination services.ConclusionsThe study highlights observed associations between service integration and uptake of maternal and child health services, indicating variation across contexts and the importance of considering these patterns in efforts to improve service delivery.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12889-025-24576-1.

460 Background: Oncology guidelines recommend that the time from surgery to post-operative radiotherapy (S-PORT) for head and neck squamous cell carcinomas should not exceed six weeks. However, in the United States, approximately 40% of people do not achieve timely S-PORT; this metric is worse for people living in rural areas. As a preparatory step to develop a multilevel intervention that improves timely S-PORT in rural communities, we engaged in community-engaged research dialogues with patients, caregivers, and staff in two rural cancer clinics to identify barriers and facilitators to timely, adjuvant head and neck cancer treatment in this context. Methods: We used a community-engaged research approach with distinct phases performed at two Cancer Center facilities, one in Lebanon, NH, and one in St. Johnsbury, VT. First, we conducted two facilitated dialogues (Partnership Academies) with patients, caregivers, and multidisciplinary health professionals. These dialogues were recorded, transcribed, and coded with patient and caregiver partners. Informed by the Intervention Mapping conceptual model and the Consolidated Framework for Implementation Science Research, we used an inductive-deductive approach to identify barriers and facilitators. To enhance our understanding of the local context, we conducted three additional dialogues (Community Engagement Studios): two with patients and caregivers, and a third with clinical staff. These dialogues were summarized by their facilitators. We performed member-checking by reviewing the results at an institutional retreat for the Head and Neck Cancer program. Results: In the first phase of dialogues, we had 11 participants with the following roles: patient, caregiver, social worker, dentist, master's student, nurse navigator, psychiatry researcher, cancer center administrators (2), radiation oncologist, and medical oncologist. In the second phase of dialogues, we had 18 participants: 11 patients, 2 caregivers, and 5 staff. We identified five barriers to timely S-PORT: 1) Communication; 2) Care coordination; 3) Access to dental care; 4) Confronting negative emotion; and 5) Transportation. We identified four facilitators: 1) Leveraging preexisting strengths; 2) Rural culture; 3) Caregivers; and 4) Key staff as a central node of contact. Our themes patient and caregiver desires for solutions included: 1) Peer support; 2) Information support beyond the treatment period; 3) Adaptation to the steep learning curve after cancer diagnosis; and 4) Using organizations within their communities. Conclusions: Our study was innovative for its focus on improving S-PORT in the rural setting and methodologically novel by using two community-engaged research techniques in a phased approach. Our findings emphasize the importance of leveraging community resources, enhancing communication, and providing ongoing support to improve care.

IntroductionAdaptations are common, expected, and often imperative for successful uptake and sustained implementation of clinical or public health programs in real-world practice settings. Understanding which adaptations have been made to evidence-based interventions and subsequent implementation strategies throughout the life cycle of a project can contextualize findings and support future scale-up of the program. Systematic documentation of adaptations is rarely conducted or reported, and little guidance exists on approaches to documenting adaptations.MethodsAccelerating Colorectal Cancer Screening and follow-up through Implementation Science (ACCSIS) is a National Cancer Institute-funded Beau Biden Cancer MoonshotSM Initiative developed to improve colorectal cancer screening, follow-up, and referral for care among underserved groups, including diverse racial and ethnic populations and people living in rural areas. Using an iterative data gathering approach—a survey, data abstraction, and data validation—we compiled information about adaptation documentation and analytic methods and intervention and implementation strategy adaptations from the eight funded ACCSIS research programs. An analytic team representing multiple ACCSIS programs reviewed, coded, and summarized the data using a rapid qualitative analytic approach.ResultsACCSIS programs varied substantially in how they defined and documented adaptations. Nine approaches were used to document adaptations; the most common were periodic reflections and review of meeting minutes and agendas. Nine analytic methods were reported to guide adaptation analysis; the most frequently mentioned were rapid qualitative methods, descriptive statistics, and mixed-methods analysis. A total of 96 adaptations were reported by the eight research programs, most of which occurred during the pre-implementation stage (68%) or were made to the program format (71%). Only 36% of the adaptations were due to the COVID-19 pandemic.ConclusionsOur multi-method, systematic approach allowed us to explore how sites document and analyze adaptations across eight ACCSIS Moonshot programs. Using a systematic approach allowed for comparisons of intervention and strategy adaptations within and across research programs and can inform the science of adaptations, while building a knowledge base of why such adaptations are needed and how they can inform implementation efforts across time. Methods described herein provide a template for similar assessment activities in other large, multi-site research initiatives.

BackgroundHIV is more common among underrepresented minority adolescents and young adults (AYA, 13–24 years old) in the United States. Low uptake of HIV prevention services suggests a missed opportunity for implementing evidence-based interventions such as pre-exposure prophylaxis (PrEP) and sexually transmitted infection testing among this important population. Most research institutions in the United States also have limited opportunities for AYA training, mentorship, and capacity-building activities.MethodsThe “Stimulating Training and Access to HIV Research Experiences” (STAR) program brings together a highly qualified group of research mentors to achieve three specific aims: (1) identify and recruit underrepresented minority AYA interested in HIV research for STAR using crowdsourcing; (2) develop implementation science research and project-based design capacity for underrepresented trainees at participating US institutions; and (3) initiate and sustain enduring AYA research capacity through a digital participatory learning community. A three-stage approach is taken to increase the number of racial and ethnic minority trainees that: (1) learn about HIV prevention services; (2) lead the design of HIV prevention services; and (3) launch and evaluate HIV prevention services serving UREM AYAs at participating community sites. Furthermore, we create a Participatory Learning Community (PLC), with virtual opportunities for interaction, mentoring, and sharing of project-based designs so that rapid exchanges can occur and be documented among trainees, faculty, and invited scholars in the field.DiscussionThere is a substantial unmet need for adolescent and young adult (AYA) HIV implementation research training in the United States among underrepresented minority AYAs. STAR seeks to identify highly qualified trainees through open calls, build capacity for youth-led research using designathons and innovation bootcamps, and sustain these benefits through participatory learning communities. These approaches break new ground in HIV training using participatory methods that empower AYAs to become junior leaders while building institutional capacity for AYA HIV research.

Black/Latino men who have sex with men (MSM) in the United States have high rates of undiagnosed HIV infection. To assess whether HIV self-testing increases HIV screening among Black/Latino MSM and how HIV self-testing for Black/Latino MSM compares to White MSM, we analyzed data from a 12-month randomized controlled trial. Participants were randomized to quarterly allocation of: HIV testing reminders (control, no HIV self-tests), home delivery of rapid HIV self-tests (standard HIV self-test), or home delivery with counseling 24 hours after opening tests (eTest). In this secondary analysis, we used Poisson regression models to evaluate HIV testing rates for the different approaches among Black/Latino MSM compared to White MSM. Of a final analytical sample of 713 participants, 353 were White MSM and 360 were Black/Latino MSM. In all approaches, we found no evidence of differences in HIV testing between White MSM and Black/Latino MSM. Predicted probabilities indicated higher testing among Black/Latino MSM assigned to the HIV self-test conditions compared to Black/Latino MSM in the control condition. The probabilities of any HIV testing among Black/Latino MSM in the standard HIV self-test, eTest, and control conditions were 92%, 90%, and 58%, respectively (all p<.05). Results from this randomized controlled trial suggest that Black/Latino MSM use HIV self-tests at high rates and found no evidence that HIV self-test use differs between Black/Latino MSM and White MSM. Implementation science research is needed to increase the availability of HIV self-tests for all MSM, especially underserved populations such as Black/Latino MSM.

Evidence-based public health, as the forefront of modern public health practice, has increasingly important in public health field. However, a significant gap remains between the available evidence and its practical application. Effectively disseminating and implementing evidence-based public health practice in real-world settings has become a key challenge in contemporary public health research. In this context, Implementation Science has emerged as a vital discipline. This paper explores the critical role of Implementation Science in public health, reviews the origins and core components of the Consolidated Framework for Implementation Research (CFIR), and analyzes the current application of CFIR in public health through bibliometric methods. Additionally, it discusses specific examples to further elucidate the steps involved in using the CFIR and its application contexts. The findings indicate that since 2015, research on CFIR in public health has progressively increased, showing a continuous upward trend. CFIR applications mainly address context-specific facilitators, health decision-making, barrier and facilitator identification, and community-based participatory evaluation, predominantly employing qualitative and mixed-methods research. This paper not only reviews and analyzes the current use of CFIR in public health but also provides a detailed discussion on its application. The goal is to offer valuable insights for the development of Implementation Science research within China's public health sector.

BackgroundCommunity-engaged research (CER) leverages knowledge, insights, and expertise of researchers and communities to address complex public health challenges and improve community well-being. CER fosters collaboration throughout all research phases, from problem identification and implementation to evaluation. Artificial Intelligence (AI) could enhance the collaborative process by improving data collection, analysis, insight, and engagement, while preserving research ethics. By integrating AI into CER, researchers could enhance their capacity to work collaboratively with communities, making research more efficient, inclusive, and impactful. However, careful consideration must be given to the ethical and social implications of AI to ensure that it supports the goals of CER. This paper introduces the PRISM-Capabilities model for AI to promote a human-centered approach that emphasizes collaboration, transparency, and inclusivity when using AI within CER.MethodsThe PRISM-Capabilities model for AI includes six components to ensure that ethical concerns are addressed, trust and transparency are maintained, and communities are equipped to use and understand AI technology. This conceptual model is specifically tailored for community-engaged implementation science research, facilitating close collaboration between researchers and community partners to guide the use of AI throughout. This paper also proposes next steps to validate the model using the HEALing Communities Study (HCS), the largest community-engaged research study to date, which aimed to reduce fatal overdose deaths in 67 highly impacted communities in the United States.Case studyThe PRISM-Capabilities model consists of six components: Optimizing engagement of implementers, settings, and recipients; characteristics of intervention implementers, settings, and recipients; equity assessment and risk management; implementation and sustainability infrastructure; external environment; and ethical assessment and evaluation. Although AI was not initially used during the HCS, we highlight how AI will be leveraged to complete post-hoc analyses of each of the six components and validate the PRISM-Capabilities model.ConclusionThe application of AI to CER relies on human-centered principles that prioritize human-AI collaboration, allowing for the operationalization of responsible AI practices. The PRISM-Capabilities model provides a framework to account for the complexities of real-world social science problems and explicitly positions AI tools at bottlenecks experienced with conventional approaches.

Despite efforts to advance universal health coverage (UHC) in different contexts, evidence gaps remain, and implementation science has been underused to address these gaps and determine ‘what works’. The study aimed to establish a research agenda that could guide future research by identifying implementation science research priorities to advance UHC. A three-round modified Delphi study design with a multi-country panel was employed. Initial implementation science research gaps were identified from two scoping reviews conducted by our team, supplemented by 10 papers that we identified through a search of Medline and CINAHL databases. We generated 64 research gaps that were shared with 272 participants in Round I. Round I responses were analysed using descriptive statistics and a cut-off of 75% to move to Round II. Round I qualitative analysis resulted in an additional 15 research gaps and one new topic area. Based on Round I findings, an improved set of research gaps was shared in Round II. Quantitative data in Round II were analysed using the same approach as Round I, using an 85% cut-off point. Open-ended responses were analysed thematically. Round II research gaps were then presented in a virtual workshop. Results from the workshop were analysed using weighted ranking analysis. Round I response rate was 34.9% with 43 research gaps across 12 topic areas. Round II response rate was 77.9% with 42 gaps across 13 topic areas that passed to the virtual workshop. The workshop response rate was 39%. Through this process, the top 10 ranked implementation science research gaps were identified. Identified research gaps are focused on assessing equity in the delivery of health services and financial risk protection interventions. Future research will further contextualise this research agenda with country-level actors.

Despite research and treatment advances in health care, the implementation of research evidence into practice remains a challenge, especially for historically marginalized populations. There have been numerous calls to action to integrate health equity into implementation science frameworks, models, and theories. Yet, progress toward better integration of these approaches has been hampered by the theoretical and aspirational nature of calls to action up to the present time, which poses a challenge as it remains unclear how to specifically move from rhetoric to action. We present three case examples from our work to illustrate how to synergize health equity research and implementation science into our approach to "equity-grounded implementation science" focused on processes and practices located at the intersection of these fields. These three distinct studies focused on reducing mental health inequities in historically marginalized communities, namely, Latino and Black individuals in mainland United States and Puerto Rico. For each study, we describe the study aim, methodology, setting in which activities were carried out, the health equity elements, and the implementation science aspects. We articulate how each study bridged implementation science and health equity research by (a) situating the study activities in community settings; (b) codesigning interventions to ensure their cultural, linguistic, and contextual relevance; and (c) weaving mixed methods and community-engaged approaches to draw community insights. Finally, we illustrate how to address key implementation outcomes in these health equity studies, representing a significant step toward turning rhetoric into actionable solutions for reducing mental health inequities in marginalized communities. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Impact of Adult Congenital Heart Disease Specialists Visits on Emergent Admissions

Currently, prehospital emergency medical care procedures and quality vary among different medical institutions, and there is no effective implementation strategy for improving medical quality. Acute cardiovascular disease imposes major burdens to all involved parties and is associated with high morbidity and mortality. Prehospital care for acute cardiovascular disease requires scientific implementation strategies. The use of implementation science research to explore new strategies may improve the quality of prehospital care and reduce the burden of acute cardiovascular disease. The research design is a stepped-wedge cluster randomized controlled trial. A digital intelligent system has been created previously. Researchers will develop a new implementation strategy based on improving ambulance equipment and integration of the intelligent software systems to drive evidence-based prehospital interventions and will select emergency teams in public hospitals to practice it randomly. Data from the entire emergency treatment process will be collected to analyze the impact of strategies in terms of outcomes tailored according to the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework. To identify possible areas of refinement and examine the feasibility of the research, the first phase will be carried out in five hospitals. This study integrates digital and intelligent technologies with implementation science in the design of a prehospital emergency care strategy on the basis of a literature review and expert recommendations, addressing limitations in previous prehospital emergency care approaches. The digital-intelligent-system-based strategy will undergo iterative optimization according to practical feedback and are expected to facilitate the implementation of evidence-based interventions, thereby improving the quality of patient care. This study was prospectively registered on the Chinese Clinical Trial Registry (ChiCTR2400088833; Version 1.0; Date of registration: 27 August 2024; URL: https://www.chictr.org.cn/ ).

Family presence during resuscitation and invasive procedures emerged as a practice innovation in the early 1980s in response to family needs during critical health care situations. By the 1990s, the American Association of Critical-Care Nurses, along with numerous other organizations, had formally supported this intervention and developed practice alerts, position statements, and other evidence-based guidelines. As the practice spread, researchers stepped up to investigate patient, family, and health care team outcomes. Today, family presence is practiced and studied across the globe. This article describes an empirical “Being There” model of the family presence intervention based on more than 125 pieces of external evidence. Using a logic model framework, it outlines the components of a family presence program, including the situation and priorities, inputs, outputs, outcomes/impact, assumptions, and external factors. This model can be used by units and organizations interested in revitalizing or initiating a family presence program in pediatric or adult emergency, high-acuity, or critical care settings. Program development and evaluation suggestions are offered, as well as recommendations for implementation science research to identify the most effective strategies for helping health care teams adopt and sustain family presence programs to meet patient and family needs in vulnerable health care moments.

Implementation science (IS) has importance in Asia to facilitate effective delivery of evidence-based interventions to bridge disease prevention and management gaps. However, IS research conducted in Asia are slower compared to the Western region. This study aims to assess barriers to conducting IS research in Asia. This study adopted a cross-sectional online survey design. Researchers who had conducted IS research in Asian settings completed a questionnaire which examined socio-demographic characteristics, IS research practices, and yes or no items on the various barriers to conducting IS research. An open-ended question was provided to gather additional barriers. The response rate for this study was 40.1% (113/282). More than half of the participants has PhD level education (68.1%, n = 77), and 46.0% (n = 52) were academic lecturers. The most common barrier to conducting IS research was the lack of funding (86.7%, n = 98) followed by the lack of awareness (59.5%, n = 67), the lack of time (56.6%, n = 64), and the lack of organisational support (48.7%, n = 55). The open-ended responses elicited additional barriers: the lack of commitment and involvement from stakeholders other than researchers, perceived low value of IS research, the lack of scientific rigour as a field, existing knowledge, system and practices challenge, the lack of capacity or training support, and the lack of academic progression indicators. To facilitate the increase of IS research in Asia, more support are needed in terms of availability of funding, capacity building and training in the region, and effective ways to build constructive long-term collaborations with stakeholders.

BackgroundIn the post-pandemic recovery era, addressing moral injury is critical due to high prevalence and impact on mental and occupational health. Interventions that address moral injury in hospital settings are limited. Further, engaging HCWs in any mental health interventions has proven challenging for a variety of reasons and exacerbated by factors such as a rural setting. Implementation science aimed at understanding barriers and facilitators to interventions is needed in order to build and offer interventions that are usable, feasible, acceptable, and effective. The current study aimed to understand such barriers and facilitators to building moral injury interventions for nurses on the medical intensive care unit (MICU).MethodsWe conducted semi-structured qualitative interviews using the Consolidated Framework for Implementation Science Research (CFIR) and Peer and Academic Model of Community Engagement with 25 participants in a rural hospital system, 19 nurses currently working in the MICU and six nurses who left their MICU employment. Interviews were transcribed and analyzed using a thematic analysis approach.ResultsThere were five CFIR domains and 14 associated CFIR constructs that impacted intervention implementation in this population. Barriers included resource costs, skepticism regarding the effectiveness of new resources, lack of support from leaders, concerns that emotions affect professional image, inability to take breaks, and a disconnect between nurses' lived experiences and community perceptions. Facilitators included interventions specifically tailored for the MICU, strengths in teaming and social support among fellow nurses, and a desire for change because of factors such as a high turnover rate. Participants also highlighted a strong motivation to provide the best care possible and a desire to build resilience by supporting each other.ConclusionAnalysis of barriers and facilitators suggests value in improving the opportunities for HCWs to process morally injurious experiences with interventions specific to a particular unit and resources such as peer support and chaplains. There is a demonstrated need for high-level organizational change to address the dynamic needs of our nurses.

Introduction and Objective: Hispanic men have a relatively high prevalence of diabetes but relatively low rates of enrollment and engagement in preventive interventions like the NDPP. This qualitative study aimed to comprehensively explore influences unique to Hispanic men with low engagement in the NDPP, compared to those with high engagement, with the goal of informing strategies to improve their engagement in the program. Methods: Participants were self-identified Hispanic men, aged ≥18 years, at risk for diabetes per electronic medical records at an urban outpatient network, and invited to the NDPP. They completed individual audio-recorded interviews in English and Spanish. Using Nvivo, transcripts were analyzed deductively, informed by the Theoretical Domains Framework, to identify influences on engagement in the NDPP. Codes emerging uniquely among those with low engagement (attendance at &amp;lt;4 NDPP sessions) were identified through consensus. Results: Of 32 Hispanic men interviewed, 15 had low engagement in the NDPP. More of those with low engagement had limited English proficiency and did not complete high school. Three major themes delineated their Capacity, Motivations, and Opportunities for engaging with the NDPP. They expressed limited awareness of their prediabetes diagnosis, felt self-sufficient about enacting lifestyle change, and were skeptical about their diabetes risk and the utility of the NDPP. They also mentioned financial barriers and limited access to the program. Conclusion: Addressing the unique barriers faced by Hispanic men in engaging with the NDPP is critical to reducing diabetes-related inequities and may require tackling knowledge gaps, financial barriers, and perceptions of program relevance before, during, and after enrollment. Future research should explore how to tailor recruitment strategies and program content to Hispanic men’s specific identities, motivations, and challenges. Disclosure C.J. Gonzalez: None. C.N. Perez-Mejia: None. N. Hernandez: None. H. Flaxman: None. C. Stephenson-Hunter: None. E.N. Gil: None. T. Formagini: None. E. Chambers: None. J.S. Gonzalez: None. Funding Robert Wood Johnson Foundation (234326-01); UCSF Research in Implementation Science for Equity Subaward (R25HL126146 Subaward No 13969sc); National Heart, Lung, and Blood Institute (T32HL079891); National Institute of Diabetes and Digestive and Kidney Diseases (3R01DK121896); National Institute of Diabetes and Digestive and Kidney Diseases (3P30DK111022)

BackgroundPre-Exposure Prophylaxis (PrEP) dramatically reduces the likelihood of acquiring human immunodeficiency virus (HIV), yet it remains under-prescribed, particularly for people in communities with high HIV incidence. While implementation science and health services researchers aim to address disparities in care, few interventions have proven effective in doing so. We aimed to identify implementation strategies associated with higher PrEP prescribing rates and pilot test a tailored intervention as a proof-of-concept in a single Veterans Health Administration (VA) facility.MethodsVA clinicians were surveyed using an instrument derived from the Evidence-based Recommendations for Implementing Change taxonomy to assess the use of various strategies for PrEP in fiscal years 2019–2021. Correlational analyses identified the strategies associated with the frequency of PrEP prescribing and semi-structured interviews with personnel from 11 VA medical facilities with high PrEP prescribing refined and manualized these strategies into the Getting to Implementation (GTI)-PrEP playbook. The playbook was subsequently pilot tested in a VA facility with high new HIV diagnosis rates and low PrEP prescribing rates.ResultsThe clinician survey collected 157 responses from 95 unique VA facilities on implementation strategy use. Analysis identified eight strategies significantly associated with PrEP prescribing, including: networking, clinician education, clinical support tools, dashboard utilization, telehealth, pharmacist involvement, direct patient engagement, and enhanced sexual health history taking. In the pilot study, the site completed the GTI-PrEP Playbook with high fidelity and newly implemented seven of the eight strategies, achieving a 363% increase in PrEP prescribing rates among Black Veterans over the one-year period.ConclusionsThis multi-year national evaluation identified a core subset of effective implementation strategies for increasing PrEP prescribing. The process of empirically specifying these strategies and pilot testing them through the GTI-PrEP playbook demonstrates a promising, data-driven approach to improve PrEP prescribing rates and reduce racial disparities in HIV prevention.

Perspective: Infant Feeding Policies among Women Living with HIV in Latin America and the Caribbean: Should They Be Updated?