An Analysis of National Institutes of Health-Funded Dissemination and Implementation Research in Low- and Middle-Income Countries.

Abstract

Implementation science can inform healthcare delivery to improve outcomes in resource-constrained settings through tailored strategies. The National Institutes of Health funds implementation science largely through its Dissemination and Implementation Research in Health program. We analyzed the program's grants with collaborators in low- and middle-income countries to understand trends and gaps in National Institutes of Health-funded global implementation science research. Query-View-Report was used to identify grants awarded between fiscal years 2013-2022 with at least one collaborating institution in a low- and middle-income country. Two coders reviewed the abstract and specific aims to determine the intervention being studied, setting, implementer, implementation outcomes, strategies, frameworks, and study design. From fiscal years 2013-2022, 81 grants had collaborating institutions across 25 low- and middle-income countries in five World Bank-defined regions, funded by 11 National Institutes of Health institutes and centers. Most grants focused on cancer (n = 12), other non-communicable diseases (n = 16), and tuberculosis (n = 12). Common implementation outcomes included costs (n = 43), fidelity (n = 38), maintenance (n = 36), and adoption (n = 35). Commonly studied implementation strategies included assess for readiness and identify barriers and facilitators (n = 18), revise professional roles (n = 17), and change service sites (n = 15). Frequently reported frameworks were RE-AIM (n = 30), CFIR (n = 22), and EPIS (n = 8). Most grants tested implementation strategies using experimental study designs (n = 52) in healthcare settings (n = 56). The National Institutes of Health funds a range of implementation science grants with collaborators in low- and middle-income countries. This analysis helps identify commonly utilized implementation outcomes, strategies, and frameworks and enables exploration of gaps and opportunities for further global research.