Global implementation research and applications最新文献

Community-based diabetes prevention and control programs are effective but limited in West Africa. We assess adoption and effectiveness of a contextually adapted Diabetes Prevention Program "Power to Prevent" (DPP-P2P) in Bamako, Mali. Guided by implementation science principles, we adapted the DPP-P2P to align with Malian culture, integrating dietary and exercise modifications. Local audiovisuals and photo guides were created for healthy food preparation and exercises. Six community health centers with high diabetes rates were randomly assigned to intervention or comparison, and 429 individuals (≥ 25 years old with diabetes, hypertension, or obesity) consented to participate (intervention = 282; control = 147). Diabetes peer educators facilitated 14 bi-weekly sessions over six months. We assessed Hemoglobin A1c (HbA1c) and blood pressure and surveyed 15 key healthy lifestyle behaviors pre-and post-intervention. Retention was 77.1%, and groups especially liked the role plays, African audio-visuals, peer educator success stories, and demonstrations. In the intervention group, individuals wanting to weigh less increased from 31.5 to 58.9% (p < 0.001), exercise days rose from 3.5 to 5.6 (p < 0.001), and the desire for a healthier diet rose by 0.64 points. Average HbA1c in the intervention group dropped from 6.5% to 5.4% (p = 0.001). The intervention increased the odds of lowering blood glucose below 6.5% by 2.31 times (p = 0.020) and blood pressure below the hypertension threshold by 2.67 times (p = 0.060). The Malian-adapted DPP-P2P was well accepted by the community, increasing the adoption of healthy behaviors and reducing blood glucose and hypertension. This program could benefit Mali and Sahelian countries in tackling diabetes and hypertension.

Trial registration: ClinicalTrials.gov #NCT05260879. Registered 6 December 2021-Retrospectively registered (registration link: https://clinicaltrials.gov/study/NCT05260879).

Strong measurement is critical for carrying out, monitoring, and evaluating implementation practice efforts. Accurate, reliable, and practical measures empower implementation teams to evaluate implementation outcomes and mechanisms of change. Poor measurement, however, is costly and impedes implementation practice. Despite substantial efforts to catalog and evaluate implementation measures, resources that guide the selection of measures are limited. As a result, practitioners still face challenges when identifying and selecting appropriate implementation measures. This paper addresses this gap by presenting a Measurement Roadmap, which offers a step-by-step guide and set of resources to help practitioners engage with the process of finding and evaluating measures for their implementation project. The Measurement Roadmap begins by detailing the importance of connecting measurement with implementation theories, models, and frameworks. Subsequently, recommendations for where and how to find measures are provided. The Measurement Roadmap provides practical explanations of psychometric properties and guides readers through a simple, three-step process for evaluating the face validity of a measure. Finally, the Measurement Roadmap provides guidance for navigating several possible paths that our team has traversed when identifying and selecting implementation measures: (1) finding an ideal measure, (2) finding a similar, but not perfectly aligned measure, (3) finding several measures that must be compared, and (4) finding no existing measures. We include a practitioner-focused handout of the Measurement Roadmap for quick reference.

Background: HIV clinicians and program implementers in Nigeria have limited implementation research training opportunities. We developed a virtual implementation research training program (iTRAIN) for clinicians and HIV program staff implementing the Intensive Combination Approach to Roll Back the Epidemic in Nigerian Adolescents (iCARE Nigeria) study.

Methods: iTRAIN was developed and facilitated by iCARE Nigeria investigators from Nigeria and the United States with extensive implementation research experience. The nine-session online course covered core principles of implementation research. incorporating developing a relevant concept note embedded into iCARE. Between September 2021-2022, content was delivered through asynchronous pre-recorded lectures and readings, followed by facilitator-led synchronous sessions. All six study site teams were assigned a course facilitator for mentoring to develop implementation research proposals nested in the iCARE study. We conducted pre- and post-training surveys to evaluate iTRAIN using the Kirkpatrick Framework and conducted analysis using explanatory mixed methods.

Findings: We enrolled 42 participants (55% male, 48% clinicians), with 50% of enrollees reporting no IR experience. Completion rate was 95%; 79% of participants rated the course overall as "excellent", and 79% reported that their goal of gaining implementation research knowledge were met "a lot". IR knowledge increased "a lot" in 71%, and 97% would "probably or definitely" use their iTRAIN knowledge in future research. All six sites developed implementation research concept notes addressing topics relevant to iCARE Nigeria, with four implemented.

Conclusion: iTRAIN represents a successful embedded implementation research virtual training and mentoring program which resulted in increased participant knowledge and capacity. Our training model can serve as a blueprint for study-embedded implementation research capacity-building in Nigeria and similar settings.

Supplementary information: The online version contains supplementary material available at 10.1007/s43477-025-00152-y.

Cognitive Stimulation Therapy (CST) is a group psychosocial intervention for people with mild-to-moderate dementia. Despite evidence supporting its effectiveness, cost-effectiveness, and cultural adaptation internationally, CST has yet to be implemented in routine practice outside of the UK. This study consisted of multiple phases. In the first phase, we engaged stakeholders to explore the barriers and facilitators to CST implementation in Tanzania. In the second phase, we developed implementation strategies. In the third phase, we tested these strategies in a study of CST in a tertiary hospital in northern Tanzania. The Consolidated Framework for Implementation Research (CFIR) guided the study. We conducted stakeholder engagement with decision-makers, healthcare professionals, people with dementia and their family caregivers (n = 49) to identify barriers and facilitators to implementation. We developed an implementation plan that included 20 implementation strategies related to 12 CFIR constructs. Subsequently, we tested these strategies by running eight CST groups with 49 participants. In follow-up interviews with people with dementia, carers and healthcare professionals, we identified 18 key CFIR constructs as barriers or facilitators to successfully implementing CST. CST was compatible with the standards of care in a tertiary referral hospital in northern Tanzania. To implement CST in low-resource settings, we recommend running dementia awareness initiatives, screening for dementia in outpatients and community settings, developing a train-the-trainer model, employing a task-shifting approach, and creating a dementia-friendly space for dementia services. Our findings can inform future efforts to implement CST and other psychosocial interventions for dementia in low-resource settings.

Supplementary information: The online version contains supplementary material available at 10.1007/s43477-024-00142-6.

Facilitation is an important, but complex strategy for implementing evidence into practice. It involves one or more individuals from within or outside an organisation taking on the role of a facilitator who enables change, provides support and problem-solves. It is often embedded or combined with multiple strategies making it challenging to study. Our objective in this qualitative follow-up study was to unpack the facilitation component of a complex implementation strategy for implementing mental health recovery guidelines for transforming services and systems called Walk the Talk toolkit. All the materials in the online toolkit are designed for facilitators to: (1) Establish an implementation team, (2) Conduct a 12-meeting planning process for implementing a recovery-oriented innovation and (3) Provide ongoing implementation coaching. We recruited 8 facilitators (researchers) and 32 Implementation Team members who had participated in the research project in which the toolkit was created and used for the first time. They participated in a semi-structured interview exploring their perspectives on facilitation. Interviews were analysed thematically. Findings emerged around three overarching themes: (1) Shifts in facilitation approaches, roles and intensity over the course of three toolkit stages, (2) Facilitator skills and attributes, such as relationship-building, simplifying implementation science concepts, and asserting equity, and (3) Facilitation challenges, which included reaching systematically excluded groups, recruiting and retaining service users and family members, confronting issues around facilitator background, and negotiating interpersonal tensions. We unpack the "black box" of facilitation and discuss the significance of deploying recovery as a shared language and vision.

Supplementary information: The online version contains supplementary material available at 10.1007/s43477-025-00170-w.

Early childhood caries affects many children, posing risks to dental and overall health. Fluoride varnish application during pediatric well-child visits has demonstrated efficacy in mitigating decay, yet rates remain notably low among medical providers. This study delves into the details of fluoride varnish adoption and delivery in pediatric practices and identifies associated barriers and facilitators by employing the updated Consolidated Framework for Implementation Research. Semi-structured interviews were the primary research method, involving participants from diverse roles within medical practices in Georgia that had previously implemented fluoride varnish application. Interviews covered aspects such as the participant's role, background in fluoride varnish application, understanding of evidence supporting fluoride varnish, factors influencing the process, and the impact on their practice. The partnerships and connections that introduced providers to fluoride varnish application and their knowledge of the evidence base led to its adoption in medical practices. Integration of fluoride varnish application into electronic health records, the motivation providers felt from understanding the patient needs related to oral health, and strategies for engaging patients served as important facilitators. Important barriers encompassed the low relative priority of fluoride varnish application compared to other demands during well-child visits, parent beliefs, and patient resistance. This study details important barriers and facilitators to initial adoption and consistent delivery of fluoride varnish application in primary care well-child visits. In practices not currently offering fluoride varnish, findings may guide and facilitate adoption, while in practices offering fluoride varnish, findings may help optimize delivery and further integration of the innovation into workflows.

Supplementary information: The online version contains supplementary material available at 10.1007/s43477-025-00160-y.

Implementation is an inherently collaborative and transdisciplinary activity; however, engaging key partners across research, practice, and policy sectors is challenging. Successful implementation requires supportive infrastructure for both research and practice. This paper presents practice-based reflections on the value of exploratory social network analysis during the early phases of developing implementation infrastructure in Alberta, Canada. Specifically, we argue that exploratory social network analysis, when paired with follow-up qualitative interviews, can help identify local implementation science assets, inform network-building, and promote implementation support services to target users. Exploratory social network analysis helped our team identify key implementation researchers and implementation support practitioners in Alberta's health-research ecosystem. The analysis also showed that implementation research in the province of Alberta follows a consultation model, with one-way assistance requests, while implementation practice is more collaborative in nature. The follow-up interviews provided an opportunity to engage with teams across the networks and allowed participants to contextualize the social network analysis findings. This uncovered: (1) widespread need for implementation science capacity-building, and (2) key implementation partnership considerations. These results illustrate how organizations can employ social network analysis in practical ways to inform implementation infrastructure development.

Supplementary information: The online version contains supplementary material available at 10.1007/s43477-025-00180-8.

Longstanding structural barriers to Pap smear-based cervical cancer screening and treatment have existed in Peru for decades. The objective of this study was to understand healthcare providers' perspectives regarding the facilitators of and barriers to the now former Pap/Visual Inspection with Acetic Acid-based cervical cancer prevention program in Iquitos, Peru, to inform the transition to the human papillomavirus (HPV) molecular testing-based screen-and-treat intervention to increase screening and completion of care. We used constructs from the Consolidated Framework for Implementation Research's Inner Setting domain to understand the strengths and failures of the former system and leverage this knowledge to enhance the new HPV-based intervention's implementation. We conducted 19 semi-structured interviews with health professionals (12 nurse-midwives, 4 doctors, and 3 laboratory technicians) who administered the former Pap smear-based cervical cancer early detection and treatment program. Providers identified information gaps between the primary level of care, where cervical cancer screening occurs, and the hospital level of care, where diagnosis and treatment occurs. These gaps, caused in part by fragmented and overlapping data systems that do not connect with one another, as well as by healthcare professionals tending to concentrate solely on their own specific role, rather than recognizing the importance of all components working cohesively to facilitate completion of the continuum of care, resulted in the loss of patients between levels of care. Participants also noted a lack of trained personnel and basic materials. Some providers found their way around these gaps by facilitating informal information exchanges among providers to ensure women were not lost to follow-up. Proyecto Precáncer leveraged these findings by collaborating with stakeholders to map the former system, reach stakeholder consensus on system inefficiencies, and design an intervention that improved system efficiencies through a patient-centered approach.

Supplementary information: The online version contains supplementary material available at 10.1007/s43477-025-00164-8.

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.

Brazil's Criança Feliz Program is one of the largest early childhood development home-visiting programs globally. After seven years of scaling up, implementation barriers across diverse municipality settings prevented the program from achieving the intended impact on parenting skills and child development. We conducted a program impact pathway analysis to generate a blueprint to enhance implementation quality by (1) identifying the critical quality control points that need to be monitored throughout the scaling up and (2) specifying implementation strategies for enhancing implementation quality. The program impact pathway analysis consisted of inductive and deductive coding of pre-existing retrospective (e.g. reports, and codebooks from in-depth interviews) and workshop with national team to identify the critical quality control points and corresponding implementation barriers and facilitators. The Expert Recommendations for Implementation Change taxonomy was used to specify implementation strategies facilitating the scaling up or opportunities to address barriers across critical quality control points. We identified seven critical quality control points: hiring municipal workforce; staff training; home visits; complementary multisectoral actions; municipal supervision; technical assistance and monitoring; and funding. Implementation strategies facilitating the scale-up were "providing assistance" and "supporting teams;" opportunities for enhancing implementation quality were "financial strategies" and "evaluative and iterative strategies." Our analysis identified seven critical quality control points necessary to achieve the intended implementation and program outcomes. The combined use of the program impact pathway and the Expert Recommendations for Implementation Change taxonomy generated a meaningful blueprint of implementation strategies to enhance implementation quality, which may support the sustainability of a large-scale program.

Supplementary information: The online version contains supplementary material available at 10.1007/s43477-024-00141-7.