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The growing burden of mental, neurological and substance use (MNS) disorders in low-resource settings has prompted efforts to integrate mental health into primary health care (PHC). This study evaluated the implementation and outcomes of a large-scale mhGAP training initiative under the Mental Health in Primary Care (MeHPriC) program in Lagos State, Nigeria. A total of 852 PHC workers from 57 facilities completed a 5-day mhGAP training and a 1-day refresher session. Using a pre-post mixed-methods design, we assessed changes in knowledge, stigma, clinical practice and self-efficacy, with follow-up at five months. Quantitative findings revealed significant improvements in knowledge and attitudes, with enhanced clinical practice reported by 69.1% of participants. Supervision, knowledge gains and self-efficacy emerged as predictors of improved practice. Qualitative data, analyzed using the Consolidated Framework for Implementation Research (CFIR), highlighted increased confidence, reduced stigma and the enabling role of supervision and peer support, alongside persistent barriers such as medication stock-outs and limited referral networks. The study offers robust evidence for the effectiveness of task-sharing approaches when supported by contextual adaptation and system-level readiness. The MeHPriC model demonstrates that government-led mhGAP scale-up in PHC is both feasible and impactful, offering a replicable pathway for mental health integration in other LMICs.
The objectives of this study were to study the psychometric properties of the Implementation Drivers Scale (IDS), for the mhGAP programme, both clinical and community; to test its structural validity, and to propose an instrument to accompany the implementation of the mhGAP in similar contexts. For this purpose, a cross-sectional quantitative methodology study was conducted.
Background:
Mental health programmes proposed in low- and middle-income countries to address gaps in care have implementation problems.
Methods:
A cross-sectional quantitative methodology study was conducted. During 2022 and 2023, the instrument was administered to 204 individuals, including primary care professionals (50%), national administrative leaders (19.11%), and community strategy leaders. Three departments of Colombia participated, two with low levels of implementation in mental health programmes and one with high levels of implementation of programmes and services.
Findings:
The Kaiser-Meyer-Olkin factor analysis resulted in 0.861, which indicated the suitability of the data for a factor analysis. Bartlett’s Test of Sphericity had a value of 2480.907 (153 degrees of freedom, p <.001). The exploratory factor analysis explained variance of 66.781%. The four factors proposed in the AIF model (System enablers for implementation, Accessibility of the strategy, Adaptability and acceptability, and Strategy training and supervision) were confirmed, with all items with loadings greater than 0.4. For the entire instrument, a Cronbach’s alpha was 0.907. The IDS could contribute to the monitoring of some components of mhGAP implementation, both clinical and community-based, in low- and middle-income settings through appropriate validation processes.
This article describes the Implementation Science (IS) Scholars Program at the University of Arkansas for Medical Sciences (UAMS). The program’s goal is to translate knowledge, approaches, and methods from IS to front-line clinicians in an academic medical center, thereby supporting its goals as a learning health system and promoting a dynamic workforce of IS-informed change leaders. Initiated in 2020, the program is relatively unique in that it attempts to translate concepts and knowledge from IS to clinicians to improve their skills as implementers and change agents. The program is supported by the Translational Research Institute, the UAMS’ awardee of the Clinical and Translational Science Award Program. The two-year program provides 20% salary coverage, bespoke didactics, and close mentoring on a Scholar-initiated project to improve care in their clinical context. The program has trained four cohorts of Scholars over the program’s initial five years. We describe the program, our evaluation of it thus far, and future plans. The program has contributed to numerous healthcare improvements and served as a gateway to future implementation and other research activities among some Scholars.
The purpose of this study was to document the development of a Community Advisory Board (CAB) to enhance equitable dissemination of research findings within an implementation mapping study to enhance equitable impact of Universal School Meals (USM) through the Designing for Dissemination and Sustainability (D4DS) process.
Methods
The D4DS process comprises 7 key elements to facilitate meaningful dissemination. To accomplish Step 1: Identify Partners, the research team conducted snowball recruitment methods within the local Philadelphia community and with existing connections. To Empathize and Outline the Problem (Step 2) and Understand the Context (Step 3), an interest meeting was held followed by monthly meetings. Our team Confirmed and Co-designed the Product (Step 4) and Developed the Dissemination Plan (Step 5) through collaborative brainstorming sessions. Finally, we started the Iterative Evaluation (Step 6) and Plan for Sustainability (Step 7) by administering a baseline and follow-up survey measuring CAB members’ perceived utility, effectiveness, and sustainability of the board.
Results
The final CAB included 8 members. The co-created dissemination products and plan comprised a 2-page infographic, social media toolkits, and a webinar slide deck, which were disseminated locally by the research team via presentations, websites, and email communication, in spring 2024. Initial findings from baseline and follow-up surveys indicated that CAB members benefited from skill development, compensation, writing credit, and autonomy in dissemination designing.
Conclusions
Sharing power and decision-making enhanced the capacity for local-level dissemination, which is much needed to advance the science of community partnerships.
Evidence-based concussion practices have been codified into legislation, yet implementation has been narrowly evaluated. We examined implementation of concussion practices in Massachusetts high schools and adopted a disproportionality lens to assess the relationship between school sociodemographic and policy implementation and examine whether differences in policy implementation represent systematic disparities consistent with the disproportionality literature.
Methods
A cross-sectional survey was sent to Massachusetts high school nurses (N=304). Responses (n=201; 68.1% response rate) were tallied so that higher scores indicated greater policy implementation. School demographic data were collected using publicly available datasets and were linked to survey responses. Descriptive statistics, correlations, k-means clustering, and groupwise comparisons were conducted.
Results
Policy implementation is varied across schools and is associated with school sociodemographic variables. As percentages of marginalized identities in student population increased, implementation rates decreased. K-means cluster analysis revealed two discrete groups based on policy implementation scores, with significant differences in sociodemographic variables between groups. Schools with low implementation scores had a greater percentage of students who identified as African American/Black and nurses with less experience.
Conclusions
Findings highlight current disparities in the implementation of concussion management policies and support adoption of a disproportionality lens in this sphere.
Task sharing is endorsed as one of the strategies to address the treatment gap in common perinatal mental health conditions. There is a well-established body of evidence on the effectiveness of psychological interventions delivered by nonspecialist health workers (NSHWs); however, there is a dearth of evidence documenting factors determining the feasibility, acceptability and sustainability of integrating and implementing these interventions. This systematic review aims to synthesize the implementation outcomes and implementation process of NSHWs-delivered psychological interventions for the management of perinatal depression and anxiety using Proctor’s implementation science framework outlining eight constructs: feasibility, acceptability, appropriateness, adoption, cost, fidelity, penetration and sustainability. We searched PubMed, Web of Science and Cochrane Center Register of Controlled Trials for studies published in English and between 2000 and 2022 using search terms under five broad categories: (a) “perinatal”; (b) “common mental disorders”; (c) “psychological interventions”; (d) “nonspecialist” and (e) “implementation outcomes.” Secondary publications were also hand-searched for data extraction. Two authors independently reviewed abstracts and full-text articles. Data for included articles were extracted using a standard data extraction sheet. A narrative synthesis of qualitative evidence was conducted. Initial searches identified 885 articles of which full text of 128 articles were screened for eligibility, with 56 studies meeting the inclusion criteria. Out of the eight constructs of Proctor’s framework, “feasibility,” “acceptability,” “appropriateness” and “fidelity” were the most evaluated outcomes. None of the studies reported “penetration” and very few reported “sustainability,” “adoption” or “cost.” None of the studies used any implementation science framework for the study evaluation. Despite the well-established evidence on the effectiveness of psychosocial interventions for perinatal depression and anxiety by NSHWs, these interventions are rarely adopted into the health system. More studies applying systems thinking are needed to explore facilitators, barriers and mechanisms for integrating interventions in the health system. Using implementation science frameworks to design, plan, execute and evaluate psychosocial interventions by NSHWs can address this gap in evidence.
Community-engaged research is essential to advance the implementation of evidence-based practices, but engagement quality is rarely assessed. We evaluated community health centers’ (CHCs) experiences partnering with the Implementation Science Center for Cancer Control Equity (ISCCCE) using an online survey of 59 CHC staff. Of 38 respondents (64.4% response rate), most perceived their engagement positively, with over 92% feeling respected by ISCCCE collaborators and perceiving projects as beneficial. Limited staff time and resources were the main challenges identified. This study suggests the utility of gathering feedback to evaluate community research engagement and inform adaptations of research processes to optimize partnership quality.
To date, the NIH Helping to End Addiction Long-term (HEAL) Initiative has funded over 1,000 projects that aim to identify new therapeutic targets for pain and substance use disorder (SUD), develop nonpharmacological strategies for pain management, and improve overdose and addiction treatment across settings. This study conducted a portfolio analysis of HEAL’s research to assess opportunities to advance translation and implementation.
Methods:
HEAL projects (FY 2018–2022) were classified into early (T0–T1) and later (T2–T4) translational stages. Eleven coders used a 54-item data collection tool based on the Consolidated Framework for Implementation Research (CFIR) to extract project characteristics (e.g., population, research setting) relevant to translation and implementation. Descriptive statistics and visualization techniques were employed to analyze and map aggregate characteristics onto CFIR’s domains (e.g., outer setting).
Results:
HEAL’s portfolio comprised 923 projects (33.7% T0–T1; 67.3% T2–T4), ranging from basic science (27.1%) and preclinical research (21.4%) to clinical (36.8%), implementation (27.1%), and dissemination research (13.1%). Most projects primarily addressed either addiction (46.3%) or pain (37.4%). Implementation-related gaps included the underrepresentation of certain populations (e.g., sexual/gender minorities: 0.5%). T0–T1 projects occurred primarily in laboratory settings (35.1%), while T2–T4 projects were concentrated in healthcare settings (e.g., hospitals: 21.6%) with limited transferability to other contexts (e.g., community: 12.9%).
Conclusion:
Opportunities to advance translational and implementation efforts include fostering interdisciplinary collaboration, prioritizing underserved populations, engaging with community leaders and policy stakeholders, and targeting evidence-based practices in nonclinical settings. Ongoing analyses can guide strategic investments to maximize HEAL’s impact on substance use and pain crises.
Translational science and implementation science are two disciplines that integrate scientific findings into practice within healthcare. One method to assess the integration of these fields is to review the academic crossover between the disciplines with respect to shared citations in the peer-reviewed literature.
Methods:
This paper used direct citation network analysis to identify potential conceptual gaps and connections between the literature in implementation science and translational science. Bibliographic references were downloaded from Web of Science to create directed citation network maps in VosViewer. Heat maps visualized the top cited literature in each field.
Results:
A literature search yielded 6,111 publications in translational science and 7,003 publications in implementation science. When all publications were combined in a directed citation network map, two separate groups of publications emerged, representing the two fields of implementation science and translational science. When the top 50 cited translational science publications were combined with implementation science publications, 14% had a 100%+ increase in citation links, 44% had a mean increase of 2.4%, and 42% shared no links. When the top 50 cited implementation science publications were combined with translational science publications, 2% had a 100%+ increase in citation links, 92% had a 3.3% mean increase, and 6% had no shared links.
Conclusions:
Results suggest moderate academic overlap in the way published authors cite each other between translational science and implementation science. We hope the implications of this paper may promote continued collaborations between these fields to disseminate lessons learned and bridge research into practice more efficiently.
The Institute for Implementation Science Scholars (IS-2) is a dissemination and implementation (D&I) science training and mentoring program. A key component of IS-2 is collaborating and networking. To build knowledge on effective networking and mentoring, this study sought to 1) conduct a social network analysis to determine whether underrepresented scholars have equivalent levels of connection and 2) gain insights into the differences in networking among racial/ethnic subgroups of scholars.
Methods:
Social network survey data were used to select participants based on number of collaborative connections (highest, lowest) and racial/ ethnic category (underrepresented, not underrepresented). Interviews were recorded, transcribed, and coded using an iterative process.
Results:
The sample consisted of eight highly networked scholars, eight less networked scholars, seven from underrepresented racial and ethnic groups, and nine from not underrepresented groups. Qualitative data showed a lack of connection, reluctance to network, and systematic issues including institutional biases as possible drivers of group differences. In addition, scholars provided suggestions on how to overcome barriers to networking and provided insights into how IS-2 has impacted their D&I research and knowledge.
Conclusions:
Underrepresented scholars have fewer network contacts than not underrepresented scholars in the IS-2 training program. It is imperative for leadership to be intentional with mentorship pairing, especially for underrepresented scholars. Future research might include interviews with program leaders to understand how network pairings are built to improve the mentorship experience.
Team Methods to Advance Processes and Performance in Science (TeamMAPPS) is an evidence-based Team Science competency model and intervention. TeamMAPPS was developed by experts in the Science of Team Science with translational teams in mind. TeamMAPPS focuses on three core teamwork competencies: (1) psychological safety, (2) awareness and exchange, and (3) self-correction and adaptation. In 2023, the TeamMAPPS framework was operationalized into five online training modules that can be used to train whole teams or individuals, with or without facilitation, in any order. This article reports formative findings from the pre-implementation stage of the TeamMAPPS Dissemination and Implementation (D&I) study.
Methods:
We conducted 27 interviews and participant-observation fieldwork with 23 individuals involved in the conceptualization, design, or implementation of TeamMAPPS (four were interviewed twice). All implementers were affiliated with a Clinical and Translational Science Award (CTSA) hub. Data were collected during pre-implementation, when modules were being tested and early-stage implementers were being trained. We used D&I theories and frameworks to structure the study, analyze interview data, and recommend implementation strategies.
Findings:
“Adoption,” “reach,” and “effectiveness” emerged as key implementation outcomes. TeamMAPPS was perceived to be evidence-based, highly adaptable, and a Team Science intervention offering unique benefits. We draw on participants’ responses and expert recommendations to suggest implementation strategies.
Conclusions:
CTSAs and other organizations can use varied strategies to implement TeamMAPPS. The flexibility of the intervention and its rootedness in an evidence-base synthesized by Team Science leaders make TeamMAPPS appealing for CTSAs seeking to enhance their team training offerings.
Dissemination and implementation (D&I) scientists are key members of collaborative, interdisciplinary clinical and translational research teams. Yet, early career D&I researchers (ECRs) have few guidelines for cultivating productive research collaborations. We developed recommendations for ECRs in D&I when serving as collaborators or co-investigators.
Methods:
We employed a consensus-building approach: (1) group discussions to identify 3 areas of interest: “Marketing yourself” (describing your value to non-D&I collaborators), “Collaboration considerations” (contributions during proposal development), and “Responsibilities following project initiation” (defining your role throughout projects); (2) first survey and focus groups to iteratively rank/refine sub-domains within each area; (3) second survey and expert input on clarity/content of sub-domains; and (4) iterative development of key recommendations.
Results:
Forty-four D&I researchers completed the first survey, 12 of whom attended one of three focus groups. Twenty-nine D&I researchers completed the second survey (n = 29) and 10 experts provided input. We identified 25 recommendations. Findings suggest unique collaboration strengths (e.g, partnership-building) and challenges (e.g., unclear link to career milestones) for ECR D&I researchers, and underscore the value of ongoing training and mentorship for ECRs and the need to intersect collaborative D&I efforts with health equity principles.
Conclusions:
Research collaborations are essential in clinical and translational research. We identified recommendations for D&I ECRs to be productive research collaborators, including training and support needs for the field. Findings suggest an opportunity to examine research collaboration needs among early career D&I scientists, and provide guidance on how to successfully provide mentorship and integrate health equity principles into collaborative research.
The Implementation Science Centers in Cancer Control (ISC3) initiative, funded by the National Cancer Institute, called for the development of implementation laboratories to bolster implementation science, create research-ready environments, and expedite adoption and implementation of evidence-based interventions (EBIs) into practice. The Building Research in Implementation and Dissemination to close Gaps and achieve Equity in Cancer Control (BRIDGE-C2) Center is one of seven ISC3 centers. BRIDGE-C2 aims to identify strategies to improve implementation of cancer prevention EBIs and conduct research / develop pragmatic methods to tailor, enhance, and support the adoption and sustainability of these strategies; advance implementation science; and build capacity and training opportunities. Since its inception, the BRIDGE-C2 Center has been conducting research and training activities to advance knowledge on how to effectively implement strategies to improve cancer prevention EBIs in primary care clinics serving socioeconomically disadvantaged patients. The translational science benefits model (TSBM) provides a useful framework for organizing a description of the BRIDGE-C2 Center’s activities. In this paper, we describe examples of BRIDGE-C2 activities and the specific impact indicators within each relevant domain/subdomain of the TSBM, demonstrating that a single activity or project has multiple impacts on methods and capacity building, clinical domains, and community health.
The continued momentum toward equity-based, patient/community-engaged research (P/CenR) is pushing health sciences to embrace principles of community-based participatory research. Much of this progress has hinged on individual patient/community–academic partnered research projects and partnerships with minimal institutional support from their academic health institutions.
Methods
We partnered with three academic health institutions and used mixed methods (i.e., institution-wide survey (n = 99); qualitative interviews with institutional leadership (n = 11); and focus group discussions (6 focus groups with patients and community members (n = 22); and researchers and research staff (n = 9)) to gain a deeper understanding of the institutional context.
Results
Five key themes emerged that were supported by quantitative data. First, the global pandemic and national events highlighting social injustices sparked a focus on health equity in academic institutions; however, (theme 2) such a focus did not always translate to support for P/CenR nor align with institutional reputation. Only 52% of academics and 79% of community partners believed that the institution is acting on the commitment to health equity (Χ2 = 6.466, p < 0.05). Third, institutional structures created power imbalances and community mistrust which were identified as key barriers to P/CenR. Fourth, participants reported that institutional resources and investments are necessary for recruitment and retention of community-engaged researchers. Finally, despite challenges, participants were motivated to transform current paradigms of research and noted that accountability, communication, and training were key facilitators.
Conclusions
Triangulating findings from this mixed-methods study revealed critical barriers which provide important targets for interventions to improving supportive policies and practices toward equity-based P/CenR.
In this chapter, we will discuss the critical features of effective prevention practices. These include (a) using data to inform prevention efforts, (b) using a problem-solving approach to identify the problem to be prevented and the steps needed for effective implementation, (c) monitoring fidelity to prevention practices, and (d) using data to determine if prevention practices are working and for whom. In addition, we discuss the need for collaborative relationships and using culturally responsive practices when determining and implementing prevention efforts. We provide school-based prevention examples to add context. Implications for practice are discussed. The science behind prevention, including the evidence of prevention interventions and the importance of implementation in the overall process of prevention efforts, is reviewed, grounding the reader in how to be a prevention scientist and practitioner.
Adrenal vein sampling (AVS) is a complicated procedure requiring clinical expertise, collaboration, and patient involvement to ensure it occurs successfully. Implementation science offers unique insights into the barriers and enablers of service delivery of AVS. The primary aim of this review was to identify implementation components as described within clinical studies, that contribute to a successful AVS procedure. The secondary aim was to inform practice considerations to support the scale-up of AVS. A scoping review of clinical papers that discussed factors contributing to effective AVS implementation was included. A phased approach was employed to extract implementation science data from clinical studies. Implementation strategies were named and defined, allowing for implementation learnings to be synthesized, in the absence of dedicated research examining implementation process and findings only. Ten implementation components reported as contributing to a successful AVS procedure were identified. These components were categorized according to actions required pre-AVS, during AVS, and post-AVS. Using an implementation science approach, the findings of this review and analysis provide practical considerations to facilitate AVS service delivery design. Extracting implementation science information from clinical research has provided a mechanism that accelerates the translation of evidence into practice where implementation research is not yet available.
There is increasing pressure on the federal research budget and shifting public opinions about the value of the academic enterprise. We must develop and apply metrics that demonstrate the broad benefits of research for health and society. The Translational Science Benefits Model (TSBM) measures the impact of large-scale translational science initiatives, such as the National Cancer Institute’s Cancer Moonshot. TSBM provides the scaffolding to illustrate how science has real-world health impacts. We propose an expansion of the TSBM to explicitly include implementation-focused outcomes.
Methods:
TSBM includes four categories of benefits, including (1) clinical and medical, (2) community and public health, (3) economic, and (4) policy and legislative. Implementation science outcomes serve as a precursor to the model’s established domains of impact and can help to sharpen focus on the translational steps needed to achieve a broad range of impacts. We provide several examples of studies that illustrate these implementation outcomes and other clinical and community benefits.
Conclusions:
It is important to consider a broad range of scientific impacts and the conditions that are necessary to achieve them. The expansion of the TSBM to include implementation science outcomes may help to accelerate the cancer community’s ability to achieve the goal of preventing 4 million cancer deaths by 2047.
The Centers for Disease Control and Prevention (CDC)-funded Cancer Prevention and Control Research Network (CPCRN) has been a leader in cancer-related dissemination & implementation (D&I) science. Given increased demand for D&I research, the CPCRN Scholars Program launched in 2021 to expand the number of practitioners, researchers, and trainees proficient in cancer D&I science methods.
Methods:
The evaluation was informed by a logic model and data collected through electronic surveys. Through an application process (baseline survey), we assessed scholars’ competencies in D&I science domains/subdomains, collected demographic data, and asked scholars to share proposed project ideas. We distributed an exit survey one month after program completion to assess scholars’ experience and engagement with the program and changes in D&I competencies. A follow-up survey was administered to alumni nine months post-program to measure their continued network engagement, accomplishments, and skills.
Results:
Three cohorts completed the program, consisting of 20, 17, and 25 scholars in Years 1-3, respectively. There was a significant increase in the total D&I competency scores for all three cohorts for 4 overarching domains and 43 subdomains (MPre = 1.38 MPost = 1.89). Differences were greatest for the domain of Practice-Based Considerations (0.50 mean difference) and Theory & Analysis (0.47 mean difference). Alumni surveys revealed that scholars appreciated access to D&I-focused webinars, toolkits, and training resources. 80% remain engaged with CPCRN workgroups and investigators.
Conclusions:
Program evaluation with scholars and alumni helped with ongoing quality assurance, introspection, and iterative program adaptation to meet scholars’ needs. This approach is recommended for large-scale capacity-building training programs.
The dissemination and implementation (D&I) of evidence at the community level is critical to improve health and advance health equity. Social networks are considered essential to D&I efforts, but there lacks clarity regarding how best to study and leverage networks. We examined networks in community-level D&I frameworks to characterize the range of network actors, activities, and change approaches. We conducted a narrative review of 66 frameworks. Among frameworks that explicitly addressed networks – that is, elaborated on network characteristics, structure, and/or activities – we extracted and synthesized network concepts using descriptive statistics and narrative summaries. A total of 24 (36%) frameworks explicitly addressed networks. Commonly included actors were implementers, adopters/decision-makers, innovation developers, implementation support professionals, and innovation recipients. Network activities included the exchange of resources, knowledge, trust, and norms. Most network-explicit frameworks characterized ties within and across organizations and considered element(s) of network structure – for example, size, centrality, and density. The most common network change strategy was identifying individuals to champion D&I efforts. We discuss opportunities to expand network inquiry in D&I science, including understanding networks as implementation determinants, leveraging network change approaches as implementation strategies, and exploring network change as an implementation outcome.