scholarly journals Implementation Science in Nutrition: Concepts and Frameworks for an Emerging Field of Science and Practice

2018 ◽  
Vol 3 (3) ◽  
Author(s):  
Alison Tumilowicz ◽  
Marie T Ruel ◽  
Gretel Pelto ◽  
David Pelletier ◽  
Eva C Monterrosa ◽  
...  
Keyword(s):  
Implementation Science ◽  
Program Implementation ◽  
Implementation Research ◽  
Scale Up ◽  
Implementation Process ◽  
Implementation Quality ◽  
Wide Range ◽  
Intervention Policy ◽  
Culture Of Inquiry ◽  
National Governments

AbstractMalnutrition in all its forms has risen on global and national agendas in recent years because of the recognition of its magnitude and its consequences for a wide range of human, social, and economic outcomes. Although the WHO, national governments, and other organizations have endorsed targets and identified appropriate policies, programs, and interventions, a major challenge lies in implementing these with the scale and quality needed to achieve population impact. This paper presents an approach to implementation science in nutrition (ISN) that builds upon concepts developed in other policy domains and addresses critical gaps in linking knowledge to effective action. ISN is defined here as an interdisciplinary body of theory, knowledge, frameworks, tools, and approaches whose purpose is to strengthen implementation quality and impact. It includes a wide range of methods and approaches to identify and address implementation bottlenecks; means to identify, evaluate, and scale up implementation innovations; and strategies to enhance the utilization of existing knowledge, tools, and frameworks based on the evolving science of implementation. The ISN framework recognizes that quality implementation requires alignment across 5 domains: the intervention, policy, or innovation being implemented; the implementing organization(s); the enabling environment of policies and stakeholders; the individuals, households, and communities of interest; and the strategies and decision processes used at various stages of the implementation process. The success of aligning these domains through implementation research requires a culture of inquiry, evaluation, learning, and response among program implementers; an action-oriented mission among the research partners; continuity of funding for implementation research; and resolving inherent tensions between program implementation and research. The Society for Implementation Science in Nutrition is a recently established membership society to advance the science and practice of nutrition implementation at various scales and in varied contexts.

scholarly journals Evaluation of the Implementation Process of the Mobile Health Platform ‘WelTel’ in Six Sites in East Africa and Canada Using the Modified Consolidated Framework for Implementation Research (mCFIR)

2020 ◽  
Author(s):  
Samia El Joueidi ◽  
Kevin Bardosh ◽  
Richard Musoke ◽  
Binyam Tilahun ◽  
Maryam Abo Moslim ◽  
...  
Keyword(s):  
Implementation Research ◽  
Digital Health ◽  
Descriptive Analysis ◽  
Scale Up ◽  
Implementation Process ◽  
Evidence Based ◽  
Structured Interviews ◽  
User Friendliness ◽  
Domain 3 ◽  
And Performance

Abstract Background: Health systems globally are investing in integrating secure messaging platforms for virtual care in clinical practice. Implementation science is essential for adoption, scale-up, spread and maintenance of complex evidence-based solutions in clinics with evolving priorities. In response, the mHealth Research Group modified the existing Consolidated Framework for Implementation Research (mCFIR) to evaluate implementation of virtual health tools in clinical settings. WelTel® is an evidence-based digital health platform widely deployed in various geographical and health contexts. Objectives: To identify the facilitators and barriers for implementing WelTel and to assess the application of the mCFIR tool in facilitating focus groups in different geographical and health settings. Methodology: Both qualitative and semi-quantitative approaches were employed. Six mCFIR sessions were held in three countries with 51 key stakeholders surveyed. The mCFIR tool consists of 5 Domains and 25 Constructs and was built and distributed through Qualtrics XM. “Performance ” and “Importance” scores were valued on a scale of 0 to 10 (Mean + SD). Descriptive analysis was conducted using R computing software. NVivo 12 Pro software was used to analyze mCFIR responses and to generate themes from the participants’ input. Semi-structured interviews were conducted with the focus group facilitators to understand their experience using the mCFIR tool. Results: We observed a parallel trend in the scores for Importance and Performance. Of the five Domains, Domain 4 (End-user Characteristics) and Domain 3 (Inner Settings) scored highest in Importance (8.9 + 0.5 and 8.6 + 0.6, respectively) and Performance (7.6 + 0.7 and 7.2 + 1.3, respectively) for all sites. Domain 2 (Outer Setting) scored the lowest in both Importance and Performance for all sites (7.6 + 0.4 and 5.6 + 1.8). Areas of strengths included timely diagnosis, immediate response, cost-effectiveness, user-friendliness, and simplicity. Areas for improvement included training, phone accessibility, health authority’s engagement, and literacy. Conclusion: The mCFIR tool allowed for a comprehensive understanding of the barriers and facilitators to the implementation, reach, and scale-up of digital health tools. Participants emphasized the importance of creating partnerships with external organizations and health authorities in order to achieve sustainability and scalability.Trial Registration: NCT02603536 – November 11, 2015NCT01549457 – March 9, 2012

scholarly journals A guide to systems-level, participatory, theory-informed implementation research in global health

2021 ◽  
Author(s):  
Nadine Seward ◽  
Charlotte Hanlon ◽  
Saba Hinrichs ◽  
Crick Lund ◽  
Jamie Murdoch ◽  
...  
Keyword(s):  
Global Health ◽  
Social Science ◽  
Implementation Science ◽  
Real World ◽  
Implementation Research ◽  
Scale Up ◽  
High Quality ◽  
High Quality Evidence ◽  
Participatory Theory ◽  
Quality Evidence

Implementation research is a multidisciplinary field that addresses the complex phenomenon of how context influences our ability to deliver evidence-informed healthcare. There is increasing realisation of the importance of applying robust implementation research to scale-up lifesaving interventions that meet health-related sustainable development goals. However, the lack of high-quality implementation research is impeding our ability to meet these targets. In this paper we provide guidance to assist researchers to understand and conceptualise how implementation research methods can be used to deliver high-quality evidence-informed practice at scale. There are four phases to implementation research: pre-implementation, piloting, implementation and evaluation, and post-implementation and scale-up phases. Implementation science and theory-driven approaches can be used to design, pilot, implement and evaluate implementation programmes. Important components of implementation research such as stakeholder engagement can be applied to embed the research into existing health systems therefore ensure applicability in the ‘real world’. Implementation research also needs to be participatory; co-designed by all stakeholders who can influence implementation efforts. Although there is increasing interest in applying robust methodology to understand how and why implementation programmes work in real-world settings, global health actors still tend to favour evaluations conducted in controlled environments. Perhaps this is due to implementation research being a multidisciplinary field requiring expertise from a range of specialist disciplines such as implementation science and social science. To help translate some of the ambiguity surrounding the methodologies applied to implementation research, we draw on our expertise from a range of disciplines including global health, social science, policy, implementation science, epidemiology, and statistics to offer an overview of how to conduct participatory, theory-driven implementation research to design and test the effectiveness of delivering high-quality evidence-informed interventions at scale.

scholarly journals A Comparative Analysis of Two Streams of Implementation Research

2017 ◽  
Vol 3 (1) ◽  
pp. 3 ◽  
Author(s):  
Stephen Roll ◽  
Stephanie Moulton ◽  
Jodi Sandfort
Keyword(s):  
Implementation Science ◽  
Program Implementation ◽  
Implementation Research ◽  
Public Affairs ◽  
Implementation Framework ◽  
Evidence Based Practices ◽  
Comparative Review ◽  
State Of Research ◽  
Research Stream ◽  
New Research

Increased pressure for evidence-based practices in policymaking and administration has led to the growth of a new research stream of implementation science. Little is known about how this new stream of research compares with scholarship on policy implementation within public administration. This paper provides a comparative review of more than 1,500 journal articles on policy and program implementation published between 2004-2013. Using bibliometric analysis and a content analysis of abstracts, implementation articles within public affairs journals and in the emerging implementation science stream are analyzed in terms of their content, methods, and focus. Following a multi-level implementation framework, this analysis considers the level at which research is taking place within the different venues of implementation research. Through this systematic review, this paper provides new insights about the current state of research, opening up new avenues for scholars to substantively engage with and contribute to this important area of study.

scholarly journals ASHA-Led Community-Based Groups to Support Control of Hypertension in Rural India Are Feasible and Potentially Scalable

2021 ◽  
Vol 8 ◽  
Author(s):  
Michaela A. Riddell ◽  
G. K. Mini ◽  
Rohina Joshi ◽  
Amanda G. Thrift ◽  
Rama K. Guggilla ◽  
...  
Keyword(s):  
Program Implementation ◽  
Scale Up ◽  
Complex Interventions ◽  
Implementation Process ◽  
Rural India ◽  
Supportive Supervision ◽  
Culturally Appropriate ◽  
Clinical Trial Registry ◽  
Community Based ◽  
Middle Income

Background: To improve the control of hypertension in low- and middle-income countries, we trialed a community-based group program co-designed with local policy makers to fit within the framework of India's health system. Trained accredited social health activists (ASHAs), delivered the program, in three economically and developmentally diverse settings in rural India. We evaluated the program's implementation and scalability.Methods: Our mixed methods process evaluation was guided by the United Kingdom Medical Research Council guidelines for complex interventions. Meeting attendance reports, as well as blood pressure and weight measures of attendees and adherence to meeting content and use of meeting tools were used to evaluate the implementation process. Thematic analysis of separate focus group discussions with participants and ASHAs as well as meeting reports and participant evaluation were used to investigate the mechanisms of impact.Results: Fifteen ASHAs led 32 community-based groups in three rural settings in the states of Kerala and Andhra Pradesh, Southern India. Overall, the fidelity of intervention delivery was high. Six meetings were delivered over a 3-month period to each of the intervention groups. The mean number of meetings attended by participants at each site varied significantly, with participants in Rishi Valley attending fewer meetings [mean (SD) = 2.83 (1.68)] than participants in West Godavari (Tukeys test, p = 0.009) and Trivandrum (Tukeys test, p < 0.001) and participants in West Godavari [mean (SD) = 3.48 (1.72)] attending significantly fewer meetings than participants in Trivandrum [mean (SD) = 4.29 (1.76), Tukeys test, p < 0.001]. Culturally appropriate intervention resources and the training of ASHAs, and supportive supervision of them during the program were critical enablers to program implementation. Although highly motivated during the implementation of the program ASHA reported historical issues with timely remuneration and lack of supportive supervision.Conclusions: Culturally appropriate community-based group programs run by trained and supported ASHAs are a successful and potentially scalable model for improving the control of hypertension in rural India. However, consideration of issues related to unreliable/insufficient remuneration for ASHAs, supportive supervision and their formal role in the wider health workforce in India will be important to address in future program scale up.Trial Registration: Clinical Trial Registry of India [CTRI/2016/02/006678, Registered prospectively].

Implementation Science

2014 ◽  
Vol 222 (1) ◽  
pp. 4-11 ◽  
Author(s):  
Terje Ogden ◽  
Dean L. Fixsen
Keyword(s):  
Systematic Review ◽  
Implementation Science ◽  
Implementation Research ◽  
Scaling Up ◽  
Program Sustainability ◽  
Implementation Quality ◽  
Good Balance ◽  
Research Challenges ◽  
Research Outcomes ◽  
Comparative Review

The field of implementation research is remarkable in many ways and, even as a young discipline, it has expanded well beyond the expectations of even its most optimistic supporters and stakeholders. In this overview we provide a selective rather than systematic review to serve as a relevant introduction to the field of implementation science. We highlight central concepts, strategies, frameworks, and research outcomes. These highlights draw heavily on the seminal systematic reviews from Brownson, Colditz, and Proctor (2012) , Fixsen, Naoom, Blase, Friedman, and Wallace (2005) , and Greenhalgh, Robert, MacFarlane, Bate, and Kyriakidou (2004) and on a thorough comparative review of implementation frameworks conducted by Meyers, Durlak, and Wandersman (2012) . Looking ahead to future implementation research, we consider research challenges related to the scaling up of programs, striking a good balance between treatment integrity and local adaptation, measuring implementation quality, and program sustainability.

scholarly journals Implementation science research for the scale-up of evidence-based interventions for sickle cell disease in africa: a commentary

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Joyce Gyamfi ◽  
Temitope Ojo ◽  
Juliet Iwelunmor ◽  
Gbenga Ogedegbe ◽  
Nessa Ryan ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Implementation Science ◽  
Sickle Cell ◽  
Implementation Research ◽  
Scale Up ◽  
Premature Death ◽  
Science Research ◽  
Evidence Based ◽  
Main Body ◽  
Cell Disease

Abstract Background The burden of sickle cell disease (SCD) is greatest among African nations. Effective scalability of evidence-based interventions (e.g., newborn screening, health education, prophylaxis for infection, optimal nutrition and hydration, hydroxyurea therapy, blood transfusions, and transcranial Doppler (TCD) screening) is urgently needed particularly in these settings for disease management. However, Africa is constrained by limited resources and the lack of capacity to conduct implementation science research for proper understanding of context, and assessment of barriers and facilitators to the uptake and scalability of evidence-based interventions (EBI) for SCD management. Main Body We outline implementation science approaches to embed EBI for SCD within the African context and highlight key implementation research programs for SCD management. Building implementation research capacity will meet the major need of developing effective life-long and accessible locally-tailored interventions for patients with SCD in Africa. Conclusion This commentary communicates the importance of the application of implementation science methodology to scale-up evidence-based interventions for the management of SCD in order to reduce pain, prevent other morbidities and premature death experienced by people with SCD in Africa, and improve their overall quality of life.

scholarly journals Digital Health Transformation of Integrated Care in Europe: Overarching Analysis of 17 Integrated Care Programs

10.2196/14956 ◽  
2019 ◽  
Vol 21 (9) ◽  
pp. e14956 ◽  
Author(s):  
Erik Baltaxe ◽  
Thomas Czypionka ◽  
Markus Kraus ◽  
Miriam Reiss ◽  
Jan Erik Askildsen ◽  
...  
Keyword(s):  
Health Care ◽  
Integrated Care ◽  
Program Analysis ◽  
Digital Health ◽  
Scale Up ◽  
Implementation Process ◽  
Strong Relationship ◽  
Longitudinal Assessment ◽  
Wide Range ◽  
Assessment Strategies

Background Digital health tools comprise a wide range of technologies to support health processes. The potential of these technologies to effectively support health care transformation is widely accepted. However, wide scale implementation is uneven among countries and regions. Identification of common factors facilitating and hampering the implementation process may be useful for future policy recommendations. Objective The aim of this study was to analyze the implementation of digital health tools to support health care and social care services, as well as to facilitate the longitudinal assessment of these services, in 17 selected integrated chronic care (ICC) programs from 8 European countries. Methods A program analysis based on thick descriptions—including document examinations and semistructured interviews with relevant stakeholders—of ICC programs in Austria, Croatia, Germany, Hungary, the Netherlands, Norway, Spain, and the United Kingdom was performed. A total of 233 stakeholders (ie, professionals, providers, patients, carers, and policymakers) were interviewed from November 2014 to September 2016. The overarching analysis focused on the use of digital health tools and program assessment strategies. Results Supporting digital health tools are implemented in all countries, but different levels of maturity were observed among the programs. Only few ICC programs have well-established strategies for a comprehensive longitudinal assessment. There is a strong relationship between maturity of digital health and proper evaluation strategies of integrated care. Conclusions Notwithstanding the heterogeneity of the results across countries, most programs aim to evolve toward a digital transformation of integrated care, including implementation of comprehensive assessment strategies. It is widely accepted that the evolution of digital health tools alongside clear policies toward their adoption will facilitate regional uptake and scale-up of services with embedded digital health tools.

scholarly journals Digital Health Transformation of Integrated Care in Europe: Overarching Analysis of 17 Integrated Care Programs (Preprint)

2019 ◽  
Author(s):  
Erik Baltaxe ◽  
Thomas Czypionka ◽  
Markus Kraus ◽  
Miriam Reiss ◽  
Jan Erik Askildsen ◽  
...  
Keyword(s):  
Health Care ◽  
Integrated Care ◽  
Program Analysis ◽  
Digital Health ◽  
Scale Up ◽  
Implementation Process ◽  
Strong Relationship ◽  
Longitudinal Assessment ◽  
Wide Range ◽  
Assessment Strategies

BACKGROUND Digital health tools comprise a wide range of technologies to support health processes. The potential of these technologies to effectively support health care transformation is widely accepted. However, wide scale implementation is uneven among countries and regions. Identification of common factors facilitating and hampering the implementation process may be useful for future policy recommendations. OBJECTIVE The aim of this study was to analyze the implementation of digital health tools to support health care and social care services, as well as to facilitate the longitudinal assessment of these services, in 17 selected integrated chronic care (ICC) programs from 8 European countries. METHODS A program analysis based on thick descriptions—including document examinations and semistructured interviews with relevant stakeholders—of ICC programs in Austria, Croatia, Germany, Hungary, the Netherlands, Norway, Spain, and the United Kingdom was performed. A total of 233 stakeholders (ie, professionals, providers, patients, carers, and policymakers) were interviewed from November 2014 to September 2016. The overarching analysis focused on the use of digital health tools and program assessment strategies. RESULTS Supporting digital health tools are implemented in all countries, but different levels of maturity were observed among the programs. Only few ICC programs have well-established strategies for a comprehensive longitudinal assessment. There is a strong relationship between maturity of digital health and proper evaluation strategies of integrated care. CONCLUSIONS Notwithstanding the heterogeneity of the results across countries, most programs aim to evolve toward a digital transformation of integrated care, including implementation of comprehensive assessment strategies. It is widely accepted that the evolution of digital health tools alongside clear policies toward their adoption will facilitate regional uptake and scale-up of services with embedded digital health tools.

scholarly journals Evaluation of the Implementation Process of the Mobile Health Platform ‘WelTel’ in Six Sites in East Africa and Canada Using the Modified Consolidated Framework for Implementation Research (mCFIR)

2020 ◽  
Author(s):  
Samia El Joueidi ◽  
Kevin Bardosh ◽  
Richard Musoke ◽  
Binyam Tilahun ◽  
Maryam Abo Moslim ◽  
...  
Keyword(s):  
Implementation Research ◽  
Digital Health ◽  
Descriptive Analysis ◽  
Scale Up ◽  
Implementation Process ◽  
Evidence Based ◽  
Structured Interviews ◽  
User Friendliness ◽  
Domain 3 ◽  
And Performance

Abstract Background: Health systems globally are investing in integrating secure messaging platforms for virtual care in clinical practice. Implementation science is essential for adoption, scale-up, spread and maintenance of complex evidence-based solutions in clinics with evolving priorities. In response, the mHealth Research Group modified the existing Consolidated Framework for Implementation Research (mCFIR) to evaluate implementation of virtual health tools in clinical settings. WelTel® is an evidence-based digital health platform widely deployed in various geographical and health contexts. Objectives: To identify the facilitators and barriers for implementing WelTel and to assess the application of the mCFIR tool in facilitating focus groups in different geographical and health settings. Methodology: Both qualitative and semi-quantitative approaches were employed. Six mCFIR sessions were held in three countries with 51 key stakeholders surveyed. The mCFIR tool consists of 5 Domains and 25 Constructs and was built and distributed through Qualtrics XM. “Performance ” and “Importance” scores were valued on a scale of 0 to 10 (Mean + SD). Descriptive analysis was conducted using R computing software. NVivo 12 Pro software was used to analyze mCFIR responses and to generate themes from the participants’ input. Semi-structured interviews were conducted with the focus group facilitators to understand their experience using the mCFIR tool. Results: We observed a parallel trend in the scores for Importance and Performance. Of the five Domains, Domain 4 (End-user Characteristics) and Domain 3 (Inner Settings) scored highest in Importance (8.9 + 0.5 and 8.6 + 0.6, respectively) and Performance (7.6 + 0.7 and 7.2 + 1.3, respectively) for all sites. Domain 2 (Outer Setting) scored the lowest in both Importance and Performance for all sites (7.6 + 0.4 and 5.6 + 1.8). Areas of strengths included timely diagnosis, immediate response, cost-effectiveness, user-friendliness, and simplicity. Areas for improvement included training, phone accessibility, health authority’s engagement, and literacy. Conclusion: The mCFIR tool allowed for a comprehensive understanding of the barriers and facilitators to the implementation, reach, and scale-up of digital health tools. Participants emphasized the importance of creating partnerships with external organizations and health authorities in order to achieve sustainability and scalability.Trial Registration: · NCT02603536 – November 11, 2015· NCT01549457 – March 9, 2012

scholarly journals Evaluation of the Implementation Process of the Mobile Health Platform ‘WelTel’ in Six Sites in East Africa and Canada Using the Modified Consolidated Framework for Implementation Research (mCFIR)

2021 ◽  
Author(s):  
Samia El Joueidi ◽  
Kevin Bardosh ◽  
Richard Musoke ◽  
Binyam Tilahun ◽  
Maryam Abo Moslim ◽  
...  
Keyword(s):  
Implementation Research ◽  
Digital Health ◽  
Descriptive Analysis ◽  
Scale Up ◽  
Implementation Process ◽  
Evidence Based ◽  
Structured Interviews ◽  
User Friendliness ◽  
Domain 3 ◽  
And Performance

Abstract BackgroundHealth systems globally are investing in integrating secure messaging platforms for virtual care in clinical practice. Implementation science is essential for adoption, scale-up, spread and maintenance of complex evidence-based solutions in clinics with evolving priorities. In response, the mHealth Research Group modified the existing Consolidated Framework for Implementation Research (mCFIR) to evaluate implementation of virtual health tools in clinical settings. WelTel® is an evidence-based digital health platform widely deployed in various geographical and health contexts. ObjectivesTo identify the facilitators and barriers for implementing WelTel and to assess the application of the mCFIR tool in facilitating focus groups in different geographical and health settings. MethodologyBoth qualitative and semi-quantitative approaches were employed. Six mCFIR sessions were held in three countries with 51 key stakeholders surveyed. The mCFIR tool consists of 5 Domains and 25 Constructs and was built and distributed through Qualtrics XM. “Performance ” and “Importance” scores were valued on a scale of 0 to 10 (Mean + SD). Descriptive analysis was conducted using R computing software. NVivo 12 Pro software was used to analyze mCFIR responses and to generate themes from the participants’ input. Semi-structured interviews were conducted with the focus group facilitators to understand their experience using the mCFIR tool. ResultsWe observed a parallel trend in the scores for Importance and Performance. Of the five Domains, Domain 4 (End-user Characteristics) and Domain 3 (Inner Settings) scored highest in Importance (8.9 + 0.5 and 8.6 + 0.6, respectively) and Performance (7.6 + 0.7 and 7.2 + 1.3, respectively) for all sites. Domain 2 (Outer Setting) scored the lowest in both Importance and Performance for all sites (7.6 + 0.4 and 5.6 + 1.8). Areas of strengths included timely diagnosis, immediate response, cost-effectiveness, user-friendliness, and simplicity. Areas for improvement included training, phone accessibility, health authority’s engagement, and literacy. ConclusionThe mCFIR tool allowed for a comprehensive understanding of the barriers and facilitators to the implementation, reach, and scale-up of digital health tools. Participants emphasized the importance of creating partnerships with external organizations and health authorities in order to achieve sustainability and scalability.Trial Registration: NCT02603536 – November 11, 2015NCT01549457 – March 9, 2012

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