¹National Cancer Institute, Rockville, MD, USA; ²AcademyHealth, Washington, DC, USA

Implementation Science 2025, 20(1):I1

For decades, the D&I science community has known that it takes too long for too little evidence-based care to reach everyone who could benefit. Much energy has been spent on the second part of the equation – can we increase the volume of evidence-based care delivered? – with less attention to the optimal pace at which this should happen. Thus, to address this underexplored concept of the pace of dissemination and implementation, the 17^th Annual Conference on the Science of Dissemination and Implementation in Health theme was Moving Fast and Slow: Optimizing the Pace of Implementation. Co-hosted by the National Institutes of Health and AcademyHealth, in collaboration with our co-sponsors, the Agency for Healthcare Research and Quality (AHRQ), the Patient Centered Outcomes Research Institute (PCORI), the Robert Wood Johnson Foundation (RWJF), and the US Department of Veterans Affairs (VA), the conference convened nearly 1500 researchers, practitioners, and other partners from across the United States and globally in Arlington, VA on December 8–11, 2024.

While one clear goal of D&I science is to understand how to speed the dissemination and implementation of evidence into practice effectively, speakers also highlighted circumstances that may require slowing down. To overcome implementation barriers and design effective strategies, our field recognizes the importance of building trust and fostering engagement with critical partners, ensuring thoughtful and intentional adaptations for sustainability and scaling, and accounting for evolving evidence that may indicate de-implementation. Furthermore, the frequency and intensity of disasters create circumstances requiring rapid implementation. Reflecting critically on the pace through which our research, practice and policy communities can effectively spread and integrate evidence-based practices into service settings can lead to improved expectations, actions and outcomes from discovery to delivery. In addition, appropriate timelines for considering longer-term implementation outcomes, such as sustainment, adaptation, evolution and de-implementation of interventions will help support partners in the full implementation life cycle.

In this seventeenth year of the D&I Conference, plenary sessions explored methodological advancements, challenges, and opportunities to investigate and optimize implementation pace across healthcare, community, and public health systems. In the first plenary panel, Pacing D&I Research in the Context of Emergencies, speakers examined challenges and opportunities for D&I research in emergencies. They explored how to plan for and evaluate response to emergencies and conduct rapid assessments. This was followed by a debate-style plenary, Marathon vs. Sprint: Getting the Pace Right, focused on the value of moving fast versus slow in implementation science. Speakers addressed picking up the pace and avoiding long-standing gaps between research and practice. Finally, in the closing plenary panel, Maximizing Implementation Decision-Making in the Long Term, speakers examined pacing for longer term decisions, such as how can we ensure sustainment, adaptation, and de-implementation over time.

Conference participants included 1489 researchers, practitioners, and other partners worldwide, including 14 low- and middle-income countries (LMICs) in sub-Saharan Africa, Latin America, and Asia. We were pleased to welcome 125 trainees, eight patient scholarship recipients, and 18 presenters from LMICs, whose broad range of perspectives added greatly to conference discourse. We again offered 59 travel scholarships to various participants globally and domestically.

In addition to plenary sessions, the conference included concurrent podium and poster sessions, discussion forums, and multiple networking events. The call for abstracts generated 1151 submissions, including individual paper presentations, posters, and panel presentations spread across nine thematic tracks. Those tracks organize this supplement and include 158 abstracts from the concurrent paper and panel sessions, representing a variety of dissemination and implementation research funded by our conference sponsors and other agencies, organizations, and systems. The additional 656 abstracts from the poster sessions are not included here but can be viewed at https://academyhealth.confex.com/academyhealth/2024di/meetingapp.cgi/ModulePosterSessions/0.

Additionally, we hosted five pre-conference workshops, which continue to grow in popularity, with over 225 registrants. Topics included methods for intervention optimization, user-centered design, implementation mapping, and other rapid and pragmatic strategies for health and healthcare improvement. The conference also featured a pre-recorded orientation to D&I with live Q&A for those new to the field, an evening musical gathering based on attendee song requests, a new “first timers” session, fun run, poster walks, meet the editors, ancillary meetings, and daily morning coffee chats with D&I experts facilitating open discussions about key priorities for the field. The networking sessions were hugely popular and well attended, allowing attendees to connect with the leaders in the field.

We look forward to welcoming attendees to the 18^th Annual D&I Science conference, which will occur December 14–17 at the Gaylord Convention Center in National Harbor, MD.

Daniel Jonas^1*, Sean Riley¹, Leslie Brouwer¹, Marcella H. Boynton², Colleen Barclay², Debbie Grammer², Chris Weathington², Adam Zolotor², Kimberly Shoenbill², Samuel Cykert², Darren DeWalt²

¹The Ohio State University Wexner Medical Center, Columbus, OH, USA;²University of North Carolina Chapel Hill, Chapel Hill, NC, USA

Correspondence: Daniel Jonas, ([email protected])

Implementation Science 2025, 20(1):S1

Background

Unhealthy alcohol use is a leading cause of preventable deaths and is associated with many social and health problems. Less than a third of people who visit primary care providers in the US are asked about or ever discuss alcohol use with a health professional. The first aim of the Stop Unhealthy Alcohol Use Now (STUN) trial was to evaluate the effect of primary care practice facilitation on uptake of evidence-based screening and brief counseling for unhealthy alcohol use.

Methods

STUN was a hybrid implementation effectiveness trial that enrolled primary care practices across the state of North Carolina. Enrolled practices received twelve months of practice facilitation, including quality improvement coaching, electronic health record (EHR) support (e.g., using available tools, creating smart phrases or flowsheets, retrieving data), and training on screening and counseling for unhealthy alcohol use. The primary outcome measures included the change from three months prior to baseline through the second quarter (i.e., months 4–6) in the number and percentage of adult patients (1) who were screened for unhealthy alcohol use and (2) who received brief counseling after a positive screening result. For count data, we used negative binomial mixed-effects models to assess trajectories; models accounted for clinic size. For percentage data, we utilized linear mixed models.

Findings

Twenty one practices serving 54,294 patients reported implementation effectiveness data. Screening rates increased significantly, from an average of 200 to over 400 adults per quarter per practice (from 20% to 50% of adult patients, p < 0.01). Additionally, the number and percentage of patients who received a brief intervention after a positive screening result increased from 0 to 12 adults per quarter per practice (from 0% to 40% of adults with a positive screen, p<0.01). After month 6, assessment of the implementation effectiveness outcomes showed reasonable sustainment. There was significant variability across participating practices for screening and counseling outcomes.

Implications for D&I Research: Our findings provide evidence for the positive effect of practice facilitation on uptake of evidence-based screening and counseling for unhealthy alcohol use when delivered to small to medium-sized primary care practices.

Primary Funding Source

Agency for Healthcare Research and Quality

¹Case Western Reserve University, Mary Ann Swetland Center for Environmental Health, Cleveland, OH, USA; ²University of Kentucky, Lexington, KY, USA; ³RTI International, North Carolina, USA; ⁴The Ohio State University, College of Medicine, Columbus, OH, USA; ⁵Case Western Reserve University, School of Medicine, Cleveland, OH, USA; ⁶The Ohio State University, Columbus, OH, USA; ⁷University of Connecticut, Hartford, USA; ⁸Columbia University, New York, NY, USA; ⁹Office of Govenor Mike DeWine, Recovery Ohio, Columbus, USA

Correspondence: Darcy Freedman ([email protected])

Implementation Science 2025, 20(1):S2

Background

Overdose education and naloxone distribution (OEND) includes a suite of harm reduction EBPs to prepare community members to prevent, recognize, and respond to an opioid overdose in real time. Engaging community coalitions to accelerate OEND implementation is one strategy to expand reach. We present results of a multi-site, parallel group, cluster randomized waitlist-controlled trial by examining how changes in coalition leadership and capacity in general and specific to OEND were associated with community partner engagement in OEND implementation and naloxone units distributed.

Methods

The HEALing (Helping to End Addiction Long-term) Communities Study (HCS) worked with community coalitions to accelerate implementation and reach of EBPs, including OEND, to reduce opioid-related fatalities in Kentucky, Massachusetts, New York, and Ohio. We focus on Wave 1 study communities (N=33) participating from January 2020-June 2022. Coalition dynamics were measured via repeated cross-sectional surveys of coalition members in 2021 (N=367) and 2022 (N=227) using adaptations of four existing scales. Outcomes included number of partners engaged in OEND implementation using study tracking data and number of naloxone units distributed in the community using state-level administrative data. We used generalized linear mixed models, with a random effect to account for community clustering over time, for analysis of outcomes at the community level adjusting for baseline opioid overdose death rate, rural-urban status, and state.

Findings

The average change rate of partners engaged in OEND implementation was 15 (range = 0,72) and naloxone units distributed was 1,753 (range = −300,8,382) per 100,000. We found a significant 56% increased risk in rate of partners engaged from midpoint to the end of the intervention per one unit change in general coalition capacity (p=0.013), adjusting for OEND-specific coalition capacity. We found a significant 43% increased risk in rate of naloxone units distributed from baseline to the end of the intervention per one unit change in general coalition capacity (p=0.018), adjusting for OEND-specific coalition capacity.

Implications for D&I Research: Finding highlight the importance of investing in general coalition capacity building to optimize implementation of EBPs to reduce opioid overdose trends. These include support for capacities, such as internal decision-making, goal attainment, and influence on community-wide decisions.

Primary Funding Source

National Institutes of Health

¹Veterans Health Administration, Syracuse, NY, USA; ²Veterans Health Administration, Cananadaigua, NY, USA

Correspondence: Jocelyn Remmert ([email protected])

Implementation Science 2025, 20(1):S3

Background

Low-burden strategies are needed to assist in rapid dissemination and implementation of evidence-based behavioral treatments. Online/digital approaches may support rapid implementation; however, the reach and effectiveness of online trainings for uptake and quality delivery of evidence-based treatments is unknown. This project utilized an online survey platform to build a self-paced, tailored training in brief cognitive behavioral therapy for insomnia (bCBT-I) for clinicians. This study describes the uptake of the training 18 months after initiation and preliminary effectiveness of the training with a subsample of clinicians completing standardized role plays.

Methods

Integrated behavioral health providers working in Veterans Health Administration medical settings were recruited through national presentations and emails. Implementation strategies based on the COM-B theoretical framework were included. A subset of clinicians (n=39) completed standardized role plays of critical bCBT-I aspects to test the effectiveness of the online training (full data set of n=50 expected in the next month). Role plays were recorded and rated by an expert fidelity rater utilizing a fidelity checklist developed in a randomized controlled trial. A minimum fidelity threshold was established based on expert feedback.

Findings

Over 18 months, 1718 clinicians (46% psychologists, 90% no prior training in CBT-I) have entered the bCBT-I training, with 489 completing all aspects of the training. Less than half (46%) of clinicians who completed role plays demonstrated minimum fidelity after the first attempt. All but 2 (94.8%) were able to demonstrate minimum fidelity after a second attempt. The most common areas that clinicians demonstrated insufficient fidelity in were sleep window calculation and describing the link between insomnia and suicide (in the context of safety planning).

Implications for D&I Research: Results show a high number of clinicians rapidly completed the bCBT-I training, demonstrating how technology can be leveraged to quickly disseminate an evidence-based intervention. The fidelity data demonstrate that additional practice and feedback is necessary for all clinicians to demonstrate minimum fidelity. A hybrid training, where the online portion is utilized to establish knowledge and additional practice is utilized to establish full capability, may help to optimize cost and efficiency of trainings for evidence-based behavioral interventions.

Primary Funding Source

Department of Veterans Affairs

¹University of California San Diego, La Jolla, CA, USA; ²ImplementatioN Science and Team Effectiveness in Practice (IN STEP) Children's Mental Health Research Center, San Diego, CA, USA; ³UC San Diego Child and Adolescent Services Research Center, San Diego, CA, USA; ⁴UC San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, La Jolla, CA, USA; ⁵UC San Diego, La Jolla, CA, USA; ⁶Pacific Institute for Research and Evaluation, Albuquerque, NM, USA; ⁷University of Central Florida, Orlando, FL, USA

Correspondence: Manon Ironside ([email protected])

Implementation Science 2025, 20(1):S4

Background

Motivational interviewing (MI) is an empirically supported treatment across diverse treatment contexts. Behavioral healthcare organizations typically support MI skill development through trainings; however, participation in trainings does not guarantee the acquisition and maintenance of MI skills over time. Across two trials designed to improve implementation climate for MI, behavioral healthcare providers had ongoing access to expert human feedback (trial 1) or Artificial Intelligence (AI)-based feedback (trial 2) on their use of MI during dialogues with patients over a 9-month period. We investigated provider- and supervisor-level predictors of provider engagement with these feedback tools to improve the quality of MI delivery.

Methods

Trial 1 included n=380 providers across n=60 supervisors, and trial 2 included n=121 providers across n=27 supervisors. Multilevel logistic regressions were used to estimate initial and ongoing engagement with the MI feedback tools based on provider- and supervisor-reported attitudes toward MI, provider-reported intentions to use MI, and supervisor reports of implementation climate within their clinic. Focus groups were conducted following each implementation period, and open- and focused-coding techniques were used to identify themes and expand upon quantitative findings related to provider engagement with the feedback tools.

Findings

More supportive clinic-level implementation climate for MI increased odds that providers submitted at least one dialogue for expert human feedback (OR=2.6, CI₉₅=1.5–5.4). Provider and supervisor attitudes toward MI were not significantly associated with initial or ongoing engagement with expert human feedback after accounting for supervisor-reported clinic implementation climate. In Trial 2, more positive provider and supervisor attitudes toward MI increased odds that providers engaged at least once with AI-based feedback (provider OR=3.3, CI₉₅=1.0–10.7; supervisor OR=3.0, CI₉₅=1.1–8.6). Across trials, none of the provider- or supervisor-level variables emerged as significant predictors of ongoing engagement with either feedback option. Themes from focus group data included provider reluctance, time/productivity constraints, and structural workplace changes impacting engagement with the tools.

Implications for D&I Research: Organizational-level support for MI implementation may have a greater influence on provider engagement with human expert feedback, while individual attitudes toward MI influenced engagement with AI-based feedback. Research is needed to better understand factors that drive ongoing engagement with feedback-based tools to support EBP implementation.

Primary Funding Source

National Institutes of Health.

NORC at the University of Chicago, Chicago, IL, USA

Correspondence: Tracy McPherson ([email protected])

Implementation Science 2025, 20(1):S5

Background

Excessive alcohol use is a leading cause of preventable death, responsible for 1 in 5 deaths among U.S. adults. In 2019, AHRQ’s EvidenceNOW: Managing Unhealthy Alcohol Use in Primary Care initiative was launched to address excessive alcohol use. The initiative funded six grantees to disseminate evidence-based approaches for managing unhealthy alcohol use (UAU) in primary care, including screening, brief intervention, and referral to treatment (SBIRT) and medication-assisted treatment/medication for alcohol use disorder (MAT/MAUD). The objective of the study was to explore best practices in implementation especially during a pandemic, identify lessons learned, and assess the impact of the initiative on implementation of SBIRT and MAT/MAUD, quality improvement, and sustainability.

Methods

Pre- and post-intervention data was collected on SBIRT and MAT/MAUD implementation from 125 primary care practices between June 2020 and December 2023. In addition, key informant interviews (KIIs) were conducted with 61 grantee staff and 17 practices between June 2021 and October 2022. KIIs were audio-recorded and transcribed for thematic analysis.

Findings

Practices demonstrated significant increases in the delivery of all SBIRT components from pre- to post-intervention. By the end of the intervention, practices reported fully implementing an evidence-based process for screening (63.5%), reviewing/interpreting screening results (52.4%), assessing for symptoms of alcohol use disorder (47.6%), and providing patient feedback and brief intervention (44.7%). Virtual practice facilitation was the primary evidence-based strategy grantees used to support SBIRT in practices. Grantees and practices shared organizational, environmental, and pandemic-related factors that facilitated or hindered implementation. Grantees developed and provided resources to support sustainability and shared factors (e.g., integration of interventions into workflow, practice motivation and leadership support, and reimbursement) believed to impact sustainability. Grantees also helped practices understand how to use their electronic health records to identify patients in need of screening and track their quality improvement efforts.

Implications for D&I Research: The study demonstrated the impact of the initiative on the implementation of SBIRT and MAT/MAUD and uncovered several key facilitators to success in real-world settings, including during a pandemic. Findings have implications for increasing uptake and sustainability of SBIRT and MAT/MAUD in primary care practices.

Primary Funding Source

Agency for Healthcare Research and Quality

Oregon Health & Science University, Portland, OR, USA

Correspondence: Erin Kenzie ([email protected])

Implementation Science 2025, 20(1):S6

Background

Implementation of screening, brief intervention, and referral to treatment (SBIRT) and medication-assisted treatment for unhealthy alcohol use (MAUD) remains low in primary care, despite evidence that the interventions reduce morbidity and mortality.

Methods

ANTECEDENT was a pragmatic implementation study evaluating a tailored, practice facilitator-led intervention to improve SBIRT and MAUD implementation in primary care practices conducted during November 2019 - April 2023. We used a convergent parallel mixed-methods approach to evaluate the study. We collected qualitative and quantitative data regarding clinic characteristics, implementation strategies, and SBIRT/MAUD outcomes through contact logs, practice facilitator interviews and periodic reflections, clinic interviews, pre-post surveys, and electronic health record queries. Quantitative analyses included descriptive statistics, logistic regression, and the Wilcoxon sign-ranked test. Qualitative data were analyzed using immersion crystallization. Data were reviewed in a matrix to evaluate intervention adoption, implementation, and effectiveness.

Findings

We recruited 75 clinics; 66 participated and 48 (73%) completed the study. Six participating clinics received foundational support (baseline and exit assessments, online resources) only (12%) while 58 engaged in supplemental support (88%) activities. All clinics receiving supplemental support received practice facilitation, while some participated in data review (35%), health information technology support (27%), expert consultation (17%), and peer-to-peer learning activities (6%). Pre- and post-intervention assessments showed significant improvement in self-reported SBIRT process outcomes among clinics receiving supplemental support. Performance data showed improvement among participating clinics able to produce data. Clinics described mostly positive experiences with the tailored, facilitator-led intervention and highlighted remaining barriers to SBIRT and MAUD implementation.

Implications for D&I Research: Identifying effective strategies for implementing SBIRT and MAUD in primary care is critical for improving screening and treatment of unhealthy alcohol use and ultimately reducing patient morbidity and mortality. In this study, we found that it was feasible and effective to use practice facilitators to tailor implementation support to diverse primary care settings.

Primary Funding Source

Agency for Healthcare Research and Quality

The Ohio State University Wexner Medical Center, Columbus, OH, USA

Correspondence: Daniel Jonas ([email protected])

Implementation Science 2025, 20(1):S7

Background

Despite national recommendations, relatively few people who visit primary care are asked about alcohol use. The Stop Unhealthy Alcohol Use Now (STUN) trial aimed to evaluate the effect of primary care practice facilitation on the uptake of screening and counseling for unhealthy alcohol use. The COVID-19 pandemic began shortly after the STUN trial started.

Methods

STUN enrolled primary care practices in North Carolina. Enrolled practices received twelve months of practice facilitation, including quality improvement coaching, electronic health record support, training on screening and counseling for unhealthy alcohol use, and expert consultation. The primary outcome measures included the change in the number and percentage of adult patients (1) who were screened for unhealthy alcohol use and (2) who received brief counseling after a positive screening result. For analyses, we used negative binomial mixed-effects models for count data to assess trajectories with models that accounted for clinic size and we utilized linear mixed models for percentage data. Semi-structured interviews of 15 practice coaches were conducted to assess barriers and facilitators.

Findings

Twenty-one practices serving 54,294 patients reported screening and counseling data. Screening rates increased from 20% to 50% from baseline to the primary endpoint (i.e., months 4–6, quarter 2), and the number of adults screened per quarter per practice increased from an average of 200 to over 400 (p<0.01). The percentage of patients who received a brief intervention after a positive screening result increased from 0% to 40% from baseline to quarter 2, and the number of adults counseled per quarter per practice increased from an average of 0 to 12 (p<0.01). Sustainment throughout the implementation and 6 months post-implementation was reasonable. The qualitative interviews revealed several themes, including staffing and financial challenges, existing relationships, and trust.

Implications for D&I Research: Our findings provide evidence for the positive effect of practice facilitation on the uptake of screening and counseling for unhealthy alcohol use when delivered to small to medium-sized primary care practices, despite the challenges of the COVID-19 pandemic. The results highlight the importance of support systems, including training and coaching, for implementing evidence-based practices.

Primary Funding Source

Agency for Healthcare Research and Quality.

¹Cambridge Health Alliance, Cambridge, MA, USA; ²Harvard Medical School, Boston, MA, USA; ³Columbia University Department of Psychiatry and New York State Psychiatric Institute, New York, NY, USA; ⁴Columbia University Irving Medical Center, New York, NY, USA

Correspondence: Lisa Rosenfeld ([email protected])

Implementation Science 2025, 20(1):S8

Background

Psychiatric measurement-based care (MBC) can be more effective than usual care, but health systems face many implementation challenges. Achieving attitudinal alignment before implementing MBC is critical, yet few MBC studies report on multi-stakeholder perspectives at this phase of planning, particularly in resource-challenged safety net health systems. We obtained pre-implementation feedback from patients, providers, and administrators remote MBC implementation in a safety net system for adult outpatient psychiatry clinics.

Methods

We used interview guides informed by the Conceptual Model of Implementation Research (CFIR) to gather qualitative pre-implementation attitudes about perceived Appropriateness, Acceptability, and Feasibility of the selected MBC symptom tool (Computerized Adaptive Test - Mental Health; CAT-MH) from five patients, two providers, and six administrators. We then coded transcribed participant data to reflect barriers and facilitators, organized codes by stakeholder group to assess degree of alignment, and grouped the codes to summarize major themes.

Findings

There was greater attitudinal alignment across stakeholder groups regarding barriers and facilitators related to MBC’s Acceptability and Feasibility in this care setting than its Appropriateness. All groups agreed that MBC roll-out would require a great degree of contextualization for patients and providers, anticipated MBC would impact patient-provider relationships, and worried the safety net system may not have capacity to address all patient mental health needs unearthed by systematic MBC. Our thematic analysis suggests that: (1) Successful MBC implementation will likely all stakeholders to participate in a culture shift; (2) MBC poses theoretical risks to health equity for safety net patients, because of limitations in access to both MBC tools and the resources needed to respond appropriately to MBC data; and (3) Tension exists between individual- and system-level applications of MBC.

Implications for D&I Research: This research revealed a great deal of overlap, but also some key differences, in pre-implementation concerns among providers, patients, and administrators. Implementation research and planning tools that help decision makers assess the degree to which pre-implementation attitudinal unalignment may itself pose a barrier to successful implementation, as well as when it may warrant delaying or revising implementation plans, will be useful for researchers and decision makers alike.

Primary Funding Source

National Institutes of Health

¹Harvard Medical School, Boston, MA, USA; ²Cambridge Health Alliance, Cambridge, MA, USA; ³Tufts Medical School, Medford, MA, USA

Correspondence: Kate Zona ([email protected])

Implementation Science 2025, 20(1):S9

Background

Behavioral measurement-based care (MBC) can improve patient outcomes and has also been advanced as a critical learning health system (LHS) tool for identifying and mitigating potential disparities in mental health treatment. However, little is known about potential disparities in uptake of remote behavioral MBC in safety net settings.

Methods

This pragmatic study uses electronic health record data to study variation in patient completion rates (uptake) at the clinic and patient level of a remote transdiagnostic MBC symptom measure during the first 6 months of implementation at three adult outpatient psychiatry clinics in a safety net health system. Provider-reported barriers to MBC adoption were also measured using repeated electronic surveys, administered every two weeks, at one of the three sites over the first 6 months of roll-out.

Findings

Out of 1219 patients who were sent an MBC measure request, uptake of completing at least one measure varied by clinic: General Adult Clinic, 38% (n = 262 of 696); Substance Use Clinic, 28% (n = 73 of 265); and Transitions Clinic, 17% (n = 44 of 258). Compared with White patients, Black and Portuguese or Brazilian patients had lower uptake. Older patients also had lower uptake. Spanish language of care was associated with much lower uptake at the patient level. Significant patient-level disparities in uptake persisted after adjusting for the clinic, mental health diagnoses, and number of measure requests sent. Providers cited time within visits and bandwidth in their workflow as the greatest consistent barriers to discussing MBC results with patients.

Implications for D&I Research: The potential benefits to patients of MBC implementation are likely to be inequitable when we observe inequities in uptake. An LHS perspective and infrastructure can serve as one key mechanism for identifying and improving upon observed challenges to equitable MBC uptake; yet, LHS efforts to address behavioral health access, quality, and outcomes are challenged in the face of systematic differences in MBC uptake like those observed in this pragmatic study. Maximizing the system-level health equity impact of LHSs will require a sustained focus on assessing equity in those processes that produce the very data that may help identify disparities and direct LHS activities.

Primary Funding Source

National Institutes of Health.

¹Cambridge Health Alliance, Cambridge, MA, USA; ²Harvard Medical School, Boston, MA, USA

Correspondence: Ana Progovac ([email protected])

Implementation Science 2025, 20(1):S10

Background

Psychiatric MBC implementation is a complex evidence-based intervention that may be vulnerable to failed implementation or low sustainability in safety net mental health settings. We elicited feedback from mental health providers one year after MBC implementation in their safety net care setting to better understand the (1) potential drivers of MBC implementation outcomes, (2) health equity implications at each of the Collect, Share, and Act (CSA) stages of MBC; and (3) relationship between MBC and Therapeutic Alliance (TA).

Methods

This explanatory sequential mixed methods study used quantitative surveys and qualitative focus groups with mental health providers. Repeated surveys were first used to understand mental health provider experiences over a six-month period, at least one year after MBC implementation. These surveys were analyzed to inform and develop the provider focus group guides to understand MBC implementation success for each CSA stage and MBC impact on TA. Focus group data were analyzed using valence coding for each CSA stage and TA, and by four implementation outcomes (Acceptability, Appropriateness, Feasibility, and Equity).

Findings

Surveys revealed relatively stable ratings for MBC Acceptability and Utility, consistently high concern that MBC was not benefiting all patients equally, little endorsement that MBC improved TA, and Feasibility scores that decreased slightly over time. Valence coding of focus group data revealed that providers had more experience with MBC’s Collect stage, which was characterized by negative average valence for Acceptability, Appropriateness, Feasibility, and Equity. Providers had less experience in the Share and Act stages of MBC, which still had negative Equity and Feasibility valences, and neutral-to-positive average valences for Acceptability and Appropriateness. TA was found to both impact and be impacted by MBC in positive and negative ways. Drivers of positive and negative experiences impacting implementation outcomes in each CSA stage and for TA are discussed.

Implications for D&I Research: Our study demonstrated sustained MBC implementation equity challenges and the need for strategies for preserving TA in diverse settings. As value-based payment initiatives increasingly incentivize collecting and demonstrating improvements in patient-reported outcomes, questions remain about how to ensure psychiatric MBC implementation is equitable and sustainable in diverse safety net health systems.

Primary Funding Source

National Institutes of Health

¹Harvard Medical School, Boston, MA, USA; ²Cambridge Health Alliance, Cambridge, MA, USA; ³Massachusetts General Hospital, Boston, MA, USA

Correspondence: Margaret Lanca ([email protected])

Implementation Science 2025, 20(1):S11

Background

Little is known about how to successfully and sustainably implement measurement-based care (MBC) in child/adolescent inpatient psychiatric settings. We used a structured pre-implementation planning approach to design and carry out clinician training and workflow design for measurement-based care (MBC) implementation in a child/adolescent inpatient psychiatry setting in a safety net hospital system.

Methods

We assessed pre-implementation barriers and facilitators using a mixed methods design drawing from the Consolidated Framework for Implementation Research (CFIR) and Expert Recommendations for Implementing Change (ERIC). Semi-structured interviews with three key informants, combined with CFIR-to-ERIC mapping, informed pre-training survey design and preliminary workflow design. The results of the pre-training survey (n=19 child/adolescent inpatient clinicians) further informed workflow refinements and finalized MBC training. Post-training surveys (n=8 child/adolescent inpatient clinicians) further informed workflow re-designs before roll-out, which continued to be refined after challenges emerged during roll-out.

Findings

The top CFIR barriers from interviews included: 1) measure compatibility, 2) relative advantage, 3) relative priority, 4) evidence strength/quality, and 5) clinician beliefs about MBC. Top ERIC strategies included identifying and preparing champions, assessing clinician readiness, and conducting trainings; specific identified barriers were incorporated into preliminary workflow and training designs. The pre-training survey showed that clinicians wanted to use MBC, and moderately agreed MBC would promote patient progress, but were less confident that MBC could be feasibly added to workloads. Workflows were refined over multiple phases (pre-implementation, phase 1 roll-out, phase 2 roll-out). Key drivers for decisions to change workflow elements will be discussed.

Implications for D&I Research: In this pragmatic study, MBC training and workflow were informed by e findings from a structured pre-implementation planning approach, and workflow was further optimized post-roll-out. Post-training repeat survey findings reflected continued high interest in MBC, an increase in attitudes that MBC could help patient progress, and an increase in feasibility attitudes, though time constraints remained a concern. This study describes a replicable process for planning and executing data collection informed by implementation science in low-resource safety net settings to rigorously incorporate clinician attitudes towards MBC in workflow design and training.

Primary Funding Source

National Institutes of Health

¹University of Connecticut, Hartford, CT, USA; ²UW SMART Center, UW SMART Center, Seattle, WA, USA

Correspondence: Jonathan Olson ([email protected])

Implementation Science 2025, 20(1):S12

Background

Wraparound is a care coordination process for youth with complex behavioral health needs. Given its emphasis on cross-system coordination, implementing Wraparound requires purposeful action within and across provider organizations and external systems within which they are embedded. As such, Wraparound takes considerable time to implement. In this study, we examined the pacing of Wraparound implementation within different administrative structures to identify factors that facilitate or inhibit implementation progress.

Methods

This study included 10 states that used one of two state-level administrative structures to implement Wraparound: Four Care Management Entities (CMEs) and six Community Mental Health Centers (CMHCs). We assessed implementation completeness and duration with the Stages of Implementation Completion (SIC) and compared implementation duration to other cross-system EBTs. We gathered fidelity data with the Coaching Observation Measure for Effective Teams (COMET). We conducted item-level analyses to identify implementation activities that varied in duration across structures; and used multi-level models to identify predictors of fidelity.

Findings

CMEs completed more implementation activities than CMHCs and were faster to implement most activities. Compared to other complex cross-system EBTs, Wraparound took significantly more days to implement during pre-implementation (M_Wraparound = 560.0, M_Comparison = 336.2, p =.014, d = 0.71) and implementation (M_Wraparound = 958.7, M_Comparison = 712.1, p =.038, d = 0.58), although differences were smaller for CME states. Item-level analyses suggest that system-level activities (e.g., engaging state leaders) and organization-level activities (e.g., conducting implementation reviews) account for the slow pacing of implementation. Multi-level models suggest that pre-implementation phase duration was positively associated with fidelity (b = <.001, t(10.85) = 3.62, p =.004), but implementation phase duration was negatively associated (b =.082, t(7.04) = −6.64, p <.001).

Implications for D&I Research: Results indicate that interventions with a strong systems-level focus require considerable time to implement. However, a hospitable administrative structure (in this case using a CME) can shorten the time. Regardless of type of structure, the current data suggest that implementation outcomes are better among states that take time early in the planning process to create hospitable inner and outer contexts, but are more expedient in later implementation stages.

¹Columbia University Irving Medical Center, New York, NY, USA; ²University of California San Francisco, San Francisco, CA, USA; ³New York State Office of Mental Health, Albany, NY, USA; ⁴Emory University, Atlanta, GA, USA

Correspondence: Nathalie Moise ([email protected])

Implementation Science 2025, 20(1):S13

Background

Successful collaborative care (CC) implementation requires enhanced implementation support and fiscal strategies. Even when implemented with high fidelity, emerging data suggest that CC reach diminishes over time. Few if any prior studies have examined predictors of long-term reach and clinical improvement rates.

Methods

From 2012-2015, New York State (NYS) Office of Mental Health (OMH) implemented CC in 32 early adopter clinics before launching the CC Medicaid Program (CCMP) to scale and sustain CC efforts using technical assistance, quality monitoring (of fidelity, clinical improvement, and enrollment rates), training and fee-for-quality Medicaid reimbursement codes. We analyzed clinics that enrolled in the CCMP program from 2012-2019, provided at least 1 quarter’s worth of quality metrics in 2021 and/or 2022, and had ≥0.5 full time equivalent (FTE) care manager. We fit multilevel negative binomial regression models, adjusting for clustering by healthcare system and county to predict clinical improvement (% of patients achieving 50% improvement in depressive symptoms) and reach (%CC enrolled among those screening positive) rates. Key predictors were depression screening rate, engagement rate (%CC enrolled patients contacted), psychiatry consultation/treatment optimization rate, clinic size, care manager FTE, and caseload/FTE.

Findings

There were 269 eligible CCMP clinics. In 2022, clinics cared for 4503 patients/quarter; 56.8% were in NYC, 14.4% were early adopters (2012-2014); 16.1% enrolled in 2015-2016, 69.5% 2017-2019; the average caseload was 53.0 patients/FTE, reach 13.0% and clinical improvement 42.0%. In multivariable analyses, key predictors of long-term reach included contact rate (5.28 [2.37,11.72]), FTE (1.02 [1.01,1.02]), caseload/FTE (1.24 [1.18,1.31]), smaller clinic size (0.68 [0.61,0.76]) and earlier adoption (0.44 [0.24,0.77]); while long-term improvement rates were associated with caseload/FTE (1.04 [1.01,1.07]) and psychiatry consultations (1.5 [1.15,1.95]). Reach and effectiveness were negatively associated (0.55 [0.4,0.75]). We developed NYS heatmaps of reach over time to convey progress in targeted interventions.

Implications for D&I Research: Our study demonstrates that despite ongoing fiscal and technical assistance strategies, clinics continue to struggle with long-term reach and to a lesser extent effectiveness. Our findings suggest tradeoffs between reach and clinical improvement. Targeting contact rates, FTEs, and caseloads/FTE (which also appeared to positively impact clinical improvement rates), may optimize the pace of sustainability efforts.

¹Northwestern University Feinberg School of Medicine, Chicago, IL, USA; ²Brown University, Providence, RI, USA; ³Northwestern University, Chicago, IL, USA; ⁴University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT, USA

Correspondence: Allison Carroll ([email protected])

Implementation Science 2025, 20(1):S14

Background

The Collaborative Care Model (CoCM) is an extensively evidence-based model for treating common mental health problems in primary care settings, thereby removing barriers to care for many patients. Unfortunately, CoCM implementation is not widely researched. We aimed to test and optimize an implementation strategy package, rolled out across 11 clinics, to support future CoCM implementation, and exhibit whether speed and completion of implementation milestones improved from the first to last clinic.

Methods

We conducted a randomized, roll-out implementation optimization (ROIO) type 2 effectiveness-implementation study of CoCM in 11 primary care clinics in Northwestern Medicine (Chicago, IL). Initial implementation strategies included leadership engagement, clinic training, audit & feedback, and technical assistance. Audit & feedback interviews with key partners (practice champions, behavioral care managers, and practice managers/leadership) were conducted 5 and 15 months after CoCM launch in each clinic. We used the Universal Stages of Implementation Completion (USIC) to measure duration and completion of Pre-Implementation, Implementation, and total activities across clinics, and regressions to test whether later clinics completed implementation activities faster than earlier clinics.

Findings

Audit & feedback interviews resulted in adapting and adding new strategies, including conducting re-training sessions for primary care clinics, developing and distributing patient-facing brochures about CoCM, and providing community feedback about CoCM via various forums. The duration of the pre-implementation phase ranged 63–615 days, implementation phase ranged 116–703 days, and overall duration ranged 198–855 days (includes overlap between pre-implementation and implementation phases). The proportion of activities completed in Pre-Implementation ranged 44–100%, Implementation ranged 39–87%, and total ranged 41–91%. The duration of implementation activities did not change significantly from clinic 1 to 11 for Pre-Implementation (B=−18.29, 95%CI=−63.02, 26.43), Implementation (B=−30.34, 95%CI=−72.56, 11.89), or overall (B=−35.89, 95%CI=−77.61, 5.83). However, the proportion of completed implementation activities decreased significantly from clinic 1 to 11 for Pre-Implementation (B=−0.04, 95%CI=−0.02, −0.06), Implementation (B=−0.03, 95%CI=−0.01, −0.06), and total (B=−0.04, 95%CI=−0.01, −0.06).

Implications for D&I Research: Although implementation pace did not increase, activity number for successful implementation was fewer with subsequent clinics because of activity refinement and overlap in clinic resources. Findings from this study provide an optimized implementation strategy toolkit and key implementation activities for future CoCM implementation.

Primary Funding Source

Woman's Board of Northwestern Memorial Hospital

¹Northwestern University Feinberg School of Medicine, Chicago, IL, USA; ²Northwestern University Feinberg School of Medicine, Center for Dissemination and Implementation Science, Chicago, IL, USA; ³The Ohio State University, Columbus, OH, USA

Correspondence: Sara Becker ([email protected])

Implementation Science 2025, 20(1):S15

Background

This presentation describes how MIMIC2 (Maximizing Implementation of Motivational Incentives in Clinics-2), a research project embedded within a NIDA-funded Center of Excellence, quickly pivoted our study design and collected unanticipated data in response to shifting behavioral health priorities. MIMIC2 was initially designed as a 5-year stepped wedge trial evaluating a multi-level implementation strategy to promote uptake of contingency management (CM) across 10 opioid treatment programs (OTPs). Between submission of the protocol and receipt of funding, the national landscape for CM changed: multiple Departments of Health (DoH) were suddenly eager to fund CM using opioid settlement funds and were resistant to being randomized to delayed support. This shifting landscape created a time-sensitive opportunity to partner on provision and evaluation of implementation support.

Methods

Partnering with two DoHs (Rhode Island and Chicago), we substantially condensed our stepped wedge timeline, granting us the flexibility to redeploy team resources. In Rhode Island, we supported the DoH’s roll-out of a digital CM platform by delivering our multi-level implementation strategy and conducting a comprehensive multi-level evaluation across 6 OTPs. In Chicago, we helped the DoH devise and deploy a needs assessment tool to determine which community-based organizations had the highest potential to implement CM, prior to launch of the stepped wedge trial.

Findings

In Rhode Island, we provided our multi-level implementation strategy to 84 providers across 6 OTPs; collected team-based data on contextual determinants from the OTPs at two timepoints (retention: 83%); collected data on contextual determinants, provider- and organization-level outcomes from providers at three timepoints (retention: 80–84%); and collected data on clinical outcomes from 122 patients. Results indicated that provider knowledge and attitudes improved, but that perceptions of barriers increased over time. In Chicago, as of July 2024, we have conducted needs assessment interviews with 15 community-based organizations and have another 31 interviews pending.

Implications for D&I Research: Nimbly adapting to meet the emergent needs of our research partners provided rich, unanticipated opportunities to deploy and evaluate our multi-level implementation strategy in the real-world. Factors that contributed to our adaptability included our longstanding relationships with the partners, close-knit research team, and being situated in a P50 Center of Excellence.

Primary Funding Source

National Institutes of Health.

Madison L. Hartstein¹, Rana K. Mazzetta¹, Heather Risser¹, Anh Doan¹, Kareem Butler², Ontisar Freelain³, Joann Glenn⁴, Arielle Guzman⁵, TaLana Hughes⁶, Sheila Sanders⁷, Hector Torres⁸, Kimberly Williams⁹, Stephanie Schmitz Bechteler¹⁰, Candace Henley¹¹, Angela Jordan¹², David Moskowitz¹³, Bonnie Spring¹⁴

¹Northwestern University, Chicago, IL, USA; ²Consultant, Chicago, IL, USA; ³Health Research and Awareness NFP, Chicago, USA; ⁴W.O.T. Foundation, Chicago, USA; ⁵Chicago Medical Organization for Latino Advancement, Chicago, USA; ⁶Sickle Cell Disease Association of Illinois, Chicago, IL, USA; ⁷SS Clarity LLC, Chicago, USA; ⁸Colibri Counseling, Chicago, USA; ⁹Erie Family Health Centers, Chicago, USA; ¹⁰Chicago Urban League, Chicago, USA; ¹¹The Blue Hat Foundation, Chicago, USA; ¹²University of South Alabama, Mobile, USA; ¹³University of Chicago, Chicago, IL, USA; ¹⁴Northwestern University School of Law, Chicago, IL, USA

Correspondence: Madison L. Hartstein ([email protected])

Implementation Science 2025, 20(1):S16

Background

Community-engaged research (CER) faces challenges in optimizing the pace of dissemination and implementation due to disparities in knowledge and resources between community and academic partners, hindering translation into real-world practices. To address this, a collaboration between community organizations (COs) and academics developed the Team Science Community Toolkit (TSCT), featuring over 50 tools ranging from static templates to interactive tools (e.g., decision calculator, communication strategies).

Methods

The TSCT was evaluated using data from 27 individuals, including 12 community-academic dyads. After accounting for attrition, 22 participants completed 4 weeks of activities including (1) assignments, (2) post-assignment surveys, and (3) brief interviews. Focus Groups were conducted after Timepoints 1–4, followed by a final survey 1-month post-evaluation to assess impact and retention, scheduled data completion August 2024. Using a convergent-parallel mixed methods design, the evaluation emphasized qualitative data integration with quantitative and process data analysis. Harnessing the principles of Team Science, the TSCT aims to empower COs with accessible tools and resources for effective research participation.

Findings

Participants enthusiastically endorsed the TSCT, noting its potential to enhance CO engagement and positively influence research outcomes. Qualitative and qualitative feedback indicated the TSCT made academic research more accessible and provided valuable resources. Dyads reported stronger partnerships, increased trust, and improved understanding of each other’s perspectives. Participants emphasized ethical considerations involving community stakeholders in dissemination of research to ensure culturally appropriate practices, elevating the partnership development the TSCT promotes as a potential facilitator. Tools like the Feasibility Checklists, Dissemination Plan Guide, Sustainability Plan, and Communication Strategies were highlighted as particularly valuable. Quantitative data supported qualitative findings, with high ratings for relevance (Mean=3.70), helpfulness (Mean=3.67), and content quality (Mean=3.64) across survey scales of 1–4.

Implications for D&I Research: The TSCT represents an advancement in capacity building within CER, fostering transparency, equity, and collaboration among community-academic partners. It enhances COs'research literacy and decision-making and accelerates implementation of research findings into practice. By integrating Team Science principles and citizen scientists'expertise, the TSCT strengthens community resilience and health outcomes, promoting a more inclusive and sustainable research ecosystem. Future steps include integrating these tools into practice among community and academic partnerships, assessing research efficiency and impact.

Primary Funding Source

National Institutes of Health

¹University of California San Diego, La Jolla, CA, USA; ²California State University Northridge, Northridge, CA, USA; ³UC San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, La Jolla, CA, USA; ⁴UC San Diego ACTRI Dissemination and Implementation Science Center, La Jolla, CA, USA

Correspondence: Kera Swanson ([email protected])

Implementation Science 2025, 20(1):S17

Background

Dissemination and Implementation Science (DIS) capacity building programs are increasing worldwide. These programs aim to enhance diverse DIS skills through a variety of activities. Our team’s systematic review of international programs found DIS consultations were offered across 67% of programs, yet their specific roles in capacity development are underexplored. This study used a mixed methods approach to identify and categorize the form and function of consultation activities across three DIS capacity building programs at the University of California San Diego: a program focused on HIV implementation science; a P50 Center focused on team-based implementation strategies in children's mental health; and a Clinical and Translational Science Award -DIS program.

Methods

117 consultation notes from the three programs were extracted for directed content analysis to identify primary consultation needs, discussion topics, and shared DIS resources. Generative artificial intelligence (AI) (ChatGPT Plus) was first used to organize themes. Multiple rounds of validation with program consultants followed to refine and finalize themes. Findings provided additional context to quantitative data gathered as part of the consultation tracking process.

Findings

The directed content analysis indicated that primary consultation needs centered around DIS specific grant assistance (29.91%), implementation strategy feedback (25.64%), mentorship and career development (21.37%), and data analysis methods (14.53%). Discussions focused around implementation frameworks (34.19%), intervention design (25.64%), and data analysis (17.09%). Key issues addressed during the consultations revolved around data management (34.19%), addressing implementation barriers and facilitators (25.64%), and quality improvement methods (17.09%). Resources shared focused on DIS specific literature (42.74%), tools (25.64%), and training (17.09%).

Implications for D&I Research: These findings indicate strong demand for methodological guidance, professional development, and strategic support to enhance DIS research and practice. To meet this demand, these DIS consultations mainly focused on providing pragmatic and methodological guidance. Our use of generative AI shows promise in expediting thematic analyses for future program development and evaluation, calling for further exploration into its role within qualitative research. Future directions include assessing consultation impact on project outcomes and exploring relationships between unique consultation needs and resources based on project type.

Primary Funding Source

National Institutes of Health

University of Kansas Medical Center, Kansas City, KS, USA

Correspondence: Maggie Padek Kalman ([email protected])

Implementation Science 2025, 20(1):S18

Background

With the growing interest from federal and local agencies for the funding of implementation science, there is a need to build capacity and infrastructure and i assess what type of impact these services can have on a research institution. Clinical and Translational Science Awards (CTSA) have recognized the need for providing dissemination and implementation services and resources at each of their hubs and is now a required component of their infrastructure. However, there is limited direction on how hubs should measure and assess the outcomes and impacts of these services

Methods

With the integration of implementation science consulting and networking efforts within the Frontiers CTSI structure, the core was able to capitalize on Frontiers’ evaluation system to assess the impact of their grant consulting and training events. A REDCap intake form recorded consultation requests and, through a series of tracking forms, tracked process outcomes achieved by the D&I core team. A one-year follow-up survey sent to consult requestors assesses the outcome of the consultation based on the goal stated by the requestor (e.g., manuscript submission, grant submission, etc). An additional REDCap form tracks D&I sponsored events and attendees. Standard return-on investment calculations were conducted based on the level of effort staff and faculty provide to the services and the total number of research dollars secured because of these services. Separately, a database of faculty and staff interested in implementation science is maintained for communication and resource delivery. Descriptive statistics were calculated based on the network member database and event documentation.

Findings

Since September 2022, the implementation science consulting service within the Frontiers CTSI conducted a methods consultation on average every two weeks. They have hosted 11 events in this period that have had over 250 attendees. The local network has grown by 60% in the first 18 months and the core has seen a return on investment of $49.40 in grant funding awarded to consult requestors for every $1 of staff and faculty effort in these services.

Implications for D&I Research: Return-on-investment numbers highlight how critical and productive it is for research institutions to incorporate implementation science resources and services into their research infrastructure.

Primary Funding Source

National Institutes of Health.

¹Baylor College of Medicine, Houston, TX, USA; ²Veterans Health Administration, Houston, TX, USA; ³Case Western Reserve University, Cleveland, OH, USA

Correspondence: Kyler Godwin ([email protected])

Implementation Science 2025, 20(1):S19

Background

Failure is not uncommon in healthcare improvement. When faced with failure in an improvement project, it is critical to distinguish between failure as part of the process or failure as a result of the misapplication of theory and implementation strategies. The VA Quality Scholars (VAQS) Healthcare Improvement Tool (VAQS HIT) was developed to provide frontline providers with an approachable framework for incorporating multiple implementation and improvement strategies into a single project. The VAQS HIT was designed to support project planning, to track project progress, and to identify organizational barriers to change.

Funded through the Department of Veterans Affairs, the VAQS program was founded in 1998 and is a 2-year interprofessional Advanced Fellowship in healthcare improvement and implementation. The VAQS program trains clinician leaders in improvement and implementation at 10 sites. Sites are comprised of interprofessional clinical fellows and faculty. Here we describe the development and utilization of the VAQS HIT.

Methods

The VAQS HIT was iteratively developed by an interprofessional team including physicians, nurses, clinical psychologists and implementation scientists. The tool was initially developed in 2017 and was iteratively refined until 2019 by 7 different key partner groups. The tool includes components from Model for Improvement, Theory of Innovation, Change Management, Lean Management, Value-Based Care, Human-Centered Design, and Implementation Science. Each section of the tool walks the user stepwise through every component of a project with questions to consider at that step of the project. The tool aligns with the SQUIRE 2.0 guidelines to foster publication of projects.

Findings

The tool has been disseminated across one local and two national programs, reaching at least 500 users since 2019. Users have reported the tool to aid in their completion of improvement projects, especially if they are new to improvement and/or implementation. One user reported the VAQS HIT to be their favorite and most used framework.

Implications for D&I Research: Improvement and implementation theory and strategies are essential for lasting healthcare change. However, theories and frameworks are not accessible for most frontline providers. A user friendly, integrated tool can foster the appropriate application of theory and strategies to foster healthcare improvement.

Primary Funding Source

Department of Veterans Affairs

¹University of Kansas Medical Center, Kansas City, KS, USA; ²Health Bourbon County Action Team, Fort Scott, USA

Correspondence: Edward Ellerbeck ([email protected])

Implementation Science 2025, 20(1):S20

Background

The COVID-19 pandemic reinforced the need to dramatically enhance the engagement of community members in public health planning, not only to improve our response to public health emergencies but also to better address upstream determinants of health and mitigate the downstream consequences of social inequities. The Communities Organizing to Promote Equity (COPE) project aimed to build capacity for local community-driven responses to public health issues and future emergency response that elevates community engagement to prevent disproportionate impact on historically resilient populations. We assessed the social network established by the COPE project to illustrate how building relationships can effectively reach highly vulnerable individuals and improve health outcomes.

Methods

As an academic-community partnership, COPE established Local Health Equity Action Teams (LHEATs) in 20 Kansas counties comprised of community members, service providers, and community health workers (CHWs) who identified resources within their communities, developed strategies to address community needs, and disseminated information about local resources. Data documented from June 2021 to December 2023 included organizational partners’ contact information, facility details, available resources, and their contributions to COPE clients. Geocoded address data was spatially joined to census block groups and merged with Area Deprivation Index (ADI) state decile rankings to identify the highest-risk neighborhoods (ADI ≥7) and to analyze the formation, distribution, and frequency of organizational partnerships in these areas.

Findings

The LHEATs established a total of 2,435 community partners, which included governmental agencies, community-based organizations, faith-based institutions, healthcare facilities, K-12 schools, academic institutions, correctional facilities, law enforcement, social service providers, and corporations. During the first year since project initiation, the LHEATs established 999 partnerships, more than doubling this number in year two. Of these partners, 1,750 were included in the final density analysis, with 63% (n=1,105) operating from locations within high ADI areas. Among COPE clients who provided an address that could be geocoded, 69% (n=1938/2797) of individuals reached by CHWs and partners residedin areas of high deprivation.

Implications for D&I Research: Applying GIS technology to CBPR evaluations can enhance gap analysis and identify high-need areas to improve planning, prioritization, allocation, and utilization of public health resources and services concurrently and in future initiatives.

Primary Funding Source

Centers for Disease Control and Prevention

¹University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; ²George Mason University, Arlington, VA, USA; ³University of Washington, Seattle, WA, USA

Correspondence: Tonya Van Deinse ([email protected])

Implementation Science 2025, 20(1):S21

Background

Specialty mental health probation (SMHP) officers supervise people with serious mental illnesses and link them to mental health treatment. Whether and how quickly this service linkage occurs depends on multiple factors, including the existence of community-based service providers, officers’ capacity, and officer-provider relationships. Despite the importance of these inter-organizational relationships, there is little focus on collaboration between SMHP officers and service providers and the resources that can be leveraged to enhance service linkage. These limitations are problematic given low rates of treatment engagement, higher rates of recidivism, and the need for timely access to services for people with serious mental illnesses.

Methods

Study methods were guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework. The research team conducted a document review (n=139) and interviewed 40 representatives from probation and behavioral health service providers. Data were analyzed using consensus-based strategies and an EPIS-informed codebook defining factors that impact cross-agency collaboration and recommendations for strategies to enhance collaboration and service linkage. Strategies for enhancing inter-organizational collaboration were coded using the Expert Recommendations for Implementing Change (ERIC).

Findings

There were five foci of officer-provider collaboration and coordination: service linkage and referrals, information sharing, compliance checking, problem-solving, and crisis management. The degree and form of collaboration varied by county and treatment provider. Participants identified multi-level factors that impact collaboration, including factors at the client level (e.g., treatment engagement), officer level (e.g., mental health knowledge, workload, attitudes about collaboration), probation organization (e.g., staffing, leadership), behavioral health provider (e.g., staffing, attitudes about criminal legal system), inter-organizational level (e.g., intermediaries, interpersonal relationships), and community level (e.g., service availability). ERIC-based strategies to increase occurrence and pace of collaboration included: promoting network weaving, tailoring strategies, mandating change, and obtaining formal commitments.

Implications for D&I Research: This research contributes to the limited application of implementation science methods within criminal legal systems. Given the high rates of mental illness and other co-occurring disorders within criminal legal systems, health interventions in corrections settings are likely to grow more common, thus increasing the need to use evidence-based methods and implementation science strategies to successfully implement effective interventions across criminal legal settings.

Primary Funding Source

National Institutes of Health

¹Florida State University, Tallahassee, FL, USA; ²Rutgers University, New Brunswick, NJ, USA

Correspondence: Gretchen Stahlman ([email protected])

Implementation Science 2025, 20(1):S22

Background

The COVID-19 pandemic highlighted critical contributions of data dashboards to timely, unrestricted, and equitable access of decisionmakers to actionable public health data. Given their ubiquity and appeal to diverse users, dashboards are cost-effective tools for sharing actionable information and insights and are also recognized for their democratizing potential. As they are poised to become more integral to public health decision-making at local, state, and national levels, it is imperative to proactively consider how they may be best designed, implemented, improved, and sustained to accelerate implementation of sound, equitable, and effective public health policies and practices.

Methods

Extensive mapping and analysis of the current landscape of public health data dashboards was conducted via the combination of a scoping review of the literature (n=89 academic and grey literature publications), theory-driven coding and analysis of a probability sample of current (2024) national and state public health dashboards (n=210), and semi-structured interviews with designers of frequently utilized dashboards (n=6). Data analyses focused on clarifying the conception and operationalization of actionability relative to implementation, design best practices, and capacity for institutionalizing use of these tools.

Findings

The current landscape of public health dashboards is considerably fragmented, lacking common standards or coherent focus regarding goals, design, usability, usefulness, and intended impact of these tools, as well as capacity-relevant factors necessary for successful adaptation across users, applications, and settings. Dashboard actionability is more complex and multifaceted than portrayed in the implementation literature. Among others, it is a function of user factors (e.g., capacity, needs); characteristics of available data (quality, completeness, relevance, timeliness, granularity); function (surveillance, analysis, prediction); decisional goals (strategic, tactical, or operational); context or setting of implementation (policy, practice, system change); and design elements (usability, functionality, interactivity, customization). To accelerate implementation, it also requires consistent and informed use of these tools, including standards regarding appropriate and ethical use, thoughtful integration with existing systems and routines, and sustained sources of funding.

Implications for D&I Research: Actionable data dashboards have significant potential to support implementation, but additional research and investments are needed to adopt a systematic approach and a template for designing and deploying these tools.

Primary Funding Source

The Robert Wood Johnson Foundation

¹NYC Department of Health and Mental Hygiene, Long Island City, NY, USA; ²Northeast/Caribbean AIDS Education and Training Center at Columbia University, New York, NY, USA

Correspondence: Cristina Rodriguez-Hart ([email protected])

Implementation Science 2025, 20(1):S23

Background

Effective stigma reduction interventions are urgently needed in healthcare organizations to improve patient engagement with HIV services. Stigma is a pervasive, structural problem, yet interventions within clinics overwhelmingly target the knowledge and attitudes of individual providers. Organization-wide determinants and strategies remain understudied. Implementation science (IS) frameworks and methods have the potential to accelerate the uptake of systems-level stigma interventions. We will present the New York City (NYC) Health Department’s five-year experience integrating IS to tackle HIV-related stigma as part of NIMH-funded Exploration and Preparation phase Ending the HIV Epidemic studies. This collaborative work with academic and State Health Department partners produced innovations and recommendations for sustainment of stigma reduction.

Methods

Multiple methods were utilized to systematically review and characterize tested stigma interventions in the US, and NYC healthcare organizations’ emerging efforts to address HIV-related stigmas and Health Department implementation strategies to promote stigma reduction. Implementation strategies utilized by the Health Department were mapped to the Expert Recommendations for Implementing Change (ERIC) taxonomy.

Findings

We will present barriers, facilitators, and strategies to address stigma from 27 NYC HIV healthcare organizations, contextualized via a broader systematic review of 28 studies of stigma interventions in healthcare sites across the U.S. We found that NYC HIV organizations were implementing stigma-reduction activities at multiple levels, but many were not sustained. Utilizing these findings from early-stage Exploration, Preparation, Implementation, Sustainment (EPIS) research, we created tools to expand traditional conceptions of organizational capacity-building for stigma reduction, including a new tool for healthcare organizations to institutionalize stigma reduction. We will recommend a number of strategies for public health funders and healthcare settings to implement in order to optimize the potential to sustain stigma-reduction initiatives that impede HIV service engagement.

Implications for D&I Research: Due to their far-reaching funding, data collection and monitoring, and training functions, health departments are optimally suited as bridging factors to accelerate the uptake and sustainment of stigma-reduction initiatives in healthcare settings. The tools, approaches, and lessons learned from our experience can be used by other public health and clinical funders, capacity-building entities, and researchers working in or with these institutions. Investing in the early EPIS stages optimizes sustainment potential.

Primary Funding Source

National Institutes of Health

¹Weill Cornell Medicine, New York, NY, USA; ²Boston College, Boston, MA, USA; ³Northwestern Feinberg School of Medicine, Chicago, IL, USA; ⁴Washington University in St. Louis, St. Louis, MO, USA

Correspondence: Radhika Sundararajan ([email protected])

Implementation Science 2025, 20(1):S24

Background

Implementation research values context, but existing theories, models, and frameworks primarily evaluate context relative to its constituent parts (e.g., Pfadenhauer, EPIS). Thus, the field lacks unifying theories as to how context influences implementation actors and how the context for implementation is itself shaped by actors'activities.

Methods

We conducted a hermeneutical review to explore the emergent meanings of “context” and “actor” in existent implementation science (IS). Using a “hermeneutic loop,” we iteratively examined these concepts under the lens of social science theories that address human agency under social constraints, focusing on how structure and agency gain meaning within implementation contexts.

Findings

Frameworks that classify domains of context imply that these domains (e.g., rules, regulations, social, and economic factors) impact actors in the implementation process (e.g., patients, healthcare workers, administrators). However, structure-agency social theories can enhance the understanding of context-actor dynamics in three key ways:

Implications for D&I Research: Interpreting context-actor dynamics through structure-agency theorizing provides explanatory and predictive power to implementation science. Understanding contexts and actors through structure-agency paradigms reveal mechanisms of social forces, guiding the identification of implementation problems, targeting their source for intervention, and designing solutions cognizant of epistemic, material, and social power, oppression, and resistance. Such accounts shift us beyond essentialist explanations, strengthening our understanding of relational networks that support successful and sustainable implementation of new innovations and social practices.

¹Boise State University, Boise, ID, USA; ²Northwestern University Feinberg School of Medicine, Chicago, IL, USA; ³Kaiser Permanente Colorado, Denver, CO, USA; ⁴Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; ⁵Henry Ford Health, Detroit, MI, USA; ⁶School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA

Correspondence: Nate Williams ([email protected])

Implementation Science 2025, 20(1):S25

Background

One way to increase the pace of implementation is to uncover the minimum necessary mechanisms activated by effective implementation strategies. The Adolescent and child Suicide Prevention in Routine clinical Encounters (ASPIRE) trial demonstrated that adding practice facilitation to an electronic health record (EHR) reminder and clinician training (“Nudge+”) increased reach of an evidence-based firearm storage program (S.A.F.E. Firearm) to youths (ages 5–17) in pediatric primary care by 27-percentage-points (N=47,307), relative to the reminder and training alone (“Nudge”). In the present analysis, we used mixed methods to examine the mechanisms through which facilitation increased program reach.

Methods

ASPIRE was a hybrid type III effectiveness-implementation trial in which 30 practices were randomized to Nudge or Nudge+ to test which strategy was most effective for increasing reach of S.A.F.E. Firearm. Reach was defined as parent receipt of both components of S.A.F.E. Firearm (i.e., brief counseling and offer of cable lock) during a well-child visit. Quantitative mediation analyses tested whether the superiority of practice facilitation (Nudge+) was explained by increased practice adaptive reserve (i.e., clinic-level capacity to make and sustain change). Qualitative analyses of semi-structured interviews with 37 clinic leaders, change agents, and clinicians explored alternative mechanisms through which facilitation enhanced reach.

Findings

Mediation analyses indicated facilitation’s superior effect on reach was not explained by improved practice adaptive reserve. Qualitative analyses indicated facilitation’s superiority may be explained by the increased logistical support, tailoring of supports to clinic context, reinforcement of clinician training, fostering of positive relationships within clinics, and increased constituent buy-in to the program, promoted by facilitators.

Implications for D&I Research: Whereas previous research suggests facilitation works by increasing practice adaptive reserve, results from ASPIRE indicated other factors were most important for explaining how facilitation influenced reach relative to the EHR reminder and training alone. These differences may be due to the less complex practice being implemented (S.A.F.E. Firearm) in the ASPIRE trial relative to prior research, and the less intensive nature of facilitation (8.7 hours per clinic over 12 months). The elucidation of these factors as potential mechanisms of facilitation, and the identification of potential moderators of facilitation’s effects (e.g., intervention complexity), are important areas of future inquiry.

Primary Funding Source

National Institutes of Health.

¹Tufts University, Boston, MA, USA; ²University of Pennsylvania, Philadelphia, PA, USA

Correspondence: Travis Moore ([email protected])

Implementation Science 2025, 20(1):S26

Background

Addressing complex public health challenges requires methodologies that adapt to complexities and optimize the pace of implementation. Traditional implementation mapping often overlooks the multifaceted nature of these issues and the optimal speed at which interventions should be developed. A systems modeling approach, using qualitative and computational models to analyze dynamic interactions within complex systems, addresses this gap by informing the design and implementation of more effective interventions. We developed a novel approach to integrate systems science with implementation mapping to address the complexities of child health equity more effectively.

Methods

We used participatory systems modeling which engaged community partners and researchers in co-creating conceptual and simulated models of research adoption behavior in community coalitions to promote child health equity. Participatory systems modeling approaches (e.g., causal loop diagrams, social network analysis) were integrated in iterative phases to co-design implementation interventions. We combined the sequential development of an implementation intervention with qualitative and quantitative models to identify mechanisms of research adoption behavior in community coalitions.

Findings

Five cross-sector community partners (e.g., hospital, community-based organization, school), two expert modelers, and one graduate student participated in ten community advisory council meetings that integrated systems science and implementation mapping. Participatory systems modeling tools included variable elicitation and ranking to create conceptual and qualitative systems models (e.g., theory of systems change) and quantitative systems models (e.g., stock and flow diagrams, sociograms, directed acyclic graphs). We found participatory systems modeling effective in identifying and addressing emergent system behaviors and complex interdependencies that traditional methods may overlook. Initial planning phases revealed the complexity of health systems, prompting a slow and iterative process. The resulting conceptual models visually displayed feedback loops and nonlinear dynamics, aiding the formulation of quantitative models tailored to simulate intervention strategies.

Implications for D&I Research: Integrating systems science and participatory modeling within implementation mapping provides a robust framework for developing, testing, and refining public health interventions. This approach, while slower at first, may support an expedited decision-making process during intervention implementation for addressing complex public health challenges. Future research should explore the application of this integrated approach across different public health issues and contexts to validate its effectiveness and adaptability.

Primary Funding Source

National Institutes of Health

¹Center for Translation Research and Implementation Science; National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA; ²Division of Lung Diseases; National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA; ³National Heart, Lung, and Blood Institute; Office of Clinical Research, National Institutes of Health, Bethesda, MD, USA

Correspondence: Veronica Tutse-Tonwe ([email protected])

Implementation Science 2025, 20(1):S27

Background

As Implementation Science (IS) enters its third decade as a formalized science, oversight of IS clinical trials takes on increasing importance. Current oversight practices, including Data Safety Monitoring Board and Institutional Review Board roles and responsibilities, protocols, and data quality assurance, adverse events reporting, are modeled after traditional drug and device safety trials, which do not address the unique challenges of IS trials. To advance the field, The National Heart, Lung, and Blood Institute led a workshop on December 2023, titled “Optimizing Oversight of Implementation Science Clinical Trials: Sharing Best Practices & Lessons Learned” to identify the challenges and opportunities in IS clinical trial oversight and the optimization of policies and procedures.

Methods

The workshop convened 18 IS subject matter experts and investigators. Presentations and discussions were recorded and transcribed for data extraction focusing on four main areas: (a) monitoring plans and oversight (b) trial designs and protocol development considerations, (c) clinical trials in low resources settings, and (d) defining adverse events, serious adverse events and unanticipated problems.

Findings

This presentation will surface 21 key themes across four main areas organized by unique issues, relevance to IS, and opportunities/solutions. Key themes that emerged from the workshop discussions include: (a) Implementation strategy operationalization, execution/adaptation, monitoring and reporting requires substantive expertise, pragmatic methods/tools, quality data management, and oversight that may be difficult to locate or curate. (b) IS interventions are frequently at the system or site level, whereas traditional clinical trials randomize at the individual patient level. Protocol templates need to be adapted for IS trials and hybrid studies. (c) Recognizing the importance of engaging local partners, adapting to context-specific challenges and ensuring ethical and culturally sensitive approaches in IS clinical trial oversight in low-resource settings is paramount. (d) Adverse event reporting in IS trials demands distinguishing IS adverse events from those naturally occurring in the patient population and distal harms (i.e., patient level adverse effects).

Implications for D&I Research: This workshop brings to light key issues that must be addressed for appropriate oversight of implementation science clinical trials that not only ensures the safety of study participants, but the quality and accuracy of the data acquired.

Primary Funding Source

National Institutes of Health.

¹Center for Translation Research and Implementation Science; National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA; ²National Institutes of Health, Bethesda, MD, USA

Correspondence: Cara Lewis ([email protected])

Implementation Science 2025, 20(1):S28

Background

To advance the scientific and practical impact of study findings beyond a single trial, it is critical to build in parameters for study execution, monitoring, and reporting of implementation strategies. To this end, the National Heart, Lung, and Blood Institute (NHLBI) federal team offered guidance for articulating implementation strategy tracking procedures in a Manual of Procedures (MOP) to teams in the Disparities Elimination through Coordinated Interventions to Prevent and Control Heart and Lung Disease Risk (DECIPHeR) Alliance. This guidance aimed to ensure (a) adherence to the independent variables (i.e., implementation strategies) and (b) unified clarity on what was in/out of scope for execution with integrity, thereby increasing transparency, replicability and enabling the scale and spread of findings.

Methods

DECIPHeR teams addressed the following prompts in their MOPs: (i) operationalize implementation strategies using a reporting framework; (ii) define strategy functions; (iii) list the universe of discrete strategies that may be deployed; (iv) provide examples of anticipated strategy tailoring; (v) articulate which adaptations would be considered fidelity-consistent versus inconsistent; (vi) detail adaptations and tracking system. The NHLBI federal team reviewed MOPs using a checklist and provided asynchronous feedback. Technical Assistance (TA) sessions allowed for in-depth probing of MOP elements, from which the federal team extracted themes for the field to consider.

Findings

Six key themes arose from this TA. (1) Teams were able to prospectively articulate the universe of discrete strategies from which practice facilitators could choose. (2) Although form versus function is a helpful heuristic, further work is needed to explore limitations in guiding adaptation. (3) The how was often missing from MOPs (e.g., how to select strategies, how strategies work). (4) Numerous MOPs described implementation strategy delivery that used grant funds to pay implementers, but they lacked cost assessment to inform sustainment, scale, and spread. (5) Instances occurred in which teams, notably community partners, were enacting strategies without capturing them in their tracking systems. (6) Clear role definitions and comprehensive training were essential for execution and monitoring.

Implications for D&I Research: Despite advances in methods for tracking implementation strategies, more pragmatic methods are needed to capture deployment details, emergent barriers, and unplanned strategies.

Primary Funding Source

National Institutes of Health.

¹University of Utah, Salt Lake City, UT, USA; ²Northwestern University Feinberg School of Medicine, Chicago, IL, USA; ³Montana State University, Bozeman, USA

Correspondence: James Merle ([email protected])

Implementation Science 2025, 20(1):S29

Background

Characterizing, tracking, and reporting implementation strategy use and adaptations over time is critical for advancing the science. The Longitudinal Implementation Strategy Tracking System (LISTS) method was developed to advance the science of strategy tracking toward greater rigor, transparency, and use of common data elements to aid data synthesis. Application of the LISTS tool has led to the identification of common use scenarios, which range from different implementation contexts and stages of implementation research, that necessitate different considerations for using the LISTS method.

Methods

The presentation will focus on three common use scenarios of the LISTS method. The first case example, which involves implementing the Kaiser bundle for blood pressure control within faith-based organizations and community health centers on Chicago’s South Side, is of a fully prospective application of the LISTS method from the onset of study planning throughout implementation. The second example incorporates the LISTS method during active implementation of a cancer symptom management intervention in a large health system of ambulatory oncology practices. The third example is an illustration of using LISTS during a study of Turtle Island Tales, an evidence-based program for childhood obesity prevention for American Indian communities, that is being scaled out from mailed, at home delivery to implementation in Head Start programs—this is an example of a study occurring within a broader program of implementation.

Findings

Methodological suggestions and lessons learned for using the LISTS method across common scenarios include: (a) the importance of designating a trained lead for initial completion and specification of strategies and adaptation tracking; (b) identifying and communicating key concepts and distinctions (e.g., program components and adaptations vs. implementation strategy components and adaptations); (c) establishing structured meeting schedule with team members and implementers to track adaptations over time.

Implications for D&I Research: The LISTS method increases the rigor and transparency of implementation strategy tracking. Those interested in tracking implementation strategy use and adaptations over time will be introduced to the freely accessible LISTS online tool and presented with data from illustrative examples across three implementation research projects representing common scenarios in which the LISTS method can be applied.

Primary Funding Source

National Institutes of Health.

¹University of Michigan Medical School, Ann Arbor, MI, USA; ²Veterans Health Administration, Ann Arbor, MI, USA; ³VA QUERI Center for Evaluation and Implementation Resources (CEIR), Ann Arbor, MI, USA

Correspondence: John Donnelly ([email protected])

Implementation Science 2025, 20(1):S30

Background

The Veterans Affairs Quality Enhancement Research Initiative (VA QUERI) funds centers to partner with health system leaders, Veterans, providers, and other frontline staff to implement evidence-based practices (EBPs). Prior work has highlighted the importance of standardized terminology to describe how strategies for improving uptake of EBPs are operationalized in VA QUERI. In response, we conducted an audit using a reporting form to better understand the use of strategies across centers.

Methods

We developed a standardized electronic reporting form based on the Expert Recommendations for Implementing Change (ERIC) taxonomy and previously refined groupings. We asked centers to report on strategies at the project level, as it is common for teams to implement multiple EBPs. Prior to fielding in May-June 2024, we iteratively reviewed the form with subject matter experts. In our analysis, we determined how frequently strategies were used and identified strategies that were often used together. We also determined how frequently frameworks or specific study designs were used and assessed respondent opinions.

Findings

We identified a total of 58 projects across 17 centers. All centers responded, with forms completed for 54/58 projects (93.1%). The most common broad strategy groupings endorsed were “Education” (94.4%), “Interested Parties” (90.7%), “Assistance” (87.0%), “Tailoring” (87.0%), and “Evaluation” (87.0%). The most common individual strategies endorsed were “Assess for Readiness and Identify Determinants” (81.5%), “Facilitation” (79.6%), and “Distribute Educational Materials” (75.9%), with more than half of the centers (57.4%) endorsing use of all three strategies. Most centers reported using CFIR or RE-AIM frameworks together or separately (CFIR 22.2%; RE-AIM 33.3%; Both 24.1%). Most centers reported conducting hybrid implementation-effectiveness projects (64.2%), and many used observational designs (47.2%). Nearly all centers indicated that the form was able to capture information “Well” or “Very Well” for strategies and study designs (98.1% and 94.4%, respectively).

Implications for D&I Research: Our findings highlight the types of strategies, frameworks, and designs used to support EBP implementation within VA QUERI. Although the reporting form was brief, respondents indicated that it effectively captured information on strategy use and study design. This work expands on existing infrastructure and provides foundational information which will support comparisons of the relative effectiveness of discrete strategies.

Primary Funding Source

Department of Veterans Affairs.

University of Pennsylvania, Philadelphia, PA, USA

Correspondence: LauraEllen Ashcraft ([email protected])

Implementation Science 2025, 20(1):S31

Background

We reviewed empirical studies of implementation strategies, agnostic to setting and EBP, to answer three questions. 1. What implementation strategies have been most commonly and rigorously tested in health and human service settings? 2. Which implementation strategies were commonly paired? 3. What is the evidence supporting commonly tested implementation strategies?

Methods

The systematic review was of US and international studies experimentally testing implementation strategies reported in English from 2010-2022. Two investigators reviewed each title, abstract, and full text. We conducted a standardized assessment of each study’s rigor, only including high quality studies. We abstracted information about the context, outcomes assessed (categorized by REAIM: Reach, Effectiveness, Adoption, Implementation, and Maintenance), and implementation strategies (categorized by the ERIC taxonomy: Expert Recommendations for Implementing Change). We calculated descriptive statistics of the distribution of implementation strategies and the extent to which implementation strategies were associated with (i.e., co-occurred) with significant REAIM outcomes.

Findings

Our search resulted in 7,206 articles. We identified 143 publications representing 129 studies which met our inclusion criteria. Studies used an average of 1.64 strategies in their Control Arm and 8.33 in the Experimental Arm. Effectiveness (n=82; 64%) and Implementation (n=73; 56%) were the most reported outcomes. 19 implementation strategies were in the Experimental Arm of more than 8.5 studies (median across all studies) and co-occurred with significant outcomes in more than 75% of those studies (median across all studies). Of these, Conduct Educational Meetings, Distribute Educational Materials, External Facilitation, and Audit and Provide Feedback continued to occur frequently, appearing in 59–99 studies, representing 75–84% co-occurrence with significant outcomes.

Implications for D&I Research: Researchers and healthcare settings require support to identify evidence-based implementation strategies. This study is the first to review the large body of global studies on strategy effectiveness across setting and EBP. While identifying strategies with stronger evidence, we also propose four recommendations for future studies: 1) Prespecify strategies using standard nomenclature; 2) Ensure that standards for measuring and reporting implementation outcomes are consistently applied and account for the complexity of implementation studies; 3) Develop infrastructure to learn lessons across multiple implementation studies; 4) Develop and apply methods to rigorously study common strategies and bundles.

Primary Funding Source

Combination of sources.

RAND Corporation, Boston, MA, USA

Correspondence: Joachim Hero ([email protected])

Implementation Science 2025, 20(1):S32

Background

Health care organizations, specifically within the US policy context, have lacked accessible resources to help them select the best implementation strategies to support evidence-based practices (EBP). To address this need, we conducted an in-depth review of quantitative US research using studies from an existing systematic review. We used a novel approach to synthesize both direct (e.g., strategies tested independently) and indirect (e.g., strategies tested in combination with other strategies) evidence.

Methods

The Expert Recommendations for Implementing Change (ERIC) taxonomy of implementation strategies, slightly modified for this project, was used to categorize the strategies used and tested in each study. For US studies (n=56), three sources of evidence were evaluated and reported: direct evidence (tests of a single strategy), indirect evidence (tests of strategies in combination), and evidence from previous systematic reviews. For a subset of some of the most commonly used strategies, these sources of evidence were synthesized to assign strength-of-evidence judgements ranging from supported to inconclusive. Patterns of strategy co-occurrence within a single implementation effort were also described. To make the results of the review more accessible to varied interests, a report summary and a website with interactive visualization tools were developed to help users to navigate information collected on strategies that match their needs.

Findings

Five strategies had the highest overall level of support: Provide implementation facilitation using external facilitators, Audit and provide feedback, Clinical Decision Support, Remind clinicians (clinical reminders), and Prepare patients/consumers to be active participants. Most studies tested bundles of multiple implementation strategies. Learning collaboratives, assess and redesign workflows, and clinical reminders were the next most supported strategies. Two strategies—conduct educational meetings and distribute educational materials to clinicians—were found to be a basic element of most implementation efforts.

Implications for D&I Research: We found that certain consultative and evaluative strategies have strong evidence supporting their effectiveness in promoting EBPs. Most evidence comes from studies where multiple strategies are used in combination, making it challenging to isolate their individual impact. Future research should focus on both evaluating individual strategies to better understand their unique contributions and common bundles to learn about synergies among strategies.

Primary Funding Source

Patient-Centered Outcomes Research Institute.

Veterans Health Administration, Ann Arbor, MI, USA

Correspondence: Jessica Dodge ([email protected])

Implementation Science 2025, 20(1):S33

Background

A systematic review of 129 US and international studies empirically testing implementation strategies in a healthcare setting identified frequencies of strategies used across various implementation outcomes and that most studies used multiple strategies. The review did not identify which strategy(ies) led to a study having significant implementation outcomes. Therefore, we applied Coincidence Analysis (CNA) to those same 129 studies to untangle which implementation strategies are leading to significant implementation outcomes.

Methods

Coincidence Analysis (CNA) was used for factor selection and analysis. The Expert Recommendations for Implementing Change (ERIC) taxonomy of implementation strategies was used to categorize strategies. Only 71 of 73 possible strategies ever led to any implementation outcome and those were considered in the factor selection process. CNA was also used to analyze which implementation strategies across 129 studies led to any significant implementation outcome within the Research, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Factor selection was done using the “minimally sufficient condition” function in R&R Studio. Several iterations of CNA were run on the final list of factors selected. This final step included the “frscore” function to account for potential model ambiguity as well as to ensure the best model was selected. This approach was run on each RE-AIM outcome.

Findings

The final model showed four distinct pathways to significant implementation outcomes across any RE-AIM outcome: (1) Identify and prepare champions OR (2) Assess and redesign workflows OR (3) Conduct cyclical small tests of change OR (4) Audit and provide feedback AND Conducted educational meetings. These four pathways independently explained 65% of the cases with any RE-AIM significant outcome (coverage score) with 85% accuracy (consistency score). Not all RE-AIM outcomes had significant CNA solutions. Of the sub analyses that had significant solutions, there was overlap in some difference making strategies (e.g., Assess and redesign workflows).

Implications for D&I Research: This study shows that there is not one pathway for implementation success and demonstrates the utility of CNA in implementation science. With proper documentation of implementation strategies, CNA could be a more useful method in future studies to assess individual strategies, even when used in a bundle.

Primary Funding Source

Department of Veterans Affairs.

Carly Comins¹, Becky Genberg¹, Mfezi Mcingana², Karen Bandeen-Roche¹, Rene Phetlhu³, Joel Steingo², Sharmistha Mishra^4,5, Stefan Baral¹, Harry Hausler^2,6, Sheree Schwartz¹

¹Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; ²TB HIV Care, Cape Town, South Africa; ³Sefako Makgatho Health Sciences University, Pretoria, South Africa; ⁴Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Canada; ⁵Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada; ⁶University of Pretoria, Pretoria, South Africa

Correspondence: Carly Comins ([email protected])

Implementation Science 2025, 20(1):S34

Background

Tailored implementation strategies to promote the uptake and scale-up of antiretroviral therapy (ART) among female sex workers (FSW) in South Africa are needed, as less than half of FSW living with HIV are on ART and <40% are virally suppressed. Identifying patterns in engagement with strategies and how heterogeneous engagement is related to outcomes may help tailor services.

Methods

We conducted a randomized trial testing two HIV treatment support strategies (decentralized treatment provision (DTP); individualized case management (ICM)) among 777 FSW living with HIV and not virally suppressed (≥50 copies/mL) in Durban, South Africa, June 2018 - January 2022. We defined strategy engagement in a six-month interval if the monthly strategy session was delivered and the FSW participated. Group-based trajectory modeling with logit response function was used to identify groups of FSW with similar engagement trajectories and to describe correlates of trajectories. We used Poisson regression analysis with robust variance estimation to assess the association between assigned trajectory group and 6- and 18-month retention and viral suppression (<50 copies/mL).

Findings

At baseline, 389 FSW were randomized to DTP and 390 were randomized to ICM and followed for 18-months. We identified four trajectories: no engagement (12%), late engagement (10%), engagement alongside study visits (53%), and consistent engagement (25%). FSW who were older, unmarried, previously received ART at the implementing organization, and assigned to the DTP strategy were more likely to be classified in the consistently engaged trajectory compared to the no engagement trajectory. The prevalence of 6- and 18-month retention and viral suppression was higher among FSW assigned to the consistent engagement trajectory compared to the no engagement trajectory (prevalence ratio [PR]=14.4, 95% confidence interval [CI] 3.6–58.3; PR= 2.9, 95%CI 1.5–5.5, respectively).

Implications for D&I Research: Person-centered HIV services that address unmet treatment needs could improve health, viral suppression, and subsequently reduce population-level HIV transmission. We found, only a quarter of FSW consistently engaged; those engaged were more likely to be retained and virally suppressed. These data provide insights into who strategies worked for, informing the need for future strategy design and implementation among younger FSW and those not in HIV care.

Primary Funding Source

National Institutes of Health.

¹Pacific Institute for Research and Evaluation (PIRE), Chapel Hill, NC, USA; ²Kenya Medical Research Institute (KEMRI), Kisumu, Kenya

Correspondence: Winnie Luseno ([email protected])

Implementation Science 2025, 20(1):S35

Background

Stigma, delayed disclosure to caregivers, and inadequate social support constitute significant barriers to optimal engagement in antenatal care and prevention of mother-to-child transmission of HIV services for pregnant adolescents living with HIV (PrALHIV). We employed an iterative, human-centered design approach with unmarried PrALHIV and caregivers in western Kenya to create and test a digital intervention to address stigma, delayed disclosure, and lack of social support.

Methods

We conducted 22 individual interviews with unmarried PrALHIV aged 15–19 and 24 “dyadic” interviews with PrALHIV and their adult caregivers. Using these data, we developed a digital intervention prototype. Subsequently, we conducted four focus groups with 22 PrALHIV to gather feedback on prototype content and features. Focus group findings informed the next prototype iteration. Finally, we conducted a one-arm pre/post (two-week follow-up) pilot involving 30 PrALHIV to evaluate the intervention’s acceptability, usability, and preliminary efficacy. All study activities were approved by the PIRE and KEMRI ethics review committees.

Findings

Interviews revealed five patterns of pregnancy/HIV disclosure: Direct, Indirect, Mediated, Accidental, and Caregiver-initiated. PrALHIV recommended that other similarly situated young women should disclose directly to parents, especially mothers, or use mediated disclosure via trusted adults. Although most PrALHIV interviewees reported having supportive caregivers, some noted that economic challenges made it difficult to request additional pregnancy/baby-related support. Focus group participants rated key prototype features highly (4.1–4.8 on 5-point scale) and provided improvement suggestions. Pilot participants rated the prototype highly on usability and acceptability (4.7–4.9 on 5-point scale). Pre-post analysis revealed statistically significant (p<.05) improvements of moderate effect sizes (.2<d<.8) in the desired direction for HIV self-stigma, HIV and pregnancy disclosure self-efficacy, social support, and anxiety. Key barriers we identified to the use of digital health technologies among PrALHIV included unreliable internet, prohibitive user-end costs, and very low adolescent smartphone ownership.

Implications for D&I Research: Our digital intervention reduced stigma and improved disclosure confidence and social support among PrALHIV. However, existing implementation barriers (e.g., low smartphone ownership) may slow down the pace of individual-level deployment, necessitating identification of alternative strategies (e.g., clinic-based deployment via tablets). Community-engaged research with PrALHIV is crucial to identify effective deployment strategies for widespread adoption and sustainability.

Primary Funding Source

National Institutes of Health

¹Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; ²DESMOND TUTU HEALTH FOUNDATION, Cape Town, South Africa; ³DESMOND TUTU HEALTH FOUNDATION, Baltimore, USA

Correspondence: Carly Comins ([email protected])

Implementation Science 2025, 20(1):S36

Background

In South Africa, 40% of adolescents and youth living with HIV are on treatment, with many experiencing suboptimal viral suppression. Long-acting injectable antiretroviral therapy (LAI-ART) may address a confluence of multilevel barriers to HIV care for youth. The objective of this analysis was to identify the potential determinants of LAI-ART implementation for youth living with HIV.

Methods

Using semi-structured guides informed by the Consolidated Framework for Implementation Research (CFIR), we conducted in-depth interviews with youth living with HIV (n=16) and caregivers (n=8) in Cape Town, and key stakeholders of the South African HIV response including HIV providers and governing officials (n=8) from May2023-May2024. Youth were recruited using maximum variation sampling, and caregivers and other stakeholders were purposively sampled. We deductively coded the transcripts using CFIR2.0, systematically identifying implementation determinants across the five CFIR domains.

Findings

Overall, acceptability and demand for LAI-ART for youth was high across participant types with potential implementation determinants identified across the five CFIR domains. All participants recognized the advantage of LAI-ART over oral pills (i.e., treatment fatigue/burden, social influences, stigma, disclosure). Perceptions of who should be prioritized for LAI-ART varied, yet the importance of choice was emphasized. All providers felt youth were able to decide the best treatment option for them, and most youth and parents agreed. Clinic infrastructure, staffing levels, and access to knowledge and resources were identified as critical to LAI-ART implementation, highlighting a number of strategies to support LAI-ART implementation and retention among youth (i.e., involving caretakers, integrating youth-friendly services/spaces, providing diverse communication methods, ensuring consistency in providers). Further, implementors stated preferences to start LAI-ART implementation at a small number of clinics prior to scale-up, citing the necessity of ensuring feasible implementation, appropriate training, and provider buy-in.

Implications for D&I Research: While perceptions of LAI-ART for youth were generally positive given the adherence facilitation of long-acting treatment over daily oral pills, addressing barriers to LAI-ART implementation will be important to ensure delivery and scale-up is appropriate and feasible. Moving forward, specification and integration of preference-driven strategies will be integral to HIV treatment optimization for youth and improved treatment outcomes.

Primary Funding Source

National Institutes of Health.

¹University of Central Florida, Orlando, FL, USA; ²UC San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, La Jolla, CA, USA; ³University of California, San Diego, San Diego, CA, USA

Correspondence: Alexandra Kandah ([email protected])

Implementation Science 2025, 20(1):S37

Background

The underutilization of evidence-based practices (EBPs) represents a persistent problem for improving healthcare quality and client outcomes. Providers face a variety of demands (e.g., workforce shortages, workload demands, burnout) that can negatively impact their receptiveness to implementation efforts. Guided by job-demands resources theory, this study examined the impact of a variety of job demands (role overload, change fatigue, and burnout) and both personal (proactive personality, prior EBP use) and organizational (organizational support, psychological safety) resources on intentions to use an EBP six months into an ongoing implementation effort. Additionally, we examined whether resources acted as a buffer to reduce the negative impact of demands.

Methods

Service providers (n=82) from eight behavioral health services organizations in one Western state in the United States completed baseline surveys as participants in a stepped-wedge trial examining the impact of the Leadership and Organizational Change for Implementation (LOCI) strategy on the implementation of Motivational Interviewing (MI). Data on burnout, change fatigue, role overload, proactive personality, prior MI use, organizational support, and psychological safety were collected at baseline, and intentions to use MI were collected six months into the implementation. Regression analyses tested the direct effects of both job demands and resources on MI intentions, as well as interactions between each demand and resource on MI intentions.

Findings

The results showed significant direct effects of proactive personality (B=.705, p<.05), prior MI use (B=.544, p<.05), and burnout (B=-.612, p<.05) on intentions to use MI. No significant interactions between any resources and demands were found.

Implications for D&I Research: This study highlights the impact of personal resources (i.e., proactive personality and prior MI use) and job demands (e.g., burnout) on MI intentions during an ongoing implementation effort. The results show that providers with proactive personality and prior use with MI reported greater intentions to use MI six months after the initiation of implementation. Additionally, we found that employees who were burned out at initiation of implementation reported lesser intentions to use MI six months later. Emphasizing the reduction of job demands and the bolstering of resources can be helpful in ensuring effective and sustained EBP implementation.

¹Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA; ²Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA; ³Geisinger Health System, Danville, PA, USA

Correspondence: Cabell Jonas ([email protected])

Implementation Science 2025, 20(1):S38

Background

Clinical guidelines recommend all ovarian cancer patients and survivors receive genetic testing for hereditary cancer risk. Knowledge of a pathogenic genetic variant can guide care for the affected individual and inform at-risk relatives’ decision-making around prophylactic procedures and enhanced cancer surveillance. “Traceback” - retrospectively identifying and offering genetic testing to previously diagnosed cancer survivors has been proposed as a strategy for addressing suboptimal ascertainment of hereditary pathogenic genetic variants. The feasibility and implementation strategies involved in operationalizing Traceback are still being explored.

Methods

As part of a National Cancer Institute-funded cooperative agreement, Geisinger, Kaiser Permanente Mid-Atlantic States (KPMAS), and Kaiser Permanente Washington (KPWA) implemented and evaluated a Traceback program in three clinical settings. After qualitative design work with ovarian cancer survivors, we established design requirements, including patient-preferred outreach methods and messaging. We adapted requirements to each local context and implemented the program at each site. Individuals with ovarian cancer without genetic testing were identified and contacted; cascade testing followed. We assessed genetic testing uptake via clinic records and the implementation outcome of acceptability through patient interviews.

Findings

Implementation strategies were adapted for each site; a nurse coordinator ordered and coordinated genetic testing at KPMAS, Geisinger used posters and outreached to patients with scheduled visits, KPWA conducted letter-based outreach as patient portal messaging was not possible. In total, 130 patients received genetic testing, with the highest at KPMAS (n=74), followed by KPWA (n=37), and Geisinger (n=19). Genetic testing identified 10 pathogenic variants, 38 variants of uncertain significance, and 82 negative results. Interviews with program implementors revealed support for Traceback and suggested preferences for tighter departmental collaboration and more streamlined approaches for identifying patients. Patients found the program acceptable and felt it provided a valued way to gain information that could benefit at-risk relatives.

Implications for D&I Research: This study examined how multiple sites used implementation strategies to optimize implementation for local contexts. A Traceback testing program was implemented at three large health systems serving different populations, was feasible and acceptable to patients and families, and led to genetic testing of untested individuals. Traceback may be feasible for other conditions beyond ovarian cancer, and further research is warranted.

Primary Funding Source

National Institutes of Health

¹Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA; ²Institute for Child Health Policy, University of Florida, Gainesville, FL, USA; ³Department of Pediatrics, College of Medicine,University of Florida, Gainesville, FL, USA; ⁴Regenstrief Institute, Inc., Indianapolis, USA; ⁵Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA; ⁶Wake Forest University School of Medicine, Winston-Salem, NC, USA; ⁷University of Virginia, Charlottesville, USA

Correspondence: Stephanie Staras ([email protected])

Implementation Science 2025, 20(1):S39

Background

In the United States, human papillomavirus (HPV) vaccination rates among adolescents remain lower than recommended by health agencies. One effective implementation strategy to increase vaccination is reminding parents about recommended vaccines with text messages, postcards, or phone calls. We evaluated the effectiveness of text messages at increasing HPV vaccination initiation (1^st dose) rates among 11-to 12-year-olds.

Methods

Florida clinics (n=30) offering primary care to adolescents participated in a doubly randomized two-level nested trial between March 2022 and September 2023. At the clinic-level, clinicians were randomly assigned to vaccine recommendation trainings. Within each clinic, we randomized parents of patients who had received zero adolescent vaccines to be sent text messages or no messages. Text messages were sent at the beginning of the study to parents of 11- to 12-year-olds, before a child’s 11^th birthday, and with appointment reminders. We used generalized estimating equations to calculate Rate Ratios (RRs) for the effect of text messages on one-year initiation adjusting for clinic-level clustering and baseline initiation rates. We estimated pairwise comparisons for increasing number of text messages received (0, 1, 2 or more). Processes were IRB approved. ClinicalTrials.gov NCT05006833.

Findings

Vaccinations were assessed among 6,559 11- to 12-year-olds. Parents of 4,327 kids were assigned to receive text messages and 3203 parents received messages (2,444 received 1 and 759 received 2 or more). The initiation rates were not different between adolescents whose parent was assigned a text message versus not (RR = 1.02, 95% CI 0.96 - 1.09). Initiation rates among adolescents whose parents received a text message versus not were 17% higher (RR= 1.17, 95% CI 1.07 - 1.28). Much of the effect of receiving text messages may be from the group who received 2 or more messages (RR of 1 vs. 0 messages = 1.08, 95% CI= 0.98 - 1.19 and RR of 2 or more vs. 0 messages = 1.47, 95% CI= 1.30 - 1.65).

Implications for D&I Research: Differences occurred between the text message random assignments and received messages. To understand the true impact of a text message strategy in a pragmatic trial, it is necessary to evaluate the effect of these differences.

Primary Funding Source

National Institutes of Health.

¹David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA; ²Veterans Health Administration, Los Angeles, CA, USA; ³Veterans Health Administration, North Hills, CA, USA; ⁴Veterans Health Administration, Seattle, WA, USA; ⁵VA Puget Sound Health Care System, Seattle, WA, USA; ⁶University of Washington, Seattle, WA, USA

Correspondence: Susan Stockdale ([email protected])

Implementation Science 2025, 20(1):S40

Background

The COVID-19 pandemic disrupted primary care delivery, changing how chronic and preventive disease care was provided, potentially impacting morbidity and mortality due to poor management of common chronic diseases. Veterans Health Administration (VA) launched the COVID-19 Preventative Health Inventory (PHI) nationally in March 2021 as a multi-component care coordination intervention embedded in the electronic health record (EHR) to support primary care in delivering chronic and preventive care delayed by the pandemic. Early evaluation showed PHI is a promising approach to addressing disrupted care, but adoption of PHI across clinics varied. We assessed implementation experiences among high- and low-adopting VA clinics.

Methods

Using administrative data, we identified primary care clinics with high and low adoption of PHI (e.g., number of Veterans with documented use per 1000, top 30% vs. bottom 70%). We conducted qualitative semi-structured interviews with nurses and supervisors at 5 high-adopting and 5 low-adopting sites. Using rapid analysis guided by the Consolidated Framework for Implementation Research, we compared high- vs. low-adopting sites, identifying successful implementation strategies, barriers, and facilitators.

Findings

37 nurses (response rate=36%) completed interviews. Interviewees agreed that the PHI was easy to use, although time-consuming and somewhat redundant with other reminder systems for preventive care that were already in place. High and low-adopting sites reported similar implementation strategies (announcement in meetings, group and one-on-one trainings, incorporating into existing workflows). Interviewees at high-adopting sites perceived staff receptivity to PHI implementation as mixed and reported that local leadership encouraged use by setting specific goals and acknowledging teams meeting those goals. At low adopting sites, interviewees said that more training was needed to explain the PHI’s purpose, when to use it, and how to route follow-up care, with most perceiving high receptivity among clinic staff. Low-adoption sites noted beneficial impacts for patients and high-adopting sites identified specific components (hypertension and vaccine screening) as most useful.

Implications for D&I Research: EHR-based tools such as the PHI are commonly used to improve chronic and preventive care delivery in VA, but administrators should carefully weigh considerations of additional workload new tools introduce with value-added for patients when implementing new tools. Additionally, older, redundant tools should be identified and de-implemented.

Primary Funding Source

Department of Veterans Affairs.

¹Yale University, New Haven, CT, USA; ²Northwestern University Feinberg School of Medicine, Chicago, IL, USA; ³RTI International, Greenfield, IN, USA; ⁴Washington University School of Medicine, St Louis, MO, USA

Correspondence: Cecelia Calhoun ([email protected])

Implementation Science 2025, 20(1):S41

Background

Adolescents and young adults with sickle cell disease (AYA-SCD) face increased mortality risk during the transition from pediatric to adult care. The American Academy of Pediatrics (AAP) has published transition guidelines for AYA-SCD, but these are underutilized or unused in many settings. We conducted a multi-method study to identify effective implementation strategies from the Expert Recommendations for Implementing Change (ERIC) compendium to improve the uptake of AAP transition guidelines. We then developed an AYA-SCD focused strategy guide to help clinicians implement these guidelines.

Methods

In Phase 1, we used the Consolidated Framework for Implementation Research (CFIR) to conduct qualitative interviews with healthcare providers to identify determinants to guideline implementation. We then employed the CFIR-ERIC Matching Tool to identify strategies that best address these determinants. In Phase 2, we utilized a quantitative approach from Rogal et. al. to survey AYA-SCD providers on the utilization of these strategies, followed by qualitative interviews to understand their operationalization. This data informed the creation of our strategy guide using the Proctor framework.

Findings

The CFIR-ERIC Matching Tool identified 52 strategies based on 8 high level themes from 14 provider interviews. In Phase 2, 37 hematology providers across 21 organizations participated in the quantitative survey to refine the strategy menu. We identified 37 total strategies that were being used, with 20 strategies employed by over 50% of respondents. Qualitative data from this phase was used to design logic models for each high-yield strategy in the AYA-SCD strategy guide. The guide is written in plain language to reach and support more audiences in implementing successful strategies in their AYA-SCD clinic. The guide provides background and definitions for understanding implementation science and the 8 high-yield strategies, along with logic models, clinical examples, and strategy specification according to the Proctor Framework.

Implications for D&I Research: To accelerate the implementation of transition guidelines for AYA-SCD, we created a strategy guide to help clinicians integrate high-yield strategies into their specific settings. Developed using rigorous implementation science methods, the guide is written for non-experts to maximize reach and facilitate the implementation of the AAP guidelines for this vulnerable population.

Primary Funding Source

National Institutes of Health.

¹Evaluation Sciences Unit, Stanford University School of Medicine, Stanford, CA, USA; ²Stanford University School of Medicine, Stanford, CA, USA; ³Stanford Health Care, Palo Alto, CA, USA; ⁴Evaluation Sciences Unit, Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA

Correspondence: Rachel Siden ([email protected])

Implementation Science 2025, 20(1):S42

Background

The rapid implementation of new digital health technologies to improve the patient experience continues to increase in healthcare settings. However, implementation is often not as simple as merely installing the new technology, and may require changing existing workflows and de-implementing pre-existing analog methods (e.g. paper). Objective: Explore implementation barriers for a rapid rollout of a new app-based patient history questionnaire to replace repetitive paper-based questionnaires in a complex academic center healthcare setting.

Methods

Observations of 10 community and faculty clinics utilizing rapid ethnography approaches. 27 hours of observation, 2 focus groups, and interviews with 100 staff (medical assistants, front desk, physicians/nurses, and managers).

Findings

Paper history questionnaires continued to exist in many settings, and were a barrier to adoption and consistent use of the app. Retaining paper coincided with staff perceptions that paper was more accessible and easier for patients. In these clinics, hierarchical communication to frontline staff during a rapid rollout did not always convey the purpose of the app, how it was intended to benefit patients, or how the new workflows prioritized patient accessibility. It also limited the sharing of feedback from frontline staff back to implementers. De-implementation of paper and adoption of the app was helped by clearly communicating the patient-centered purpose to frontline staff and active bi-directional communication between frontline staff and clinic managers.

Conclusions

Implementation of a digital health technology is helped by fully de-implementing previous analog methods and clearly communicating the purpose and intended benefits to the staff impacted by the change in workflow. Further attention should be paid to: 1) how communication channels dictated by staff hierarchies can limit information sharing, and 2) how there can be divergent perspectives on the extent to which a technology is considered “patient-centered.” Use of rapid ethnography observation methods is effective, and potentially necessary, for exploring on-the-ground implementation barriers with digital health technology adoption.

Implications for D&I Research: While the technological implementation of a new digital health technology to replace an analog method can be done rapidly, the work to sustain the implementation and prevent regression to old methods involves greater care and commitment.

Primary Funding Source

Stanford Health Care.

¹Thomas Jefferson University, Philadelphia, PA, USA; ²Nemours Children's Health, Philadelphia, PA, USA

Correspondence: Neera Goyal ([email protected])

Implementation Science 2025, 20(1):S43

Background

Mothers with opioid use disorder (OUD) have described traditional well child care (WCC) visits as limited in time and resources to comprehensively address their questions and needs, and low attendance to WCC for this patient population has been reported. Group well child care (WCC) may enhance pediatric care effectiveness and engagement, however evidence supporting the use of group WCC for mothers with OUD is lacking. Here we describe implementation and acceptability of a novel group WCC program for mother-infant dyads impacted by maternal OUD.

Methods

In a cluster-randomized controlled trial, dyads were randomized to one of 2 study arms (intervention or usual care [individual WCC]) based on the infant’s date of birth. The intervention was co-located group WCC, defined as the provision of WCC on-site at a maternal OUD treatment program with a group of similarly aged children using a longer visit duration and group discussion. Routine immunizations, screenings, and anticipatory guidance were included in the visit, as well as specific emphasis on maternal wellness and recovery. Acceptability was determined by assessing representativeness of the group WCC cohorts, examining participation in group WCC and attendance at sessions, and reviewing responses to interviews completed by intervention participants.

Findings

Of the 46 enrolled mothers, 27 were randomized to the intervention arm, 5 of which opted out of the intervention after randomization and 22 agreed to participate in group WCC (81% acceptance rate). 95% of the 22 intervention participants attended ≥ 1 group WCC visit; 7 were lost to follow-up due to relapse or discharge from the treatment program. The intervention was implemented among women with varying backgrounds (e.g., racial, ethnic, education level). Intervention fidelity was high, with a median of 2 participants per group WCC visit, and a mean visit duration of 114 minutes. Participant interviews suggest high satisfaction and support intervention acceptability.

Implications for D&I Research: Group WCC co-located with maternal OUD treatment is feasible, acceptable to mothers, and may be associated with increased satisfaction with pediatric care. However, maternal relapse and discharge from treatment present significant challenges to implementation. Future analyses will examine differences in clinical and healthcare outcomes between study arms.

Primary Funding Source

Agency for Healthcare Research and Quality.

¹Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA; ²UMass Chan Medical School, Worcester, MA, USA; ³Boston University School of Public Health, Boston, MA, USA

Correspondence: Shana A. B. Burrowes ([email protected])

Implementation Science 2025, 20(1):S44

Full paper published

¹University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; ²UNC Eshelman School of Pharmacy, Chapel Hill, NC, USA; ³University of Washington, Seattle, WA, USA; ⁴Fred Hutchinson Cancer Center, Seattle, WA, USA

Correspondence: Feyi Odebunmi ([email protected])

Implementation Science 2025, 20(1):S45

Background

Fecal Immunochemical tests (FITs) are effective routine at-home screening methods recommended by the United States Preventive Services Task Force (USPSTF) for the early detection of colorectal cancer (CRC). Community pharmacies could be ideal in distributing FITs for routine CRC screening due to their convenience and accessibility, potentially mitigating disparities in access to CRC screening. We assessed pharmacists’ preferences for implementing a pharmacy-based FIT distribution program called PharmFIT™.

Methods

We conducted a national online survey of 578 community pharmacists between September 2022 and January 2023 (response rate 59%). The survey assessed pharmacists’ design preferences for PharmFIT™. We used descriptive statistics to evaluate design preferences and conducted a multiple logistic regression to identify correlates of pharmacists’ perceived difficulty in screening FIT-eligible patients through their pharmacy systems.

Findings

Most pharmacists preferred: (1) physicians to inform patients of their FIT eligibility (63%), (2) patients to pick up FITs in-person (90%), and (3) pharmacists to counsel patients with an information sheet (76%) or in-person (72%). Over half of pharmacists wanted physicians to communicate negative test results (55%), while around three-fourths (73%) preferred the physician to communicate positive FIT results to patients. Pharmacists preferred sending patient reminders for repeat annual FITs via text (54%) or email (44%). For patients who receive positive FIT results, most pharmacists (72%) wanted the physician to refer their patients for colonoscopy.

Staff pharmacists (OR:1.50, CI95%:1.04–2.16), pharmacists working in independent practice (OR:1.70, CI95%:1.03–2.80), regional chain (OR:2.24, CI95%:1.15–4.35) or supermarket (OR:1.85, CI95%: 1.05–3.29) pharmacies were more likely to think that screening FIT-eligible patients would be hard to do with their pharmacy systems than pharmacy owners or national chain pharmacies. Pharmacists who perceived PharmFIT™ to be less complex (OR:.49, CI95%:.39-.62), had more years in practice (OR:.86, CI95%:.78-.96), or had advanced credentials (OR:.49, CI95%:.29-.83) were less likely to think that screening FIT-eligible patients would be hard to do with their pharmacy systems.

Implications for D&I Research: The perception of PharmFIT™’s complexity could impact its implementation in pharmacies. The pharmacy structure and pharmacists’ clinical experience and capability need to be considered in the design, implementation, and sustainability of PharmFIT™.

Primary Funding Source

Centers for Disease Control and Prevention.

¹UMass Chan Medical School, Boston, MA, USA; ²University of Massachusetts Boston, Boston, MA, USA; ³University of Illinois Chicago, Chicago, IL, USA; ⁴Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA

Correspondence: Daniel Amante ([email protected])

Implementation Science 2025, 20(1):S46

Background

We applied the RE-AIM framework to evaluate a personalized, multicomponent diabetes management intervention, mHealth for Diabetes Adherence Support (mDAS), for African American and Latinx adults. The bilingual intervention included remote blood glucose monitoring and medication adjustments by clinical pharmacists, as well as in-person and remote support from health coaches. A randomized trial involving 221 adults with high HbA1c levels (≥8%) found effectiveness in improving HbA1c over 12 months. We sought to understand contributing factors to the found effectiveness, recognizing context, adaptations required, and barriers for sustainment.

Methods

To evaluate reach, we compared those who participated in the study with 4,310 eligible patients within the same healthcare system. To assess adoption, implementation, and maintenance, we interviewed 170 patients upon intervention completion and three intervention health coaches. Qualitative analyses were performed using MAXQDA software (v. 24) and thematic development involved two coders and consensus review.

Findings

Study participants were younger (age mean (SD) 55.2 (9.5) vs 56.3 (11.6), p =.03) and more likely female (70% vs 57%, p <.001) than eligible patients not enrolled. There were no differences in the number receiving public insurance (63% in study vs. 62% eligible) or language preference (17% vs 12% Spanish preferred, respectively). Despite significant adaptations made in response to COVID-19, which limited in-person support and facilitated telehealth engagement, the number of health coach encounters remained consistent each month of the study period (2017-2021). Qualitative analyses reflected the impact of the intervention providing multiple types of support; such as emotional, instrumental, informational, and appraisal support. Health coaches identified >13 unique barriers to medication adherence; most often multiple barriers per patient, such as lack of knowledge (e.g. why a medicine is needed; n = 72). After study completion, pharmacists maintained support for patients, while the study health coaches shifted to other research and clinical projects. Continued funding for health coaches prevented intervention sustainability and remains a major barrier.

Implications for D&I Research: Researchers and decision makers may use this information to understand what may be required for multicomponent, mobile health interventions to be implemented and maintained. No single RE-AIM domain alone appears sufficient to evaluate such multifaceted interventions in practice.

Primary Funding Source

National Institutes of Health.

¹Atrium Health, Charlotte, NC, USA; ²Atrium Health, Concord, NC, USA; ³Wake Forest University School of Medicine, Winston-Salem, NC, USA

Correspondence: Tara Eaton ([email protected])

Implementation Science 2025, 20(1):S47

Background

To inform large-scale implementation of clinical pharmacy services at rural primary care practices in a large health system, we qualitatively examined implementation determinants and outcomes of a pilot telehealth-based clinical pharmacy intervention for Type 2 diabetes (T2D) called the Rural Area Pharmacist Intervention for Diabetes-Management using eHealth (RAPID-ME) program.

Methods

We conducted IRB-approved telephonic, semi-structured qualitative interviews with enrolled patients (n=29) from four rural primary care practices in North Carolina. Interviews were informed by the Consolidated Framework for Implementation Research (CFIR) 2.0 and contained questions about program information received, program activities, convenience/burden of participation, program likes and dislikes, how RAPID-ME compares to T2D care at PCPs’ offices, barriers to participation and adherence, and recommendations for program improvement. Interview recordings were transcribed and analyzed in ATLAS.ti using the constant comparison method, CFIR 2.0, and Reach Effectiveness Adoption Implementation and Maintenance (RE-AIM).

Findings

All patients (n=29) found RAPID-ME to be helpful for T2D management, with 72% (n=21) stating they had no dislikes about the program. CFIR 2.0-guided implementation determinants were found spanning the Innovation, Individuals, Outer Setting, and Inner Setting domains. Implementation facilitators included: T2D-related patient needs were met by RAPID-ME (Recipient Need), participation being convenient and not burdensome (Innovation Adaptability + Complexity), patient availability and dedication to participate in calls (Recipient Opportunity + Motivation), personalized care (Innovation Design), pharmacist skill and effectiveness (Deliverer Capability), user-friendly information (Innovation Complexity), T2D management different from PCP care (Relative Advantage), and information sharing with patients’ PCPs (Communications). Barriers included: Lack of patient availability and dedication to goals (Recipient Opportunity + Motivation), high T2D medication costs and insurance limitations (Innovation Cost + Policies & Laws), recommended frequency of blood sugar testing (Innovation Design), health literacy (Recipient Capability), and the program duration (Innovation Design). RE-AIM-guided outcomes suggesting intervention effectiveness included: patients’ T2D self-management practices and medication awareness improved, patients’ blood sugar levels or A1 C lowered or stabilized, patients lost weight and felt better physically.

Implications for D&I Research: Implementation determinants and patient-reported effectiveness of a telehealth-based clinical pharmacy program RAPID-ME were successfully determined using qualitative methods. Facilitators and barriers of implementation identified in this study can guide implementation of telehealth-based clinical pharmacy services.

Primary Funding Source

The Duke Endowment.

¹Veterans Health Administration, Bedford, MA, USA; ²University of Massachusetts, Lowell, Zuckerberg School of Health Sciences, Lowell, MA, USA; ³Veterans Health Administration, Iowa City, IA, USA

Correspondence: Megan McCullough ([email protected])

Implementation Science 2025, 20(1):S48

Background

In 2020, the VA Clinical Pharmacy Practice Office, with Office of Rural Health, launched a clinical pharmacy intervention to increase access to medications for opioid use disorder (MOUD) and alcohol use disorder (MAUD) for rural Veterans by implementing clinical pharmacy practitioners (CPP). Rural areas carry a high burden of substance use and have low access to care. We report how rural Veteran experiences of SUD care, as an implementation metric, improved the pharmacy-based intervention and changed the next iteration of this intervention which now includes SUD and mental health (MH) care.

Methods

As part of a larger mixed-methods evaluation, we completed two rounds of surveys (n = 267) and conducted interviews with 28 rural Veterans to understand their experiences of SUD comprehensive medication management with pharmacists. Interviews were analyzed thematically to identify Veterans’ experiences of the CPP therapeutic relationship and access, quality, and adherence to care.

Findings

Findings highlight Veteran’s perspectives on factors contributing to successful SUD medication implementation. CPPs improved treatment accessibility and enhanced Veterans’ experience of SUD care by utilizing a patient-centered care approach, creating a stigma-reducing environment, providing effective medication management and coordinating Veteran care with other services. Veterans’ experiences of patient-centered care and stigma reduction strategies were incorporated into adaptations of the original intervention. Findings on the need for dual diagnosis care, more stigma-reduction training, accessibility and care coordination were key components of the subsequently launched follow-on intervention (MH and SUD) for rural Veterans.

Implications for D&I Research: This innovative evaluation showcases the importance of patient voices in implementation evaluation and iterative designing of subsequent interventions. CPPs, per Veterans, made effective use of patient-centered care principles that built acceptance of the intervention, leading to effective behavioral changes among Veterans with challenging healthcare needs. This led to the development of an expanded intervention to include MH care and promoted efforts to expand clinical pharmacy care to meet critical patient needs and access in rural areas. By centering Veterans’ voices and experiences, this work underlines the importance of gathering and applying patient-level evidence to improve and promote implementation science as a patient inclusive discipline.

Primary Funding Source

Department of Veterans Affairs.

¹Scripps Gerontology Center, Miami University, Oxford, OH, USA; ²Department of Sociology and Gerontology, Miami University, Oxford, OH, USA; ³Philadelphia, PA, USA; ⁴United Church Homes, Marion, OH, USA; ⁵Indiana University School of Medicine, Indianapolis, IN, USA; ⁶Regenstrief Institute, Indianapolis, IN, USA; ⁷The Pennsylvania State University, University Park, PA, USA; ⁸The Polisher Research Institute at Abramson Senior Care, Horsham, PA, USA

Correspondence: Katherine Abbott ([email protected])

Implementation Science 2025, 20(1):S49

Background

The Individualized Positive Psychosocial Interaction (IPPI) is an evidence-based program designed to support care partners in engaging people living with dementia (PLWD) with brief, one-to-one preference-based activities. Nursing home (NH) staff are trained via an on-line platform on emotion-focused communication strategies. The aim of this project is to conduct a pilot embedded Pragmatic Clinical Trial (ePCT) to evaluate and establish the feasibility of implementing the IPPI program in 9 NHs among 108–135 residents. The IPPI ePCT targets residents living with dementia who are communicating distress as reported in Minimum Data Set (MDS) Sections D Mood or E Behavior.

Methods

NHs were asked to establish implementation teams, complete training, use the MDS to identify eligible residents, and enroll 15 residents over the course of 3 months. Knowledge and self-efficacy for using emotion-focused communication strategies were evaluated via a pre-test/post-test design. In the post-assessment we also assessed education acceptability (AIM), appropriateness (IAM), feasibility (FIM), and satisfaction. Organizational readiness was assessed via the ORIC and fidelity to the intervention was assessed via an 18-item observational checklist by the champion.

Findings

Of the 7 NHs that started implementation, 100% were able to establish an IPPI implementation team. Of the n=70 staff that started the emotion-focused on-line education, 86% were able to complete the requirement. Knowledge of emotion-focused communication strategies and self-efficacy for using strategies significantly increased from pre- to post-training. Staff gave high ratings to the acceptability, appropriateness, and feasibility of the training. Champions completed fidelity observations on 78% of IPPI interventionists and the majority (51%) reached 100% fidelity. Twenty percent of interventionists missed one item and 29% missed two items on the fidelity checklist. All 7 of the NHs were successful in using MDS data to identify eligible residents and enroll 3–6 residents per month. Communities were able to replace individuals who passed away due to advanced dementia. A total of n=130 individuals were enrolled.

Implications for D&I Research: Findings indicate that pragmatic implementation of the IPPI program in NHs is feasible. Findings from this pilot study will guide the implementation, approach, and power needed for a full-scale Stage IV effectiveness ePCT study.

Primary Funding Source

National Institutes of Health.

¹Veterans Health Administration, Philadelphia, PA, USA; ²University of Pennsylvania, Philadelphia, PA, USA; ³College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA

Correspondence: Octavia Goodman ([email protected])

Implementation Science 2025, 20(1):S50

Background

The Department of Veterans Affairs (VA) has prioritized adoption of an Age-Friendly Health System (AFHS). In response, the VA’s Safer Aging Through Geriatrics-Informed Evidence-Based Practices (SAGE) Quality Enhancement Research Initiative (QUERI) was developed to test tailored implementation strategies on the effectiveness and reach of four evidence-based care practices (EBPs) in nine VA Medical Centers (VAMCs) that align with the “four Ms” of AFHS: What Matters, Medication, Mentation, and Mobility. The Tailored Activity Program (TAP), a multicomponent EBP for Veterans with dementia and their caregivers, was chosen to address “Mentation”. TAP is designed to realign the abilities of a person with dementia with their environment, facilitate meaningful engagement, and reduce caregiver burden. Implementing multicomponent interventions, such as TAP, can pose significant challenges. We explored the determinants (i.e., barriers and facilitators) necessary to consider before implementation.

Methods

We conducted semi-structured interviews with clinicians and leaders at each VAMC prior to implementation of TAP to understand the unique implementation contexts and to engage key informants. We used a team-based rapid qualitative analysis based on the integrated PRISM-REAIM framework to identify themes related to implementation determinants.

Findings

We conducted 59 interviews with 66 clinicians and leaders across 6 VAMCs. Participants identified three key determinants that are crucial to consider before implementing TAP: 1) Alignment with organizational priorities, including Geriatrics and Extended Care initiatives and programs (e.g., home-based primary care, dementia specialty programs), AFHS implementation, and Whole Health; 2) Competing priorities that require funding and staff time, including falls prevention programs and Caregiver Support Program initiatives; and 3) Perceptions of TAP, including clinicians’ positive or negative beliefs about TAP’s core components (e.g., required number of visits, assessment, activity prescriptions) and the perceived benefit or burden of the intervention for Veterans and caregivers (e.g., decreasing caregiver burden, caregivers being too overwhelmed to participate).

Implications for D&I Research: We identified key factors to consider for successful implementation of a multicomponent EBP within a complex healthcare system. These factors provide useful guidance for clinicians, leaders, and implementation scientists planning for implementation of multicomponent interventions in healthcare systems.

Primary Funding Source

Department of Veterans Affairs.

¹University of Arkansas for Medical Sciences, Little Rock, AR, USA; ²Wake Forest- School of Medicine, Winston-Salem, NC, USA; ³Providence Health System, Portland, OR, USA

Correspondence: Jennifer Vincenzo ([email protected])

Implementation Science 2025, 20(1):S51

Background

Centers for Disease Control and Prevention (CDC)’s Stopping Elderly Accidents, Deaths, and Injury (STEADI) is a structured screening, assessment, and intervention toolkit for falls prevention among adults ≥ 65 years old utilized in primary care. This study is the first to investigate the contextual determinants of implementing STEADI in outpatient physical therapy.

Methods

An explanatory mixed-methods approach was employed with nested samples associated with one health system. Key partners surveyed and interviewed included physical therapists, assistants, managers (n=16), referring physicians (n=5), older adults (n=10) who have had physical therapy, their care partners (n=10), and administrative staff (n=3). Surveys and descriptive statistics identified key partners’ perceptions of STEADI’s feasibility, acceptability, and appropriateness. CFIR 2.0-based interviews and rapid template analysis identified contextual determinants of implementing STEADI.

Findings

All respondents reported that implementing STEADI in outpatient rehabilitation was feasible, acceptable, and appropriate (mean score >4/5). Barriers for physical therapists and assistants included a lack of capability to conduct some components of STEADI and a lack of compatibility with workflow and electronic health records. Facilitators included therapists’ motivation, relative advantage, innovation design, and capability with components of STEADI. Barriers for referring physicians included a lack of knowledge of therapists’ capabilities and communication challenges. Facilitators included innovation adaptability, therapists’ opportunity and capability, and recipient-centeredness. Older adults and care partners had similar determinants. Barriers included a potential lack of motivation and resources for engagement. Facilitators included local conditions, relative advantage, need, opportunity, and motivation. Administrative staff reported one barrier of compatibility, specifically the potential need for assistance with intake forms. Facilitators included adaptability and recipient-centeredness.

Implications for D&I Research: The study illustrates that key partners perceive implementing STEADI for fall prevention in outpatient physical therapy as feasible, acceptable, and appropriate for older adults. Determinants of implementation vary based on key partner groups. These findings will be used to co-develop implementation strategies to address barriers and maximize facilitators for STEADI implementation in outpatient physical therapy.

Primary Funding Source

National Institutes of Health.

¹David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; ²UCLA-Olive View Medical Center, Sylmar, CA, USA; ³LA General Medical Center, Los Angeles, CA, USA; ⁴Harbor-UCLA Medical Center, Torrance, CA, USA; ⁵Kaiser Permanente Southern California, Pasadena, CA, USA

Correspondence: Thanh Neville ([email protected])

Implementation Science 2025, 20(1):S52

Background

Compassionate end-of-life (EOL) care is foundational to medicine, but palliative care interventions are often difficult to implement in safety-net hospitals (SNH). Providing largely uncompensated healthcare to low income and uninsured patients, SNH budgets are universally tight and do not include discretionary funds to implement healthcare innovations. We hypothesized that the 3 Wishes Project (3 WP), a low-cost palliative care initiative in which healthcare workers implement small but meaningful wishes for dying patients and their families, can be successfully implemented in the intensive care units (ICU) of SNHs.

Methods

Stakeholders from 3 Los Angeles SNHs participated in individual semi-structured or focus group interviews to elicit feedback regarding the 3 WP implementation strategy. Questions were designed to identify actionable items within the five major domains in the Consolidated Framework for Implementation, acknowledging that implementation must address intervention refinement, the individuals involved, the process, and the inner and outer settings. Findings were used to guide tailored 3 WP implementation at each SNH, which was staggered by 2 months (stepped-wedge study design). We show results from the initial 3-month period.

Findings

Based on stakeholder interviews, informational 3 WP brochures for families and instructional badge buddies for nurses were included as part of the initiative and personalized for each SNH. Nurse 3 WP champions were appointed for both day and night shifts. Per stakeholder suggestions, items that met the cultural and spiritual needs of the SNH’s majority Catholic patient population (rosaries, flameless prayer candles, Bibles) were purchased for each SNH's 3 WP inventory. Depending on stakeholder preference, two to eight training sessions were conducted at each SNH to familiarize the staff with the 3 WP innovation as well as the logistics of eliciting, fulfilling, and documenting wishes. Twenty-nine nurses from two SNHs (3^rd SNH is pending implementation) have elicited and implemented wishes for 26 patients (67% of eligible patients). Patients and/or families have received wishes such as keepsakes (e.g. fingerprints, locks of hair), religious items (e.g, rosaries/crosses), favorite foods, and special gatherings (e.g. a wedding). The direct cost of 3 WP averaged $24.50 per patient.

Implications for D&I Research: Patient and family-centered interventions can be successfully implemented in SNHs when guided by stakeholder engagement and a methodical implementation strategy.

Primary Funding Source

National Institutes of Health.

Nicholas Schiltz¹, Grace Armstrong¹, Camaryn Petersen¹, Brant Oliver², Sarah Ball³, Anne Pohnert³, Mary A Dolansky¹

¹Case Western Reserve University, Cleveland, OH, USA; ²Value Institute, Dartmouth Health, Lebanon, NH, USA; ³CVS Health MinuteClinic, Woonsocket, RI, USA

Correspondence: Nicholas Schiltz ([email protected])

Implementation Science 2025, 20(1):S53

Background

The Age-Friendly Health Systems 4Ms (What Matters, Mobility, Mentation, and Medication) is an evidence-based framework to deliver effective and tailored care to older adults. The 4Ms framework was implemented in all 1100+ locations of the MinuteClinic at CVS health system nationwide beginning in May 2020. Despite initial improvements focused on provider education, the overall delivery of 4Ms care by providers was low after one year.

Methods

To enhance the delivery of 4Ms care, we introduced several implementation strategies. These included a best practice alert (BPA) in the electronic health record, real-time performance dashboards for both providers and managers, the addition of 4Ms performance measures in provider’s annual performance review, and ongoing provider education and communication. Beginning in May 2022, MinuteClinic allotted an additional 10 minutes for visits of adults aged 65 and older. We used statistical process control analyses and model-based recursive partitioning to analyze trends in 4Ms care delivery over time and identify strategies leading to significant changes in 4Ms delivery.

Findings

Since the initiative’s launch in June 2020, out of over 1.1 million age-friendly eligible visits, 432,896 (39%) received at least one M, and 224,447 (20%) received all 4Ms. The percentage of patients receiving all 4Ms increased quarter-over-quarter from 3.5% at the end of the first year (Q2 2021) to 41.9% as of Q2 2024. The addition of 10 extra minutes allotted to visits was associated with considerable increases in patients receiving all 4Ms. The creation of the age-friendly dashboard and the addition of 4Ms metrics in the provider's annual performance review were some of the strategies that significantly increased delivery of What Matters, Mentation, Medication, and/or Mobility screening.

Implications for D&I Research: MinuteClinic experienced consistent quarter-over-quarter increase in the delivery of 4Ms care, despite challenges including workforce transitions, COVID-19, and systemwide changes (e.g. clinic openings and closings). While this demonstrates the success of the implementation project, it also underscores the need for multiple and ongoing strategies and monitoring to achieve this progress. This project highlights the importance of implementing strategies to accelerate the pace of implementation to improve health system outcomes.

Primary Funding Source

The John A. Hartford Foundation.

¹Harvard T.H. Chan School of Public Health, Boston, MA, USA; ²Harvard Medical School, Boston, MA, USA; ³Abt Global, Cambridge, MA, USA; ⁴University of Colorado School of Medicine, Aurora, CO, USA; ⁵University of Colorado Health System, Denver, USA

Correspondence: Ana Progovac ([email protected])

Implementation Science 2025, 20(1):S54

Background

In June 2019, UCHealth implemented a real-time benefit tool (RTBT) to help clinicians prescribe affordable medications. When a clinician clicks to order a medication for which there is a lower-cost alternative, an alert pops up before the order is transmitted, showing the medication’s out-of-pocket (OOP) price and the OOP price(s) of the alternative(s). Limited data exist on whether clinicians change medication orders after RTBT alerts or whether these changes differentially impact certain patient populations. In-depth patient, provider, and staff perspectives on the tool are also unknown.

Methods

We conducted an explanatory sequential mixed methods study. First, we conducted a retrospective cohort study by linking RTBT medication OOP price estimates displayed during primary care visits to data on medication orders and patient characteristics between July 2019 – June 2022. We described frequencies that clinicians change their original medication order after RTBT alerts. We evaluated whether these frequencies varied with prices and patient characteristics using multivariable linear regression with year and clinician fixed effects; robust standard errors were clustered on the clinician. Second, we are conducting interviews and focus groups with patients, clinicians, social workers, and pharmacists. Thematic analysis will describe various factors influencing clinical decisions around prescribing, the use and value of RTBT, and areas for improvement.

Findings

RTBT alerts popped-up during 181,887 medication orders (for 92,681 unique patients), equivalent to 9.7% of orders. Overall, 1 in 8 medication orders was changed after clinicians reviewed RTBT OOP price estimates, however 1 in 6 orders was changed when potential cost savings were $20 or more (p<0.001). No patient sociodemographic characteristics were associated with clinicians changing orders. Qualitative interviews with clinicians, pharmacists, social workers, and patients are ongoing and will be completed by Fall 2024; themes will be presented at the conference.

Implications for D&I Research: Quantitative data suggest that the RTBT affected medication changes across patients equally, regardless of sociodemographic characteristics. It remains to be seen whether clinicians report similar perspectives in the qualitative data or whether RTBT can address access to care for marginalized populations. Results from this study will inform strategies to accelerate implementation of medication changes to reduce patients’ OOP cost and advance health equity.

Primary Funding Source

National Institutes of Health.

¹Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA; ²University of Vermont Larner College of Medicine, Burlington, VT, USA; ³Dartmouth College, Hanover, NH, USA; ⁴Vanderbilt University Medical Center, Nashville, TN, USA; ⁵Veterans Health Administration, Nashville, TN, USA

Correspondence: Jeremiah Brown ([email protected])

Implementation Science 2025, 20(1):S55

Background

While strategies for preventing contrast-associated acute kidney injury (AKI) are well known, they are based on findings from randomized clinical trials, with virtually no evaluation for sustainability after cessation of the intervention. IMPROVE AKI was a national hybrid type 1 implementation effectiveness trial with both an implementation and sustainment phase.

Methods

A 2x2 factorial cluster-randomized trial was conducted among 20 Veteran Affairs hospitals randomized to three implementation strategies, including team-based coaching in a Virtual Learning Collaborative (Collaborative) or Technical Assistance (Assistance), both with and without Automated Surveillance Reporting (Surveillance). Multilevel logistic regression models for 7-day AKI were fit with site-level random effects. Surveys and focused interviews were collected at baseline and every 6-months among implementation staff to understand barriers and facilitators to sustain the intervention.

Findings

The implementation phase (18-months) had 4,517 patients, 510 with AKI, and the sustainment phase (18-months) had 4,160 patients, 440 with AKI. Substantial reduction in AKI occurred within the Collaborative+Surveillance compared to Assistance (Table 1), demonstrating a statistically significant 46% reduction in the odds of AKI during implementation and a sustained 40% reduction in the odds of AKI during sustainment. Among 14 responders, sites implemented standardized orders (11), oral and/or IV hydration standing orders (13), and contrast limiting protocols (10).

Implications for D&I Research: Collaborative and Surveillance implementation strategies can sustainably reduce AKI by 40% even after the implementation phase is complete. Process improvement education, care process standardization, and automated outcome feedback may effectively and durably sustain the AKI Prevention toolkit in clinical practice. Together, these results suggest that a time-limited, intensive intervention well supported by cardiac catheterization staff and health system leadership could result in sustained improvements in AKI following cardiac catheterization.

Primary Funding Source

National Institutes of Health.

Ascension Health, St. Louis, MO, USA

Correspondence: Cynthia LaFond ([email protected])

Implementation Science 2025, 20(1):S56

Background

Fall TIPS (Tailoring Interventions for Patient Safety) is an evidence-based program that includes patient fall risk assessment and aligning interventions to those risks, as opposed to intervening based on a fall risk score. In past trials, Fall TIPS has increased patient activation and engagement in their fall prevention plans and reduced falls/falls with injury. This study aims to describe strategies used and process and outcome measures associated with successful adoption of Fall TIPS in a large health system.

Methods

The Iowa Model for Sustainability guided implementation planning. Healthcare facilitation was used as a strategy to promote adoption at sites and included weekly “collaborative calls''prior to and following program go-live. During calls, internal experts in implementation, fall prevention, and education partnered with site leaders and fall champions to prepare for implementation and de-implementation, address barriers during go -live, and support sustained adoption. Measures included a Fall TIPS gap analysis, bedside audits, and implementation evaluation survey. Outcomes included falls/falls with injury. Focus groups were conducted at a subset of sites with healthcare end-users and leaders/fall champions.

Findings

97 facilities implemented Fall TIPS and initiated bedside audits. Audits demonstrated overall strong adoption and improved patient knowledge; of 107,915 audits conducted between January and March 2024, a majority (92%) indicated the bedside tool was being used. Over three months, improvement was seen in patient/family ability to verbalize their risk factors and fall prevention plan (85% January vs. 90% March, p<.001). During the 22 weeks following implementation (Feb-June 2024), a 9.8% reduction in average weekly falls, 8% reduction in injurious falls, and a 15.1% reduction in the system’s acute care fall rate resulted. Additional quantitative and qualitative analyses to identify factors and consolidated framework for implementation research constructs associated with program adoption, de-implementation and individual hospital outcomes will be completed by November 2024.

Implications for D&I Research: A facilitation approach supported 97 sites of varying bed size and geographic locations to successfully adopt Fall TIPS. Audits demonstrated program sustainment and improved patient/family knowledge of the plan of care.

Veterans Health Administration, Durham, NC, USA; University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA

Correspondence: Kelli Allen ([email protected])

Implementation Science 2025, 20(1):S57

Background

Little is known about optimal strategies for supporting implementation of new clinical programs in outpatient physical therapy (PT) settings. We conducted a hybrid effectiveness-implementation trial comparing two implementation approaches to support spread of group-based PT (Group PT) for Veterans with knee osteoarthritis.

Methods

Nineteen VA medical centers were randomized to receive one of two implementation support approaches over 12-months: 1) Low-touch, consisting of self-guided tools and monthly learning collaborative calls, and 2) High-touch, consisting of low-touch approaches plus individualized support (e.g., external facilitator calls) for sites that did not meet benchmarks for adoption or sustainment at 6 and 9 months, respectively. Implementation outcomes included penetration (primary) and adoption, assessed between 6 and 12 months. Descriptive statistics were computed for implementation outcomes by study arm. This study was approved by the Durham VA Institutional Review Board (#2334).

Findings

Sixteen of 19 sites delivered a Group PT program during the study period. All sites in the high-touch arm received additional support at 6-months (6 sites) or 9-months (3 sites). Mean penetration was slightly greater in the low-touch arm compared to high-touch arm (Table 1). The proportion of sites meeting the adoption benchmark was also slightly higher in the low-touch arm; two additional sites in the high-touch arm met the adoption benchmark before 6 months (Table 1).

Implications for D&I Research: The high-touch implementation approach did not out-perform the low-touch approach. These results are important since the low-touch approach is more efficient to apply at scale. While adoption was high overall, penetration was modest, suggesting more time may be needed to fully embed a new clinical program in outpatient PT settings.

Primary Funding Source

Department of Veterans Affairs.

Veterans Health Administration, Durham, NC, USA; Duke University School of Medicine, Durham, NC, USA; Duke University, Durham, NC, USA

Correspondence: Courtney Van Houtven ([email protected])

Implementation Science 2025, 20(1):S58

Background

In partnership with the Veterans Affairs (VA) Caregiver Support Program (CSP), an evidence-based group training for family caregivers called Caregivers FIRST was announced for national dissemination. Few caregiver support interventions have been scaled nationally; thus, gaps remain regarding the optimal level of support needed to successfully adopt caregiver trainings in diverse clinical contexts. We evaluated the effectiveness of two implementation support approaches on Caregivers FIRST implementation outcomes (Durham VA IRB #2334).

Methods

In a hybrid type III effectiveness-implementation trial, we enrolled 25 VA medical centers that did not meet adoption benchmarks within 6 months following the announcement of a Caregivers FIRST mandate. Sites were randomized to low-touch (self-guided) support only or low-touch with the addition of high-touch support (external facilitation). Co-primary penetration outcomes were 1) percentage of caregivers of Veterans who received referrals to caregiver services and/or were approved for CSP that attended at least one class over 12-months and 2) number of classes delivered over 12-months (8 total expected). Secondary outcomes were fidelity and adoption. We fit general linear models to examine differences in implementation outcome between high-touch and low-touch arms.

Findings

Twelve sites were randomized to low-touch and 13 to high-touch support. Across the 25 sites, the percentage of caregivers that attended at least one class ranged from 0.0% to 19.0% and number of classes offered ranged from 0 to 17 classes over 12-months. The estimated mean percentage of caregivers attending a class and number of classed offered was 8.2% and 9.4 classes in high touch and 6.1% and 5.7 classes in low touch. There were no differences in mean percentage of caregivers attending a class (mean difference=2.1%; 95% CI −1.8%,6.1%; p=0.27) or mean number of classes offered (rate ratio=1.6; 95% CI 0.9,2.9; p=0.09) in high-touch vs. low-touch. Similarly, no differences between arms in fidelity or adoption outcomes were found.

Implications for D&I Research: The implementation outcomes were descriptively higher in high-touch support arms but did not reach a priori clinically meaningful benchmarks to warrant the need for more intensive implementation support. Investing in targeted high-touch support for sites struggling to adopt caregiver training may not improve integration into routine clinical care nationally.

Primary Funding Source

Department of Veterans Affairs.

Veterans Health Administration, Durham, USA; Duke University School of Medicine, Durham, NC, USA; Veterans Health Administration, Durham, NC, USA

Correspondence: Susan Hastings ([email protected])

Implementation Science 2025, 20(1):S59

Background

STRIDE is a supervised walking program for hospitalized older adults shown to reduce discharge rates to a skilled nursing facility. The program has potential for broad spread across the VA health system, but questions remain about the most effective and efficient strategies to support large-scale implementation. This study compared the effects of two approaches for supporting implementation of the STRIDE program (Durham VA IRB#2334).

Methods

In a cluster randomized trial, 35 VA hospitals were randomized to either foundational implementation support (n=19) based on the Replicating Effective Programs framework (toolkit, data dashboard, office hours, peer support) or enhanced support (n=16), consisting of the same foundational support plus 2–4 months of higher intensity facilitation for sites that did not meet predetermined benchmarks for program activity at 6- and 8-months. Outcomes were (1) penetration, the proportion of hospitalizations with at least one documented STRIDE walk, and (2) adoption, a binary outcome based on ≥5 patients with ≥1 documented STRIDE walk vs. not, both assessed between 6 months and 10 (primary), 13, and 16 months.

Findings

3/16 sites (19%) in the enhanced arm met benchmarks for program activity and did not receive facilitation. Using standardized criteria to enable cross-site comparisons, mean penetration in discrete time intervals is shown in Table 1. At the primary endpoint of 6–10 months, observed penetration ranged from 0–11.4% in the enhanced arm (median=1.4; 25^th−75^th quartile: 0–3.6) compared to 0–16.6% in the foundational support arm (median=3.5; 25^th−75^th quartile: 0–6.9). At 10 months, 9/16 sites (56.3%) randomized to the enhanced arm met the threshold for STRIDE adoption compared to 13/19 (68.4%) in the foundational arm. By 16 months, 13/16 sites (81.3%) in the enhanced arm had adopted compared to 14/19 (73.7%) in the foundational arm.

Implications for D&I Research: There was no clear impact of enhanced support on penetration or program adoption at the primary endpoint of 10 months. Results demonstrate that resource intensive strategies may not necessarily improve implementation if robust standardized support is provided.

Primary Funding Source

Department of Veterans Affairs.

¹Kaiser Permanente Southern California, Pasadena, CA, USA; ²Southern California Permanente Medical Group, Pasadena, CA, USA

Correspondence: Erin Hahn ([email protected])

Implementation Science 2025, 20(1):S60

Background

Primary human papillomavirus (HPV) testing in lieu of conventional Pap testing is now recommended for cervical cancer screening for women aged 30–65 years. However, there is little guidance regarding effective strategies for substituting primary HPV screening for Pap testing. As part of an ongoing randomized trial comparing strategies to implement primary HPV testing and de-implement Pap testing (a centrally administered + usual care strategy vs. centrally administered + locally tailored strategy) in an integrated healthcare system, Kaiser Permanente Southern California, we assessed clinician experiences and perceptions of the substitution process and strategies.

Methods

Both arms of the trial received centralized education (e.g., webinars, leadership announcements) and health technology support, including changes to the ordering process that highlighted the primary HPV testing option. Those in the tailored arm also received materials and trainings tailored to clinic preferences. We conducted qualitative interviews with internal medicine, family medicine, and obstetrics/gynecology clinicians to understand barriers and facilitators to practice substitution, fidelity to the interventions and implementation strategies, and recommendations for improvements. Interview guides were developed using the Consolidated Framework for Implementation Research (CFIR). Interviews were recorded and transcribed. Using a team coding approach, we developed an initial coding structure refined during iterative analysis; the data were subsequently organized thematically into domains, key themes, and sub-themes using thematic analysis, followed by framework analysis informed by CFIR.

Findings

Thirty-two interviews were conducted. Participants in both arms of the trial reported high awareness, preparedness, buy-in, and fidelity to the new screening process. An unanticipated concern was the length of time required to receive lab results for reflexive cytology tests after a positive HPV result which reportedly increased patient anxiety. Participants in both arms reported high fidelity to the centralized strategy, particularly the new ordering process. In the local-tailored arm, few participants recalled the local-tailored materials.

Implications for D&I Research: The centralized strategy was perceived as highly acceptable and feasible, and fidelity to the centralized interventions appeared to facilitate practice change. Findings can be applied to other health systems and settings considering primary HPV screening implementation, particularly those within the U.S. or with a similar health care model.

Primary Funding Source

Patient-Centered Outcomes Research Institute

¹Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; ²Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; ³University of Michigan, Department of Surgery, Ann Arbor, MI, USA; ⁴Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; ⁵Veterans Health Administration, Hines, IL, USA; ⁶Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; ⁷Robert H Lurie Comprehensive Cancer Center, Chicago, IL, USA; ⁸Division of Hematology and Medical Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

Correspondence: Ryan Jacobs ([email protected])

Implementation Science 2025, 20(1):S61

Background

Next-generation sequencing (NGS) testing is an evidence-based molecular testing modality used to identify actionable oncogenic drivers in tumor tissue to guide selection of targeted therapy, which has led to improvements in survival for patients with early-stage and metastatic non-small cell lung cancer (NSCLC). However, uptake into oncology practices has been variable. In this qualitative study of a multidisciplinary group of clinicians diagnosing and treating lung cancer, we aimed to identify barriers and possible interventions for incorporating timely NGS testing into routine practice throughout Illinois.

Methods

We conducted semi-structured focus groups and interviews with clinical stakeholders at 11 hospital systems in Illinois which included medical oncology, surgical pathology, molecular pathology, thoracic surgery, interventional pulmonology, and radiation oncology practicing in urban, academic, and rural settings. We used an inductive approach to develop a codebook and identify prominent themes.

Findings

We grouped themes into two broad categories: (1) barriers to timely use of NGS testing and (2) potential system-level intervention strategies to promote testing uptake. In the first category (ie: barriers), we found that, across the NSCLC care pathway, delays related to NGS testing shaped the most significant barriers to timely use of NGS testing. From the time of initial consultation to tissue diagnosis, delays included lack of available diagnostic modalities and unstandardized clinical data transfer between facilities. From the time of tissue diagnosis to the receipt of NGS testing results, delays included the need for repeat tissue sampling, limited feedback loops of tissue specimen quality, and unstandardized tissue processing across facilities. In the second category (ie: intervention strategies), interventions included improved communication between hospital systems and clinical stakeholders, standardization of diagnostic processes, and consideration for automated reflex NGS testing ordering.

Implications for D&I Research: Increasing timely uptake of NGS testing requires: (1) overcoming delays currently associated with the testing process; (2) enhancing communication and coordination of testing at system- and cilnician-levels, and (3) developing strategies to standardize diagnostic processes. These topics will be addressed in an intervention toolkit bundle developed to facilitate broader implementation of timely NGS testing and ensuring delivery of targeted NSCLC care.

Primary Funding Source

AstraZeneca Pharmaceuticals LP.

¹Kaiser Permanente Center for Health Research, Portland, OR, USA; ²OCHIN, PORTLAND, OR, USA; ³Oregon Health & Science University, Portland, OR, USA

Correspondence: Rachel Gold ([email protected])

Implementation Science 2025, 20(1):S62

Background

Cancer screening rates are low in marginalized patients, in part because of barriers that hamper their primary care teams’ ability to provide and follow up on screening orders. Electronic health record (EHR)-based decision support tools might effectively enhance such orders’ provision by automating the identification of patient ‘care gaps’ (e.g., overdue for colorectal (CRC) or cervical (CVC) cancer screening) and the placement of indicated orders. Adoption of such tools in safety net community clinics might reduce CRC and CVC screening disparities. We assessed: 1) if use of the Care Gaps SmartSet (CGS), an EHR tool that expedites orders, is associated with CRC/CVC screening order rates, and 2) implementation strategies, barriers, and facilitators that drive CGS use in safety net clinic encounters.

Methods

In sequential mixed methods analyses, multivariate regressions assessed associations between CGS use and cancer screening order rates; surveys and interviews assessed what strategies (i.e., a modular EHR optimization training series) improve tool use adoption. Quantitative EHR data came from >1,500 safety net clinics for 3/2018-12/2022. Survey data came from 81 clinic staff and qualitative data from 11 staff interviews. Outcomes included clinic- and provider-level CRC/CVC screening order rates, and clinic staff perceptions of barriers and facilitators to CGS adoption, and of various implementation strategies used to improve such adoption.

Findings

Clinics and providers that ever used the CGS had higher screening order rates than non-users. Higher CGS use was associated with higher CRC screening order rates; e.g., by 12/2022, CRC screening orders were 7.9 percent (p<0.05) higher in high-use clinics vs. those with no CGS use. Clinic staff optimization training attendance was associated with higher CGS use. Effective CGS use was enhanced by leadership support and clear workflows. Some interviewees reported that clinic-led trainings facilitated CGS use. Reasons for non-use included low user awareness of/trust in the tool, and tool functions that were not optimized.

Implications for D&I Research: Use of EHR-based decision support tools like the CGS is associated with higher cancer screening order rates. These results provide knowledge on how to support the adoption of such interventions using varied training approaches and workflow redesign.

Primary Funding Source

National Institutes of Health.

¹University of California, Davis, Sacramento, CA, USA; ²Internal Medicine, University of California, Davis, Sacramento, CA, USA

Correspondence: Julie Dang ([email protected])

Implementation Science 2025, 20(1):S63

Background

Despite guideline recommendations from the United States Preventive Services Taskforce, lung cancer screening (LCS) using low dose computed tomography (LDCT) is under-utilized. The Enhancing Lung Cancer Screening for Eligible Patients Through Human-Centered Intervention (ELFE) study aims to increase LCS through a two arm randomized comparative effectiveness intervention trial that compares patient navigation with and without patient decision aids to usual care. Intervention materials were co-designed with UC Davis Health (UCDH) patients and researchers to increase LCS among eligible patients.

Methods

A two phased co-design process was utilized to guide the development and content of the intervention materials and to identify modifiable facilitators and barriers to implementation. First, 34 key informant interviews were conducted with eligible UCDH patients who had not received LCS, patients who received LCS, and primary care team members. Interviews were transcribed verbatim, and a rapid qualitative analysis approach to summarize and organize transcript data. Second, patients from the interviews were recruited for a patient advisory board (PAB). The PAB confirmed and validated key findings and recommendations from the summarized transcripts and provided feedback that finalized the intervention materials and strategies.

Findings

Our co-design strategy resulted in: 1) a three-minute patient decision-aid video with content, scripting, and messaging informed by the key informant interviews and approved by the PAB; 2) patient-centered LCS infographics; 3) implementation of a LCS patient navigator (PN) intervention; and 4) development and implementation of new clinic protocols and workflows to identify and schedule appointments for eligible LCS patients. Between 12/18/23 −7/15/24, 44 patients in the intervention arms met LCS eligibility criteria and 20 (46%) have either completed or scheduled an LCS appointment compared to the overall UCDH LCS completion rate of 10%.

Implications for D&I Research: Engaging the PAB in co-designing the LCS decision-aid and educational materials led to messaging that was specifically tailored to the target audience. Early findings reveal two key insights: first, the importance of having a PN check for eligibility, and second, the advantage of sending decision aids and educational materials before eligibility verification. These strategies have the potential to enhance the adoption and implementation of LCS interventions.

Primary Funding Source

V Foundation: Cancer Foundation for Research

American Medical Association, Chicago, IL, USA

Correspondence: Laken Barkowski ([email protected])

Implementation Science 2025, 20(1):S64

Background

Practice facilitation, or quality improvement (QI) coaching, supports organizations and teams in adopting evidence-based guidelines into practice and builds organizational capacity for continuous improvement. AMA MAP™ Hypertension, an evidence-based QI program designed to improve blood pressure (BP) control, uses practice facilitation as a key implementation strategy for program adoption, scale and sustainment.

Methods

AMA MAP HTN focuses on three main components; Measure Accurately (M), Act Rapidly (A), and Partner with Patients (P). Each component addresses a key barrier to BP control by improving the accuracy of blood pressure measurements (M), increasing the use of evidence-based treatment for uncontrolled hypertension (A), and engaging patients in self-management of their blood pressure (P). Each health care organization (HCO) enrolled in the program receives peer-to-peer practice facilitation from the American Medical Association (AMA) to support change management associated with program components. Organizational leaders and AMA facilitators work together to identify program champions and sites, understand the current processes around BP measurement and management, and set organizational goals. The AMA team provides audience-specific training on the evidence-based strategies, action steps, metrics, and resources available through the program. AMA facilitators also provide customized facilitation support that includes sharing best practices, addressing clinical and operational questions, and conducting ongoing data review. Facilitation activities can be conducted virtually, in-person or in a hybrid manner.

Findings

The program has demonstrated the ability to help health care organizations improve their blood pressure control by up to 10 percentage points within 6 months and sustain those improvements. To date, approximately 30 health care organizations across the country have implemented the program with practice facilitation support.

Implications for D&I Research: The AMA MAP HTN program has shown that sites that implement this program can see a sustainable increase in BP control over time. While around 30 HCOs participated in this program, further evaluation of practice facilitation effectiveness will help identify essential components of support to inform future directions.

¹American Medical Association, Chicago, IL, USA; ²The American Medical Association, Greenville, SC, USA

Correspondence: Susan Sutherland ([email protected])

Implementation Science 2025, 20(1):S65

Background

AMA MAP™ Hypertension quality improvement is an evidence-based quality improvement program (QI) designed to help health care organizations (HCO) improve blood pressure control in their patient population. Approximately 30 HCOs have participated in this program with the American Medical Association. To understand the impact of this QI program, this pilot study analyzed overall blood pressure control rates at different time periods throughout the program implementation process for five HCOs.

Methods

Data was collected from the 5 pilot HCOs enrolled in the AMA MAP HTN throughout 2020-2021. Patient BP data 6 months prior to the program’s implementation and 12 months after the end of facilitation. Controlled blood pressure was the number of patients'blood pressures below 140 systolic and 90 diastolic. Overall control rate percentages pre and post MAP BP implementation and relative differences were collected and analyzed.

Findings

The five HCOs enrolled in AMA MAP HTN program were from the southeast, midwest, and south regions of the US with multiple sites implementing the program. Overall, four sites improved their BP control rates, with two sites seeing improvements of over 15%. The relative differences in pre and post control rates ranged from 3.2% to 31.8%. One HCO saw a slight decrease in BP control rates, with a relative difference of –5.1%.

Implications for D&I Research: Four of the five HCOs improved their BP control rates after AMA MAP HTN implementation. Furthermore, two of the HCOs had over a 15% increase in their HCO blood pressure control rate. While these preliminary results show improvement in blood pressure control, additional statistical analysis is needed to understand if AMA MAP HTN can have a significant impact over time. Furthermore, additional research to assess inequities in hypertension control are needed to make refinements to the QI program.

American Medical Association, Chicago, IL, USA

Correspondence: Tamkeen Khan ([email protected])

Implementation Science 2025, 20(1):S66

Background

Five health care organizations (HCO) enrolled in the AMA MAP™ Hypertension quality improvement (QI) program were previously analyzed to see if there is an improvement in blood pressure control pre and post MAP BP program. A more detailed statistical analysis is needed to understand AMA MAP HTN’s impact and understand disparities within blood pressure control. This longitudinal study assesses the impact of the AMA MAP™ Hypertension quality improvement program over time along with focusing on potential inequities in blood pressure control at a large public health care institution.

Methods

18,252 patients diagnosed with hypertension were identified at Cook County Health. Blood pressure (BP) values were obtained for patients in the 2 -years prior to implementation of the QI program (July 2019 to June 2021) compared to BP in the 2-years after implementation (July 2021 to July 2023). A multivariable logistic regression model of BP control status, paired t-tests, and ANCOVA analyses, stratified by race, ethnicity, sex, and age are conducted to assess SBP and measure the gaps by demographic characteristics.

Findings

Prior to the QI program, BP control (<140/<90) was significantly less for Black as compared to White patients (OR 0.82 [0.74–0.92]). The racial difference remained after the program, although it was slightly diminished (OR 0.86 [0.76–0.97]). Patients who were older were less likely to have controlled BP prior to the program, but these differences were no longer evident following the QI program. The QI program led to a decline in SBP in all demographic groups, including between ethnicity (Hispanic: −5.74 [CI:6.19- −5.29] vs Non-Hispanic −4.92 [−5.21- −4.63]), White (−5.96 [CI: −6.45- −5.47]) and Black (−4.80 [CI: −5.11- −4.49]) patients, and by age between 45–64 years (−5.79 [CI: −6.12- −5.46] and 65–85 years (−4.31[CI: −4.68- −3.94]).

Implications for D&I Research: The results indicate an overall improvement in BP control and SBP, however, gaps persisted in SBP across ethnicity, race, and certain age groups. Quality improvement coaching and dashboards may support clinical care teams in addressing inequities in patient BP control.

¹Northwestern University Feinberg School of Medicine, Chicago, IL, USA; ²Brown University, Providence, RI, USA; ³University of Washington, Seattle, WA, USA; ⁴University of Connecticut, Farmington, CT, USA; ⁵The Ohio State University, Columbus, OH, USA

Correspondence: Sara Becker ([email protected])

Implementation Science 2025, 20(1):S67

Background

Contingency management (CM) is one of the most effective behavioral interventions for treatment of opioid use disorder, yet is rarely offered in opioid treatment programs. The theory of implementation effectiveness posits that implementation climate (the extent to which implementation is expected, supported, and rewarded) is a key mechanism of implementation effectiveness (the consistency and quality of implementation). In Project MIMIC, we tested the incremental impact of two implementation strategies explicitly selected to enhance CM implementation climate: a team-focused support strategy called Implementation and Sustainment Facilitation (ISF) + a staff-focused incentivization strategy called Pay-For-Performance (P4P).

Methods

Opioid treatment programs (N = 28) and staff (N = 186) were cluster-randomized to receive the real-world control strategy used by the federally-funded Addiction Technology Transfer Centers (ATTC; workshop + feedback + coaching) or an enhanced experimental strategy targeting implementation climate (E-ATTC; ATTC + ISF + P4P). Intention-to-train analyses examined impacts on: CM adoption (1 = implemented with 1+ client; 0 = never implemented), CM time-to-adoption (days until first CM implementation), CM exposure (number of clients receiving 10 CM sessions), and CM skill (number of CM sessions implemented at or above predefined CM fidelity benchmark rating of 5.8). We also examined the number of OTPs sustaining CM with fidelity 6–12 months post-implementation.

Findings

Overall, 95 staff received ATTC and 91 received E-ATTC. Relative to ATTC, E-ATTC staff had significantly higher CM adoption (33% vs. 51%, p <.05), quicker CM time-to-adoption (84% greater likelihood of implementing CM at any given day, p <.01), higher CM exposure (19% vs. 34%, p <.05), and higher CM skill attainment (4% vs. = 12%, p <.05). There were no condition differences in CM sustainment (4 ATTC programs, 4 E-ATTC programs).

Implications for D&I Research: CM implementation outcomes significantly improved when enhancing the ATTC strategy with ISF as a support strategy and P4P as a reward/incentivization strategy. Implementation strategies targeting the extent to which an innovation is expected/supported (ISF) and rewarded (P4P) have the potential to improve implementation outcomes, but improvement of sustainment outcomes remains a challenge.

Primary Funding Source

National Institutes of Health.

¹University of Wisconsin-Madison, Madison, WI, USA; ²Stanford University School of Medicine, Palo Alto, CA, USA; ³Washington State Healthcare Authority, Olympia, WA, USA

Correspondence: Jay Ford ([email protected])

Implementation Science 2025, 20(1):S68

Background

As the opioid epidemic continues to plague the US, considerable federal investment is underway in expanding access to evidence-based prevention and treatment services. A particular emphasis is improved reach, adoption, and care quality of life-saving medications for opioid use disorder (MOUD). However, little is known about the effectiveness or efficiency of a wide range of implementation strategies being deployed to expand MOUD access. The Stagewise Implementation-to-Target Medications for Addiction Treatment (SITT-MAT) project recruited 69 specialty addiction and primary care clinics across one western US state. SITT-MAT uses a measurement-based stepped implementation approach to identify the most effective and efficient implementation strategies. Within the context of the RE-AIM framework, this preliminary primary outcome analysis examines how exposure to the first “soft touch” step, Enhanced Monitoring and Feedback (EMF), influenced changes in implementation quality.

Methods

Implementation outcomes were assessed using a standardized, validated measure of MOUD care quality (the I of the RE-AIM framework): Integrating Medications for Addiction Treatment (IMAT) Index. The IMAT consists of a total score, seven dimension scores, and one subscale score assessing low barrier care. We also examined various baseline covariates including clinic type, rurality, and a quantitative measure of contextual determinants (Contextual Determinant Inventory; CDI) as possible predictors of implementation outcomes. We used hierarchical linear modeling with maximum likelihood estimation to evaluate the proportion of all clinics with high IMAT at T1 (pre-EMF), T2 (post-EMF), and the change from T1 to T2. A sensitivity analysis was performed including only clinics with both T1 and T2 IMATs.

Findings

IMAT outcomes post EMF implementation strategy found significant improvement in the total IMAT score (∆=0.27, p=0.006), Workforce (∆=0.62, p=0.004), and Staff Training & Development (∆=0.31, p=0.034). The CDI was a significant predictor of both baseline IMAT and change in the IMAT Total Score. Sensitivity analysis showed similar results.

Implications for D&I Research: A first step “soft touch” implementation strategy, yielded incremental positive change on measures of MOUD care quality. Within the context of this adaptive implementation trial, as strategies intensify, future analyses will focus on effectiveness, maintenance, and cost.

Primary Funding Source

National Institutes of Health.

¹Columbia University, New York, NY, USA; ²University of Kentucky, Lexington, KY, USA; ³Baystate Medical Center, Springfield, MA, USA; ⁴Boston Medical Center, Boston, MA, USA; ⁵RTI International, Research Triangle Park, NC, USA; ⁶The Ohio State University, Columbus, OH, USA; ⁷National Institutes of Health, Gaithersburg, MD, USA; ⁸Friends Research Institute, Baltimore, MD, USA; ⁹RTI International, Atlanta, GA, USA; ¹⁰University of Cincinnati, Addiction Sciences, Cincinnati, OH, USA

Correspondence: Timothy Hunt ([email protected])

Implementation Science 2025, 20(1):S69

Background

Opioid-related overdose is the leading cause of mortality among individuals recently released from incarceration in the US. Naloxone is an FDA-approved opioid antagonist medication designed to rapidly reverse opioid overdose. Despite evidence of its acceptability and effectiveness at reducing the risk of opioid overdose death after release from incarceration, only an estimated 25% of US jails provide naloxone upon release. This study examines the effectiveness of the HEALing Communities Study (HCS) Communities That HEAL (CTH) intervention, a community coalition, data-driven approach promoting evidence-based practices on expediting access to overdose education and naloxone distribution (OEND) in participating jails in Kentucky, New York, Massachusetts, and Ohio.

Methods

Communities were randomized to intervention (n=34) or wait-list control (n=33) arms stratified by state. Jail-based (n=59) surveys were implemented at 3 time points during 2019 to 2022. Generalized linear mixed models (GLMM) captured intervention effects during the evaluation period (July 1, 2021-June 30, 2022). Interpretation of results was informed by the Practical, Robust Implementation and Sustainability Model (PRISM) framework with a focus on external factors, state polices and innovative responses to implementation barriers and facilitators.

Findings

The CTH intervention was significantly associated with the hypothesized outcome, resulting in a greater number of jails providing overdose education (H1, relative risk_Adj = 1.51 [95% CI: 1.09, 2.08], p = 0.013) and the number of jails providing naloxone upon release (H2, relative risk_Adj = 1.49 [95% CI: 1.05, 2.13], p = 0.027). External factors related to OEND implementation, such as correctional health care models, available resources, and state COVID restrictions, varied across communities.

Implications for D&I Research: The CTH intervention engaged community coalitions to deploy evidence-based practices that effectively increased OEND implementation in jails, helping address elevated overdose risks for individuals during and post-release from incarceration. Partnerships between state, community, and jail-based stakeholders addressing multilevel implementation factors are needed to assure expanded and expedited access to this lifesaving, evidence-based approach.

Primary Funding Source

National Institutes of Health.

¹Columbia University, New York, NY, USA; ²George Mason University, Arlington, VA, USA; ³Chestnut Health Systems, Bloomington, IL, USA

Correspondence: Corianna Sichel ([email protected])

Implementation Science 2025, 20(1):S70

Background

In contrast to research on strategies supporting implementation and adoption of evidence-based practices, efforts to identify and address challenges in sustainment have received relatively little attention. This presentation draws on data from an NIMH-funded project to document rates of sustainment of an evidence-based practice (“e-Connect”), identify barriers and facilitators to sustainment, and inform selection and planned pacing of possible solutions. e-Connect is an evidence-based suicide prevention intervention for youth on probation. In e-Connect, probation officers (POs) use a digital clinical decision support system (CDSS) to facilitate the screening, referral, and linkage of youth at risk for suicide and associated behavioral health problems, to care. However, e-Connect only “works” if POs use it correctly.

Methods

We used mixed methods for the purpose of complementarity, guided by a novel theoretical integration of the gateway provider model and the dynamic sustainability framework. The former informed development of e-Connect; the latter identifies factors associated with long-term sustainment. Quantitative data were drawn from the e-Connect system and administrative records; qualitative data were drawn from interviews with probation staff.

Findings

Descriptive quantitative methods documented differences in e-Connect use during the sustainment phase (12 months) across n=10 counties. Rates of screening fell from 73% during implementation to 53% during sustainment, while rates of referral remained constant at approximately 90% across all counties. Additionally, there was considerable county variability, ranging from a 3% increase to a 70% decrease in rates of screening and a 37% increase to a 32% decrease in rates of referral. Rapid qualitative analysis of our interview data explored barriers and facilitators to CDSS use during sustainment. We identified agency/county, and PO characteristics associated with increasing and decreasing rates of e-Connect use, as well as staff-reported facilitators and barriers at system- (e.g., logistical, institutional), PO- (e.g., perceived behavioral health needs, availability of refresher trainings), and family/youth- (e.g., stigma, refusal) levels. Results also addressed PO preferences for the pacing of supports/strategies during sustainment.

Implications for D&I Research: e-Connect demonstrates sustainability. However, variable rates across counties suggest some county probation departments and/or POs may require additional supports/interventions. Possible strategies to support sustainment of e-Connect and similar practices will be discussed.

Primary Funding Source

National Institutes of Health

¹University of Virginia, Charlottesville, VA, USA

Correspondence: Pamela DeGuzman ([email protected])

Implementation Science 2025, 20(1):S71

Background

Nurses at our large academic medical center adopted the 4-phase Iowa Implementation Framework for Sustainability to guide timely and sustainable implementation of evidence-based interdisciplinary practice changes. This process framework is based on Roger’s Innovation-Decision Process. In Fall 2022, nursing leaders led a system-wide evidence-based change to switch from heparin flush for central venous catheters, to normal saline. The purpose of this study was to evaluate use of the Iowa Implementation Framework for Sustainability for implementation of evidence in a large complex health system.

Methods

We used a qualitative design supplemented with quantitative outcomes data to evaluate the research purpose. We interviewed implementation team members to understand their use of the framework in successfully achieving system-wide change and used an inductive approach to map activities to each phase’s recommended goals and change management activities. Organization-wide heparin purchases were tracked to evaluate change in practice.

Findings

During Phase 1, awareness was created by implementers through direct communication with providers (nurses, physicians and pharmacists) during existing leadership meetings; however, existing communication channels did not efficiently reach all adopters during Phase 1. Implementers designed workflow changes to the electronic medical record and the medication dispensing system to make the old behavior difficult and the new behaviors easier. Due to the strength of these systems, Phase 2 (i.e., typically focused on building pre-implementation knowledge and commitment) and Phase 3 (i.e., the actual behavior change point) were conducted simultaneously in most areas such that the implementers did not engage in trialability and instead collected feedback and distributed evidence through knowledge brokers during initial implementation. Phase 4 was characterized by monitoring alteplase and heparin use to stay aware of and troubleshoot ongoing implementation issues. Over the course of one year, heparin use decreased, with over $30,000 savings estimated in heparin purchases.

Implications for D&I Research: The Iowa Implementation Model for Sustainability can be used to guide change across a highly complex, large medical system. Designing technology to support behavior change is likely a key component of sustainable change in a large system. Future research should examine if linear use of model phases can speed organization-wide implementation.

¹University of Florida College of Medicine, Gainesville, FL, USA;²Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA; ³Indiana University, Bloomington, IN, USA; ⁴University of Florida Health Cancer Center, Gainesville, FL, USA; ⁵University of Wisconsin-Madison, Madison, WI, USA; ⁶Memorial Sloan Kettering Cancer Center, New York, NY, USA; ⁷New York University School of Global Public Health Global Center for Implementation Science, New York, NY, USA; ⁸Medical University of South Carolina, Charleston, SC, USA

Correspondence: Magda Montague ([email protected])

Implementation Science 2025, 20(1):S72

Background

The Cancer Center Cessation Initiative (C3I) is a National Cancer Institute (NCI) Cancer Moonshot^SM program that funded 52 NCI-designated cancer centers in three successive cohorts between 2017 and 2021 to implement and enhance sustainable tobacco treatment programs (TTPs). Although participating sites were required to submit plans for sustainability to NCI at the end of the funded period, little is known about the actual sustainment of the programs. This study aimed to characterize the sustainment of the programs two to four years post-funding.

Methods

An electronic survey was sent to program representatives from the 52 C3I-funded TTPs between Fall 2023 – Spring 2024 to inquire about current program status, funding, and evaluation. Data were analyzed descriptively.

Findings

Of the 47 TTPs that responded to the survey (90.4% response rate), 40 (85.1%) were still operating. Among the non-operating programs, the main reasons cited for discontinuing operations were financial constraints and lack of institutional commitment. The majority (73%, n=27) of the sustained TTPs were maintaining their annual operational budget at the same level as their highest historical funded amount, while 10 (27%) were maintaining their program at a decreased budget. The majority of sustained TTPs continued to assess program referrals (77.5%) and tobacco use status among patients (85%), while 27 (67.5%) continued to use C3I standardized metrics to assess program reach (defined as patients receiving tobacco treatment, among all patients who smoke). Only 55% continued to assess effectiveness using the standardized measure (defined as patients reporting 7-day point prevalence abstinence at 6 months, among all patients enrolled).

Implications for D&I Research: This national sustainment study concluded that the majority of cancer centers are still operating their C3I tobacco treatment programs after NCI implementation funding. The initial NCI investment appears to have led to highly sustainable programs with varying degrees of budget maintenance and continued evaluation during sustained operations.

Primary Funding Source

National Institutes of Health

¹Veterans Health Administration, Bedford, MA, USA; ²Hanoi Medical University, Hanoi, Viet Nam; ³UNC-Vietnam, Hanoi, Viet Nam; ⁴University of North Carolina at Chapel Hill, Chapel Hill, USA; ⁵Washington University in St. Louis, St. Louis, MO, USA; ⁶Vietnam Administration HIV/AIDS Control, Hanoi, Viet Nam

Correspondence: Sophia Bartels ([email protected])

Implementation Science 2025, 20(1):S73

Background

Evidence-based intervention (EBI) sustainment is one of public health’s most challenging translational research problems. Fewer than half of public health EBIs are sustained long-term, and sustainment challenges are even more pressing in low and middle-income countries (LMICs). Organizational characteristics, including organizations’ inner structures, culture, and climate, may play a key role in EBI sustainment. However, little quantitative research has examined these relationships, particularly in LMICs.

Methods

We assessed the association between baseline organizational characteristics and EBI sustainment within a cluster randomized implementation trial in Vietnam that was testing strategies to scale-up Systems Navigation and Psychosocial Counselling for people who inject drugs (PWID) with HIV across 42 HIV testing clinics. From the Exploration, Preparation, Implementation, and Sustainment Framework, five baseline organizational characteristics were selected for investigation: 1) implementation leadership; 2) clinic workload; 3) percent PWID; 4) implementation climate; and 5) organizational readiness. Six to ten months post-study completion, clinic staff and leadership (n=218) completed a survey that included the Provider Report of Sustainment Scale (PRESS), a measure of EBI sustainment across a clinic. We conducted a clinic-level multiple linear regression analysis to evaluate these relationships as well as cognitive interviews of the PRESS among staff (n=31) in a sub-sample of clinics to inform interpretation of the results.

Findings

Clinics with high organizational readiness had significantly greater sustainment than clinics with low organizational readiness

(ß=1.91, p=0.015). None of the other organizational characteristics were associated with sustainment. During the cognitive interviews, some participants had challenges interpreting the PRESS items, including responding aspirationally rather than based on their clinic’s actual sustainment experience or responding for themselves rather than for staff across the clinic, which could have contributed to the null findings.

Implications for D&I Research: Assessing clinics’ organizational readiness pre-implementation and providing tailored support to those with low readiness scores could improve EBI sustainment. This work also has important implications for cross-cultural implementation science measurement and signals the need for more development and/or adaptation of sustainment measures and use of innovative methods (e.g., administrative data review) to more objectively assess this construct.

Primary Funding Source

National Institutes of Health

¹University of Alabama at Birmingham, Birmingham, AL, USA; ²Alabama Primary Health Care Association, Montgomery, AL, USA; ³Qsource, Memphis, TN, USA

Correspondence: Larry Hearld ([email protected])

Implementation Science 2025, 20(1):S74

Background

Sustaining interventions in primary care is a well-known challenge and barrier to improving population health. We examined the sustainability infrastructure of primary care clinics participating in the Alabama Heart Health Improvement Project (HHIP), a 12-month practice facilitation intervention focused on reducing regional disparities in uncontrolled hypertension, and the conditions associated with this infrastructure.

Methods

We recruited 47 practices from across Alabama, a mixture of federally qualified health centers (FQHCs) and non-FQHCs, to participate in the HHIP program. Practice champions completed baseline surveys to assess quality improvement (QI) infrastructure (Change Process Capability Questionnaire) and change readiness (Organizational Readiness for Implementing Change) at the start of the intervention. Twenty-seven practices completed an end-of-intervention Clinical Sustainment Assessment Survey (CSAT) that measured seven domains of the sustainability infrastructure (engaged leadership, engaged staff, organizational readiness, workflow integration, implementation/training, monitoring/evaluation, outcomes/effectiveness) and attitudes about the HHIP (acceptability, appropriateness, and feasibility). Ordinary least squares regression models were used to examine the relationship between QI infrastructure, change readiness, attitudes toward the HHIP, and sustainability infrastructure while controlling for organizational and respondent characteristics.

Findings

Attitudes toward the HHIP, on average, were high (M > 4.10, range = 1–5, for acceptability, appropriateness, and feasibility). Similarly, participants reported relatively high levels of sustainability infrastructure (M > 5.30, range = 1–7, for all seven domains). Regression analysis showed change readiness was consistently associated with greater sustainability infrastructure (6 of 7 relationships statistically significant), while QI infrastructure was not significantly associated with any of the sustainability infrastructure domains. Change readiness was also significantly associated with perceived acceptability (b=0.34, p<.05), appropriateness (b=0.38, p<.05), and feasibility (b=0.38, p<.05). Sustainability infrastructure was greater among clinics with more favorable perceptions of HHIP feasibility and acceptability. These relationships varied, however, across different attitude-infrastructure domain combinations (feasibility associated with leadership, readiness, workflow integration vs. acceptability associated with implementation/training, monitoring/evaluation, outcomes/effectiveness).

Implications for D&I Research: Certain organizational conditions may be more important considerations for improving clinic member’s attitudes toward and sustaining interventions in primary care settings. Our findings also suggest that clinic members’ attitudes toward interventions may play a mediational role between organizational conditions and sustainment capabilities.

Primary Funding Source

Agency for Healthcare Research and Quality

Shivani Mishra^1,2, Deborah Onakomaiya^1,2, Angela Aifah^1,2, Nafesa Kanneh^1,2, Nwankwo Chioma Hope³, Oluwayemi Dorcas Odejobi³, Oluwatosin Odubela³

¹Institute for Excellence in Health Equity, NYU Grossman School of Medicine, New York, NY, USA; ²Section for Global Health, Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA; ³The Nigerian Institute of Medical Research, Lagos, Nigeria, Lagos, Nigeria

Correspondence: Shivani Mishra ([email protected])

Implementation Science 2025, 20(1):S75

Background

Implementation strategies are dynamic and multi-faceted, and may require adaptations to fit implementation contexts, especially in lower-and-middle income countries. We report the adaptations for an ongoing late-stage implementation science trial [R01HL147811] that integrates hypertension management into HIV care in Lagos, Nigeria – a country with a high dual-disease burden – using the Task Strengthening Strategy for Hypertension [TASSH] control as the intervention, and practice facilitation as the implementation strategy.

Methods

FRAME (Framework for Reporting Adaptations and Modifications - Enhanced) and FRAME-IS (Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies) modules were used to report adaptations to the intervention and the implementation strategy respectively in order to enhance the recruitment and retention rates for the participants. Data collection sources included (but were not limited to) patient records, nurses’ log and minutes of meetings. Data across these sources was coded retrospectively by trained research staff, and triangulated during virtual meeting discussions. Once consensus was reached, data was mapped onto the relevant framework modules using Microsoft Excel.

Findings

We modified FRAME and FRAME-IS to include an additional component on ‘what was originally planned’ for context of the adaptations. The adaptations characterized using the frameworks included reordering recruitment start dates of study cohorts, providing patients incentives to attend follow-up visits, adding feeder sites to the study sites, and increasing frequency of trainings to account for the high nurse turnover in the primary healthcare system. Overall, 25% of the adaptations involved expanding the structure of the intervention and implementation strategies, and 33% involved adding new elements to the strategies. All adaptations occurred in the implementation phase of the trial.

Implications for D&I Research: The documentation of the modifications using FRAME and FRAME-IS demonstrates their combined applicability to an ongoing trial that can be tailored to fit the local context. Based on our experiences, we recommend the development of a combined tracking system to include both FRAME and FRAME-IS components so that multi-faceted adaptations across both implementation strategies and evidence-based practices can be documented using a single framework.

Primary Funding Source

National Institutes of Health

¹Centers for Disease Control and Prevention, Atlanta, GA, USA; ²John Snow Inc. Research & Training Institute (JSI), Arlington, VA, USA; ³JSI, Accra, Ghana; ⁴JSI, Washington, DC, USA; ⁵Centers for Disease Control and Prevention, Accra, Ghana; ⁶Saha Consulting and Services Limited, Accra, Ghana; ⁷University for Development, Department of Global Health, Accra, Ghana; ⁸Expanded Program on Immunization, Ghana Health Service, Accra, Ghana

Correspondence: Nessa Ryan ([email protected])

Implementation Science 2025, 20(1):S76

Background

Implementation of gender-responsive interventions is critical to address gender-related barriers to immunization uptake. Two types of evidence translation are key for implementation: slower translation of evidence-based interventions into immunization program design, including interventions from other health sectors that have leveraged a critical gender lens; and more rapid, evidence-into-action translation in the field to tailor interventions. Objective: To adapt, implement, and evaluate a gender-responsive intervention to promote family engagement in childhood immunization.

Methods

We conducted a mixed-methods evaluation for the intervention in Kpone Katamanso, Ghana. Slower translation consisted of preparatory stakeholder engagement and synthesis of lessons learned from other maternal health areas that have successfully addressed gender-related barriers in program design. In May 2023, we conducted a baseline household survey (n=481 caregivers), eight focus group discussions (FGDs) among caregivers, and 20 interviews (n=10 health workers, n=10 caregivers). For rapid translation, stakeholders reviewed baseline findings for intervention input and tailoring at a co-creation workshop. The multi-component intervention was implemented (Nov 2023‒June 2024) and endline evaluation conducted (June 2024), including rapid surveys (n~250), seven FGDs, and 25 interviews. The FRAME (Framework for Reporting Adaptations and Modifications to Evidence-based interventions) guided iterative adaptation.

Findings

Learning from prior evidence, we designed our intervention on increasing fathers’ involvement in immunization by increasing their knowledge, awareness, and support for vaccination. Baseline findings showed that fathers needed vaccine knowledge and mothers needed social support to seek vaccination. During co-creation, stakeholders reported acceptability of proposed intervention components (interpersonal communication training of health workers, community meetings, community-based quality improvement teams). We implemented on-going intervention adaptations: having gender-specific groups for community conversations, holding community sessions on weekends to promote male engagement, and expanding outreach sites to engage new participants. Endline findings suggest improved joint decision-making between caregivers and social support among fathers for attending the vaccination visit, sharing reminders, and providing money for transport to vaccination.

Implications for D&I Research: This work highlights examples of slower and rapid evidence translation in resource-limited setting, demonstrating how lessons from other health areas can be incorporated into vaccine programs to design and implement a community-engaged and evidence-based intervention addressing gender-related barriers to vaccine demand.

Primary Funding Source

Centers for Disease Control and Prevention

¹Makerere University School of Public Health, Kampala, Uganda; ²San Diego State University, San Diego, CA, USA; ³Boston College, Boston, MA, USA; ⁴Mildmay Uganda, Kampala, Uganda

Correspondence: Susan M. Kiene ([email protected])

Implementation Science 2025, 20(1):S77

Background

Implementation research expedites the translation of data into real-world public health interventions. Uganda’s dual burden of heavy alcohol use and HIV is driven by environmental factors. We developed Kisoboka (“It is possible”) in response to a lack of contextually relevant evidence-based interventions aimed at addressing these issues in tandem. Prior analyses demonstrated preliminary efficacy of the intervention, however, rates of hazardous alcohol use remained high for some. We used a mixed methods assessment of implementation outcomes (per Proctor et al.) after the pilot and used the Framework for Reporting Adaptations and Modifications to Evidence-Based Interventions (FRAME) to outline intervention refinements for a subsequent type 2 hybrid RCT.

Methods

Kisoboka, an alcohol reduction and HIV treatment engagement intervention grounded in behavioral economics and motivational interviewing, was pilot tested in a two-arm pilot RCT (n=160). The intervention consisted of counseling sessions, text message reminders of savings and health goals, and a structural component supporting saving via mobile banking to reduce alcohol expenditure. We quantitatively assessed intervention fidelity (coding 20% of audio-recorded sessions) and feasibility (attendance) and qualitatively explored its appropriateness and acceptability via participant exit interviews (n=16). We utilized a modified version of the FRAME to document modifications based on participant feedback.

Findings

Intervention session completion was high (>96%); the phone session had the lowest completion rate (94%). Fidelity was high (93–100% of steps completed) but results highlighted areas needing improvement. Key recommendations include increased implementer training and/or content on defining low-risk drinking, reiterating goals at the end of each session, and improving visual aids. Exit interviews revealed high appropriateness and acceptability with suggestions for enhancements. Participants expressed a need for more sessions and extending program duration to better support behavior change. Proposed modifications include increasing the number of intervention sessions, incorporating support for substance-free activities, and changing the phone session to in-person.

Implications for D&I Research: This mixed methods assessment informed intervention refinement before the hybrid effectiveness implementation RCT. Our continued use of FRAME to analyze how, when, and why further modifications occur—and their subsequent impact—will facilitate intervention tailoring to ensure contextual relevance, thereby promoting program sustainability and speeding the time from evidence to real world scale-up.

Primary Funding Source

National Institutes of Health.

¹St. Jude Children's Research Hospital, Memphis, TN, USA; ²Washington University in St. Louis School of Medicine, St. Louis, MO, USA

Correspondence: Alejandra Méndez Aceituno ([email protected])

Implementation Science 2025, 20(1):S78

Background

The Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) informs planned modifications to implementation strategies. Proyecto EVAT and Project PASHA support implementation of a Pediatric Early Warning System (PEWS), an evidence-based intervention to reduce deterioration mortality among hospitalized children with cancer in Spanish- and English-speaking centers. Brazil, a Portuguese-speaking country, has 77 centers providing childhood cancer care which have struggled to integrate into these initiatives. To address this challenge, we used FRAME-IS to assess and adapt the implementation strategies used in EVAT/PASHA for the Brazilian context, resulting in the development of ESAP Max (Escala de Sinais de Alerta Precoce Máxima), an initiative to scale PEWS in pediatric cancer centers in Brazil.

Methods

An implementation strategy model was developed by a core team with expertise in PEWS implementation with the goal to efficiently scale-up PEWS in Brazil while maintaining high-fidelity, sustainable PEWS use. The implementation process was classified into 3 phases used by Proyecto EVAT/Project PASHA: planning, pilot/implementation, and sustainability. Planned adaptations to the implementation strategy across the three phases were documented using all modules of FRAME IS.

Findings

A total of 18 needed adaptations were identified across the three implementation phases: 10 (55%) in the planning phase, 7 (39%) in pilot and implementation, and 1 (6%) in sustainability. Among FRAME-IS components, “what” was the most adapted (9 adaptations, 51%), with majority being changes to context/environment (7 adaptations, 39%). Needed content and training adaptations were also noted (1 adaptation, 6%). The nature of adaptations was primarily elimination and shortening (9 adaptations, 50% each). All proposed adaptations were considered fidelity consistent.

Implications for D&I Research: FRAME-IS can be used prospectively to guide adaptations to an established implementation strategy. Our work is one of the first to use this framework to promote regional scale-up, applying it to PEWS efforts. This highlights an approach for future work that can systematically identify and describe adaptations to implementation strategies. Future work will focus on piloting ESAP-MAX, the proposed new implementation strategy in Brazil and tracking planned and un-planned reactive adaptations in response to contextual needs. This work brings further empiric evidence for use of FRAME-IS in real-world clinical settings.

Primary Funding Source

St Jude Children's Research Hospital/ALSAC

¹Northwestern University Feinberg School of Medicine, Chicago, IL, USA; ²Saint Louis University, Saint Louis, MO, USA; ³Wake Forest University School of Medicine, Winston-Salem, NC, USA; ⁴Washington University School of Medicine, Saint Louis, MO, USA; ⁵Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria; ⁶Department of Medical Social Science, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; ⁷Washington University in St. Louis School of Medicine, Saint Louis, MO, USA

Correspondence: Chisom Obiezu-Umeh ([email protected])

Implementation Science 2025, 20(1):S79

Background

HIV/AIDS continues to be a major driver of mortality among adolescents and young adults in sub-Saharan Africa (SSA). Despite substantial research and growing evidence on effectiveness, the benefits of proven interventions have not been fully explored due to challenges sustaining such efforts. Existing sustainability measures developed in high-income countries may not accurately reflect determinants unique to sustainability of interventions and in low-income countries, including SSA. To fill this gap, our study developed the Sustainability Tool to Assess Evidence-Based Interventions and Programs (STEPS), which provides a theory-based measure that can be used to assess multilevel determinants of sustainability from the perspective of implementation practitioners.

Methods

STEPS domains and the initial scale item pool were generated after reviewing existing literature on sustainability in the African region. Two rounds of expert reviews were conducted with 10 experts from nine SSA countries, providing ratings and feedback on the relevancy of each item. Then, face validity was conducted among ten healthcare workers involved in implementing interventions and programs in Nigeria. Content validity metrics and consensus methods were used to remove redundancy, reducing the final scale to 31 items. We then piloted and evaluated STEPS among 256 healthcare workers in Nigeria directly involved in implementing HIV programs and/or interventions. The data was analyzed using exploratory factor analysis (EFA) to determine the underlying factor structure and lastly, reliability analysis was performed.

Findings

The EFA indicated that a four-factor 31-item structure best fits the data (Kaiser Criterion of eigenvalues > 1, confirmed by scree plot, and interpretability). The four subscales are:1) intervention characteristics 2) organizational capacity, 3) implementation context and values, and 4) socio-cultural and community context. The Cronbach’s alpha for the subscales ranged from 0.83 to 0.95. Overall, STEPS demonstrated adequate content validity and excellent internal consistency for the overall scale with a Cronbach's alpha of 0.97.

Implications for D&I Research: This research findings contribute to the implementation science literature by providing future researchers/programmers a means to assess factors associated with the long-term delivery and subsequent benefits of evidence-based interventions and programs in African settings. STEPS provides a context-relevant tool for assessing sustainability in the African context and similar settings.

Primary Funding Source

Graduate Research Funds

¹Washington University in St Louis, St Louis, MO, USA; ²Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria; ³Saint Louis University College for Public Health and Social Justice, Saint Louis, MO, USA; ⁴Wake Forest University School of Medicine, Winston-Salem, NC, USA

⁵University of North Carolina at Chapel-Hill, Chapel-Hill, NC, USA; ⁶Georgia State University, Atlanta, GA, USA

Correspondence: Titilola Gbaja-Biamila ([email protected])

Implementation Science 2025, 20(1):S80

Background

Youth can be engaged in designathons to co-create sustainable community-driven strategies. Designathons are a participatory approach to developing implementation strategies that promote creativity and innovation. The interactive nature of designathons can improve the success of implementation, solution innovation, and sustainability, as the solutions are more culturally-appropriate and aligned to the needs of the end users. This study aims to assess the feasibility and acceptability of designathons in co-creating sustainability strategies for HIVST.

Methods

Participants responded to an open call, “How might community-based organizations in Nigeria sustain HIV self-testing (HIVST) and youth-friendly preventive services for at-risk AYA.” The top ten teams were invited for a 72-hour-designathon. Each team was made of 4 to 6 members. The study utilized the conceptual framework of sustainability of interventions implemented in Africa. During the designathon, a descriptive survey with a pretest-posttest design was conducted to assess 36 youths. Participants completed a questionnaire prior to the designathon and after the designathon. The Descriptive and Wilcoxon signed-rank tests were used for data analyses.

Findings

The majority of the participants were aged 19–24 (61.1%), held a senior secondary school certificate (55.6%), and were students (86.1%). The total score of most participants was Moderate Strength (61.1%). Three domains had significant improvement: Adequate Resource provided in the designathon (p = 0.005), Collaboration (p = 0.009), and Communication (p = 0.020). Most participants indicated that the sessions on Human-centered Design Thinking (67.6%) and the role of community-based organizations in sustaining the ‘for youth by youth’(4YBY) programs were most helpful. About 62.2% rated themselves highly for coming up with ideas. They had positive feelings about the designathon (94.6%).

Implications for D&I Research: The study's findings show the feasibility and potential of participatory processes like designations in co-creating sustainability strategies and building capacity among participants. Significant improvements in strategies for solutions were observed with the creation of useful tools for developing meaningful and innovative solutions to complicated health concerns in different demographics and situations. The designathon facilitated the collaboration between the community and professionals from other professions.

Primary Funding Source

National Institutes of Health

¹Northwestern University, Chicago, IL, USA; ²University of Abuja Teaching Hospital, Abuja, Nigeria; ³Washington University School of Medicine, Saint Louis, MO, USA; ⁴University of Utah, Salt Lake City, UT, USA

Correspondence: Nanna Ripiye ([email protected])

Implementation Science 2025, 20(1):S81

Background

The Hypertension Treatment in Nigeria Program is a large-scale hypertension control program that adapted and implemented the WHO HEARTS technical package in 60 primary healthcare centers (PHCs) in FCT, Nigeria from January 2021-December 2023. The program recruited 21,922 patients and demonstrated an increase in hypertension control from 22% to 56% using an interrupted time series design. The objective of the current study was to evaluate normalization and sustainability of this program.

Methods

From October 2023-December 2023, healthcare workers (HCWs) from participating PHCs were invited to complete the 5-point Normalization Measurement Development (NoMAD) survey to evaluate normalization of the adapted HEARTS package into routine care. Over the same time, facility managers from sites and policymakers from local government area councils were invited to complete the 7-point Program Sustainability Assessment Tool (PSAT) to evaluate program sustainability. Descriptive analyses were performed, and Kruskal-Wallis tests were used to evaluate potential differences in normalization and sustainability across HCW types and local government area councils.

Findings

Among 217 NoMAD respondents (55% community health extension workers), median (IQR) scores across all normalization domains were 4 or greater and were highest for cognitive participation (4.8 [4.5, 5.0]). Results were similar across HCW type with modest variability by area council. Among 48 PSAT respondents (91% facility managers), median (IQR) scores were 6 or greater and were highest for program evaluation (6.8 [6.2, 7.0], communication 6.8 [5.8, 7.0], and strategic planning (6.8 [6.0, 7.0]). Results were similar across area councils.

Implications for D&I Research: These results demonstrate a high degree of normalization of the WHO HEARTS package into PHCs in Nigeria with favorable conditions for long-term sustainability, both of which are necessary for scale-up in Nigeria and other resource-limited contexts.

Primary Funding Source

National Institutes of Health

¹New York University School of Global Public Health, New York, NY, USA; ²Institute of Social and Medical Studies, Hanoi, Viet Nam; ³Montefiore Medical Center, New York, NY, USA; ⁴Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda

Correspondence: Donna Shelley ([email protected])

Implementation Science 2025, 20(1):S82

Background

Despite high rates of tobacco use among people living with HIV, integration of evidence-based treatment for tobacco use has lagged in the context of HIV care. We conducted a Type 2 hybrid randomized controlled trial that tests the effectiveness of three tobacco use treatments (TUTs): Ask, Advise and Assist with brief counseling + Quitline referral (3 As +R); 3 As + six-session counseling delivered by a trained nurse (C); and 3 As+C+Nictone Replacement Therapy, while simultaneously evaluating strategies used to increase adoption of the TUT components. Herein, we present the impact of these strategies on provider adoption of TUT.

Methods

Implementation strategies employed during the trial included training, workflow redesign, system changes and practice supervision. We conducted baseline, 12-month (end of treatment), and 18-month surveys of all health care providers (n= 77) in 14 HIV outpatient clinics to assess delivery of the 3 As and evaluate constructs that predict the adoption of 3 As adapted from the Theoretical Domains Framework (TDF).

Findings

Adoption of the 3 As increased significantly from baseline (ask 14.2%, advise 22.4%, assist 4.8%) to 12 months (ask 47.3%, advise 56.1%, assist 31.0%) and were sustained at 18 months (ask 58.6%, advise 69.0%, assist 31.0%). Nearly all providers agreed that they had the time to continue providing 3 As at 12 and 18 months (97.1% and 100%, respectively). Providers remained confident that they had the necessary training to provide 3 As at both 12 and 18 months (100%). We will present in-depth data on correlates of adoption and sustainment mapped to the TDF.

Implications for D&I Research: Sustained improvements in changes in provider behavior are rarely reported in implementation studies, particularly in LMICs. The implementation strategies used in this trial results in increased adoption and sustained improvement in the delivery of TUT. Factors associated with both adoption and sustainment of TUTs should be explored in future research.

Primary Funding Source

National Institutes of Health

Yale University School of Medicine, New Haven, CT, USA

Correspondence: J. Lucian Davis ([email protected])

Implementation Science 2025, 20(1):S83

Full paper published

¹Tulane School of Public Health and Tropical Medicine, Lima, Peru; ²The George Washington University, Washington, DC, USA; ³National Institutes of Health, Rockville, USA

Correspondence: Valerie Paz-Soldan ([email protected])

Implementation Science 2025, 20(1):S84

Full paper published

Shifa Tameer-e-Millat University (STMU), London, United Kingdom

Correspondence: Syed Usman Hamdani ([email protected])

Implementation Science 2025, 20(1):S85

Full paper published

¹Institute for Excellence in Health Equity, NYU Grossman School of Medicine, New York, NY, USA; ²Section for Global Health, Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA; ³Department of Population, NYU Grossman School of Medicine, New York, NY, USA; ⁴Cardiovascular Research Unit, University of Abuja., Abuja, Nigeria; ⁵Department of Biostatistics, NYU Grossman School of Medicine, New York, NY, USA

Correspondence: Shivani Mishra ([email protected])

Implementation Science 2025, 20(1):S86

Background

Integrated HIV and non-communicable disease (NCD) programs, especially for hypertension management, show promise in low- and middle-income countries (LMICs) grappling with this dual burden. However, their success hinges on robust community engagement. Existing frameworks emphasize community involvement, but a critical gap exists: the lack of individual-level capacity assessments within community-based organizations (CBOs), which can ensure that specific skills and abilities of individuals within the organization are contextualized when linking communities to clinics. We highlight the strengths of staff in CBOs serving people with HIV to implement a community clinical linkage for HIV-hypertension integration in Akwa Ibom State, Nigeria.

Methods

As part of Community Asset Mapping, 22 CBOs were engaged using a tailored individual capacity survey (ICS). Three researchers identified at least one key staff member from each CBO to complete the ICS, based on their involvement in the organization’s operations and ability to consent. The ICS included 58 closed-ended and five open-ended questions on assets and skills. Data was securely transferred from paper forms to Microsoft Excel. Data analysis consisted of frequency calculations and thematic analysis. Findings were triangulated in group discussions to reach a consensus on respondents'capacities.

Findings

Of the 60 respondents across 22 CBOs, the majority confirmed having general healthcare skills related to lifestyle counselling (90%) and peer support (80%). Approximately half of the respondents engaged in community project(s) or issue(s) (58%), with the most frequent types of engagement being: carrying out activities to kickstart a program (70%), bringing an issue to the community’s attention (68%), and putting a plan of action together (67%). A significant number of respondents reported lacking online consultation and HIV screening skills (68%) but reported having skills in HIV education and promotion (77%).

Implications for D&I Research: Findings reveal both the technical and non-technical strengths of CBO staff, highlighting key capacities that can be utilized for implementing a community clinical linkage for hypertension integration in HIV care. This information supports the creation of targeted capacity building for CBO representatives to enhance the implementation of a community-clinical linkage for HIV-NCD integrated care in LMICs. Future implementation research should assess the impact of individual capacities to sustain CBO engagement.

Primary Funding Source

National Institutes of Health

¹University of Washington, Seattle, WA, USA; ²Universidade Eduardo Mondlane, Maputo, Mozambique; ³Comité para Saúde de Moçambique, Maputo, Mozambique; ⁴Northwestern University Feinberg School of Medicine, Chicago, IL, USA; ⁵Ministry of Health of Mozambique, Maputo, Mozambique

Correspondence: Ermyas Birru ([email protected])

Implementation Science 2025, 20(1):S87

Background

Few studies examine how primary care managers influence the implementation of evidence-based interventions in their facilities, particularly in sub-Saharan Africa (sSA). This study explores whether previously completed formal management training for primary care managers enhances the effect of a system-level intervention to improve the coverage and quality of a bundle of evidence-based guidelines targeting major causes of neonatal mortality in Mozambique.

Methods

The Theory of Middle Managers’ Role in Implementing Innovative Practices was used to examine the role of primary care managers in The Integrated District Evidence to Action (IDEAs) program. IDEAs is a system-level audit and feedback (A&F) implementation strategy for improving maternal and child health (MCH) service availability. Using the World Health Organization’s Service Availability and Readiness Assessment survey, we selected basic obstetric and neonatal service availability as our outcome indicator for MCH services, measured on a scale of 0–100, with 100 indicating complete availability. A longitudinal analysis using repeated annual cross-sectional surveys from August 2019 to July 2022 was conducted in three rounds. We examined the interaction between the IDEAs and formal management training on basic obstetric and neonatal service availability using a controlled linear mixed-effects regression.

Findings

We included 56 public-sector primary health care facilities across three rounds of the study. Participation in the health facility managers'survey remained consistent across rounds ranging between 56–59 participants per round. Only twenty-three percent of managers reported receiving formal management training, despite having an average of eight years’ experience in the health sector. We found that IDEAs intervention’s effectiveness in enhancing service availability was highest when health facility managers in the intervention sites had received formal management training, with an average increase of 11.1 points out of 100 per round (95% CI: 0.7 to 21.5, p=0.037), after adjusting for potential confounders.

Implications for D&I Research: Our findings highlight that the effectiveness of the audit and feedback strategy in improving service availability when health facility managers in the intervention facilities had received formal management training.A&F interventions in sSA should either target areas that have already had formal management training or provide training as part of the package of implementation strategies.

Primary Funding Source

National Institutes of Health

¹Washington University in Saint Louis, St. Louis, MO, USA; ²Center for Public Health Systems Science, Brown School, Washington University in Saint Louis, St. Louis, MO, USA; ³St. Jude Children's Research Hospital, Memphis, TN, USA

Correspondence: Sayeda Islam ([email protected])

Implementation Science 2025, 20(1):S88

Background

The Clinical Sustainability Assessment Tool (CSAT) is a valid, reliable measure of clinical capacity for sustainability. Although providers play a critical role in sustaining evidence-based interventions, literature about their perspectives on capacity for sustainability, and how this varies by profession is limited. This study explores clinician perceptions on the sustainability of Pediatric Early Warning Systems (PEWS), an evidence-based intervention to identify early clinical deterioration in hospitalized pediatric oncology patients.

Methods

This analysis is part of a study on PEWS sustainability across resource-varied pediatric oncology centers in Latin America. Clinicians using PEWS completed an anonymous survey, including CSAT and demographic questions, at two phases of PEWS implementation (pre- and post-pilot). Overall CSAT scores were calculated by averaging 35 CSAT items across 7 domains, scored on a 5-point Likert scale (higher scores representing higher capacity), with each response being the unit of analysis. Descriptive analyses summarized respondent and hospital-level characteristics and determined changes in overall CSAT scores across these categories. A multilevel model explored how respondent and hospital-level characteristics affect CSAT scores across two timepoints. Chi-squared tests determined the statistical significance of the models.

Findings

We analyzed 668 responses from 19 hospitals across 8 countries with measurements pre-pilot and post-pilot. Among respondents, perceived clinical capacity (overall CSAT scores) generally decreased between the two timepoints for different professions (nurses) and PEWS roles (implementation leaders and clinical staff). Multi-level models of CSAT scores were significant when including profession (p=0.033) and role (p<0.05). The relationship between CSAT scores and profession across the two timepoints was also significant (p=0.0341), with nurses perceiving lower sustainability capacity after the PEWS pilot.

Implications for D&I Research: This study identified differences in perceived clinical capacity for sustainability of PEWS, an evidence-based intervention, among clinicians of different professions and implementation roles. Nurses had lower perceptions of capacity and assessed capacity as even lower following the PEWS pilot, demonstrating differences in anticipated versus real-world capacity to sustain a clinical intervention. This study provides important empirical evidence of perceived sustainability capacity across different professional and implementation roles and highlights that early assessment of sustainability capacity, prior to intervention use, may not be accurate.

Primary Funding Source

National Institutes of Health

¹Brown University, Providence, RI, USA; ²RTI, Washington, D.C., USA; ³Save the Children International, London, United Kingdom; ⁴Caritas-Freetown, Freetown, Sierra Leone

Correspondence: Alethea Desrosiers ([email protected])

Implementation Science 2025, 20(1):S89

Full paper published

¹Yale University School of Medicine, New Haven, CT, USA; ²Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda; ³Yale School of Public Health, New Haven, CT, USA; ⁴Uganda Ministry of Health, Kampala, Uganda; ⁵Johns Hopkins School of Public Health, Baltimore, MD, USA; ⁶MIT, Cambridge, MA, USA; ⁷University of California San Francisco, San Francisco, CA, USA; ⁸Massachusetts General Hospital, Boston, MA, USA; ⁹Makerere University, Kampala, Uganda

Correspondence: J. Lucian Davis ([email protected])

Implementation Science 2025, 20(1):S90

Background

Low uptake and completion of contact investigation for tuberculosis(TB) limit its yield and public health impact globally. We sought to determine if an implementation strategy developed through human-centered design could improve completion, yield, and impact of TB contact investigation.

Methods

We conducted a stepped-wedge, cluster-randomized, hybrid type III implementation-effectiveness trial comparing user-centered and standard strategies for TB contact investigation at 12 healthcare facilities in Uganda(March 2022-October 2023). The user-centered strategy included: 1) an educational booklet to encourage participation in contact investigation; 2) a comprehensive contact identification algorithm; 3) an instructional sputum-collection video; and 4) a motorbike service to collect and transport sputum, clients, and community-health workers(CHWs) between facilities and homes. The user-centered strategy was implemented with support from audit-and-feedback reports, weekly collaborative improvement meetings, and a digital group-chat application for CHWs. Facilities transitioned from the standard to the user-centered strategy through randomization in six eight-week steps. The primary implementation outcome was the proportion of symptomatic contacts completing TB evaluation ≤60 days. Secondary effectiveness and impact outcomes included proportions(i.e., yield) and counts(impact) of contacts 1) initiating treatment for active TB disease and 2) initiating TB preventive therapy. In an intention-to-treat analysis, we constructed mixed-effects probit and Poisson regression models, adjusting for facility-level clustering.

Findings

There were 843 persons with TB and 2,874 close contacts who underwent contact investigation during standard strategy periods and 999 persons with TB and 5,761 close contacts during user-centered strategy periods. Participant characteristics were similar in the two strategy periods. Comparing user-centered to standard periods, more symptomatic contacts completed TB evaluation(adjusted odds ratio [aOR] 3.70, 95%CI 3.12–4.40, p<0.0001), and more contacts initiated active TB treatment(aOR 1.53, 95%CI 1.31–1.80, p<0.0001), but not TB preventive therapy(aOR 1.08, 95%CI 0.95–1.80, p=0.25). The counts of contacts initiating active TB treatment increased substantially between standard and user-centered periods(adjusted relative risk [aRR] 2.61, 95%CI 1.78–3.83, p<0.0001). The counts initiating TB preventive therapy also increased but not not significantly(aRR 1.11, 95%CI 0.86–1.44, p=0.41).

Implications for D&I Research: A user-centered implementation strategy dramatically increased the implementation, effectiveness, and public health impact of TB contact investigation in Uganda compared to a standard implementation strategy.

Primary Funding Source

National Institutes of Health

¹National Blood Service Ghana, Accra, Ghana; ²Liverpool School of Tropical Medicine, Liverpool, United Kingdom; ³University of Ghana, Accra, Ghana; ⁴Korle-Bu, University of Ghana, Accra, Ghana; ⁵Legon, University of Ghana, Accra, Ghana; ⁶Syracuse University, Syracuse, NY, USA; ⁷University of Pennsylvania, Philadelphia, USA; ⁸Centre for Science and Health Communication, Accra, Ghana

Correspondence: Lucy Asamoah-Akuoko ([email protected])

Implementation Science 2025, 20(1):S91

Background

Communication interventions for encouraging repeat blood donation are largely lacking in Sub-Saharan Africa. This pilot study aimed to create docudrama (drama with documentary) and WhatsApp interventions on blood donor retention for use later in a pragmatic hybrid effectiveness implementation trial in Ghana. The study is grounded in the PRECEDE-PROCEED model, an implementation science framework. PRECEDE focuses on planning whereas PROCEED emphasizes implementation and evaluation. This pilot study focused only on PRECEDE.

Methods

These involved using a) 25 key informant interviews (KIIs) with blood donors, non-blood donors, blood donation staff and community for perspectives on designing both the docudrama and WhatsApp messaging, b) conducting a 2-day docudrama design workshop with 19 participants including blood donors, drama actors, and drama and communication experts to help create scripts for the docudrama, and c) reviewing the literature and other relevant documents. The PRECEDE component was conducted in five phases. Social assessment involved assessing social factors that influence repeat donation; epidemiological assessment to determine the return rate of first-time blood donors in Ghana; behavioral and environmental assessment: to identify behavioral and environmental factors that impact repeat blood donation; educational and ecological assessment for predisposing factors, reinforcing factors, and enabling factors that impact decisions to repeat donation; administrative and policy assessment to create a script for 2 docudrama episodes, each lasting 15 minutes, and to create WhatsApp messages for aiding donor retention.

Findings

Several critical factors that facilitate repeat blood donations were highlighted from the assessments, and influenced the creation of the docudrama episodes and the WhatsApp messages. These included a) a need for the docudrama to be entertaining, educative, and projecting voluntary blood donation as an activity to save lives, b) a need for the WhatsApp messages to address issues including barriers to blood donation and benefits of donating blood for the donor.

Implications for D&I Research: We now have docudrama episodes and WhatsApp messages on blood donation being used in the next phase, PROCEED, in a pragmatic hybrid effectiveness implementation trial. Lessons from using PRECEDE component to design docudrama and WhatsApp messaging to encourage repeat blood donation among first-time blood in Ghana could be relevant in similar settings.

Primary Funding Source

National Institutes of Health

¹Brown School of Social Work, Washington University in St. Louis, Saint Louis, MO, USA; ²Washington University in St. Louis School of Medicine, Saint Louis, MO, USA; ³Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria; ⁴Lead City University, Ibadan, Oyo, Nigeria; ⁵Wake Forest University School of Medicine, Winston-Salem, NC, USA; ⁶University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; ⁷Georgia State University, Atlanta, GA, USA; ⁸London School of Hygiene and Tropical Medicine, London, United Kingdom

Correspondence: Onyekachukwu Anikamadu ([email protected])

Implementation Science 2025, 20(1):S92

Background

Cervical cancer is a major public health problem in Nigeria. Human papillomavirus (HPV) vaccines are effective in preventing nearly all cervical cancer cases. However, only 3% of girls aged 9–14 have been vaccinated against HPV in Nigeria. Current implementation strategies for HPV vaccine in Nigeria are primarily expert-driven with limited input from the communities. Crowdsourcing open call, which involves the community in generating culturally-relevant and salient solutions to issues that affect them, could be leveraged to develop community-driven strategies for HPV vaccination. This study synthesizes ideas from a crowdsourcing open call among the Nigerian public exploring strategies to rapidly and effectively promote the uptake and reach of the HPV vaccine, addressing the need to optimize the pace of implementation.

Methods

From February 10, 2024, to March 17, 2024, a crowdsourcing open call was launched in Nigeria, asking the general public to submit innovative ideas to the prompt, “How might we promote HPV vaccination among girls in Nigeria?” A total of 365 submissions were proposed various strategies to increase HPV vaccination rates among girls. Using purposive sampling, the top 38 submissions were selected for rapid thematic analysis guided by the Relationship and Expectations domain (perceptions, enablers, nurturers) of the PEN-3 cultural model. Special attention was given to the implementation pace, evaluating both rapid deployment and sustained engagement strategies.

Findings

Three main themes emerged as implementation strategies for HPV vaccines: addressing misinformation by increasing knowledge of HPV vaccination; disseminating information through creative outlets such as storytelling, slogans, and television shows; and leveraging the influence of key community leaders as ambassadors to facilitate promotion of HPV vaccines in communities. These strategies were identified as being salient to optimize the uptake and implementation pace for HPV vaccination.

Implications for D&I Research: The findings underscore the importance of incorporating community-driven strategies in HPV vaccine implementation to enhance the pace and effectiveness of dissemination, ensuring both rapid deployment and sustained engagement. Through active engagement of the community in generating culturally relevant solutions, implementation science can benefit from diverse perspectives that improve knowledge, leverage influential stakeholders, and utilize creative dissemination channels.

Primary Funding Source

National Institutes of Health

¹Yale School of Public Health, New Haven, CT, USA; ²Kathmandu University School of Medical Sciences, Dhulikhel, Nepal; ³Dhulikhel Hospital, Kathmandu, Nepal

Correspondence: Ashley Hagaman ([email protected])

Implementation Science 2025, 20(1):S93

Background

Low and middle income countries (LMIC) hold 75% of the world's suicides. However, little research in non-western and low-income contexts has informed suicide-specific prevention interventions and how they may be implemented in complex and resource-strained health systems. This project is situated in Nepal, a country with high suicide burden and increased mental health infrastructure. This study investigated preliminary implementation of a suicide prevention package (SuPP) for individuals at high-risk for suicide following discharge from a large peri-rural Nepali hospital.

Methods

SuPP was co-designed with a community advisory board of individuals with lived experience of suicide, hospital staff, and our team of Nepali anthropologists, psychiatrists, and public health experts. SuPP included a culturally anchored decolonized approach to “safety planning” called aashako diyo (meaning lighting hope), and tapered phone calls to adjust aashako diyo, increase connectedness, and decrease helplessness over six months. We conducted a pilot hybrid type two open pilot trial testing SuPP. We culturally adapted implementation assessment tools to measure acceptability, appropriateness, and fidelity. We used mixed methods and the EPIS framework to design, adapt, and assess the feasibility and acceptability of SuPP. We conducted embedded ethnography and periodic reflections to examine implementation climate, barriers, and facilitators. We track implementation adaptations with the FRAME.

Findings

Thirteen implementers and 24 individuals at high-risk for suicide were enrolled and 92% and 91.7% remained at six months respectively. SuPP met all pre-determined milestones to establish feasibility, fidelity, and acceptability, however, several barriers existed that suggest the hospital may not be an appropriate delivery agent particularly across genders. The presentation will highlight mixed-methods findings, focusing on elements related to fidelity, adaptations to improve delivery (attending to salient EPIS sub-domains of innovation fit and patient/family characteristics), and recommendations for future suicide prevention implementation in resource-strained, culturally diverse settings, like Nepal. Important adaptations attended to contextual needs including important forms (creating indigenous graphics for low-literate patients) and fidelity strength.

Implications for D&I Research: Decolonizing implementation components of the package as well as implementation strategies enhanced acceptability, appropriateness, and feasibility. Lived experience integration enhanced both intervention form adaptations as well as strategy adaptations.

Primary Funding Source

American Foundation for Suicide Prevention

Erika Crable, Siena Fisk

University of California, San Diego, La Jolla, CA, USA

Correspondence: Erika Crable ([email protected])

Implementation Science 2025, 20(1):S94

Background

D&I research often cites a 17-year lag between evidence generation and the uptake of evidence into practice. But too little attention is paid to how state/payer policies contribute to that lag, and the types of evidence or other information influencing policy. This study investigated evidence use behaviors and preferences of state/payer policy decision-makers who oversee Medicaid policy decisions related to medications for opioid use disorder (MOUD) – an effective and underused treatment – as a preliminary step to designing dissemination strategies tailored to their evidence needs.

Methods

An online survey was sent to behavioral health/pharmacy staff who oversee MOUD decisions for Medicaid agencies and MCOs in every U.S. state/territory. Survey items investigated Policy-Optimized Exploration, Preparation, Implementation, Sustainment (EPIS) Framework domains: outer (e.g., state partisanship, political rhetoric, lobbyists/advocates) and inner (e.g., Medicaid/MCO leadership and staff evidence use behaviors, policy design processes) contexts, bridging factors (e.g., evidence intermediaries), MOUD innovation factors (e.g., stigma, knowledge, acceptability of MOUD). Descriptive statistics summarize evidence use behaviors/preferences.

Findings

To date, 93 participants with Medicaid MOUD coverage decision-making authority in 36 states and 3 U.S. territories have responded (51% Democrat, 49% Republican). The survey and analyses will close in September 2024. Most (75.9%) said they are frustrated by outer context political disagreement about MOUD and 27.6% say it’s hard to make decisions because of conflicting information about MOUD. 96.5% trust NIH-funded research, but prefer internal literature reviews, seek federal guidance or convene experts instead of working directly with researchers. Lack of actionable messages/recommendations is the greatest barrier to using research in policy design. Policy briefs, peer-to-peer networks, and online data tools are preferred dissemination formats. MOUD effectiveness and cost-effectiveness outcomes are most desired.

Implications for D&I Research: Prior research has focused on why policymakers do not use research. We advance the literature by examining how policymakers prefer to receive research to inform health policy decisions. These results are critical to developing effective dissemination strategies (e.g., desired format, timing, outcomes) that mitigate the research-to-policy gap. This study also demonstrates a Policy-Optimized EPIS-driven study to investigate the understudied role of partisan rhetoric as a determinant in dissemination science research.

Primary Funding Source

National Institutes of Health

¹New York University Grossman School of Medicine, New York, NY, USA; ²RAND Corporation, Santa Monica, CA, USA; ³Chestnut Health, Normal, USA

Correspondence: Matthew Lee ([email protected])

Implementation Science 2025, 20(1):S95

Background

Policymakers generally lack research-informed guidance on how to leverage federal funding to promote reach (i.e., widespread implementation) of high-quality, evidence-based practices across health and social services – including adolescent substance use treatment. Starting in 2012, the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) funded a series of grants to improve state-level infrastructure for delivery of evidence-based adolescent substance use disorder treatments. Our project examined states funded to implement the Adolescent Community Reinforcement Approach (A-CRA), one of the recommended approaches. We sought to explain variation in the extent of A-CRA reach (proportion of trained providers certified to deliver and/or supervise A-CRA in each state) among grantee states and identify implications for federal grant policies.

Methods

Using a longitudinal mixed-methods comparative case study design, we examined each state as a case. We categorized states as achieving high, medium, and low A-CRA reach during their active grant periods (2–6 years of funding). We then synthesized available data (interviews with state agency administrators, grant administrative records/reports, other documents collected about each state’s A-CRA delivery efforts) to summarize grant activities and factors influencing reach in each state. Finally, we compared and contrasted state experiences to identify key findings.

Findings

We characterized differences between 19 states with high- (n=9), medium- (n=4), and low-rates (n=6) of A-CRA reach in terms of states’ grant-related activities (e.g., staffing, financial mapping and sustainability planning; policy/regulatory changes; treatment organization engagement, adoption, and support; inter-agency coordination; promoting youth/family engagement). One medium-reach and two low-reach states sub-contracted external entities (e.g., academic institutions/other intermediaries) to administer their grants which likely had a negative impact on reach. Further, several states were found to be case anomalies (having low quantity of activities, while achieving high reach and vice versa) – suggesting that quality (e.g., A-CRA-specific youth/family engagement) of the activities mattered more than presence/number of them.

Implications for D&I Research: Our mixed-methods comparative case study uses an innovative approach to conduct policy-focused implementation research on the impact of financing strategies on A-CRA reach across 19 higher and lower performing states. These findings have implications for how future grant initiatives and policies can facilitate the financing and delivery of evidence-based treatments.

Primary Funding Source

National Institutes of Health

University of Connecticut, Farmington, CT, USA

Correspondence: Neena Qasba ([email protected])

Implementation Science 2025, 20(1):S96

Background

With increasing reproductive health restrictions, policymakers have passed progressive legislation to expand contraception access; however, the implementation of these laws is unknown. Approximately 20% of all contraceptive users choose the oral pill, ring, patch, or injection. Providing an extended supply of short-acting reversible contraceptives (SARCs) improves patient adherence and can reduce the risk of unintended pregnancy. In 2017, Massachusetts passed the “ACCESS” law requiring all insurers, except self-insured businesses, to cover dispensing of a 12-month supply of SARCs at one time. We performed a multi-part, multi-level study assessing implementation of the 12-month supply dispensing provision.

Methods

We conducted a mixed-methods, multipart study that included an online patient survey, semi-structured interviews with clinicians and pharmacists, and in-depth policy analysis. Using a Qualtrics patient panel, we surveyed 205 women between 16 and 48 years old who lived in Massachusetts and were eligible for 12-month supply based on their insurance to assess general awareness. Descriptive, bivariate and multivariate analyses were used to examine factors associated with awareness. We purposively recruited primary care, OBGYN clinicians, and pharmacists from all regions of the state to interview. We applied the four-level model of the Health Care System Framework, (patient, care team, organizational, and environmental) to organize themes. For the policy analysis, a qualified attorney licensed in Massachusetts used an established legal analysis framework to outline regulatory requirements in the current statute.

Findings

Of 205 survey respondents, 76% were aware of the law, 94% expressed interest in a 12-month supply; however, only 9% received it. Of 47 participants interviewed, 31 were clinicians and 16 were pharmacists. The majority were unaware of this provision and identified similar barriers at the organizational and environmental levels such as insurance coverage. At the care team level, they identified a need for training and changes to the electronic medical record workflow. Pharmacists specifically had concerns about having sufficient supply and stocking. The in-depth legal analysis revealed a lack of enforcement and regulatory oversight to ensure compliance with insurance coverage.

Implications for D&I Research: Identifying barriers and facilitators to policy implementation can help promote practice change and improve patient care.

Primary Funding Source

Society of Family Planning, internal institutional funding

Emory University, Atlanta, GA, USA

Correspondence: Snigdha Peddireddy ([email protected])

Implementation Science 2025, 20(1):S97

Background

Good Samaritan Laws (GSLs) aim to reduce drug overdose mortality by protecting individuals at overdose scenes from criminal sanctions (e.g., arrest) and removing such criminal-legal barriers to seeking emergency assistance. However, evidence of GSL effectiveness remains mixed, attributed to variations in the implementation of protections by law enforcement officers (LEOs). In particular, the racialized legal implementation of GSL protections may introduce or reinforce inequities in drug-related harms among people who use drugs (PWUD), disproportionately harming Black and Indigenous PWUD who now have the highest rates of opioid overdose mortality. Using Street-Level Bureaucracy Theory (SLBT), this scoping review aimed to identify factors that may influence the racialized implementation of GSLs by LEOs and advance racism-consciousness in legal implementation research.

Methods

We reviewed five databases for studies that investigated 1) facilitators and barriers among LEOs in enacting legal protections with fidelity to GSL statutes and 2) factors influencing the implementation of legal protections at overdose scenes from the perspectives of PWUD, particularly those who are racially minoritized. Arksey and O'Malley's methodological framework for scoping reviews guided the search strategy, screening, and data extraction, and we organized findings by SLBT constructs.

Findings

The included studies (n=23) highlighted resource constraints among LEOs, such as a lack of training on state GSL protections and high caseloads. Per SLBT, LEOs use certain coping and client control mechanisms to navigate these constraints, including allocating more policing resources to racialized neighborhoods with high rates of drug-related harms. Combined with the outsized role of LEO discretion in searches for and seizures of illegalized drugs and paraphernalia, these mechanisms often lead to the inequitable application of GSL protections by race/ethnicity and jurisdiction, reducing overall GSL implementation fidelity. Conversely, clear organizational policies that center harm reduction and reduce discretionary practices at overdose scenes may facilitate GSL implementation fidelity.

Implications for D&I Research: This scoping review demonstrates a theory-informed, racism-conscious approach for investigating the implementation of laws and policies by meso-level actors such as LEOs. The findings may inform 1) measures that enable researchers to evaluate legal implementation processes and their impact on the effectiveness of laws and 2) multilevel interventions that enhance the equitable implementation of laws.

Primary Funding Source

National Institutes of Health

¹CHEO Research Institute, Ottawa, Canada; ²Canadian Blood Services, Ottawa, Canada; ³Partner with lived experience, London, Canada; ⁴Partner with lived experience, Calgary, Canada; ⁵Ottawa Hospital Research Institute, Ottawa, ON, Canada

Correspondence: Elisabeth Vesnaver ([email protected])

Implementation Science 2025, 20(1):S98

Background

Canada introduced new policies that expanded blood donation eligibility among 2SLGBTQIA+ communities. To understand impact of inclusion efforts, there is a need to consider implementation outcomes with an equity lens. Guided by the conceptual framework of Equity-focused Implementation Research(EquIR), this study aimed to explore the acceptability and appropriateness of the policy and its implementation among impacted communities.

Methods

This project is supported by partnerships with people with lived experience of blood donation after exclusion and with close collaboration with the blood operator. N=12 newly eligible blood donors were interviewed about the policy change and their experience of blood donation. Thematic inductive analysis was used to develop initial themes. Themes were mapped to the Theoretical Framework of Acceptability. Themes related to fit among 2SLGBTQIA+ communities were used to understand appropriateness. Focus groups with 12–20 non-donors who were excluded by prior criteria will be conducted to broaden understanding across impacted communities. These will be completed and analyzed by the conference.

Findings

Acceptability of implementation: Dissemination of the new policy was viewed as insufficient, negatively impacting the effectiveness of the policy. Once in the centre, donors largely reported positive donation experiences. Appropriateness of implementation: Lack of community outreach about the implementation led some donors to question the organization’s commitment to inclusion. Some did not feel sufficiently psychologically safe to disclose their previous exclusion and aspects of their identity. Others initiated conversations about the criteria change with staff which usually led to expressions of acceptance, creating safety. Although donors largely reported positive experiences, the onus was borne primarily by the impacted communities to learn about the change, create opportunities for authentic exchange with staff, and initiate efforts to feel safer in a space long closed to them.

Implications for D&I Research: Examining implementation outcomes with an equity lens can surface opportunities to modify implementation strategies and enhance policy impact. For example, our findings suggest that improved communications of the policy change may not only increase awareness among newly eligible prospective donors potentially increasing participation among this group but may also improve the experience of donors by increasing the perception of institutional welcome. Next steps will be discussed.

Primary Funding Source

Canadian Institutes of Health Research

¹Brandeis University, Columbia, MO, USA; ²University of Colorado School of Medicine-Anschutz, Aurora, CO, USA; ³Education Development Center, Waltham, MA, USA; ⁴Massachusetts General Hospital, Boston, MA, USA

Correspondence: Douglas Levy ([email protected])

Implementation Science 2025, 20(1):S99

Background

Comprehensive theoretical frameworks for analyzing"Big P” policy implementation are emerging, though research applying the frameworks remains sparse. We applied Bullock’s policy implementation framework (2021) to analyze e-cigarette policy across multiple levels of government to understand the circumstances that impacted the pace at which policies are implemented.

Methods

Semi-structured qualitative interviews were conducted from April 2023 to July 2024 with 32 state and 28 local government personnel in 27 states (+DC), and 21 local jurisdictions in Massachusetts to understand the policy implementation process for two different e-cigarette control policies: minimum legal sales age and flavor restrictions. Participants were referred by the Tobacco Control Network and town health directors. Interview guides incorporated framework constructs including policy instruments and strategies, determinants, policy actors, and outputs/outcomes. Key informant interviews (~1 hour) were recorded, transcribed, and deductively coded in Nvivo. To explore pace of implementation, codes relevant to implementation speed and timing/sequencing were thematically analyzed.

Findings

Many events accelerated or hindered the pace of implementation of e-cigarette policies. Acceleration was led by public health events including reports of lung injury (EVALI) and spikes in youth use rates. Additional implementation factors that accelerated pace included policies initiated as temporary orders, bidirectional diffusion of policies from other levels of government (e.g. local to state), implementation staff input before adoption, and ability to leverage existing public health infrastructure. COVID, staff turnover, lack of financial resources, mismatch in anticipated and actual resources, unclear enforcement authority, lack of existing compliance activities, and legal challenges slowed implementation. Timing from adoption to effective date of laws also impacted pace, with shorter time periods not necessarily speeding up implementation if inadequate preparation resulted. The agility of industry to skirt laws often left staff scrambling to effectively implement policies as intended. Many implementation efforts were affected by external factors and their timing, including public attention, government prioritization, retailer education, compliance checks, and resources.

Implications for D&I Research: Applying this policy implementation framework structured our inquiry, helping identify unique insights into tobacco policy implementation that will guide future assessments of policy outputs and outcomes. Evaluations of other “Big P” policies may benefit similarly.

Primary Funding Source

National Institutes of Health

¹Duke University School of Medicine, Durham, NC, USA; ²Department of Population Health Sciences, Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA; ³Boise State University, Boise, ID, USA; ⁴Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

Correspondence: Hannah Lane ([email protected])

Implementation Science 2025, 20(1):S100

Background

Federally-funded School Meal Programs (SMPs) reduce food insecurity, improve diet, and reduce risk for obesity, chronic disease and cancer among low-income children. Districts participating in SMPs must adhere to federally-determined operational standards which ensure nutritional quality but often create barriers to access. During COVID-19 school closures, standards were relaxed and districts were given authority to develop localized service models that could increase access and mitigate rising food insecurity. Drawing upon the Dynamic Sustainability Framework, we investigated how local decision-making processes under relaxed standards influenced fit, reach and effectiveness of SMPs over time, with intent to inform sustainable policy and practice change.

Methods

We conducted a secondary case study analysis of 25 school districts across 4 geographically-diverse states in the initial 6 months of COVID-19. Districts were 35% rural, 45% majority non-white, and 85% low-income. Available data included interviews with SMP implementers in all districts (e.g., district staff), and parent/caregivers surveys and interviews in 5 districts. We conducted a cross-case analysis (to be completed October 2024) to explore variations in local decision-making processes based on contextual factors such as rurality, poverty distribution, and cultural needs.

Findings

Substantial variations in SMP operations were observed across districts based on different contextual factors. Both implementers and parents/caregivers perceived that SMPs were more accessible via strategic site placement and innovative meal distribution models under the relaxed standards. Implementers attributed this to decision-making that could account for locally-relevant context (e.g., neighborhood safety, high need neighborhoods), and be responsive to evolving community needs (e.g., incorporating culturally-appropriate menus). While implementers perceived no changes to nutritional quality under the relaxed standards, parents/caregivers perceived a decline in quality.

Implications for D&I Research: While relaxed SMP standards temporarily reduced parents’/caregivers’ perceptions of nutritional quality during the initial COVID-19 months, local implementers leveraged their decision-making power to increase access in their communities. The operational standards were reinstated in 2022; however our data suggest the need to continue to investigate ways to improve SMP fit and reach in communities over time through local decision-making power. Our approach provides important precedent for studying and scaling localized implementation strategies for complex public health policies.

Primary Funding Source

National Institutes of Health

Borsika Rabin^1,2, Bryan Ford³, Rebekah Gomes³, Elise Robertson⁴, Sara Malone⁵, Alison Hamilton⁶, Russell Glasgow⁷, Ross Brownson⁸

¹University of California, San Diego, CA, USA; ²UC San Diego Altman Clinical and Translational Research Center, San Diego, CA, USA; ³University of Colorado Anschutz Medical Campus, Aurora, CO, USA; ⁴Dartnet Institute, Kansas City, MO, USA; ⁵Washington University in St. Louis School of Medicine, St. Louis, MO, USA; ⁶Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA, USA; ⁷Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), Aurora, CO, USA; ⁸Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA

Correspondence: Borsika Rabin ([email protected])

Implementation Science 2025, 20(1):S101

Background

D&I science theories, models, and frameworks (TMFs) are key to successful research projects. A critical step in operationalizing TMFs is to link them with qualitative and/or quantitative assessments. However, doing so can be daunting, and failure to link a TMF with assessment of the TMF’s constructs is a frequent criticism of grant applications and project implementation. The D&I Models in Health Research and Practice Webtool (www.dissemination-implementation.org) is a widely used interactive resource to help researchers and practitioners select the TMFs that best fit their research question or practice problem, combine multiple complementary TMFs as needed, adapt the TMFs to context, and integrate the TMFs into the research or practice process. We will present on our new expanded webtool section that addresses identifying and selecting assessment instruments for the TMFs’ constructs.

Methods

We used an iterative process informed by international implementation science experts to identify key characteristics of assessment instruments (i.e., metadata) and select and identify an initial set of instruments to include in the assessment’s repository. With input from the experts, we developed guidance on how to select and use assessment instruments as well as recruited a diverse set of 20 usability testing participants to provide feedback that will inform the iterative refinement of the repository and associated guidance.

Findings

A searchable, curated, easy to use inventory of both quantitative and qualitative D&I assessment instruments (e.g., surveys, tracking forms, observational methods) was developed and will be presented. Each assessment instrument included is described using 39 metadata characteristics organized by six categories (i.e., Overview, General Characteristics, Implementation Science Considerations, Intended Focus, Psychometric Properties, Pragmatic Properties). Currently, we have 40 assessment instruments in the webtool representing 25 quantitative, 11 qualitative, and four mixed instruments. Additional instruments are being abstracted and added. Guidance topics include strategies to select assessment instruments, pragmatic assessment, unique issues for qualitative assessment, and linking TMFs with assessment instruments.

Implications for D&I Research: We will present the new D&I assessment repository, discuss how it is integrated within the D&I TMFs webtool, and summarize multiple use cases for the repository including its ability to support collection of common data elements.

Primary Funding Source

National Institutes of Health

¹UT Southwestern Medical Center, Dallas, TX, USA; ²Northwestern University Feinberg School of Medicine, Chicago, IL, USA; ³Mayo Clinic, Rochester, MN, USA; ⁴Dana Farber Cancer Institute, Boston, MA, USA; ⁵University of Washington, Seattle, WA, USA; ⁶National Institutes of Health, Rockville, MD, USA; ⁷National Institutes of Health, Bethesda, MD, USA; ⁸Dana-Farber Cancer Institute, Boston, MA, USA; ⁹Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA

Correspondence: Lisa DiMartino ([email protected])

Implementation Science 2025, 20(1):S102

Full paper published

¹University of Washington, Seattle, WA, USA; ²Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA; ³University of Michigan, Ann Arbor, MI, USA; ⁴Center for Translation Research and Implementation Science; National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA; ⁵Department of Psychiatry and Behavioral Sciences Division of Public Behavioral h, University of Washington, Seattle, WA, USA

Correspondence: Bryan Weiner ([email protected])

Implementation Science 2025, 20(1):S103

Background

When researchers and their implementation partners employ methods for systematically assessing barriers to implementing evidence-based interventions, they often identify more barriers than they can feasibly address with available time, effort, and resources. Although methods for prioritizing implementation strategies have been developed, methods for prioritizing implementation barriers have not. Deploying implementation strategies to address high-priority barriers increases the likelihood of implementation success. Easy-to-use methods for systematically prioritizing barriers could support implementation in research and practice.

Methods

Two NIH-funded Implementation Science Centers developed a suite of methods for identifying and prioritizing barriers that can be used solo or in tandem: rapid evidence synthesis, rapid ethnographic assessment, and barrier prioritization. For each method, we established a cross-center lead and team. Each team used a critical review of existing literature related to the method, expert methods consultation, and subject matter expertise to scope and draft a toolkit. We iteratively worked with Center-funded pilot grantees, who provided insights on the methods they employed in their projects including feedback on the usefulness, clarity, and look and feel of each toolkit. Toolkits were revised based on feedback and center communications team members harmonized the structure across the toolkits.

Findings

We developed a toolkit that contains six criteria that could be used for prioritizing implementation barriers: importance, frequency, duration, addressability, timing, and equity impact. The toolkit includes scoring systems for rating barriers on the criteria, guidance for using scores and criteria, free or low-cost tools to support rating barriers, and templates for visualizing rating results. The toolkit describes procedures that researchers could use to support facilitated barrier prioritization with implementation partners and includes practical advice for using the procedures (e.g., when to prioritize barriers, how to use multiple criteria, and how to prioritize interdependent barriers). The toolkit is publicly available.

Implications for D&I Research: Use of methods for systematically prioritizing implementation barriers can increase procedural transparency, reduce perceptual bias, and support shared understanding of key issues to address for successful implementation in research studies or practice initiatives.

Primary Funding Source

National Institutes of Health

¹University of Arkansas for Medical Sciences, Little Rock, AR, USA; ²University of Limerick, Ireland, Limerick, Ireland; ³University, Chapel Hill, NC, USA; ⁴University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA; ⁵University of South Carolina, Columbia, SC, USA; ⁶Department of Veterans Affairs, North Little Rock, AR, USA; ⁷UNC Chapel Hill, Asheville, NC, USA

Correspondence: Geoffrey Curran ([email protected])

Implementation Science 2025, 20(1):S104

Background

We were funded by the National Institutes of Health (USA) to study implementation of an evidence-based COVID-19 vaccine hesitancy intervention in 30 rural pharmacies. After IRB approval from a single IRB of record, our stepped wedge trial comparing a standard implementation condition (training and technical assistance) with added external facilitation was launched in Fall 2023. Within 6–8 weeks, study-threatening problems emerged relating to pharmacist engagement and data collection. Pharmacists were not delivering the intervention or submitting necessary data (intervention documentation forms or audio recordings of themselves delivering the intervention) at the levels needed to test the study’s hypotheses.

Methods

We took four steps: 1) informed the funder and requested time to collect additional data (to understand the problems) and propose corrective actions; 2) conducted a CFIR 2.0-informed determinants evaluation consisting of key informant interviews and review of facilitation notes collected after each pharmacist encounter; 3) created an external advisory committee of implementation trial experts to help us interpret the determinants evaluation and develop potential solutions; and 4) consulted continuously with the study’s pre-existing Patient Advisory Board.

Findings

A host of outer- and inner-setting barriers impacted pharmacist engagement and data collection, e.g., poor community demand for the vaccine caused numerous pharmacists to stop carrying the vaccine and drop out; staffing shortfalls caused many pharmacists to suspend intervention delivery; many pharmacists struggled with their confidence to approach the “very hesitant”; a majority of patients declined to provide consent for audio recording of interventions (our fidelity measure), causing some pharmacists to stop/restrict intervention delivery. Recommendations for changes to data collection (e.g., shift to using standardized patients for fidelity assessment), the standard implementation approach (e.g., more training and tools to increase pharmacist confidence and better support integrating the intervention into workflows), and recruitment criteria (e.g., pledge to continually carry the vaccine) were submitted to the funder and accepted. A new trial initiation date was approved.

Implications for D&I Research: Implementation trials often encounter potentially fatal problems due to shifting contexts. Studies can be salvaged if the team takes quick action, in partnership with funders and other constituents (end-users, experienced implementation trialists), to systematically understand the problems and develop solutions.

Primary Funding Source

National Institutes of Health

¹University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT, USA; ²Arizona State University, Tempe, AZ, USA

Correspondence: J.D. Smith ([email protected])

Implementation Science 2025, 20(1):S105

Background

Under the CDCs’ Childhood Obesity Research Demonstration (CORD) 2.0, we were funded to conduct a trial of the Family Check-Up® 4 Health (FCU4Health) program—an adaptation of the evidence-based Family Check-Up® parenting intervention (a) for delivery in coordination with pediatric primary care and (b) with a whole child focus that incorporated health behaviors for pediatric obesity management. Primary care is ideal for parenting programs like FCU4Health, but implementation barriers include financing, workforce factors, workflow integration, and others.

Methods

As this was the first study to test the effectiveness of this adapted intervention, we proposed a hybrid type 2 effectiveness-implementation study with a family-level RCT comparing FCU4Health to primary care as usual. This RCT was embedded within a non-randomized implementation strategy condition of 1) coordinated/integrated care in which staff in two Federally Qualified Health Centers (FQHCs) were trained to deliver the program in-house, and 2) a large children’s hospital-based pediatrics clinic that referred families to FCU4Health for home visiting delivery. The study was IRB approved.

Findings

Despite planning for nearly two years, buy-in and commitment from practice leadership, individualized workflows for each clinic, and other strategies, within 6 months of implementation, the coordinated/integrated care arm was failing. Enrollment numbers were dismal and FCU4Health had only been provided to a few families across the two FQHCs. Ongoing attempts to adapt our implementation strategies to improve outcomes had little impact. We proposed a solution to our funders that would move the FQHCs to the referral-based strategy (eliminating the two-arm strategy element) and expanding to more clinics to increase overall family enrollment in the study to test effectiveness of FCU4Health and implementation process and outcome measurement.

Implications for D&I Research: Many eventualities that lead to “failed” implementation studies are unpredictable or otherwise unanticipated. In this project, we averted overall disaster due to the within-strategy condition family-level RCT that preserved the effectiveness aim of this hybrid study. The implementation aim was essentially achieved by demonstrating the infeasibility and barriers of the coordinated/integrated strategy. We offer tips on the process of changing a study design midstream, as well as ways to approach implementation study design considering potential worst-case scenarios.

Primary Funding Source

Centers for Disease Control and Prevention

¹Veterans Health Administration, North Little Rock, AR, USA; ²Veterans Health Administration, Denver, CO, USA; ³Veterans Health Administration, Gainesville, FL, USA

Correspondence: Sara Landes ([email protected])

Implementation Science 2025, 20(1):S106

Background

Suicide is a serious public health problem; it was among the top nine causes of death for people ages 10–64 in 2021. Veterans are at elevated risk of death by suicide with a suicide rate 57% higher than non-veterans in 2020. Improving suicide prevention requires innovative methods for identifying people at high risk. In 2017, the Veterans Health Administration conducted national implementation of a clinical suicide prevention program, Recovery Engagement and Coordination for Health – Veterans Enhanced Treatment (REACH VET), that uses a predictive algorithm to identify patients at highest risk of suicide for care assessments and outreach.

Methods

A hybrid effectiveness-implementation type 2 program evaluation was conducted to examine the impact of REACH VET on patient outcomes and the impact of facilitation to support implementation at facilities that were underperforming on implementation metrics. The evaluation was funded through a partnered research grant that funded the evaluation team and operational partners to work together in a planning phase and then design the larger evaluation. The project began with local pilots and formative evaluation with qualitative interviews. The project was determined non-human subjects research.

Findings

During the course of planning and pilots, the implementation and evaluation plans experienced significant changes. These included changes in: national Department of Veterans Affairs (VA) leadership, funding levels for roll outs, the clinical intervention being implemented, timeline, and which implementation strategies would be deployed where and when (ending the planned adaptive design). Following the pilots and qualitative interviews, a planning meeting of key stakeholders was convened. This allowed for results from the pilot and operational knowledge (e.g., of funding, priorities for facilities) to guide changes for the national program evaluation. Given that this was partnered research, the evaluation team was able to document these changes and adjust course, changing evaluation design multiple times.

Implications for D&I Research: Large scale implementation effort provide great opportunities to learn about implementation of an intervention, but shifting contextual priorities can impact design and data collection decisions. Conducting partnered research requires that the evaluation team document contextual changes that could impact the evaluation and be flexible enough to respond to those changes to allow for meaningful evaluation.

Primary Funding Source

Department of Veterans Affairs

¹Veterans Health Administration, Los Angeles, CA, USA; ²David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA; ³UCLA, Los Angeles, CA, USA

Correspondence: Alison Hamilton ([email protected])

Implementation Science 2025, 20(1):S107

Background

Cardiovascular disease (CVD) among persons living with HIV (PLWH) has emerged as an increasingly common threat to health and well-being. In order to address CVD risk among PLWH, we blended four interventions, resulting in the Healing our Hearts, Minds, and Body (HHMB) intervention. We used the Replicating Effective Programs (REP) framework and a logic model to guide the use of implementation strategies within our participating clinics. The objective of this analysis is to examine how the logic of the implementation plan dramatically shifted when the COVID-19 pandemic began during the trial.

Methods

The study was IRB approved. We investigated organizational factors associated with implementation outcomes and effectiveness of HHMB as delivered to PLWH receiving care in two participating organizations. A mixed methods evaluation was conducted throughout each REP phase. Attendance at the five HHMB sessions was tracked and engagement and retention approaches were systematically documented.

Findings

HHMB was delivered to 202 individuals. It was designed to be delivered in-person, but due to the COVID-19 pandemic, a substantial shift was necessary in order to continue the trial. We shifted to virtual delivery via tablets, which required not only purchasing tablets but also figuring out how to maintain group-based cohesion and engagement, with participants often facing significant adversity and not having digital literacy. Moreover, our ability to evaluate clinic-based implementation was curtailed for several months due to the shut-down of our participating clinics. The logic of our strategies quickly became illogical and even inappropriate given the pressing priorities of the healthcare teams. Thus, maintaining intervention delivery and supporting our participants became the focal points. The community-based team went to extraordinary efforts to retain individuals in the virtual intervention; the mean number of sessions attended was 4.8/5 (standard deviation, 0.8).

Implications for D&I Research: Extenuating “external” factors such as unprecedented public health crises pose challenges to implementation plans, which are deliberately aligned and ideally realized within partnered contexts. When those contexts become unavailable, implementation goes off the rails and may require drastic changes. Embracing these challenging shifts requires creativity, readiness for change on the implementation team, and acceptance of altered priorities that may disrupt the logic of our models.

Primary Funding Source

National Institutes of Health

¹Harvard Medical School, Boston, MA, USA; ²Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; ³Dartmouth Geisel School of Medicine, Hanover, NH, USA

Correspondence: Stephen Bartels ([email protected])

Implementation Science 2025, 20(1):S108

Background

A fundamental premise of conducting conventional empirical research trials is the use of fixed parallel comparisons, fixed experimental context, and fixed outcomes. Despite innovations advancing the science of adaptation, the recent COVID-19 pandemic highlighted some of the limitations of these conventional implementation research designs and related assumptions. This methods presentation addresses the question: “How can agile learning health system methods be applied in hybrid effectiveness-implementation research when there are unanticipated changes in the comparison conditions, outer context, inner context, implementation strategy, and key implementation outcomes?”

Methods

This analysis leverages results from a completed randomized effectiveness-implementation trial comparing tailored vs general best practices for prevention of COVID-19 for n=5,538 staff and n=3,836 residents with mental disabilities residing in 416 group homes within six mental health organizations in Massachusetts. Components of agile research methods developed and incorporated in the study design included: (1) rapid simulation modeling to determine optimal intervention components and implementation strategies prior to implementation; (2) weekly tracking of implementation fidelity; external and internal policy context affecting the intervention (changing federal, state and agency-specific guidance in required prevention strategies); changes in primary outcome context (COVID-19 population incidence and changes in variants); and (3) modification of key implementation outcomes reflecting technological advances (e.g. introduction and uptake of vaccines).

Findings

Following the initial rapid simulation modeling to identify optimal intervention components and implementation strategies, over the subsequent 18 months of the project we documented 19 different changes in inner and outer context affecting the intervention and control condition (CDC, state, and agency policy recommendations and mandates regarding COVID-19 prevention); documented staffing turnover and shortfalls at the group-home level affecting fidelity; two different peaks in COVID-19 population based incidence reflecting delta and omicron variants influencing our primary effectiveness outcome of COVID-19 incidence in the staff and residents; and the addition of COVID-19 vaccine and booster uptake as a primary implementation outcome measure.

Implications for D&I Research: Rapid changes in the health care environment coupled with the increasing frequency of environmental and health-related population-based emergencies and disasters necessitate methodological innovations in implementation research methods embracing agile, accelerated, and adaptive learning health system methods and real-time dynamic measurement of context.

Primary Funding Source

Patient-Centered Outcomes Research Institute

¹Stanford University School of Medicine, Palo Alto, USA; ²University of Wisconsin-Madison, Madison, WI, USA

Correspondence: Hannah Cheng ([email protected])

Implementation Science 2025, 20(1):S109

Background

A successful implementation endeavor requires selecting a strategy that is not only effective but also economically feasible and efficient. Current research focuses on evaluating the costs of participating in a strategy; however, assessing the cost of participating and delivering a strategy is non-existent. This study examines the total implementation costs of two common implementation strategies within a stagewise adaptive trial designed to improve access to and care quality of medications for opioid use disorders (MOUD).

Methods

Sixty-nine addiction specialty and primary care clinics in a western US state were offered a stagewise sequence of strategies of increasing intensity and costs–Audit and Feedback (A&F), Workshop, Internal Facilitation, and External Facilitation. Leveraging an activity-based microcosting approach, we prospectively estimated implementation delivery costs over the first 2 years of the 4-year trial. Delivery costs were mapped along the Exploration, Preparation, Implementation, and Sustainment framework. Participation costs of strategy were tracked using the Stages of Implementation Completion^® and its cost mapping companion tool, the Cost of Implementing New Strategies. Personnel efforts were collected via self-reported surveys, attendance trackers, and facilitation logs. Labor costs were estimated by linking efforts with national median hourly wages from the Bureau Labor of Statistics. We examined total implementation costs relative to RE-AIM outcomes of Reach (patient receipt of MOUD), Effectiveness (MOUD access and six-month retention), Adoption (active MOUD prescribers), and Implementation (implementation quality). A&F and Workshop strategies are the focus of this presentation. Internal Facilitation and External Facilitation are currently underway.

Findings

A&F incurred a setup cost of $32,266 and annual recurring cost of $4,231 per clinic; Workshop incurred a setup cost of $1,584 and annual recurring cost of $52,454 per clinic. Reach, Adoption, and Implementation increased across both strategies. Effectiveness increased by end of A&F but decreased slightly by end of the Workshop.

Implications for D&I Research: While A&F and Workshop both yielded improvements in outcomes, the former had a higher initial setup cost, and the latter had a higher recurring cost. By understanding total cost implications relative to outcomes, decision-makers can better select the most suitable strategy based on the context, goals, and budget constraints to efficiently optimize the pace of implementation.

Primary Funding Source

National Institutes of Health

¹Indiana University, Bloomington, IN, USA; ²University of Michigan, Ann Arbor, MI, USA; ³Medical College of Wisconsin, Milwaukee, WI, USA; ⁴MetaStar, Madison, WI, USA; ⁵Kaiser Permanente, San Diego, CA, USA

Correspondence: Reid Parks ([email protected])

Implementation Science 2025, 20(1):S110

Background

Practice facilitation is an effective implementation strategy but its usage is limited by the significant time constraints already pressuring primary care practices. Allocating facilitation resources to practice needs may benefit from evaluations of how engaged practices are with facilitation. However, collecting engagement data from participating staff is burdensome. We previously reported on our pragmatic measure of change engagement building on normalization process theory. This 5-point rubric, the Practice Assessment of Change Engagement (PACE), allows a facilitator to rapidly assess practice engagement following encounters with no additional burden to practices. We sought to describe longitudinal changes in engagement using PACE data from an ongoing trial and identify factors that predict engagement.

Methods

Practice facilitators used the PACE rubric to characterize practice engagement (maximum engagement = 5) following each facilitation encounter (n=89) with each clinic (n=29) in an ongoing EvidenceNOW implementation trial. Encounters spanned project phases of pre-implementation (2 months), implementation (6 mo.), and post-implementation maintenance (6 mo.). Pre-implementation, representatives from each clinic completed organizational readiness for implementing change (ORIC) surveys. Longitudinal, correlation, and regression analyses were used to characterize changes in engagement over time and identify predictors of engagement.

Findings

Engagement increased over the study period; average PACE scores rose from 3.3 (CI: [2.4, 4.2]) pre-implementation, to 4.2 (CI: [3.4, 5.0]) during implementation, and to 4.6 (CI: [3.7, 5.3]) post-implementation. Change engagement (PACE) was positively correlated with pre-implementation organizational readiness (ORIC) (τ_b = 0.41; p < 0.001) and regression analyses of this non-linear relationship identified two levels: high readiness/engagement and low readiness/engagement. Further, early enrollment in the study was also positively correlated (r = 0.31) with higher PACE scores during the project.

Implications for D&I Research: PACE is a rapid and pragmatic approach to collecting engagement data in ongoing implementations. Longitudinal changes in engagement reflect changing site needs and may inform adaptations to interventions and implementation strategies. Additionally, the positive correlation between readiness and engagement is consistent with theoretical models and may be used by facilitators to predict local implementation needs. Change engagement is a pragmatically measurable construct that can be further evaluated to elucidate the mechanisms by which facilitation influences implementation outcomes.

Primary Funding Source

Agency for Healthcare Research and Quality

¹The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; ²Duke University, Durham, NC, USA

Correspondence: Catherine Rohweder ([email protected])

Implementation Science 2025, 20(1):S111

Background

Severe hypertension is a primary contributor to pregnancy-related morbidity and mortality, with rates being the highest among birthing people who are Black, rural residents, and/or have low income. To ameliorate these disparities, we are conducting a Hybrid Type 3 implementation-effectiveness study testing a Hypertension Safety Bundle (HTN Bundle) in 20 outpatient clinics. Engagement is widely understood to be essential in identifying and addressing determinants of equitable care. Therefore, we are engaging the expertise of patients with lived experience, family members, and representatives from clinics and community-based organizations throughout our research. For this presentation, we detail how we are operationalizing the Assessing Meaningful Community Engagement (ACES) conceptual model to assess the quality and impact of our engagement methods.

Methods

Our approach is guided by the four ACES model components: (1) To strengthen relationships, we created a coalition and patient workgroups. Measures include the Research Engagement Survey Tool (REST) and participation rates (number and representativeness). (2) To expand knowledge, we engaged community members to identify determinants of respectful, timely HTN care and HTN bundle implementation. We tailored implementation strategies to address determinants and are capturing adaptations using the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS). (3) To improve healthcare, we are tailoring strategies to implement the HTN Bundle and assessing acceptability of and fidelity to both the strategies and HTN Bundle. (4) For thriving communities, we are promoting community/clinical linkages and measuring community-level impact via Ripple Effect Mapping (REM).

Findings

We co-created six implementation strategies: coalition, workgroups, training, facilitation, education materials, and simulations of severe hypertension events. We are using data from the REST and participation rates to examine and improve the quality of engagement. We are applying FRAME-IS to describe how we tailored implementation strategies to address community input. We are using implementation outcomes (e.g. feasibility) to assess the impact of those strategies. REM will be used to explore the community-wide impact of our engagement approaches.

Implications for D&I Research: Profound disparities persist in perinatal outcomes. D&I as a field affirms engaging communities to deeply understand barriers to equitable care. This presentation provides details on how one study is operationalizing this goal.

Primary Funding Source

National Institutes of Health

Colorado Clinical and Translational Sciences Institute, Aurora, CO, USA

Correspondence: Bethany Kwan ([email protected])

Implementation Science 2025, 20(1):S112

Background

Several implementation science theories, frameworks, and models consider the importance of fit or alignment among contextual factors, interventions, and implementation strategies. Yet definitions and measures of “fit to context” are not well established. The Fit to Context (F2 C) Framework for Designing for Dissemination and Sustainability is a four-phase process framework that specifies fit to context outcomes. We applied the F2 C Framework and multiple methods to assess context and fit of dissemination and implementation (D&I) strategies for monoclonal antibody (mAb) treatments for COVID-19.

Methods

We used community engagement, process mapping, surveys, interviews, and focus group methods guided by diffusion of innovation theory to assess F2 C conceptualization phase outcomes (e.g., need, demand, capacity for change). We used participatory co-design methods to develop D&I strategies and assess F2 C design phase outcomes (e.g., alignment with systems of communication and influence). Upon deploying D&I strategies, we used surveys, distribution trackers, newsletter metrics, and digital analytics to assess F2 C dissemination phase outcomes (e.g., broad and equitable reach). We used state health department data to evaluate F2 C Impact phase outcomes (e.g., mAb referral rates). All activities were completed over 9 months in 2021.

Findings

Relevant contextual factors included perceived strength of evidence, absorptive capacity for change, resources and logistics, health equity priorities, and audience-specific communication channels. D&I strategies deemed to be a “fit to context” included a centralized referral system operated via virtual urgent care, a mobile treatment bus, regional health connector distribution, a Project ECHO provider education series, and a muti-media communication campaign. Referrals increased by 400%.

Implications for D&I Research: Theories and frameworks such as diffusion of innovations and the Fit to Context Framework and multiple methods (quantitative, qualitative, participatory co-design) for assessing context and fit can aid in development of strategies that rapidly increase access to evidence-based treatment.

Primary Funding Source

National Institutes of Health

University of Colorado | Anschutz Medical Campus, Aurora, CO, USA

Correspondence: Mustafa Ozkaynak ([email protected])

Implementation Science 2025, 20(1):S113

Background

We propose to use the concept of workflow to measure context. Workflow can be defined as the flow of work through space and time. Workflow highlights temporal features such as sequence and concurrency. Other than temporal properties, activities, actors, information, and additional resources (e.g., technology, materials) are considered building blocks of workflow. Moreover, organizational infrastructure such as rules, policies, and the external environment are crucial factors that affect workflow.

Methods

We conducted five studies between 2014 and 2023, to evaluate workflow in emergency departments, nursing homes, simulated ambulance settings and self-management in daily living. These studies employed various field methods such as interviews, observations, EHR Audit logs and journaling. This specific presentation reports on a secondary analysis of the workflow data from these five studies. The purpose of the analysis is to identify what components of context are captured through the concept of workflow.

Findings

These studies highlighted two mechanisms of how workflow studies revealed essential information related to context. First, workflow is shaped by and a result of contextual factors. Therefore, by examining workflow, we can identify important contextual effects on the intervention and be able to ask relevant questions to measure context that will inform the intervention. This mechanism would allow us to focus on essential characteristics of context while leaving the other characteristics in the/background. Second, workflow and context can be intertwined. When we study workflow, we in fact also study context. This presentation will provide a mapping between workflow components that were captured in the five projects and contextual dimensions as identified in implementation literature.

Implications for D&I Research: Workflow studies can be used to measure context. Our findings will guide future workflow studies that focus on Design for Dissemination and Sustainability as well as adaptation tracking studies. However, further collaboration is needed with other disciplines, such as human factors engineering or health informatics, in which workflow studies are common.

Primary Funding Source

Agency for Healthcare Research and Quality

Veterans Health Administration, Aurora, CO, USA

Correspondence: Heather Gilmartin ([email protected])

Implementation Science 2025, 20(1):S114

Background

There are many reasons focus group participants do not share their perceptions, feelings, and ideas with a group. There are also many reasons healthcare programs fail to be implemented. The context of the focus group and sites in which a program will be implemented is one of those reasons. The brainwriting premortem is a rapid, focus group approach designed to engage healthcare teams implementing evidence-based practices in a written brainstorming activity (i.e., brainwriting) to identify contextual barriers to program success and guide adaptations prior to implementation (i.e. project premortem).

Methods

The brainwriting premortem method was developed to engage partners to identify contextual barriers prior to implementation of a national transitions of care program. Additional case studies in healthcare include a project in rural India to increase access to healthcare and a U.S. program to design an electronic health record-based discharge readiness communication tool. The method was adapted to a virtual setting to refine the content of an online brief emotion regulation training program for emerging adults.

Findings

In total 116 healthcare providers from the national transitions of care program participated in 10 brainwriting premortem sessions and indicated satisfaction with their groups productivity, and agreement they were able to give ideas without concerns of criticism, suggesting high levels of psychological safety. The method generated a total of 217 unique barriers to program implementation, was deemed efficient and accessible by facilitators, and was well received by participants. The virtual method provided invaluable input and simplified scheduling and data collection.

Implications for D&I Research: The brainwriting premortem is an efficient, low-cost approach to engage partners while gathering insights about contextual influences. The method is available as an open-access toolkit and can be used with minimal training. The next step is for the method to be broadly disseminated to ensure equitable implementation for greatest impact.

Primary Funding Source

Department of Veterans Affairs

Indiana University, Bloomington, IN, USA

Correspondence: Edmond Ramly ([email protected])

Implementation Science 2025, 20(1):S115

Background

Two national trends motivate the importance of measuring and comparing context: the implementation gap from evidence to practice and variations across practice sites. The gap can be closed more successfully when interventions and implementation strategies are adapted to overcome the barriers and promote the facilitators that are specific to a given context. Comparing context across sites can inform that adaptation to drive the successful implementation of effective interventions. In parallel, evaluating how variations across sites interact with contextual determinants using a systems approach can improve our understanding of the underlying mechanisms by which equitable processes and outcomes for everyone can be achieved across diverse contexts.

Methods

We used systems engineering methods across multiple implementation studies in outpatient and long-term care settings to pragmatically capture contextual determinants and tailor interventions to site needs. In this multiple case study, we will assess the utility of various systems engineering methods and present a systems conceptualization of implementation context.

Findings

Across these cases systems engineering approaches were pragmatic for assessing context. Going beyond contextual determinants, we used root cause analysis and work systems analysis to identify areas of acute need and priority barriers to implementation. We used two approaches to context-informed tailoring. Existing contextual determinant-strategy mapping to tailor implementations based on expert feedback was useful only in planning and preparation. Our configural menu-based approach allowed for ongoing tailoring in response to changing context over time.

Implications for D&I Research: These studies highlight the pragmatic value of conceptualizing context as a system of interacting determinants with varying importance. Additionally, by framing interventions as sets of configurable components, we identified a pragmatic approach to assess and respond to changing context over time with intervention adaptations. These cases studies highlight the benefits of systems engineering approaches to proactively and reactively address context in implementations.

Primary Funding Source

Agency for Healthcare Research and Quality

¹The Ohio State University, Columbus, OH, USA; ²Brown University School of Public Health, Providence, RI, USA; ³Meals on Wheels America, Arlington, VA, USA; ⁴Johns Hopkins School of Nursing, Baltimore, MD, USA

Correspondence: Lisa Juckett ([email protected])

Implementation Science 2025, 20(1):S116

Background

Complex health interventions consist of two constructs – core functions and forms – that are critical to intervention implementation and evaluation. “Core functions” are what an intervention intends to change whereas “forms” are the context-specific activities that are needed for an intervention to be delivered. Linking forms to their corresponding functions is essential for understanding how interventions can be adapted and how these adaptations affect outcomes. However, core functions and forms are widely underreported, and methodological guidance for specifying intervention functions and their prevailing forms is limited. Accordingly, we present our team’s methods for characterizing the functions and forms of one complex community-based intervention – the Meals on Wheels (MOW) program – implemented in a multi-site, comparative effectiveness pragmatic trial.

Methods

To identify core functions, we first procured the Older Americans Act legislative documents, which specify federal requirements for MOW programming. To determine MOW program forms, data were drawn from three sources: site visits at six different MOW agencies, a nationwide survey from Meals on Wheels America, and a virtual listening session with staff from nine MOW programs to further understand how programming is adapted to the local context. Data sources were analyzed through directed content analysis with final core functions and forms adjudicated by three study team members. Lastly, we conducted a modified e-Delphi panel with MOW experts (e.g., drivers, clients, caregivers, program staff) to determine which forms were most essential for achieving the core functions of MOW programming.

Findings

Analyses indicated that MOW programs implement three core functions of the Older Americans Act using 103 different forms. Three core functions include: 1) reduce malnutrition, hunger, and food insecurity, 2) promote socialization, and 3) promote health and well-being. Twenty-four e-Delphi panel experts identified 32 forms considered to be “most essential” for achieving the core functions of MOW programming.

Implications for D&I Research: As complex interventions are adapted to the local context, it is necessary to understand how these adaptations may influence intervention effectiveness. We present our novel methodology for characterizing these adaptations using the core functions and forms paradigm. Current work is ongoing to determine the effect of our identified forms on MOW participant outcomes.

Primary Funding Source

Patient-Centered Outcomes Research Institute

¹VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; ²Veterans Health Administration, Ann Arbor, MI, USA; ³Veterans Health Administration, Los Angeles, CA, USA; ⁴Veterans Health Administration, Boston, USA; ⁵San Fransisco State University, San Francisco, USA

Correspondence: Andrea Nevedal ([email protected])

Implementation Science 2025, 20(1):S117

Background

Qualitative methods are invaluable for understanding contextual factors affecting implementation and sustainment. However, longstanding epistemological and historical beliefs favor quantitative methods and, in turn, contribute to biases against qualitative methods. As a result, qualitative manuscripts and proposals encounter barriers during peer review related to perceived value and impact, poor fit, and a lack of reviewer familiarity with key concepts. Our objective was to develop an inventory of common biases and misperceptions that impede the impact of qualitative contributions in implementation science, and to offer suggestions for overcoming these, with the goal of helping editors, reviewers, and authors to foster and curate high-quality qualitative research.

Methods

We convened a panel of six researchers with extensive experience in: designing, implementing, and reporting on qualitative research in implementation science and other healthcare research; training and mentoring others on qualitative methods; and serving as journal editors and manuscript/grant peer-reviewers. We reviewed existing literature, published and unpublished reviewer critiques of qualitative grants and manuscripts, and discussed challenges facing qualitative methodologists. Throughout ongoing one-hour meetings, we identified candidate topics, ranked each by priority, and used a consensus-based process to finalize the inventory and develop written guidance for handling each topic.

Findings

We identified 12 common biases and misperceptions that impede the potential impact of qualitative work in implementation science. Common biases related to qualitative methods include concerns about small sample size, generalizability, representativeness, code frequency, interrater reliability, and subjectivity in qualitative studies. Common misperceptions regarding qualitative rigor include an overreliance on saturation, member checking, coding, prevailing paradigms, software, and themes. We provide guidance on each topic regarding key issues, potential responses to common critiques, and resources for citing appropriate literature.

Implications for D&I Research: Common biases and misperceptions, if not effectively handled, can impede the contributions of qualitative research in implementation science. We offer consensus-based guidance to aid in dispelling misperceptions and biases about qualitative methods and offer guidance to support effective evaluation of qualitative methods in manuscripts and grant proposals. The results from this work can advance the field by supporting a more epistemologically equitable approach to assessing qualitative methods in implementation science.

Primary Funding Source

Department of Veterans Affairs

¹UTHealth Houston Institute for Implementation Science, Houston, TX, USA; ²The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA

Correspondence: Hugo Sanchez Blas ([email protected])

Implementation Science 2025, 20(1):S118

Background

Adapting evidence-based interventions (EBIs) is an essential practice in implementation science. Leveraging available EBIs may accelerate their implementation pace while improving their fit and effectiveness, especially within underrepresented populations and settings. Systematic approaches to adaptation planning are necessary to ensure that core components are retained while improving fit Intervention Mapping for Adaptation (IM-ADAPT) offers a systematic, theory-based approach to guide public health practitioners in this process. We conducted a systematic review to understand the current use of IM-ADAPT, its applied contexts, and the observed outcomes to inform future improvements.

Methods

This systematic review was conducted following PRISMA guidelines. We identified records from Web of Science, PubMed/Medline, Embase, and Intervention Mapping databases. Our inclusion criteria encompassed studies written in English that utilized IM-ADAPT or EBI adaptation through Intervention Mapping. Three independent authors reviewed full texts for data extraction, focusing on health topics, target populations, and settings from the original and adapted EBIs. Also, we retrieved information regarding the use of the six specific steps and 20 subtasks of IM-ADAPT.

Findings

From IM-ADAPT's inception in 2005 to 2023, we identified 480 studies, of which 37 met our inclusion criteria. Most studies were conducted in Europe and North America. The interventions frequently addressed obesity, physical activity, and mental health. Priority populations were defined by sociodemographic characteristics (e.g., targeting only males or females, specific age groups, or ethnic/racial groups), patient diagnoses (e.g., cancer, HIV, diabetes), or occupation (e.g., students, employees). The use of IM-ADAPT steps varied across studies. 75% reported Step 1: Needs Assessment and Creation of Logic Models, 30% Step 2: EBI Search, and 10% Step 3: Fit Assessment and Planning for Adaptation. Step 4: Make Adaptations was included in 35%, Step 5: Plan for Implementation in 30%, and Step 6: Plan for evaluation in 10%.

Implications for D&I Research: The use of IM-ADAPT has increased, reflecting a growing number of publications and a broader diversity of topics, populations, and settings. This trend has the potential to help increasing EBI implementation and reduce health disparities. However, the utilization and reporting of the framework varies across studies. Continuous efforts to improve systematic adaptation will advance EBI implementation in diverse contexts.

¹Northwestern University Feinberg School of Medicine, Chicago, IL, USA; ²Brown School, Washington University in St. Louis, St. Louis, USA; ³Washington University, St. Louis, MO, USA; ⁴Research Triangle Institute (RTI) International, Seattle, WA, USA; ⁵Colorado School of Public Health, Aurora, CO, USA

Correspondence: Callie Walsh-Bailey ([email protected])

Implementation Science 2025, 20(1):S119

Background

It is recommended to use theories, models, and frameworks (TMFs) to inform dissemination and implementation science (D&I) studies. However, there is substantial variation in how TMFs are applied, the quality of their integration into research, and how their applications are communicated in scholarly literature. Without clear communication of how TMFs are applied, the field is limited in its ability to learn from TMF uses across studies and generate evidence around common constructs. We report findings on TMF applications and how these are presented in published articles from five systematic and scoping reviews of D&I TMFs conducted by our team. We offer recommendations for communicating TMF applications in publications

Methods

We conducted primary data extraction from one in progress review of health equity-focused TMFs and secondary data extraction from articles included in three published and one in process D&I TMF reviews. All included reviews followed established guidelines for conducting systematic reviews and PRISMA reporting. We performed descriptive statistical analyses of closed ended extraction items, and thematic analyses of open-ended qualitative data.

Findings

We coded 8 unique types of TMF applications across 500 studies, the most common of which were to inform research aims/questions, select/measure variables, and interpret findings. We synthesized exemplar approaches for communicating how a TMF is used, including use of narrative text descriptions in text figures and tables, and supplemental materials (e.g., TMF-informed data collection instruments and codebooks), and in what manuscript sections the uses are reported (introduction, methods, results, appendix). We summarized illustrative case examples of high-quality TMF integrations and provide comparisons of high versus low quality integration across multiple uses of commonly applied TMFs.

Implications for D&I Research: Studies varied greatly in the number and type of TMF uses, as well as the extent to which the integration of TMFs was clearly communication in published articles. The recommendations from this synthesis of five TMF reviews can improve scientific communication and inform grant and manuscript writing and review.

Sarit Golub¹, Ariel de Roche¹, Imani Hall¹, Maria Ma², Staci Barton², Lucila Wood², Angela Merges²

¹Hunter College of the City University of New York, New York, NY, USA; ²NYC Department of Health and Mental Hygiene, New York, NY, USA

Correspondence: Sarit Golub ([email protected])

Implementation Science 2025, 20(1):S120

Background

In 2021, New York City became one of the first jurisdictions in the U.S. to adopt a quality-based financing (QBF) approach to HIV prevention programming. The NYC Health Department (NYCHD) utilized a multi-level implementation strategy that included: a) provider-level service delivery model focused on universal screening, holistic care provision, and sex-positive, “risk-free” HIV prevention conversations; b) program-level supportive infrastructure (training, technical assistance, learning collaboratives); and c) systems-level accountability structure that tied funding to 136 program-level QBF indicators.

Methods

Implementation in 19 funded programs was assessed by Project PACE, a government-academic partnership funded by CDC to accelerate the impact of health-department delivered HIV prevention. Data collection included: (1) documentation and content analysis of implementation activities; (2) qualitative interviews with 19 funded agencies and NYCHD staff (n = 62); (3) thematic coding of TA/program monitoring data (n = 628); and (4) quantitative analysis of indicator performance (client n = 8,865). Quantitative analyses focused on appropriateness, adoption, and penetration. Qualitative analyses focused on acceptability and feasibility; we also applied the Consolidated Framework for Implementation Research (CFIR) to examine barriers and facilitators to the implementation process and outcomes.

Findings

From March 2022 to February 2024, adoption of supportive infrastructure was high: 100% TA calls attended, 100% learning collaborative sessions attended; median number of staff trained 80% (IQR 75%−89%). Visit-level adoption of universal screening increased from 75% to 91% (HIV testing), 75% to 87% (STI testing), and 50% to 69% (supportive services). Provider-level PrEP adoption increased from 64% to 78%. Service delivery innovations were highly acceptable to programs, who cited impacts on client access, equity, and stigma. Supportive infrastructure was deemed helpful but also challenging, primarily because it was developed simultaneously to program implementation. Programs expressed resistance to the accountability structure, but also recognized it as a major driver of change. Ultimately, the NYCHD decided to stop indicator-based payments to programs, due to funding restrictions and systems-level barriers.

Implications for D&I Research: The NYCHD’s multi-level implementation strategy demonstrated meaningful program- and provider-level impacts, but was also met with challenges in in the innovation, inner-setting, and outer-setting domains. Findings suggest both best practices and potential pitfalls for future QBF implementation strategies.

Primary Funding Source

Centers for Disease Control and Prevention

¹Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA; ²Rhode Island Hospital, Providence, RI, USA; ³Brown University Warren Alpert Medical School, Providence, RI, USA; ⁴University of California David Geffen School of Medicine, Los Angeles, CA, USA; ⁵Yale University School of Nursing, New Haven, CT, USA; ⁶Northwestern University Feinberg School of Medicine, Chicago, IL, USA; ⁷Pacific Institute for Research and Evaluation, Albuquerque, NM, USA; ⁸University of Alabama School of Public Health, Birmingham, AL, USA; ⁹University of Chicago, Chicago, IL, USA; ¹⁰University of California School of Medicine, San Diego, CA, USA; ¹¹University of Alabama Heersink School of Medicine, Birmingham, AL, USA; ¹²Johns Hopkins University School of Medicine, Baltimore, MD, USA

Correspondence: Joseph G. Rosen ([email protected])

Implementation Science 2025, 20(1):S121

Background

Status-neutral care, or person-centered services integrating HIV treatment and prevention, is an evidence-based approach to enhancing HIV service delivery and patient engagement. Despite the potential for status-neutral care to accelerate progress towards the U.S. Ending the HIV Epidemic (EHE) goals, its implementation determinants in federally funded clinical settings remain understudied.

Methods

From March to June 2024, we convened eight focus group discussions (FGDs) with frontline providers (n=56) from 20 clinics implementing or intending to implement status-neutral care and receiving Ryan White HIV/AIDS Program funding. FGDs were conducted in six EHE priority jurisdictions: Alabama, Baltimore, Chicago, Dallas, Los Angeles, and San Diego. Using participatory process mapping, FGDs explored determinants, processes, and strategies facilitating or hindering adoption and penetration of HIV status-neutral models. We used team-based, rapid thematic analysis to identify emerging themes, mapped to domains and constructs from the Consolidated Framework for Implementation Research.

Findings

FGDs revealed an interplay between the outer and inner settings in guiding the pace and scale of status-neutral care implementation. Barriers included: service demands outpacing workforce capacity, particularly for clinics availing same-day/walk-in services; bottlenecks along the service referral pathway, notably linkage-to-care delays from external HIV testing programs and insurance authorization requirements for appointment scheduling; rigid clinical workflows, rendering service delivery unresponsive to individual patient needs; and contract language prohibiting spending on HIV pre-exposure prophylaxis (PrEP) services. Implementation strategies to overcome barriers included: protocolizing agile clinical workflows (e.g., policies decoupling insurance review from clinical service provision, medication dispensing protocols for non-clinicians, expanding intervals between clinical appointments, telemedicine options); fostering stronger communication and connectivity within multidisciplinary teams; staff cross-trainings to address critical workforce vacancies; cost-sharing across contracts to support underfunded positions and services; and formalizing partnerships with clinical and community-based organizations to expedite service referrals across institutions.

Implications for D&I Research: Despite geographic diversity in participating clinics, we identified consistent implementation determinants of status-neutral care across jurisdictions and scalable strategies to overcome barriers in federally funded clinics across the U.S. Sustained financial commitments from federal agencies funding HIV prevention and treatment programs, coupled with contracting flexibility promoting integration of siloed service delivery models, will be essential to national scale-up of HIV status-neutral care.

Primary Funding Source

National Institutes of Health

¹Chestnut Health Systems-Lighthouse Institute, Eugene, OR, USA

Correspondence: Lisa Saldana ([email protected])

Implementation Science 2025, 20(1):S122

Background

Understanding the pace of implementation process is critical to effectively move an evidence-based prevention program (EBP) into practice, but little is known about the pace of ongoing implementation once the program is set to maintain. Sustainment often is described as an outcome or an implementation phase to achieve. However, for many behavioral health preventive interventions, the effort necessary to maintain program delivery in sustainment is significant. This presentation highlights implementation strategies to address challenges experienced in sustainment of four clinics implementing a complex, multilevel, program for parents involved with, or at-risk for involvement with the child welfare system. Most parents are referred with opioid and/or methamphetamine use disorders.

Methods

Four clinics adopted an EBP as part of a research-practice collaboration to increase access to preventive interventions for parental substance use. The EBP is a continuum of care, with parents able to access individualized services at the point of service entry needed (e.g., education, harm reduction, treatment). Program implementation followed a standardized roadmap from pre-implementation to active implementation to sustainment. While services are funded through reimbursement, purveyor support was grant supported. Now, post-grant, all four clinics are unique in their positionality for long-term sustainment. Barriers and facilitators related to sustainment are identified through ongoing leadership contact. The pace and type of response to both types of determinants is continually tracked.

Findings

All clinics experience unplanned inner and outer context determinants of ongoing sustainment. Barriers: full or partial team turnover, loss or delay in funding, change in state policy, limited workforce, change in agency priorities, delays in licensing/certification/credentialing. Unexpected facilitators: increased funding, new partnerships and sponsors, new facilities. For both barriers and facilitators, a near immediate response was required to at least initiate action. Implementation strategies included: redefining roles, cost-calculator, budgeting, advertising, advocacy, hiring, retraining, contact governing body, partner meetings.

Implications for D&I Research: Plans for post-grant longevity must consider the rapid pace necessary to respond within the sustainment phase. It is not enough to reach sustainment—programs must be prepared to act quickly when unexpected barriers arise. Similarly, programs must be able to act on facilitators quickly to seize funding or referral opportunities that otherwise might be missed.

Primary Funding Source

National Institutes of Health

¹University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; ²Centers for Disease Control and Prevention, Atlanta, GA, USA; ³Iowa Department of Public Health, Des Moines, IA, USA; ⁴Rhode Island Department of Health, Providence, RI, USA; ⁵Nevada Cancer Coalition, Reno, NV, USA; ⁶Emory University, Atlanta, GA, USA; ⁷University of Arizona, Tucson, AZ, USA; ⁸LSU Health Science Center, New Orleans, LA, USA; ⁹South Carolina Department of Health & Environmental Control, North Charleston, SC, USA; ¹⁰NYU Langone, New York, NY, USA

Correspondence: Rachel Hirschey ([email protected])

Implementation Science 2025, 20(1):S123

Background

The Centers for Disease Control and Prevention (CDC) sought to scale three successful cancer prevention and control (CPC) pilot projects: 1) Project ECHO and patient navigation for rural cancer survivors, 2) addressing childhood risk factors for adult cancers, and 3) increasing gynecologic oncology access. Fourteen of the 66 National Comprehensive Cancer Control Program (NCCCP) award recipients (recipients) participated in the pilot projects. The Scaling What Works (SWW) project provides multi-modality training, technical assistance (TA), and mentorship for the remaining NCCCP recipients to build capacity to implement these projects.

Methods

We used multi-phase methods to support NCCCP recipients in learning objectives (LO) for understanding, adapting, implementing, evaluating, and sustaining the projects. We assessed NCCCP recipients’ TA and capacity needs through four focus groups and three information sessions, wherein NCCCP pilot staff shared exemplary implementation practices. We used findings from these sessions to develop a three-day symposium. The symposium included didactic and mentored breakout sessions using the Putting Public Health Evidence in Action (PPHEIA) curriculum, and networking. We conducted a paired t test of pre/post-evaluation surveys to assess LO competencies and to inform the development of a learning collaborative (LC) through which SWW provides ongoing support.

Findings

A total of 89 NCCCP program staff or cancer coalition members from 41 NCCCP recipients (32 states, 2 tribes, 7 US jurisdictions) participated in the focus groups (n=16), information sessions (n=40), and the symposium (n=51). Formative results revealed capacity needs related to personnel, partnerships, funding, facilities, geography, and healthcare infrastructure. Additionally, participants reported moderate confidence in describing projects, limited confidence in project implementation planning, and a need to connect with exemplary pilot sites. Following the symposium, we observed statistically significant increases in attendees’ (n=25) confidence for all LOs: understanding (10.2–12.8), adapting (13.3–16.8), implementing (12.9–17.2), evaluating (13.7–17.4), and sustaining (15.8–20.4) SWW projects.

Implications for D&I Research: SWW maximizes resources to promote the implementation of projects that improve CPC across NCCCP recipients. Using TA, training, breakout sessions, mentoring, and both in-person and virtual LCs, SWW increased capacity in 41 geographically diverse NCCCP recipients. SWW has the potential to improve the wellness of cancer survivors and reduce cancer risk factors across diverse communities.

Primary Funding Source

Centers for Disease Control and Prevention

University of South Carolina, Columbia, SC, USA

Correspondence: Caroline Rudisill ([email protected])

Implementation Science 2025, 20(1):S124

Background

Program administration and implementation costs are critical for scale-up and dissemination of effective public health interventions. Costing methods within dissemination and implementation studies examining organizational-level implementation outcomes are limited. Therefore, this study focuses on the implementation outcome of costs as part of a 2020-2023 national implementation study of Faith, Activity, and Nutrition (FAN). FAN is an evidence-based program with positive impacts on church policy, systems, and environments and church member physical activity and dietary behaviors.We demonstrate robust methodologies supporting intervention scale-up and financial feasibility.

Methods

We examined costs in two ways using micro-costing approaches. The first is costs to an organization (n=1) hosting and administering web-based training and support for churches, using time tracking and programmatic data. The second is costs to churches (n=90) trained to implement FAN, using surveys completed after each training module and yearly church leadership surveys with reported time use, space needs, and other expenditures. We account for the potentially voluntary nature of FAN implementation at churches by costing labor in three ways: assume labor has zero cost because FAN is run by volunteers, take a societal perspective and attach costs to volunteer time at minimum wage, and attach costs to volunteer time at the rate of equivalent church personnel. Finally, we analyze the relationship between church implementation costs and implementation outcomes (i.e., fidelity).

Findings

On average, 3.97 hours/week of person time was spent by an organization hosting and administering FAN (9.93% of work week). The average cost/year to host and administer FAN was $6,635.92, which includes program administration, recruitment, and IT support. Churches implementing FAN spent 23.4±19.6 hours/year planning and 28.3±37.3 hours/year implementing FAN-related activities. The average annual church budget for FAN, of those who allocated a budget (n=26), was $759.42 (range, $0 - $2,000.00). Additional results will be presented on total costs for churches to implement FAN including training and cost per implementation outcome (i.e., fidelity).

Implications for D&I Research: Methodologies for costing community-based interventions with organizational-level outcomes are under-developed. This cost analysis of FAN provides an exemplar for public health programmatic costing methods that can be used for implementation in other organizational settings.

Primary Funding Source

Centers for Disease Control and Prevention

¹Duquesne University, Pittsburgh, PA, USA; ²Kaiser Permanente Center for Health Research, Portland, OR, USA

Correspondence: Melanie Turk ([email protected])

Implementation Science 2025, 20(1):S125

Background

The Centers for Medicare and Medicaid Services and the Centers for Disease Control and Prevention partnered to launch landmark coverage of the Medicare Diabetes Prevention Program (MDPP) in 2018, making this evidence-based lifestyle intervention available at no cost to ~27.2 older adults with prediabetes. However, implementation of the MDPP has been challenged by a lack of program suppliers, which limits access and diminishes public health impact. This study describes the opportunities and obstacles associated with MDPP implementation, specifically related to supplier reimbursement.

Methods

Using a semi-structured interview guide based on the Consolidated Framework for Implementation Research (CFIR), we interviewed ten program coordinators from suppliers across the US. Interviews were transcribed verbatim and analyzed using the Rapid Group Analysis process. Because MDPP policies are revised every few years, we focused on identifying key findings to expediently share with policy makers.

Findings

Five themes were identified. Themes for opportunities included: 1) Program coordinators are dedicated, passionate, and intrinsically-motivated to offer the MDPP to prevent type 2 diabetes, and 2) Suppliers work hard to sustain the MDPP to the best of their ability. Obstacle themes included: 1) Obtaining Medicare designation is overly burdensome, 2) The logistics of billing are challenging and confusing, especially for community-based organizations, and 3) Low reimbursement rates and the pay-for-performance model are problematic. Suppliers need Medicare reimbursement for program sustainability after initially relying on grants. However, suppliers are discouraged by their inability to receive payments from Medicare Advantage plans that impose additional demands for contracts, yet frequently deny claims without reasonable explanations. Suppliers identified actionable recommendations, including shifting to payment models used for Diabetes Self-Management Education and Support.

Implications for D&I Research: As the first Medicare-covered public health intervention for disease prevention, the MDPP urgently needs wider dissemination to capitalize on the opportunity to prevent diabetes for millions of older adults. Findings suggest the Inner Setting CFIR domain (organizational culture) is a program strength, while the Intervention Characteristics (complexity, cost) and the Outer Setting (external policies, resources) domains contribute to the lack of MDPP uptake. Results highlight where policy changes can address reimbursement issues and facilitate wider MDPP dissemination.

Primary Funding Source

National Institutes of Health

¹Weill Cornell Medicine, New York, NY, USA; ²Mbarara University of Science and Technology, Mbarara, Uganda; ³Cornell University, Ithaca, USA

Correspondence: Misha Hooda ([email protected])

Implementation Science 2025, 20(1):S126

Background

Task shifting bridges the evidence-practice gap, particularly for underserved and marginalized populations. Task shifting has been broadly implemented among community health workers, and rapidly scaled up without much time for evaluation and programmatic evolution for optimal sustainment. Recently, task shifting has expanded to include community laypersons such as religious leaders, barbers, hair stylists, and traditional healers. Few programs with these lay cadres have been nationally scaled, providing an opportunity for slower implementation and evaluation to accommodate an iterative implementation process. Koh & Lee’s empowerment framework outlines four engagement domains essential for successful task shifting to community health workers, but its applicability to lay cadres and program sustainability remains unclear. We conducted a qualitative sub-study within an ongoing clinical trial to explore traditional healers’ (TH) perspectives on task training, uptake, and engagement as lay HIV supporters in rural Uganda.

Methods

From July-August 2023, we conducted in-depth qualitative interviews with 22 TH following a two-day training session. The training curriculum included information on HIV transmission and prevention, the role of antiretrovirals, providing adherence support, reducing stigma, and facilitating HIV self-testing. Interviews were conducted in the local language, audio-recorded, translated, and transcribed into English. Two authors independently analyzed transcripts using a thematic analysis-approach, and results were organized using Koh & Lee’s empowerment framework.

Findings

All four domains described by Koh & Lee were relevant to TH in new task-shifted roles. TH perceived their work as meaningful because they could help clients otherwise struggling to engage with formal health systems. TH also felt competent to support their clients with HIV effectively. TH described feeling “free” after task-shifting training (self-determination), previously being limited in what they could offer clients with HIV. TH considered their new roles impactful because they represented a confidential space for HIV patients in communities. We identified an additional domain, external validation, referring to the supportive impact of recognition from the formal health sector.

Implications for D&I Research: The empowerment framework is largely applicable to engaging laypersons in task shifting programs, with an important additional domain of external validation. Tailored training programs leveraging these motivators could facilitate scalable and sustainable task-shifting implementation among lay health workers.

Primary Funding Source

National Institutes of Health

¹The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA

Correspondence: Paula Cuccaro ([email protected])

Implementation Science 2025, 20(1):S127

Background

Adolescent HPV vaccine uptake remains suboptimal despite its effectiveness in preventing cancer. All for Them (AFT) is a theory- and evidence-based multilevel, multicomponent program delivered through schools to increase HPV vaccination among medically-underserved youth across Texas. However, logistical challenges may hinder AFT implementation. The overall goal of this project is to develop a multifaceted implementation strategy (Implementing All for Them [IM-AFT]) for schools and healthcare providers to adopt and implement AFT.

Methods

We use Implementation Mapping (IM), a systematic and iterative process, to develop the implementation strategy, IM-AFT, to support user implementation. In Task 1 (needs/assets assessment), we established an advisory committee to acquire stakeholder input for strategy development and interviewed potential adopters and current implementers to understand school- and provider-level barriers and facilitators of AFT adoption and implementation. In Task 2 (implementation outcomes), we developed matrices of performance and change objectives to identify adoption and implementation outcomes.

Findings

Members of school districts, healthcare providers, and experts in research quality improvement, dissemination, and community engagement provided insights about strategy development. From the interviews, current implementers reported facilitators as leadership buy-in and organizational support, while barriers were school nurse resistance, clinic staff shortages, and minimal school-provider collaborations. Facilitators for potential adopters included evidence of previous program success, and barriers were resistance from new staff and anticipated lack of organizational buy-in. In Task 2, informed by Task 1, we specified six psychosocial determinants influencing behavior: knowledge, attitudes, skills, self-efficacy, perceived norms, and perceived barriers. We identified 45 performance objectives and 400 change objectives for school personnel and 36 performance objectives and 326 change objectives for providers. While the performance objectives illustrate step-by-step actions required by both schools and providers for successful adoption and implementation, the change objectives linking behavioral determinants and performance objectives will guide IM-AFT development and dissemination.

Implications for D&I Research: This study highlights the key barriers/facilitators to AFT implementation and implementers’ performance objectives and behavioral determinants necessary to achieve outcomes of AFT implementation. This information provides the underpinnings for a theory-informed implementation strategy and a model approach for supporting implementation of school-based vaccines.

Primary Funding Source

Cancer Prevention and Research Institute of Texas

¹University of North Carolina at Charlotte, Charlotte, NC, USA; ²UNC Chapel Hill, Chapel Hill, NC, USA

Correspondence: Meagan Zarwell ([email protected])

Implementation Science 2025, 20(1):S128

Background

The CDC’s Social Network Strategy (SNS) is an “evidence-supported approach” designed to increase HIV testing and reach multiply marginalized populations within high HIV prevalence. Leveraging social networks may also improve access to other HIV services (i.e. pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART)), particularly for members of Black sexual and gender minority (BSGM) groups. We explored key barriers and facilitators to implementing an enhanced SNS (eSNS) to improve access to HIV services among BGSM in the US South.

Methods

Guided by the Consolidated Framework for Implementation Research (CFIR), we conducted four focus groups with 19 client services staff and 12 in-depth interviews with local health department officials, clinicians, and community-based organization leaders. Transcripts were deductively and inductively coded, applying constructs from the CFIR to identify potential barriers and facilitators to implementing eSNS.

Findings

We identified three themes that reflect the delicate balance of trust and mistrust that operates within social networks prioritized by eSNS. Each theme represents a “Peer Paradox”, wherein eSNS core components and implementation strategies may have unpredictable effects on trust and mistrust within these peer networks. The Incentives Paradox captures how financial incentives may work synergistically with interpersonal ties to strengthen engagement with HIV services but may also introduce a transactional element into peer-to-peer interactions. The Readiness Paradox is the perception that people from BSGM groups best positioned to recruit peers who could most benefit from HIV services are likely to require the greatest amount of additional support in delivering eSNS. The Credibility Paradox reflects a concern that although trust among peers may be harnessed to disseminate health information and increase acceptance of HIV services, peers are not necessarily considered credible sources of information about HIV.

Implications for D&I Research: Disruptions to the interplay of trust and mistrust may influence the effectiveness of the eSNS intervention we propose to support BSGM and increase access to HIV services. Our findings suggest that public health practitioners implementing SNS or similar social networking interventions may benefit from identifying specific obstacles to fostering trust before and during implementation and consider strategies that address peer credibility, readiness, and the impact of financial incentives.

Primary Funding Source

National Institutes of Health

¹Wake Forest University School of Medicine, Winston-Salem, NC, USA; ²University of North Carolina at Charlotte, Charlotte, NC, USA

Correspondence: Ucheoma Nwaozuru ([email protected])

Implementation Science 2025, 20(1):S129

Background

HIV self-testing (HIVST) is an evidence-based tool that is effective in reducing the challenges associated with facility-based testing, including stigma and transportation barriers. However, HIVST reach among young adults (18–29 years) remains suboptimal. In preparation for a pilot implementation study to promote the uptake of HIVST among young adults in Mecklenburg County, North Carolina, this qualitative study explores opportunities, barriers, and facilitators to implementing HIVST among young adults.

Methods

Semi-structured interviews (N=13) were conducted with staff from implementing sites, the health department, and young adults. The interview guide and analysis were guided by the Consolidated Framework for Implementation Research (CFIR). Interviews were audio-recorded, transcribed verbatim, and analyzed using rapid qualitative analysis techniques to identify contextual determinants of implementation. The salient barriers identified will inform a participatory process (crowdsourcing open call and charrettes) with implementing community partners and young adults to co-create HIVST implementation strategies that address these barriers.

Findings

The majority of interview participants were female (69%) and Black (61.5%). Themes within the CFIR domains of individual characteristics, intervention characteristics, inner setting, and outer setting emerged as implementation determinants. Facilitators to the adoption of HIVST include the ease and confidentiality of HIVST, fit within local HIV testing efforts, and support from local community partners. Barriers included limited awareness about HIVST programs among young adults, challenges with follow-up care post-HIVST, and limited focus on syndemic factors, including housing instability. Additional patient-level barriers to implementation include the ability of young adults to appropriately administer and return HIVST results, as well as their readiness to receive status diagnoses outside of clinical space. Potential opportunities include leveraging existing resources within the community, including active collaboration with community partners to foster the sustainability of proposed co-created strategies.

Implications for D&I Research: This study generated important insights regarding barriers, facilitators, and opportunities to implement HIVST for young adults in a prioritized Ending the HIV Epidemic (EHE) jurisdiction. Findings will be incorporated into co-creating implementation strategies for HIVST that leverage facilitators and assets while addressing the challenges identified.

Primary Funding Source

National Institutes of Health

S130 Advancing Implementation of Breast Cancer Risk Assessment among Community-Dwelling Latinas: Qualitative Exploration of Multilevel Contextual Factors and Implementation Strategies

Correspondence: Jessica D. Austin ([email protected])

Implementation Science 2025, 20(1):S130

Background

Latinas is the U.S. are at higher risk of breast cancer-specific mortality and more likely to be diagnosed at younger ages. Guideline organizations recommend breast cancer risk assessment (BCRA) by age 25 to 30, but failure to implement BCRA recommendations reduces benefits and may widen disparities by limiting access to risk-reduction care for those that could benefit the most. This is particularly the case for younger Latinas who may not regularly seek/have access to care. This qualitative formative study explores contextual factors, including barriers (B) and facilitators (F), and potential strategies to improve implementation of BCRA among Latinas.

Methods

Between June 2023 and May 2024, we conducted individual interviews in English and Spanish with 20 Latinas (Mean age 39.5, range 40–50; 70% Spanish speaking), with no history of breast cancer. Guided by NIMHD Minority Health and Health Disparities Research Framework, transcripts were analyzed using a deductive-inductive approach to thematic analysis, categorized into Bs and Fs, and matched to Expert Recommendations for Implementing Change (ERIC) strategies.

Findings

Individual-level Bs included limited knowledge/awareness of BCRA, limited English proficiency, low literacy, not prioritizing health/preventive screening, while Fs included interest in and perceived importance of BCRA. Interpersonal-level Bs included generational folklore/myths and language discordance with providers, while Fs included the presence of strong family/social networks. Community-level Bs were affordability and availability of healthcare services, while Fs were support and services from community organizations. Perceived discrimination and being “invisible” was identified as a B across multiple levels of influence. Results from the matching exercise indicated potential ERIC strategies in the following categories: 1) Training and education; 2) Developing interrelationships; 3) Engaging consumers; and 4) Tailoring to implementation context.

Implications for D&I Research: Obtaining perspectives from younger Latinas and leveraging a robust health disparity framework provided in-depth context to Bs and Fs across multiple levels of influence that are not well-defined by current implementation science frameworks. These findings also emphasize the need for novel, community-informed methods for developing and selecting implementation strategies tailored to target communities/populations rather than settings and that account for advantageous interpersonal (family/social networks) and community influences, besides hurdles associated with availability/utilization of services and discrimination.

Primary Funding Source

Mayo Clinic Breast Cancer Specialized Programs of Research Excellence (SPORE)

¹Monash University, Melbourne, VIC, Australia; ²Monash University, Clayton, VIC, Australia; ⁴Pharmaceutical Society of Australia, Parkville, VIC, Australia

Correspondence: Alex Waddell ([email protected])

Implementation Science 2025, 20(1):S131

Background

Australia has one of the highest rates of prescription opioid use and related harm in the world. Despite a $10 million government investment in provision of the overdose-antidote naloxone, less than 2% of those at risk of prescription opioid harm were estimated to have received it. Prior research has shown that despite many people being worried about their opioid use, less than 5% had spoken to a healthcare professional about their concerns. This study presents the co-design of a digital opioid safety toolkit for national dissemination through pharmacies to encourage consumers engagement in opioid safety behaviours including 1) naloxone uptake, 2) creating a safety plan, and 3) discussing their opioid prescription with their healthcare provider.

Methods

The digital opioid safety toolkit was co-designed and developed using a novel approach to digital health intervention design combining the Theoretical Domains Framework (TDF), Behaviour Change Techniques (BCTs) and Double-Diamond design process. Co-design involved seven iterative workshops with consumers and healthcare experts, followed by user testing of the toolkit. Workshops focused on identifying barriers and facilitators to each opioid safety behaviour, exploring design preferences, sense checking and ideation of the user flow.

Findings

13 consumers and 11 healthcare experts participated in up to four and three online co-design workshops, respectively. Six facilitators were identified as priorities including consumers’ knowledge of the need for opioid safety, public knowledge on the use of naloxone, personalisation, support from healthcare providers, normalising naloxone use, and data ownership. Barriers included stigmatising language, lack of knowledge of risks and benefits and alternatives to opioids, and lack of healthcare provider support. The co-designed digital opioid safety toolkit includes BCTs to address each barrier and facilitator. Preliminary randomized control data (RCT) shows increased naloxone uptake and high satisfaction among participants. A national dissemination campaign is planned.

Implications for D&I Research: A multi-faceted implementation and dissemination approach to safer opioid use must include consumers and healthcare experts. This study utilised a novel approach to co-designing a digital opioid safety toolkit by combining the TDF, BCTs and Double Diamond design process. The approach provides a framework for the design of digital health interventions for researchers and practitioners.

Primary Funding Source

The Australian Federal Department of Health

¹Columbia University Mailman School of Public Health, New York, NY, USA; ²Columbia University Irving Medical Center, New York, NY, USA; ³New York University Grossman School of Medicine, New York, NY, USA; ⁴Vynamic, LLC: Health Industry Management Consulting, New York, NY, USA; ⁵Columbia University, New York, NY, USA; ⁶CARE-LA, Los Angeles, CA, USA

Correspondence: Savannah Alexander ([email protected])

Implementation Science 2025, 20(1):S132

Background

The U.S. opioid overdose epidemic is worsening. Opioid overdose education and naloxone training/distribution (OEND) programs are critical within a multi-pronged public health response. College campus infrastructure could support national implementation, reaching adolescents/young adults who could disseminate to broader social networks and geographic communities. This important setting is underutilized, and critical gaps remain in understanding college campus OEND program adoption/implementation.

Methods

We conducted in-depth interviews among purposefully-selected college health administrators (n=21), representing 19 diverse universities nationally (e.g., regarding regional overdose prevalence, extent of OEND program implementation – including campuses without a program) and 1 statewide higher education substance-use consortium (24 member colleges/universities). The Consolidated Framework for Implementation Research (CFIR) informed data collection/analysis.

Justification: Regarding Relative Priority (Inner Setting) and High/Mid-Level Leaders (Individuals), participants described the need for compelling justification to adopt/implement the program. Student opioid overdoses were the primary catalyst for administration to do so. Absent overdoses and related to Assessing Needs (Implementation Process), participants described the need for and difficulty obtaining opioid use data to justify investment. Universities’ levels of community obligation/integration determined what opioid overdoses and opioid use data (e.g., student, community, on/off campus) were relevant to justify adoption/implementation.

Partnerships: Regarding Partnerships and Connections (Outer Setting), participants illustrated why external partners (e.g., local health systems) might be critical, including: 1) navigating administration’s pushback/passivity; 2) allowing students to access the program elsewhere during the university’s exploration/preparation; 3) overcoming resource constraints; 4) promoting sustainability; 5) building academic-community relationships. Regarding Relational Connections (Inner Setting), participants described the need for internal campus partnerships (e.g., public health schools).

Politics/culture: Regarding Local Attitudes (Outer Setting), political risk management/optics concerns could prevent adoption and must be addressed (e.g., framing the program as prevention, not incrimination of a campus problem). Regarding Culture (Inner Setting), institutionalizing recovery programming and supportive values (e.g., progressivism) could catalyze OEND program adoption/implementation.

Implications for D&I Research: This is the first study to provide in-depth insights from a national sample of college health administrators into determinants of adopting/implementing OEND programs on college campuses, a critical setting that remains underutilized as the opioid overdose epidemic worsens. This study contributes to growing literature on applying/refining CFIR among diverse community/school contexts.

Primary Funding Source

National Institutes of Health

¹Centers for Disease Control and Prevention, Atlanta, GA, USA; ²Oak Ridge Institute for Science and Education (ORISE), Atlanta, GA, USA; ³Applied Science, Research, and Technology (ARST, Inc.), Atlanta, GA, USA

Correspondence: Nancy Andrade ([email protected])

Implementation Science 2025, 20(1):S133

Background

Almost half of adults in the United States have cardiovascular disease (CVD), the leading cause of death for the last century and a major contributor to billions of dollars in annual healthcare costs. Despite progress made to identify evidence-based strategies to address CVD risk and burden, a lag in implementation persists. To expedite the identification and improve the dissemination and adoption of effective approaches to prevent and manage CVD, the Centers for Disease Control and Prevention (CDC) developed the Best Practices Clearinghouse (BPC).

Methods

The authors used multiple frameworks and tools to efficiently identify, assess, and describe the strategies. The Best Practices Framework was used to identify and categorize strategies considering public health impact and quality of evidence. The Continuum of Evidence of Effectiveness tool was used to further assess the strength of evidence for each strategy across a continuum of six effectiveness dimensions. The Cross-Cutting Themes Survey was used to understand a strategy’s potential to improve cardiovascular health and health equity and demonstrate cost-effectiveness. The Rapid Synthesis Translation Process provided a structure to guide all development processes.

Findings

Eighteen strategies were identified; authors categorized fifteen as ‘Best’ and three as ‘Leading’, based on the evidence of effectiveness, reach, feasibility, sustainability, and transferability. Authors developed strategy summaries, each including (1) descriptions of the evidence of health, health equity, and economic impact, (2) a brief narrative describing successful strategy implementation, (3) implementation considerations regarding settings and policies, and (4) implementation resources. To extend the utility and enhance dissemination, strategy details were transferred to and are hosted on the BPC, a dynamic online database designed to support decision-making for a variety of audiences with an interest in addressing CVD.

Implications for D&I Research: Using existing knowledge translation frameworks and tools demonstrates a replicable approach to efficiently synthesize and translate research to facilitate the uptake and implementation of evidence-based interventions for various disease states. The authors translated complex evidence into clear guidance that decision-makers, state and local health departments, public health professionals, and clinicians can use to inform the implementation of effective strategies across the continuum of care for CVD.

Primary Funding Source

Centers for Disease Control and Prevention

¹University of Illinois Chicago, Chicago, IL, USA; ²Sinai Health System, Chicago, IL, USA; ³Northwestern University, Chicago, IL, USA; ⁴Loyola University Chicago, Chicago, IL, USA; ⁵University of Chicago, Chicago, IL, USA; ⁶Sinai Urban Health Institute, Chicago, IL, USA; ⁷Washington University in St. Louis, St. Louis, MO, USA

Correspondence: Katherine Merrill ([email protected])

Implementation Science 2025, 20(1):S134

Background

The Chicagoland Community Engagement Alliance (CEAL) program was established during the national response to COVID-19 to increase vaccination rates among minoritized urban populations through community-academic partnerships (CAPs). Post-pandemic, the CAPs broadened their focus to establish, grow, or improve health equity- focused work of partner organizations. Many CAPs began using capacity-building to enhance the knowledge, skills, and/or networks of organizations and communities. We explored implementation determinants (i.e., barriers and facilitators) of these initiatives using the Exploration, Preparation, Implementation, Sustainment (EPIS) framework.

Methods

We conducted seven virtual focus groups with community organization representatives (n=14) and researchers (n=12) involved in delivering six capacity-building initiatives. A four-person team coded the transcripts and grouped emerging themes by the EPIS domains and constructs. We assigned each construct/sub-construct a valence (+/-) and presented findings by salience.

Findings

Our findings showed: 1) Bridging factors: Mutually beneficial, trusting relationships were foundational to the health of CAPs. A community partner explained, “I cannot emphasize enough how important that core, trusting relationship is.” CAPs facilitated connections between the inner (i.e., organizational) and outer (i.e., beyond organizational) setting—e.g., through network-building. 2) Innovation factors: Initiatives were tailored to community needs and adapted in an “organic” process through “fluid learning on both sides.” 3) Outer context: Flexible funding supported implementation; “structural barriers” related to local infrastructure, transportation, safety, and negative perceptions of researchers/health providers hindered implementation. 4) Inner context: All organizations were invested in the initiatives but competing priorities and “calendaring” were barriers.

Implications for D&I Research: The data show that CAPs can be an important set of bridging factors. In the outer context, we identified barriers not currently explicitly addressed in EPIS (i.e., social climate, local infrastructure). Our findings also emphasize the importance of sufficient time and flexible grant funding to cultivate meaningful, trusting relationships between academic partners and community organizations to promote health equity. This study expands the literature of implementation science by outlining important aspects related to the pace of implementation and importance of the early stages of preparation, and additional concepts in the EPIS framework.

Primary Funding Source

National Institutes of Health

¹San Diego State University, San Diego, CA, USA; ²Sweetwater Union High School District, Chula Vista, CA, USA

Correspondence: Amanda P. Miller ([email protected])

Implementation Science 2025, 20(1):S135

Background

Health equity focused implementation research can lead to improved health outcomes in the broader community. The present study qualitatively explores the determinants of implementation success from a district wide disparity focused COVID-19 testing program from the perspective of multilevel stakeholders to identify lessons learned for future public health application. This analysis was guided by the CFIR to promote interpretation of the results within the broader implementation research literature.

Methods

Return to Schools (RTS) was an implementation study of school-based distribution of at-home COVID-19 test kits at eleven middle schools near the US-Mexico border comprised predominately of racial and ethnic minority students. Post implementation (April-May 2023), we conducted focus groups and interviews with 42 participants across stakeholder categories including principals (n=9), assistant principals (n=7), COVID Coordinators, (n=2), community health workers (CHWs) (n=8), CHW coordinators (n=2), administrative/afterschool staff (n=2) and custodians (n=12) from the participating middle schools. All sessions were recorded and transcribed. The CFIR informed interview guide and codebook development, analysis, and interpretation.

Findings

By implementing the program across a socioeconomically diverse district serving racial and ethnic minority students, we were able to identify aspects of the program that universally facilitated implementation success as well as aspects that performed differently across communities. Application of the CFIR to organize these findings supported a systematic approach. Factors with the greatest influence on program uptake included (1) the extent to which the program addressed an existing unmet need in each community (2) program responsiveness to community feedback (3) enthusiasm and willingness to support the program in the inner setting and (4) political will.

Implications for D&I Research: Rapid scale-up of RTS was successful largely because it was responsive to the needs and preferences of key stakeholders in the inner and outer settings. School-based programming that is supported by external staff was a successful implementation strategy that minimized burden on school administration while leveraging access to the broader community through existing infrastructure. The lessons learned through evaluation of our implementation process provide a road map for implementation of future responses to public health crises along with guidance for best practices in integration of more routine school-based health programming delivery.

Primary Funding Source

National Institutes of Health

¹The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA; ²The Cooper Institute, Dallas, TX, USA

Correspondence: Derek Craig ([email protected])

Implementation Science 2025, 20(1):S136

Background

Schools are recommended to use a whole-of-school (WOS) approach to support students’ physical activity (PA) (i.e., providing PA opportunities before, during, and after school), yet the extent to which a WOS approach is implemented by schools is not well understood. Determinant frameworks, such as the R=MC² framework for organizational readiness, can help identify barriers/facilitators that influence implementation. This study examines associations between implementation-related constructs from the R=MC² heuristic and schools’ implementation of a WOS approach.

Methods

We conducted a cross-sectional analysis of data from U.S. elementary schools participating in the NFL PLAY60 FitnessGram Project during the 2022-23 school year. From surveys administered to school staff, we created a WOS index (WOSI, range=0–12) comprising six PA practices: physical education, recess, before and after-school programs, classroom-based approaches, and active transport. We also assessed how constructs from the R=MC² heuristic (culture, implementation climate, leadership, access to knowledge and information, priority, resources utilization, resource availability) impact physical activity implementation using a series of questions measured on a 5-point Likert scale. We used Pearson’s correlations and linear regression models to examine associations between R=MC² constructs (independent variables) and WOSI scores (dependent variable). We controlled for school-level characteristics (student enrollment, percentage of race/ethnicity and economically disadvantaged students served) and state-level clustering.

Findings

Representatives from 132 schools across 18 states completed the survey. On average, school staff rated leadership (mean=4.1, range=1.5–5) and organizational culture (mean=4.0, range=2.25–5) the highest whereas implementation climate (mean=3.5; range=1–5) and resource availability (mean=3.7; range=1–5) were rated the lowest. The mean WOSI index value was 6.1. Correlation analyses and partially adjusted models both indicated significant positive associations between each R=MC² construct and WOSI scores. Fully adjusted regression models revealed priority (β=0.31; p=0.010; 95%CI=0.23–1.51) and implementation climate (β=0.28; p=0.047; 95%CI=0.01–1.36) were positively and significantly associated with WOSI scores.

Implications for D&I Research: Our study provides insights into key implementation constructs associated with schools’ ability to provide PA opportunities consistent with a WOS approach. Our findings can inform the development of resources and readiness building strategies that in turn help schools address implementation-related disparities. As a result, schools are better positioned to implement PA opportunities successfully and equitably.

Primary Funding Source

The Cooper Institute, NFL Foundation

¹The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA; ²Suite 2080, UTHealth Houston School of Public Health, Houston, TX, USA

Correspondence: Timothy Walker ([email protected])

Implementation Science 2025, 20(1):S137

Background

Physically active breaks and lessons are evidence-based approaches to improve student’s physical activity (PA). Yet, schools/teachers face multiple implementation challenges, requiring the need for effective implementation strategies. In this presentation, we describe the development of an implementation strategy for classroom-based PA approaches and the proposed mechanisms of actions, and report findings related to the strategy’s feasibility and acceptability.

Methods

In collaboration with the district partner, we assembled a planning group with expertise in public health, education, and implementation science. The planning group carried out the five Implementation Mapping tasks. We also created an Implementation Mapping (IMap) Logic Model showcasing proposed mechanisms of action along with the strategy’s form (how it is delivered) and function (why it works). We then conducted a mixed methods evaluation of the strategy’s feasibility and acceptability through surveys and interviews with teachers and school staff from the partner elementary school.

Findings

The strategy focused on primary implementers: principal/assistant principal, instructional coaches, and teachers. The primary implementation outcome was teacher implementation fidelity (implementation ≥2 physically active breaks/lessons per day). The developed strategy consisted of leadership training, teacher training, a monthly newsletter, and parent flyer. The strategy operationalized multiple change methods (theoretical techniques influencing implementation determinants) and practical applications (operationalization of change methods) to address implementation determinants and outcomes. For example, the teacher training included activity demonstrations (practical application of the change method, direct experience) to help teachers experience the benefits of movement-based teaching and shift their attitudes. Ninety-one percent (n=29/32) of teachers attended all training sessions; 87% (n=28/32) reported liking the training; 87% (n=27/31) reported the training was easy to understand, 84% (n=26/31) reported the training helped improve their use of PA approaches, and 97% (n=31/32) reported they would recommend the training.

Implications for D&I Research: This study showcases the Implementation Mapping process and ways to optimize pace during the development process. The strategy’s mechanisms, form, and function are also clearly identified using an IMap Logic Model, which aids reporting and further mechanistic testing. The trainings had high attendance demonstrating feasibility, and the trainings/other materials had high positive ratings demonstrating acceptability.

Primary Funding Source

National Institutes of Health

Morehouse School of Medicine, ATLANTA, GA, USA

Correspondence: Rhonda Holliday ([email protected])

Implementation Science 2025, 20(1):S138

Background

Historically Black Colleges and Universities (HBCUs) and Minority Serving Institutions (MSIs) offer a unique opportunity to address health disparities among historically underserved populations. These institutions experience unique implementation challenges. Take Charge addressed HIV and substance use among African Americans (18–24) through the implementation of HIV testing, condom distribution, and peer education on three college campuses.

Methods

Formative research, guided by the CFIR model, included student focus groups (n = 7), and key informant interviews (n = 17) with administrators, faculty and staff to assess the structural characteristics, campus policies, partnerships, health service needs, and barriers and facilitators to implementation. A detailed implementation plan was co-created with each institution and capacity building activities were conducted to assist with implementation that occurred over a two-year period. Post-implementation key informant interviews (n = 7) were conducted to assess the barriers and facilitators to implementation. The data were managed using Dedoose and analyzed using the RARE methodology.

Findings

Formative assessment findings indicated a need for the intervention to address student knowledge gaps and risk behaviors, capacity to implement the intervention, and sustainability. The implementation plan accounted for varying levels of institutional capacity and was adapted to address changes due to COVID-19. Institutional capacity was increased via partnerships with community-based organizations and public health departments. Implementation included virtual peer educator training (n = 5), virtual and in person educational activities (n = 49), and online condom distribution (274 orders). Post-implementation data revealed that institutions encountered challenges with peer educator recruitment and retention, internal communication, and personnel resources. Some of these challenges were overcome through collaboration with community partners and technical assistance.

Implications for D&I Research: Capacity building activities were key components for successful implementation. Take Charge highlighted the need for tailored approaches to capacity building and intervention implementation. The unique context and setting of HBCUs and MSIs required leveraging existing partnerships and developing new partnerships to create sustainable interventions. Environmental factors (COVID-19) required implementation adaptations to accommodate ever changing institutional policies. This work may inform future implementation of other prevention and education efforts at HBCUs and MSIs to reduce health disparities among African Americans and other ethnic minority populations.

Primary Funding Source

Centers for Disease Control and Prevention

Sara Wilcox¹, Ruth P. Saunders¹, A. Caroline Rudisill¹, Ye Sil Kim¹, Deborah Kinnard¹, Jasmin Parker-Brown¹, Kelsey R. Day²

¹University of South Carolina, Columbia, SC, USA; ²University of Virginia, Charlottesville, VA, USA

Correspondence: Sara Wilcox ([email protected])

Implementation Science 2025, 20(1):S139

Background

Strategies are needed to scale up community interventions more quickly and efficiently. We adapted an evidence-based intervention designed to improve organizational practices related to physical activity (PA) and healthy eating (HE) in churches - Faith, Activity, and Nutrition (FAN) – to an online format and examined its impact on implementation outcomes (fidelity).

Methods

US churches were recruited from 2020-2022 with assistance from faith-based and public health partners. Church committee training included 8 online lessons delivered 1/week, a discussion board, and 12 months of resources. To assess implementation outcomes (fidelity), each church’s coordinator completed an online pre-training baseline and 12-month survey that assessed church practices for PA/HE targeted in FAN (opportunities, policies, messages, and pastor support). Because COVID-19 may have impacted intervention implementation, we reported implementation separately for churches that met entirely/mostly in person or entirely/mostly online at baseline. Using mixed-effects regression models, we examined changes over time and whether these changes differed by how churches met at baseline.

Findings

Churches (N=107, 75% predominantly African American) from 23 states and representing 21 denominations were enrolled. Coordinators from 90/107 (84%) churches completed baseline and 12-month surveys. Implementation of all PA practices increased (p<.01), with effect sizes ranging from d=0.30–1.50 for churches meeting online and d=0.59–1.18 for churches meeting in person at baseline. Effects were larger (p<.05) for churches meeting in person for PA policies, opportunities, and messages. Implementation of all HE practices increased (p<.01), with effect sizes ranging from d=0.13–0.45 for churches meeting online and d=0.56–1.03 for churches meeting in person (HE opportunities not evaluated for churches meeting online). Effects were larger (p<.05) for churches meeting in person for HE policies and messages (p=.08 for HE pastor support).

Implications for D&I Research: In a sample where the majority of churches were African American, we demonstrated that an online training was associated with significantly improved PA and HE church practices at 12 months. The magnitude of the effects for churches meeting in person at baseline were comparable to those seen in our three prior studies using in-person training (i.e., moderate to large). Training for this intervention is scalable and has the potential to advance racial health equity.

Primary Funding Source

Centers for Disease Control and Prevention

¹UW Health Promotion Research Center, Seattle, WA, USA; ²Health Promotion Research Center, Seattle, WA, USA; ³Neighborhood House, Seattle, WA, USA; ⁴Inland Caregiver Resource Center, Colton, CA, USA; ⁵Health Promotion Research Center, University of Washington, Seattle, WA, USA; ⁶Psychiatry & Behavioral Sciences, University of Washington, School of Medicine, Seattle, WA, USA

Correspondence: Lesley Steinman ([email protected])

Implementation Science 2025, 20(1):S140

Background

Adapting evidence-based programs (EBPs) is an essential implementation strategy for health equity to improve fit to under-resourced organizations and the systemically marginalized populations they reach. Actively partnering to build trust and share power through adapting dissemination and implementation (D&I) strategies in these contexts can help correct historical inequities and optimize conditions for EBP adoption and implementation. Our PRC program engaged community partners to co-adapt D&I strategies to improve equitable access to PEARLS (an EBP for late-life depression and social disconnectedness).

Methods

We conducted the PEARLS Equity Study in 2019-2024, partnering with community-based organizations (CBOs) from California and Washington that reach older adults experiencing poverty who are BIPOC, linguistically diverse, and/or rural-dwelling. Audience research with 39 organizations guided adapted dissemination strategies to improve PEARLS awareness among CBOs that reach priority populations, and implementation strategies to facilitate uptake and delivery among these organizations. During stepped-wedge RCT with 500 organizations to test whether these D&I strategies improved adoption and reach, process evaluation findings guided strategy modifications. We conducted a secondary data analysis of interviews, observations, and notes, using FRAME-IS and health equity and CBPR principles to describe adaptations process, what was adapted, by whom, when, and the nature, goal and level of adaptations.

Findings

Adapted dissemination strategies included shifting from reactive to proactive outreach to priority CBOs; a new peer-to-peer video with CBOs sharing why and how they adopted PEARLS; and modified messaging to align with the culture, strengths, and needs of CBO leadership, staff, and clients. Adapted implementation strategies included Zoom webinars and community conversations co-led by PEARLS CBOs sharing cultural and operational adaptations and stories of impact; 1:1 support calls with tailored guidance to integrate PEARLS into different contexts; on-demand distance training with trainers from priority CBOs and populations with lived experience and PEARLS expertise; and ongoing monthly community of practice calls with adopters to share adaptations successes and needs. Preliminary findings suggest adapted strategies facilitated PEARLS uptake among priority CBOs and populations.

Implications for D&I Research: Lessons learned from co-adapting D&I strategies to improve older adult mental health equity may be relevant for D&I researchers and practitioners working to reduce inequities through adaptations for underserved contexts.

Primary Funding Source

Centers for Disease Control and Prevention

¹University of Rochester School of Medicine and Dentistry, Rochester, NY, USA; ²University of North Carolina, Chapel Hill, NC, USA; ³YMCA of Greater Rochester, Rochester, NY, USA

Correspondence: Lori DeWindt ([email protected])

Implementation Science 2025, 20(1):S141

Background

The Deaf Weight Wise (DWW) research programs represent a long-standing collaboration of two CDC Prevention Research Centers (PRCs): the Rochester NY PRC, also known as the National Center for Deaf Health Research (NCDHR), and the University of North Carolina PRC, also known as the Center for Health Promotion and Disease Prevention (HPDP). NCDHR conducts public health research with Deaf communities to identify community strengths and address disparities. Rochester Deaf communities identified the attainment of healthy weight as a health research priority. Barriers to participation in mainstream health programs include language (American Sign Language [ASL] is not English), isolation from being the only Deaf ASL-user in the program, and low health literacy from inequities in access to information that hearing people often consider common knowledge. We need healthy lifestyle interventions developed to the unique strengths of Deaf populations.

Methods

The Rochester PRC uses community-based participatory research (CBPR). Our premise is that an evidence-based healthy lifestyle intervention adapted by Deaf people for use with Deaf people and delivered by Deaf people will improve diet, physical activity, overall health, and result in weight loss. NCDHR partnered with HPDP to adapt their Weight Wise Program (WWP) to create Deaf Weight Wise (DWW). The partnership of NCDHR and HPDP with DWW now spans more than 15 years, with two DWW randomized clinical trials (RCTs) in Rochester and one DWW implementation trial with Deaf communities in Western/Central NYS. All DWW participants and DWW Coaches are Deaf adult ASL-users.

Findings

Both RCTs demonstrate DWW’s success. Key components include peer delivery and support (Deaf-to-Deaf), a culturally appropriate approach, and language concordant communication. To prepare for DWW implementation, we credentialed 8 Deaf community members as new DWW Coaches. Since 2019, we implemented DWW with 7 sites via Zoom during the COVID-19 pandemic, with 14 DWW groups, led by 7 DWW Coaches, totaling 85 DWW participants from Western and Central NYS. Outcomes of fidelity assessments approached 100% for “delivered as intended.”

Implications for D&I Research: Deaf people are profoundly underrepresented in public health and research careers. DWW creates opportunities for Deaf ASL-users to become employed in public health and research fields, addressing social determinants of health.

Primary Funding Source

Centers for Disease Control and Prevention

Health Resources and Services Administration, Rockville, USA

Correspondence: Tracy McClair ([email protected])

Implementation Science 2025, 20(1):S142

Background

Social determinants of health (SDOH)—the conditions of the places people are born, live, learn, work, and play—can strongly influence health and quality of life of people with HIV. Priority populations who are disproportionately affected by HIV experience inequities and disparities largely owing to SDOH. The Health Resources and Services Administration (HRSA) HIV/AIDS Bureau’s (HAB) implementation science initiatives increasingly focus on addressing SDOH. These efforts can be strengthened with a centralized collection of validated SDOH measures used in HIV studies.

Methods

A scoping review was performed with support from a NIH Librarian by searching Web of Science, Scopus, and PubMed to identify validated SDOH measures used in HIV studies from January 2015 to July 2023. Search terms were derived from the Healthy People 2030 SDOH framework and SDOH-related studies conducted at HAB. Two staff examined a subset of articles’ titles and abstracts (70% of the total) using review criteria and discussed discrepancies; one reviewer then completed the title/abstract screen and completed a full-text review of articles included after the title/abstract screen. Both staff extracted SDOH measures from included articles. Extracted data included focus population, geographic location, SDOH category and subcategory, measure name, number of items in measure, and question type. Information on psychometric properties were extracted when available.

Findings

Our search yielded 3,088 articles, of which 2,015 were excluded at title/abstract screen and 712 met the full-text inclusion criteria. More than half of extracted measures focused on mental and behavioral health, while other prevalent SDOH categories were trauma and violence, stigma and discrimination, and social relationships/social cohesion. Measures also assessed cultural, neighborhood, and economic factors, housing status, transportation, education, experience with and access to services, quality of life, social policies/practices/norms, sexual behaviors, and access to basic needs.

Implications for D&I Research: To the best of our knowledge, this is the first effort to compile measures assessing all HIV-related SDOH domains. This review highlights the most common SDOH measures in HIV studies and identifies gaps in measures for priority populations. The resulting measures compendium can be used by researchers and practitioners alike to select appropriate, validated SDOH measures for use in HIV studies and programs.

Primary Funding Source

Health Resources and Services Administration

The Fenway Institute, Boston, MA, USA

Correspondence: Milo Dorfman ([email protected])

Implementation Science 2025, 20(1):S143

Background

The Health Resources and Services Administration HIV/AIDS Bureau (HRSA HAB)-funded initiative, Using Innovative Intervention Strategies to Improve Health Outcomes Among People with HIV (2iS), is a four-year project (2021-2025) to facilitate the rapid implementation, evaluation, and dissemination of seven emerging and evidence-informed interventions. The initiative’s goal is to understand whether these interventions can improve outcomes for clients in four focus areas (substance use disorders, LGBTQ+ youth, incarceration experience, telehealth) in Ryan White HIV/AIDS Program settings.

Methods

The 2iS Coordinating Center for Technical Assistance (2iS CCTA), led by The Fenway Institute in partnership with AIDS United, supports 2iS sites in customizing, implementing, and sustaining their interventions through requests for support. The approach to provision of support is to simulate a naturalistic context to ensure intervention sustainability. The 2iS CCTA has developed and applied a novel approach to track requests for support nationally across 20 Ryan White HIV/AIDS Program direct service organizations during their longitudinal implementation of 2iS interventions. The 2iS CCTA tracks support provision systematically to facilitate implementation at each organization, evaluate and learn from the types of support requested and the outcomes, and distill lessons learned from implementation into toolkit materials for national dissemination.

Findings

From 6/1/22 to 5/31/24, 210 requests for support were opened and 206 were closed. Levels of support provision included publicly available resources, peer-to-peer support, 2iS CCTA engagement, community experts, and academic/intervention experts. The 2iS CCTA responded to almost half of requests with peer-to-peer support and resolved approximately one third of requests by peer-to-peer support as the highest level of assistance provided. Tracking of outcomes focused on whether the request for support resulted in adaptation of the intervention, development of a new resource, policy changes, or identification of best practices for dissemination products.

Implications for D&I Research: This session will focus on results from and implications of this novel and rigorous tracking of support requests received from implementation sites, as a model for future large-scale rapid implementation science initiatives that seek to optimize responsiveness, tailoring, equity, and sustainability of emerging and evidence-informed interventions within community health settings.

Primary Funding Source

Health Resources and Services Administration

Boston University School of Social Work, Boston, MA, USA

Correspondence: Allyson Baughman ([email protected])

Implementation Science 2025, 20(1):S144

Background

People with HIV who experience unstable housing face significant disparities in HIV outcomes. Ten implementation sites in the U.S. are implementing and adapting Rapid Re-housing (RRH) as part of the Supporting Replication of Housing Interventions (SURE Housing Initiative) in the Ryan White HIV/AIDS Program (RWHAP). This implementation science initiative is a Health Resources and Services Administration HIV/AIDS Bureau RWHAP Part F Special Project of National Significance. SURE Housing focuses on people who identify as LGBTQ+, people involved in the legal system, and youth/young adults ages 18–24.

Methods

Guided by the HRSA HAB implementation science framework, we collected qualitative data on barriers and facilitators to starting up RRH within organizational and community settings. Data were gathered from sites via monthly coaching calls, site visits, and a cross-site peer learning session. Data were coded using FRAME/FRAME-IS to identify adaptations to address challenges and promote RRH implementation. Rapid qualitative analytic techniques were used to identify key themes across population groups and formulate recommendations to promote equitable access to housing for people with HIV.

Findings

Adaptations for successful RRH start-up include: 1) hiring staff that reflect the population served facilitates trust in the staff-client relationship; 2) identifying landlord champions with shared experiences as the population; and 3) having a dedicated staff at the organization to serve as a liaison between the client and landlord. Implementation strategies that support RRH uptake include:using community advisory boards and task forces to support client engagement and build housing, employment, and other resources; developing tools to engage client feedback in choice of neighborhood and housing type; and training staff new to housing and/or HIV care in cultural humility, trauma-informed care, and motivational interviewing are core elements for staff success. Start-up phase varied from 6–8 months depending on the population group.

Implications for D&I Research: Adaptations to a RRH intervention can be made to meet the needs of specific groups while keeping fidelity to the program core components. Strategies like integrating landlord and client feedback into housing plans, having dedicated trained staff to address client and landlord interests, and engaging consistently with community advisory boards could facilitate the start-up process for housing interventions.

Primary Funding Source

Health Resources and Services Administration

University of Massachusetts, Lowell, Lowell, MA, USA

Correspondence: Serena Rajabiun ([email protected])

Implementation Science 2025, 20(1):S145

Background

The 2025 National HIV/AIDS Strategy identifies Black women as a priority for HIV prevention and care and promotes implementation research to adapt evidence based/informed interventions (EBI/EII) to local settings. The Health Resources and Services Administration, HIV/AIDS Bureau, in partnership with the Minority HIV/AIDS Fund, launched in 2020 the Improving Care and Treatment Coordination for Black women with HIV initiative, funding 12 clinical and community-based organizations and one evaluation center to adapt, implement, and assess the uptake of culturally tailored services for Black women with HIV. This study examines the barriers and facilitators for sustainment of six EBI/EII intervention bundles to improve health outcomes and quality of life for Black women with HIV.

Methods

Guided by the Greenhalgh’s Model of Diffusion of Innovation within Health Service Organizations and Proctor’s implementation outcomes for sustainability, we surveyed 57 organizational leaders and staff on their ability and strategies to maintain a bundled EBI/EIIs and policies to promote services for Black women with HIV, focusing on the relationship between sustainability and equity. Our survey included: components maintained, leadership support, data utilization, partnerships, and contributions to organizational policy change on promoting racial and/or gender equity. Descriptive analysis by participant role and organizational type and rapid thematic qualitative data analysis were used to generate findings.

Findings

The components most likely to be maintained were peer/patient navigation and trauma informed care. Components were scaled out to new populations, including transgender women or women at risk for HIV. Leadership support included specific events for women or support groups. Two-thirds reported sustaining new partnerships for referrals to services for Black women. Challenges were lack of funding for organizations focused on Black women compared to other gender groups and leadership development and finding and retaining Black women staff.

Implications for D&I Research: Our findings highlight key strategies to sustain more equitable services for Black cisgender and transgender women through inclusive hiring and promotion policies, training staff on racial and gender equity and expanding partnerships for women-centered care. Capacity building for leadership opportunities for Black women and fundraising for Black led organizations are also necessary for sustaining equitable HIV care for Black women.

Primary Funding Source

Health Resources and Services Administration

The University of Texas at Austin, Austin, TX, USA

Correspondence: Leah Galuban ([email protected])

Implementation Science 2025, 20(1):S146

Background

Children with medical complexity (CMC) have life-long conditions leading to significant functional challenges that require exceptional but necessary levels of support to achieve the outcomes that matter most to them and their families. To ensure that all CMC have a fair and just opportunity to be as healthy as possible, health equity assessment (HEA) is a critical aspect to implementing system change. We chose a qualitative approach to begin our HEA. Our objective was to understand first the lived experience of English and Spanish-speaking caregivers of CMC, then explore through thematic analyses if and how health inequities appear.

Methods

We used two qualitative methods for our HEA: Experience Group™ (EG) sessions and Photovoice. EG sessions are 90-minute lightly facilitated discussions between 3–7 participants who share their experience living with a particular condition. Photovoice is a community-based participatory research method where participants share their story through photographs to increase awareness, promote dialogue, and create change. 30 Spanish-speaking caregivers of CMC were engaged in EG sessions. 16 Spanish-speaking and 13 English-speaking caregivers participated in Photovoice. Discussions from EG sessions and Photovoice were transcribed and analyzed to synthesize common themes that were mapped to 12 domains of health equity.

Findings

In the EG sessions and through Photovoice, feelings of joy, achievement, and pride were expressed alongside exhaustion, isolation, and struggle. Caregivers emphasized the blessing that their children are, and they also shared countless unseen costs to finances, relationships, time, and health. These families experience EXTRA-ordinary stressors and trauma leading to EXTRA-ordinary negative consequences. Caregivers must be chronically hypervigilant in caring for CMC. They also find themselves confronting ableist systems and attitudes. Spanish-speaking caregivers shared how they cannot access basic necessities due to inequities and discrimination because of their immigration status, how they look, and limited English proficiency.

Implications for D&I Research: Research must start with understanding the lived experience of individuals and families. By empowering caregivers through EG sessions and Photovoice we better understood the intimate and often unseen challenges that these caregivers face. Effectiveness, access, and value in health care can only be realized by centering patient and caregiver experience, paying particular attention to including underrepresented voices.

Primary Funding Source

Health Resources and Services Administration

Childkind, Tucker, GA, USA

Correspondence: Koslyn Lyles ([email protected])

Implementation Science 2025, 20(1):S147

Background

Childkind’s target population is families with children who are medically complex, ages 0 to 17, who live in low to extreme-low-income households in metro Atlanta. A correlation exists between the complexity of an individual child’s prescriptive care regimen and their family’s social circumstances (marital status, poverty, and unemployment). Social barriers surrounding a family can contribute as much to hospitalization frequency as the child’s diagnosis itself. In partnership with parents, Childkind addresses these social and environmental obstacles and guides families to success in the four domains of their Take Charge Model: Child Bonding, Parenting Sustainability, Child Well-being, and Family Sustainability.

Methods

The health equity assessment (HEA) is a collaborative process that involves two qualitative sessions and focuses on the Take Charge Model domains. Families are first contacted via phone to review the survey and gather information, then they complete an in-person assessment to allow for any changes to prior responses. Throughout this process, families are assured of their safety and comfort, and are encouraged to share as much information as is comfortable.

Findings

In completion of the HEA, we learned our families continue to struggle within the following four areas: Mental Health, Family and Community Support, Financial Strain, and Transportation. Out of the four areas, there were two major concerns: financial and transportation. Within the financial area, our families continue to struggle financially to obtain and maintain employees. If families make an unearned income of $2,398 per month or less or their earned income is $3,897 or less, they will not qualify for SSI. Within the transportation area, we learned that our families struggle with Medicaid transportation. They frequently rise early and still miss appointments due to transportation no-shows. These families also have multiple children who are not allowed to be transported.

Implications for D&I Research: D&I research holds significant promise for improving the lives of caregivers of CMC. The research can help identify and address barriers within healthcare systems that hinder the implementation of effective support programs for caregivers. This could involve finding ways to integrate support services into routine care or developing training programs for healthcare professionals on effectively communicating with caregivers.

Primary Funding Source

Health Resources and Services Administration

University of Florida, College of Medicine, Jacksonville, FL, USA

Correspondence: Jeffrey Goldhagen ([email protected])

Implementation Science 2025, 20(1):S148

Background

Health equity is grounded in the principles of human rights. Achieving child health equity is dependent on fulfilling children’s rights as articulated in the UN Convention on the Rights of the Child1 (CRC) Thus, Child Health Equity Assessments (CHEAs) must identify and assess the status of rights realization relevant to priority issues. All CHEAs should assess the four principle articles in the CRC: Article 2. Non-discrimination; Article 3. Consideration of the child’s best interests; Article 6. Right to optimal survival and development; and Article 12. Right to a voice and participation. Several guiding principles must also be considered in implementing CHEAs: Universality, Accountability, and Interdependence of rights. In addition, CHEAs should evaluate three domains necessary for the fulfilment of rights: Structures, Processes, and Outcomes (SPO).

Methods

GlobalChild (GC), a child rights assessment tool with structure, process and outcome indicators for all 40 substantive rights, was utilized to develop the CHEA. All SPO indicators for rights included in the GC Health Cluster were reviewed, and a core set of indicators were identified. These rights and indicators were then submitted for review by our Parent Advisory Board. They identified three domains of rights as priorities: Non-Discrimination (Article 2), Best Interest of the Child (Articles 3, 5, 6, 17), and Access to Health Services (Article 24). Qualitative questions were then generated related to the identified SPO indicators and were delivered by Project care coordinators.

Findings

Developing a child rights-based approach (CRBA) to CHEA takes time, trust and patience. Assumptions about CHEA priorities did not always align with families’—casting a wide net of input is critical. Families are open to sharing in ways they had not shared before, facilitated by trust in the person asking the questions. Families appreciate our interest in their experience and feel heard.

Implications for D&I Research: A CRBA provides a framework for developing CHEAs relevant to the issues being addressed. GlobalChild can provide a comprehensive inventory of indicators to be used for developing CHEAs. Parents play a critical role in developing CHEAs. CHEAs delivered by trusted individuals allow parents to provide honest and intimate responses to the health equity issues they are confronting.

Primary Funding Source

Health Resources and Services Administration

¹Temple University, Philadelphia, PA, USA; ²Washington University in St. Louis Implementation Science Center for Cancer Control (WU-ISC3), St. Louis, MO, USA; ³Drexel University, Philadelphia, USA; ⁴RAND, Santa Monica, CA, USA; ⁵University of Central Florida, Orlando, FL, USA; ⁶Washington University in St. Louis, Brown School, St. Louis, MO, USA

Correspondence: Gabriella McLoughlin ([email protected])

Implementation Science 2025, 20(1):S149

Background

Policies, such as Universal School Meals (USM), are essential for preventing inequities in chronic disease among economically marginalized populations. Implementing USM reduces food insecurity and obesity risk, among other academic/health outcomes; unfortunately, across the nation student participation (i.e., reach) is lower than expected, limiting its public health impact. The aims of this study were to 1) understand implementation determinants of USM and 2) Identify key elements to address in an implementation strategy.

Methods

As part of Implementation Mapping, a needs & assets assessment was undertaken in the 2023-2024 academic year with the School District of Philadelphia to address implementation-related challenges for USM. 8 schools (6 middle; 2 high) participated in a mixed methods study comprising qualitative interviews, quantitative surveys, and observations of mealtimes. Data collection was grounded in the Consolidated Framework for Implementation Research (CFIR) and Health Equity Measurement Framework (HEMF). Interviews were recorded and transcribed verbatim, following deductive analysis through the CFIR and quantitative scoring. Barriers were coded negatively (−1 or -2), supports coded positively (+1 or +2), and neutral determinants coded as 0.

Findings

193 participants participated in the study comprising teachers (29%), parents (26%), middle (14%) and high school students (10%), administrators (13.5%), and food service personnel (11%). Participants identified as Black/African American (43%), White (26%), Hispanic/Latino (20%), Asian (5%), Middle Eastern/North African (1.8%), and other (3.8%). The strongest facilitators were Individuals – Mid-level leaders (M=1.29±0.83), High-Level leaders (M=0.96±0.79), and Implementation Process – Adapting (M=0.97.47); negative determinants were Outer Setting – Market Pressure (M=−1.35±0.66), Inner Setting – Relative Priority (M=−1.17±0.39), and Available Resources (i.e., Time (M=−1.10±0.88). Overarching challenges comprise culture of school meals and stigma of participating, alignment of meals to the background of students/families, and ensuring students have enough time to eat.

Implications for D&I Research: Conducting in-depth needs assessments grounded in health equity research is essential to developing equity-focused implementation strategies, but data analysis workload and building a community advisory board to ensure equitable partnerships takes longer which may impede “rapid” change in implementation. Findings inform key implementation roles and barriers/facilitators to address through development of an implementation strategy to be tested in a clinical trial.

Primary Funding Source

National Institutes of Health

¹University of Michigan College of Pharmacy, Ann Arbor, MI, USA; ²University of Wisconsin-Madison School of Pharmacy, Madison, WI, USA; ³Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA

Correspondence: Olayinka Shiyanbola ([email protected])

Implementation Science 2025, 20(1):S150

Background

Black adults experience unique barriers that make them less likely to participate in evidence-based Diabetes Self-Management Education and Support Programs (DSMES). Our prior study identified a non-culturally relevant approach to program delivery as a barrier to participation. Our study (1) engaged a diverse stakeholder advisory board to co-design a training for Black facilitators on culturally tailoring the delivery of DSMES, (2) piloted the feasibility of implementing the program among Black adults, and (3) gathered preliminary data on effectiveness.

Methods

Twelve stakeholders participated in 5 co-design advisory board meetings. Subsequently, two 6-week culturally tailored DSMES were conducted by Black facilitators trained in the new training. Using an embedded mixed methods design, based on RE-AIM, and Proctor Outcomes, we evaluated reach, adoption, implementation including feasibility of delivering the program, and its signal of effectiveness. Outcomes were measured at baseline, 6-weeks, and 6-months. Within-group difference was analyzed using Wilcoxon Signed-Rank tests. Participant semi-structured interviews were analyzed using qualitative content analysis. To establish qualitative data rigor on credibility and confirmability; investigator triangulation, peer briefing, and audit trail was used.

Findings

A 34-page facilitator training manual was developed during co-design. Thirty-two Black adults completed the culturally tailored DSMES, primarily female (26, 87%) with an average age of 57.1 (SD = 12.1). We exceeded our recruitment goal (107%, 32/30). Facilitators reported applying the adapted content to be moderate to extremely feasible (mean = 4.7, SD = 0.6). We met our session attendance goal (86%) and achieved a 100% retention rate. There was a significant increase (p <.05) in participants’ self-care activities including diet (36%), glucose monitoring (38%) and foot care (29%), at 6 weeks compared to baseline. Qualitative results showed participants appreciated how facilitators established group norms, created safe environments, and provided culturally relevant dietary recommendations. Participants reported learning skills for preparing healthy, culturally appropriate meals, managing stress in a culturally appropriate manner, communicating with providers and self-advocacy.

Implications for D&I Research: Using design for dissemination and co-design principles, we developed culturally relevant approaches to address Black adults’ barriers to DSMES participation. Preliminary implementation and effectiveness data show the possibility of increasing the uptake of DSMES among Black adults.

Primary Funding Source

UW Institute of Clinical and Translational Research

¹Veterans Health Administration, Los Angeles, CA, USA; ²Veterans Health Administration, Menlo Park, CA, USA; ³Veterans Health Administration, Pittsburgh, PA, USA

Correspondence: Michelle Wong ([email protected])

Implementation Science 2025, 20(1):S151

Background

Implementation of evidence-based practices (EBP) can inadvertently exacerbate health disparities for underserved patient groups if implemented inequitably. However, implementation strategies do not explicitly consider health equity. We conducted a mixed-methods evaluation of a health equity adaptation to the evidence-based quality improvement (EBQI) implementation strategy within the High-RIsk VETeran (RIVET) initiative, which uses EBQI to implement EBPs for high-risk, complex patients in primary care – a heterogeneous group with risk factors related to health disparities.

Methods

The health equity EBQI adaptation consisted of two components: 1) a one-hour didactic session providing actionable guidance to incorporate health equity into the implementation process (e.g., develop equity-related implementation goals and outcomes, and address inequities within implementation plans and workflows); and 2) quality improvement (QI) coaching to guide these efforts throughout the RIVET initiative.

We are evaluating acceptability through surveys and interviews with frontline primary care team clinical champions implementing EBPs through November 2024. Interview topics included opinions about the health equity adaptation, and barriers and facilitators to health equity activities. We calculated survey response means and used rapid analysis to analyze interview transcripts.

Findings

Survey responses from five champions indicated neutral to high acceptability of the health equity didactic session. After the health equity didactics, 80% of respondents planned to incorporate health equity into RIVET implementation. Methods that champions used to incorporate health equity included developing an implementation goal to use EBP among women veterans and adapting EBP for older and rural patients.

During interviews, clinical champions noted increased recognition and awareness of health equity’s relevance to high-risk patients, and more broadly in general patient care; that facilitators to health equity implementation activities included the QI coach’s support, while barriers included a lack of infrastructure to address structural barriers experienced by vulnerable patient groups e.g., for rural patients, long travel times and limited broadband coverage.

Implications for D&I Research: Our health equity adaptation demonstrates a practical way to incorporate health equity considerations into projects that use EBQI or other implementation strategies. Additionally, incorporating health equity training within an EBQI approach can potentially build capacity for conducting health equity-focused QI and promote greater awareness of equity concerns in general patient care.

Primary Funding Source

Department of Veterans Affairs

¹The University of Texas Health Sciences Center at Houston School of Public Health, Houston, TX, USA; ²Icahn School of Medicine at Mount Sinai, New York, NY, USA; ³Radiant Digital, Vienna, VA, USA

Correspondence: William Perkison ([email protected])

Implementation Science 2025, 20(1):S152

Full paper published

Providence Health & Services, Renton, WA, USA

Correspondence: Kara Bensley ([email protected])

Implementation Science 2025, 20(1):S153

Background

Multicancer early detection (MCED) tests are a novel technology that may increase the ability to screen for cancers that currently have no recommended screenings, as well as offer an opportunity to supplement existing evidence-based screenings. A large community-based hospital in Southern California offered free MCED tests to patients to better understand what barriers to adoption of this new technology exist in addition to cost.

Methods

Between 2022-2023, 4480 patients at elevated risk for cancer were invited to a study offering a no-cost MCED test. Of these, 1322 enrolled and 1182 completed the test. Examining enrollment as a proxy for interest in or early adoption of MCED testing, multivariate logistic regression examined demographic factors associated with enrollment. Among enrolled, test completion was assessed using chi-square tests of independence.

Findings

Enrolled were less likely versus White to be Black (AOR 0.5, 95% CI: 0.31–0.82) or Asian (0.74, 0.56–0.97) participants; less likely Hispanic versus non-Hispanic participants (0.55, 0.45–0.68); and more likely a cancer survivor versus having familial/genetic risk (2.51, 1.83–3.45), all p<0.001. Age was also significant, but there were no significant differences by sex. Among those enrolled, those who completed the test were more likely to be 50+ years old versus under 50 (OR: 1.99, 95% CI: 1.39–2.85; p=0.001), to have Medicare versus commercial/private (2.38, 1.26–4.96, p=0.006), and to have a higher health status versus lower health status (2.35, 1.45–3.83, p=0.002). There were no significant differences in test completion by race, ethnicity, sex, prior cancer history, family history of cancer, smoking status, cancer worry, or recommended screening adherence intentions.

Implications for D&I Research: Demographic differences in study enrollment mirrored enrollment disparities in other cancer screening studies. Among those enrolled, there were no differences by race or ethnicity. In this interested group, those who were younger and less healthy were less likely to complete this test. These results may indicate barriers to MCED test utilization in addition to cost among those with elevated risk for cancer (such as perceived benefit of the test). Focusing on barriers to adoption earlier in the translational research continuum may provide guidance to decrease the research-to-practice gap for novel cancer screening tests.

Primary Funding Source

GRAIL

Providence, Renton, WA, USA

Correspondence: Kristi Roybal ([email protected])

Implementation Science 2025, 20(1):S154

Background

Limited access to recommended screenings contributes to significant inequities in cancer diagnosis and mortality for marginalized communities in the US. Blood-based multi-cancer early detection (MCED) tests, currently under study to screen for multiple cancers in a single test, could help reduce these inequities by improving screening accessibility. The purpose of this qualitative study was to investigate barriers and facilitators to MCED test adoption in communities with healthcare access challenges and translate findings into empathy maps and personas to inform equitable MCED test implementation design strategies in the future.

Methods

Participants were recruited from existing healthcare system patients and community members and were screened with an online questionnaire. The study included 15 virtual focus groups segmented by participant characteristics. Data were transcribed and analyzed using reflexive thematic analysis. We applied the social-ecological model to examine multilevel factors affecting cancer screening behaviors. Thematic insights led to the creation of research-informed empathy maps and personas, tools that can be leveraged to enhance MCED test access for communities experiencing healthcare challenges.

Findings

Through our qualitative research, we identified the following six patient and community member MCED test user segments: 1) Proactive Cancer Screener; 2) Skeptical Health Care Engager; 3) Structurally Excluded Neighbor; 4) Long Distance Traveler; 5) Reactive Health Care Seeker; and 6) Lost and Alone Patient.

We highlighted each segment’s most salient thoughts, feelings, behaviors, and needs using visual empathy maps and personas, though it is important to note that these segments are not mutually exclusive.

Implications for D&I Research: It is vital to understand and address barriers and facilitators to MCED test adoption prior to widespread implementation to develop and optimize equitable implementation strategies from the outset. Failure to do so runs the risk of exacerbating existing cancer inequities and missing the opportunity to leverage MCED tests as a population health strategy and tool to advance health equity. Our empathy maps and personas provide a whole-person perspective, centering user experience and voice and differentiating the unique needs of diverse MCED test user segments to drive strategies for the equitable implementation of MCED tests.

Primary Funding Source

GRAIL

¹Providence Health & Services, Orange, CA, USA; ²Providence Health & Services, Renton, WA, USA

Correspondence: Sandra Brown ([email protected])

Implementation Science 2025, 20(1):S155

Background

In 2020, a Providence working group of researchers, medical oncologists, and executive leadership began engaging in studies involving multi-cancer early detection (MCED) technology in the real world to assess health outcomes, behavior, and the implementation science of delivering a novel screening technology. As part of this effort, Providence developed the Early Detection Case Conference (EDCC), a system-wide supportive case conference for MCED results discussion. The EDCC’s goal is to combine shared medical expertise and provide opinion on the best possible care plan for a patient as this new screening technology is more widely implemented.

Methods

The EDCC is held monthly via virtual video call and facilitated by a centralized research and genomics team. Attendees comprise the EDCC team, medical oncologists, primary care clinicians, clinical genetics, and radiologists and pathologists as needed for case discussion. Cases are identified by the central research and genomics team or submitted by treating provider. Case presentations follow a tumor board format, with review of the patient’s clinical history, MCED result, diagnostic workup to date, and open discussion and recommendations. The opinion of the EDCC is summarized back to the treating provider for subsequent clinical follow up as needed.

Findings

Providers brought 39 research cases to the EDCC between 2022-2024. Most of these were positive cancer signals, but the EDCC also reviewed cases of patients who screened negative on an MCED test but received a cancer diagnosis in the subsequent months or cases where a provider was deciding between pursuing traditional cancer screening methods vs. MCED.

Implications for D&I Research: MCED tests are different from other existing cancer screening tests because they test for multiple cancers at one time. The development of the EDCC has led to important additional considerations for health systems interested in implementing MCED tests. The EDCC provides an ongoing learning opportunity about how to best use this novel technology and support patients.

¹Emory University Rollins School of Public Health, Atlanta, GA, USA; ²Emory Global Diabetes Research Center, Atlanta, GA, USA; ³Yale-Griffin Prevention Research Center, Derby, CT, USA; ⁴Hispanic Health Council, Hartford, CT, USA; ⁵Yale School of Public Health, New Haven, CT, USA

Correspondence: Elizabeth Rhodes ([email protected])

Implementation Science 2025, 20(1):S156

Background

Produce prescription programs (PRx) improve food security and health outcomes for patients with type 2 diabetes, but uptake is suboptimal. Community health workers (CHWs) are effective in enhancing patient uptake of a diversity of evidence-based interventions among marginalized groups, but this implementation strategy is novel for PRx. In preparation for testing in a randomized controlled trial a CHW implementation strategy for increasing PRx uptake among Medicaid-eligible, Hispanic patients with diabetes, we co-designed the strategy with primary service users, including patients and CHWs.

Methods

We used human-centered design, guided by the Discover, Design/Build, and Test framework. In the Discover Phase, we conducted 3 group listening sessions with patients and 4 interviews with CHWs in English and Spanish. Using semi-structured guides with questions derived from the Capability, Opportunity, and Motivation Behavior model (COM-B), we elicited perceived barriers and facilitators to PRx uptake behaviors (i.e., receiving, activating, and using produce debit cards to purchase fruits and vegetables at stores; attending nutrition education classes; and preparing and eating produce) and implementation strategy functions to address them. Data were analyzed using a team-based rapid qualitative analysis approach, and barriers and facilitators and implementation strategy functions were mapped to COM-B. In the Design/Build Phase, we conducted 4 group listening sessions (n=2 with patients, n=2 with CHWs) to iteratively refine the strategy and generate potential activities or forms to perform each function.

Findings

We identified nine CHW implementation strategy functions to increase capability (e.g., provide education on the card to minimize logistical and technological challenges with receiving, activating, and using the card), opportunity (e.g., identify and engage family members who can prepare and eat produce with patients to enhance social support), and motivation (e.g., encourage patients to prioritize diabetes self-management to promote interest in attending classes). We identified forms for each function, ranging from preferred modes of communication with CHWs to acceptable and effective ways for CHWs to involve family members.

Implications for D&I Research: Our rigorous, theory-guided rapid approach to co-designing the CHW implementation strategy provides a pragmatic approach for engaging people with lived experiences in the development and tailoring of implementation strategies with a quick turnaround.

Primary Funding Source

American Heart Association

¹National Institutes of Health, Bethesda, MD, USA; ²Center for Translation Research and Implementation Science; National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA

Correspondence: Karen Plevock Haase ([email protected])

Implementation Science 2025, 20(1):S157

Background

Alongside the high rate of maternal morbidity and mortality (MMM) in the US, there are striking disparities in health outcomes related to age, race, ethnicity, geographic location, and socioeconomic status. To combat this crisis the NIH established the Community Implementation Platform. This community-focused framework was used to launch the Maternal-Health Community Implementation Program (CIP) and the Implementing a Maternal health and PRegnancy Outcomes Vision for Everyone CIP (IMPROVE CIP). Current programs support implementation science projects to test multifaceted community-driven strategies to implement evidence-based interventions (EBIs) targeting preventable contributors to MMM in populations that experience health disparities.

Methods

The CIPs use a phased-award structure to support two critical components of research; (Phase-1) the planning phase which includes community-based needs assessments, the selection and tailoring of EBIs, and the design of community-informed implementation science strategies and (Phase-2) research execution phase to rigorously test community-informed implementation science strategies.

Findings

The CIPs center a tension in the pace of research: between the urgency to address MMM while moving at the speed of trust in community-partnered research. Using implementation science, CIP community and academic partnerships, referred to as research coalitions, address system-level impacts on MMM such as racism, women’s preventive health services (e.g. preconception care and doulas), health care access and quality in maternity care deserts and urban areas including through maternal safety bundles and health literacy.

While the overall goal of CIPs is to use implementation science strategies and methods to bring effective EBIs into communities of high need, each research coalition has a specific maternal health focus such as mental health or hypertension. Research coalitions combat barriers to receiving equitable preconception, perinatal and postpartum care, and ultimately equitably improve maternal health outcomes. CIPs are structured with a coordinating center to collect community and research insights across programs.

Implications for D&I Research: As CIPs empower communities across the US to be full partners in research, they navigate a pacing tension (urgency vs. trust) and showcase how community-engaged research can yield more sustainable implementation strategies. Overall, this powerful use-case could serve as a model to implement effective strategies to improve health and build capacity, trust, and strong partnerships within communities.

Primary Funding Source

National Institutes of Health

University of Wisconsin-Madison, Madison, WI, USA

Correspondence: Diana Martinez Garcia ([email protected])

Implementation Science 2025, 20(1):S158

Background

Diabetic eye screening and treatment can prevent 90% of all blindness from diabetes. However, nearly all diabetic eye disease among Latinos remains undetected, resulting in a disproportionate burden of blindness. Teleophthalmology is an evidence-based method for diabetic eye screening that is greatly underutilized. We aimed to culturally adapt our existing teleophthalmology implementation program by tailoring strategies to increase diabetic eye screening in Latinx communities.

Methods

We performed Implementation Mapping with a Latinx community-based, stakeholder group in Madison, WI using a series of three 90-minute meetings conducted in Spanish by bilingual research team members from November 2023 - March 2024. We first reviewed and discussed themes identified from individual interviews with Latinx patients with diabetes completed in an earlier stage of the project. Using the Nominal Group Technique, the stakeholder group then tailored strategies and prioritized key messages to directly address what they believed to be the most important barriers and facilitators to diabetic eye screening in Latinx communities.

Findings

The community stakeholder group (n=9) was composed of 6 women and 3 men (mean age: 75.9 years (range: 66–85) who self-identified as Latinx. Tailored strategies included reducing or eliminating out-of-pocket costs for eye screening, as well as providing culturally appropriate video-based, patient educational materials with testimonials from Latinx patients and clinicians (i.e., trusted messengers). Key messages addressed social isolation, community support, self-advocacy, and religious faith, such as: “You are not alone. There are many resources in the community to help you manage your diabetes and protect your vision,” and “It is very important to take charge of one’s health because it is said that ‘God helps he who helps himself.’” We will further test and refine the culturally adapted implementation program at an urban, federally qualified health center with a large Latinx population in the next phase of our project.

Implications for D&I Research: Our work demonstrates the use of Implementation Mapping as a systematic method for culturally adapting implementation programs in partnership with a community advisory board to advance health equity.

Primary Funding Source

National Institutes of Health

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