Publications

Abstract

Background: The past decade of research has seen theoretical and methodological advances in both implementation science and health equity research, opening a window of opportunity for facilitating and accelerating cross-disciplinary exchanges across these fields that have largely operated in siloes. In 2019 and 2020, the National Cancer Institute’s Consortium for Cancer Implementation Science convened an action group focused on ‘health equity and context’ to identify opportunities to advance implementation science. In this paper, we present a narrative review and synthesis of the relevant literature at the intersection of health equity and implementation science, highlight identified opportunities (i.e., public goods) by the action group for advancing implementation science in cancer prevention and control, and integrate the two by providing key recommendations for future directions.

Discussion: In the review and synthesis of the literature, we highlight recent advances in implementation science, relevant to promoting health equity (e.g., theories/models/frameworks, adaptations, implementation strategies, study designs, implementation determinants, and outcomes). We acknowledge the contributions from the broader field of health equity research and discuss opportunities for integration and synergy with implementation science, which include (1) articulating an explicit focus on health equity for conducting and reviewing implementation science; (2) promoting an explicit focus on health equity in the theories, models, and frameworks guiding implementation science; and (3) identifying methods for understanding and documenting influences on the context of implementation that incorporate a focus on equity.

Summary: To advance the science of implementation with a focus on health equity, we reflect on the essential groundwork needed to promote bi-directional learning between the fields of implementation science and health equity research and recommend (1) building capacity among researchers and research institutions for health equity-focused and community-engaged implementation science; (2) incorporating health equity considerations across all key implementation focus areas (e.g., adaptations, implementation strategies, study design, determinants, and outcomes); and (3) continuing a focus on transdisciplinary opportunities in health equity research and implementation science. We believe that these recommendations can help advance implementation science by incorporating an explicit focus on health equity in the context of cancer prevention and control and beyond.

Citation: Adsul P, Chambers D, Brandt HM, Fernandez ME, Ramanadhan S, Torres E, Leeman J, Baquero B, Fleischer L, Escoffery C, Emmons KM, Soler M, Oh A, Korn AR, Wheeler S, Shelton RC. Grounding implementation science in health equity for cancer prevention and control. Implementation Science Communications. 2022: 3;56. Published 2022 Jun 3. https://doi.org/10.1186/s43058-022-00311-4

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Abstract

Background and Aims: Inflammatory bowel disease (IBD), including ulcerative colitis and Crohn’s disease are inflammatory diseases of the gastrointestinal tract. The incidence of IBD is increasing in minority populations; however, little is known about the epidemiology and disease characteristics of IBD in Black women.

Methods: Our study population included participants in the Black Women’s Health Study. Diagnosis of IBD was self-reported through the biennial questionnaires starting at baseline in 1995. We estimated the incidence of IBD according to age and geographic region. A follow up supplementary questionnaire was also sent to a subset of participants who reported diagnosis of IBD to evaluate the accuracy of self-reported diagnosis and to assess disease characteristics.

Results: Through December 31st 2021, a total of 609 cases of IBD were reported, of which 142 were prevalent at baseline (prevalence = 0.24%) and 467 were incident (crude incidence rate = 33.2/100, 000 person-years). The incidence of IBD was highest in the <30 years age group and similar across geographic region. Among the participants who responded to the supplementary questionnaire, 62.1% had confirmed diagnosis of IBD.

Conclusions: In a large prospective cohort of US Black women, we found that the incidence of IBD was similar to previously published estimates in US White women. Future studies should focus on identifying risk factors for IBD in Black individuals in the US.

Citation: Anyane-Yeboa A, Buadu MAE, Khalili H, Cozier Y. Epidemiology of inflammatory bowel disease in a cohort of US Black women. medRxiv. 2022; 14.22277547. Published 2022 Jul 17. https://doi.org/10.1101/2022.07.14.22277547

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Abstract

Summary: The incidence of inflammatory bowel disease (IBD) is rising in racial and ethnic minority groups in the United States, and socioeconomic, racial, and ethnic disparities in IBD are increasingly being identified. In addition, there has been great appreciation for the social determinants of health as contributors to these disparities, and that upstream social determinants of health propagate downstream poor health outcomes in IBD. We propose strategies to achieve health equity in IBD that target the medical trainee, provider, practice, community, industry, and policy levels.

Citation: Anyane-Yeboa A, Quezada S, Rubin DT, Balzora S. The Impact of the Social Determinants of Health on Disparities in Inflammatory Bowel Disease. Clin Gastroenterol Hepatol. 2022; 20:11. Published 2022 Mar 17. doi:10.1016/j.cgh.2022.03.011

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Abstract

Background: Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States and disproportionately impacts Black individuals. Here, we describe the mixed-methods approach used to develop a tailored message guidebook to promote CRC screening among Black individuals in the setting of recently updated screening guidelines.

Methods: This mixed-methods study included 10 in-depth qualitative interviews and 490 surveys in a nationally representative sample of unscreened Black individuals age ≥ 45. Messages were developed based on American Cancer Society (ACS) and National Colorectal Cancer Roundtable (NCCRT) research findings, tested among Black individuals using MaxDiff analytic methods, and reviewed by a multi-sector expert advisory committee of NCCRT members.

Conclusions: We identified age-specific barriers to CRC screening and tailored messaging to motivate participation among unscreened Black people age ≥ 45. Findings informed the development of the NCCRT and ACS guidebook for organizations and institutions aiming to increase CRC screening participation in Black individuals.

Citation: Anyane-Yeboa A, Aubertine M, Parker A, Sylvester K, Levell C, Bell E, Emmons KM, May FP. Use of a mixed‐methods approach to develop a guidebook with messaging to encourage colorectal cancer screening among Black individuals 45 and older. Cancer Medicine. 2023;12(18):19047-19056. doi:10.1002/cam4.6461

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Abstract

Background: Policy implementation science (IS) is complex, dynamic, and fraught with unique study challenges that set it apart from biomedical or clinical research. One important consideration is the ways in which policy interacts with local contexts, such as power and social disadvantage (e.g., based on ability, race, class, sexual identity, geography). The complex nature of policy IS and the need for more intentional integration of equity principles into study approaches calls for creative adaptations to existing implementation science knowledge and guidance. Effectiveness-implementation hybrid studies were developed to enhance translation of clinical research by addressing research questions around the effectiveness of an intervention and its implementation in the same study. The original work on hybrid designs mainly focused on clinical experimental trials; however, over the last decade, researchers have applied it to a wide range of initiatives and contexts, including more widespread application in community-based studies. This perspectives article demonstrates how effectiveness-implementation hybrid studies can be adapted for and applied to equity-centered policy IS research. We draw upon principles of targeted universalism and Equity in Implementation Research frameworks to guide adaptations to hybrid study typologies, and suggest research and engagement activities to enhance equity considerations; for example, in the design and testing of implementing strategies. We also provide examples of equity-centered policy IS studies. As the field of policy IS rapidly evolves, these adapted hybrid type studies are offered to researchers as a starting guide.

Citation: Asada Y, Kroll-Desrosiers A, Chriqui JF, Curran GM, Emmons KM, Haire-Joshu D, Brownson RC. Applying hybrid effectiveness-implementation studies in equity-centered policy implementation science. Frontiers in Health Services. 2023;3. doi:10.3389/frhs.2023.1220629

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Abstract

Background: Adaptations to evidence-based practices (EBPs) are common but can impact implementation and patient outcomes. In our prior research, providers in routine care made a fidelity-inconsistent adaptation to an EBP that improved health outcomes in people with serious mental illness (SMI). The purpose of this study was to characterize the process and reasons for the adaptation using a framework for reporting adaptations and modifications to EBPs, with a focus on equity.

Methods: This study used qualitative data collected during a national implementation of the InSHAPE EBP addressing obesity in persons with SMI. We reviewed transcripts from five behavioral health organizations that made a successful fidelity-inconsistent adaptation to a core component of InSHAPE that was associated with cardiovascular risk reduction. We coded the data using the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) with an emphasis on exploring whether the adaptation addressed inequities in using the EBP related to social determinants of health.

Results: Across the five agencies, the fidelity-inconsistent adaptation was characterized as unplanned and reactive in response to challenges InSHAPE teams experienced delivering the intervention in community fitness facilities as intended. In all cases, the goal of the adaptation was to improve intervention access, feasibility, and fit. Social and economic disadvantage were noted obstacles to accessing fitness facilities or gyms among participants with SMI, which led agencies to adapt the program by offering sessions at the mental health center.

Conclusion: Findings from this study show the advantages of applying a health equity lens to evaluate how obstacles such as poverty and discrimination influence EBP adaptations. Recommendations can also assist researchers and community partners in making proactive decisions about allowable adaptations to EBPs.

Citation: Aschbrenner KA, Mueller NM, Banerjee S, Bartels SJ. Applying an equity lens to characterizing the process and reasons for an adaptation to an evidenced-based practice. Implementation Research and Practice. 2021; 2. Published 2021 May 6. https://doi.org/10.1177/26334895211017252

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Abstract

Background: Pilot feasibility studies serve a uniquely important role in preparing for larger scale intervention trials by examining the feasibility and acceptability of interventions and the methods used to test them. Mixed methods (collecting, analyzing, and integrating quantitative and qualitative data and results) can optimize what can be learned from pilot feasibility studies to prepare rigorous intervention trials. Despite increasing use of mixed method designs in intervention trials, there is limited guidance on how to apply these approaches to address pilot feasibility study goals. The purpose of this article is to offer methodological guidance for how investigators can plan to integrate quantitative and qualitative methods within pilot feasibility studies to comprehensively address key research questions.

Methods: We used an informal consensus-based process informed by key methodological resources and our team’s complementary expertise as intervention researchers and mixed methodologists to develop guidance for applying mixed methods to optimize what can be learned from pilot feasibility studies. We developed this methodological guidance as faculty in the Mixed Methods Research Training Program (MMRTP) for the Health Sciences (R25MH104660) funded by the National Institutes of Health through the Office of Behavioral and Social Science Research.

Results: We provide the following guidance for applying mixed methods to optimize pilot feasibility studies: (1) identify feasibility domain(s) that will be examined using mixed methods, (2) align quantitative and qualitative data sources for the domain(s) selected for mixing methods, (3) determine the timing of the quantitative and qualitative data collection within the flow of the pilot study, (4) plan integrative analyses using joint displays to understand feasibility, and (5) prepare to draw meta-inferences about feasibility and implications for the future trial from the integrated data.

Conclusions: By effectively integrating quantitative and qualitative data within pilot feasibility studies, investigators can harness the potential of mixed methods for developing comprehensive and nuanced understandings about feasibility. Our guidance can help researchers to consider the range of key decisions needed during intervention pilot feasibility testing to achieve a rigorous mixed methods approach generating enhanced insights to inform future intervention trials.

Citation: Aschbrenner KA, Kruse G, Gallo J, Plano-Clark V. Applying mixed methods to pilot feasibility studies to inform intervention trials. Pilot and Feasibility Studies. 2022; 8:217. Published 2022 Sep 26. https://doi.org/10.1186/s40814-022-01178-x

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Abstract

Background: A Health Equity Task Force (HETF) of members from seven Centers funded by the National Cancer Institute’s (NCI) Implementation Science in Cancer Control Centers (ISC3) network sought to identify case examples of how Centers were applying a focus on health equity in implementation science to inform future research and capacity-building efforts.

Methods: HETF members at each ISC3 collected information on how health equity was conceptualized, operationalized, and addressed in initial research and capacity-building efforts across the seven ISC3 Centers funded in 2019–2020. Each Center completed a questionnaire assessing five health equity domains central to implementation science (e.g., community engagement; implementation science theories, models, and frameworks (TMFs); and engaging underrepresented scholars). Data generated illustrative examples from these five domains.

Conclusions: Examples of approaches to integrating health equity across the ISC3 network can inform other investigators and centers’ efforts to build capacity and infrastructure to support growth and expansion of health equity-focused implementation science.

Citation: Aschbrenner KA, Oh AY, Tabak RG, Hannon PA, Angier HE, Likumahuwa-Ackman S, Caroll JK, Baumann AA, Beidas RS, Mazzucca-Ragan S, Waters EA, Sadasivam RS, Shelton RC. Integrating a Focus on Health Equity in Implementation Science: Case Examples from the National Cancer Institute’s Implementation Science in Cancer Control Centers (ISC3) Network. Journal of Clinical and Translational Science. 2023;7(1). doi:10.1017/cts.2023.638

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Abstract

Health equity-focused implementation research requires using definitions and approaches that are relevant and meaningful to implementation partners. Toward this goal, our research team asked leadership and staff at Federally Qualified Health Centers (FQHCs) to share how they defined and addressed health equity at their practice settings. FQHC participants defined health equity as the essential mission of FQHCs as safety net organizations delivering care to medically underserved populations. In addition, key informants identified barriers (e.g. financing models) and facilitators (e.g. interpreter services) to advancing health equity at FQHCs. We presented these findings to a larger group of FQHC stakeholders who recommended that future implementation research and practice consider how FQHCs are challenged to address the root causes of healthcare inequities with limited resources. They also highlighted the importance of meaningful collaboration among researchers, FQHCs, and communities for data collection, data interpretation, data use, and data ownership to advance health equity. Conducting research to understand the perspectives and experiences of FQHC partners can provide clear, context-specific direction for actions to improve health equity and can inform future approaches to health equity-focused implementation research that is meaningful to FQHC partners and the communities they serve.

Citation: Aschbrenner KA, Cruz J., Kruse G, Nguyen H, Huebner Torres C, Celli M, Sarcione C, Singh D, Emmons KM. Leveraging an implementation science partnership network to understand how Federally Qualified Health Centers operationalize and address health equity. Translational Behavioral Medicine. Published August 5, 2023. doi:10.1093/tbm/ibad046

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Abstract

We conducted a mixed methods pilot feasibility study of a Stakeholder and Equity Data-Driven Implementation (SEDDI) process to facilitate using healthcare data to identify patient groups experiencing gaps in the use of evidence-based interventions (EBIs) and rapidly adapt EBIs to achieve greater access and equitable outcomes. We evaluated the feasibility and acceptability of SEDDI in a pilot hybrid type 2 effectiveness-implementation trial of a paired colorectal cancer (CRC) and social needs screening intervention at four federally qualified community health centers (CHCs). An external facilitator partnered with CHC teams to support initial implementation, followed by the SEDDI phase focused on advancing health equity. Facilitation sessions were delivered over 8 months. Preliminary evaluation of SEDDI involved convergent mixed methods with quantitative survey and focus group data. CHCs used data to identify gaps in outreach and completion of CRC screening with respect to race/ethnicity, gender, age, and language. Adaptations to improve access and use of the intervention included cultural, linguistic, and health literacy tailoring. CHC teams reported that facilitation and systematic review of data were helpful in identifying and prioritizing gaps. None of the four CHCs completed rapid cycle testing of adaptations largely due to competing priorities during the COVID-19 response. SEDDI has the potential for advancing chronic disease prevention and management by providing a stakeholder and data-driven approach to identify and prioritize health equity targets and guide adaptations to improve health equity.

Citation: Aschbrenner KA, Kruse G, Emmons K, Singh D, Barber-Dubois ME, Miller A, Thomas A, Bartels S. Stakeholder and Equity Data-Driven Implementation: a Mixed Methods Pilot Feasibility Study. Prevention Science. 2022. Published 2022 Oct 4. https://doi.org/10.1007/s11121-022-01442-9

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Abstract

Implementation science offers a rigorous set of tools to help mitigate long-standing and worsening gender disparities in academia.

We are women scientists who have worked in university settings for most of our careers. National data suggesting persistent gender inequities are corroborated by our daily lived experiences. Women are overrepresented in nontenure track roles, are underrepresented among full professors and senior leadership, and receive lower pay across all ranks compared to men counterparts (1). These data tell an even more dire story for women from racial and/or ethnic minority groups. The coronavirus disease 2019 (COVID-19) has made everything worse, and many women are leaving the academy. Universities and funders must take action now.

What is the best path forward? We recommend using implementation science to deploy and evaluate interventions that work. This approach focuses on the scientific study of methods and strategies to implement interventions that work in real-world settings (2). Practically speaking, this means that universities must prioritize scientifically backed approaches to support women faculty, including individual-level approaches such as leadership training. They should also develop and evaluate new structural approaches, such as hiring strategies and policies, to make universities more inclusive, diverse, and equitable places for all faculty.

Citation: Beidas RS, Hannon PA, Emmons KM. Advancing gender equity in the academy. Science Advances. 2022; 8:13. Published 2022 Mar 30. doi:10.1126/sciadv.abq0430

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Abstract

Background: Logic models map the short-term and long-term outcomes that are expected to occur with a program, and thus are an essential tool for evaluation. Funding agencies, especially in the United States (US), have encouraged the use of logic models among their grantees. They also use logic models to clarify expectations for their own funding initiatives. It is increasingly recognized that logic models should be developed through a participatory approach which allows input from those who carry out the program being evaluated. While there are many positive examples of participatory logic modeling, funders have generally not engaged grantees in developing the logic model associated with their own initiatives. This article describes an instance where a US funder of a multi-site initiative fully engaged the funded organizations in developing the initiative logic model. The focus of the case study is Implementation Science Centers in Cancer Control (ISC3), a multi-year initiative funded by the National Cancer Institute.

Methods: The reflective case study was collectively constructed by representatives of the seven centers funded under ISC3. Members of the Cross-Center Evaluation (CCE) Work Group jointly articulated the process through which the logic model was developed and refined. Individual Work Group members contributed descriptions of how their respective centers reviewed and used the logic model. Cross-cutting themes and lessons emerged through CCE Work Group meetings and the writing process.

Conclusions: The ISC3 case study demonstrates how participatory logic modeling can be mutually beneficial to funders, grantees and evaluators of multi-site initiatives. Funded groups have important insights about what is feasible and what will be required to achieve the initiative’s stated objectives. They can also help identify the contextual factors that either inhibit or facilitate success, which can then be incorporated into both the logic model and the evaluation design. In addition, when grantees co-develop the logic model, they have a better understanding and appreciation of the funder’s expectations and thus are better positioned to meet those expectations.

Citation: Easterling D, Jacob RR, Brownson RC, Haire-Joshu D, Gundersen DA, Angier H, DeVoe JE, Likumahuwa-Ackman S, Vu T, Glasgow RE, Schnoll R. Participatory logic modeling in a multi-site initiative to advance implementation science. Implementation Science Communications. 2023;4(1). doi:10.1186/s43058-023-00468-6

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Abstract

Over the past 20 years, the National Institutes for Health (NIH) has implemented several policies designed to improve sharing of research data, such as the NIH public access policy for publications, NIH genomic data sharing policy, and National Cancer Institute (NCI) Cancer Moonshot public access and data sharing policy. In January 2023, a new NIH data sharing policy has gone into effect, requiring researchers to submit a Data Management and Sharing Plan in proposals for NIH funding (NIH. Supplemental information to the, 2020b; NIH. Final policy for data, 2020a). These policies are based on the idea that sharing data is a key component of the scientific method, as it enables the creation of larger data repositories that can lead to research questions that may not be possible in individual studies (Alter and Gonzalez, 2018; Jwa and Poldrack, 2022), allows enhanced collaboration, and maximizes the federal investment in research. Important questions that we must consider as data sharing is expanded are to whom do benefits of data sharing accrue and to whom do benefits not accrue? In an era of growing efforts to engage diverse communities in research, we must consider the impact of data sharing for all research participants and the communities that they represent.

We examine the issue of data sharing through a community-engaged research lens, informed by a long-standing partnership between community-engaged researchers and a key community health organization (Kruse et al., 2022). We contend that without effective community engagement and rich contextual knowledge, biases resulting from data sharing can remain unchecked. We provide several recommendations that would allow better community engagement related to data sharing to ensure both community and researcher understanding of the issues involved and move toward shared benefits. By identifying good models for evaluating the impact of data sharing on communities that contribute data, and then using those models systematically, we will advance the consideration of the community perspective and increase the likelihood of benefits for all.

Citation: Emmons KM, Mendez S, Lee RM, Erani D, Mascioli L, Abreu M, Adams S, Daly J, Bierer BE. Data sharing in the context of community-engaged research partnerships. Social Science & Medicine. 2023;325. https://doi.org/10.1016/j.socscimed.2023.115895

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Abstract

COVID-19 has disproportionately impacted underserved populations, including racial/ethnic minorities. Prior studies have demonstrated that mobile health units are effective at expanding preventive services for hard-to-reach populations, but this has not been studied in the context of COVID-19 vaccination. Our objective was to determine if voluntary participants who access mobile COVID-19 vaccination units are more likely to be racial/ethnic minorities and adolescents compared with the general vaccinated population. We conducted a cross-sectional study of individuals who presented to three different mobile COVID-19 vaccination units in the Greater Boston area from May 20, 2021, to August 18, 2021. We acquired data regarding the general vaccinated population in the state and of target communities from the Massachusetts Department of Public Health. We used chi-square testing to compare the demographic characteristics of mobile vaccination unit participants and the general state and community populations that received COVID-19 vaccines during the same time period. We found that during this three-month period, mobile vaccination units held 130 sessions and administered 2622 COVID-19 vaccine doses to 1982 unique participants. The median (IQR) age of participants was 31 (16-46) years, 1016 (51%) were female, 1575 (80%) were non-White, and 1126 (57%) were Hispanic. Participants in the mobile vaccination units were more likely to be younger (p < 0.001), non-White race (p < 0.001), and Hispanic ethnicity (p < 0.001) compared with the general vaccinated population of the state and target communities. This study suggests that mobile vaccination units have the potential to improve access to COVID-19 vaccination for diverse populations.

Citation: Gupta PS, Mohareb AM, Valdes C, et al. Expanding COVID-19 vaccine access to underserved populations through implementation of mobile vaccination units. Prev Med. 2022;163:107226. doi:10.1016/j.ypmed.2022.107226

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Abstract

Mobile health units can improve access to preventive health services, especially for medically underserved populations. However, there is little published experience of mobile health units being used to expand access to COVID-19 vaccination. In concert with local public health departments and community members, we implemented a mobile COVID-19 health unit and deployed it to 12 predominantly low-income and racial/ethnic minority communities in Massachusetts. We describe the success and challenges of this innovative program in expanding access to COVID-19 vaccination.

As with prior infectious disease outbreaks and public health crises, socially marginalized communities have borne a disproportionate burden of COVID-19. In the state of Massachusetts, Black and Hispanic people have 1.5 to 3 times the risk of COVID-19 infection and higher age-adjusted incidence rates of mortality.1 Communities with higher social vulnerability indices, predominantly composed of Black and Hispanic people, have had access to less COVID-19 testing and fewer vaccination resources than would be expected for their level of COVID-19 risk.2 Novel, community-based efforts are needed in these communities to address the continued high burden of COVID-19 in addition to long-standing disparities in chronic diseases and health care access.

Citation: Gupta PS, Mohareb AM, Valdes C, et al. Mobile health services for COVID-19: counseling, testing, and vaccination for medically underserved populations. American Journal of Public Health. 2022; 112. Published 2022 Oct 12. https://doi.org/10.2105/AJPH.2022.307021

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Abstract

Background: Multi-center research initiatives offer opportunities to develop and strengthen connections among researchers. These initiatives often have goals of increased scientific collaboration which can be examined using social network analysis.

Methods: The National Cancer Institute (NCI)-funded Implementation Science Centers in Cancer Control (ISC3) initiative conducted an online social network survey in its first year of funding (2020) to (1) establish baseline network measures including the extent of cross-center collaboration and (2) assess factors associated with a network member’s access to the network such as one’s implementation science (IS) expertise. Members of the seven funded centers and NCI program staff identified collaborations in planning/conducting research, capacity building, product development, scientific dissemination, and practice/policy dissemination.

Results: Of the 192 invitees, 182 network members completed the survey (95%). The most prevalent roles were faculty (60%) and research staff (24%). Almost one-quarter (23%) of members reported advanced expertise in IS, 42% intermediate, and 35% beginner. Most members were female (69%) and white (79%). One-third (33%) of collaboration ties were among members from different centers. Across all collaboration activities, the network had a density of 14%, suggesting moderate cohesion. Degree centralization (0.33) and betweenness centralization (0.07) measures suggest a fairly dispersed network (no single or few central member(s) holding all connections). The most prevalent and densely connected collaboration was in planning/conducting research (1470 ties; 8% density). Practice/policy dissemination had the fewest collaboration, lowest density (284 ties’ 3% density), and the largest number of non-connected members (n=43). Access to the ISC3 network varied significantly depending on members’ level of IS expertise, role within the network, and racial/ethnic background. Across all collaboration activities, most connected members included those with advanced IS expertise, faculty and NCI staff, and Hispanic or Latino and white members.

Conclusions: Results establish a baseline for assessing the growth of cross-center collaborations, highlighting specific areas in need of particular growth in network collaborations such as increasing engagement of racial and ethnic minorities and trainees or those with less expertise in IS.

Citation: Jacob RR, Korn AR, Huang GC, Easterling D, Gundersen DA, Ramanadhan S, Vu T, Angier H, Brownson RC, Haire-Joshu D, Oh AO, Schnoll R. Collaboration networks of the implementation science centers for cancer control: a social network analysis. Implementation Science Communications. 2022; 3:41. Published 2022 Apr 13. https://doi.org/10.1186/s43058-022-00290-6

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Abstract

Background: Improving the delivery, uptake, and implementation of cancer screening to meet evidence-based recommendations is needed to reduce persistent cancer health disparities in the USA. Current national public health targets emphasize the role of social determinants of health (SDOH) on cancer screening. However, there remains a need to explicate these linkages, toward the goal of identifying and implementing effective interventions that target and address SDOH to reduce inequities in cancer screening.

Methods: We will conduct a systematic review of English language peer-reviewed original research articles published between 2010 and 2021 that describe observational (qualitative and quantitative) and intervention studies conducted in the USA. In alignment with Healthy People 2030, we will include studies of breast, cervical, colorectal, and/or lung cancer screening. Guided by multiple SDOH frameworks, we will broadly define SDOH by five domain areas: economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context. Following systematic literature searches in five databases (Ovid MEDLINE, Embase, CINAHL, Web of Science, Cochrane Library) and piloting of screening procedures, reviewers will independently screen titles/abstracts for potential relevance. Reviewer pairs will then screen full text articles for eligibility criteria. We will extract data items from included articles, including study characteristics, cancer screening intervention information, and coding of SDOH constructs. We will assess study quality using the Mixed Methods Appraisal Tool and synthesize our findings using narrative, descriptive statistics, tables, and figures. Our approach will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) recommendations.

Discussion: By completing this systematic review, we will summarize recent literature on SDOH and cancer screening, identify research gaps for inclusion of SDOH, and propose future opportunities for advancing equity in cancer screening by integrating SDOH as part of the implementation context to promote uptake, sustainability, and scale-up in the implementation of screening guidelines.

Citation: Korn AR, Walsh-Bailey C, Pilar M, Sandler B, Bhattacharjee P, Moore WT, Brownson RC, Emmons KM, Oh AY. Social determinants of health and cancer screening implementation and outcomes in the USA: a systematic review protocol. Systematic Reviews. 2022; 11:117. Published 2022 Jun 8. https://doi.org/10.1186/s13643-022-01995-4

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Background: Bundling is combining individual interventions to meet quality metrics. Bundling offers of cancer screening with screening for social determinants of health (SDOH) may enable health centers to assist patients with social risks and yield efficiencies.

Methods: Outreach to 50–75-year-olds overdue for CRC screening to offer FIT with SDOH screening. The implementation strategy used facilitation and training for data monitoring and reporting.

Key Results: FQHCs tailored implementation processes to their infrastructure, workflows, and staffing and prioritized different groups for outreach. Two FQHCs used population health outreach, and two integrated FIT-SDOH within established programs, such as pre-visit planning. Of 34,588 patients overdue for CRC screening, 54% were female; 20% Black, 11% Latino, 10% Asian, and 47% white; 32% had Medicaid, 16% Medicare, 32% private insurance, and 11% uninsured. Odds of CRC screening completion in implementation “steps” compared to controls were higher overall and among groups prioritized for outreach (overall: adjusted odds ratio (aOR) 2.41, p = 0.005; prioritized: aOR 2.88, p = 0.002). Odds of SDOH screening did not differ across “steps.”

Citation: Kruse GR, Percac-Lima S, Barber-Dubois M. et al. Bundling Colorectal Cancer Screening Outreach with Screening for Social Risk in Federally Qualified Health Centers: A Stepped-Wedge Implementation-Effectiveness Study. J GEN INTERN MED 39, 1188–1195 (2024). https://doi.org/10.1007/s11606-024-08654-5 

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Background: In 2019–2020, with National Cancer Institute funding, seven implementation laboratory (I-Lab) partnerships between scientists and stakeholders in ‘real-world’ settings working to implement evidence-based interventions were developed within the Implementation Science Centers in Cancer Control (ISC3) consortium. This paper describes and compares approaches to the initial development of seven I-Labs in order to gain an understanding of the development of research partnerships representing various implementation science designs.

Methods: In April-June 2021, members of the ISC3 Implementation Laboratories workgroup interviewed research teams involved in I-Lab development in each center. This cross-sectional study used semi-structured interviews and case-study-based methods to collect and analyze data about I-Lab designs and activities. Interview notes were analyzed to identify a set of comparable domains across sites. These domains served as the framework for seven case descriptions summarizing design decisions and partnership elements across sites.

Conclusions: The development of the ISC3 implementation laboratories, which represented a variety of research partnership designs, offers the opportunity to advance understanding of how researchers developed and built partnerships to effectively engage stakeholders throughout the cancer control research lifecycle. In future years, we will be able to share lessons learned for the development and sustainment of implementation laboratories.

Citation: Kruse G, Hale E, Bekelman JE, et al. Creating research-ready partnerships: the initial development of seven implementation laboratories to advance cancer control. BMC Health Services Research. 2023;23(1). Published February 21, 2023. doi:10.1186/s12913-023-09128-w

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Abstract

Gaps in the implementation of effective interventions impact nearly all cancer prevention and control strategies in the US including Massachusetts. To close these implementation gaps, evidence-based interventions must be rapidly and equitably implemented in settings serving racially, ethnically, socioeconomically, and geographically diverse populations. This paper provides a brief overview of The Implementation Science Center for Cancer Control Equity (ISCCCE) and describes how we have operationalized our commitment to a robust community-engaged center that aims to close these gaps. We describe how ISCCCE is organized and how the principles of community-engaged research are embedded across the center. Principles of community engagement have been operationalized across all components of ISCCCE. We have intentionally integrated these principles throughout all structures and processes and have developed evaluation strategies to assess whether the quality of our partnerships reflects the principles. ISCCCE is a comprehensive community-engaged infrastructure for studying efficient, pragmatic, and equity-focused implementation and adaptation strategies for cancer prevention in historically and currently disadvantaged communities with built-in methods to evaluate the quality of community engagement. This engaged research center is designed to maximize the impact and relevance of implementation research on cancer control in community health centers.

Citation: Kruse GR, Lee RM, Aschbrenner KA, Daly JG, Dargon-Hart S, Davies ME, Gundersen DA, Pelton-Cairns L, Winickoff J, Taveras E, Emmons KM, and The ISCCCE Consortium. Embedding community-engaged research principles in implementation science: The implementation science center for cancer control equity. Journal of Clinical and Translational Science. 2023;7(1):e82. doi:10.1017/cts.2023.32

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Abstract

Background: Community Health Centers (CHCs) are a critical source of care for low-income and non-privately insured populations. During the pandemic, CHCs have leveraged their infrastructure and role as a trusted source of care to engage the communities they serve in COVID-19 testing.

Methods: To directly address the impact that COVID-19 has had on historically marginalized populations in Massachusetts, we designed a study of community-engaged COVID-19 testing expansion: (1) leveraging existing partnerships to accelerate COVID-19 testing and rapidly disseminate effective implementation strategies; (2) incorporating efforts to address key barriers to testing participation in communities at increased risk for COVID-19; (3) further developing partnerships between communities and CHCs to address testing access and disparities; (4) grounding the study in the development of a shared ethical framework for advancing equity in situations of scarcity; and (5) developing mechanisms for communication and science translation to support community outreach. We use a controlled interrupted time series design, comparing number of COVID-19 tests overall and among people identified as members of high-risk groups served by intervention CHCs compared with six matched control CHCs in Massachusetts, followed by a stepped wedge design to pilot test strategies for tailored outreach by CHCs.

Conclusions: Here, we describe a community-partnered strategy to accelerate COVID-19 testing in historically marginalized populations that provides ongoing resources to CHCs for addressing testing needs in their communities. The study aligns with principles of community-engaged research including shared leadership, adequate resources for community partners, and the flexibility to respond to changing needs over time.

Citation: Kruse GR, Pelton-Cairns L, Taveras E, Dargon-Hart S, Gundersen G, Lee RM, Bierer BE, Lawlor E, LaRocque R, Marcus JM, Davies ME, Emmons K, the RADx-MA Research Partnership. Implementing expanded COVID-19 testing in Massachusetts community health centers through community partnerships: Protocol for an interrupted time series and stepped wedge study design. Contemporary Clinical Trials. 2022; 118:106783. Published 2022 July. https://doi.org/10.1016/j.cct.2022.106783.

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Abstract

Introduction: Access to COVID-19 testing has been inequitable and misaligned with community need. However, community health centers have played a critical role in addressing the COVID-19 testing needs of historically disadvantaged communities. The aim of this paper is to explore the perceptions of COVID-19 testing barriers in six Massachusetts communities that are predominantly low income and describe how these findings were used to build tailored clinical-community strategies to addressing testing inequities.

Methods: Between November 2020 and February 2021, we conducted 84 semi-structured qualitative interviews with 107 community health center staff, community partners, and residents. Resident interviews were conducted in English, Spanish, Vietnamese, and Arabic. We used a 2-phase framework analysis to analyze the data, including deductive coding to facilitate rapid analysis for action and an in-depth thematic analysis applying the Social Ecological Model.

Results: Through the rapid needs assessment, we developed cross-site suggestions to improve testing implementation and communications, as well as community-specific recommendations (e.g., locations for mobile testing sites and local communication channels). Upstream barriers identified in the thematic analysis included accessibility of state-run testing sites, weak social safety nets, and lack of testing supplies and staffing that contributed to long wait times. These factors hindered residents’ abilities to get tested, which was further exacerbated by individual fears surrounding the testing process and limited knowledge on testing availability.

Discussion: Our rapid, qualitative approach created the foundation for implementing strategies that reached underserved populations at the peak of the COVID-19 pandemic in winter 2021. We explored perceptions of testing barriers and created actionable summaries within 1-2 months of data collection. Partnering community health centers in Massachusetts were able to use these data to respond to the local needs of each community. This study underscores the substantial impact of upstream, structural disparities on the individual experience of COVID-19 and demonstrates the utility of shifting from a typical years’ long research translation process to a rapid approach of using data for action.

Citation: Lee RM, Handunge VL, Augenbraun SL, et al. Addressing COVID-19 Testing Inequities Among Underserved Populations in Massachusetts: A Rapid Qualitative Exploration of Health Center Staff, Partner, and Resident Perceptions. Front Public Health. 2022;10:838544. Published 2022 Mar 24. doi:10.3389/fpubh.2022.838544

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Abstract

Background: More than half of cancers could be prevented by employing evidence-based interventions (EBIs), including prevention interventions targeting nutrition, physical activity, and tobacco. Federally qualified health centers (FQHCs) are the primary source of patient care for over 30 million Americans — making them an optimal setting for ensuring evidence-based prevention that advances health equity. The aims of this study are to (1) determine the degree to which primary cancer prevention EBIs are being implemented within Massachusetts FQHCs and (2) describe how these EBIs are implemented internally and via community partnerships.

Methods: We used an explanatory sequential mixed methods design to assess the implementation of cancer prevention EBIs. First, we collected 34 quantitative surveys from staff at 16 FQHCs across Massachusetts to determine the frequency of EBI implementation. We followed up with 12 qualitative one-on-one interviews among a sample of staff to understand how the EBIs selected on the survey were implemented. Exploration of contextual influences on implementation and use of partnerships was guided by the Consolidated Framework for Implementation Research (CFIR). Quantitative data were summarized descriptively, and qualitative analyses used reflexive, thematic approaches, beginning deductively with codes from CFIR, then inductively coding additional categories.

Results: All FQHCs indicated they offered clinic-based tobacco interventions, such as clinician-delivered screening practices and prescription of tobacco cessation medications. Quitline interventions and some diet/physical activity EBIs were available at all FQHCs, but staff perceptions of penetration were low. Only 38% of FQHCs offered group tobacco cessation counseling and 63% referred patients to mobile phone-based cessation interventions. We found multilevel factors influenced implementation across intervention types — including the complexity of intervention trainings, available time and staffing, motivation of clinicians, funding, and external policies and incentives. While partnerships were described as valuable, only one FQHC reported using clinical-community linkages for primary cancer prevention EBIs.

Conclusions: Adoption of primary prevention EBIs in Massachusetts FQHCs is relatively high, but stable staffing and funding are required to successfully reach all eligible patients. FQHC staff are enthusiastic about the potential of community partnerships to foster improved implementation—providing training and support to build these relationships will be key to fulfilling that promise.

Citation: Lee RM, Daly JG, Mallick K, Ramanadhan S, Torres CH, Hayes CR, Manuel A, Nalls R, Emmons KM. Implementation of evidence-based primary cancer prevention interventions in MA community health centers: an explanatory sequential mixed methods study. Implementation Science Communications. 2023;4(1). doi:10.1186/s43058-023-00483-7

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Abstract

Background: Dissemination and implementation (D&I) research is a key factor in the uptake and use of evidence-based cancer control interventions. National Cancer Institute (NCI)–designated cancer centers are ideal settings in which to further D&I knowledge. The purpose of this study was to summarize the characteristics of NCI-funded D&I science grants in the nation’s cancer centers to understand the nature, extent, and opportunity for this key type of translational work.

Methods: We used the National Institutes of Health Research Portfolio Online Reporting Tool to identify active NCI-funded grants in D&I science at NCI clinical cancer centers (n = 13) and comprehensive cancer centers (n = 51) as well as their academic affiliates. Active projects were eligible for inclusion if they 1) were awarded directly to an NCI cancer center or an academic or research affiliate, and 2) identified D&I content in the abstract. Portfolio data were collected in February 2021.

Results: We identified 104 active NCI-funded D&I research or training grants across the 64 cancer centers; 57.8% of cancer centers had at least 1 NCI-funded D&I grant. Most awards (71.1%) were for research grants. Training grants constituted 29.1% of D&I-focused grants. Overall, 50.0% of grants (n = 52) concentrated on specific cancers. Almost two-thirds of grants (n = 68, 65.4%) had a stated health equity focus.

Conclusions: More than one-half of NCI-designated cancer centers have active funding in D&I science, reflecting a substantial investment by NCI. There remains considerable room for further development, which would further support NCI’s translational mission.

Citation: Mueller NM, Hsieh A, Ramanadhan S, Lee RM, Emmons KM. The prevalence of dissemination and implementation research and training grants at National Cancer Institute–Designated Cancer Centers. JNCI Cancer Spectru. 2022; 6:1. Published 2021 Dec 15. https://doi.org/10.1093/jncics/pkab092

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Abstract

Racial/ethnic minorities have been disproportionately impacted by COVID-19. The effects of COVID-19 on the long-term mental health of minorities remains unclear. To evaluate differences in odds of screening positive for depression and anxiety among various racial and ethnic groups during the latter phase of the COVID-19 pandemic, we performed a cross-sectional analysis of 691,473 participants nested within the prospective smartphone-based COVID Symptom Study in the United States (U.S.) and United Kingdom (U.K). from February 23, 2021 to June 9, 2021. In the U.S. (n=57,187), compared to White participants, the multivariable odds ratios (ORs) for screening positive for depression were 1·16 (95% CI: 1·02 to 1·31) for Black, 1·23 (1·11 to 1·36) for Hispanic, and 1·15 (1·02 to 1·30) for Asian participants, and 1·34 (1·13 to 1·59) for participants reporting more than one race/other even after accounting for personal factors such as prior history of a mental health disorder, COVID-19 infection status, and surrounding lockdown stringency. Rates of screening positive for anxiety were comparable. In the U.K. (n=643,286), racial/ethnic minorities had similarly elevated rates of positive screening for depression and anxiety. These disparities were not fully explained by changes in leisure time activities. Racial/ethnic minorities bore a disproportionate mental health burden during the COVID-19 pandemic. These differences will need to be considered as health care systems transition from prioritizing infection control to mitigating long-term consequences.

Citation: Nguyen LH, Nguyen LH, Anyane-Yeboa A, Klaser K, Merino J, Drew DA, et al. The mental health burden of racial and ethnic minorities during the COVID-19 pandemic. PlosOne. 2022; 17:8. Published 2022 Aug 10. https://doi.org/10.1371/journal.pone.0271661

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Abstract

Background: There is little guidance for conducting health equity-focused economic evaluations of evidence-based practices in resource-constrained settings, particularly with respect to staff time use. Investigators must balance the need for low-touch, non-disruptive cost data collection with the need for data on providing services to priority subpopulations.

Methods: This investigation took place within a pilot study examining the implementation of a bundled screening intervention combining screening for social determinants of health and colorectal cancer at four federally qualified health centers (FQHCs) in the Boston metropolitan area. Methods for collecting data on personnel costs for implementation and intervention activities, including passive (automatic) and active (non-automatic, requiring staff time and effort) data collection, as well as three alternate wordings for self-reporting time-use, were evaluated qualitatively using data collected through interviews with FQHC staff (including clinicians, population health staff, and community health workers) and assessments of data completeness.

Conclusion: Passively collected time use data are the least burdensome and should be pursued in research efforts when possible, but should be accompanied by qualitative assessments to ensure the data are an accurate reflection of effort. When workflows are already tracked by active data collection, these are also strong data collection methods. Self-reported time use will be most accurate when questions inquire about “typical” tasks and specific types of patients.

Citation: Levy DE, Singh D, Aschbrenner KA, Davies ME, Pelton-Cairns L, Kruse GR. Challenges and recommendations for measuring time devoted to implementation and intervention activities in health equity-focused, resource-constrained settings: a qualitative analysis. Implementation Science Communications. 2023;4(1). doi:10.1186/s43058-023-00491-7

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Abstract

The purpose of this study was to understand challenges that school administrators faced in their approaches to address adolescent vaping in Massachusetts middle and high schools. We analyzed open-ended comments from Massachusetts school administrators who completed a survey between November 2020 and January 2021. Further, we analyzed nine interviews with administrators (e.g., principals, vice principals, school nurses) from Massachusetts school systems (n = 6) and school-based anti-tobacco advocates (n = 3); interviews took place between May and December 2021. We found that challenges to addressing adolescent vaping included school personnel capacity, funding, and lack of mental health and counseling supports. The COVID-19 pandemic was a major barrier to conducting usual in-person vaping programs, but also reduced student vaping at school due to new social distancing practices and bathroom use policies. Successful approaches included peer-led initiatives and parental involvement, and participants discussed the importance of educating adolescents on the harms of vaping. Based on our findings, school-based anti-vaping program practitioners—such as school districts, state departments of education, or local health departments—should leverage peer-led initiatives, alternatives-to-suspension approaches, and parental involvement, to increase the potential impact of adolescent vaping prevention and treatment efforts.

Citation: Liu J, Roberts J, Reynolds MJ, Hanby E, Gundersen DA, Winickoff JP, Rees VW, Emmons KM, Tan ASL. Barriers and facilitators to address vaping in Massachusetts schools: a mixed-methods study of school-based stakeholders. Translational Behavioral Medicine. 2023;13(8):589-600. doi:10.1093/tbm/ibad012

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Abstract

The National Cancer Institute’s Implementation Science Centers in Cancer Control (ISC³) Network represents a large-scale initiative to create an infrastructure to support and enable the efficient, effective, and equitable translation of approaches and evidence-based treatments to reduce cancer risk and improve outcomes. This Cancer Moonshot^SM–funded ISC³ Network consists of 7 P50 Centers that support and advance the rapid development, testing, and refinement of innovative approaches to implement a range of evidence-based cancer control interventions. The Centers were designed to have research-practice partnerships at their core and to create the opportunity for a series of pilot studies that could explore new and sometimes risky ideas and embed in their infrastructure a 2-way engagement and collaboration essential to stimulating lasting change. ISC³ also seeks to enhance capacity of researchers, practitioners, and communities to apply implementation science approaches, methods, and measures. The Organizing Framework that guides the work of ISC³ highlights a collective set of 3 core areas of collaboration within and among Centers, including to 1) assess and incorporate dynamic, multilevel context; 2) develop and conduct rapid and responsive pilot and methods studies; and 3) build capacity for knowledge development and exchange. Core operating principles that undergird the Framework include open collaboration, consideration of the dynamic context, and engagement of multiple implementation partners to advance pragmatic methods and health equity and facilitate leadership and capacity building across implementation science and cancer control.

Citation: Oh A, Emmons KM, Brownson RC, Glasgow RE, Foley KL, Lewis CC, Schnoll R, Huguet N, Caplon A, Chambers DA. Speeding implementation in cancer: The National Cancer Institute’s Implementation Science Centers in Cancer Control. JNCI: Journal of the National Cancer Institute. 2022; 115:2. Published 2022 Oct 31. https://doi.org/10.1093/jnci/djac198

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Abstract

COVID-19 vaccine development has advanced at lighting speed. Research that would normally require years has been completed in months. As a result of this unprecedented effort, two vaccine candidates, mRNA-1273 (Moderna, Cambridge, MA) and BNT162b2 (Pfizer, New York, NY), have been found to be safe and more than 90% effective in preventing symptomatic COVID-19 shortly after vaccination. These vaccines are extremely promising and will eventually be distributed widely. Unfortunately, as the science of vaccine development has swiftly progressed, the equally important science of community engagement, which should guide the establishment of mutually beneficial partnerships and promote eventual vaccine uptake, has lagged behind. Research methods focused on the development of effective public health interventions place communities—groups with shared culture, norms, beliefs, or language—at their core and emphasize the primacy of community ownership as essential for uptake and sustainability.1 Yet, communities of color (i.e., Black, Latinx, and Indigenous communities), who remain at highest risk for infection, have been peripheral, not central actors in the pursuit of COVID-19 vaccines. Instead, the tripartite relationship between industry, government, and academia has dominated the research enterprise related to COVID-19.

The peripheral position of community has been evident since early in vaccine development. Notably, initial trial recruitment consisted of short-term community outreach, and more detailed plans for longer-term community engagement to support enrollment and eventual vaccine uptake commenced late in phase III trials. Such a critical oversight may be the Achilles’ heel of this unprecedented effort. Deeply rooted mistrust bred by centuries of well-documented, abusive medical experimentation and ongoing structural racism impedes racially and ethnically diverse individuals’ participation in clinical trials and threatens the uptake of future COVID-19 vaccines, particularly among Black individuals.

This history may be overcome by reimagining how industry, government, and academic institutions partner with marginalized communities. COVID-19 vaccine development offers an opportunity to shift from transient outreach to true investment in communities of color, which may mitigate mistrust, improve vaccine uptake, and have far-reaching effects beyond COVID-19.

Citation: Ojikutu BO, Stephenson KE, Mayer KH, Emmons KM. Building trust in COVID-19 vaccines and beyond through authentic community investment. American Journal of Public Health. 2021; 111:3. Published 2021 Mar 1. https://doi.org/10.2105/AJPH.2020.306087

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Abstract

Background: Numerous reports have demonstrated the disproportionate impact that COVID-19 has had on vulnerable populations. Our purpose is to describe our health care system’s response to this impact.

Methods: We convened a Workgroup with the goal to mitigate the impact of COVID-19 on the most medically vulnerable people in Springfield, Massachusetts, USA, particularly those with significant social needs. We did this through (1) identifying vulnerable patients in high-need geographic areas, (2) developing and implementing a needs assessment/outreach tool tailored to meet cultural, linguistic and religious backgrounds, (3) surveying pharmacies for access to medication delivery, (4) gathering information about sources of food delivery, groceries and/or prepared food, (5) gathering information about means of travel, and (6) assessing need for testing. We then combined these six elements into a patient-oriented branch and a community outreach/engagement branch.

Conclusions: Our highly intentional and methodical approach to patient and community outreach with a strong geographic component has led to fruitful efforts in COVID-19 mitigation. Our patient-level outreach engages our health centers’ clinical teams, particularly community health workers, and is providing the direct benefit of material and service resources for our at-risk patients and their families. Our community efforts leveraged existing relationships and created new partnerships that continue to inform us—healthcare entities, healthcare employees, and clinical teams—so that we can grow and learn in order to authentically build trust and engagement.

Citation: Pirraglia PA, Huebner Torres C, Collins J, Garb J, Kent M, Perez McAdoo S, Oloruntola-Coates M, Smith JM, Thomas A. COVID-19 mitigation for high-risk populations in Springfield Massachusetts USA: a health systems approach. Int J Equity Health. 2021; 20:230. Published 2021 Oct 19. https://doi.org/10.1186/s12939-021-01567-3

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Abstract

Objective: This study aimed to estimate the 10-year cost-effectiveness of school-based BMI report cards, a commonly implemented program for childhood obesity prevention in the US where student BMI is reported to parents/guardians by letter with nutrition and physical activity resources, for students in grades 3 to 7.

Methods: A microsimulation model, using data inputs from evidence reviews on health impacts and costs, estimated: how many students would be reached if the 15 states currently measuring student BMI (but not reporting to parents/guardians) implemented BMI report cards from 2023 to 2032; how many cases of childhood obesity would be prevented; expected changes in childhood obesity prevalence; and costs to society.

Conclusions: School-based BMI report cards are not cost-effective childhood obesity interventions. Deimplementation should be considered to free up resources for implementing effective programs..

Citation: Poole MK, Gortmaker SL, Barrett JL, McCulloch SM, Rimm EB, Emmons KM, Ward ZJ, Kenney EL. The societal costs and health impacts on obesity of BMI report cards in US schools. Obesity. 2023;31(8):2110-2118. doi:10.1002/oby.23788

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Abstract

Qualitative methods are critical for implementation science as they generate opportunities to examine complexity and include a diversity of perspectives. However, it can be a challenge to identify the approach that will provide the best fit for achieving a given set of practice-driven research needs. After all, implementation scientists must find a balance between speed and rigor, reliance on existing frameworks and new discoveries, and inclusion of insider and outsider perspectives. This paper offers guidance on taking a pragmatic approach to analysis, which entails strategically combining and borrowing from established qualitative approaches to meet a study’s needs, typically with guidance from an existing framework and with explicit research and practice change goals.

Section 1 offers a series of practical questions to guide the development of a pragmatic analytic approach. These include examining the balance of inductive and deductive procedures, the extent to which insider or outsider perspectives are privileged, study requirements related to data and products that support scientific advancement and practice change, and strategic resource allocation. This is followed by an introduction to three approaches commonly considered for implementation science projects: grounded theory, framework analysis, and interpretive phenomenological analysis, highlighting core analytic procedures that may be borrowed for a pragmatic approach. Section 2 addresses opportunities to ensure and communicate rigor of pragmatic analytic approaches. Section 3 provides an illustrative example from the team’s work, highlighting how a pragmatic analytic approach was designed and executed and the diversity of research and practice products generated.

As qualitative inquiry gains prominence in implementation science, it is critical to take advantage of qualitative methods’ diversity and flexibility. This paper furthers the conversation regarding how to strategically mix and match components of established qualitative approaches to meet the analytic needs of implementation science projects, thereby supporting high-impact research and improved opportunities to create practice change.

Citation: Ramanadhan S, Revette AC, Lee RM, Aveling EL. Pragmatic approaches to analyzing qualitative data for implementation science: an introduction. Implementation Science Communications. 2021; 2:70. Published 2021 Jun 29. https://doi.org/10.1186/s43058-021-00174-1

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Abstract

Artificial intelligence (AI) and machine learning (ML) systems are increasingly used in medicine to improve clinical decision-making and healthcare delivery. In gastroenterology and hepatology, studies have explored a myriad of opportunities for AI/ML applications which are already making the transition to bedside. Despite these advances, there is a risk that biases and health inequities can be introduced or exacerbated by these technologies. If unrecognised, these technologies could generate or worsen systematic racial, ethnic and sex disparities when deployed on a large scale. There are several mechanisms through which AI/ML could contribute to health inequities in gastroenterology and hepatology, including diagnosis of oesophageal cancer, management of inflammatory bowel disease (IBD), liver transplantation, colorectal cancer screening and many others. This review adapts a framework for ethical AI/ML development and application to gastroenterology and hepatology such that clinical practice is advanced while minimising bias and optimising health equity.

Citation: Uche-Anya E, Anyane-Yeboa A, Berzin T, Ghassemi M, May F. Artificial intelligence in gastroenterology and hepatology: how to advance clinical practice while ensuring health equity. Gut. 2022; 71:1909-1915. Published 2022 Sep. http://dx.doi.org/10.1136/gutjnl-2021-326271

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Abstract

Background: Implementation science (IS) could accelerate progress toward achieving health equity goals. However, the lack of attention to the outer setting where interventions are implemented limits applicability and generalizability of findings to different populations, settings, and time periods. We developed a data resource to assess outer setting across seven centers funded by the National Cancer Institute’s IS Centers in Cancer Control (ISC3) Network Program.

Methods: Our Data Resource captures seven key environments, including: (1) food; (2) physical; (3) economic; (4) social; (5) health care; (6) cancer behavioral and screening; and (7) cancer-related policy. Data were obtained from public sources including the US Census and American Community Survey. We present medians and interquartile ranges based on the distribution of all counties in the US, all ISC3 centers, and within each Center for twelve selected measures. Distributions of each factor are compared with the national estimate using single sample sign tests.

Conclusions: Our results indicate that the outer setting varies across Centers and often differs from the national level. These findings demonstrate the importance of assessing the contextual environment in which interventions are implemented and suggest potential implications for intervention generalizability and scalability.

Citation: Warner ET, Huguet N, Fredericks M, Gundersen D, Nederveld A, Brown MC, Houston TK, Davis KL, Mazzucca S, Rendle KA, Emmons KM. Advancing health equity through implementation science: Identifying and examining measures of the outer setting. Social Science & Medicine. 2023;331:116095. doi:10.1016/j.socscimed.2023.116095

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