I am a behavioral scientist with expertise in implementation science, cancer disparities, and community-based participatory research. My work focuses on strengthening systems in underserved communities to leverage the best available evidence for cancer prevention and control.
My research falls into three streams. First, I design and evaluate workforce development interventions to promote the use of research evidence within community-based organizations in the US and India. This work also includes examinations of the impacts of staff social networks on the uptake and use of research evidence. Second, I study the adaptation of evidence-based preventive services for use in underserved communities in the US and India. My goal is to design practice-focused guidelines for strategic adaptation so that implementing organizations can increase the impact of available interventions by leveraging practice- and research-based expertise. The third stream of my work focuses on methods to incorporate practitioner expertise into the health promotion evidence base more effectively. This includes evaluations of strategies to identify and engage critical implementation stakeholders as well as technology-based methods to gather stakeholder insight efficiently. Much of my work is conducted in partnership with community-based organizations and coalitions.
My research focuses on implementation science which, as you have heard from Vish [K. “Vish” Viswanath], emphasizes the integration of evidence-based programs, practices, and policies into public health and healthcare settings. Within that space, I focus on local organizations that work with underserved communities.
To give you a sense of the “why” for this, if we take cancer as an example, we see that we can prevent half of cancer cases by using tools already at our disposal — knowledge that we already have. Cervical cancer screening is an example. And yet, as we all know, this evidence isn’t always utilized in practice and it certainly isn’t applied evenly. So, we end up with these major inequities in cervical cancer morbidity and mortality. In the US, we see them based on race, ethnicity, geography, and so many other factors. To me, the promise that is when we look at evidence syntheses —things like the CDC Community Guide or resources from the WHO — we consistently see that there’s a real opportunity where we use multi-level interventions. Maybe you are taking a policy approach and, in concert, you’re conducting community-level education or norm campaigns. Or we tie clinical action, like provider reminders, to community-facing efforts to increase access or reduce logistical barriers. I see important opportunities for health equity that come from partnering with community-based organizations to serve those who are not currently effectively served by our traditional public health and healthcare channels. Given this goal of creating practice change in community settings, it only makes sense to leverage local assets and expertise and bring folks along. So, a lot of my work is stakeholder-engaged. A lot of that happens here in Massachusetts and I have a growing portfolio of work in a few states in India.
Having given you a big picture of my work, I thought I’d share a couple of buckets where there are opportunities for student involvement immediately. I focus on capacity-building, program adaptation, and participatory implementation science.
One area for student involvement would be on a measures development project that I’ve just started which will gather expertise from practitioners and academics to identify the core skills that practitioners need in hand to use research evidence with the goal of addressing health equity. Having defined that, then we’ll create and test some pragmatic measures for those skills. Then, when we run these capacity-building interventions, we will know: are they really having the impact, are they really worth the investments that we’re making? And if not, how do we refine?
So that’s one bucket. The second focuses on program adaptation. As many of you who have worked in the space know, we have evidence-based interventions that are developed in a very particular context with a specific population. And then, we often need to use them in a setting and with a population that is quite different from the original population. So what do we do to increase impact and relevance of these interventions as we move them across settings and populations? There’s not a lot of great guidance for practitioners around how you do this in a systematic and strategic way while preserving those core functions that make the interventions successful in the first place. I am really interested in questions of how one might unpack that process and what supports are needed in community settings to give practitioners the ability to do that? As an example of this, Vish and I have just started a new R01 [Adapting and evaluating a brief advice tobacco intervention in high-reach, low-resource settings in India] in Mumbai, India that will allow us to adapt and test an evidence-based intervention for tobacco cessation. We will be looking at cultural adaptation, contextual adaptation and also task-shifting so that we can use less formally credentialed staff to deliver this intervention. So, it becomes more resource appropriate, it becomes more scalable.
Then, the last area is participatory implementation science. I co-direct the Outreach Core for a U54 partnership between UMass Boston, which is a local minority-serving institution, and the Dana Farber /Harvard Cancer Center (www.umb.edu/u54/cores/outreach_core). We’re in our final year, so we have a lot of attention to pay to disseminating research findings and engaging community members in our work. So, there are some really nice opportunities to think about creative ways to connect with community members to share the science that’s been done and to set future priorities for cancer prevention research. The project also includes efforts to diversify the cancer prevention and control research workforce. So, there’s opportunities to engage high school students and undergrads from groups that are underrepresented in public health research at this time. For folks would like to get hands0on experience and participate in an engaged research project, this can be a really nice opportunity and have supported a number of practicum placements in the past. It’s been a really nice experience for them.
Finally, I’ll leave you with an invitation to join our strong and growing implementation science community here at HSPH [Harvard T.H. Chan School of Public Health], and I know Karen [Emmons] is going to highlight a few specific ways for you to engage. It’s a really vibrant and welcoming community and I hope you’ll join us. Also, for those looking for an overview of the field, you can take my introductory course in Spring 2 [SBS 201: Introduction to Dissemination and Implementation Science].
Edited for clarity.
ScD, Harvard T.H. Chan School of Public Health
MPH, Yale School of Public Health
BS, Cornell University