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Conversations that Inform Implementation Science

For the last 15 years, NCI’s Research to Reality (R2R) online community of practice has convened researchers and practitioners around a shared commitment to implement evidence-based, cancer-related (e.g., physical activity, tobacco control, screening, prevention) interventions in public health settings.  Several approaches are used to facilitate dynamic communication and collaboration, including monthly webinars, question, and answer (Q&A) sessions, and discussion posts.

Thanks to the robust participation of many of you reading this post, R2R has met with a large measure of success – we have (as of October 10th) 2,917 members, 318 discussion posts, seven learning communities, and an amazing 2,300 pieces of content.

An under-appreciated aspect of the R2R community of practice is the extent to which it has served as a “living lab” for implementation science.  Indeed, by convening researchers and practitioners, we can examine in situ the programmatic considerations most important to community members.

Last year, Implementation Science team members Wynne Norton, Jordan Tompkins, Kaelin Rappaport, and I conducted a thorough content analysis of webinar Q&A sessions and related discussions to get a better idea of how R2R strengthens collaboration between researchers and public health practitioners --- collaboration I consider critical for effectively disseminating and implementing evidence-based interventions.

We examined conversations related to implementation strategies (Powell et al 2015; Wang 2016) and intervention adaptation (Wiltsey-Stirman et al, 2012), and explored thematic patterns from participants’ questions.  We coded, sorted, and analyzed 62 cyber-seminar transcripts and the related online discussions over a 6-year period (2010-2016).

Several themes emerged from the content analysis, including inquiries around financial and institutional support, program sustainability, program tools, and resources:

·         Community members requested additional information from presenters about contextual variables of research studies (e.g., the role of partnerships in implementing initiatives and adapting programs to reach underserved populations) as well as evidence-based programs and tools (e.g., evaluation measures).

o   “How were you able to establish the relationships with the community partners?”

o   “What were characteristics that were valuable in the partners that you worked with?”

o   “Can you discuss the power dynamics associated with partnerships?”

 

·         Practitioners consistently sought to better understand variables that made an intervention effective and often requested guidance on the most appropriate implementation strategies for their programs.

o   “What were the funding sources for your projects?”

o   “What other costs should be considered?”

o   “Is there a mechanism for local coalition funding?”

I have led R2R since it launched and came to the program after working in public health on the local, state, and national levels. While I am predisposed to view cancer control from an implementer’s perspective, I derive the greatest satisfaction by providing a forum for researchers to speak frankly about their work and its promise.  Indeed, while many resources are designed to help implement evidence-based health programs, the strategies and programmatic considerations most salient to practitioners are difficult to elicit but essential for researchers to address.

Highlighted throughout these conversations on R2R are considerations researchers should include in their intervention presentations, summaries, and publications --- considerations practitioners are anxious to address in their own work.

·         Target Populations (“Could this program be used across cultures or is this really unique to the American Indian and Alaska Native population?”)

·         Delivery Setting (“Can the program be used in small doctors’ offices?”)

·         Health Domain (“What are some factors you’d (consider) when adapting the [program] to cervical cancer survivors?”)

·         Adaptation Process (“Were any of the original creators of these interventions involved as you adapted them?”)

The R2R conversations illustrate that only by addressing the priority concerns of practitioners will researchers ensure the dissemination and appropriate use of evidence-based public health interventions.

The next few months will be exciting ones as we roll out significant changes to R2R and this collaboration model we have developed.  I look forward to our community’s unique role in advancing the field of implementation science.


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