Dispatches from Implementation Science at NCI

Amplifying Practitioner Perspectives to Strengthen Implementation Science

By Margaret Farrell

March 2019

The NCI Implementation Science Team takes seriously our mission to advance the science of implementation and integrate implementation science within the broader cancer control and population sciences context.

By convening researchers and practitioners in collaboration with NCI’s CIS Partnership program[1], and later via the Research to Reality Community of Practice[2], we gained important insights into how NCI can support the adoption, implementation, and sustainment of research-tested interventions in communities and clinics. Such work – moving interventions from research to practice – is central to reducing the burden of cancer[3].

Practitioners emphasize that top–down rollouts of research-tested interventions often lead to poor outcomes and unsustainable programs[4]. Research-practice partnerships conversely have led to evidence-based cancer control approaches that use resources more efficiently, better account for dollars spent, and increase programmatic impact[5]. Much of cancer control practice happens outside of such collaborations, however. There remains a rich body of research knowledge that is not moving into the hands of practitioners quickly and efficiently. 

A greater understanding and uptake of implementation science frameworks and measures can help both cancer control practitioners and researchers leverage crucial insights into how to best deliver research-based initiatives in the complex communities where they are crucially needed. Later this month, NCI will release Implementation Science at a Glance, a workbook to introduce practitioners and policymakers to the building blocks of implementation science. This resource is a natural extension of our experiences funding[6] and training researchers[7] in implementation science as well as perspectives we gained through this work[8]. Moreover, this resource reflects our conviction that the advances in our understanding of implementation science will have greater benefit if communicated in a way that supports and informs the important work of cancer control practitioners. Indeed, in order move both the field of cancer control practice and implementation science forward, we must speak a common vernacular and better integrate our efforts.

Two areas where implementation science researchers may be uniquely able to inform practice is around scalability and sustainability.  Identifying whether and how to increase the adoption of an intervention across a larger population or community[9] without losing its effectiveness[10] (scale) and determining how an evidence-based intervention can deliver its intended benefits over an extended period after external (often funding) support ends (sustainment)[11] are crucial to cancer control[12].  Practitioners grapple daily with these issues and implementation science could help elucidate how best to identify, measure, and overcome barriers to scalability and sustainability that limit the impact of evidence-based practice[13]. Working together to address these challenges could transform the uptake and maintenance of research-tested interventions where they are needed the most: in the complex community settings that support traditionally underserved populations[14].

While implementation science has a great deal to teach cancer control practitioners, practitioners themselves - in their day-to-day work - generate insights incredibly relevant to implementation science. Such evidence could elucidate how best to implement new evidence-based implementation strategies[15] and the reasons why those strategies worked[16], and track the effect of those strategies in communities[17]. Indeed, Preventing Chronic Disease recently published a “Call to Action” for public health professionals to actively inform the science of implementation (Estabrooks, 2018). The online journal made explicit its commitment by welcoming submissions outside of traditional research and evaluation that provide a clear understanding of how real-world challenges are met with tailored evidence-based practice[18]. Indeed, these experiences could help address some gaps within the relatively new field of implementation science[19]. Other areas of active research within implementation science that have called for greater practitioner insights and collaboration include fidelity[20], adaptation[21], and deimplementation[22].

While I am enthused about the impending release of Implementation Science at a Glance, I am more enlivened by its potential to drive more practitioner-centered and practitioner-driven implementation science research questions forward.  Increasing the involvement of cancer prevention and control practitioners, agencies, and organizations in posing questions and conducting research can help advance the field while simultaneously reducing the research-to-practice gap[23].

  • Do you agree?
  • How has leveraging the insights of practitioners into your research impacted your work?
  • What strategies do you find helpful as you think about the implementation of your research into practice?

Share your comments or tweet me @margaretworking

We must be creative and tireless in our commitment to ensure that implementation science approaches speed up translation not just from research to practice but to create the venues and opportunities for cancer control practitioners to authentically inform implementation science.  I look forward to continuing this conversation and leveraging your insights as together we move this important work forward.

[1]La Porta M, Hagood H, Kornfeld J, Treiman K. Partnership as a means for reaching special populations: evaluating the NCI’s CIS Partnership Program. J Cancer Educ 2007;22(1Suppl):S35–40 10.1007/BF03174344

[2] Farrell MM, La Porta M, Gallagher A, Vinson C, Bernal SB. Research to reality: moving evidence into practice through an online community of practice. Prev Chronic Dis. 2014;11:E78. Published 2014 May 8. doi:10.5888/pcd11.130272

[3] Platz EA. Reducing Cancer Burden in the Population: An Overview of Epidemiologic Evidence to Support Policies, Systems, and Environmental Changes. Epidemiol Rev. 2017;39(1):1-10.

[4] Frieden TR. Six components necessary for effective public health program implementation. Am J Public Health. 2014;104(1):17–22.

[5] Steele CB, Rose JM, Townsend JS, Fonseka J, Richardson LC, Chovnick G. Comprehensive Cancer Control Partners’ Use of and Attitudes About Evidence-Based Practices. Prev Chronic Dis 2015;12:150095. DOI: https://dx.doi.org/10.5888/pcd12.150095 exit disclaimer

[6] Neta G, Sanchez MA, Chambers DA, Phillips SM, Leyva B, Cynkin L, Farrell MM, Heurtin-Roberts S, Vinson C. Implementation science in cancer prevention and control: a decade of grant funding by the National Cancer Institute and future directions. Implement Sci 2015;10(1):4

[8] Tabak RG, Padek MM, Kerner JF, Stange KC, Proctor EK, Dobbins MJ, Colditz GA, Chambers DA, Brownson RC. Dissemination and implementation science training needs: insights from practitioners and researchers. Am J Prev Med 2017;52(3S3):S322-S329

[9] Pronk NP. Designing and evaluating health promotion programs: simple rules for a complex issue. Dis Manag Health Outcomes 2003;11(3):8

[10] Milat AJ, King L, Bauman AE, Redman S. The concept of scalability: increasing the scale and potential adoption of health promotion interventions into policy and practice. Health Promot Int 2013;28(3):285–98

[11] Shediac-Rizkallah MC, Bone LR. Planning for the sustainability of community-based health programs: conceptual frameworks and future directions for research, practice and policy. Health Educ Res 1998;13(1):87–108

[12] D.A. Chambers, R.E. Glasgow, K.C. Stange. The dynamic sustainability framework: addressing the paradox of sustainment amid ongoing change Implement Sci, 8 (2013), p. 117

[13] Proctor E, Luke D, Calhoun A, McMillen C, Brownson R, McCrary S, et al. Sustainability of evidence-based healthcare: research agenda, methodological advances, and infrastructure support. Implement Sci 2015;10(1):88

[14] Estabrooks PA, Brownson RC, Pronk NP. Dissemination and Implementation Science for Public Health Professionals: An Overview and Call to Action. Prev Chronic Dis 2018;15:180525. DOI: https://dx.doi.org/10.5888/pcd15.180525 exit disclaimer

[15] Slaughter SE, Hill JN, Snelgrove‐Clarke E. What is the extent and quality of documentation and reporting of fidelity to implementation strategies: a scoping review. Implement Sci 2015; 10: 129.

[16] Powell BJ, Fernandez ME, Williams NJ, Aarons GA, Beidas RS, Lewis CC, McHugh SM and Weiner BJ (2019) Enhancing the Impact of Implementation Strategies in Healthcare: A Research Agenda. Front. Public Health 7:3. doi: 10.3389/fpubh.2019.00003

[17] Estabrooks PA, Brownson RC, Pronk NP. Dissemination and Implementation Science for Public Health Professionals: An Overview and Call to Action. Prev Chronic Dis 2018;15:180525. DOI: https://dx.doi.org/10.5888/pcd15.180525 exit disclaimer

[19] Brownson R, Colditz G, Proctor E. Future issues in dissemination and implementation research. In: Brownson R, Colditz G, Proctor E, editors. Dissemination and implementation research in health: translating science to practice. 2nd edition. New York (NY): Oxford University Press; 2018. p. 481–90.

[21] Chambers, D. A., & Norton, W. E. (2016). The adaptome. American Journal of Preventive Medicine, 51(4), S124–S131. https://doi.org/10.1016/j.amepre.2016.05.011 exit disclaimer

[22] R.C. Brownson, P. Allen, R.R. Jacob, et al. Understanding mis-implementation in public health practice
Am J Prev Med, 48 (5) (2015), pp. 543-551

[23] Chambers DA, Vinson CA, Norton WE, eds. Advancing the Science of Implementation across the Cancer Continuum. New York, NY: Oxford University Press; 2018; p 382

Margaret Farrell
Margaret M. Farrell, M.P.H, R.D., is a public health adviser for the Implementation Science Team in the Office of the Director in the Division of Cancer Control and Population Sciences (DCCPS) at the National Cancer Institute (NCI). Read More »


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