The COVID-19 pandemic has shed a new light on the importance of implementation science (IS) both in delivering the right interventions for the control of the pandemic, the direct impact, as well as adapting to the disruption in health services as a result of the pandemic, the indirect impact (e.g., addressing delay in cancer screening). Scaling up IS capacity is more important now than ever, notably in precision health research, where successful implementation of interventions is needed at the population level.
Studies on the direct COVID-19 impact of public health interventions are under way. A June 2020 published study assessed how state public health agencies implemented social distancing approaches and recognized that initiation time was shorter in decentralized agencies in comparison to those that were centralized. This should prompt implementation scientists to help identify more precise strategies for social distance intervention approaches based upon public health agency organizational factors.
Implementation studies on the indirect impact of COVID-19 include attention to necessary adaptation of interventions for non-COVID-19 health issues, such as cancer screening programs. New tools and technologies within the realm of precision health (e.g., telehealth) can be used to adapt interventions. A recent publication reported on the feasibility of telehealth to minimize risk for COVID-19 exposure for high-risk obstetric patients. The ongoing priority for implementation scientists to mitigate health inequities offers opportunities for use of big data (e.g., socio-economic, geographic, and genomic data) within their research. Additionally, the use of digital technologies (e.g., mobile phone applications), artificial intelligence and deep learning for modeling may help advance IS activities.
Scaling up IS capacity within precision public health efforts and actions is essential. To accomplish this, we may need to develop IS training activities specific to researchers within this area. Precision public health researchers can apply IS concepts, for example, to measure reach of a contact tracing program that incorporates electronic health record information (e.g., viral test results) into their program. Through IS capacity building, researchers will understand how to design implementation strategies that are tailored to populations based upon diverse health needs of the specific population being studied, and learning to factor in the inner and outer contextual factors and barriers and facilitators will all help achieve the goals of precision implementation. Additionally, understanding that the ability to recognize and adapt to the dynamic nature of any intervention is essential and will enable adaptation and sustainability of that intervention. We must also acknowledge that ongoing learning is necessary throughout one’s research agenda as well as throughout one’s career.
During the first annual Implementation Science Consortium in Cancer (ISCC) discussion, participants identified the need to increase IS capacity building for research within Precision Health and Big Data (click here to view the video summary of the activities discussed at the ISCC 2019 meeting). Following the meeting, ongoing discussion has included the desire to find avenues for targeted training for genomic and precision health researchers. Combined in-person and virtual mini-courses similar to TIDIRC have been discussed, as well as the option for an add-on course during an annual genomics or precision health conference. For anyone interested in actively collaborating in this IS capacity building effort specific to precision health, please feel free to get in touch with me.
We expect that the COVID-19 pandemic will provide opportunities for innovation in IS towards more precision, while IS remains grounded in its core principles. Capacity building in IS for precision health and big data could help us incorporate more rapid-cycle studies, whereby ongoing data collection and continuous monitoring and feedback will enable faster translation time. Strategies that use precision and digital technologies have been critical for health care continuity during the pandemic, so adaptation of interventions using these tools may become more commonplace even after we get back to the “new” normal. We would love to hear from our IS community if you have suggestions for how precision health, big data, and implementation science can come together toward the benefit of all.
Mindy Clyne, M.H.S., C.G.C., is a research assistant 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). Ms. Clyne collects and assembles existing tools, peer-reviewed literature, and documentation on implementation science in the areas of precision medicine and public health genomics.
Dispatches from the Implementation Science Team, is an episodic collection of short form updates, authored by members and friends of the IS team representing a sample of the work being done and topics that our staff are considering for future projects. Topics address some of the advances in implementation science, ongoing issues that affect the conduct of research studies, reflections on fellowships and meetings, as well as new directions for activity from our research and practice communities.