Reflections on Policy Implementation Science

As we shake off the dust of a year in isolation and begin to reimagine a post-pandemic world, it is an exciting time to be in implementation science. The emergence of COVID-19 has led to an increased interest in exploring effective uptake of evidence-based interventions in a rapidly changing public health environment. The scientific community and practitioners alike are exploring with renewed interest not only the translation of evidence to health-related policy, but also a rethinking of the implementation of health-related polices to improve health and reduce inequities. The pandemic has revealed deeply embedded social, economic, health, and political inequalities on an unprecedented scale. During post-pandemic planning and recovery, new systems of thinking about the implementation of health policies will be required to examine policy’s direct impact on patients, providers, and health systems.

The Implementation Science (IS) team within the Division of Cancer Control and Population Sciences has been a leader in prioritizing the development of the field over the last 20 years, and we are once again taking a leading role to identify and expand on opportunities to extend the field’s activities into policy. Over the last couple of years, I have been working with Karen Emmons, Professor of Social and Behavioral Sciences at Harvard School of Public Health (who is on an Intergovernmental Personnel Act (IPA) Mobility Program assignment with the IS team), and colleagues across government and academia to explore how implementation science may contribute to understanding the translation of scientific evidence to health-related policy—an area of inquiry that we refer to as policy implementation science (Policy IS). We define policy IS as the application of implementation science methods and measures to increase our knowledge about, and speed of translation of scientific evidence to, health-related policy in governmental and non-governmental sectors. Policy IS captures a wide range of activities related to policy adoption, diffusion, and enactment, including policy implementation strategies, enforcement, sustainability, and policy effects and outcomes.

Recognizing that the considerable body of implementation research underway rarely utilizes policy approaches, we believe there are several key opportunities that could build the field’s strength in policy IS. As part of a planning process that began in late 2019 to expand our focus into the policy IS space, Karen and I completed a landscape review of the literature and conducted nearly 40 interviews in early 2020 with stakeholders within the federal government and those in academia working at the intersection of policy and health research to better understand barriers and opportunities. Our stakeholders span geographic zones across the US and work in diverse disciplines, including political science and public policy, public health law, behavioral science, and social policy among others. Our reviews and conversations yielded a number of domains through which we are actively considering policy IS engagement, including the following:

• Field-Seeding/Writing: How can we develop and publish papers laying out elements of policy IS and examples of relevant research questions?
• Leveraging Data Resources: How can we utilize partnerships in governmental and non-governmental sectors to identify and pursue opportunities for generating policy data while creating a one-stop shop resource for policy-relevant data?
• Developing a Research Agenda: Work to develop a strategy to integrate policy research focus into existing IS-relevant research networks such as ISC3.
• Stakeholder Engagement: Create a “kitchen cabinet” of policy-minded researchers and practitioners to serve as high-level knowledge brokers to participate and/or advise ongoing policy IS work.
• Policy IS Training Series: Work with experts to highlight policy trainings that train a cadre of researchers to do policy research while holding educational webinars to inform the field on emerging topics in policy IS.

Since our work began in late 2019, the IS team has made considerable inroads collaborating on papers laying out elements of policy IS, developing ideas for a research agenda, and has been in frequent contact with our “kitchen cabinet” of stakeholders. Elements of our work are arranged by those that we consider to be tenable within shorter periods, those that have significant value-add but are likely to take more time and resources, and those that are worth considering as part of a long-term strategy.

In the fall of 2020, we held a five-part webinar series designed to set the stage for focusing on policy IS, explore the earlier stages of the policy life cycle, consider the intersection between policies and health inequities, and to reflect on what this area of work can contribute to the field. Over a span of five months, we hosted nearly 20 different speakers from academia, governmental, and non-governmental sectors across five different sessions to offer their expertise and perspectives on policy IS opportunities and barriers.

Session topics ranged among the following:

• Policy Implementation Science: A Critical Component of Evidence Translation
• Improving the Use of Scientific Evidence in Policy Formulation
• Adoption of Evidence-Based Policy in Governmental and Non-Governmental Sectors
• Strategies for Integrating Evidence into Policy Implementation
• Reflection on Policy Implementation Science: Growing the Field

Between 150-200 guests attended each session, and there was ample opportunity for engagement and follow-up collaborations. Taken as a whole, this webinar series highlighted the important role that policy IS can play in the improvement of population health while providing ample content for implementation scientists to consider policy-relevant considerations in their own work. We have a robust toolkit of methods within implementation science that are increasing the pace of adoption and maintenance of evidence-based programs in a variety of settings. Building on these efforts, we believe the time is right to expand our toolkit and focus to include policy implementation.

If you are interested in learning more and in potential collaborations to push our work forward, please feel free to reach out to Ali Abazeed at ali.abazeed@nih.gov.