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Integrating implementation science into covid-19 response and recovery

Integrating implementation science into covid-19 response and recovery BMJ 2020;369:m1888 doi: 10.1136/bmj.m1888 (Published 14 May 2020) Page 1 of 2 Editorials EDITORIALS Integrating implementation science into covid-19 response and recovery 1 2 1 Lisa Hirschhorn professor , Justin D Smith associate professor , Miriam F Frisch research 2 2 associate , Agnes Binagwaho professor 1 2 Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; University of Global Health Equity, Kigali Heights, Kigali, Rwanda National and subnational responses to the covid-19 pandemic different contexts and at different stages of the evolving 6-8 have varied in their implementation of critical evidence based pandemic. interventions, including social distancing, handwashing, Implementation differences SARS-CoV-2 testing, and contact tracing. The variable success of such measures also reflects differences in the nature of initial South Korea and the UK show this well, having implemented outbreaks and contextual factors within communities and health similar evidence based interventions for the covid-19 pandemic systems. Implementation science methods can make all the at different speeds and with implementation strategies that had difference, allowing us to build on these successes and ensure different contexts and differing results. South Korea responded that new epidemiological and sociobehavioural models and successfully, rapidly implementing key interventions for other innovations can sustain and accelerate action to end this pandemic control, including widespread testing, early contact pandemic. tracing, building health system capacity, and community education. Its implementation strategies reflected the nature of Implementation science focuses on applying rigorous 1 2 the epidemic (first wave and concentrated), a strong health frameworks, measures, and research designs, to study what, system and public health capacity and capability, and receptive why, and how interventions are implemented in real world sociopolitical and community attitudes based on experience settings and tests strategies to improve their outcomes and with SARS. For example, high rates of mobile phone coverage impact.This helps policy makers, managers, and implementers and technology to track individuals facilitated contact tracing understand existing and emerging evidence based interventions that would not be possible in countries where culture and laws and choose strategies to implement them that take account of focus on data privacy. (and modify) contextual factors that influence success. Evidence produced through implementation research can inform countries’ The UK implemented some of the same interventions but had responses as epidemics emerge and as strategies are considered key contextual differences, including no recent experience of a and enacted globally and locally for subsequent phases. similar pandemic and the nature of the outbreak at the time Integrating this approach requires strong diverse strategies were implemented (later start of the first wave and partnerships—including among implementers, researchers, delayed initial response resulting in more diffuse spread). policy makers, and communities—within and across countries. Furthermore, factors that facilitated the response in South Korea were challenges in the UK, where rapid coherent political The rapid spread of covid-19 highlights the need to use engagement and action were lacking and the population was implementation science methods from the outset of outbreaks. initially less responsive to public health messages, and some Evidence from the 2014 Ebola outbreak on how strategies were first cases were unrecognised. chosen to tackle the epidemic and mitigate the damage to essential health services was slow to emerge and limited in its Despite reporting its first cases after responses in South Korea dissemination. As a result, knowledge on what worked then and other countries were under way, the UK delayed in choosing 4 5 and might be relevant in the covic-19 pandemic was lost. implementation strategies (including for community education, strict social distancing, and testing), although many were To respond effectively to covid-19, countries must identify, effectively implemented once started. Contact tracing was understand, and incorporate knowledge learnt throughout the initially planned, then abandoned in early March owing to lack course of the pandemic. Many countries are implementing of capacity. The UK moved from containment to a delay phase, established interventions. But they are not always applying the and a policy of widespread contact tracing was not announced learning that implementation science can drive to select, analyse, until mid-May. and adapt data driven strategies for effective outcomes in Correspondence to: L Hirschhorn lisa.hirschhorn@northwestern.edu For personal use only: See rights and reprints http://www.bmj.com/permissions Subscribe: http://www.bmj.com/subscribe BMJ 2020;369:m1888 doi: 10.1136/bmj.m1888 (Published 14 May 2020) Page 2 of 2 EDITORIALS 2 Smith JD, Hasan M. Quantitative approaches for the evaluation of implementation research As we face the spread of covid-19 to new settings, including studies. Psychiatry Res 2020;283:112521-9. 10.1016/j.psychres.2019.112521 31473029 low income countries with differing resources and contexts, 3 Powell BJ, Waltz TJ, Chinman MJ, etal . A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project. prepare for multiple waves, and try to reduce harms related to Implement Sci 2015;10:21. 10.1186/s13012-015-0209-1 25889199 disruption of critical care, we need an implementation science 4 Elston JWT, Cartwright C, Ndumbi P, Wright J. The health impact of the 2014-15 Ebola outbreak. Public Health 2017;143:60-70. 10.1016/j.puhe.2016.10.020 28159028 approach more than ever. Public health efforts to stop the 5 Shultz JM, Cooper JL, Baingana F, etal . The role of fear-related behaviors in the pandemic must be sustained without neglecting other evidence 2013-2016 west Africa Ebola virus disease outbreak. Curr Psychiatry Rep 2016;18:104. based interventions to maintain demand, access, and availability 10.1007/s11920-016-0741-y 27739026 6 Helfrich CD, Weiner BJ, McKinney MM, Minasian L. Determinants of implementation of other health services, including those for maternal and child effectiveness: adapting a framework for complex innovations. Med Care Res Rev health and chronic diseases. Recognising contextual factors 2007;64:279-303. 10.1177/1077558707299887 17507459 7 Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering and using appropriate implementation strategies can help implementation of health services research findings into practice: a consolidated framework ensure that lessons are learnt and evidence based responses are for advancing implementation science. Implement Sci 2009;4:50. 10.1186/1748-5908-4-50 19664226 applied and spread faster than the pandemic itself, with sufficient 8 Aarons GA, Sklar M, Mustanski B, Benbow N, Brown CH. “Scaling-out” evidence-based adaptation to improve population health worldwide. interventions to new populations or new health care delivery systems. Implement Sci 2017;12:111. 10.1186/s13012-017-0640-6 28877746 9 Oh J, Lee J-K, Schwarz D, Ratcliffe HL, Markuns JF, Hirschhorn LR. National Response Competing interests: The BMJ has judged that there are no disqualifying financial to covid-19 in the Republic of Korea and lessons learned for other countries. Health Syst ties to commercial companies. The authors declare no other interests. The BMJ Reform 2020;6:e1753464. 10.1080/23288604.2020.1753464 32347772 10 Roberton T, Carter ED, Chou VB, etal . Early estimates of the indirect effects of the policy on financial interests is here: www.bmj.com/sites/default/files/attachments/ coronavirus pandemic on maternal and child mortality in low- and middle-income countries. resources/2016/03/16-current-bmj-education-coi-form.pdf. SSRN 2020.[Preprint] https://ssrn.com/abstract=3576549 11 Smith JD, Li D, Rafferty MR. The implementation research logic model: a method for Provenance and peer review: Not commissioned; externally peer reviewed. planning, executing, reporting, and synthesizing implementation projects. medRxiv 2020.04.05.20054379. [Preprint]. 10.1101/2020.04.05.20054379 1 Hwang S, Birken SA, Melvin CL, Rohweder CL, Smith JD. Designs and methods for Published by the BMJ Publishing Group Limited. For permission to use (where not already implementation research: advancing the mission of the CTSA program. J Clin Transl Sci granted under a licence) please go to http://group.bmj.com/group/rights-licensing/ 2020. [Epub ahead of print.] 10.1017/cts.2020.16 permissions For personal use only: See rights and reprints http://www.bmj.com/permissions Subscribe: http://www.bmj.com/subscribe http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png The BMJ British Medical Journal

Integrating implementation science into covid-19 response and recovery

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Publisher
British Medical Journal
Copyright
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions
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0959-8154
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1756-1833
DOI
10.1136/bmj.m1888
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Abstract

BMJ 2020;369:m1888 doi: 10.1136/bmj.m1888 (Published 14 May 2020) Page 1 of 2 Editorials EDITORIALS Integrating implementation science into covid-19 response and recovery 1 2 1 Lisa Hirschhorn professor , Justin D Smith associate professor , Miriam F Frisch research 2 2 associate , Agnes Binagwaho professor 1 2 Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; University of Global Health Equity, Kigali Heights, Kigali, Rwanda National and subnational responses to the covid-19 pandemic different contexts and at different stages of the evolving 6-8 have varied in their implementation of critical evidence based pandemic. interventions, including social distancing, handwashing, Implementation differences SARS-CoV-2 testing, and contact tracing. The variable success of such measures also reflects differences in the nature of initial South Korea and the UK show this well, having implemented outbreaks and contextual factors within communities and health similar evidence based interventions for the covid-19 pandemic systems. Implementation science methods can make all the at different speeds and with implementation strategies that had difference, allowing us to build on these successes and ensure different contexts and differing results. South Korea responded that new epidemiological and sociobehavioural models and successfully, rapidly implementing key interventions for other innovations can sustain and accelerate action to end this pandemic control, including widespread testing, early contact pandemic. tracing, building health system capacity, and community education. Its implementation strategies reflected the nature of Implementation science focuses on applying rigorous 1 2 the epidemic (first wave and concentrated), a strong health frameworks, measures, and research designs, to study what, system and public health capacity and capability, and receptive why, and how interventions are implemented in real world sociopolitical and community attitudes based on experience settings and tests strategies to improve their outcomes and with SARS. For example, high rates of mobile phone coverage impact.This helps policy makers, managers, and implementers and technology to track individuals facilitated contact tracing understand existing and emerging evidence based interventions that would not be possible in countries where culture and laws and choose strategies to implement them that take account of focus on data privacy. (and modify) contextual factors that influence success. Evidence produced through implementation research can inform countries’ The UK implemented some of the same interventions but had responses as epidemics emerge and as strategies are considered key contextual differences, including no recent experience of a and enacted globally and locally for subsequent phases. similar pandemic and the nature of the outbreak at the time Integrating this approach requires strong diverse strategies were implemented (later start of the first wave and partnerships—including among implementers, researchers, delayed initial response resulting in more diffuse spread). policy makers, and communities—within and across countries. Furthermore, factors that facilitated the response in South Korea were challenges in the UK, where rapid coherent political The rapid spread of covid-19 highlights the need to use engagement and action were lacking and the population was implementation science methods from the outset of outbreaks. initially less responsive to public health messages, and some Evidence from the 2014 Ebola outbreak on how strategies were first cases were unrecognised. chosen to tackle the epidemic and mitigate the damage to essential health services was slow to emerge and limited in its Despite reporting its first cases after responses in South Korea dissemination. As a result, knowledge on what worked then and other countries were under way, the UK delayed in choosing 4 5 and might be relevant in the covic-19 pandemic was lost. implementation strategies (including for community education, strict social distancing, and testing), although many were To respond effectively to covid-19, countries must identify, effectively implemented once started. Contact tracing was understand, and incorporate knowledge learnt throughout the initially planned, then abandoned in early March owing to lack course of the pandemic. Many countries are implementing of capacity. The UK moved from containment to a delay phase, established interventions. But they are not always applying the and a policy of widespread contact tracing was not announced learning that implementation science can drive to select, analyse, until mid-May. and adapt data driven strategies for effective outcomes in Correspondence to: L Hirschhorn lisa.hirschhorn@northwestern.edu For personal use only: See rights and reprints http://www.bmj.com/permissions Subscribe: http://www.bmj.com/subscribe BMJ 2020;369:m1888 doi: 10.1136/bmj.m1888 (Published 14 May 2020) Page 2 of 2 EDITORIALS 2 Smith JD, Hasan M. Quantitative approaches for the evaluation of implementation research As we face the spread of covid-19 to new settings, including studies. Psychiatry Res 2020;283:112521-9. 10.1016/j.psychres.2019.112521 31473029 low income countries with differing resources and contexts, 3 Powell BJ, Waltz TJ, Chinman MJ, etal . A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project. prepare for multiple waves, and try to reduce harms related to Implement Sci 2015;10:21. 10.1186/s13012-015-0209-1 25889199 disruption of critical care, we need an implementation science 4 Elston JWT, Cartwright C, Ndumbi P, Wright J. The health impact of the 2014-15 Ebola outbreak. Public Health 2017;143:60-70. 10.1016/j.puhe.2016.10.020 28159028 approach more than ever. Public health efforts to stop the 5 Shultz JM, Cooper JL, Baingana F, etal . The role of fear-related behaviors in the pandemic must be sustained without neglecting other evidence 2013-2016 west Africa Ebola virus disease outbreak. Curr Psychiatry Rep 2016;18:104. based interventions to maintain demand, access, and availability 10.1007/s11920-016-0741-y 27739026 6 Helfrich CD, Weiner BJ, McKinney MM, Minasian L. Determinants of implementation of other health services, including those for maternal and child effectiveness: adapting a framework for complex innovations. Med Care Res Rev health and chronic diseases. Recognising contextual factors 2007;64:279-303. 10.1177/1077558707299887 17507459 7 Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering and using appropriate implementation strategies can help implementation of health services research findings into practice: a consolidated framework ensure that lessons are learnt and evidence based responses are for advancing implementation science. Implement Sci 2009;4:50. 10.1186/1748-5908-4-50 19664226 applied and spread faster than the pandemic itself, with sufficient 8 Aarons GA, Sklar M, Mustanski B, Benbow N, Brown CH. “Scaling-out” evidence-based adaptation to improve population health worldwide. interventions to new populations or new health care delivery systems. Implement Sci 2017;12:111. 10.1186/s13012-017-0640-6 28877746 9 Oh J, Lee J-K, Schwarz D, Ratcliffe HL, Markuns JF, Hirschhorn LR. National Response Competing interests: The BMJ has judged that there are no disqualifying financial to covid-19 in the Republic of Korea and lessons learned for other countries. Health Syst ties to commercial companies. The authors declare no other interests. The BMJ Reform 2020;6:e1753464. 10.1080/23288604.2020.1753464 32347772 10 Roberton T, Carter ED, Chou VB, etal . Early estimates of the indirect effects of the policy on financial interests is here: www.bmj.com/sites/default/files/attachments/ coronavirus pandemic on maternal and child mortality in low- and middle-income countries. resources/2016/03/16-current-bmj-education-coi-form.pdf. SSRN 2020.[Preprint] https://ssrn.com/abstract=3576549 11 Smith JD, Li D, Rafferty MR. The implementation research logic model: a method for Provenance and peer review: Not commissioned; externally peer reviewed. planning, executing, reporting, and synthesizing implementation projects. medRxiv 2020.04.05.20054379. [Preprint]. 10.1101/2020.04.05.20054379 1 Hwang S, Birken SA, Melvin CL, Rohweder CL, Smith JD. Designs and methods for Published by the BMJ Publishing Group Limited. For permission to use (where not already implementation research: advancing the mission of the CTSA program. J Clin Transl Sci granted under a licence) please go to http://group.bmj.com/group/rights-licensing/ 2020. [Epub ahead of print.] 10.1017/cts.2020.16 permissions For personal use only: See rights and reprints http://www.bmj.com/permissions Subscribe: http://www.bmj.com/subscribe

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The BMJBritish Medical Journal

Published: May 14, 2020

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