Scaling Interventions to Manage Chronic Disease: Innovative Methods at the Intersection of Health Policy Research and Implementation Science

A mapping review and critique of the literature on translation, dissemination, and implementation capacity building initiatives for different audiences

BACKGROUND

Capacity building is critical for research and practice as the fields of dissemination, implementation and translation science continue to grow. Some scholars state that capacity building should be grounded in competencies. However, the fields are unclear in determining which competencies are relevant for whom, including the content and appropriate level of information and skills for different roles. The goal of this study was to catalogue competencies across current D&I capacity building initiatives.

METHODS

We conducted a mapping review to examine to what extent are theories or frameworks used to guide capacity building, who is being trained, to what extent do capacity building initiatives include a health equity focus, which competencies are being outlined or suggested, how are they being defined, and whether the competencies can be organized along different roles of participants. As a mapping review, we broadly searched for papers using the keywords "training D&I" OR "training implementation" OR "training translation" OR "training dissemination" and included debate and empirical papers about capacity building initiatives in the sample.

RESULTS

A total of 42 articles (from 2011 to 2024) were reviewed, including training development and/or evaluation (n = 25) and conceptual (n = 17) articles. Of the training articles, 13 (52%) specified a framework that guided training. Participants in training included graduate students, researchers, practitioners, and mixed audiences. Fourteen (56%) of the trainings were conducted in the USA, seven (28%) in Canada and other countries. The length of training ranged from two days to two years. Four trainings had an explicit focus on equity. A total of 307 unique competencies were identified and divided into themes: Knowledge, Skills, Engagement with Other Disciplines, Equity, Attitude and Relational Aspects, Capacity Building, Quality Improvement, and Mentorship.

CONCLUSIONS

While there are many D&I capacity building initiatives, we found little consistency in competencies that guided training activities for diverse audiences. Few training activities explicitly identified guiding theories or frameworks or tailored competencies toward different levels of interest in D&I research. Even fewer had an explicit focus on health equity. As the fields continue to foster capacity building programs, it will be important to think critically about the types of competencies we are developing for whom, how, and why.

Evidence for Public Policies to Prevent Suicide Death in the United States

Suicide rates have increased in the United States in recent years. Public policies have great potential to prevent suicide death, and well-designed quasi-experimental studies have identified policies that are effective at reducing suicide rates; however, evidence about these policies has not been synthesized. This review summarizes evidence across three domains of public policies: (a) policies that affect structural determinants of suicide risk (e.g., policies that improve economic security), (b) policies that promote access to clinical services (e.g., Medicaid expansion), and (c) policies that limit access to lethal means for completing suicide (e.g., policies that restrict access to firearms). The historical context of suicide prevention in US public policy is provided, considerations for successful suicide prevention policy implementation are discussed-such as policy awareness among key groups, enforcement, and sufficient funding-and priority areas for future research are enumerated.

A capsule network-based public health prediction system for chronic diseases: clinical and community implications

Objective

To observe the role of a public health chronic disease prediction method based on capsule network and information system in clinical treatment and public health management.

Methods

Patients with hypertension, diabetes, and asthma admitted from May 2022 to October 2023 were incorporated into the research. They were grouped into hypertension group (n = 341), diabetes group (n = 341), and asthma group (n = 341). The established chronic disease prediction method was used to diagnose these types of public health chronic diseases. The key influencing factors obtained by the prediction method were compared with the regression analysis results. In addition, its diagnostic accuracy and specificity were analyzed, and the clinical diagnostic value of this method was explored. This method was applied to public health management and the management approach was improved based on the distribution and prevalence of chronic diseases. The effectiveness and residents' acceptance of public health management before and after improvement were compared, and the application value of this method in public health management was explored.

Results

The key factors affecting the three diseases obtained by the application of prediction methods were found to be significantly correlated with disease occurrence after regression analysis (p < 0.05). Compared with before application, the diagnostic accuracy, specificity and sensitivity values of the method were 88.6, 89 and 92%, respectively, which were higher than the empirical diagnostic methods of doctors (p < 0.05). Compared with other existing AI-based chronic disease prediction methods, the AUC value of the proposed method was significantly higher than theirs (p < 0.05). This indicates that the diagnostic method proposed in this study has higher accuracy. After applying this method to public health management, the wellbeing of individuals with chronic conditions in the community was notably improved, and the incidence rate was notably reduced (p < 0.05). The acceptance level of residents toward the management work of public health management departments was also notably raised (p < 0.05).

Conclusion

The public health chronic disease prediction method based on information systems and capsule network has high clinical value in diagnosis and can help physicians accurately diagnose patients' conditions. In addition, this method has high application value in public health management. Management departments can adjust management strategies in a timely manner through predictive analysis results and propose targeted management measures based on the characteristics of residents in the management community.

Barriers and facilitators for implementation of continuity of midwife care: A review of reviews

BACKGROUND

Continuity of Midwife Care (CoMC) significantly improves maternal and neonatal outcomes, including reducing mortality. However, global implementation remains limited, hindered by various barriers and facilitators across healthcare settings. This review of reviews synthesizes existing evidence on barriers and facilitators to CoMC implementation using the Consolidated Framework for Implementation Research (CFIR) as an analytical tool.

METHODS

Following the Joanna Briggs Institute (JBI) methodology, a review of reviews was conducted. Comprehensive searches of Embase, Medline, CINAHL, and grey literature identified reviews published between 2013 and 2024 that addressed CoMC implementation. Data were categorized by CFIR 2.0 domains: innovation characteristics, outer setting, inner setting, characteristics of individuals, and implementation processes.

RESULTS

Six reviews met inclusion criteria. Barriers to CoMC were systemic and included hierarchical power dynamics, limited midwife autonomy, workforce shortages, and inadequate policy support. Facilitators were more context-specific, influenced by healthcare infrastructure and resources. Key facilitators included supportive leadership, collaborative care models, and national guidelines promoting CoMC.

CONCLUSION

Barriers to CoMC are deeply embedded in healthcare systems, while facilitators are highly dependent on local contexts. Bridging the evidence-practice gap requires applying implementation science methodologies, such as CFIR, to inform policy and intervention strategies. Collaboration between countries with similar healthcare systems can foster knowledge-sharing and adaptation of successful CoMC models. These findings offer actionable insights for policymakers and healthcare professionals to advance CoMC integration globally.

Operational and organizational variation in determinants of policy implementation success: the case of policies that earmark taxes for behavioral health services

BACKGROUND

Research on determinants of health policy implementation is limited, and conceptualizations of evidence and implementation success are evolving in the field. This study aimed to identify determinants of perceived policy implementation success and assess whether these determinants vary according to: (1) how policy implementation success is operationally defined [i.e., broadly vs. narrowly related to evidence-based practice (EBP) reach] and (2) the role of a person's organization in policy implementation. The study focuses on policies that earmark taxes for behavioral health services.

METHODS

Web-based surveys of professionals involved with earmarked tax policy implementation were conducted between 2022 and 2023 (N = 272). The primary dependent variable was a 9-item score that broadly assessed perceptions of the tax policy positively impacting multiple dimensions of outcomes. The secondary dependent variable was a single item that narrowly assessed perceptions of the tax policy increasing EBP reach. Independent variables were scores mapped to determinants in the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework. Multiple linear regression estimated associations between measures of determinants and policy implementation success.

RESULTS

Perceptions of tax attributes (innovation determinant), tax EBP implementation climate (inner-context determinant), and inter-agency collaboration in tax policy implementation (outer-context and bridging factor determinant) were significantly associated with perceptions of policy implementation success. However, the magnitude of associations varied according to how success was operationalized and by respondent organization type. For example, the magnitude of the association between tax attributes and implementation success was 42% smaller among respondents at direct service organizations than non-direct service organizations when implementation success was operationalized broadly in terms of generating positive impacts (β = 0.37 vs. β = 0.64), and 61% smaller when success was operationalized narrowly in terms of EBP reach (β = 0.23 vs. β = 0.59). Conversely, when success was operationalized narrowly as EBP reach, the magnitude of the association between EBP implementation climate and implementation success was large and significant among respondents at direct service organizations while it was not significant among respondents from non-direct service organizations (β = 0.48 vs. β=-0.06).

CONCLUSION

Determinants of perceived policy implementation success may vary according to how policy implementation success is defined and the role of a person's organization in policy implementation. This has implications for implementation science and selecting policy implementation strategies.

Design considerations for developing measures of policy implementation in quantitative evaluations of public health policy

Typical quantitative evaluations of public policies treat policies as a binary condition, without further attention to how policies are implemented. However, policy implementation plays an important role in how the policy impacts behavioral and health outcomes. The field of policy-focused implementation science is beginning to consider how policy implementation may be conceptualized in quantitative analyses (e.g., as a mediator or moderator), but less work has considered how to measure policy implementation for inclusion in quantitative work. To help address this gap, we discuss four design considerations for researchers interested in developing or identifying measures of policy implementation using three independent NIH-funded research projects studying e-cigarette, food, and mental health policies. Mini case studies of these considerations were developed via group discussions; we used the implementation research logic model to structure our discussions. Design considerations include (1) clearly specifying the implementation logic of the policy under study, (2) developing an interdisciplinary team consisting of policy practitioners and researchers with expertise in quantitative methods, public policy and law, implementation science, and subject matter knowledge, (3) using mixed methods to identify, measure, and analyze relevant policy implementation determinants and processes, and (4) building flexibility into project timelines to manage delays and challenges due to the real-world nature of policy. By applying these considerations in their own work, researchers can better identify or develop measures of policy implementation that fit their needs. The experiences of the three projects highlighted in this paper reinforce the need for high-quality and transferrable measures of policy implementation, an area where collaboration between implementation scientists and policy experts could be particularly fruitful. These measurement practices provide a foundation for the field to build on as attention to incorporating measures of policy implementation into quantitative evaluations grows and will help ensure that researchers are developing a more complete understanding of how policies impact health outcomes.

Acceptability and feasibility of policy implementation strategies for taxes earmarked for behavioral health services

Background

This study's aims are to: (1) Compare the acceptability and feasibility of five types of implementation strategies that could be deployed to increase the reach of evidence-based practices (EBPs) with revenue from policies that earmark taxes for behavioral health services, and (2) Illustrate how definitions of implementation strategies and measures of acceptability and feasibility can be used in policy-focused implementation science research.

Methods

Web-based surveys of public agency and community organization professionals involved with earmarked tax policy implementation were completed in 2022-2023 (N = 211, response rate = 24.9%). Respondents rated the acceptability and feasibility of five types of implementation strategies (dissemination, implementation process, integration, capacity-building, and scale-up). Aggregate acceptability and feasibility scores were calculated for each type of strategy (scoring range 4-20). Analyses of variance compared scores across strategies and between organizational actor types.

Findings

For acceptability, capacity-building strategies had the highest rating (M = 16.3, SD = 3.0), significantly higher than each of the four other strategies, p ≤ . 004), and scale-up strategies had the lowest rating (M = 15.6). For feasibility, dissemination strategies had the highest rating (M = 15.3, significantly higher than three of the other strategies, p ≤ .002) and scale-up strategies had the lowest rating (M = 14.4).

Conclusions

Capacity-building and dissemination strategies may be well-received and readily deployed by policy implementers to support EBPs implementation with revenue from taxes earmarked for behavioral health services. Adapting definitions of implementation strategies for policy-focused topics, and applying established measures of acceptability and feasibility to these strategies, demonstrates utility as an approach to advance research on policy-focused implementation strategies.

A National Approach to Promoting Health Equity in Cardiovascular Disease Prevention: Implementation Science Strengths, Opportunities, and a Changing Chronic Disease Context

In the USA, structural racism contributes to higher rates of cardiovascular disease (CVD) including hypertension, heart disease, and stroke among African American persons. Evidence-based interventions (EBIs), which include programs, policies, and practices, can help mitigate health inequities, but have historically been underutilized or misapplied among communities experiencing discrimination and exclusion. This commentary on the special issue of Prevention Science, "Advancing the Adaptability of Chronic Disease Prevention and Management Through Implementation Science," describes the Centers for Disease Control and Prevention, Division for Heart Disease and Stroke Prevention's (DHDSP's) efforts to support implementation practice and highlights several studies in the issue that align with DHDSP's methods and mission. This work includes EBI identification, scale, and spread as well as health services and policy research. We conclude that implementation practice to enhance CVD health equity will require greater coordination with diverse implementation science partners as well as continued innovation and capacity building to ensure meaningful community engagement throughout EBI development, translation, dissemination, and implementation.

Implementation costs of sugary drink policies in the United States

To support implementation of important public health policies, policymakers need information about implementation costs over time and across stakeholder groups. We assessed implementation costs of two federal sugar-sweetened beverage (SSB) policies of current policy interest and with evidence to support their effects: excise taxes and health warning labels. Our analysis encompassed the entire policy life cycle using the Exploration, Preparation, Implementation, and Sustainment framework. We identified implementation actions using key informant interviews and developed quantitative estimates of implementation costs using published literature and government documents. Results show that implementation costs vary over time and among stakeholders. Explicitly integrating implementation science theory and using mixed methods improved the comprehensiveness of our results. Although this work is specific to federal SSB policies, the process can inform how we understand the costs of many public health policies, providing crucial information for public health policy making.

Who's "in the room where it happens"? A taxonomy and five-step methodology for identifying and characterizing policy actors

BACKGROUND

Engaging policy actors in research design and execution is critical to increasing the practical relevance and real-world impact of policy-focused dissemination and implementation science. Identifying and selecting which policy actors to engage, particularly actors involved in "Big P" public policies such as laws, is distinct from traditional engaged research methods. This current study aimed to develop a transparent, structured method for iteratively identifying policy actors involved in key policy decisions-such as adopting evidence-based interventions at systems-scale-and to guide implementation study sampling and engagement approaches. A flexible policy actor taxonomy was developed to supplement existing methods and help identify policy developers, disseminators, implementers, enforcers, and influencers.

METHODS

A five-step methodology for identifying policy actors to potentially engage in policy dissemination and implementation research was developed. Leveraging a recent federal policy as a case study-The Family First Prevention Services Act (FFPSA)-publicly available documentation (e.g., websites, reports) were searched, retrieved, and coded using content analysis to characterize the organizations and individual policy actors in the "room" during policy decisions.

RESULTS

The five steps are as follows: (1) clarify the policy implementation phase(s) of interest, (2) identify relevant proverbial or actual policymaking "rooms," (3) identify and characterize organizations in the room, (4) identify and characterize policy actors in the "room," and (5) quantify (e.g., count actors across groups), summarize, and compare "rooms" to develop or select engagement approaches aligned with the "room" and actors. The use and outcomes of each step are exemplified through the FFPSA case study.

CONCLUSIONS

The pragmatic and transparent policy actor identification steps presented here can guide researchers' methods for continuous sampling and successful policy actor engagement. Future work should explore the utility of the proposed methods for guiding selection and tailoring of engagement and implementation strategies (e.g., research-policy actor partnerships) to improve both "Big P" and "little p" (administrative guidelines, procedures) policymaking and implementation in global contexts.

County- and state-level immigration policies are associated with Supplemental Nutrition Assistance Program (SNAP) participation among Latino households

The purpose of this study was to investigate the association between county- and state-level immigrant criminalizing and integrating policies and Latino household participation in the largest safety net program against food insecurity in the U.S., the Supplemental Nutrition Assistance Program (SNAP). Our outcome, county-level proportion of SNAP-participating Latino households, and county-level covariates were obtained from the American Community Survey 1-year county files (N = 675 counties) for 13 years (2007-2019). Our exposures were county-level presence of sanctuary policies and a state-level immigrant friendliness score, created based on 19 immigrant criminalizing and integrating state-level policies obtained from the Urban Institute's State Immigration Policies Resource. We classified every county in the sample as 1) sanctuary policy + immigrant friendly state, 2) sanctuary policy + immigrant unfriendly state, 3) no sanctuary policy + immigrant friendly state, and 4) no sanctuary policy + immigrant unfriendly state. Using multivariable generalized linear models that adjusted for poverty levels and other social composition characteristics of counties, we found that county-level SNAP participation among Latino households was 1.1 percentage-point higher in counties with sanctuary policies (B = 1.12, 95%CI = 0.26-1.98), compared to counties with no sanctuary policies, and 1.6 percentage-point higher in counties with sanctuary policies in immigrant friendly states (B = 1.59, 95%CI = 0.33-2.84), compared to counties with no sanctuary policy in immigrant unfriendly states. Local and state immigration policy, even when unrelated to SNAP eligibility, may influence SNAP participation among Latino households. Jurisdictions which lack sanctuary policies or have more criminalizing and less integrating policies should consider adopting targeted outreach strategies to increase SNAP enrollment among Latino households.

Quantitative measures used in empirical evaluations of mental health policy implementation: A systematic review

Background

Mental health is a critical component of wellness. Public policies present an opportunity for large-scale mental health impact, but policy implementation is complex and can vary significantly across contexts, making it crucial to evaluate implementation. The objective of this study was to (1) identify quantitative measurement tools used to evaluate the implementation of public mental health policies; (2) describe implementation determinants and outcomes assessed in the measures; and (3) assess the pragmatic and psychometric quality of identified measures.

Method

Guided by the Consolidated Framework for Implementation Research, Policy Implementation Determinants Framework, and Implementation Outcomes Framework, we conducted a systematic review of peer-reviewed journal articles published in 1995-2020. Data extracted included study characteristics, measure development and testing, implementation determinants and outcomes, and measure quality using the Psychometric and Pragmatic Evidence Rating Scale.

Results

We identified 34 tools from 25 articles, which were designed for mental health policies or used to evaluate constructs that impact implementation. Many measures lacked information regarding measurement development and testing. The most assessed implementation determinants were readiness for implementation, which encompassed training (n  =  20, 57%) and other resources (n  =  12, 34%), actor relationships/networks (n  =  15, 43%), and organizational culture and climate (n  =  11, 31%). Fidelity was the most prevalent implementation outcome (n  =  9, 26%), followed by penetration (n  =  8, 23%) and acceptability (n  =  7, 20%). Apart from internal consistency and sample norms, psychometric properties were frequently unreported. Most measures were accessible and brief, though minimal information was provided regarding interpreting scores, handling missing data, or training needed to administer tools.

Conclusions

This work contributes to the nascent field of policy-focused implementation science by providing an overview of existing measurement tools used to evaluate mental health policy implementation and recommendations for measure development and refinement. To advance this field, more valid, reliable, and pragmatic measures are needed to evaluate policy implementation and close the policy-to-practice gap.

Plain Language Summary

Mental health is a critical component of wellness, and public policies present an opportunity to improve mental health on a large scale. Policy implementation is complex because it involves action by multiple entities at several levels of society. Policy implementation is also challenging because it can be impacted by many factors, such as political will, stakeholder relationships, and resources available for implementation. Because of these factors, implementation can vary between locations, such as states or countries. It is crucial to evaluate policy implementation, thus we conducted a systematic review to identify and evaluate the quality of measurement tools used in mental health policy implementation studies. Our search and screening procedures resulted in 34 measurement tools. We rated their quality to determine if these tools were practical to use and would yield consistent (i.e., reliable) and accurate (i.e., valid) data. These tools most frequently assessed whether implementing organizations complied with policy mandates and whether organizations had the training and other resources required to implement a policy. Though many were relatively brief and available at little-to-no cost, these findings highlight that more reliable, valid, and practical measurement tools are needed to assess and inform mental health policy implementation. Findings from this review can guide future efforts to select or develop policy implementation measures.