Implementation Science Training

Purpose: The training is designed to build research capacity in dissemination and implementation science, specifically as it applies to cancer prevention and care in HIV clinical settings in Uganda and Zambia. The training's goals are to help participants understand the foundations of implementation science, recognize its significance for public health, become familiar with implementation frameworks and terminology, and be able to evaluate evidence-based interventions, strategies, and policies.

Content: The training opens by introducing the research team and the Quit4Life+ study's three specific aims: adapting an SMS cessation program for PLWH in low-income countries, testing its efficacy against standard care and NRT via RCT, and estimating its cost-effectiveness.

Download the training slides here.

Module 1 introduces implementation science broadly — defining evidence-based interventions (EBIs) with examples like smoking cessation, vaccination, and cancer screening, and defining implementation science itself as the study of integrating evidence-based practice into real-world settings. It traces the history of the field from Diffusion of Innovation theory in the 1960s through the translational science gap of the 1990s, the RE-AIM framework, NIH funding initiatives, and the founding of the Implementation Science journal in 2006. The module covers the multilevel contexts in which care occurs (from individual patients up through provider, organizational, community, and policy levels), health disparities frameworks, the case for using D&I science to address health disparities, and the long lag time between research publication and clinical implementation (citing data suggesting it takes roughly 17 years to translate about 14% of original research into patient care). It also covers implementation outcomes (feasibility, fidelity, penetration, acceptability, sustainability, cost) versus downstream service and health outcomes (Proctor et al. framework), the concept of "equitable implementation," and a taxonomy of implementation strategies (training/educating stakeholders, supporting clinicians, engaging consumers, financial strategies, infrastructure change, etc.). Module 1 closes with local case examples from Zambia's HPV vaccination program, including vaccination coverage data and national trends, and ends with a note about preparing for Module 2 and a post-training worksheet.

Module 2 shifts to applying these concepts specifically to identifying barriers and facilitators for implementing cancer-prevention EBIs within HIV clinics, again illustrated using the Zambia HPV vaccination program and additional examples from Uganda. It covers how to frame evaluation questions at different implementation stages (pre-, early/mid-, and late-implementation), the role of theoretical and conceptual frameworks in public health (contrasting process models, determinant frameworks, classic theories, D&I-specific theories, and evaluation frameworks), and specific tools such as the Knowledge to Action Framework. It defines implementation strategies as the concrete actions used to promote adoption and sustainability of an EBI (e.g., stakeholder engagement or community forums to support routine childhood vaccination), and introduces Implementation Mapping as a method for identifying determinants, mechanisms of change, and prioritized strategies. The module concludes with a structured approach to defining context (noting that it is multilevel, can act as either barrier or facilitator, changes over time, and is only partly modifiable) and a four-step process for identifying and prioritizing barriers and facilitators: brainstorming, applying theories/frameworks, collecting new qualitative/quantitative data, and prioritizing by importance and changeability.

Module 3 moves into action planning, with goals centered on applying the Implementation Research Logic Model (Smith, Li & Rafferty, 2020) to organize barriers, facilitators, and strategies, and on developing a concrete implementation plan — including goals, strategies, responsible stakeholders, and timelines. It opens with a review of a prior training activity, then defines what an implementation plan is (a documentation tool covering scope, roles, responsibilities, data monitoring, communication, and timeframes) and walks through key considerations, including who should be involved in creating one. This section emphasizes co-creating plans collaboratively with both internal stakeholders (those coordinating, funding, or supporting implementation) and external stakeholders (patients, community members, and other affected parties), and stresses that stakeholder engagement should continue throughout the assess-prepare-implement-evaluate cycle (citing NCI's "Implementation Science at a Glance" guide).