The prevalence of diabetes in Appalachian Kentucky is among the highest in the United States. Diabetes self-management education and support (DSMES) is a cost-effective, evidence-based intervention that improves patient outcomes yet is underutilized due to multilevel barriers. Throughout 2023–2024, we implemented a 9-month learning collaborative with two regional healthcare systems to increase DSMES referrals and documented their clinical strategies. At study conclusion, we assessed clinical perceptions of each strategy’s feasibility, acceptability, appropriateness, as well as likelihood of sustainment of the clinical DSMES referral program. After 6 months of participation and at study conclusion, participants (N = 13) described timing and intended outcomes for activities, which were then mapped to relevant Expert Recommendations for Implementing Change (ERIC) domains. Intended outcomes were coded to Practical, Robust Implementation and Sustainability Model (PRISM) contextual factors and implementation outcomes, and refinements to implementation strategies were documented iteratively throughout the study. At study end, participants (n = 9) individually assessed each strategy’s acceptability, appropriateness, and feasibility, as well as its potential for sustainment. Assessments used 5-point unidimensional Likert scales that were summed and averaged, with higher numbers indicating greater favorability. To help facilitate DSMES referrals, clinic learning collaborative participants most frequently employed implementation strategies within the ERIC stakeholder interrelationshipsand supporting clinicians domains. Specific activities included creating a new electronic health record referral system, utilizing morning huddles to identify eligible patients, and creating patient face sheets for providers to review during visits. Strategies were refined minimally, primarily to increase provider and staff participation and patient and provider acceptability of activities. Across all strategies, mean scores for acceptability, appropriateness, and feasibility were mostly high, as was the overall likelihood of sustainment. The process of developing and refining implementation strategies to fit context was associated with positive clinical perceptions of acceptability, appropriateness, feasibility, and sustainability. Systematically documenting strategies along with their intended outcome targets throughout an intervention can help contextualize the dynamic nature of implementation and inform future scale-up.

BackgroundCollaborative Decision Skills Training (CDST) is a promising group intervention for adults with serious mental illness (SMI) intended to increase collaborative decision-making (CDM) at the patient-clinician level. CDST previously underwent a systematic, community-engaged mixed methods adaptation to increase fit and feasibility for Veterans with psychosis at VA Psychosocial Rehabilitation and Recovery Centers (PRRCs). This qualitative study applies the Practical, Robust Implementation and Sustainability Model (PRISM) framework to identify the fit and feasibility of the adapted version of CDST within VA PRRCs for Veterans with psychosis.MethodsNine Veterans with psychosis and two clinicians who participated in a CDST pilot trial at a VA PRRC provided feedback about CDST in qualitative interviews. PRISM-mapped guides were used to administer semi-structured interviews and develop qualitative codes. Following the initial coding of interviews, four analysts applied a systematic thematic approach to identify themes within each PRISM domain, inclusive of the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) evaluation framework housed within PRISM. Identified themes were then reviewed by three analysts who reached consensus on the final themes to be presented in this paper.ResultsFive cross-cutting themes were identified across PRISM domains, capturing CDST's conceptual alignment with PRRCs and the recovery model; variability of Veteran and clinician interest despite fit or effectiveness; the need for structural integration for sustainability; mixed perceptions of CDST's virtual format; and challenges with at-home practice completion. Additional themes were identified under PRISM Intervention Characteristics, Implementation and Sustainability Infrastructure, Recipients, and all RE-AIM outcomes which inform Veterans' and clinicians' implementation viability and sustainability.ConclusionsApplication of the PRISM framework facilitated identification of multilevel determinants for CDST feasibility. CDST shows promising alignment with the recovery model and the structural approach to care at PRRCs, but delivery mode and auxiliary practice group require adjustment to support CDST's sustainability.

Physical activity (PA) interventions in faith-based organizations (FBOs) delivered by para-professionals (e.g., community health workers, promotoras) have been effective in increasing PA among participants. However, given their role within the FBO, promotoras often face implementation challenges such as limited organizational support and resources and lack of familiarity with how to change organizational procedures. Many existing promotora trainings lack professional skills development needed to address these barriers. This study developed a promotora empowerment training program to improve PA intervention implementation in FBOs and increase physical activity levels among Latina parishioners. The study used Implementation Mapping to develop a promotora empowerment training curriculum within the Faith in Action project, an evidence-based intervention designed to increase PA levels among Latina parishioners. Curriculum development included (1) conducting a needs assessment through post-intervention focus groups with Faith in Action promotoras; (2) identifying implementation outcomes and performance objectives, identifying determinants, and creating matrices of change objectives; (3) selecting theory-informed methods and implementation strategies; (4) developing implementation protocols and materials; and (5) planning for implementation evaluation. (1) Focus group findings suggest that promotoras needed additional training in advocating for resources and problem-solving barriers with FBO staff. (2) Key implementation outcomes (e.g., engaging FBO leaders), performance objectives (e.g., identifying resources), and the determinants (e.g., understanding program goals) influencing these objectives were identified. Change objectives were mapped to the corresponding performance objectives and determinants. (3) Empowerment Theory and Dialectical Behavior Therapy interpersonal skills were selected to guide the development of the training. (4) The study team focused training sessions on communication, conflict resolution, planning, problem-solving, and social media use. The training will be delivered by a promotora coordinator in Spanish. (5) Implementation outcomes will be evaluated by examining program fidelity and participant engagement. This study offers a roadmap for development of future promotora trainings and can inform the extent to which the additional promotora training leads to successful implementation outcomes and enhanced efficacy. This study also serves as an example of how Implementation Mapping can be utilized to improve implementation outcomes for a high-priority population in real-world settings.

Scientific evidence regarding AKI and acute kidney care has advanced in recent years. However, a knowledge gap remains on the implementation of these evidence-based practices (EBPs) into clinical care. Implementation science (IS) is focused on ensuring that this knowledge is translated in an effective, efficient and sustainable fashion. OBJECTIVES:1) Define the current status of IS; 2) Define a roadmap for accelerating IS with a focus on patient/care partner advocacy, digital tool application, social determinants of health, and resource-limited settings; and 3) Develop a robust and broad research agenda incorporating IS methodology into the programs. EVIDENCE REVIEW:ADQI XXXV was conducted through a modified Delphi process with virtual meetings preceding an in-person meeting. Five workgroups were determined a priori to focus on 1) IS definitions and methods applicable to AKI and acute kidney care; 2) IS literature in AKI and acute kidney care; 3) Innovations in IS to accelerate the adoption, adherence to, and sustainment of EBPs in AKI and acute kidney care; 4) IS methods in resource-limited settings; and 5) Recommendations to identify and evaluate EBPs that are ready for implementation or de-implementation. Prior to the in-person meeting, each workgroup met virtually to review the literature and develop framework questions to address their objectives. During the two-day in person meeting, through iterative discussions, questions and supporting statements were finalized. These questions and statements were agreed upon through voting to achieve consensus, defined as agreement of ≥80%. CONCLUSIONS AND RELEVANCE:We report a structured multidisciplinary consensus for defining the role of IS in AKI and acute kidney care. Future programs should address these consensus questions and apply these statements along with IS methodology in the translation of science into clinical practice and the implementation/de-implementation of EBPs in clinical care.

BackgroundImplementation science (IS) plays a critical role in translating research into real-world health outcomes. Few studies have evaluated models that provide technical assistance and other resources to build IS capacity. The Coordinating and Capacity-Building Hubs to Enhance the Science of HIV Implementation Research (CHESHIRE) network supports US-based HIV research awardees participating in the Ending the HIV Epidemic in the US (EHE) initiative. ObjectiveThe objective of this study is to describe the evaluation protocol for CHESHIRE and assess the effect of the implementation of hub technical assistance activities on EHE-funded research team outcomes, including IS competencies, scientific collaboration, and research productivity. MethodsThis protocol describes a mixed methods evaluation using qualitative interviews with EHE project leads (n=36); social network analysis of CHESHIRE-affiliated researchers and hub members (n=265); and secondary data analysis of National Institutes of Health (NIH) RePORTER, PubMed, and NIH Implementation Science Coordination Initiative EHE Project Final Progress Report Survey data (n=248). We will use descriptive analyses, network metrics, and thematic coding to describe outcomes following CHESHIRE implementation, including IS competencies, interinstitutional partnerships, and research productivity. ResultsCHESHIRE coordinating center and hub activities were funded through NIH Center for AIDS Research and AIDS Research Center supplements beginning in 2019, with hubs funded between 2019 and 2024. Available survey data include EHE projects that completed the EHE Project Final Progress Report Survey between August 2021 and February 2025. As of January 2026, we have completed enrollment, with 265 network members in the final recruiting list. Data abstraction and analysis of the evaluation components are ongoing. Publication of findings is anticipated for December 2026. Evaluation findings will be disseminated after completion of data analysis. The findings will provide insights on whether structured IS support through CHESHIRE increases researchers’ IS competencies, interinstitutional partnerships, and research productivity. ConclusionsThis evaluation will provide empirical evidence to guide the development and optimization of technical assistance hubs in public health research and inform their future evaluation of hub-based IS capacity-building models. Findings will inform strategies to optimize IS capacity building and accelerate the translation of evidence-based interventions into practice, especially in HIV prevention and treatment. International Registered Report Identifier (IRRID)DERR1-10.2196/91374

BackgroundImplementation science theories, models, and frameworks (TMFs) are central to rigorous, theory-informed research and practice; however, linking TMF constructs to appropriate assessment instruments is challenging for many users. Existing repositories have been valuable but are fragmented, vary in accessibility, and are often limited in scope, modality, and TMF linkage. To address this gap, we expanded the Dissemination and Implementation (D&I) Models Webtool.Materials and methodsUsing a user-centered, expert-informed, iterative process, we redesigned the webtool's Assess section into a public, construct-linked tool. We first identified and refined a set of instrument metadata (characteristics) through reviews of prior repositories and multistage expert engagement (subject matter experts and an external advisory board). Each candidate metadata field was rated for usefulness and feasibility, culminating in 38 finalized fields. We then purposefully selected and abstracted priority instruments to ensure diversity across modalities (quantitative, qualitative, or mixed), implementation phase, setting, audience, and equity/policy relevance. Abstraction followed a consensus approach with quality checks and regular reconciliation. Usability testing with intended users informed content, navigation, and functionality refinements.ResultsPhase 1 includes 51 instruments linked to relevant TMFs and constructs. Instruments span quantitative (n = 33), qualitative (n = 14), and mixed-method (n = 4) formats. Common types include surveys (n = 31), interviews (n = 6), and worksheets (n = 3). Coverage encompasses preimplementation, implementation, and sustainment phases; varied clinical and public health settings; multiple priority user groups; and equity- and policy-relevant tools. The tool provides multipath navigation (by instrument, construct, or model), search and filtering using key metadata, and guidance for selecting and applying Implementation Science (IS) assessments.ConclusionsThe Assess section of the D&I Models Webtool offers a curated, publicly available, continually updated, construct-linked tool that operationalizes TMFs through concrete measurement options across modalities and contexts. This resource supports more consistent, theory-driven assessment in IS and will continue to expand through iterative updates and community input.

BACKGROUND: Implementing evidence-based interventions for population-level benefit can be challenging in resource-limited primary care settings. Research is needed to identify, specify, and systematically study implementation strategies that address the multilevel, contextual influences on implementation in these settings. This study reviewed and compared the implementation strategies proposed by Research Projects (RPs) funded through the Accelerating Colorectal Cancer Screening through Implementation Science (ACCSIS) initiative. ACCSIS research projects implemented multilevel interventions to increase colorectal cancer screening and follow-up among their local populations. METHODS: Participating AC`CSIS RPs provided structured information about activities proposed to facilitate the implementation of evidence-based interventions to increase colorectal cancer screening, follow-up, and referral across project phases (i.e., exploration, preparation, implementation, sustainment). Three implementation science experts reviewed and matched program data to implementation strategies and domains using the Expert Recommendations for Implementing Change (ERIC) classification. ACCSIS RP teams then reviewed and validated matched strategies. Analyses examined similarities and differences among implementation strategies used by each RP and tracked across the screening continuum. RESULTS: Seven ACCSIS RPs participated in this analysis. Collectively, they reported 89 unique activities that matched 68 ERIC implementation strategies (range: 3 to 17 per site). Several similarities were noted across RPs, such as: four RPs developed and distributed educational materials and three used external facilitation as an implementation strategy. Of the nine domains under which the ERIC strategies are classified, most strategies used by the ACCSIS RPs fell under the domain of using evaluative and iterative strategies (e.g., conducting a local need assessment), followed by training and education (e.g., provider education). All RPs used strategies focused on screening and six used strategies to ensure screening follow-up; only one RP used strategies to improve access to treatment. Most strategies were reported in the preparation and implementation phases. CONCLUSIONS: Systematically documenting and collating implementation strategies across ACCSIS RPs contributes to the evidence base of how multilevel interventions can be implemented to reduce the burden of colorectal cancer through screening and follow-up. Study findings can be used to guide real-world implementation efforts, including future scale-up and sustainment.

BACKGROUND:Use of an implementation science (IS) theory, model, or framework (TMF) is one of the hallmarks of a well-executed IS study. Although TMFs are frequently used in IS studies, the TMFs themselves are seldom evaluated. Understanding the relationships between the constructs within an IS TMF and their effect on the implementation and effectiveness outcomes can help to refine the TMF, advance IS and assist implementers. METHODS:We evaluated several hypotheses pertinent to the context domains and Reach, Effectiveness Adoption, Implementation, and Maintenance (RE-AIM) outcomes from the Practical, Robust Implementation and Sustainability Framework (PRISM). Data for these evaluations emerged from the use of the Iterative PRISM (iPRISM) webtool, which includes 21 assessment questions that operationalize PRISM context and outcomes constructs. We tested 11 'a priori' hypotheses including relationships within and between different framework constructs and considered whether some of the webtool's assessment questions could be refined or changed to make the assessment more pragmatic and helpful. RESULTS:A total of 348 clinical, community, and public health respondents completed the iPRISM survey using the publicly available webtool. They reported on projects from a wide variety of clinical, community, and public health settings; in English and Spanish; and in different project phases. Seven of the 11 hypotheses were fully or partially supported (e.g. that ratings for Maintenance would be lower than other RE-AIM outcomes). One exception was that the hypothesis that the correlation between Reach and Effectiveness would be the lowest among RE-AIM outcomes was not supported. As hypothesized, scores on the equity items on the various RE-AIM dimensions (e.g. Reach) were consistently lower than general ratings for that dimension. Fewer of the hypotheses about the PRISM context items were supported, possibly due to there being only one item per contextual domain. CONCLUSIONS:The webtool questions provide a standardized way to operationalize PRISM constructs and initial norms for different items. Future research, including qualitative evaluation, is needed to replicate, explore, and understand the complex relationships found within RE-AIM outcomes, within PRISM context domains, and between PRISM context ratings and RE-AIM outcomes.

IntroductionDespite strong evidence linking adverse childhood experiences (ACEs) to poor health, current healthcare interventions lack robust empirical support, underscoring the need for a new framework to build child resilience across healthcare, policy, community, and family systems.ObjectivesTo introduce and provide preliminary empirical evidence supporting the Circles of Resilience (CoR) model by examining whether social connections and vital conditions buffer pathways linking ACEs, maternal anxiety, and child self-regulation in a Federally Qualified Health Center (FQHC) serving Latino families.MethodsWe conducted a cross-sectional study using parent-reported data collected from 2021–2023 at an FQHC in San Diego, California (N = 156 Latino mother–child dyads). Measures included ACEs, maternal anxiety, child self-regulation, and protective factors: (1) social connections and (2) vital conditions (housing, food security, transportation, community resources). Structural equation modeling examined interrelationships among ACEs, maternal anxiety, and child self-regulation, including whether maternal anxiety mediated pathways and whether familial protective factors moderated associations.ResultsHigher ACEs were associated with worse child self-regulation (β = 7.44, p < 0.001). There was an indirect association between ACEs and child self-regulation via maternal anxiety (indirect β = 2.48, p = 0.006; ACEs → anxiety β = 0.67, p = 0.007; anxiety → self-regulation β = 3.72, p < 0.001). Vital conditions were significantly associated with child self-regulation (β = −1.81, SE = 0.92, p = 0.049), whereas social connections were not (β = 2.08, SE = 1.87, p = 0.266). Higher social connections weakened the ACEs–maternal anxiety association (interaction β = −0.70, p = 0.005), while the buffering effect of vital conditions was not significant (β = −0.61, p = 0.078).ConclusionFindings provide preliminary support for CoR model pathways. Higher ACEs were associated with poorer child self-regulation, partially mediated by maternal anxiety. Vital conditions were directly associated with child self-regulation, whereas parental social connections were not. However, social connections significantly buffered the ACEs–maternal anxiety association, suggesting a protective effect on caregiver stress. The buffering effect of vital conditions was not significant. If replicated longitudinally, findings may clarify distinct mechanisms through which contextual resources shape resilience in children exposed to early adversity.

Theories, models, and frameworks (TMFs) are frequently used to facilitate rigorous qualitative data collection and analysis of context in dissemination and implementation (D I) science. The Practical, Robust Implementation and Sustainability Model (PRISM), which includes contextual determinants of Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) dimensions, is one of the most widely used TMFs. Yet, missing from the literature is an assessment of how PRISM can inform the collection of qualitative data across implementation phases (i.e., pre-implementation, implementation, and post-implementation). The purpose of this study was to curate a collection of PRISM-informed qualitative data collection guides and assess how questions relate to PRISM domains and RE-AIM dimensions. In this retrospective observational study, exemplar interview and focus group guides were collected from a group of D I science experts to assess how PRISM constructs were operationalized. All guides were compiled into a database, and each question and sub-question were labelled with one or more relevant PRISM domains and RE-AIM dimensions. We calculated descriptive characteristics of all interview guides included in the database. The frequency of each PRISM domain was calculated across all interview guides, by implementation phase and by participant role. Guides (n=31) were collected from 13 research studies and were primarily used in individual interviews (n=30) and across pre-implementation (n=8), implementation (n=8), and post-implementation (n=15) phases. Research settings included the Veterans Health Administration (n=16), community health settings (n=10), schools (n=4), and an academic health center (n=1). Questions and sub-questions were more commonly labelled with PRISM domains (n=667) than RE-AIM dimensions (n=303). The Perspectives of Implementers (n=201), Perspectives of Recipients (n=152) and Implementation and Sustainability Infrastructure (n=103) were the most frequently used PRISM domains and Implementation (n=113) was the most frequent RE-AIM dimension. Our findings demonstrate that PRISM has valuable applications in qualitative data collection with recipients and implementers across all implementation phases and highlights how PRISM can be adapted for different topics and settings. The database of qualitative guides is publicly available and can be used as a resource for D I investigators using PRISM to guide their qualitative contextual assessment.

Adaptations are expected when complex public health interventions are implemented in dynamically and rapidly changing real-world settings. Systematic documentation of adaptations to intervention components and strategies are critical when assessing their impact on implementation. The purpose of this paper is to describe our approach to systematically tracking, documenting, and evaluating adaptations made during the CO-CREATE-Ex project, which aimed to address COVID-19 testing disparities in the San Ysidro US/Mexico border community. The study utilized a longitudinal, prospective, multi- method approach to systematically document and assess adaptations across the pre-implementation, early and mid/late-implementation, and maintenance phases of the project. Adaptations were aggregated from a combination of sources (i.e., meeting notes, Advisory Board transcripts, and periodic reflections). Adaptations were entered weekly into an electronic database that captured information on 16 characteristics and were validated by study staff. Descriptive statistics were used to describe adaptation characteristics. Adaptation impact was evaluated using a combination of objective and subjective measures aligned with the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) outcomes. Eighty-four unique adaptations were included in this analysis. Adaptations were organized by study phase with most occurring during pre-implementation. Most adaptations (n = 79, 94.04

The incorporation of implementation science approaches into tobacco control program delivery remains limited. Programs developed using these approaches, including co-creation, are often more feasible and sustainable, as they are designed to consider the operational and cultural context of an organization. This study utilized multiple implementation science approaches to co-create a tobacco cessation workflow within a Federally Qualified Health Center (FQHC), where tobacco use is disproportionately higher than the national average. In this study we conducted six structured meetings across two advisory groups between July-September 2025. Multiple implementation science methods (i.e., functions and forms , brainwriting premortem, and Practical, Robust Implementation and Sustainability Model (PRISM) assessments) were integrated to optimize the tobacco cessation workflow for future piloting, along with co-creation and evaluation methods (i.e., ethnographic observations, engagement survey) to evaluate advisory board engagement. Qualitative and quantitative data were collected and analyzed simultaneously using rapid qualitative analysis and descriptive statistics allowing for a comprehensive understanding and iterative incorporation of the results. Thirteen individuals participated in this study as co-creation partners who were between the ages 27 to 69 years (M = 38.6). Participants represent various roles within the FQHC including front-line staff, administrators, providers, and patients. Workflow Optimization: Participants identified 5 core functions and 16 forms in the refinement of the tobacco cessation workflow. Brainwriting Premortem resulted in 28 unique failures and 19 solutions within the workflow across PRISM contextual domains, of which 16 were integrated. The final version of the co-created workflow had high acceptability (M = 4.8), appropriateness (M = 4.6), and feasibility (M = 4.5). Participant Engagement: A total of 394 interactions were identified across meetings. The most frequent interaction was giving information (53

Despite persistent tobacco control efforts, the prevalence of smoking, especially among low-income populations, remains high. The prevalence of tobacco use among the primarily low-income populations served by Federally Qualified Health Centers (FQHCs), is approximately 5 percentage points higher than the national average. Evidence based interventions such as clinician delivered tobacco cessation counseling are brief and effective, however, providers are often faced with various barriers that impede their ability to offer tobacco related counseling consistently. The purpose of this study was to understand multilevel and multi-perspective barriers and facilitators to implementing tobacco screening and cessation counseling at a large, multi-site FQHC. This study used a descriptive qualitative design. Semi-structured interviews were conducted among a diverse group of FQHC staff including providers, clinical staff (e.g., nurse, medical assistant), clinic site managers, and administrators. Interviews were guided by the Practical, Robust Implementation and Sustainability Model (PRISM), lasting an average of 35 min. Data analysis included descriptive statistics to summarize participant characteristics and applied thematic analysis to identify themes related to barriers and facilitators in implementing tobacco screening and cessation counseling. Sixteen FQHC staff participated in the study. Participants were between the ages of 31–69 years old (M = 47.6, SD = 11.2) and had 4–45 years of medical experience (Median = 17.25). Participants represented various roles within the FQHC with 8 Providers, 5 Administrators, and 1 Registered Nurse, Care Coordinator, and Medical Assistant each. Key themes were identified across PRISM contextual domains, including provider knowledge gaps and time constraints, patients’ motivation to quit and hesitation to disclose tobacco use, as well as external referral challenges. Prioritizing tobacco cessation alongside other important health conditions, coupled with rapport building and involving dedicated support staff in tobacco cessation efforts, were perceived to be key strategies to increase consistent delivery of tobacco cessation services. This study sheds light on the multifaceted barriers and facilitators to implementing tobacco cessation services within a large multi-site FQHC. By addressing these key determinants, FQHCs can further enhance ongoing efforts to reduce tobacco use among low-income communities and improve patients’ overall health. Not applicable.

The Practical, Robust Implementation and Sustainability Model (PRISM) was utilized to develop an assessment for improving fit between implementation context, intervention, and implementation efforts. We present findings from the PRISM assessment used in seven military to Veterans Affairs clinics implementing eScreening to improve rate and time for the completion of mental health screenings for veterans and increasing referral to mental health treatment. Questions developed by Glasgow et al. (2020) were adapted to the study context covering the PRISM domains (six items) and reach, effectiveness, adoption, implementation, and maintenance (13 items) outcomes. Assessment results were summarized for each site graphically including comments and were presented in a discussion-based action-planning meeting. Group discussion involving implementation partners and research team members, including an external facilitator, focused on identifying ways to improve the implementation of eScreening. Participants across all sites identified areas of concern related to reach, adoption, and patient expectations. Survey data and comments on these concerns drove the team discussion and identification of implementation activities, which included (a) increasing communication of the value for veteran care, (b) standardizing minimum-effort workflows, and (c) increasing buy-in and collaboration with leadership and other facility services. In this study, the PRISM assessment was used as a one-time activity to enhance implementation across military to Veterans Affairs clinics. The assessment was feasible, and discussion yielded important data on alignment and potential adaptations of the implementation efforts within the dynamically changing local context. Recommendations are provided for those interested in applying the PRISM assessment in their studies. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Background Adaptations are expected when complex public health interventions are implemented in dynamically and rapidly changing real-world settings, as seen for many programs during the COVID-19 pandemic. Systematic documentation of adaptations to intervention components and strategies are critical when assessing their impact on implementation. Here, we report processes used for tracking and evaluating adaptations made during the CO-CREATE project, which aimed to address COVID-19 testing disparities in the San Ysidro US/Mexico border community.Methods The study utilized a longitudinal, prospective, mixed methods approach to systematically document and assess adaptations across the pre-implementation, early and mid/late-implementation phases of the project. Aggregated from a combination of sources (i.e., meeting notes, Advisory Board transcripts, and periodic reflections), adaptations were entered weekly into an electronic database that captured information on 16 characteristics and were validated by study staff. The impacts of the adaptations were determined using a team consensus approach and based on the outcomes from the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. Each adaptation was evaluated to determine whether it increased, decreased, had no effect, or not applicable to the RE-AIM outcomes. Data were analyzed using descriptive statistics.Results 98 adaptations were identified, and most were identified by research staff (n = 79, 75.2%). Planned adaptations were defined as those discussed between at least two research team members prior to implementation. Unplanned adaptations were defined as a change made without shared discussion and agreement among at least 2 research team members. Most adaptations were planned (n = 93, 94.9%). Of those that were planned, (n = 21, 22.6%) occurred during pre-implementation, (n = 26, 28.0%) during early implementation, and (n = 46, 49.4%) during mid/late implementation. Of those that were unplanned, (n = 1, 20.0%) occurred during pre-implementation and (n = 4, 80.0%) occurred during implementation. Most adaptations (n = 45, 45.9%) had a positive impact (i.e., increase) on the efficiency of delivery of services, meaningful engagement of partners, and reach of community members through the program.Conclusion This work describes our systematic and prospective approach to document and analyze adaptations over a two-year period and assesses the impact of these adaptations. Lessons learned from this work can be used to develop best practices for adapting interventions to ensure sustainable implementation and address disparities in public health and clinical programs.

Implementation strategies are essential to deliver evidence-based programs that align with local context, resources, priorities, and preferences. However, it is not always clear how specific strategies are selected (vs. others) and strategies are not always operationalized clearly, distinctly, and dynamically. Implementation logic models provide one useful way to conceptualize the role and selection of implementation strategies, plan evaluation of their intended impacts on implementation and effectiveness outcomes, and to communicate key aspects of a project. This paper describes our initial plans, experiences, and lessons learned from applying implementation logic models in the Quadruple Aim Quality Enhancement Research Initiative (QUERI) a large multi-study program funded by the Veterans Health Administration (VA). We began with two primary implementation strategies based on our earlier work (i.e., Iterative RE-AIM and Relational Facilitation) that were applied across three different health outcomes studies. Our implementation strategies evolved over time, and new strategies were added. This evolution and reasons for changes are summarized and illustrated with the resulting logic models, both for the overall Quadruple Aim QUERI and the three specific projects. We found that implementation strategies are often not discrete, and their delivery and adaptation is dynamic and should be guided by emerging data and evolving context. Review of logic models across projects was an efficient and useful approach for understanding similarities and differences across projects. Implementation logic models are helpful for clarifying key objectives and issues for both study teams and implementation partners. There are challenges in logic model construction and presentation when multiple strategies are employed, and when strategies change over time. We recommend presentation of both original and periodically updated project models and provide recommendations for future use of implementation logic models.

Engaging community partners in research meaningfully can guide effective implementation efforts. This approach is particularly crucial when we work with complex, multilevel programs in low-resource settings that serve diverse populations. The application of dissemination and implementation science theories, models, and frameworks to facilitate the iterative, multilevel engagement of partners in selecting and optimizing implementation strategies is not commonly described in the literature. In collaboration with three federally qualified health centers in San Diego County, we utilized the Practical, Robust Implementation and Sustainability Model (PRISM), which is a contextually expanded version of the widely used Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, to guide partner-engaged data collection on processes, resources, facilitators, and barriers for colorectal cancer (CRC) screening. We gathered implementation-relevant information from each FQHC, including partner introductory meetings, an Agile Science workshop, secondary data collection, surveys, and in-depth interviews. Insights from the PRISM domains led to the development of process maps that guided the selection of implementation strategies to support the use of evidence-based interventions for CRC screening.

INTRODUCTION:Community-academic partnerships played an important role in addressing Covid-19-related health disparities in historically marginalised groups such as racial ethnic minorities and low-income and rural communities in the pandemic. Part of the federal response involved establishing regional community academic networks that engaged highly impacted communities in health disparities research. The statewide Share, Trust, Organize, Partner COVID-19 California Alliance (STOP COVID-19 CA) network was part of the federal response. METHODS:In spring 2024, ripple effects mapping (REM), a participatory action research method, was used to conduct an evaluation of the impact of the STOP COVID-19 network on the capacity of community-academic partnerships to carry out Covid-19-related health disparities research. This method uses group interviews to capture direct and indirect outcomes, that is, ripples, of community-based programmes. Short-, medium- and long-term changes and conditions related to community-academic partnerships in the statewide network were mapped onto the spheres of influence of the social ecological model. RESULTS:A total of 24 participants took part in one of three REM sessions. Community and academic partners were represented in all sessions, and most had been involved in community-engaged research for 3 to 10+ years. Most identified as female, Hispanic/Latino, and between the ages of 40 and 49. Qualitative analysis of sessions indicated that most changes occurred at the individual and interpersonal levels and involved medium-term changes (e.g., increased capacity to partner in research and shared understanding). Neighbourhood- or community-level changes included identification of culturally and linguistically responsive intervention and dissemination efforts (e.g., promotora model). Policy and built environment conditions reveal the inequities in higher education and the need for structural-level changes to university infrastructure and grant administration. CONCLUSION:Most outcomes were observed at the individual and interpersonal (group) levels and involved primarily medium-term changes. However, the network itself served as a platform to discuss the need for structural-level changes within university infrastructure to facilitate community-engaged scholarship. Such networks have the potential to facilitate capacity building for community-academic partnerships to collaborate in health disparities research that can generate evidence to move forward public health policy change. PATIENT OR PUBLIC CONTRIBUTION:Community partners, including grassroots leaders and staff of community-based organisations, were involved in the development of the research questions, the design of the study, and data collection, analysis and interpretation of the findings. Community partners also contributed to manuscript development.

A major gap in implementation research is guidance for designing studies to assess the impact of adaptations to interventions and implementation strategies. Many researchers regard experimental designs as the gold standard. However, the possible study designs for assessing the impact of adaptation on implementation, service and person-level outcomes is broad in scope, including descriptive and correlational research and variations of randomized controlled trials. This article provides a set of key methodological recommendations for assessing the impact of adaptations to interventions and implementation strategies on implementation outcomes. We offer four key recommendations for investigating the impact of adaptations on implementation outcomes. First, we recommend defining the construct of adaptations and identifying the type and timing of adaptations. Second, we recommend that study teams identify the expected proximal and distal outcomes of adaptations. Third, we recommend that study teams consider all possible study design options and select the design that is best suited to answer the research question(s), and is feasible given practical and technical constraints, and acceptable to research partners and participants. Fourth, we recommend that study teams consider the type of adaptation and outcome data available, the goals of the adaptation study, and the complexity of the study design when selecting analytic approaches. We provide materials and examples related to the four key recommendations to help study teams plan and conduct adaptation studies. This article provides methodological recommendations for assessing the impact of adaptations to interventions and implementation strategies on implementation, service, and person-level outcomes that are grounded in the practical realities of implementation research. Increasing the number of studies examining how, which, and under what conditions adaptations are associated with mechanisms and outcomes will advance research on adaptation.