Theories, Models, Frameworks:A Practical ApplicationRajesh Vedanthan, MD MPHDirector, Section for Global HealthAssociate Professor, Departments of Population Health and MedicineNYU Grossman School of Medicine
I receive financial support from the following company or companies related to the products listed below. These relationships may lead to bias in my presentation.
Disclosures
Entity Type(s) of relationship(s)
Product name(s)
Relevant disease(s) or condition(s)
NONE
K01TW009218R01HL125487R56HL150036U01HL114200
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Knowledge-Practice (Know-Do) Gap
3
Implementation research
• Implementation research is the scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice, and, hence, to improve the quality and effectiveness of health services and public health
• It includes the study of influences on healthcare professional and organizational behaviour.
• (Eccles/Mittman, 2006)
4
Research Pipeline
5
Dissemination
Scale Up
Scale Out
Suggested criteria for a good theory:
@PilvikkiA / GACD ISRTS 2019
1. Clarity of theoretical concepts2. Clarity of relationships between constructs3. Measurability4. Testability5. Being explanatory (statistically or logically)6. Describing causality7. Achieving parsimony8. Generalisability9. Having an evidence base
Michie S, West R, Campbell R, et al. An ABC of behaviourchange theories. London: Silverback Publishing, 2014.
Theories, Models, Frameworks—Why?
7https://impsciuw.org/research/frameworks/
Implementation Research
Vedanthan (2011) MSJM
PI (Kenya): Constantine Akwanalo, MMedCo-I (USA): Rajesh Vedanthan, MD MPH; Tim Mercer, MD MPH;
Sonak Pastakia, PhD; Gerald Bloomfield, MD MPH; Jonathan Dick, MD
Strengthening Referral Networks for Management of Hypertension
Across the Health System
Implementation Research
Vedanthan (2011) MSJM
Mercer et al. (2019) Trials
Referral Networks
TertiaryNational Referral Hospital
(MTRH)
SecondarySub-County and County Hospitals
PrimaryHealth Centers and Dispensaries
Implementation Research
Vedanthan (2011) MSJM
Analyze Determinants• Context, Agency, Structure
Daivadanam et al. PLoS One 2019
Implementation Research Frameworks—PRECEDE-PROCEED
14Green and Kreuter (1999)
Process Model—PRECEDE-Proceed
Mercer et al. Forthcoming
Process Map – Task Map
Pathak et al. Forthcoming
Implementation Research
Vedanthan (2011) MSJM
Intervention/Strategy Selection• Patient-focused• Provider-focused• Education• Feedback/Reminders• Patient safety• Organizational change• Economic strategies• Policy/Regulation• Multifaceted
DESIGN THINKINGDesigner's sensibility and methods to match:
• Desirability (people’s needs)
• Feasibility (social, political, technological, cultural)
• Viability (economic, sustainable, scalable)
Designer’s Sensibility:Integrative Thinking
ANALYTICAL THINKING
Deductive reasoning
Inductive reasoning
INTUITIVE + IMAGINATIVE THINKING
Abductivereasoning
INTEGRATIVE THINKING
Reduces spillage by over 80%!
BaselineAssessment
STRENGTHS—Design Process
Design Parameters(Study Protocol)
Scalable InterventionModel
Community Engagement
Design Capacity Building
Parallel Health System Development
Design Inputs Design Outputs
Prot
otyp
e #1
Prot
otyp
e #2
Prot
otyp
e #3Do you like this idea?
Is it a good fitfor your community?
Did the prototypeseem effective
in facilitating referrals?Overall Positive Feedback:
• Improved referral experience• Encouraged referral adherence via peer counseling• Facilitated communication between clinicians• Reinforced referral practices
Persistent Challenges:• Some barriers not directly addressed• Integration of Health IT tools across clinics
Pillsbury et al. (2020) CUGH
STRENGTHS
Implementation Research
Vedanthan (2011) MSJM
STRENGTHS: Cluster RCT
The PRagmatic-Explanatory Continuum Indicator Summary 2 (PRECIS-2) wheel
Kirsty Loudon et al. BMJ 2015;350:bmj .h2147
Pragmatic vs. Explanatory
Pragmatic vs. Traditional
30Krist, et al. (2012) Imp Sci
Pragmatic vs. Traditional
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Implementation Research
Vedanthan (2011) MSJM
Implementation pipeline- Mittman & Curran 2012
Hybrid – Type 1Test intervention,
gather information on implementation
Hybrid – Type 2Test intervention,
Test implementation strategy
Hybrid – Type 3Test implementation
strategy, gather effectiveness data
Process evaluation
NYU School of Medicine36
Process EvaluationThe Saunders Framework
STRENGTHS Process Evaluation – Methods
NYU School of Medicine37
Process Evaluation Component Data Collection Method
Objective Structured Clinical Examinations (OSCEs)
Implementation Research
Vedanthan (2011) MSJM
THANK YOU