Finding the path for dissemination and implementation in health
By Caroline Soi, Department of Global Health, University of Washington
The 10th Annual Conference on the Science of Dissemination and Implementation in Health co-hosted by the National Institutes of Health (NIH) and AcademyHealth aimed to bridge the gap between research, practice, and policy in health and healthcare. For me, participating in this conference, it felt like I was a child at Disneyland! With 1200 researchers from all over the world in the room, it felt like a unique opportunity.
The conference was a mix of plenary, panels, podium and poster sessions. This year’s theme was “A Decade of Progress and the Path Forward”. It was an opportunity to reflect on the accomplishments in the field as well as planning for the future. During the session ‘Reflections on the Impact of a Decade of Research”, it emerged that the field of ‘dissemination and implementation’ has developed so much, that it is now accepted as a science. Nevertheless, as a young field key there are key challenges ahead, including:
- How to make implementation evidence-based
- What specialties can be developed to deepen knowledge
- How translation from evidence to research can be hastened
- How to demonstrate the added value of the impact of the field on health of populations.
Expands into low- and middle-income countries
In the Implementation Science in Low- and Middle-Income Countries (LMICs) podium I learnt about the competencies, metrics, core methodologies and tools being covered in current training programs implementation science in these countries. Students from Witwatersrand University in South Africa and Professor Aggrey Semeere from Makerere University in Uganda, shared their experiences which were instrumental in facilitating the understanding of some of the barriers and facilitators that they had encountered while establishing and accessing training programs, and their priorities in implementation science for LMIC researchers.
While, existing research knowledge was a facilitator, one of the major barriers was the discipline in which to locate the implementation science program in. There was a tendency of competition between schools of public health, community medicine and sometimes the faculty of general medicine.
My understanding of the expansion of ‘implementation science’ has grown significantly. This is particularly in relation to the form of capacity building for health researchers back in my home continent of sub-Saharan Africa.
In the poster sessions, walking through the rows of posters and listening to each of the presenters was discovery of the innovations in implementation research. In particular, I was fascinated by the Embedding implementation research in health systems strengthening: Lessons learned across the African health initiative. As I am new to this type of research I found the results from the cross-country evaluation funded through the Population Health Implementation and Training (PHIT) useful for understanding embedded research.
Partnerships between US-based academic institutions and the public sector in Tanzania, Ghana, Zambia, Mozambique and Rwandaalso produced compelling lessons. This model in which researchers collaborated with health decision makers as part of research teams helped build the local research capacity amongst country decision makers.
A changing landscape compels novel approaches
At the Integrative Care and Task-sharing Models session, a number of the presentations’ were about the changing morbidity patterns in LMICs. These called for a transformation of the health systems from being primarily acute care driven to ones that cater for chronic conditions. During discussions it was clear that the provision of antiretrovirals to HIV patients in Africa had led to the provision of chronic health care services. These structures are now playing a critical role in providing the models for which the integration of services for chronic non- communicable diseases (NCDs) such as hypertension and diabetes is currently being studied in a number of countries.
The Causes, Consequences and Healthy populations speech delivered by Dr Sandro Galea was for me an introduction to the concept of the science of population health. The speech presented three arguments for the reasons why the United States health indicators were falling behind those of other high-income countries. His message was that the US health focus had been on targets that were easy to achieve. For example, tackling the symptoms of diseases rather than their underlying causes such as socioeconomic, physical environment, genetics and access to care. These are indeed much more complex to tackle and require higher commitment and financial resources than those available at present. However, he was challenging the audience to reevaluate where their research emphasis should be placed in order for higher gains to be achieved in population health outcomes.
As a new implementation researcher just about to graduate from the first implementation science PhD program, the conference enriched my understanding of this new field. It identified challenges and the priorities, which will be particularly useful as I think about the focus my career in going forward. I am particularly interested in population health and how more efforts can be focused on positive outcomes back home in Africa, in order to avoid the pitfalls that the US has encountered.
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Caroline would like to thank the HSG Translating Evidence into Action Thematic Working Group for supporting her to attend the NIH/AcademyHealth Dissemination and Implementation Science 2017 conference. Special thanks toVivienne Benson and Nasreen Jessani for editorial contributions to this article.
The call for abstracts for the 11th Annual Conference on the Science of Dissemination and Implementation in Health is now open.
