ABSTRACT
BACKGROUND: Despite significant progress in the field of implementation science (IS), current training programs are inadequate to meet the global need, especially in low-and middle-income countries (LMICs). Even when training opportunities exist, there is a "knowledge-practice gap," where implementation research findings are not useful to practitioners in a field designed to bridge that gap. This is a critical challenge in LMICs where complex public health issues must be addressed. This paper describes results from a formal assessment of learning needs, priority topics, and delivery methods for LMIC stakeholders. METHODS: We first reviewed a sample of articles published recently in Implementation Science to identify IS stakeholders and assigned labels and definitions for groups with similar roles. We then employed a multi-step sampling approach and a random sampling strategy to recruit participants (n = 39) for a semi-structured interview that lasted 30-60 min. Stakeholders with inputs critical to developing training curricula were prioritized and selected for interviews. We created memos from audio-recorded interviews and used a deductively created codebook to conduct thematic analysis. We calculated kappa coefficients for each memo and used validation techniques to establish rigor including incorporating feedback from reviewers and member checking. RESULTS: Participants included program managers, researchers, and physicians working in over 20 countries, primarily LMICs. The majority had over 10 years of implementation experience but fewer than 5 years of IS experience. Three main themes emerged from the data, pertaining to past experience with IS, future IS training needs, and contextual issues. Most respondents (even with formal training) described their IS knowledge as basic or minimal. Preferences for future training were heterogeneous, but findings suggest that curricula must encompass a broader set of competencies than just IS, include mentorship/apprenticeship, and center the LMIC context. CONCLUSION: While this work is the first systematic assessment of IS learning needs among LMIC stakeholders, findings reflect existing research in that current training opportunities may not meet the demand, trainings are too narrowly focused to meet the heterogeneous needs of stakeholders, and there is a need for a broader set of competencies that moves beyond only IS. Our research also demonstrates the timely and unique needs of developing appropriately scoped, accessible training and mentorship support within LMIC settings. Therefore, we propose the novel approach of intelligent swarming as a solution to help build IS capacity in LMICs through the lens of sustainability and equity.
ABSTRACT
INTRODUCTION: Both US and global communities lag on key health indicators. There has been limited progress in building capacity to improve health beyond the healthcare field. Yet, communities also need to engage in health improvement initiatives. A substantial body of literature describes standards and core components for quality improvement (QI) approaches in clinical settings. This study aims to determine how communities in the USA, Australia, New Zealand and Canada use QI approaches for health and well-being improvement and how such approaches compare to those in clinical settings. METHODS AND ANALYSIS: We developed a study protocol based on scoping review framework by Arksey and O'Malley, methodological advancements for scoping studies (Levac et al ) and other published protocols. We developed research questions in an iterative process and used the Population, Intervention, Comparison, Outcomes strategy to determine eligibility criteria. Electronic databases deemed appropriate (Web of Science, Scopus, and Proquest Health Management) will be searched for studies that meet inclusion criteria. References of included studies will be included when relevant. Two reviewers will independently screen all abstracts and full-text studies for inclusion. A third reviewer will adjudicate disagreements that arise. An instrument will be developed to extract data from included studies. Quantitative and qualitative results will be reported. ETHICS AND DISSEMINATION: We developed this protocol to systematically conduct a scoping review of how US communities use QI approaches to address community health and well-being. Results will benefit multiple stakeholders by informing how to better support, design and evaluate community well-being improvement interventions. Results will be distributed through peer-reviewed journals, conferences, presentations and a public health graduate course.
