Written by April Houston, communications manager, Division of Infectious Diseases, and Anne Trolard, staff scientist, Center for Dissemination and Implementation
The 16th Annual Conference on the Science of Dissemination and Implementation (D&I) in Health, co-hosted by the National Institutes of Health (NIH) and AcademyHealth, recently convened a growing network of health researchers, practitioners, program managers, and enthusiasts in Washington, D.C. to explore the latest innovations in D&I science. This year’s conference concentrated on capitalizing on progress in using and refining D&I methods while also focusing attention on areas needing growth.
A common refrain was the importance of embracing complexity in implementation science. Consider the context in which most health researchers and practitioners operate – health care systems. A vast number of interactions and connections between people, places, and things take place within a health care system. Patients visits clinics, providers examine patients, patients ask questions, providers prescribe medications, pharmacies hand out those meds – meds that have side effects and cost money. Going one level deeper reveals even more complexity: patients must have resources to transport themselves to clinics, providers need enough time and the right tools to evaluate each patient thoroughly. Patients may feel mistreated by their provider or that their concerns are not taken seriously. Power dynamics are at play here as they are everywhere, and policies may reinforce these power dynamics.
Getting a handle on this complexity is crucial for implementation scientists because optimizing health care involves influencing many of these interactions and connection points. One way the field has tackled this complexity is by developing theories, models, and frameworks. Although these tools can help to guide our thinking about where and how to intervene in a system, they can sometimes mislead us because they don’t capture the complexity, or the dynamic nature, of a health care system; nor do they illuminate the potential mechanisms that undergird the outcomes we try to influence.
WashU, home to many D&I trailblazers and leaders, was well represented at this year’s conference. Elvin Geng, co-director of the Center for Dissemination and Implementation, kicked things off by facilitating a standing-room-only pre-conference workshop on D&I Strategies in the Global Context. Ana Baumann participated in a plenary panel discussion on the application and relevance of theories, models, and frameworks for addressing health equity. Others, including Enola Proctor, Ross Brownson, Aaloke Mody, and Center co-Director Byron Powell spoke with groups of attendees.
Conference attendees had much to say about their conference experience and take-aways.
From Anne Trolard, Staff Scientist:
One thing that struck me in the opening remarks at the conference was a call to invite and embrace complexity in implementation science. I wasn’t sure exactly what that meant when I heard it, so I made a mental sticky note to pay attention. What I learned — from exposure to many talks at the conference as well as my own work here at WashU — is that health care systems are complex systems. The delivery of health care is made up of a vast number of interactions and connections between people, places, and things. Patients visits clinics, providers examine patients, patients ask questions, providers prescribe medications, pharmacies hand out those meds. Going one level deeper reveals even more complexity. Patients must have resources to transport themselves to clinics. Providers are pressed for time and may not perform all recommended screenings. Patients may feel rebuffed when they ask questions that are not taken seriously. Power dynamics are at play; policies may reinforce these power dynamics. Medications have side effects, and cost money. The number of interactions for any given encounter start to add up quickly when you look at health care in this way. In fact, the real complexity comes when you start to see what all these interactions produce —the health care system’s living ecosystem or “life unto its own” as a result of all these repeated interactions.
Getting a handle on this complexity is crucial for implementation science because optimizing health care involves influencing many of these connection points and interactions. One way the field has tackled this complexity is by developing models, frameworks, and theory. Models and frameworks in particular specify all the parts of the health care system to help guide our thinking about where and how to intervene. But these frameworks can sometimes mislead us because they don’t capture the complexity, or the living nature, of a health care system; nor do they illuminate the potential mechanisms that undergird the outcomes we try to influence. It is understanding those mechanisms that we are after, that will move the science forward.
From Kayla Zebrowski:
As a first year PhD student who chose WashU based on its leadership within dissemination and implementation science, it was awesome to see that leadership in action at the conference. Even though I am new to the field, scholars and public health workers wanted to speak with me because I am part of WashU. It was also very exciting to see so many different fields working together – physicians, social workers, public health workers, nurses, etc. There was also collaboration among specialties (i.e., HIV, diabetes, mental health, etc.), all learning together to move science forward. I have worked in academic research for years and seen how long it takes effective interventions to get to the public. This conference was an opportunity to share ideas on new strategies to get effective interventions to the people faster and try to remove ineffective ones. The conference gave me many ideas to narrow my scope for my dissertation, several contacts for me to follow-up with, and a call to the field to incorporate theory better into D&I science.
From Helen Etya’ale:
As a first year, PhD Student, it was incredibly insightful for me to attend. I was exposed to so much of the conversations happening in this field, which is itself still developing. It was great to witness that, it is not rigid and there’s room for voices to come in and shape the conversation. Like seeing how the cake is being made! I was aware of the prominent place that WashU plays in shaping the field as well, but the conference definitely drove that home even more – to see our very own, such as Enola Proctor, Ross Brownson, Elvin Geng, Byron Powell, Ana Baumann featured, quoted, and referenced.
I was also interested in the new directions or intersections with the D&I field that were raised. Some mentioned the work around mechanisms, which is still new but has a lot of potential. For me, that is one of the areas that makes D&I interesting. Even if we can use frameworks and map out strategies to improve practice/enhance uptake of interventions, the question of how the successful approaches work is the real “secret sauce”. Personally, I think figuring that out helps inform how we can replicate and/or adapt in other settings.