Peter S. Hovmand

Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda.

An unresolved issue in the field of implementation research is how to conceptualize and evaluate successful implementation. This paper advances the concept of “implementation outcomes” distinct from service system and clinical treatment outcomes. This paper proposes a heuristic, working “taxonomy” of eight conceptually distinct implementation outcomes—acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability—along with their nominal definitions. We propose a two-pronged agenda for research on implementation outcomes. Conceptualizing and measuring implementation outcomes will advance understanding of implementation processes, enhance efficiency in implementation research, and pave the way for studies of the comparative effectiveness of implementation strategies.

Implementation of Evidence-Based Practice in Community Behavioral Health: Agency Director Perspectives

Despite a growing supply of evidence-based mental health treatments, we have little evidence about how to implement them in real-world care. This qualitative pilot study captured the perspectives of agency directors on the challenge of implementing evidence-based practices in community mental health agencies. Directors identified challenges as limited access to research, provider resistance, and training costs. Director leadership, support to providers, and partnerships with universities were leverage points to implement evidenced-based treatments. Directors’ mental models of EBP invoked such concepts as agency reputation, financial solvency, and market niche. Findings have potential to shape implementation interventions.

Community based system dynamics

Preface and acknowledgements 1. Introduction to community based system dynamics (CBSD) 2. Group model building and community based system dynamics process 3. Engaging communities 4. Problem scoping and identification 5. Core modeling team planning, training, and capacity building 6. Group model building workshop and facilitation 7. Model Refinement, synthesis, formulation, and analysis 8. Implementation and evaluation 9. Conclusion

ADOPTING AND TEACHING EVIDENCE-BASED PRACTICE IN MASTER'S-LEVEL SOCIAL WORK PROGRAMS

This article makes specific suggestions for teaching evidence-based practice (EBP) in the masters-in-social-work (MSW) curriculum. The authors use the model of EBP as it was originally conceived: a process for posing empirically answerable questions, finding and evaluating the best available evidence, and applying that evidence in conjunction with client characteristics and practitioner judgment. The authors suggest that EBP, in its original form, is both sufficiently well operationalized and flexible to serve as a primary paradigmatic component of social work education. Furthermore, EBP carries a series of distinct advantages for MSW education that have not been widely recognized to date. These include the provision of a structure for more explicitly recognizing client factors, bridging the micro–macro and researcher–clinician divides, and emphasizing the professionalism of MSW-level practice. Specific curricular components are proposed and discussed.

Implementation of Evidence-Based Practice and Organizational Performance

Administrators of mental health services may expect evidence-based practice (EBP) to offer strategic benefits. Existing theory suggests that the benefits of implementing EBP vary by organizational characteristics. This paper presents a conceptual framework for considering how implementation impacts organizational performance. The framework is developed as a system dynamics simulation model based on existing literature, organizational theory, and key informant interviews with mental health services administrators and clinical directors. Results from the simulations show how gains in performance depended on organizations’ initial inertia and initial efficiency and that only the most efficient organizations may see benefits in organizational performance from implementing EBP. Implications for administrators, policy makers, and services researchers are discussed.

The 2011–2016 Transdisciplinary Research on Energetics and Cancer (TREC) Initiative: Rationale and Design

PurposeRecognition of the complex, multidimensional relationship between excess adiposity and cancer control outcomes has motivated the scientific community to seek new research models and paradigms.MethodsThe National Cancer Institute developed an innovative concept to establish a center grant mechanism in nutrition, energetics, and physical activity, referred to as the Transdisciplinary Research on Energetics and Cancer (TREC) Initiative. This paper gives an overview of the 2011–2016 TREC Collaborative Network and the 15 research projects being conducted at the centers.ResultsFour academic institutions were awarded TREC center grants in 2011: Harvard University, University of California San Diego, University of Pennsylvania, and Washington University in St. Louis. The Fred Hutchinson Cancer Research Center is the Coordination Center. The TREC research portfolio includes three animal studies, three cohort studies, four randomized clinical trials, one cross-sectional study, and two modeling studies. Disciplines represented by TREC investigators include basic science, endocrinology, epidemiology, biostatistics, behavior, medicine, nutrition, physical activity, genetics, engineering, health economics, and computer science. Approximately 41,000 participants will be involved in these studies, including children, healthy adults, and breast and prostate cancer survivors. Outcomes include biomarkers of cancer risk, changes in weight and physical activity, persistent adverse treatment effects (e.g., lymphedema, urinary and sexual function), and breast and prostate cancer mortality.ConclusionThe NIH Science of Team Science group will evaluate the value added by this collaborative science. However, the most important outcome will be whether this transdisciplinary initiative improves the health of Americans at risk of cancer as well as cancer survivors.

A Novel System Dynamics Model of Female Obesity and Fertility

OBJECTIVES Our objective was to create a system dynamics model specific to weight gain and obesity in women of reproductive age that could inform future health policies and have the potential for use in preconception interventions targeting obese women. METHODS We used our system dynamics model of obesity in women to test various strategies for family building, including ovulation induction versus weight loss to improve ovulation. Outcomes included relative fecundability, postpartum body mass index, and mortality. RESULTS Our system dynamics model demonstrated that obese women who become pregnant exhibit increasing obesity levels over time with elevated morbidity and mortality. Alternatively, obese women who lose weight prior to pregnancy have improved reproductive outcomes but may risk an age-related decline in fertility, which can affect overall family size. CONCLUSIONS Our model highlights important public health issues regarding obesity in women of reproductive age. The model may be useful in preconception counseling of obese women who are attempting to balance the competing risks associated with age-related declines in fertility and clinically meaningful weight loss.

Evaluation of Active Living by Design: Implementation Patterns Across Communities

BACKGROUND Twenty-five cross-sector, multidisciplinary community partnerships received funding through the Active Living by Design (ALbD) national program to design, plan, and implement innovative initiatives to support active living. PURPOSE This paper examines implementation patterns across ALbD community partnerships related to community characteristics; preparation efforts; and policy, environmental, programmatic, and promotional strategies. METHODS Investigators used a mixed-methods, participatory evaluation design, triangulating multiple qualitative and quantitative data sources collected from 2007 to 2009. Configural frequency analysis facilitated detection of variables as well as configurations of variables occurring more (types) or less (anti-types) frequently than patterns expected by chance alone. RESULTS Overall, community partnerships with more preparation activities (assessment, sustainability) implemented a larger number of active living promotions, programs, policy influences, and physical projects, cumulatively (type). Yet, community partnerships working in communities with >40% of the population from a non-Caucasian racial and ethnic background and >40% of the population in poverty implemented fewer active living promotions, programs, policy influences, and physical projects, cumulatively (type). CONCLUSIONS The resulting types and anti-types provide insight into patterns across communities that may be ascribed to varying configurations of community contexts, resources, and strategies implemented. Rigorous, systematic examination of the underlying causal structures related to the configurations of community characteristics, preparation efforts, and implementation strategies is needed.

Sequence and Timing of Three Community Interventions to Domestic Violence

Community responses to domestic violence typically involve the introduction of multiple interventions. Yet very little is known about the impact of the timing and sequencing of these interventions on community outcomes. A reason for this is the inherent limitations of traditional methods in social science. New methods are needed to understand the effect of varying the sequence and timing of interventions. This study responds to the issue by introducing system dynamics as a method for modeling community interventions. The paper presents a model of domestic violence cases moving through a criminal justice response, and uses the simulation model to evaluate the impact of implementing three interventions—mandatory arrest, victim advocacy, and changes in level of cooperation—on two system-level outcomes: improving offender accountability and increasing victim safety. Results illustrate the complex nature of these relationships. Implications for community practice and future research are also discussed.

Applying Systems Science to Evaluate a Community-Based Social Marketing Innovation A Case Study

In the United States, community coalitions are an important part of the public health milieu, and thus, subject to many of the same external pressures as other organizations—including changes in required strategic orientation. Many funding agencies have shifted their funding agenda from program development to policy change. Thus, the Florida Prevention Research Center created the Community-Based Prevention Marketing (CBPM) for Policy Development framework to teach community coalitions how to apply social marketing to policy change. The research reported here was designed to explicate the framework’s theory of change. We describe and demonstrate a hybrid evaluation approach: utilization-focused developmental evaluation. The research question was “What are the linkages and connections among CBPM inputs, activities, immediate outcomes, intermediate outcomes, and ultimate impacts?” We implemented a case study design, with the case being a normative community coalition. The study adhered to a well-developed series of steps for system dynamics modeling. Community coalition leaders may expect CBPM to provide immediate gains in coalition performance. Results from causal diagramming show how gains in performance are delayed and follow an initial decline in performance. We discuss the practical implications for CBPM’s developers—for example, importance of managing coalition expectations—and other social marketers—for example, expansion of the evaluation toolkit.