![Page 1: Theories, Models, Frameworks: A Practical Application](https://reader033.vdocuments.us/reader033/viewer/2022050512/6271f48cb27bf005c45f1d14/html5/thumbnails/1.jpg)
Theories, Models, Frameworks:A Practical ApplicationRajesh Vedanthan, MD MPHDirector, Section for Global HealthAssociate Professor, Departments of Population Health and MedicineNYU Grossman School of Medicine
![Page 2: Theories, Models, Frameworks: A Practical Application](https://reader033.vdocuments.us/reader033/viewer/2022050512/6271f48cb27bf005c45f1d14/html5/thumbnails/2.jpg)
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
U01HL138636U01HL142099 R01MH118075R21HL14047414SFRN20490315
![Page 3: Theories, Models, Frameworks: A Practical Application](https://reader033.vdocuments.us/reader033/viewer/2022050512/6271f48cb27bf005c45f1d14/html5/thumbnails/3.jpg)
Knowledge-Practice (Know-Do) Gap
3
![Page 4: Theories, Models, Frameworks: A Practical Application](https://reader033.vdocuments.us/reader033/viewer/2022050512/6271f48cb27bf005c45f1d14/html5/thumbnails/4.jpg)
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
![Page 5: Theories, Models, Frameworks: A Practical Application](https://reader033.vdocuments.us/reader033/viewer/2022050512/6271f48cb27bf005c45f1d14/html5/thumbnails/5.jpg)
Research Pipeline
5
Dissemination
Scale Up
Scale Out
![Page 6: Theories, Models, Frameworks: A Practical Application](https://reader033.vdocuments.us/reader033/viewer/2022050512/6271f48cb27bf005c45f1d14/html5/thumbnails/6.jpg)
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.
![Page 7: Theories, Models, Frameworks: A Practical Application](https://reader033.vdocuments.us/reader033/viewer/2022050512/6271f48cb27bf005c45f1d14/html5/thumbnails/7.jpg)
Theories, Models, Frameworks—Why?
7https://impsciuw.org/research/frameworks/
![Page 8: Theories, Models, Frameworks: A Practical Application](https://reader033.vdocuments.us/reader033/viewer/2022050512/6271f48cb27bf005c45f1d14/html5/thumbnails/8.jpg)
Implementation Research
Vedanthan (2011) MSJM
![Page 9: Theories, Models, Frameworks: A Practical Application](https://reader033.vdocuments.us/reader033/viewer/2022050512/6271f48cb27bf005c45f1d14/html5/thumbnails/9.jpg)
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
![Page 10: Theories, Models, Frameworks: A Practical Application](https://reader033.vdocuments.us/reader033/viewer/2022050512/6271f48cb27bf005c45f1d14/html5/thumbnails/10.jpg)
Implementation Research
Vedanthan (2011) MSJM
![Page 11: Theories, Models, Frameworks: A Practical Application](https://reader033.vdocuments.us/reader033/viewer/2022050512/6271f48cb27bf005c45f1d14/html5/thumbnails/11.jpg)
Mercer et al. (2019) Trials
Referral Networks
TertiaryNational Referral Hospital
(MTRH)
SecondarySub-County and County Hospitals
PrimaryHealth Centers and Dispensaries
![Page 12: Theories, Models, Frameworks: A Practical Application](https://reader033.vdocuments.us/reader033/viewer/2022050512/6271f48cb27bf005c45f1d14/html5/thumbnails/12.jpg)
Implementation Research
Vedanthan (2011) MSJM
![Page 13: Theories, Models, Frameworks: A Practical Application](https://reader033.vdocuments.us/reader033/viewer/2022050512/6271f48cb27bf005c45f1d14/html5/thumbnails/13.jpg)
Analyze Determinants• Context, Agency, Structure
Daivadanam et al. PLoS One 2019
![Page 14: Theories, Models, Frameworks: A Practical Application](https://reader033.vdocuments.us/reader033/viewer/2022050512/6271f48cb27bf005c45f1d14/html5/thumbnails/14.jpg)
Implementation Research Frameworks—PRECEDE-PROCEED
14Green and Kreuter (1999)
![Page 15: Theories, Models, Frameworks: A Practical Application](https://reader033.vdocuments.us/reader033/viewer/2022050512/6271f48cb27bf005c45f1d14/html5/thumbnails/15.jpg)
Process Model—PRECEDE-Proceed
Mercer et al. Forthcoming
![Page 16: Theories, Models, Frameworks: A Practical Application](https://reader033.vdocuments.us/reader033/viewer/2022050512/6271f48cb27bf005c45f1d14/html5/thumbnails/16.jpg)
Process Map – Task Map
Pathak et al. Forthcoming
![Page 17: Theories, Models, Frameworks: A Practical Application](https://reader033.vdocuments.us/reader033/viewer/2022050512/6271f48cb27bf005c45f1d14/html5/thumbnails/17.jpg)
Implementation Research
Vedanthan (2011) MSJM
![Page 18: Theories, Models, Frameworks: A Practical Application](https://reader033.vdocuments.us/reader033/viewer/2022050512/6271f48cb27bf005c45f1d14/html5/thumbnails/18.jpg)
Intervention/Strategy Selection• Patient-focused• Provider-focused• Education• Feedback/Reminders• Patient safety• Organizational change• Economic strategies• Policy/Regulation• Multifaceted
![Page 19: Theories, Models, Frameworks: A Practical Application](https://reader033.vdocuments.us/reader033/viewer/2022050512/6271f48cb27bf005c45f1d14/html5/thumbnails/19.jpg)
DESIGN THINKINGDesigner's sensibility and methods to match:
• Desirability (people’s needs)
• Feasibility (social, political, technological, cultural)
• Viability (economic, sustainable, scalable)
![Page 20: Theories, Models, Frameworks: A Practical Application](https://reader033.vdocuments.us/reader033/viewer/2022050512/6271f48cb27bf005c45f1d14/html5/thumbnails/20.jpg)
Designer’s Sensibility:Integrative Thinking
ANALYTICAL THINKING
Deductive reasoning
Inductive reasoning
INTUITIVE + IMAGINATIVE THINKING
Abductivereasoning
INTEGRATIVE THINKING
![Page 21: Theories, Models, Frameworks: A Practical Application](https://reader033.vdocuments.us/reader033/viewer/2022050512/6271f48cb27bf005c45f1d14/html5/thumbnails/21.jpg)
![Page 22: Theories, Models, Frameworks: A Practical Application](https://reader033.vdocuments.us/reader033/viewer/2022050512/6271f48cb27bf005c45f1d14/html5/thumbnails/22.jpg)
![Page 23: Theories, Models, Frameworks: A Practical Application](https://reader033.vdocuments.us/reader033/viewer/2022050512/6271f48cb27bf005c45f1d14/html5/thumbnails/23.jpg)
Reduces spillage by over 80%!
![Page 24: Theories, Models, Frameworks: A Practical Application](https://reader033.vdocuments.us/reader033/viewer/2022050512/6271f48cb27bf005c45f1d14/html5/thumbnails/24.jpg)
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
![Page 25: Theories, Models, Frameworks: A Practical Application](https://reader033.vdocuments.us/reader033/viewer/2022050512/6271f48cb27bf005c45f1d14/html5/thumbnails/25.jpg)
STRENGTHS
![Page 26: Theories, Models, Frameworks: A Practical Application](https://reader033.vdocuments.us/reader033/viewer/2022050512/6271f48cb27bf005c45f1d14/html5/thumbnails/26.jpg)
Implementation Research
Vedanthan (2011) MSJM
![Page 27: Theories, Models, Frameworks: A Practical Application](https://reader033.vdocuments.us/reader033/viewer/2022050512/6271f48cb27bf005c45f1d14/html5/thumbnails/27.jpg)
STRENGTHS: Cluster RCT
![Page 28: Theories, Models, Frameworks: A Practical Application](https://reader033.vdocuments.us/reader033/viewer/2022050512/6271f48cb27bf005c45f1d14/html5/thumbnails/28.jpg)
The PRagmatic-Explanatory Continuum Indicator Summary 2 (PRECIS-2) wheel
Kirsty Loudon et al. BMJ 2015;350:bmj .h2147
![Page 29: Theories, Models, Frameworks: A Practical Application](https://reader033.vdocuments.us/reader033/viewer/2022050512/6271f48cb27bf005c45f1d14/html5/thumbnails/29.jpg)
Pragmatic vs. Explanatory
![Page 30: Theories, Models, Frameworks: A Practical Application](https://reader033.vdocuments.us/reader033/viewer/2022050512/6271f48cb27bf005c45f1d14/html5/thumbnails/30.jpg)
Pragmatic vs. Traditional
30Krist, et al. (2012) Imp Sci
![Page 31: Theories, Models, Frameworks: A Practical Application](https://reader033.vdocuments.us/reader033/viewer/2022050512/6271f48cb27bf005c45f1d14/html5/thumbnails/31.jpg)
Pragmatic vs. Traditional
31
![Page 32: Theories, Models, Frameworks: A Practical Application](https://reader033.vdocuments.us/reader033/viewer/2022050512/6271f48cb27bf005c45f1d14/html5/thumbnails/32.jpg)
Implementation Research
Vedanthan (2011) MSJM
![Page 33: Theories, Models, Frameworks: A Practical Application](https://reader033.vdocuments.us/reader033/viewer/2022050512/6271f48cb27bf005c45f1d14/html5/thumbnails/33.jpg)
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
![Page 34: Theories, Models, Frameworks: A Practical Application](https://reader033.vdocuments.us/reader033/viewer/2022050512/6271f48cb27bf005c45f1d14/html5/thumbnails/34.jpg)
![Page 35: Theories, Models, Frameworks: A Practical Application](https://reader033.vdocuments.us/reader033/viewer/2022050512/6271f48cb27bf005c45f1d14/html5/thumbnails/35.jpg)
Process evaluation
![Page 36: Theories, Models, Frameworks: A Practical Application](https://reader033.vdocuments.us/reader033/viewer/2022050512/6271f48cb27bf005c45f1d14/html5/thumbnails/36.jpg)
NYU School of Medicine36
Process EvaluationThe Saunders Framework
![Page 37: Theories, Models, Frameworks: A Practical Application](https://reader033.vdocuments.us/reader033/viewer/2022050512/6271f48cb27bf005c45f1d14/html5/thumbnails/37.jpg)
STRENGTHS Process Evaluation – Methods
NYU School of Medicine37
Process Evaluation Component Data Collection Method
Objective Structured Clinical Examinations (OSCEs)
![Page 38: Theories, Models, Frameworks: A Practical Application](https://reader033.vdocuments.us/reader033/viewer/2022050512/6271f48cb27bf005c45f1d14/html5/thumbnails/38.jpg)
Implementation Research
Vedanthan (2011) MSJM
![Page 39: Theories, Models, Frameworks: A Practical Application](https://reader033.vdocuments.us/reader033/viewer/2022050512/6271f48cb27bf005c45f1d14/html5/thumbnails/39.jpg)
![Page 40: Theories, Models, Frameworks: A Practical Application](https://reader033.vdocuments.us/reader033/viewer/2022050512/6271f48cb27bf005c45f1d14/html5/thumbnails/40.jpg)
THANK YOU