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Implementation Research at NHLBI: Methodological and Design Challenges and Lessons Learned from the DECIPHeR
David M Murray1, Patrick Heagerty2, James Troendle3
1National Institutes of Health, Bethesda, MD.
Ethnicity & Disease
|June 7, 2024
Summary
The Disparities Elimination through Coordinated Interventions to Prevent and Control Heart and Lung Disease Risk (DECIPHeR) Initiative faced challenges in implementation research. Key lessons learned emphasize focusing on implementation outcomes and refining study designs for complex interventions.
Area of Science:
- Implementation science
- Public health research
- Health disparities
Background:
- The National Heart, Lung, and Blood Institute (NHLBI) funded the Disparities Elimination through Coordinated Interventions to Prevent and Control Heart and Lung Disease Risk (DECIPHeR) Initiative.
- Seven projects aimed to reduce cardiovascular and pulmonary health disparities in high-burden communities using evidence-based multilevel interventions.
Purpose of the Study:
- To highlight methodological and study design challenges encountered in implementation research within the DECIPHeR Initiative.
- To share lessons learned for improving the design and execution of future implementation studies.
Main Methods:
- Projects utilized validated implementation research frameworks and designs, focusing on implementation measures as primary outcomes.
- A Technical Assistance Workgroup provided support to refine study aims, research designs, and analytic plans.
Main Results:
- Challenges included distinguishing intervention from implementation strategies, addressing clustering and cross-classification in analyses, and accommodating time-varying effects in stepped-wedge designs.
- A critical need for greater emphasis on implementation outcomes and data-based sample size estimation was identified.
Conclusions:
- Refining study designs to prioritize implementation outcomes is crucial for effectively reducing health disparities.
- Addressing complex methodological issues is essential for successful population health improvement initiatives.
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