Dalla Lana School of Public Health

Application of Implementation Science in Global Health

Course Description:

This course is an introduction to implementation science with an emphasis on its application in global health. Implementation science is the scientific study of methods to promote the systematic update of research findings and other evidence-based practices into routine practice, and hence, to improve the quality and effectiveness of health services. Implementation science requires interdisciplinary efforts, with an intent to understand what, why and how interventions work in real world settings and to test approaches to improve it. This course aims to fill the gap in DLSPH curricula to provide students an opportunity to understand the core concepts, theories and frameworks of implementation health research in global health setting, and what research methods of implementation science can be applied in tackling key global health challenges in low and middle income countries (LMICs). We will discuss implementation challenges such as ethics, research design, data collection, evaluation, quality improvement, policy update and scale-up as a continuum of implementation. Real-life cases in LMICs that applied implementation science will be explored on a variety of topics such as COVID-19, Ebola, tuberculosis, HIV, antimicrobial resistance, diabetes, hypertension, and maternal and child health. Students will form groups to apply implementation science frameworks and methods in critiquing, designing and evaluating approaches in implementing evidence-based health interventions in LMICs.

The course is intended to complement courses in knowledge Translation and Exchange (HAD 5727H), Population Health Intervention Research (CHL5132H), Theory and Practice of Program Evaluation (CHL5110H) and Public Health Policy (CHL5300H). The course director and co-instructors will make relevant adjustment for any duplications.

This course is intended for 2^nd year Master or PhD students in both Public Health Sciences (PHS) and the Institute of Health Policy Management and Evaluation (IHPME). Interested students are encouraged to contact the Course Director. Enrollment is limited to 12 students.

Course Objectives

This course aims to review the concept of and recent developments in implementation science; it introduces interdisciplinary theories, frameworks, and research tools to design and evaluate global health interventions, and how to facilitate scale-up research evidence into policy and practice; and explores research tools through case studies to identify and contextualize implementation successes and failures. Specifically, we will discuss how to evaluate and design complex interventions, the application of effectiveness trials and mixed methods studies in evaluating health interventions in LMICs.

By the end of the course, students should

• Be able to articulate the key concepts, theories and frameworks of implementation science and its application in responding to global health challenges;
• Explain various research methods and their applications in implementation science;
• Understand the ethical, program, health system and implementation issues and contextual factors in real-life cases in designing, implementing and evaluating health interventions;
• Be able to employ implementation science concepts to critique health interventions in LMICs;
• Be able to write a proposal employing implementation science frameworks and research methods to solve real-life health challenges.

Methods of Assessment

Grades will be based on three parts: participation (10%), mid-term critique (30%); group presentation (25%) and proposal (35%).

1. Participation (10 marks, 10% of total):

Students are expected to participate in at least 80% of the lectures and be actively engaged in the class discussions in each session to get the full marks of participation. Absence of one session without prior notice and approval from the instructor and course director will result in an automatic deduction of 2 marks (2%). Each student will have the chance of presenting a paper (preferably from the reading list) and leading the discussion of course reading. Marking of participation will be based on attendance, and participation in discussion (from full as leaders in discussion to little evidence of reading), and interaction (from actively engagement to no participation in discussions with others in the class or breakout rooms).

Participation Rubric was based on a publication by Adam Chapnick, “A Participation Rubric”, The Teaching Professor. March 2005, p4.

http://www46.homepage.villanova.edu/john.immerwahr/TP101/lects/participation%20matrix0001.pdf

2. Mid-term short critique (30 marks, 30%)

Students will write a short critique (1000 words maximum) to employing implementation science framework for a paper regarding health interventions in LMICs. Detailed guidance can be reached at:  Allyson Skene, The Writing Centre, UT Scarborough

https://www.utsc.utoronto.ca/twc/sites/utsc.utoronto.ca.twc/files/resource-files/CritReview.pdf

Grading will be based on overview of the topic (5 marks), list of key points (8 marks), balanced comments (3 marks), and logic and clarity (4 marks).

3. Presentation (25 marks, 25%)

Students will choose a topic with common interests for which an evidence-based intervention exists. The group will propose an implementation research study to test the implementation of interventions that will improve quality, health outcomes, and policy uptake. Each student will present the implementation science proposal. The presentation should include a description of the problem, gaps in knowledge, aims of the study and overall design, use of a particular implementation science framework, methodology, and data collection and analyses, knowledge dissemination and policy uptake strategies. Each group will have 15 minutes presentation, followed by another 5 minutes for questions and answers. Points will be given based on 1) content score (15 marks, 3 marks of each point): background regarding the problem, evidence based interventions, contexts and health systems, appropriate and sufficient use of evidence and adequate discussion of findings; and 2) presentation score (10 marks): clarity, organization, logic, visual layout, and time management. Any overdue of 3 minutes will result in 2 marks (2%) deducted.

4. Proposal (35 marks, 35%)

Students will be required to write the proposal based on presentation. This proposal should be focused on a specific component of project implementation such as needs assessment, pilot, process evaluation, outcome evaluation or scale-up.

The proposal will be in 5-6 page research proposal that fits into the format of CIHR/ tri-council rapid call of operational grants https://www.researchnet-recherchenet.ca/rnr16/vwOpprtntyDtls.do?prog=3248&printfriendly=true

The proposal will be evaluated based on:

• Adequately describe the health problem, the evidence-based interventions proposed, and the context; (5 marks)
• Clearly outline the research question, aim and objectives (this can fidelity assessment, process evaluation or complex evaluation); (5 marks)
• Employ one implementation science framework or theory; (5 marks)
• Appropriate research design that fits with the objective on how to evaluate the implementation using qualitative and/or quantitative methods, and the analyses plan; (10 marks)
• Appropriately outline the knowledge dissemination and scale-up plan (5 marks)
• logistic flow, clarity, conciseness and overall organization of the proposal (5 marks)