Commentary on “Addressing Crime, Violence, and Other Determinants of Health through Community-Based Participatory Research and Implementation Science”

The paper “Addressing Crime, Violence, and Other Determinants of Health through Community-Based Participatory Research and Implementation Science” by Stalker and others is an example of how implementation science methods can be combined with other disciplines to address system-level challenges to implementation. The need for implementation to address multiple levels of the social ecological model has been recognized in the implementation science literature,[1] but there are few examples of how exactly this can be done or who needs to be at the table. Similarly, it has been recognized that understanding barriers to implementation and developing and testing implementation strategies has to be a joint enterprise between researchers and practitioners[2], but the practitioners have traditionally meant program implementers, organizational leaders or service providers. Inputs of those at the receiving end of evidence-based programs or interventions, such as patients or those with lived experience in communities, are typically solicited to assess acceptability or appropriateness of interventions, but there are few examples of how patients or community members are included in the development of implementation strategies.

By contrast, fields such as design thinking or Community-Based Participatory Research emphasize the participation of users or customers of the system, and their involvement in solution development. However, without a formal process for identifying barriers to implementation, ideas or solutions created by the use of these methods can fail to be implemented because tools for formally assessing implementation outcomes, such as acceptability, feasibility or sustainability, are not built into these approaches. By combining the QUERI implementation science framework with a CBPR process, the authors have demonstrated how a community-engaged approach can be used to develop and adapt evidence-based solutions for system change, and how implementation science frameworks can guide the assessment of barriers to implementation. Many complex public health problems of today will benefit from this kind of approach.

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[1] Raghavan, R., Bright, C. L., & Shadoin, A. L. (2008). Toward a policy ecology of implementation of evidence-based practices in public mental health settings. Implementation Science, 3(1).

[2] Peterson, H. B., Haidar, J., Fixsen, D., Ramaswamy, R., Weiner, B. J., & Leatherman, S. (2018). Implementing innovations in global Womenʼs, Childrenʼs, and adolescentsʼ health. Obstetrics & Gynecology, 131(3)