Projects

Our project page provides NEISE members a place to showcase their implementation science awards and projects! We hope this space can be a resource for collaboration and for highlighting institutional strengths as we all write new proposals. Fill out the form to let us know a bit about a project you would like us to feature.

Implementing postpartum family planning services in Kigali, Rwanda

The Icyemezo Cyacu study (which means ‘Our choice’ in Kinyarwanda) is a project that seeks to implement high-quality, cost-effective, and sustainable postpartum family planning services in Kigali, the capital of Rwanda.

 

Multilevel Barriers and Facilitators to Addressing Disparities in Perinatal Mental Health

Black perinatal women face significant mental health disparities. In particular, Black women are at increased risk for trauma and stressor-related disorders, which have been shown to be associated with significantly increased risk for severe maternal morbidity. Few Obstetric departments screen patients for trauma and stressor-related disorders, and Black women are less likely to be insured and have access to perinatal care. To begin to address disparities in unmet trauma and stress needs among Black perinatal women, we propose a sequential mixed-method study with three aims: (1) utilizing data from the National Survey on Drug Use and Health (NSDUH), identify determinants of mental health treatment utilization and unmet mental health needs among a national sample of Black women of reproductive age (18-44 years) with serious psychological distress; (2) to contextualize findings from Aim 1, use the patient-centered access framework to analyze data from 5 focus groups with Black perinatal women living in two urban areas (n=40) to understand barriers and facilitators to accessing perinatal mental health supports and recommendations to improve access; and (3) conduct semi-structured interviews with 20 OB providers and administrators from two urban, safety-net hospital systems serving primarily Black patient populations to assess provider and systems-level barriers and facilitators to conducting trauma and stress-related screenings and referrals. Achieving the aims of this study will lead to the identification of multilevel barriers and facilitators to addressing unmet mental health needs among Black perinatal women experience trauma and stress. By utilizing a mixed-methods approach that integrates national estimates with contextualized patient, provider, and administrator perspectives, this study will generate targeted policy and program-based recommendations to promote access to trauma and stress-related screenings and services for Black perinatal women in order to reduce disparities in maternal morbidity.

  • Funder: R36/Agency for Healthcare Research & Quality (AHRQ)

  • NEISE contact: Marcia J. Ash (mjash@emory.edu)

  • Project period: 2022-2024

 

Implementing Family-Driven Behavioral Health Services in the Juvenile Justice System

Engaging families in behavioral health services is a high priority area for juvenile justice systems and family advocacy groups across the country. Family engagement in juvenile justice settings improves youth, family, and community wellbeing. However, there is little guidance on how to integrate evidence-based family engagement strategies in the criminal justice setting. The goal of the Juvenile Justice Family Engagement Study, led by Kaitlin Piper, is to understand factors that promote integration and scale-up of family engagement strategies in juvenile justice systems. We will conduct surveys and interviews with justice-involved families and juvenile justice staff to understand barriers and facilitators to family engagement in behavioral health services within justice settings.

  • Funder: National Institute on Drug Abuse

  • NEISE contact: Kaitlin Piper (kaitlin.piper@emory.edu)

  • Project period: 2021-2024

 

The Integrating HIV and hEART health in South Africa (iHEART-SA) project

South Africa is home to the largest number of people living with HIV worldwide. An estimated 5 million people receive care and anti-retroviral therapies at clinics around the country. However, as this population experiences greater longevity, they are at risk for chronic cardio-metabolic conditions like hypertension and diabetes, which often go unrecognized and untreated, leading to a new burden of heart disease and strokes in this population.

We will implement and evaluate interventions for integrating blood pressure measurement and management into HIV care clinics. To make sure that these interventions are relevant and easy to implement, they will be co-designed with the relevant local and international stakeholders. The resulting package of services will be implemented, in the Johannesburg inner city, and later, scaled-up to rural KwaZulu-Natal.

 

An Interactive Systems Approach to Ending the HIV Epidemic Among Women in Atlanta

Supply and demand constraints have affected PrEP scale-up for cisgender women in the Southern US. PrEP use requires ensuring that cisgender women who can benefit from PrEP are aware of it (i.e., demand side) and ensuring PrEP is accessible in settings where cisgender women seek care (i.e., supply side). Anchoring PrEP care to Title X-funded family planning services that cisgender women already trust, access routinely, and deem useful for their sexual health is of great appeal, as it offers an ideal opportunity to reach women who may benefit from PrEP. In Georgia, the state with the highest rate of new HIV diagnoses, our work demonstrates that many Title X family planning clinics do not provide PrEP. Our research also shows low PrEP awareness and use among Atlanta cisgender women. Further, our Atlanta-based family planning-focused PrEP implementation research indicates that even when FP clinics offer PrEP, few cisgender women uptake PrEP, and providers note continued discomfort with screening, recommending and counseling about PrEP. Lessons learned from HPV vaccine and contraception rollout demonstrates that awareness and availability alone may not be sufficient; moving cisgender women from PrEP awareness to uptake demands alternative delivery models, inclusive of women’s perspectives, to overcome other factors impeding women from using PrEP. Improving PrEP reach among cisgender women may therefore require more effectively engaging them in the development of appropriated and acceptable patient-centered PrEP care approaches to support uptake.

In the proposed project, we will (Aim 1) use the Interactive Systems Framework to employ tailored implementation strategies informed by our extensive prior work to support PrEP adoption and implementation across Atlanta Title X clinics (addressing supply-side barriers); (Aim 2) use an evidence-based Community Organizing Approach to raise awareness, interest, and connection to PrEP among cisgender women (addressing demand-side barriers); and (Aim 3) innovatively use human centered design (HCD), a patient-centered methodology that brings bringing end-users and developers together to co-create care delivery strategies, to bring Southern women’s voices into the development of PrEP care delivery strategies. Given limited research pertaining to strategies to increase PrEP reach among cisgender women in the South, findings from each aim will independently fill numerous gaps for optimizing clinic and community strategies to strengthen HIV prevention for Southern women. Given our collaboration with Georgia Family Planning System (Georgia’s Title X grantee), Atlanta area Title X clinics, and robust partnerships with sexual health CBOs (led by SisterLove), we are uniquely positioned to mount a coordinated approach across diverse Atlanta counties built around our clinic-academic-CBO collaboration to strengthen HIV prevention for women, and importantly, to create a sustainable systems approach to move new HIV prevention (and sexual health) innovations more quickly to women.

  • Funder: National Institute of Mental Health (NIMH)

  • NEISE contact: Jessica Sales (jmcderm@emory.edu), Anandi Sheth (ansheth@emory.edu)

 

Implementation of the functional outcome measures in post-acute care facilities

As a LeaRRn scholar, Dr. Krishnan will be working with the team of Boston Medical Center under the mentorship of Dr. Mary Slavin. Dr. Krishnan will implement the functional outcome measures in post-acute care.

 
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Multi-Institutional Implementation of Quality Decisions: a Clinical Decision Support Analytics Tool to Drive Outcomes

Phrase Health is a clinical decision support (CDS) analytics company that empowers health systems to deliver high value clinical care through data-driven improvements of CDS. CDS enhances health‐related decisions and actions with pertinent, organized clinical knowledge, and patient information. For example, physicians may have trouble remembering to order all guideline-recommended care for sepsis. CDS delivered via an order set in the electronic health record (EHR) can simplify this process and reduce mortality by bundling the recommended diagnostic and therapeutic orders together. However, CDS may fail to improve outcomes because: (1) the CDS tool is underutilized; (2) the user may not follow the recommended action from the CDS; (3) the recommended action may not lead to the appropriate evidence-based practice (EBP); and/or (4) the EBP may not translate to the expected outcome in a novel population. Healthcare organizations need an efficient, rigorous, and scalable process evaluation method to diagnose when and why CDS is not leading to the intended improvements.

In Phase 1, our team demonstrated the technical feasibility and usability of a new software product, Quality Decisions, that guides quality improvement (QI) advocates of all experience levels to (1) rigorously evaluate the impact of CDS on clinical outcomes and (2) convert data-driven insights into action. In this Phase 2 proposal, we will use the RE-AIM framework to evaluate implementation of Quality Decisions at three diverse health systems (Children’s Healthcare of Atlanta, Children’s Hospital of Philadelphia, and The University of Vermont Health Network). In Aim 1 of this proposal, we will evaluate the implementation effectiveness of Quality Decisions. Our primary outcome will be how often the software leads to (1) new QI or CDS intervention(s), (2) increased confidence in CDS effectiveness, or (3) changes in cohort or measure definitions. Using mixed methods including surveys, log data, and focus groups, we will evaluate implementation efficacy, adoption, and fidelity. We will also assess implementation barriers and facilitators using the Consolidated Framework for Implementation Research.

In Aim 2, we will determine the customer resources required to implement Quality Decisions at scale. In a pilot phase, each health system will implement the software for a limited number of CPGs and collect hours of work required to get the software up and running. In an expansion phase, we will estimate the number of institutional CPGs that could feasibly be incorporated into the software and the number actually built in one year. At the end of this project, we will have collected the primary data required to commercialize our software to potential customers including (1) a description of the customer resource requirements to use the software across CPGs in a health system and (2) implementation outcomes demonstrating that users use the software frequently as intended and gain meaningful insights. These data will demonstrate value for future customers and investors, allowing us accelerate the translation of knowledge into better health outcomes.

 

Assessment of Gender & Social Inclusion in the RISE (Revitalizing Informal Settlements and their Environments) Trial

This project is part of the Water for Women Fund and operates as a sub-study within the Revitalizing Informal Settlements and their Environments (RISE) trial. RISE is a randomized controlled trial that aims to assess the impact of water-sensitive infrastructure upgrades on environmental, ecological, and human health and well-being in 24 sites in Fiji and Indonesia. The intervention involves an intensive co-design process by which residents share perspectives that shape the site-specific infrastructure design plans. The Water for Women sub-study is using quantitative and qualitative methods, guided by the Consolidated Framework for Implementation Research (CFIR), to identify the key elements of the intersectional gender and socially inclusive community engagement and co-design approach used in RISE. The study also examines the impact of the RISE approach on diverse women and men’s resources to respond to shocks and crises, including COVID-19, as measured through their social capital.

 

Exemplars in Global Health: Vaccine Delivery

The vaccine exemplar project is one in a series of exemplar projects funded by The Bill & Melinda Gates Foundation in conjunction with Gates Ventures. We seek to identify and understand “exemplar” immunization programs at a national and subnational level which performed better than their peers in driving improvements in high and sustainable vaccine coverage. This research will explore the catalysts, motivators, change management, and implementation success factors through a multidisciplinary approach. The goal of the vaccine exemplar project is to generate actionable recommendations to the foundation, its partners, and to the global health community at large.

 

Examining multilevel barriers and facilitators to implementation of evidence-based genetic risk-stratified breast cancer screening

This project aims to explore primary care providers’ and institution leadership staff’s perceptions of genetic risk-stratified breast cancer screening guideline, and their perceived barriers and facilitators to its implementation in different primary care settings across Georgia. Taken together with our prior work on patients’ responses to risk-stratified guidelines, this project will add insights regarding provider and influential stakeholder factors that would need to be considered for successful guideline implementation.

 

Rural Sanitation Sustainability Review

This study applies a case study approach to assessing the impact and sustainability of the SSH4A approach, implemented by SNV: Netherlands Development Organization. The purpose of this qualitative research is to thoroughly describe rural sanitation service delivery modalities in Africa and Asia, highlight context-specific adaptations to universal frameworks, and address common challenges to sustaining latrine coverage and usage. Findings from this research can be used by international organizations to develop, describe, and adapt established modalities for rural sanitation programs focused on technical support and capacity building. We plan to develop an evidence-based theory of change for rural sanitation service delivery targeting universal, equitable coverage. Case studies include Western Kenya, Northern Zambia, and Siraha district in Nepal.

 

School Water, Sanitation and Hygiene plus Community Impact (SWASH+)

The SWASH+ project was an action‐research and advocacy project focusing on increasing the scale, impact, and sustainability of school water, sanitation, and hygiene (WASH) programming in Kenya. Funded by the Bill & Melinda Gates Foundation, the project was a 13 year partnership between CARE, Emory University and the Government of Kenya, with other partners involved at various stages. This lasting partnership has helped improve the quality of life and learning environment for school children across Kenya. Through evidence-based advocacy we have increased school WASH funding, enabled the adoption of WASH curriculum and materials, developed a school WASH sustainability charter, increased attention for menstrual hygiene and developed tools for school stakeholders to use in procuring private sector sanitation services, and in budgeting for WASH. Over 20 publications from SWASH+ have help demonstrate the tremendous importance of school WASH.