Title
Integrative systems praxis for implementation research (INSPIRE): An implementation methodology to facilitate the global elimination of cervical cancer
Date Issued
01 September 2020
Access level
open access
Resource Type
journal article
Author(s)
Gravitt P.E.
Rositch A.F.
Jurczuk M.
Meza G.
Carillo L.
Jeronimo J.
Adsul P.
Nervi L.
Kathleen Tracy J.
Publisher(s)
American Association for Cancer Research Inc.
Abstract
Background: The World Health Organization (WHO) has called for a systems thinking approach to health systems strengthening to increase adoption of evidence-based interventions (EBI). The Integrative Systems Praxis for Implementation Research (INSPIRE) methodology operationalizes the WHO systems thinking framework to meet cervical cancer elimination–early detection and treatment (CC-EDT) goals. Methods: Using a systems thinking approach and grounded in the consolidated framework for implementation research, INSPIRE integrates multiple research methodologies and evaluation frameworks into a multilevel implementation strategy. Results: In phase I (creating a shared understanding), soft systems methodology and pathway analysis are used to create a shared visual understanding of the CC-EDT system, incorporating diverse stakeholder perspectives of the “what, how, and why” of system behavior. Phase II (finding leverage) facilitates active stakeholder engagement in knowledge transfer and decision-making using deliberative dialogues and multiple scenario analyses. Phase III (acting strategically) represents stakeholder-engaged implementation planning, using well-defined implementation strategies of education, training, and infrastructure development. In phase IV (learning and adapting), evaluation of key performance indicators via a reach, effectiveness, adoption, implementation, and maintenance framework is reviewed by stakeholder teams, who continuously adapt implementation plans to improve system effectiveness. Conclusions: The INSPIRE methodology is a generalizable approach to context-adapted implementation of EBIs. Impact: Replacing static dissemination of implementation “roadmaps” with learning health systems through the integration of systems thinking and participatory action research, INSPIRE facilitates the development of scalable and sustainable implementation strategies adapted to local contexts.
Start page
1710
End page
1719
Volume
29
Issue
9
Language
English
OCDE Knowledge area
Oncología
Scopus EID
2-s2.0-85100351696
PubMed ID
Source
Cancer Epidemiology Biomarkers and Prevention
ISSN of the container
10559965
Sponsor(s)
The authors would like to thank the stakeholders in the Ministry of Health, the DIRESA-Loreto, and the Micro Red Iquitos-Sur health network for their partnership in this implementation research study and the work of Jennifer Ríos, Gessy Salva, Rachel Morse, Jessica Mori, Andrea Dawson, Lorena Mestanza, Karina Román, Jhonny Cordova, Rosa Celis, Cecilia Montes, and Elizabeth Tracy. Members of the Proyecto PreCancer Study Group are as follows: Joanna Brown, Lita Carrillo, Patti E. Gravitt, JoséJerónimo, Alcedo Jorges, Magdalena Jurczuk, Margaret Kosek, Gabriela Ladrón de Guevarra, Renso Lopez, Graciela Meza, Reyles Ríos, Anne F. Rositch, Hermán Silva, Anna Smith, Valerie A. Paz-Soldan, Sandra Soto, Nolberto Tangoa, and Javier Vásquez. The Proyecto PreCancer group may be contacted via e-mail at proyectoprecancer@gmail.com. This work was funded through the NIH/NCI (grant ID: R01-CA190366, mPI to P.E. Gravitt/V.A. Paz-Soldan and grant ID: P30-CA118100-11S5, to project leaders P.E. Gravitt/L. Nervi, and principal investigator Cheryl Willman). Cepheid provided discounted HPV tests and instrument loans.
Sources of information: Directorio de Producción Científica Scopus