Implementation Science Podcast with Randy Schwartz and Justin Moore

Implementation Science Randy Schwartz

“[I]n the course of my career, I’ve really seen that there’s a strong mutual benefit for researchers and practitioners to work together and collaborate, particularly in… getting evidence-based work — public health research, tested interventions, things that are funded on a large scale for research and evaluation — in the literature; that’s really an opportunity for the practitioner to pick up on that and then have really good quality, evidence-based implementation.”

Today, Justin Moore, Associate Editor of the Journal of Public Health Management and Practice, speaks with JPHMP Editorial Board Member Randy Schwartz about the importance of implementation science to public health and his commentary “In Appreciation Of ‘Amplifying Practitioner Perspectives To Strengthen Implementation Science’ With Caveats,” published by Implementation Science News.

Moore and Schwartz also discuss their recent participation in the first Implementation Science Consortium in Cancer (ISCC) meeting, which focused on “developing a new approach to establish an expectation of how the field can work together to address key challenges and identify and develop areas of research that require ongoing relationship and facilitation towards advancing the implementation science agenda in cancer control.”     

Randy Schwartz is President of Public Health Systems Consultants, Inc., and an expert in leading the implementation and evaluation of public health promotion, disease prevention, and public health policy programs. He is recognized as a leader in evidence-based public health practice, with extensive experience in leading teams of skilled professionals in the development and delivery of public health and health policy initiatives involving policy, systems, and environmental change strategies.

Justin B. Moore is Associate Professor in the Department of Family & Community Medicine of the Wake Forest School of Medicine at the Wake Forest Baptist Medical Center in Winston-Salem, NC. He conducts community-engaged research focused on the dissemination and implementation of evidence-based strategies for the promotion of healthy eating and physical activity in youth. 

Read the transcript below:

Justin Moore: Hello, today I’m talking with Randy Schwartz. Mr. Schwartz is the President of Public Health Systems Consultants, Inc., and is a nationally recognized public health professional with over 30 years of experience in implementing health promotion and disease prevention initiatives with an emphasis on chronic disease prevention and control, cancer control, and community-based health promotion. Randy and I recently attended the first Implementation Science Consortium in Cancer meeting where the goal of the consortium was introduced. The mission of the consortium was to develop collaborative approaches to address key challenges in cancer prevention and control. So, welcome, Randy. Great to talk with you today.     

Randy Schwartz: Hi.

Justin Moore: So, in a previous commentary you made the case that the practice community should actively engage in initiatives such as this consortium. Why is the inclusion of public health practitioners in collaboration with researchers in the dissemination and implementation of evidence-based public health strategies important?       

Randy Schwartz: Well, yeah, thanks. So, in the course of my career I’ve really seen that there’s a strong mutual benefit for researchers and practitioners to work together and collaborate, particularly in exactly what we’re talking about, getting evidence-based work… public health research, tested interventions, things that are funded on a large scale for research and evaluation… and then get in the literature, that’s really an opportunity for the practitioner to pick up on that and then have really good quality, evidence-based implementation. The whole field of implementation science has really grown in the last decade, thanks to a number of folks at NCI and other places. But even before that there were a few large-scale national initiatives that I think provide great examples, a pair of which came from the National Cancer Institute, which were known as the acronyms the COMMIT program and the ASSIST program. [They] were really good examples of taking evidence-based work and implementing it in a quality approach in practice. So, these weren’t necessarily the cases of practitioner-researcher collaboration, making it happen, although I certainly think that was the case with COMMIT. In COMMIT, they really widely tested, around a number of sites around the country, tobacco intervention activities. The findings of that helped inform some the first state health department-based tobacco and control programs, like in California and Massachusetts. And with that, around the same time, some very visionary people  at NCI, Joe Cullen, Tom Glynn, and others, formulated the ASSIST program. This was before CDC had a tobacco program that funded the states. It took the findings from COMMIT and other work and identified what are evidence-based intervention strategies, and to their credit, also had a good amount of policy advocacy in that which was kind of a leap of faith, I think, for the scientific community as well. But we now know that it’s critical for tobacco, and they funded 17 state health departments. These state health departments implemented the ASSIST program through the 1990s, and with that really took what was evidence-based and then worked with coalition-based approaches, policy advocacy, health communications, community interventions, and clinical interventions like cessation, and put into practice in 17 states nationwide. Now, that’s a great example of accelerating the translation, or the pick-up, of evidence-based research and approaches into public health practice. And clearly, we really need more of that. As you know, there’s a good deal of the public health workforce that is not necessarily trained in public health. They arrived in their position through any number of other channels, and it’s important that as we’re addressing these huge public health issues, we’re implementing evidence-based approaches, or at least evidence-informed and even promising practices, so that an evidence-based approach is not necessarily just implementing the tested intervention strategy like a cookbook approach directly. We need some innovation. We need the ability to tailor and test. We need to go from smaller to larger or more widespread interventions for scalability. These are all the kind of things that practitioners are working on, but you know they really don’t have a lot of basis of working with researcher colleagues. So, I think it’s a mutual benefit. Researchers want to develop and test. They have a sort of publication imperative. And practitioners want to implement quality, evidence-based work so it will have an impact in public health practice in the field. I think the combination is critical. And I would add to that, that the third sort of leg of the stool is the community. So, in order for this to all work right, there’s the researcher, the practitioner, and the community engagement. If you put all that together, we could have a lot of success. And I think the work in implementation sciences over the last number of years has created a really good body of knowledge that adds to practitioner ability to do things well in the field. 

I think learning collaboratives provide a great opportunity to take work that’s been tested and translate that into application in various settings and bringing in experts and those working on implementation, trying to learn the best approaches and pulling them together.”

Justin Moore: It’s really fascinating to think about the progress that’s been made, you know, using tobacco as an example and then how there has been this bi-directional communication. It’s so crucial. It’s one thing to talk about having the research perspective, but even if it’s going to be useful research, it has to have that grounding in practice. I think you make a really good point there. So you’ve given us some good examples already, but you point out in some of your writing that there’s been considerable progress made in establishing these linkages and having this bi-directional flow of information. Are there other examples that you’d like to talk about to describe the progress that we’ve made in these linkages?

Randy Schwartz: Sure, and I would just add to the previous discussion, we now have the CDC National Tobacco Control Program and the Office on Smoking and Health is funding states, territories, and tribes nationwide as well as national networks. So that early work in COMMIT and ASSIST helps inform what’s now a nationwide program. I think that’s a great story of success. The commentary that you referred to by Margaret Farrell from NCI, I think is an important one. It was in their March 2019 Dispatches from Implementation Science at NCI, and she talked about the value and importance of strengthening implementation scientists via the practitioner engagement. And, of course, that’s where I’m advocating, and I agree greatly… many of us have heard the quote by Larry Green: “If we want more evidence-based practice, we need more practiced-base evidence.” And he’s been a great advocate for the true need to inform, as you said, a bi-directional, reciprocal approach for researchers and practitioners to be working together to really get some good, quality public health implementation and advance that translation. A number of other good examples, of course, I think as I’ve mentioned, is the community engagement. We’ve had a tremendous growth in community based participatory research… the CDC Prevention Research Centers, focused around CBPR. I think they provide a lot of good examples of researchers and practitioners working together. They have a network, the Cancer Prevention and Control Research Network, which funds the Coordinating Center and a number of centers around the country, and I think, for example, they do a good job really engaging researchers and practitioners in the work together. They look at implementation of cancer prevention control, for example, through federally qualified health centers, and through the lens of the rural cancer control issue, which is, of course, currently a very timely issue, looking at disparities based on a rural lens. We have some really strong tools. The Community Guide has been a great advent to this over the last several decades. And those folks working at CDC and the Community Preventive Services Task Force; that volunteer committee that worked on that have done a great service to the field by really doing systematic reviews, testing things, and then putting out their ratings. So, when we look at implementation in the field, we know, for example, that the colorectal cancer screening initiative… I mean, we know there’s been provider reminders, that patient outreach is removing the barriers in the system, for example, access to services, transportation, and hours of the site being open for certain types of testing, etc. So, the Community Guide gives tremendous amount of credibility to this, and the practitioner learning how to use tools like the Community Guide or the NCI site RTIPsand look at evidence-based programs and implement them, the practitioner also, as we talked about before, really needs to learn about tailoring, scalability, adaptation issues, which is all part of implementation science. We’ve seen a lot of work in the last few years around learning collaboratives. And I think learning collaboratives provide a great opportunity to take work that’s been tested and translate that into application in various settings and bringing in experts and those working on implementation, trying to learn the best approaches and pulling them together. And the learners, working with learners. So there’s been a lot of learning collaboratives around evidence-based approaches. My work has been based very much on cancer prevention control, so my examples relate to that, but  I was involved, for example, with a learning collaborative in New England when I was with the American Cancer Society at the time. And we worked with five New England states on work that had been done some years prior, a colorectal cancer learning collaborative led by Steve Taplin who had been at NCI. That, plus the Institute for Healthcare Improvement, the IHI breakthrough model, looking at quality improvement approaches. Put the two of them together and worked with a group of federally qualified health centers in a learning collaborative approach over the course of a year and each and everyone of the participating sites improved their screening rates. So models for implementation, getting the work out, models for application to be used by practitioners, I think I’ve learned a lot. NCI is also on the verge of funding some implementation science centers that are both in the category of developing and advance centers. And I think these sites have significant opportunity to engage the practice community in their area that they’ll be working in, as well as, of course, the community and community engagement. So it provides a great opportunity for the triad I talked about, the researcher, the practitioner, and the community with these newly funded sites. And the other thing to mention is, regarding Margaret Farrell’s commentary … some of that was based around NCI publishing a document this past year, which is excellent for the practitioner, Implementation Science at a Glance: A Guide for Cancer Control Practitioners. This document takes a lot of the concepts, puts it into public health practice language. I think it makes it very easy to understand. And they develop programs built around the principles and components of implementation science. I think we’re at a great point at this. There’s been some great work that’s been done, but there’s great opportunity ahead.

Justin Moore: As you’re talking about these linkages and the collaboration along the research to practice continuum, I’m also reminded of our failures as a field. And I think a lot of it has to do with researchers coming in and not understanding the landscape on the ground and trying to shoehorn efforts into a reality that they weren’t quite expecting. You mentioned community research and more interaction with CBPR and just how important that is because, in my opinion, it eliminates some of the surprises that you have with the truth on the ground, which is not exactly the truth in the ivory tower.

Randy Schwartz: Yeah, that’s a good comment. And a good thing to add to that is engagement early is a great thing. Same thing as we say, oh, you shouldn’t think about evaluation at the end. Well, you shouldn’t think about engaging the practice community, or the community at large, later after you have your findings. So the more you do that up front, I think it helps practitioners where a practitioner can gain a lot by working with a researcher colleague and not wait till something’s in the literature, you know, read it, figure out how to adapt it, but building a relationship and working in an interactive approach is really important. And the researcher, as you point out, can learn a whole lot from the practitioner as well as the community, as we know. So I think engagement early on is really an important part of a relationship process here.          

The researchers, of course, have their academic incentives to publish in these journals, but there’s also a great opportunity for researchers and practitioners to work together and be part of publications together as well as, of course, making sure that your community engaged participants are part of that as well. Publishing should involve all the people that are engaged, not just the researchers, who are funded, if you will.”

Justin Moore: Yeah, and you mentioned the work of folks like Ross Brownson and others in closing the gap, integrating practice, and bridging that to sustainability. And one of the strengths I think that people like Ross brings is that they often come from the practice world into academia, which to me grounds their work quite a bit. But in talking about that integration between practice and becoming standard practice that sustainability issue, which to me is the final frontier. You know we’ve got a lot of great examples of things that work really, really well until the funding is pulled, or work really, really well until that particular project comes to an end and they don’t sustain beyond that. But how do you think the thinking on that has evolved and how do you think these new efforts around implementation with an eye toward sustainability will benefit the field?          

Randy Schwartz: Yeah, there are a lot of good points in that question. First off, people like Ross Brownson and colleagues — these folks I mentioned at the Prevention Research Centers (CPCRN) — they’ve done a lot of good work in documenting what works and it’s been really valuable for the practitioner… such things as CDC’s online journal, for example, Preventing Chronic Disease, has also made this type of material way more accessible for the practitioner. There are a lot of good journals… of course our journal, the Journal of Public Health Management and Practice, has a tremendous practice focus and has very helpful, very readable, accessible articles…Health Promotion Practice, these kind of journals that have developed over the last number of years have really, I think, made the type of work we’re talking about way more accessible. But, as you point out, people like Ross come from practice. He worked at the Missouri Health Department before he was in academia. And I think he’s the most published person in public health these days. And if you look at his work, almost all of it is about what works in practice, or about translating research into practice, or how to communicate into practice, or disseminate to policymakers. And it’s all very critical. If you take that body of work and put it together, you practically have a very good manual on how to do your job in public health, working in a state or local health department. And the combination of that type of work and, as I said, the several journals I mentioned, again, speaks to the fact that a practitioner should be up on the current trends and be looking at what’s in these journals. The researchers, of course, have their academic incentives to publish in these journals, but there’s also a great opportunity for researchers and practitioners to work together and be part of publications together as well as, of course, making sure that your community engaged participants are part of that as well. Publishing should involve all the people that are engaged, not just the researchers, who are funded, if you will. I’ve had great experiences in trying to link with academic / researcher colleagues in my public health career, and they have resulted in a number of cases, in practice-based publications. And I think it’s really important to add to that practice-based literature. And that’s the whole issue in implementation science… what we’re trying to advocate about there is we really need to expand the community so that it’s not just the researchers who are researching and being funded by, for example, NIH types of funding to do implementation science, but that practitioners are also involved, and again, from the beginning. So you mentioned the consortium meeting we were just at, a great kickoff meeting of Implementation Science Consortium in Cancer that NCI put on, and again the group at NCI has been stellar at this over the years, both in the national meeting, the implementation science meeting, and now with this, starting with Jon Kerner, Russ Glasgow, and David Chambers, and all their colleagues, all the great people who work with them. They’ve advanced this work a lot. But I think at that meeting, if I looked around the room, and I may not have this exact, probably myself and Mandi Chapman from George Washington University may have been the only two “practitioners” in the room. I may be wrong, off be a few people, of course. But mostly everybody else had a researcher/academic identity there. So in order for this to work, we really need to, as I said, engage from the beginning. Get those new funded implementation science centers, work with the practice community around them, and make this a reality. It’s a great opportunity. But I think there’s been great advancement of this through the work of people like Ross and others who put this into the literature and give people ideas about tested intervention strategies, tested policy strategies, tested communication strategies that then work in practice in various settings. We’re in a good place, but there’s definitely a road ahead that I think we can advance even further.            

[bctt tweet=”What we’re trying to advocate in Implementation Science is that we need to expand the community so that it’s not just the researchers who are being funded to do implementation science but that practitioners are also involved from the beginning. — Randy Schwartz @JPHMPDirect” username=”@JPHMPDirect”]

Justin Moore: Speaking of the road ahead, the last thing I want to ask you about and get your thoughts on… you mentioned workforce and workforce development… I know my university here at Wake Forest is developing course work for folks in implementation science, the University of North Carolina – Chapel Hill, the University of California San Francisco, the University of Washington, among others, now offer graduate courses, a certificate program, or even doctoral degrees in the case of Washington in implementation science. In your opinion, what is the potential impact of these expanded training opportunities on the field?         

Randy Schwartz: I think the opportunity is great. It’s great to see there are actually faculty positions where the title of the faculty is implementation science. I’ve seen the ads for that. And there’s coursework. I’m aware of one article just recently published about some coursework at the University of North Carolina in implementation science. So it’s a good opportunity. I think, again, having not just the positions and course funded at the doctoral level but ways to integrate this work into the MPH programs, for example, and it’s a great opportunity, of everything we’ve been talking about, to partner researchers and practitioners with the faculty as they’re all developing skills in this area. So again, as you point out, there’s graduate courses, there’s certificate programs, maybe a doctoral degree in implementation science. But the setting, that academic setting where there’s people being trained at all levels, I think, also provides a great opportunity for that researcher-practitioner engagement right there from the beginning.    

Justin Moore: So much of the workforce doesn’t come from public health. There are a lot of people who are trained as nurses who are, over the course of their careers, have evolved into health educators at local health departments. I wonder if there is a way that we could package some of this coursework in a way that we could reach those folks who are on the ground who don’t really have an urge to even get a certificate or other degree programs but would be interested in continuing education. I just wonder if there’s an opportunity there?   

Randy Schwartz: Yeah, oh, and I think there is. And the Implementation Science at a Glance document that I mentioned that NCI just put out could really form the basis for that. As you look through that, it’s all about putting these principles into practice, and I know that they’re looking at putting presentations and workshops around this. Yeah, we really should be looking to build this into professional meetings, have professional organizations take this up as workshops. I think there are now, between this document and the type of articles and publications that we’ve talked about, there are tools, there are great examples, there’s good case examples of researchers and practitioners working together to highlight… So, yeah, I totally agree with you. Even without the degree program, there’s definitely opportunity for professional capacity building in this.      

Justin Moore: Well, great. I want to be mindful of the clock, and thank you for your time and talking with me today. I think this conversation will be interesting to a variety of listeners out there. So, I greatly appreciate your time, and I’ll give you the last word. Anything else for the good of the cause?

Randy Schwartz: Yeah, I appreciate talking with you about it. I think we’ve covered a lot of good points. Just to reiterate that the interactive aspect of this between researcher, practitioner, and engaged community is critical. I appreciate all the great work of the Journal of Public Health Management and Practice in getting these types of articles and case studies and work that’s very practitioner accessible out into the field. And I think the IS Consortium in Cancer, as we mentioned the kickoff meeting that was just held, I think is also a tremendous opportunity as are the implementation science centers. So we’re at a good point to look ahead and do this right and do a good job with it. Happy to talk with you about it and really get the word out about this type of work through this podcast and through this journal. 

Justin Moore: Thank you. So this ends my conversation with Randy Schwartz. You’ve been listening on JPHMP Direct.

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