Donna Shelley
Donna Shelley
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Vice Dean for Research
Professor of Public Health Policy and Management
Co-Director of the Global Center for Implementation Science
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Professional overview
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Dr. Shelley is a tenured Professor and Vice Dean for Research in the Department of Public Health Policy and Management and the founding Co-Director of the Global Center for Implementation Science at the NYU School of Global Public Health. She conducts translational, population-based, and policy-relevant research that aims to accelerate dissemination and implementation of tobacco use treatment in safety net health care delivery systems and implementation of tobacco control policies. This research has been funded by the National Cancer Institute (NCI), National Institute of Drug Abuse, National Heart, Lung, Blood Institute, the Agency for Healthcare Research and Quality and the New York State Department of Health.
Dr. Shelley’s implementation research focuses on building the evidence for effective theory-driven strategies that target barriers to implementation and sustainability of evidence-based tobacco use treatment in primary care settings in the U.S and Viet Nam. Her research is also addressing the growing dual burden of noncommunicable and communicable diseases in LMICs and, specifically, the health impact on people living with HIV/AIDS. With funding from the NCI, Dr. Shelley is conducting a randomized controlled trial comparing the effectiveness of behavioral interventions and pharmacotherapy to improve cessation outcomes among people living with HIV/AIDs who use tobacco, and simultaneously, answering questions about the feasibility and effectiveness of implementation strategies to improve adoption of tobacco use treatment in HIV care settings in Viet Nam. An example of her policy research includes a recently completed NCI-funded study that evaluated the impact of the US federally mandated smoke free public housing policy on exposure to secondhand smoke and explored the implementation process to identify strategies with the potential to improve the process and maximize public health impact.
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Education
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BS, University of Pennsylvania, PAMD, Mount Sinai School of Medicine, NYMPH, Health Policy and Management, Columbia University's Mailman School of Public Health, NY
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Areas of research and study
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Health Systems StrengtheningImplementation scienceTobacco CessationTobacco Policy
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Publications
Publications
A community-academic partnership to develop an implementation support package for overdose prevention in permanent supportive housing
AbstractGaeta Gazzola, M., Torsiglieri, A., Velez, L., Blaufarb, S., Hernandez, P., O’Grady, M. A., Blackburn, J., Florick, J., Cleland, C. M., Shelley, D., & Doran, K. M. (n.d.).Publication year
2025Journal title
Journal of Substance Use and Addiction TreatmentVolume
168AbstractIntroduction: The overdose crisis in the U.S. disproportionately impacts people experiencing homelessness. Permanent supportive housing (PSH) – permanent, affordable housing with voluntary support services – is an effective, evidence-based intervention to address homelessness. However, overdose risk remains high even after entering PSH for individual and structural reasons. In this study, we aimed to refine a set of evidence-based overdose prevention practices (EBPs) and an associated implementation support package for PSH settings using focus groups with PSH tenants, frontline staff, and leaders. Methods: Our community-academic team identified an initial set of overdose EBPs applicable for PSH through research, public health guidance, and a needs assessment. We adapted these practices based on feedback from focus groups with PSH leaders, staff, and tenants. Focus groups followed semi-structured interview guides developed using the EPIS (Exploration, Preparation, Implementation, Sustainment) framework constructs of inner context, outer context, and bridging factors related to overdose prevention and response. Results: We conducted 16 focus groups with 40 unique participants (14 PSH tenants, 15 PSH staff, 11 PSH leaders); focus groups were held in two iterative rounds and individuals could participate in one or both rounds. Participants were diverse in gender, race, and ethnicity. Focus group participants were enthusiastic about the proposed EBPs and implementation strategies, while contributing unique insights and concrete suggestions to improve upon them. The implementation support package contains an iteratively refined PSH Overdose Prevention (POP) Toolkit with 20 EBPs surrounding overdose prevention and response, harm reduction, and support for substance use treatment and additional core implementation strategies including practice facilitation, tenant-staff champion teams, and learning collaboratives. Conclusions: This manuscript describes how robust community-academic partnerships and input from people with lived experience as tenants and staff in PSH informed adaptation of evidence-based overdose prevention approaches and implementation strategies to improve their fit for PSH settings. This effort can inform similar efforts nationally in other settings serving highly marginalized populations. We are currently conducting a randomized trial of the refined overdose prevention implementation support package in PSH.Attributes of higher- and lower-performing hospitals in the Consult for Addiction Treatment and Care in Hospitals (CATCH) program implementation: A multiple-case study
AbstractStevens, E. R., Fawole, A., Rostam Abadi, Y., Fernando, J., Appleton, N., King, C., Mazumdar, M., Shelley, D., Barron, C., Bergmann, L., Siddiqui, S., Schatz, D., & McNeely, J. (n.d.).Publication year
2025Journal title
Journal of Substance Use and Addiction TreatmentVolume
168AbstractIntroduction: Six hospitals within the New York City public hospital system implemented the Consult for Addiction Treatment and Care in Hospitals (CATCH) program, an interprofessional addiction consult service. A stepped-wedge cluster randomized controlled trial tested the effectiveness of CATCH for increasing initiation and engagement in post-discharge medication for opioid use disorder (MOUD) treatment among hospital patients with opioid use disorder (OUD). The objective of this study was to identify facility characteristics that were associated with stronger performance of CATCH. Methods: This study used a mixed methods multiple-case study design. The six hospitals in the CATCH evaluation were each assigned a case rating according to intervention reach. Reach was considered high if ≥50 % of hospitalized OUD patients received an MOUD order. Cross-case rating comparison identified attributes of high-performing hospitals and inductive and deductive approaches were used to identify themes. Results: Higher-performing hospitals exhibited attributes that were generally absent in lower-performing hospitals, including (1) complete medical provider staffing; (2) designated office space and resources for CATCH; (3) existing integrated OUD treatment resources; and (4) limited overlap between the implementation period and COVID-19 pandemic. Conclusions: Hospitals with attributes indicative of awareness and integration of OUD services into general care were generally higher performing than hospitals that had siloed OUD treatment programs. Future implementations of addiction consult services may benefit from an increased focus on hospital- and community-level buy-in and efforts to integrate MOUD treatment into general care.Implementation of a peer-delivered opioid overdose response initiative in New York City emergency departments: Insight from multi-stakeholder qualitative interviews
AbstractGoldberg, L. A., Chang, T. E., Freeman, R., Welch, A. E., Jeffers, A., Kepler, K. L., Chambless, D., Wittman, I., Cowan, E., Shelley, D., McNeely, J., & Doran, K. M. (n.d.).Publication year
2025Journal title
Journal of Substance Use and Addiction TreatmentVolume
168AbstractBackground: Emergency departments (EDs) are critical touchpoints for overdose prevention efforts. In New York City (NYC), the Health Department's Relay initiative dispatches trained peer “Wellness Advocates” (WAs) to engage with patients in EDs after an overdose and for up to 90 days subsequently. Interest in peer-delivered interventions for patients at risk for overdose has grown nationally, but few studies have explored challenges and opportunities related to implementing such interventions in EDs. Methods: We conducted in-depth interviews with Relay WAs, ED patients, and ED providers across 4 diverse NYC EDs. Sampling was purposeful and continued until theoretical saturation was reached. Interviews followed a semi-structured interview guide based on key domains from the Consolidated Framework for Implementation Research (CFIR). Interviews were conducted by telephone or web conferencing; audio recordings were professionally transcribed. The study utilized rapid qualitative analysis using template summaries and summary matrices followed by line-by-line coding conducted independently by 3 researchers, then discussed and harmonized at group coding meetings. Coding was both inductive (using an a priori code list based on CFIR domains and study goals) and deductive (new codes allowed to emerge from transcripts). Dedoose software was used for data organization. Results: We conducted 32 in-depth interviews (10 WAs, 12 patients, 10 ED providers). Four overarching themes emerged: 1) EDs are characterized by multiple competing demands (e.g., related to provider time and physical space), underscoring the utility of Relay and leading to some practical challenges for its delivery; 2) There is a strong role distinction of WAs as peers with lived experience; 3) ED providers value Relay, even though they have a limited understanding of its full scope and outcomes; 4) While the role of structural factors (e.g., homelessness and unstable housing) is recognized, responsibility is often placed on patients for controlling their own success. Conclusions: We identified four themes that shed new light on the implementation of peer-based overdose prevention programs in EDs. Our findings highlight unique ED inner and outer setting factors that may impact program implementation and effectiveness. The findings provide actionable information to inform implementation of similar programs nationally.A "what Matters Most" approach to investigating intersectional stigma toward HIV and cancer in Hanoi, Vietnam
AbstractEschliman, E. L., Hoang, D., Khoshnam, N., Ye, V., Kokaze, H., Ji, Y., Zhong, Y., Morumganti, A., Xi, W., Huang, S., Choe, K., Poku, O. B., Alvarez, G., Nguyen, T., Nguyen, N. T., Shelley, D., & Yang, L. H. (n.d.).Publication year
2024Journal title
Journal of the National Cancer Institute - MonographsVolume
2024Issue
63Page(s)
11-19AbstractBackground: Vietnam is experiencing a growing burden of cancer, including among people living with HIV. Stigma acts as a sociocultural barrier to the prevention and treatment of both conditions. This study investigates how cultural notions of "respected personhood"(or "what matters most") influence manifestations of HIV-related stigma and cancer stigma in Hanoi, Vietnam. Methods: Thirty in-depth interviews were conducted with people living with HIV in Hanoi, Vietnam. Transcripts were thematically coded via a directed content analysis using the What Matters Most conceptual framework. Coding was done individually and discussed in pairs, and any discrepancies were reconciled in full-Team meetings. Results: Analyses elucidated that having chu tín-a value reflecting social involvement, conscientiousness, and trustworthiness-and being successful (eg, in career, academics, or one's personal life) are characteristics of respected people in this local cultural context. Living with HIV and having cancer were seen as stigmatized and interfering with these values and capabilities. Intersectional stigma toward having both conditions was seen to interplay with these values in some ways that had distinctions compared with stigma toward either condition alone. Participants also articulated how cultural values like chu tín are broadly protective against stigmatization and how getting treatment and maintaining employment can help individuals resist stigmatization's most acute impacts. Conclusions: HIV-related and cancer stigma each interfere with important cultural values and capabilities in Vietnam. Understanding these cultural manifestations of these stigmas separately and intersectionally can allow for greater ability to measure and respond to these stigmas through culturally tailored intervention.Depression and associated factors among HIV-positive smokers receiving care at HIV outpatient clinics in Vietnam: A cross-sectional analysis
AbstractNguyen, N. T., Nguyen, T., Vu, G. V., Truong, N., Pham, Y., Guevara Alvarez, G., Armstrong-Hough, M., & Shelley, D. (n.d.).Publication year
2024Journal title
BMJ openVolume
14Issue
2AbstractObjectives To assess the prevalence of depressive symptoms and associated factors among people living with HIV (PLWH) who were current cigarette smokers and receiving treatment at HIV outpatient clinics (OPCs) in Vietnam. Design A cross-sectional survey of smokers living with HIV. Setting The study was carried out in 13 HIV OPCs located in Ha Noi, Vietnam. Participants The study included 527 PLWH aged 18 and above who were smokers and were receiving treatment at HIV OPCs. Outcome measures The study used the Centre for Epidemiology Scale for Depression to assess depressive symptoms. The associations between depressive symptoms, tobacco dependence and other characteristics were explored using bivariate and Poisson regression analyses. Results The prevalence of depressive symptoms among smokers living with HIV was 38.3%. HIV-positive smokers who were female (prevalence ratio, PR 1.51, 95% CI 1.02 to 2.22), unmarried (PR 2.06, 95% CI 1.54 to 2.76), had a higher level of tobacco dependence (PR 1.06, 95% CI 1.01 to 1.11) and reported their health as fair or poor (PR 1.66, 95% CI 1.22 to 2.26) were more likely to have depression symptoms compared with HIV-positive smokers who were male, married, had a lower level of tobacco dependence and self-reported their health as good, very good or excellent. Conclusion The prevalence of depressive symptoms among smokers receiving HIV care at HIV OPCs was high. Both depression and tobacco use screening and treatment should be included as part of ongoing care treatment plans at HIV OPCs.Factors Influencing Tobacco Smoking and Cessation Among People Living with HIV: A Systematic Review and Meta-analysis
AbstractHoang, T. H., Nguyen, V. M., Adermark, L., Alvarez, G. G., Shelley, D., & Ng, N. (n.d.).Publication year
2024Journal title
AIDS and BehaviorVolume
28Issue
6Page(s)
1858-1881AbstractTobacco smoking is highly prevalent among people living with HIV (PLWH), yet there is a lack of data on smoking behaviours and effective treatments in this population. Understanding factors influencing tobacco smoking and cessation is crucial to guide the design of effective interventions. This systematic review and meta-analysis of studies conducted in both high-income (HICs) and low- and middle-income countries (LMICs) synthesised existing evidence on associated factors of smoking and cessation behaviour among PLWH. Male gender, substance use, and loneliness were positively associated with current smoking and negatively associated with smoking abstinence. The association of depression with current smoking and lower abstinence rates were observed only in HICs. The review did not identify randomised controlled trials conducted in LMICs. Findings indicate the need to integrate smoking cessation interventions with mental health and substance use services, provide greater social support, and address other comorbid conditions as part of a comprehensive approach to treating tobacco use in this population. Consistent support from health providers trained to provide advice and treatment options is also an important component of treatment for PLWH engaged in care, especially in LMICs.Identifying important and feasible primary care structures and processes in the US healthcare system: a modified Delphi study
AbstractAlbert, S. L., Kwok, L., Shelley, D. R., Paul, M. M., Blecker, S. B., Nguyen, A. M., Harel, D., Cleland, C. M., Weiner, B. J., Cohen, D. J., Damschroder, L., & Berry, C. A. (n.d.).Publication year
2024Journal title
BMJ openVolume
14Issue
11AbstractObjective To identify primary care structures and processes that have the highest and lowest impact on chronic disease management and screening and prevention outcomes as well as to assess the feasibility of implementing these structures and processes into practice. Design A two-round Delphi study was conducted to establish consensus on the impact and feasibility of 258 primary care structures and processes. Participants 29 primary care providers, health system leaders and health services researchers in the USA. Outcomes Primary outcomes were (1) consensus on the impact of each structure and process on chronic disease management and screening and prevention outcomes, separately and (2) consensus on feasibility of implementation by primary care practices. Results Consensus on high impact and feasibility of implementation was reached on four items for chronic disease management: 'Providers use motivational interviewing to help patients set goals', 'Practice has designated staff to manage patient panel', 'Practice has onsite providers or staff that speak the most dominant, non-English language spoken by patients' and 'Practice includes mental health providers and/or behavioural health specialists in care team' and seven items for screening and prevention: 'Practice utilizes standing protocols and orders', 'Practice generates reports to alert clinicians to missed targets and to identify gaps in care, such as overdue visits, needed vaccinations, screenings or other preventive services', 'Practice has designated staff to manage patient panel', 'Practice sets performance goals and uses benchmarking to track quality of care', 'Practice uses performance feedback to identify practice-specific areas of improvement', 'Practice builds quality improvement activities into practice operations' and 'Pre-visit planning data are reviewed during daily huddles'. Only 'Practice has designated staff to manage patient panel' appeared on both lists. Conclusion Findings suggest that practices need to focus on implementing mostly distinct, rather than common, structures and processes to optimise chronic disease and preventive care.Temporal Trends in Tobacco Smoking Prevalence During the Period 2010–2020 in Vietnam: A Repeated Cross-Sectional Study
AbstractVu, L. T. H., Bui, Q. T. T., Shelley, D., Niaura, R., Tran, B. Q., Pham, N. Q., Nguyen, L. T., Chu, A., Pratt, A., Thi Lan Pham, C., & Hoang, M. V. (n.d.).Publication year
2024Journal title
International Journal of Public HealthVolume
69AbstractObjectives: This study used repeated cross-sectional data from three national surveys in Vietnam to determine tobacco smoking prevalence from 2010 to 2020 and disparities among demographic and socioeconomic groups. Methods: Tobacco smoking temporal trends were estimated for individuals aged 15 and over and stratified by demographic and socioeconomic status (SES). Prevalence estimates used survey weights and 95% confidence intervals. Logistic regression models adjusted for survey sample characteristics across time were used to examine trends. Results: Tobacco smoking prevalence dropped from 23.8% in 2010 to 22.5% in 2015 and 20.8% in 2020. The adjusted OR for 2015 compared to 2010 was 0.87, and for 2020 compared to 2010 was 0.69. Smoking decreased less for employed individuals than unemployed individuals in 2020 compared to 2010. Smoking was higher in the lower SES group in all 3 years. Higher-SES households have seen a decade-long drop in tobacco use. Conclusion: This prevalence remained constant in lower SES households. This highlights the need for targeted interventions to address the specific challenges faced by lower-SES smokers and emphasizes the importance of further research to inform effective policies.Utilizing a patient advocacy-led clinical network to engage diverse, community-based sites in implementation-effectiveness research
AbstractCiupek, A., Chichester, L. A., Acharya, R., Schofield, E., Criswell, A., Shelley, D., King, J. C., & Ostroff, J. S. (n.d.).Publication year
2024Journal title
BMC health services researchVolume
24Issue
1AbstractBackground: Increased engagement with community-based practices is a promising strategy for increasing clinical trials access of diverse patient populations. In this study we assessed the ability to utilize a patient-advocacy organization led clinical network to engage diverse practices as field sites for clinical research. Methods: GO2 for Lung Cancer led recruitment efforts of 17 field sites from their Centers of Excellence in Lung Cancer Screening Network for participation in an implementation-effectiveness trial focused on smoking cessation integration into screening programs for lung cancer. Sites were engaged by one of three methods: 1) Pre-Grant submission of letters of support, 2) a non-targeted study information dissemination campaign to network members, and 3) proactive, targeted outreach to specific centers informed by previously submitted network member data. Detailed self-reported information on barriers to participation was collected from centers that declined to join the study. Results: Of 17 total field sites, 16 were recruited via the targeted outreach campaign and 1 via pre-grant letter of support submission. The sites covered 13 states and 4 United States geographic regions, were varied in annual screening volumes and years of screening program experience and were predominantly community-based practices (10 of 17 sites). The most reported reason (by 33% of sites) for declining to participate as a field site was inadequate staffing bandwidth for trial activities. This was especially true in community-based programs among which it was reported by 45% as a reason for declining. Conclusions: Our results suggest that this model of field site recruitment leveraging an existing partnership between an academic research team and an informal clinical network maintained by a disease-specific patient advocacy organization can result in engagement of diverse, community-based field sites. Additionally, reported barriers to participation by sites indicate that solutions centered around providing additional resources to enable greater capacity for site staff may increase community-practice participation in research.Variability in self-reported and biomarker-derived tobacco smoke exposure patterns among individuals who do not smoke by poverty income ratio in the USA
AbstractTitus, A. R., Shelley, D., & Thorpe, L. E. (n.d.).Publication year
2024Journal title
Tobacco controlAbstractIntroduction: Tobacco smoke exposure (TSE) among individuals who do not smoke has declined in the USA, however, gaps remain in understanding how TSE patterns across indoor venues - including in homes, cars, workplaces, hospitality venues, and other areas - contribute to TSE disparities by income level. Methods: We obtained data on adults (ages 18+, N=9909) and adolescents (ages 12-17, N=2065) who do not smoke from the National Health and Nutrition Examination Survey, 2013-2018. We examined the prevalence of self-reported, venue-specific TSE in each sample, stratified by poverty income ratio (PIR) quartile. We used linear regression models with a log-transformed outcome variable to explore associations between self-reported TSE and serum cotinine. We further explored the probability of detectable cotinine among individuals who reported no recent TSE, stratified by PIR. Results: Self-reported TSE was highest in cars (prevalence=6.2% among adults, 14.2% among adolescents). TSE in own homes was the most strongly associated with differences in log cotinine levels (β for adults=1.92, 95% CI=1.52 to 2.31; β for adolescents=2.37 95% CI=2.07 to 2.66), and the association between home exposure and cotinine among adults was most pronounced in the lowest PIR quartile. There was an income gradient with regard to the probability of detectable cotinine among both adults and adolescents who did not report recent TSE. Conclusions: Homes and vehicles remain priority venues for addressing persistent TSE among individuals who do not smoke in the USA. TSE survey measures may have differential validity across population subgroups.“In the Village That She Comes from, Most of the People Don’t Know Anything about Cervical Cancer”: A Health Systems Appraisal of Cervical Cancer Prevention Services in Tanzania
AbstractChelva, M., Kaushal, S., West, N., Erwin, E., Yuma, S., Sleeth, J., Yahya-Malima, K. I., Shelley, D., Risso-Gill, I., & Yeates, K. (n.d.).Publication year
2024Journal title
International journal of environmental research and public healthVolume
21Issue
8AbstractIntroduction: Cervical cancer is the fourth most common cancer in women globally. It is the most common cancer in Tanzania, resulting in about 9772 new cases and 6695 deaths each year. Research has shown an association between low levels of risk perception and knowledge of the prevention, risks, signs, etiology, and treatment of cervical cancer and low screening uptake, as contributing to high rates of cervical cancer-related mortality. However, there is scant literature on the perspectives of a wider group of stakeholders (e.g., policymakers, healthcare providers (HCPs), and women at risk), especially those living in rural and semi-rural settings. The main objective of this study is to understand knowledge and perspectives on cervical cancer risk and screening among these populations. Methods: We adapted Risso-Gill and colleagues’ framework for a Health Systems Appraisal (HSA), to identify HCPs’ perspective of the extent to which health system requirements for effective cervical cancer screening, prevention, and control are in place in Tanzania. We adapted interview topic guides for cervical cancer screening using the HSA framework approach. Study participants (69 in total) were interviewed between 2014 and 2018—participants included key stakeholders, HCPs, and women at risk for cervical cancer. The data were analyzed using reflexive thematic analysis methodology. Results: Seven themes emerged from our analysis of semi-structured interviews and focus groups: (1) knowledge of the role of screening and preventive care/services (e.g., prevention, risks, signs, etiology, and treatment), (2) training and knowledge of HCPs, (3) knowledge of cervical cancer screening among women at risk, (4) beliefs about cervical cancer screening, (5) role of traditional medicine, (6) risk factors, and (7) symptoms and signs. Conclusions: Our results demonstrate that there is a low level of knowledge of the role of screening and preventive services among stakeholders, HCPs, and women living in rural and semi-rural locations in Tanzania. There is a critical need to implement more initiatives and programs to increase the uptake of screening and related services and allow women to make more informed decisions on their health.Facilitation of team-based care to improve HTN management and outcomes: a protocol for a randomized stepped wedge trial
AbstractShelley, D. R., Brown, D., Cleland, C. M., Pham-Singer, H., Zein, D., Chang, J. E., & Wu, W. Y. (n.d.).Publication year
2023Journal title
BMC health services researchVolume
23Issue
1AbstractBackground: There are well-established guidelines for treating hypertension (HTN), yet only half of patients with HTN meet the defined target of < 140/90. Team-based care (TBC) is an evidence-based strategy for improving blood pressure (BP) management and control. TBC is defined as the provision of health services by at least two health professionals “who work collaboratively with patients and their caregivers to accomplish shared goals to achieve coordinated, high-quality care”. However, primary care practices experience challenges to implementing TBC principles and care processes; these are more pronounced in small independent practice settings (SIPs). Practice facilitation (PF) is an implementation strategy that may overcome barriers to adopting evidence-based TBC to improve HTN management in SIPs. Methods: Using a stepped wedge randomized controlled trial design, we will test the effect of PF on the adoption of TBC to improve HTN management in small practices (< 5 FTE clinicians) in New York City, and the impact on BP control compared with usual care. We will enroll 90 SIPs and randomize them into one of three 12-month intervention waves. Practice facilitators will support SIPs to adopt TBC principles to improve implementation of five HTN management strategies (i.e., panel management, population health, measuring BP, supporting medication adherence, self-management). The primary outcome is the adoption of TBC for HTN management measured at baseline and 12 months. Secondary outcomes include the rate of BP control and sustainability of TBC and BP outcomes at 18 months. Aggregated data on BP measures are collected every 6 months in all clusters so that each cluster provides data points in both the control and intervention conditions. Using a mixed methods approach, we will also explore factors that influence the effectiveness of PF at the organization and team level. Discussion: This study will provide much-needed guidance on how to optimize adoption and sustainability of TBC in independent primary care settings to reduce the burden of disease related to suboptimal BP control and advance understanding of how facilitation works to improve implementation of evidence-based interventions. Trial registration: ClinicalTrials.gov; NCT05413252 .Four very basic ways to think about policy in implementation science
AbstractPurtle, J., Moucheraud, C., Yang, L. H., & Shelley, D. (n.d.).Publication year
2023Journal title
Implementation Science CommunicationsVolume
4Issue
1AbstractBackground: Policy is receiving increasing attention in the field of implementation science. However, there remains a lack of clear, concise guidance about how policy can be conceptualized in implementation science research. Building on Curran’s article “Implementation science made too simple”—which defines “the thing” as the intervention, practice, or innovation in need of implementation support—we offer a typology of four very basic ways to conceptualize policy in implementation science research. We provide examples of studies that have conceptualized policy in these different ways and connect aspects of the typology to established frameworks in the field. The typology simplifies and refines related typologies in the field. Four very basic ways to think about policy in implementation science research. 1) Policy as something to adopt: an evidence-supported policy proposal is conceptualized as “the thing” and the goal of research is to understand how policymaking processes can be modified to increase adoption, and thus reach, of the evidence-supported policy. Policy-focused dissemination research is well-suited to achieve this goal. 2) Policy as something to implement: a policy, evidence-supported or not, is conceptualized as “the thing” and the goal of research is to generate knowledge about how policy rollout (or policy de-implementation) can be optimized to maximize benefits for population health and health equity. Policy-focused implementation research is well-suited to achieve this goal. 3) Policy as context to understand: an evidence-supported intervention is “the thing” and policies are conceptualized as a fixed determinant of implementation outcomes. The goal of research is to understand the mechanisms through which policies affect implementation of the evidence-supported intervention. 4) Policy as strategy to use: an evidence-supported intervention is “the thing” and policy is conceptualized as a strategy to affect implementation outcomes. The goal of research is to understand, and ideally test, how policy strategies affect implementation outcomes related to the evidence-supported intervention. Conclusion: Policy can be conceptualized in multiple, non-mutually exclusive ways in implementation science. Clear conceptualizations of these distinctions are important to advancing the field of policy-focused implementation science and promoting the integration of policy into the field more broadly.Synchronous Home-Based Telemedicine for Primary Care: A Review
AbstractLindenfeld, Z., Berry, C., Albert, S., Massar, R., Shelley, D., Kwok, L., Fennelly, K., & Chang, J. E. (n.d.).Publication year
2023Journal title
Medical Care Research and ReviewVolume
80Issue
1Page(s)
3-15AbstractSynchronous home-based telemedicine for primary care experienced growth during the coronavirus disease 2019 pandemic. A review was conducted on the evidence reporting on the feasibility of synchronous telemedicine implementation within primary care, barriers and facilitators to implementation and use, patient characteristics associated with use or nonuse, and quality and cost/revenue-related outcomes. Initial database searches yielded 1,527 articles, of which 22 studies fulfilled the inclusion criteria. Synchronous telemedicine was considered appropriate for visits not requiring a physical examination. Benefits included decreased travel and wait times, and improved access to care. For certain services, visit quality was comparable to in-person care, and patient and provider satisfaction was high. Facilitators included proper technology, training, and reimbursement policies that created payment parity between telemedicine and in-person care. Barriers included technological issues, such as low technical literacy and poor internet connectivity among certain patient populations, and communication barriers for patients requiring translators or additional resources to communicate.Adapting a tobacco cessation treatment intervention and implementation strategies to enhance implementation effectiveness and clinical outcomes in the context of HIV care in Vietnam: a case study
AbstractShelley, D., Alvarez, G. G., Nguyen, T., Nguyen, N., Goldsamt, L., Cleland, C., Tozan, Y., Shuter, J., & Armstrong-Hough, M. (n.d.).Publication year
2022Journal title
Implementation Science CommunicationsVolume
3Issue
1AbstractBackground: Smoking rates remain high in Vietnam, particularly among people living with HIV/AIDS (PLWH), but tobacco cessation services are not available in outpatient HIV clinics (OPCs). The research team is conducting a type II hybrid randomized controlled trial (RCT) comparing the cost-effectiveness of three tobacco cessation interventions among PLWH receiving care in HIV clinics in Vietnam. The study is simultaneously evaluating the implementation processes and outcomes of strategies aimed at increasing the implementation of tobacco dependence treatment (TDT) in the context of HIV care. This paper describes the systematic, theory-driven process of adapting intervention components and implementation strategies with demonstrated effectiveness in high-income countries, and more recently in Vietnam, to a new population (i.e., PLWH) and new clinical setting, prior to launching the trial. Methods: Data collection and analyses were guided by two implementation science frameworks and the socio-ecological model. Qualitative interviews were conducted with 13 health care providers and 24 patients in three OPCs. Workflow analyses were conducted in each OPC. Qualitative data were analyzed using rapid qualitative analysis procedures. Based on findings, components of the intervention and implementation strategies were adapted, followed by a 3-month pilot study in one OPC with 16 patients randomized to one of two intervention arms. Results: The primary adaptations included modifying the TDT intervention counseling content to address barriers to quitting among PLWH and Vietnamese sociocultural norms that support smoking cessation. Implementation strategies (i.e., training and system changes) were adapted to respond to provider- and clinic-level determinants of implementation effectiveness (e.g., knowledge gaps, OPC resource constraints, staffing structure, compatibility). Conclusions: Adaptations were facilitated through a mixed method, stakeholder (patient and health care provider, district health leader)-engaged evaluation of context-specific influences on intervention and implementation effectiveness. This data-driven approach to refining and adapting components aimed to optimize intervention effectiveness and implementation in the context of HIV care. Balancing pragmatism with rigor through the use of rapid analysis procedures and multiple methods increased the feasibility of the adaptation process. Trial registration: ClinicalTrials.gov NCT05162911 . Registered on December 16, 2021.Analyzing Trajectories of Acute Cigarette Reduction Post-Introduction of an E-Cigarette Using Ecological Momentary Assessment Data
AbstractGuttentag, A., Tseng, T. Y., Shelley, D., & Kirchner, T. (n.d.).Publication year
2022Journal title
International journal of environmental research and public healthVolume
19Issue
12AbstractElectronic cigarettes (ECs) may hold great potential for helping smokers transition off combustible cigarettes (CCs); however, little is known about the patterns that smokers follow when using an EC as a CC-substitute in order to ultimately reduce and quit smoking. Our primary aim in this study was to evaluate whether common patterns of CC use exist amongst individuals asked to substitute an EC for at least half of the CCs they would normally smoke. These patterns may eluci-date the immediate switching and reduction behaviors of individuals using ECs as a reduction/ces-sation tool. This analysis uses data from a randomized controlled trial of 84 adult smokers assigned to receive either 4.5% nicotine or placebo (0% nicotine) EC. Participants were advised to use the EC to help them reach a 50% reduction in cigarettes-per-day (CPD) within 3 weeks. Longitudinal trajectory analysis was used to identify CPD reduction classes amongst the sample; participants clus-tered into four distinct, linear trajectories based on daily CC use during the 3-week intervention. Higher readiness to quit smoking, prior successful quit attempts, and lower baseline CC consumption were associated with assignment into “more successful” CC reduction classes. ECs may be a useful mechanism to promote CC reduction. This study demonstrates that a fine-grained trajectory approach can be applied to examine switching patterns in the critical first weeks of an attempt.Considerations Before Selecting a Stepped-Wedge Cluster Randomized Trial Design for a Practice Improvement Study
AbstractNguyen, A. M., Cleland, C. M., Dickinson, L. M., Barry, M. P., Cykert, S., Duffy, F. D., Kuzel, A. J., Lindner, S. R., Parchman, M. L., Shelley, D. R., & Walunas, T. L. (n.d.).Publication year
2022Journal title
Annals of family medicineVolume
20Issue
3Page(s)
255-261AbstractPURPOSE Despite the growing popularity of stepped-wedge cluster randomized trials (SWCRTs) for practice-based research, the design’s advantages and challenges are not well documented. The objective of this study was to identify the advantages and challenges of the SW-CRT design for large-scale intervention implementations in primary care settings. METHODS The EvidenceNOW: Advancing Heart Health initiative, funded by the Agency for Healthcare Research and Quality, included a large collection of SW-CRTs. We conducted qualitative interviews with 17 key informants from EvidenceNOW grantees to identify the advantages and challenges of using SW-CRT design. RESULTS All interviewees reported that SW-CRT can be an effective study design for largescale intervention implementations. Advantages included (1) incentivized recruitment, (2) staggered resource allocation, and (3) statistical power. Challenges included (1) time-sensitive recruitment, (2) retention, (3) randomization requirements and practice preferences, (4) achieving treatment schedule fidelity, (5) intensive data collection, (6) the Hawthorne effect, and (7) temporal trends. CONCLUSIONS The challenges experienced by EvidenceNOW grantees suggest that certain favorable real-world conditions constitute a context that increases the odds of a successful SW-CRT. An existing infrastructure can support the recruitment of many practices. Strong retention plans are needed to continue to engage sites waiting to start the intervention. Finally, study outcomes should be ones already captured in routine practice; otherwise, funders and investigators should assess the feasibility and cost of data collection.Development of the ASSESS tool: a comprehenSive tool to Support rEporting and critical appraiSal of qualitative, quantitative, and mixed methods implementation reSearch outcomes
AbstractRyan, N., Vieira, D., Gyamfi, J., Ojo, T., Shelley, D., Ogedegbe, O., Iwelunmor, J., & Peprah, E. (n.d.).Publication year
2022Journal title
Implementation Science CommunicationsVolume
3Issue
1AbstractBackground: Several tools to improve reporting of implementation studies for evidence-based decision making have been created; however, no tool for critical appraisal of implementation outcomes exists. Researchers, practitioners, and policy makers lack tools to support the concurrent synthesis and critical assessment of outcomes for implementation research. Our objectives were to develop a comprehensive tool to (1) describe studies focused on implementation that use qualitative, quantitative, and/or mixed methodologies and (2) assess risk of bias of implementation outcomes. Methods: A hybrid consensus-building approach combining Delphi Group and Nominal Group techniques (NGT) was modeled after comparative methodologies for developing health research reporting guidelines and critical appraisal tools. First, an online modified NGT occurred among a small expert panel (n = 5), consisting of literature review, item generation, round robin with clarification, application of the tool to various study types, voting, and discussion. This was followed by a larger e-consensus meeting and modified Delphi process with implementers and implementation scientists (n = 32). New elements and elements of various existing tools, frameworks, and taxonomies were combined to produce the ASSESS tool. Results: The 24-item tool is applicable to a broad range of study designs employed in implementation science, including qualitative studies, randomized-control trials, non-randomized quantitative studies, and mixed methods studies. Two key features are a section for assessing bias of the implementation outcomes and sections for describing the implementation strategy and intervention implemented. An accompanying explanation and elaboration document that identifies and describes each of the items, explains the rationale, and provides examples of reporting and appraising practice, as well as templates to allow synthesis of extracted data across studies and an instructional video, has been prepared. Conclusions: The comprehensive, adaptable tool to support both reporting and critical appraisal of implementation science studies including quantitative, qualitative, and mixed methods assessment of intervention and implementation outcomes has been developed. This tool can be applied to a methodologically diverse and growing body of implementation science literature to support reviews or meta-analyses that inform evidence-based decision-making regarding processes and strategies for implementation.Implementation, interrupted: Identifying and leveraging factors that sustain after a programme interruption
AbstractHennein, R., Ggita, J., Ssuna, B., Shelley, D., Akiteng, A. R., Davis, J. L., Katamba, A., & Armstrong-Hough, M. (n.d.).Publication year
2022Journal title
Global Public HealthVolume
17Issue
9Page(s)
1868-1882AbstractMany implementation efforts experience interruptions, especially in settings with developing health systems. Approaches for evaluating interruptions are needed to inform re-implementation strategies. We sought to devise an approach for evaluating interruptions by exploring the sustainability of a programme that implemented diabetes mellitus (DM) screening within tuberculosis clinics in Uganda in 2017. In 2019, we conducted nine interviews with clinic staff and observed clinic visits to determine their views and practices on providing integrated care. We mapped themes to a social ecological model with three levels derived from the Consolidated Framework for Implementation Research (CFIR): outer setting (i.e. community), inner setting (i.e. clinic), and individuals (i.e. clinicians). Respondents explained that DM screening ceased due to disruptions in the national supply chain for glucose test strips, which had cascading effects on clinics and clinicians. Lack of screening supplies in clinics limited clinicians’ opportunities to perform DM screening, which contributed to diminished self-efficacy. However, culture, compatibility and clinicians’ beliefs about DM screening sustained throughout the interruption. We propose an approach for evaluating interruptions using the CFIR and social ecological model; other programmes can adapt this approach to identify cascading effects of interruptions and target them for re-implementation.Patients’ Perspectives on the Shift to Telemedicine in Primary and Behavioral Health Care during the COVID-19 Pandemic
AbstractBerry, C. A., Kwok, L., Massar, R., Chang, J. E., Lindenfeld, Z., Shelley, D. R., & Albert, S. L. (n.d.).Publication year
2022Journal title
Journal of general internal medicineVolume
37Issue
16Page(s)
4248-4256AbstractBackground: Studies specifically focused on patients’ perspectives on telemedicine visits in primary and behavioral health care are fairly limited and have often focused on highly selected populations or used overall satisfaction surveys. Objective: To examine patient perspectives on the shift to telemedicine, the remote delivery of health care via the use of electronic information and communications technology, in primary and behavioral health care in Federally Qualified Health Centers (FQHCs) during COVID-19. Design: Semi-structured interviews were conducted using video conference with patients and caregivers between October and December 2020. Participants: Providers from 6 FQHCs nominated participants. Eighteen patients and caregivers were interviewed: 6 patients with only primary care visits; 5 with only behavioral health visits; 3 with both primary care and behavioral health visits; and 4 caregivers of children with pediatric visits. Approach: Using a protocol-driven, rapid qualitative methodology, we analyzed the interview data and assessed the quality of care, benefits and challenges of telemedicine, and use of telemedicine post-pandemic. Key Results: Respondents broadly supported the option of home-based synchronous telemedicine visits in primary and behavioral health care. Nearly all respondents appreciated remote visits, largely because such visits provided a safe option during the pandemic. Patients were generally satisfied with telemedicine and believed the quality of visits to be similar to in-person visits, especially when delivered by a provider with whom they had established rapport. Although most respondents planned to return to mostly in-person visits when considered safe to do so, they remained supportive of the continued option for remote visits as remote care addresses some of the typical barriers faced by low-income patients. Conclusions: Addressing digital literacy challenges, enhancing remote visit privacy, and improving practice workflows will help ensure equitable access to all patients as we move to a new post-COVID-19 “normal” marked by increased reliance on telemedicine and technology.Rapid Community Engagement in Response to SARS-CoV-2 Funding Opportunities: New York City, 2020–2021
AbstractWilliams, N. J., Gill, E., Punter, M. A., Reiss, J., Goodman, M., Shelley, D., & Thorpe, L. E. (n.d.).Publication year
2022Journal title
American journal of public healthVolume
112Page(s)
S904-S908AbstractIn response to fast-turnaround funding opportunities, collaborations have been forming across the country to address severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disparities. Here we describe the process, notes from the field, and evaluation results from a new collaboration involving multiple partners, formed in October 2020 in New York City as part of the Rapid Acceleration of Diagnostics initiative. We used the validated Research Engagement Survey Tool to evaluate the partnership. Results can inform future research and improve engagement efforts aimed at reducing SARS-CoV-2 disparities.Rapid Transition to Telehealth and the Digital Divide: Implications for Primary Care Access and Equity in a Post-COVID Era
AbstractChang, J. E., Lai, A. Y., Gupta, A., Nguyen, A. M., Berry, C. A., & Shelley, D. R. (n.d.).Publication year
2021Journal title
Milbank QuarterlyVolume
99Issue
2Page(s)
340-368AbstractPolicy Points Telehealth has many potential advantages during an infectious disease outbreak such as the COVID-19 pandemic, and the COVID-19 pandemic has accelerated the shift to telehealth as a prominent care delivery mode. Not all health care providers and patients are equally ready to take part in the telehealth revolution, which raises concerns for health equity during and after the COVID-19 pandemic. Without proactive efforts to address both patient- and provider-related digital barriers associated with socioeconomic status, the wide-scale implementation of telehealth amid COVID-19 may reinforce disparities in health access in already marginalized and underserved communities. To ensure greater telehealth equity, policy changes should address barriers faced overwhelmingly by marginalized patient populations and those who serve them. Context: The COVID-19 pandemic has catalyzed fundamental shifts across the US health care delivery system, including a rapid transition to telehealth. Telehealth has many potential advantages, including maintaining critical access to care while keeping both patients and providers safe from unnecessary exposure to the coronavirus. However, not all health care providers and patients are equally ready to take part in this digital revolution, which raises concerns for health equity during and after the COVID-19 pandemic. Methods: The study analyzed data about small primary care practices’ telehealth use and barriers to telehealth use collected from rapid-response surveys administered by the New York City Department of Health and Mental Hygiene's Bureau of Equitable Health Systems and New York University from mid-April through mid-June 2020 as part of the city's efforts to understand how primary care practices were responding to the COVID-19 pandemic following New York State's stay-at-home order on March 22. We focused on small primary care practices because they represent 40% of primary care providers and are disproportionately located in low-income, minority or immigrant areas that were more severely impacted by COVID-19. To examine whether telehealth use and barriers differed based on the socioeconomic characteristics of the communities served by these practices, we used the Centers for Disease Control and Prevention Social Vulnerability Index (SVI) to stratify respondents as being in high-SVI or low-SVI areas. We then characterized respondents’ telehealth use and barriers to adoption by using means and proportions with 95% confidence intervals. In addition to a primary analysis using pooled data across the five waves of the survey, we performed sensitivity analyses using data from respondents who only took one survey, first wave only, and the last two waves only. Findings: While all providers rapidly shifted to telehealth, there were differences based on community characteristics in both the primary mode of telehealth used and the types of barriers experienced by providers. Providers in high-SVI areas were almost twice as likely as providers in low-SVI areas to use telephones as their primary telehealth modality (41.7% vs 23.8%; P <.001). The opposite was true for video, which was used as the primary telehealth modality by 18.7% of providers in high-SVI areas and 33.7% of providers in low-SVI areas (P <0.001). Providers in high-SVI areas also faced more patient-related barriers and fewer provider-related barriers than those in low-SVI areas. Conclusions: Between April and June 2020, telehealth became a prominent mode of primary care delivery in New York City. However, the transition to telehealth did not unfold in the same manner across communities. To ensure greater telehealth equity, policy changes should address barriers faced overwhelmingly by marginalized patient populations and those who serve them.Telephone vs. video visits during COVID-19: Safety-net provider perspectives
AbstractChang, J. E., Lindenfeld, Z., Albert, S. L., Massar, R., Shelley, D., Kwok, L., Fennelly, K., & Berry, C. A. (n.d.).Publication year
2021Journal title
Journal of the American Board of Family MedicineVolume
34Issue
6Page(s)
1103-1114AbstractObjective: To review the frequency as well as the pros and cons of telephone and video-enabled telemedicine during the first 9 months of the Coronavirus disease 2019 (COVID-19) pandemic as experienced by safety net providers across New York State (NYS). Methods: Analysis of visits to 36 community health centers (CHCs) in NYS by modality (telephone vs video) from February to November 2020. Semi-structured interviews with 25 primary care, behavioral health, and pediatric providers from 8 CHCs. Findings: In the week following the NYS stay-at-home order, video and telephone visits rose from 3.4 and 0% of total visits to 14.9 and 22.3%. At its peak, more than 60% of visits were conducted via telemedicine (April 2020) before tapering off to about 30% of visits (August 2020). Providers expressed a strong preference for video visits, particularly for situations when visual assessments were needed. Yet, more visits were conducted over telephone than video at all points throughout the pandemic. Video-specific advantages included enhanced ability to engage patients and use of visual cues to get a comprehensive look into the patient’s life, including social supports, hygiene, and medication adherence. Telephone presented unique benefits, including greater privacy, feasibility, and ease of use that make it critical to engage with key populations and as a backup for when video was not an option. Conclusions: Despite challenges, providers reported positive experiences delivering care remotely using both telephone and video during the COVID-19 pandemic and believe both modalities are critical for enabling access to care in the safety net.Cardiovascular Disease Guideline Adherence: An RCT Using Practice Facilitation
AbstractShelley, D. R., Gepts, T., Siman, N., Nguyen, A. M., Cleland, C., Cuthel, A. M., Rogers, E. S., Ogedegbe, O., Pham-Singer, H., Wu, W., & Berry, C. A. (n.d.).Publication year
2020Journal title
American journal of preventive medicineVolume
58Issue
5Page(s)
683-690AbstractIntroduction: Practice facilitation is a promising practice transformation strategy, but further examination of its effectiveness in improving adoption of guidelines for multiple cardiovascular disease risk factors is needed. The objective of the study is to determine whether practice facilitation is effective in increasing the proportion of patients meeting the Million Hearts ABCS outcomes: (A) aspirin when indicated, (B) blood pressure control, (C) cholesterol management, and (S) smoking screening and cessation intervention. Study design: The study used a stepped-wedge cluster RCT design with 4 intervention waves. Data were extracted for 13 quarters between January 1, 2015 and March 31, 2018, which encompassed the control, intervention, and follow-up periods for all waves, and analyzed in 2019. Setting/participants: A total of 257 small independent primary care practices in New York City were randomized into 1 of 4 waves. Intervention: The intervention consisted of practice facilitators conducting at least 13 practice visits over 1 year, focused on capacity building and implementing system and workflow changes to meet cardiovascular disease care guidelines. Main outcome measures: The main outcomes were the Million Hearts’ ABCS measures. Two additional measures were created: (1) proportion of tobacco users who received a cessation intervention (smokers counseled) and (2) a composite measure that assessed the proportion of patients meeting treatment targets for A, B, and C (ABC composite). Results: The S measure improved when comparing follow-up with the control period (incidence rate ratio=1.152, 95% CI=1.072, 1.238, p<0.001) and when comparing follow-up with intervention (incidence rate ratio=1.060, 95% CI=1.013, 1.109, p=0.007). Smokers counseled improved when comparing the intervention period with control (incidence rate ratio=1.121, 95% CI=1.037, 1.211, p=0.002). Conclusions: Increasing the impact of practice facilitation programs that target multiple risk factors may require a longer, more intense intervention and greater attention to external policy and practice context. Trial registration: This study is registered at www.clinicaltrials.gov NCT02646488.Hookah use patterns, social influence and associated other substance use among a sample of New York City public university students
AbstractEl Shahawy, O., Park, S. H., Rogers, E. S., Shearston, J. A., Thompson, A. B., Cooper, S. C., Freudenberg, N., Ball, S. A., Abrams, D., Shelley, D., & Sherman, S. E. (n.d.).Publication year
2020Journal title
Substance Abuse: Treatment, Prevention, and PolicyVolume
15Issue
1AbstractBackground: Most hookah use studies have not included racial and ethnic minorities which limits our understanding of its use among these growing populations. This study aimed to investigate the individual characteristics of hookah use patterns and associated risk behaviors among an ethnically diverse sample of college students. Methods: A cross-sectional survey of 2460 students (aged 18-25) was conducted in 2015, and data was analyzed in 2017. Descriptive statistics were used to present the sociodemographic characteristics, hookah use-related behavior, and binge drinking and marijuana use according to the current hookah use group, including never, exclusive, dual/poly hookah use. Multivariate logistic regression was conducted to examine how hookah related behavior and other risk behaviors varied by sociodemographics and hookah use patterns. Results: Among current hookah users (n = 312), 70% were exclusive hookah users and 30% were dual/poly hookah users. There were no statistically significant differences in sociodemographic characteristics except for race/ethnicity (p < 0.05). Almost half (44%) of the exclusive hookah users reported having at least five friends who also used hookah, compared to 30% in the dual/poly use group. Exclusive users were less likely to report past year binge drinking (17%) and past year marijuana use (25%) compared to those in the dual/poly use group (44 and 48% respectively); p < 0.001. Conclusions: The socialization aspects of hookah smoking seem to be associated with its use patterns. Our study calls for multicomponent interventions designed to target poly tobacco use as well as other substance use that appears to be relatively common among hookah users.