Donna Shelley

Professor of Public Health Policy and Management

Co-Director of the Global Center for Implementation Science

Professional overview

Dr. Shelley is a tenured Professor 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, and 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.  Her policy research includes a 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.

Education

BS, University of Pennsylvania, PA

MD, Mount Sinai School of Medicine, NY

MPH, Health Policy and Management, Columbia University's Mailman School of Public Health, NY

Areas of research and study

Health Systems Strengthening

Implementation science

Tobacco Cessation

Tobacco Policy

Current Research

Policy

Purtle J, Moucheraud C, Yang LH, Shelley D. Four very basic ways to think about policy in implementation science. Implement Sci Commun. 2023 Sep 12;4(1):11

Shelley D. Kyriakas C, McNeill A, Murray R, Nilan K, Sherman SE, Raw M. Challenges to implementing the WHO Framework Convention on Tobacco Control guidelines on tobacco cessation treatment: a qualitative analysis. Addiction. 2020;115:527-533

Thorpe L, Anastasiou E, Wyka K, Tovar A, Gill E, Rule A, Elbel B, Kaplan SA, Jiang N, Gordon T, Shelley D. Evaluation of Secondhand Smoke Exposure in New York City Public Housing After Implementation of the 2018 Federal Smoke-Free Housing Policy. JAMA Netw Open. 2020 Nov 2;3(11):e2024385

Tobacco cessation 

Hoang THL … Shelley D. Factors Influencing Tobacco Smoking and Cessation Among People Living  with HIV: A Systematic Review and Meta‑analysis. AIDS and Behavior. 2024 https://doi.org/10.1007/s10461-024-04279-1

Shelley et al. WHO Knowledge Summary: Tobacco and HIV https://iris.who.int/bitstream/handle/10665/378509/9789240096868-eng.pdf

Ostroff JS, Shelley DR, Chichester LA, King JC, Li Y, Schofield E, Ciupek A, Criswell A, Acharya R, Banerjee SC, Elkin EB, Lynch K, Weiner BJ, Orlow I, Martin CM, Chan SV, Frederico V, Camille P, Holland S, Kenney J. Study protocol of a multiphase optimization strategy trial (MOST) for delivery of smoking cessation treatment in lung cancer screening settings. Trials. 2022 Aug 17;23(1):664.

Health systems improvement and Implementation Science

Nwaozuru U, Murphy P, Richard A, …Shelley D, Airhihenbuwa C, Ogedegbe G, Ezechi O, Iwelunmor J. The sustainability of health interventions implemented in Africa: an updated systematic review on evidence and future research perspectives. Implement Sci Commun. 2025 Apr 8;6(1):39. https://pmc.ncbi.nlm.nih.gov/articles/PMC11980204/ 

Gaeta Gazzola M, Torsiglieri A, Velez L, Blaufarb S, Hernandez P, O'Grady MA, Blackburn J, Florick J, Cleland CM, Shelley D, Doran KM A community-academic partnership to develop an implementation support package for overdose prevention in permanent supportive housing. J Subst Use Addict Treat. 2025 Jan;168:209533. doi: 10.1016/j.josat.2024.209533. Epub 2024 Oct 9.PMID: 39389548

Kilbourne AM, Geng E, Eshun-Wilson I, Sweeney S, Shelley D, Cohen DJ, Kirchner JE, Fernandez ME, Parchman ML. How does facilitation in healthcare work? Using mechanism mapping to illuminate the black box of a meta-implementation strategy. Implement Sci Commun. 2023 May 16;4(1):53. 

Parascandola M, Neta G, Salloum RG, Shelley D, Rositch AF.JCO Glob Oncol. Role of Local Evidence in Transferring Evidence-Based Interventions to Low- and Middle-Income Country Settings: Application to Global Cancer Prevention and Control.2022 Aug;8:e2200054.

Shelley D, Alvarez GG, Nguyen T, Nguyen N, Goldsamt L, Cleland C, Tozan Y, Shuter J, Armstrong-Hough M. 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. Implement Sci Commun. 2022 Oct 17;3(1):112. 

Shelley D, Wang VH, Taylor K, Williams R, Toll B, Rojewski A, Foley KL, Rigotti N, Ostroff JS. Accelerating integration of tobacco use treatment in the context of lung cancer screening: Relevance and application of implementation science to achieving policy and practice. Transl Behav Med. 2022 Nov 21;12(11):1076-1083.

Shelley D, Cleland CM, Nguyen T, VanDevanter N, Siman N, Van Minh H, Nguyen N. Nicotine Tob Res. Effectiveness of a Multicomponent Strategy for Implementing Guidelines for Treating Tobacco Use in Vietnam Commune Health Centers 2022 Feb 1;24(2):196-203.

Hennein R, Ggita J, Ssuna B, Shelley D, Akiteng AR, Davis JL, Katamba A, Armstrong-Hough M. Implementation, interrupted: Identifying and leveraging factors that sustain after a programme interruption. Glob Public Health. 2022 Aug-Sep;17(9):1868-1882

Publications

Publications

The CATALYTIC tool to assess feasibility of implementing evidence-based interventions for cardiovascular diseases in 46 low- and middle-income countries: survey outcomes and tool reliability testing

Shelley, D., Ojo, T., Yassin, H., Sowunmi, E., Hameed, T., Ryan, N., Gyamfi, J., Shelley, D., Ogedegbe, O., & Peprah, E. (n.d.).

Publication year

2025

Journal title

Frontiers in public health

Volume

13

Page(s)

1597996

Abstract

Abstract

Evidence-based interventions (EBI) for cardiovascular disease (CVD) in low- and middle-income countries (LMIC) may face feasibility challenges due to the inadequacy of existing instruments. To address this, researchers developed the Contextual Index of Feasibility on Early-Stage Implementation in LMIC (CATALYTIC) tool, which integrates contextual factors into the assessment of feasibility.

The sustainability of health interventions implemented in Africa : an updated systematic review on evidence and future research perspectives

Nwaozuru, U., Murphy, P., Richard, A., Obiezu-Umeh, C., Shato, T., Obionu, I., Gbajabiamila, T., Oladele, D., Mason, S., Takenaka, B. P., Blessing, L. A., Engelhart, A., Nkengasong, S., Chinaemerem, I. D., Anikamadu, O., Adeoti, E., Patel, P., Ojo, T., Olusanya, O., … Iwelunmor, J. (n.d.).

Publication year

2025

Journal title

Implementation Science Communications

Volume

6

Issue

1

10.1186/s43058-025-00716-x

Abstract

Abstract

Background: Sustaining evidence-based interventions in resource-limited settings is critical to optimizing gains in health outcomes. In 2015, we published a review of the sustainability of health interventions in African countries, highlighting gaps in the measurement and conceptualization of sustainability in the region. This review updates and expands upon the original review to account for developments in the past decade and recommendations for promoting sustainability. Methods: First, we searched five databases (PubMed, SCOPUS, Web of Science, Global Health, and Cumulated Index to Nursing and Allied Health Literature (CINAHL)) for studies published between 2015 and 2022. We repeated the search in 2023 and 2024. The review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Studies were included if they reported on the sustainability of health interventions implemented in African countries. Study findings were summarized using descriptive statistics and narrative synthesis, and sustainability strategies were categorized based on the Expert Recommendations for Implementing Change (ERIC) strategies. Results: Thirty-four publications with 22 distinct interventions were included in the review. Twelve African countries were represented in this review, with Nigeria (n = 6) having the most representation of available studies examining sustainability. Compared to the 2016 review, a similar proportion of studies clearly defined sustainability (52% in the current review versus 51% in the 2015 review). Eight unique strategies to foster sustainability emerged, namely: a) multi-sectorial partnership and developing stakeholder relationships, b) tailoring strategies to enhance program fit and integration, c) active stakeholder engagement and collaboration, d) capacity building through training, e) accessing new funding, f) adaptation, g) co-creation of intervention and implementation strategies and h) providing infrastructural support. The most prevalent facilitators of sustainability were related to micro-level factors (e.g., intervention fit and community engagement). In contrast, salient barriers were related to structural-level factors (e.g., limited financial resources). Conclusions: This review highlights some progress in the published reports on the sustainability of evidence-based intervention in Africa. The review emphasizes the importance of innovation in strategies to foster funding determinants for sustainable interventions. In addition, it underscores the need for developing contextually relevant sustainability frameworks that emphasize these salient determinants of sustainability in the region.

Tobacco spending and the perceived cost of tobacco among smokers living with HIV and receiving treatment at outpatient clinics in Viet Nam : A mixed methods study

Alvarez, G. G., Hoang, T., Kapur, R., Nguyen, C., Armstrong-Hough, M., Nguyen, T., Nguyen, N., Van Minh, H., & Shelley, D. (n.d.).

Publication year

2025

Journal title

PloS one

Volume

20

Issue

7 July

10.1371/journal.pone.0327490

Abstract

Abstract

Background Tobacco use among people living with HIV (PWH) is 2–3 times higher than among HIV-negative individuals. In Viet Nam, over 50% of men living with HIV use tobacco. Reducing smoking is important to improving disparities among PWH who smoke including their higher exposure to chronic disease. However, data on tobacco spending as well as the potential impact of tobacco policies, such as taxation, is limited among PWH. Viet Nam has one of the lowest taxes on tobacco in the world, thus underutilizing this tool. Our study aims to understand tobacco spending among PWH who smoke as well as examine the financial burden of tobacco use, and their perceptions about the affordability of tobacco products. Methods We conducted qualitative interviews (n=24) that explored smoking behavior and perceptions about the cost of tobacco, alongside cross-sectional quantitative surveys (n=75) that assessed daily tobacco expenditures and the proportion of income spent on tobacco. We applied convergent parallel design to these two independent samples taken from the same study population of PWH enrolled in a tobacco use treatment study at HIV clinics in Ha Noi, Viet Nam. Results Participants spent 7.47% of their annual income on tobacco products. Tobacco dependence was positively associated with higher daily expenditure on tobacco. Qualitatively, participants did not describe tobacco-related spending as a financial burden and did not consider the price of cigarettes as a motivation to quit. However, participants acknowledged that smoking is still a costly expenditure and indicated that quitting would yield financial savings which could be redirected to other household needs. Conclusion Despite spending a considerable percentage of their income spent on tobacco, most participants perceived cigarettes as affordable. This may reflect our sample’s strong socioeconomic resources as well as the low price of cigarettes in Viet Nam, which may be too low to cause financial hardship and thus reduce motivation to quitting.

Tobacco spending and the perceived cost of tobacco among smokers living with HIV and receiving treatment at outpatient clinics in Viet Nam: A mixed methods study

Shelley, D., Guevara Alvarez, G., Hoang, T., Kapur, R., Nguyen, C., Armstrong-Hough, M., Nguyen, T., Nguyen, N., Van Minh, H., & Shelley, D. (n.d.).

Publication year

2025

Journal title

PloS one

Volume

20

Issue

7

Page(s)

e0327490

Abstract

Abstract

Tobacco use among people living with HIV (PWH) is 2-3 times higher than among HIV-negative individuals. In Viet Nam, over 50% of men living with HIV use tobacco. Reducing smoking is important to improving disparities among PWH who smoke including their higher exposure to chronic disease. However, data on tobacco spending as well as the potential impact of tobacco policies, such as taxation, is limited among PWH. Viet Nam has one of the lowest taxes on tobacco in the world, thus underutilizing this tool. Our study aims to understand tobacco spending among PWH who smoke as well as examine the financial burden of tobacco use, and their perceptions about the affordability of tobacco products.

Understanding overdose risk and response in permanent supportive housing: results of focus groups with tenants, staff, and leaders

Shelley, D., Gaeta Gazzola, M., Torsiglieri, A., Blaufarb, S., Velez, L., Hernandez, P., O’Grady, M. A., Shelley, D., Frank, D., Cleland, C. M., & Doran, K. M. (n.d.).

Publication year

2025

Journal title

Addiction science & clinical practice

Volume

20

Issue

1

Page(s)

91

Abstract

Abstract

Permanent supportive housing (PSH) is an evidence-based intervention for people experiencing homelessness which integrates permanent housing with voluntary support services. PSH tenants are at high risk for overdose death, yet little research to date has examined overdose in PSH. We sought to examine overdose risk and existing responses in PSH, which can shed light on opportunities for future overdose prevention efforts.

A "what Matters Most" approach to investigating intersectional stigma toward HIV and cancer in Hanoi, Vietnam

Eschliman, 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. G., Nguyen, T., Nguyen, N. T., Shelley, D., & Yang, L. (n.d.).

Publication year

2024

Journal title

Journal of the National Cancer Institute - Monographs

Volume

2024

Issue

63

Page(s)

11-19

10.1093/jncimonographs/lgae002

Abstract

Abstract

Background: 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

Nguyen, N. T., Nguyen, T., Vu, G. V., Truong, N., Pham, Y., Guevara Alvarez, G., Armstrong-Hough, M., & Shelley, D. (n.d.).

Publication year

2024

Journal title

BMJ open

Volume

14

Issue

2

10.1136/bmjopen-2023-077015

Abstract

Abstract

Objectives 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 associated with retention in Quitline counseling for smoking cessation among HIV-positive smokers receiving care at HIV outpatient clinics in Vietnam

Nguyen, N. T., Nguyen, T., Van Vu, G., Cleland, C. M., Pham, Y., Truong, N., Kapur, R., Alvarez, G. G., Phan, P. T., Armstrong-Hough, M., & Shelley, D. (n.d.).

Publication year

2024

Journal title

PloS one

Volume

19

Issue

12

10.1371/journal.pone.0316250

Abstract

Abstract

Background Quitline counseling is an effective method for supporting smoking cessation, offering personalized and accessible assistance. Tobacco use is a significant public health issue among people living with HIV. In Vietnam, over 50% of men living with HIV use tobacco. However, there is limited research on Quitline use and retention rates in this population and a lack of research on factors associated with retention in Quitline counseling. The study aims to evaluate the factors associated with retention in Quitline counseling for smoking cessation among HIV-positive smokers receiving care at HIV outpatient clinics in Vietnam. Method The study analyzed data from a randomized controlled trial (RCT) that compared the effectiveness of three smoking cessation interventions for smokers living with HIV at 13 Outpatient Clinics in Ha Noi. A total of 221 smokers aged 18 and above living with HIV participated in Arm 1 of the RCT, which included screening for tobacco use (Ask), health worker-delivered brief counseling (Assist), and proactive referral to Vietnam’s national Quitline (AAR), in which the Quitline reached out to the patient to engage them in up to 10 sessions of smoking cessation counseling. Retention in Quitline counseling was defined as participating in more than five counseling calls. The study used bivariate and logistic regression analyses to explore the associations between retention and other factors. Results Fifty-one percent of HIV-positive smokers completed more than five counseling sessions. Smokers living with HIV aged 35 or older (OR = 5.53, 95% CI 1.42–21.52), who had a very low/low tobacco dependence level (OR = 2.26, 95% CI 1.14–4.51), had a lower score of perceived importance of quitting cigarettes (OR = 0.87, 95% CI 0.76–0.99), had a household ban or partial ban on cigarettes smoking (OR = 2.58, 95% CI 1.39–4.80), and had chosen a quit date during the Quitline counseling (OR = 3.0, 95% CI 1.63–5.53) were more likely to retain in the Quitline counseling than those smokers living with HIV whose ages were less than 35, who had a high/very high tobacco dependence level, had a higher score of perception of the importance of quitting cigarettes, did not have a household ban on cigarettes smoking, and did not choose a quit date during counseling. Conclusion There is a high retention rate in Quitline counseling services among PLWHs receiving care at HIV outpatient clinics. Tailoring interventions to the associated factors such as age, tobacco dependence, perceived importance of quitting, household smoking bans, and setting a quit date during counseling may improve engagement and outcomes, aiding in the reduction of smoking prevalence among HIV-positive individuals.

Factors Influencing Tobacco Smoking and Cessation Among People Living with HIV : A Systematic Review and Meta-analysis

Hoang, T. H., Nguyen, V. M., Adermark, L., Alvarez, G. G., Shelley, D., & Ng, N. (n.d.).

Publication year

2024

Journal title

AIDS and Behavior

10.1007/s10461-024-04279-1

Abstract

Abstract

Tobacco 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

Albert, S. L., Kwok, L., Shelley, D., Paul, M. M., Blecker, S. B., Nguyen, A. M., Harel, D., Cleland, C. M., Weiner, B. J., Cohen, D. J., Damschroder, L., & Berry, C. (n.d.).

Publication year

2024

Journal title

BMJ open

Volume

14

Issue

11

10.1136/bmjopen-2023-082989

Abstract

Abstract

Objective 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.

Implementation Science: Applications in Public Health and Psychology

Shelley, D. (n.d.). (N. S. (Editor-in-Chief), Ed.).

Publication year

2024

Volume

3

Abstract

Abstract

~

State of the Science of Scale-Up of Cancer Prevention and Early Detection Interventions in Low- and Middle-Income Countries : A Scoping Review

Friebel-Klingner, T. M., Alvarez, G. G., Lappen, H., Pace, L. E., Huang, K. Y., Fernández, M. E., Shelley, D., & Rositch, A. F. (n.d.).

Publication year

2024

Journal title

JCO Global Oncology

Volume

10

Page(s)

e2300238

10.1200/GO.23.00238

Abstract

Abstract

PURPOSE: Cancer deaths in low- and middle-income countries (LMICs) will nearly double by 2040. Available evidence-based interventions (EBIs) for cancer prevention and early detection can reduce cancer-related mortality, yet there is a lack of evidence on effectively scaling these EBIs in LMIC settings. METHODS: We conducted a scoping review to identify published literature from six databases between 2012 and 2022 that described efforts for scaling cancer prevention and early detection EBIs in LMICs. Included studies met one of two definitions of scale-up: (1) deliberate efforts to increase the impact of effective intervention to benefit more people or (2) an intervention shown to be efficacious on a small scale expanded under real-world conditions to reach a greater proportion of eligible population. Study characteristics, including EBIs, implementation strategies, and outcomes used, were summarized using frameworks from the field of implementation science. RESULTS: This search yielded 3,076 abstracts, with 24 studies eligible for inclusion. Included studies focused on a number of cancer sites including cervical (67%), breast (13%), breast and cervical (13%), liver (4%), and colon (4%). Commonly reported scale-up strategies included developing stakeholder inter-relationships, training and education, and changing infrastructure. Barriers to scale-up were reported at individual, health facility, and community levels. Few studies reported applying conceptual frameworks to guide strategy selection and evaluation. CONCLUSION: Although there were relatively few published reports, this scoping review offers insight into the approaches used by LMICs to scale up cancer EBIs, including common strategies and barriers. More importantly, it illustrates the urgent need to fill gaps in research to guide best practices for bringing the implementation of cancer EBIs to scale in LMICs.

Temporal Trends in Tobacco Smoking Prevalence During the Period 2010–2020 in Vietnam : A Repeated Cross-Sectional Study

Vu, L. T., Bui, Q. T., Shelley, D., Niaura, R. S., Tran, B. Q., Pham, N. Q., Nguyen, L. T., Chu, A., Pratt, A., Thi Lan Pham, C., & Hoang, M. V. (n.d.).

Publication year

2024

Journal title

International Journal of Public Health

Volume

69

10.3389/ijph.2024.1607104

Abstract

Abstract

Objectives: 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

Ciupek, A., Chichester, L. A., Acharya, R., Schofield, E., Criswell, A., Shelley, D., King, J. C., & Ostroff, J. S. (n.d.).

Publication year

2024

Journal title

BMC health services research

Volume

24

Issue

1

10.1186/s12913-024-11376-3

Abstract

Abstract

Background: 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

Titus, A. R., Shelley, D., & Thorpe, L. E. (n.d.).

Publication year

2024

Journal title

Tobacco control

10.1136/tc-2023-058512

Abstract

Abstract

Introduction: 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

Chelva, M., Kaushal, S., West, N., Erwin, E., Yuma, S., Sleeth, J., Yahya-Malima, K. I., Shelley, D., Risso-Gill, I., & Yeates, K. E. (n.d.).

Publication year

2024

Journal title

International journal of environmental research and public health

Volume

21

Issue

8

10.3390/ijerph21081059

Abstract

Abstract

Introduction: 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.

A Matched Analysis of the Association Between Federally Mandated Smoke-Free Housing Policies and Health Outcomes Among Medicaid-Enrolled Children in Subsidized Housing, New York City, 2015-2019

Titus, A. R., Mijanovich, T. N., Terlizzi, K., Ellen, I. G., Anastasiou, E., Shelley, D., Wyka, K., Elbel, B., & Thorpe, L. E. (n.d.).

Publication year

2023

Journal title

American Journal of Epidemiology

Volume

192

Issue

1

Page(s)

25-33

10.1093/aje/kwac089

Abstract

Abstract

Smoke-free housing policies are intended to reduce the deleterious health effects of secondhand smoke exposure, but there is limited evidence regarding their health impacts. We examined associations between implementation of a federal smoke-free housing rule by the New York City Housing Authority (NYCHA) and pediatric Medicaid claims for asthma, lower respiratory tract infections, and upper respiratory tract infections in the early post-policy intervention period. We used geocoded address data to match children living in tax lots with NYCHA buildings (exposed to the policy) to children living in lots with other subsidized housing (unexposed to the policy). We constructed longitudinal difference-in-differences models to assess relative changes in monthly rates of claims between November 1, 2015, and December 31, 2019 (the policy was introduced on July 30, 2018). We also examined effect modification by baseline age group (≤2, 3-6, or 7-15 years). In New York City, introduction of a smoke-free policy was not associated with lower rates of Medicaid claims for any outcomes in the early postpolicy period. Exposure to the smoke-free policy was associated with slightly higher than expected rates of outpatient upper respiratory tract infection claims (incidence rate ratio = 1.05, 95% confidence interval: 1.01, 1.08), a result most pronounced among children aged 3-6 years. Ongoing monitoring is essential to understanding long-term health impacts of smoke-free housing policies.

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. Annual Symposium on Global Cancer Research, 

Shelley, D. (n.d.).

Publication year

2023

Abstract

Abstract

~

An effectiveness-implementation hybrid trial of phone-based tobacco cessation interventions in the Lebanese primary healthcare system : protocol for project PHOENICS

Salloum, R. G., Romani, M., Bteddini, D. S., El-Jardali, F., Lee, J. H., Theis, R., LeLaurin, J. H., Hamadeh, R., Osman, M., Abla, R., Khaywa, J., Ward, K. D., Shelley, D., & Nakkash, R. (n.d.).

Publication year

2023

Journal title

Implementation science communications

Volume

4

Issue

1

10.1186/s43058-023-00456-w

Abstract

Abstract

Background: Tobacco use remains the leading cause of preventable disease, disability, and death in the world. Lebanon has an exceptionally high tobacco use burden. The World Health Organization endorses smoking cessation advice integrated into primary care settings as well as easily accessible and free phone-based counseling and low-cost pharmacotherapy as standard of practice for population-level tobacco dependence treatment. Although these interventions can increase access to tobacco treatment and are highly cost-effective compared with other interventions, their evidence base comes primarily from high-income countries, and they have rarely been evaluated in low- and middle-income countries. Recommended interventions are not integrated as a routine part of primary care in Lebanon, as in other low-resource settings. Addressing this evidence-to-practice gap requires research on multi-level interventions and contextual factors for implementing integrated, scalable, and sustainable cessation treatment within low-resource settings. Methods: The objective of this study is to evaluate the comparative effectiveness of promising multi-component interventions for implementing evidence-based tobacco treatment in primary healthcare centers within the Lebanese National Primary Healthcare Network. We will adapt and tailor an existing in-person smoking cessation program to deliver phone-based counseling to smokers in Lebanon. We will then conduct a three-arm group-randomized trial of 1500 patients across 24 clinics comparing (1) ask about tobacco use; advise to quit; assist with brief counseling (AAA) as standard care; (2) ask; advise; connect to phone-based counseling (AAC); and (3) AAC + nicotine replacement therapy (NRT). We will also evaluate the implementation process to measure factors that influence implementation. Our central hypothesis is that connecting patients to phone-based counseling with NRT is the most effective alternative. This study will be guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, supported by Proctor’s framework for implementation outcomes. Discussion: The project addresses the evidence-to-practice gap in the provision of tobacco dependence treatment within low-resource settings by developing and testing contextually tailored multi-level interventions while optimizing implementation success and sustainability. This research is significant for its potential to guide the large-scale adoption of cost-effective strategies for implementing tobacco dependence treatment in low-resource settings, thereby reducing tobacco-related morbidity and mortality. Trial registration: ClinicalTrials.gov, NCT05628389, Registered 16 November 2022.

Attitudes, perceptions, and preferences towards SARS CoV-2 testing and vaccination among African American and Hispanic public housing residents, New York City : 2020–2021

Izeogu, C., Gill, E., Van Allen, K., Williams, N., Thorpe, L. E., & Shelley, D. (n.d.).

Publication year

2023

Journal title

PloS one

Volume

18

Issue

1 January

10.1371/journal.pone.0280460

Abstract

Abstract

Background African American and Hispanic populations have been affected disproportionately by COVID-19. Reasons are multifactorial and include social and structural determinants of health. During the onset and height of the pandemic, evidence suggested decreased access to SARS CoV-2 testing. In 2020, the National Institutes of Health launched the Rapid Acceleration of Diagnostics (RADx)- Underserved Populations initiative to improve SARS CoV-2 testing in underserved communities. In this study, we explored attitudes, experiences, and barriers to SARS CoV-2 testing and vaccination among New York City public housing residents. Methods Between December 2020 and March 2021, we conducted 9 virtual focus groups among 36 low-income minority residents living in New York City public housing. Results Among residents reporting a prior SARS CoV-2 test, main reasons for testing were to prepare for a medical procedure or because of a high-risk exposure. Barriers to testing included fear of discomfort from the nasal swab, fear of exposure to COVID-19 while traveling to get tested, concerns about the consequences of testing positive and the belief that testing was not necessary. Residents reported a mistrust of information sources and the health care system in general; they depended more on “word of mouth” for information. The major barrier to vaccination was lack of trust in vaccine safety. Residents endorsed more convenient testing, onsite testing at residential buildings, and home self-test kits. Residents also emphasized the need for language-concordant information sharing and for information to come from “people who look like [them] and come from the same background as [them]”. Conclusions Barriers to SARS CoV-2 testing and vaccination centered on themes of a lack of accurate information, fear, mistrust, safety, and convenience. Resident-endorsed strategies to increase testing include making testing easier to access either through home or onsite testing locations. Education and information sharing by trusted members of the community are important tools to combat misinformation and build trust.

Data envelopment analysis to evaluate the efficiency of tobacco treatment programs in the NCI Moonshot Cancer Center Cessation Initiative

Pluta, K., Hohl, S. D., D’Angelo, H., Ostroff, J. S., Shelley, D., Asvat, Y., Chen, L. S., Cummings, K. M., Dahl, N., Day, A. T., Fleisher, L., Goldstein, A. O., Hayes, R., Hitsman, B., Buckles, D. H., King, A. C., Lam, C. Y., Lenhoff, K., Levinson, A. H., … Salloum, R. G. (n.d.).

Publication year

2023

Journal title

Implementation science communications

Volume

4

Issue

1

10.1186/s43058-023-00433-3

Abstract

Abstract

Background: The Cancer Center Cessation Initiative (C3I) is a National Cancer Institute (NCI) Cancer Moonshot Program that supports NCI-designated cancer centers developing tobacco treatment programs for oncology patients who smoke. C3I-funded centers implement evidence-based programs that offer various smoking cessation treatment components (e.g., counseling, Quitline referrals, access to medications). While evaluation of implementation outcomes in C3I is guided by evaluation of reach and effectiveness (via RE-AIM), little is known about technical efficiency—i.e., how inputs (e.g., program costs, staff time) influence implementation outcomes (e.g., reach, effectiveness). This study demonstrates the application of data envelopment analysis (DEA) as an implementation science tool to evaluate technical efficiency of C3I programs and advance prioritization of implementation resources. Methods: DEA is a linear programming technique widely used in economics and engineering for assessing relative performance of production units. Using data from 16 C3I-funded centers reported in 2020, we applied input-oriented DEA to model technical efficiency (i.e., proportion of observed outcomes to benchmarked outcomes for given input levels). The primary models used the constant returns-to-scale specification and featured cost-per-participant, total full-time equivalent (FTE) effort, and tobacco treatment specialist effort as model inputs and reach and effectiveness (quit rates) as outcomes. Results: In the DEA model featuring cost-per-participant (input) and reach/effectiveness (outcomes), average constant returns-to-scale technical efficiency was 25.66 (SD = 24.56). When stratified by program characteristics, technical efficiency was higher among programs in cohort 1 (M = 29.15, SD = 28.65, n = 11) vs. cohort 2 (M = 17.99, SD = 10.16, n = 5), with point-of-care (M = 33.90, SD = 28.63, n = 9) vs. no point-of-care services (M = 15.59, SD = 14.31, n = 7), larger (M = 33.63, SD = 30.38, n = 8) vs. smaller center size (M = 17.70, SD = 15.00, n = 8), and higher (M = 29.65, SD = 30.99, n = 8) vs. lower smoking prevalence (M = 21.67, SD = 17.21, n = 8). Conclusion: Most C3I programs assessed were technically inefficient relative to the most efficient center benchmark and may be improved by optimizing the use of inputs (e.g., cost-per-participant) relative to program outcomes (e.g., reach, effectiveness). This study demonstrates the appropriateness and feasibility of using DEA to evaluate the relative performance of evidence-based programs.

Emergency Nurses’ Perceived Barriers and Solutions to Engaging Patients With Life-Limiting Illnesses in Serious Illness Conversations : A United States Multicenter Mixed-Method Analysis

The PRIM-ER Investigators, A., Adeyemi, O., Walker, L., Bermudez, E. S., Cuthel, A. M., Zhao, N., Siman, N., Goldfeld, K., Brody, A. A., Bouillon-Minois, J. B., DiMaggio, C., Chodosh, J., Grudzen, C. R., Johnston, A., Venkat, A., Chuirazzi, D., O'Neill, J., Szabo, K., Urosek, R., … Brody, A. A. (n.d.).

Publication year

2023

Journal title

Journal of Emergency Nursing

10.1016/j.jen.2023.09.010

Abstract

Abstract

Introduction: This study aimed to assess emergency nurses’ perceived barriers toward engaging patients in serious illness conversations. Methods: Using a mixed-method (quant + QUAL) convergent design, we pooled data on the emergency nurses who underwent the End-of-Life Nursing Education Consortium training across 33 emergency departments. Data were extracted from the End-of-Life Nursing Education Consortium post-training questionnaire, comprising a 5-item survey and 1 open-ended question. Our quantitative analysis employed a cross-sectional design to assess the proportion of emergency nurses who report that they will encounter barriers in engaging seriously ill patients in serious illness conversations in the emergency department. Our qualitative analysis used conceptual content analysis to generate themes and meaning units of the perceived barriers and possible solutions toward having serious illness conversations in the emergency department. Results: A total of 2176 emergency nurses responded to the survey. Results from the quantitative analysis showed that 1473 (67.7%) emergency nurses reported that they will encounter barriers while engaging in serious illness conversations. Three thematic barriers—human factors, time constraints, and challenges in the emergency department work environment—emerged from the content analysis. Some of the subthemes included the perceived difficulty of serious illness conversations, delay in daily throughput, and lack of privacy in the emergency department. The potential solutions extracted included the need for continued training, the provision of dedicated emergency nurses to handle serious illness conversations, and the creation of dedicated spaces for serious illness conversations. Discussion: Emergency nurses may encounter barriers while engaging in serious illness conversations. Institutional-level policies may be required in creating a palliative care-friendly emergency department work environment.

Facilitation of team-based care to improve HTN management and outcomes : a protocol for a randomized stepped wedge trial

Shelley, D., Brown, D., Cleland, C. M., Pham-Singer, H., Zein, D., Chang, J. E., & Wu, W. Y. (n.d.).

Publication year

2023

Journal title

BMC health services research

Volume

23

Issue

1

10.1186/s12913-023-09533-1

Abstract

Abstract

Background: 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

Purtle, J., Moucheraud, C., Yang, L. H., & Shelley, D. (n.d.).

Publication year

2023

Journal title

Implementation science communications

Volume

4

Issue

1

10.1186/s43058-023-00497-1

Abstract

Abstract

Background: 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.

How does facilitation in healthcare work? Using mechanism mapping to illuminate the black box of a meta-implementation strategy

Kilbourne, A. M., Geng, E., Eshun-Wilson, I., Sweeney, S., Shelley, D., Cohen, D. J., Kirchner, J. A., Fernandez, M. E., & Parchman, M. L. (n.d.).

Publication year

2023

Journal title

Implementation science communications

Volume

4

Issue

1

10.1186/s43058-023-00435-1

Abstract

Abstract

Background: Healthcare facilitation, an implementation strategy designed to improve the uptake of effective clinical innovations in routine practice, has produced promising yet mixed results in randomized implementation trials and has not been fully researched across different contexts. Objective: Using mechanism mapping, which applies directed acyclic graphs that decompose an effect of interest into hypothesized causal steps and mechanisms, we propose a more concrete description of how healthcare facilitation works to inform its further study as a meta-implementation strategy. Methods: Using a modified Delphi consensus process, co-authors developed the mechanistic map based on a three-step process. First, they developed an initial logic model by collectively reviewing the literature and identifying the most relevant studies of healthcare facilitation components and mechanisms to date. Second, they applied the logic model to write vignettes describing how facilitation worked (or did not) based on recent empirical trials that were selected via consensus for inclusion and diversity in contextual settings (US, international sites). Finally, the mechanistic map was created based on the collective findings from the vignettes. Findings: Theory-based healthcare facilitation components informing the mechanistic map included staff engagement, role clarification, coalition-building through peer experiences and identifying champions, capacity-building through problem solving barriers, and organizational ownership of the implementation process. Across the vignettes, engagement of leaders and practitioners led to increased socialization of the facilitator’s role in the organization. This in turn led to clarifying of roles and responsibilities among practitioners and identifying peer experiences led to increased coherence and sense-making of the value of adopting effective innovations. Increased trust develops across leadership and practitioners through expanded capacity in adoption of the effective innovation by identifying opportunities that mitigated barriers to practice change. Finally, these mechanisms led to eventual normalization and ownership of the effective innovation and healthcare facilitation process. Impact: Mapping methodology provides a novel perspective of mechanisms of healthcare facilitation, notably how sensemaking, trust, and normalization contribute to quality improvement. This method may also enable more efficient and impactful hypothesis-testing and application of complex implementation strategies, with high relevance for lower-resourced settings, to inform effective innovation uptake.