Report
Virtual workshop on Design and conduct of Implementation Research
Platform for Research Excellence Related to National Aims (PRERNA) -conducted by KEM Hospital Research Centre, Pune
Day 1
The session on day 1 started with a welcome address by Dr. Sanjay Juvekar, KEMHRC, Vadu which was followed by a brief introduction to the PRERNA platform. This was followed by an introduction to the workshop. A pretest was conducted with some questions related to the core topics of Implementation research to assess the pre-workshop knowledge of the participants.
The first session on introduction to implementation research was conducted by Dr. Rajiv Bahl from Maternal Child Health, WHO. He started with the definition of implementation research (IR) as the search of knowledge for developing practical solutions to common but critical problems of health care interventions to improve their access quality and quantity-wise. For the conduct of implementation research, it is necessary that the efficacy of the intervention is proven. Though there is a slight overlap between the concept of implementation and operations research; IR is the method of diagnosing the problems in the health system. Hence it is different from efficacy/effectiveness research. He also explained about the three components of implementation research identified by WHO are as follows:-
- Identification of problem in implementation and its determinants
- Development of practical solutions
- Introduction of an implementation strategy to overcome the problem
So it is important for the Research team and Implementation team to work together. Dr. Bahl also explained about the fact that how implementation research is helpful in improving government in health program development and help in effectively developing policies and strategies in the health sector. Lastly, he concluded that implementation research is about identifying the barriers to scale up activities and to achieve high coverage and quality.
For effective implementation research, be right research question has to be identified. Usually, IR is designed to questions starting with ‘HOW’. It is also important to define pragmatic objectives for the implementation research.
The next session on Theories and frameworks was conducted by Dr. Jose Martines. He described the theoretical approaches and models used in implementation science. He discussed the process models like Dynamic sustainability, EPIS (Exploration, Preparation, Implementation, and Sustainment), Dynamic adaptation, etc. He also discussed the RE-AIM model (Reach, Effectiveness, Adoption, Implementation, and Maintenance) of evaluating implementation.
Both sessions ended with active question-answer sessions.
Activities of day 1 ended with a post-test on topics related to the day 1 session and were conducted by Aditi Apte, KEMHRC.
Day 2
The second day of the workshop started with a Recap of day 1, summarized by a young investigator from CMC, Vellore, Dr. Manikandan.
The first session on research questions and study designs in IR was conducted by Dr. Sanjay Juvekar and Dr. Sudipto Roy from KEMHRC, Pune. They described the types, terminologies and hierarchical role of IR and also discussed the steps in IR cycle i.e. contextualizing the challenge, development of the proposal, plan and implement, analysis of data, dissemination of findings, monitoring and evaluation. Consolidated framework of IR, Implementation outcomes and their descriptions of IR was also described. IR designs such as pragmatic research, effectiveness implementation hybrid trials, mixed-method designs, quality improvement studies, participatory action research, realistic review etc. were also discussed.
In the second session, Dr. Shamim Quazi, WHO gave an overview of analytical methods in IR studies. He explained about the physical, socioeconomic and cultural contexts of interventions and elements of health system. He also discussed the analytical methods for qualitative data such as participant observation, field observation, review documents, in depth interviews, focused Group discussion and for quantitative data such as structured observations, questionnaires etc. He mentioned about the phases of such acceptability, appropriateness, quality, fidelity, coverage etc. The session ended with questions and answers.
In the second half of day 2, some successful examples of IR were discussed. These included a brief description of an ongoing implementation research on a government health program for management of high-risk pregnancies in tribal communities in Pune district: barriers, facilitators and scalability’ by Rutuja Patil, KEMHRC, Pune. Later, Sharmila Majumdar, SAS, New Delhi described the successful implementation of Kangaroo Mother Care in Haryana for low birth weight babies.
Sudipto Roy covered another example of implementation research by the KEM team on the feasibility of the implementation of simplified management of young infants with possible serious bacterial infection when a referral is not feasible in tribal areas of Pune district, Maharashtra, India.
Last session of the day was conducted by Dr. Sanjay Juvekar and Rutuja Patil, KEMHRC on stakeholders in IR and challenges in stakeholder engagement in IR. They discussed the stakeholders in IR such as patients or participants, healthcare providers, researchers, implementers and policymakers etc, and modes of their engagement in IR process.
Activities of day 2 ended with post-test 2 conducted by Dr. Aditi Apte, KEMHRC.
Day 3
The third and the final day of the workshop started with Recap of day 1, summarized by Ravi Shastri, SAS, New Delhi.
The first session on developing IR proposal was conducted by Dr. Sharmila Mujumdar from CHRD, SAS. She described the structure of the proposal as Introduction, Research design Project plan, Expected Impact and Supplements of IR. She mentioned the differences in the IR and routine research proposals. She explained in brief about developing the title, rationale, statement of the problem, research objectives, quality management, capacity building, dissemination plan, conceptual work, role, and responsibilities, etc. She also gave important tips about the reviewer’s perspectives.
This important session was followed by one-hour group activity in which all participants were grouped into three groups of about 22 participants and each group was given one of the following themes to design research questions. Discussion in each group was facilitated by a senior researcher. Each group also included a senior government official to provide inputs related to the need and feasibility of implementation.
|
Group |
Theam |
Facilitator |
Government partners |
| 1. |
Infection during pregnancy and childhood |
Samira Aboubaker |
MV Karnataki(UNICEF) |
| 2. |
Nutrition during pregnancy and childhood |
Jose Martines |
Suresh Dalpat (DD, HSHRC, Haryana) |
| 3. |
COVID-19 |
Sanjay Juvekar |
Mukta Gadgil(SHSRC, Maharashtra) |
The groups were asked to develop one or two priority research questions related to the theme and present them to the larger audience at the end of the group activity. The overall session was coordinated by Samira Aboubaker, WHO. Each group came up with at least one research question which will be developed in the future into full proposals for implementation research. Dr. Jose Martines graciously agreed to mentor the participants for IR proposal development on select topics.
At the end of the session, Dr. Sudipto Roy and Dr. Sanjay Juvekar gave the vote of thanks.
The workshop was attended by 66 participants out of 73 registered participants. Feedbacks collected from participants were also mentioned that the workshop was informative and comprehensive. Participants also appreciated the discussion to well-conducted and all sessions were conducted in lucid language.
