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Background Despite the development of numerous evidence-based interventions (EBIs), many go unused in practice. Hesitations to use existing EBIs may be due to a lack of understanding about EBI components and what it would take to adapt it or implement it as designed. To improve the use of EBIs, program planners need to understand their goals, core components, and mechanisms of action. This paper presents EBI Mapping, a systematic approach based on Intervention Mapping, that can be used to understand and clearly describe EBIs, and help planners put them into practice. Methods We describe EBI Mapping tasks and provide an example of the process. EBI Mapping uses principles from Intervention Mapping, a systematic framework for planning multilevel health promotion interventions. EBI Mapping applies the Intervention Mapping steps retrospectively to help planners understand an existing EBI (rather than plan a new one). We explain each EBI Mapping task and demonstrate the process using the VERB Summer Scorecard (VSS), a multi-level community-based intervention to improve youth physical activity. Results EBI Mapping tasks are: 1) document EBI materials and activities, and their audiences, 2) identify the EBI goals, content, and mechanisms of action, 3) identify the theoretical change methods and practical applications of those methods, 4) describe design features and delivery channels, and 5) describe the implementers and their tasks, implementation strategies, and needed resources. By applying the EBI Mapping tasks, we created a logic model for the VSS intervention. The VSS logic model specifies the links between behavior change methods, practical applications, and determinants for both the at-risk population and environmental change agents. The logic model also links the respective determinants to the desired outcomes including the health behavior and environmental conditions to improve the health outcome in the at-risk population. Conclusions EBI Mapping helps program planners understand the components and logic of an EBI. This information is important for selecting, adapting, and scaling-up EBIs. Accelerating and improving the use of existing EBIs can reduce the research-to-practice gap and improve population health.

PurposeCommunity engagement is essential in effective public health programs. This paper illustrates the methods used to engage community in the development of a multi-level implementation intervention to address cancer disparities related to hereditary cancer syndromes. MethodsImplementation Mapping (IM), was used to guide the co-creation of an intervention. Key partners were recruited to a 13-member statewide community advisory board (CAB) representing healthcare and community-based organizations. As part of a needs assessment, a 3-round modified Delphi method with the CAB was used to identify implementation outcomes to use in later steps of IM. An anonymous online survey of a validated community engagement measure assessed CAB members’ satisfaction with the process. ResultsUsing a modified Delphi method as part of the needs assessment of IM, the CAB identified three broad categories of strategies: Changing infrastructure using patient navigation; training and educating patients, navigators and providers; and supporting clinicians in case identification and management. Self-reported satisfaction with the IM and Delphi process was high.ConclusionsImplementation Mapping facilitated the use of available evidence, new data, and community engagement to identify strategies to improve the delivery of programs to reduce hereditary cancer disparities. The modified Delphi method was easy to administer in a virtual environment and may be a useful for others in community-engaged research.

Background A fundamental challenge of implementation is identifying contextual determinants (i.e., barriers and facilitators) and determining which implementation strategies will address them. Numerous conceptual frameworks (e.g., the Consolidated Framework for Implementation Research; CFIR) have been developed to guide the identification of contextual determinants, and compilations of implementation strategies (e.g., the Expert Recommendations for Implementing Change compilation; ERIC) have been developed which can support selection and reporting of implementation strategies. The aim of this study was to identify which ERIC implementation strategies would best address specific CFIR-based contextual barriers. Methods Implementation researchers and practitioners were recruited to participate in an online series of tasks involving matching specific ERIC implementation strategies to specific implementation barriers. Participants were presented with brief descriptions of barriers based on CFIR construct definitions. They were asked to rank up to seven implementation strategies that would best address each barrier. Barriers were presented in a random order, and participants had the option to respond to the barrier or skip to another barrier. Participants were also asked about considerations that most influenced their choices. Results Four hundred thirty-five invitations were emailed and 169 (39%) individuals participated. Respondents had considerable heterogeneity in opinions regarding which ERIC strategies best addressed each CFIR barrier. Across the 39 CFIR barriers, an average of 47 different ERIC strategies (SD = 4.8, range 35 to 55) was endorsed at least once for each, as being one of seven strategies that would best address the barrier. A tool was developed that allows users to specify high-priority CFIR-based barriers and receive a prioritized list of strategies based on endorsements provided by participants. Conclusions The wide heterogeneity of endorsements obtained in this study’s task suggests that there are relatively few consistent relationships between CFIR-based barriers and ERIC implementation strategies. Despite this heterogeneity, a tool aggregating endorsements across multiple barriers can support taking a structured approach to consider a broad range of strategies given those barriers. This study’s results point to the need for a more detailed evaluation of the underlying determinants of barriers and how these determinants are addressed by strategies as part of the implementation planning process.

Background Incorporating physical movement in the teaching of academic content (active learning) is a promising approach to improve children’s health and academic performance. Despite documented benefits, implementation of active learning remains challenging for schools. The aims of this study are to develop an implementation strategy to support the delivery of active learning in elementary schools and examine the impact of the developed implementation strategy on the implementation and effectiveness of active learning. Methods Aim 1 will use Implementation Mapping, which is a multi-step approach that guides the use of theory, stakeholder input, and existing literature to develop a scientifically based implementation strategy for active learning in elementary schools. Aim 2 will feature a feasibility study to examine the impact of the implementation strategy on both implementation and effectiveness outcomes, consistent with a Hybrid Type 2 design. Acceptability and implementation fidelity will be the primary implementation outcomes, and student physical activity levels will be the primary effectiveness outcome. We will recruit two elementary schools within our partner district, and one will be randomly assigned to receive usual support while the other will receive the newly developed implementation strategy. Participants from each school will complete baseline, 6-, and 12-month assessments. Bayesian statistical approaches will quantitatively examine preliminary effectiveness outcomes. We will also use an embedded mixed methods approach to triangulate findings. Discussion This study’s innovative overarching conceptual framework (centered on Implementation Mapping) will inform the development and testing of the implementation strategy. This study also uses methodological approaches optimal for feasibility studies, including mixed methods and Bayesian statistics. As a result, we will be able to gain a thorough understanding about the feasibility and preliminary effectiveness of the implementation strategy, which will inform subsequent research and practice for implementing active learning in schools. Trial registration ClinicalTrials.gov, NCT05048433 , registered on September 8, 2021.

Abstract Background Physically active breaks and lessons are evidence-based approaches to improving student’s physical activity. Yet, schools and teachers face implementation challenges, requiring the need for effective implementation strategies. Purpose Use Implementation Mapping to develop an implementation strategy for physically active breaks and lessons in elementary schools. Methods With our partner school district, we assembled a planning group with expertise in education, public health, and implementation science. The group completed five Implementation Mapping tasks: (i) conduct needs and assets assessment and identify adopters and implementers, (ii) identify implementation outcomes, performance objectives, and determinants, and create matrices of change objectives, (iii) choose theoretical change methods and select and create implementation strategies, (iv) produce implementation protocols and materials, and (v) evaluate implementation outcomes. We also developed an Implementation Mapping (IMap) Logic Model illustrating proposed mechanisms of action. Results The implementation strategy focused on the principal/assistant principal, instructional coaches, and teachers. The implementation outcome was teacher implementation fidelity (implementation ≥2 physically active breaks/lessons per day). The developed strategy consisted of leadership training, teacher training, a newsletter, resources for teachers, and a parent flyer. The strategy operationalized change methods (theoretical techniques influencing implementation determinants) and practical applications (operationalization of change methods) to address implementation determinants and outcomes. Conclusions Implementation Mapping provided a systematic process for developing an implementation strategy for physically active breaks and lessons in elementary schools. The IMap Logic Model identifies the proposed mechanisms of action for further testing. The strategy has the potential to benefit schools, teachers/staff, and students by enhancing physical activity. An implementation strategy to support elementary schools use physically active breaks and physically active lessons was developed. Lay Summary Physically active breaks and lessons can help students be more physically active during the school day, which is important for their overall health and well-being. However, it can be difficult for schools and teachers to use these approaches. To address this difficulty, our team worked with a partner school district to develop an implementation strategy to reduce the challenges teachers and staff face. We used implementation mapping, which is a systematic process for developing implementation strategies. As part of the process, we first assembled a planning group, which included experts in education, public health, and implementation science. The group helped guide the Implementation Mapping process and key decisions throughout the project. We created an implementation strategy that included leadership training, teacher training, newsletters, resources, and a flyer for parents. The goal of the strategy was to ensure teachers could successfully incorporate at least two physically active breaks or lessons each day. Our approach provides a clear, step-by-step approach for implementation strategy development in schools. The resulting implementation strategy has the potential to help schools create a more active environment for students, benefiting their health and learning.

BackgroundDespite tremendous therapeutic advancements, a significant proportion of coronary artery disease patients suffer from refractory angina pectoris, that is, quality-of-life-compromising angina that is non-manageable with established pharmacological and interventional treatment options. Adenoviral vascular endothelial growth factor-DΔNΔC (AdVEGF-D)-encoding gene therapy (GT) holds promise for the treatment of refractory angina.MethodsReGenHeart is an investigator-initiated, multicentre, randomised, placebo-controlled and double-blinded phase 2 clinical trial that aims to study the safety and efficacy of intramyocardially administered angiogenic AdVEGF-D GT for refractory angina. Patients will be randomised in a 2:1 ratio and blocks of six to receive either AdVEGF-D or placebo. Primary endpoints are improvements in functional capacity assessed with the 6 min walking test and angina symptoms with Canadian Cardiovascular Society class after 6 month follow-up. Secondary endpoints are improvements in myocardial perfusion assessed with either positron emission tomography or single-photon emission CT after 6 month follow-up and functional capacity and angina symptoms after 12 months. In addition, changes in the quality of life, the use of angina medication and the incidence of major adverse cardiac and cerebrovascular events will be evaluated.ConclusionsThe phase 2 ReGenHeart trial will provide knowledge of the safety and efficacy of AdVEGF-D GT to ameliorate symptoms in refractory angina patients, extending and further testing positive results from the preceding phase 1/2a trial.

Pastoral social-ecological systems (SES) provide myriad benefits to humanity and face multiple challenges in the 21st century, including interacting climate and land-use change, political marginalization, and demographic shifts, leading to loss of traditional knowledge and practices associated with sustainable use. Research and policy increasingly recognize women's roles in sustaining pastoral SES in the Global South, yet women pastoralists in the Global North have received scant attention. In Spain, like other countries in the Global North, the rise of intensive industrialized agriculture contributed to rural depopulation, land abandonment, and the masculinization of rural spaces. In this qualitative study, we address the empirical gap in studies of women pastoralists in the Global North by investigating Spanish women pastoralists' roles in pastoral SES conservation, adaptive transformation, and abandonment (regime shift). Drawing on in-depth life-history interviews with 31 women from 4 regions of Spain, and participatory workshops with women in each region, we explored women pastoralists' diverse identities and roles in conserving, transforming, and abandoning pastoral SES, focusing on 3 levels of social organization: the household/enterprise and local community, the extensive livestock sector, and society broadly. We found that women contributed to all three processes and we highlight synergies between women's roles as tradition-keepers and change agents that could serve as a leverage point for adaptive transformation. Our analysis also revealed key contradictions in women's material and discursive practices; how these are shaped by intersecting axes of social differences such as age, class, origins. and family status; and their implications for policy and practice to foster adaptive transformation of extensive livestock systems. This work advances SES/resilience research by addressing social science critiques of resilience approaches through the application of feminist theories and methodology that center the voices and subjective lived experiences of women pastoralists and attend to the roles of gender and power in SES dynamics.

More than 60% of cancer-related deaths in the United States are attributable to tobacco use, poor nutrition, and physical inactivity, and these risk factors tend to cluster together. Thus, strategies for cancer risk reduction would benefit from addressing multiple health risk behaviors. We adapted an evidence-based intervention grounded in social cognitive theory and principles of motivational interviewing originally developed for smoking cessation to also address physical activity and fruit/vegetable consumption among Latinos exhibiting multiple health risk behaviors. Literature reviews, focus groups, expert consultation, pretesting, and pilot testing were used to inform adaptation decisions. We identified common mechanisms underlying change in smoking, physical activity, and diet used as treatment targets; identified practical models of patientcentered cross-cultural service provision; and identified that family preferences and support as particularly strong concerns among the priority population. Adaptations made to the original intervention are described. The current study is a practical example of how an intervention can be adapted to maximize relevance and acceptability and also maintain the core elements of the original evidence-based intervention. The intervention has significant potential to influence cancer prevention efforts among Latinos in the United States and is being evaluated in a sample of 400 Latino overweight/obese smokers.

Despite increasing calls for knowledge integration around the world, traditional knowledge is rarely used in formal, Western-science-based monitoring and resource management. To better understand indicators herders use and their relationship to researcher-measured indicators, we conducted in-depth field interviews with 26 herders in three ecological zones of Mongolia. We asked each herder to (1) assess the overall condition of three different sites located along a livestock-use gradient from their winter camp using a numeric scale, (2) describe the indicators they used in their assessment, and (3) explain what caused their pastures to remain healthy or become degraded. At each site, we collected field data on vegetation variables and compared these with herders’ ratings and indicators using linear regression. We used classification and ordination to understand how herders’ assessment scores related to plant community composition, and determine how well multivariate analysis of factors determining plant community composition aligned with herders’ observations of factors causing rangeland change. Across all ecological zones, herders use indicators similar to those used in formal monitoring. Herders’ assessment scores correlated significantly and positively with measured total foliar cover in all three ecological zones, and with additional measured variables in the steppe and desert steppe. Ordination revealed that herder assessment scores were correlated with the primary ordination axis in each zone, and the main factors driving plant community composition in each zone were the same as those identified by herders as the primary causes of rangeland change in that zone. These results show promise for developing integrated indicators and monitoring protocols and highlight the importance of developing a common language of monitoring terminology shared by herders, government monitoring agencies, and researchers. We propose a new model for integrating herder knowledge and participation into formal monitoring in Mongolia, with implications for rangelands and pastoral people globally. We suggest practical ways of involving herders in formal monitoring that have potential broad application for promoting local and indigenous people’s participation in implementing international agreements such as the UN Convention to Combat Desertification and the UN Convention on Biological Diversity, both of which call for involvement of local people and indigenous/traditional knowledges.

Learning is recognized as central to collaborative adaptive management (CAM), yet few longitudinal studies examine how learning occurs in CAM or apply the science of learning to interpret this process. We present an analysis of decision-making processes within the collaborative adaptive rangeland management (CARM) experiment, in which 11 stakeholders use a structured CAM process to make decisions about livestock grazing and vegetation management for beef, vegetation, and wildlife objectives. We analyzed four years of meeting transcripts, stakeholder communications, and biophysical monitoring data to ask what facilitated and challenged stakeholder decision making, how challenges affected stakeholder learning, and whether CARM met theorized criteria for effective CAM. Despite thorough monitoring and natural resource agency commitment to implementing collaborative decisions, CARM participants encountered multiple decision-making challenges born of ecological and social complexity. CARM was effective in achieving several of its management objectives, including reduced ecological uncertainty, knowledge coproduction, and multiple-loop social learning. CARM revealed limitations of the idealized CAM cycle and challenged conceptions of adaptive management that separate reduction of scientific uncertainty from participatory and management dimensions. We present a revised, empirically grounded CAM framework that depicts CAM as a spiral rather than a circle, where feedback loops between monitoring data and management decisions are never fully closed. Instead, complexities including time-lags, trade-offs, path-dependency, and tensions among stakeholders' differing types of knowledge and social worlds both constrain decision making and foster learning by creating disorienting dilemmas that challenge participants' pre-existing mental models and relationships. Based on these findings, we share recommendations for accelerating learning in CAM processes.