The Many Forms and Purposes of Implementation Research in Nutrition: Definitions, Domains and Distinctions for Advancing Research and Practice

Poor nutrition is recognized as the biggest risk factor for morbidity and mortality worldwide. Over the past decade there has been increasing momentum within the global community to commit to “ending malnutrition in all its forms by 2030”[i]. Despite this unprecedented commitment, the Global Nutrition Report [ii] observed considerable variation in coverage across various interventions, as well as within and between countries. This demonstrates the persistent and significant gaps between global targets and actual achievements. Furthermore, the poor quality and coverage of the data itself hinders efforts to assess progress and establish accountability.

To some degree these gaps highlight a significant imbalance in research agendas.  It is estimated that implementation of existing, proven interventions could reduce stunting by 36%[iii] and child mortality by 62% [iv]. However, current research agendas have focused on mechanistic research and development of new technologies with only 3% of funding devoted to improving the delivery of existing interventions[v].  Not surprisingly, investigators in the 2008 Lancet series noted that the vast majority of papers available for review were based on small-scale efficacy studies with only 3% focused on large-scale delivery efforts [vi].

Together these observations highlight the profound challenge of translating the current evidence base, and the collective will, into high quality and sustainable implementation and impact at-scale.  It is not enough to know that a nutrition intervention is efficacious; it is also necessary to identify and address barriers and enablers of effectiveness under large-scale, real-world conditions. Awareness of this need has stimulated interest in implementation science (IS) and also led to the founding of SISN.

IS offers an opportunity for multiple stakeholders to engage in collaborative and sustainable efforts to advance our understanding of how interventions can work in ‘real-world’ settings. To that end it is important that the nutrition communities at global and country levels develop a shared understanding of the scope and breadth of decisions and processes that make up and affect ‘implementation’; the diverse forms of ‘implementation research’ (IR) that can inform and strengthen implementation; and the even broader and more immediate ways in which ‘implementation science’ can inform and strengthen implementation.

Implementation

Simply put, this involves “systematic and planned efforts within a system (or organization) to introduce and institutionalize a policy, plan, program, intervention, guideline, innovation or practice and ensure its intended effects and impacts.”  Taking this a step further, and building on some seminal reviews in the literature, SISN is embracing the view that implementation quality and impact is affected by the characteristics of, and fit among, five domains:

1. The object of implementation (e.g. a supplement versus a multisectoral program)
2. The implementing organizations and staff (e.g. an NGO versus a ministry of health)
3. The broader enabling environment and stakeholder interests and dynamics
4. The individuals, households, communities and community actors
5. Implementation strategies and processes (e.g. private sector versus health clinics). 

These five domains represent a ‘framework’ that can guide implementation itself as well as various forms of implementation research to identify and address weaknesses. 

Implementation Research

In order for implementation efforts to succeed we need to strengthen the commitment, capacity and practice to systematically ‘assess and address’ potential weaknesses within and between each of these five domains.  In broad terms such weaknesses could exist or arise in four broad functional areas, specifically during:

1. Initiation and scoping of intervention, implementation and partnership possibilities;
2. Planning of implementation inputs, activities and strategies in greater detail;
3. Implementation, iterative improvement and scaling up at field level;
4. Commitment, support, financing and sustainability, as part of the enabling environment.

IR can take many forms, depending on which of the five implementation domains or four functional areas is of concern.  For instance, IR could take the form of rigorous evaluation of pilot or larger-scale implementation trials, with or without comparison groups and with or without randomization at household or community level.  This is an important and underfunded form of IR, but involves long timelines and answers only certain implementation questions.  A broader family of research methods is needed to ‘assess and address’ the wide range of weaknesses that may exist within and between the five domains and four functional areas.  This includes, for example, stakeholder analysis, opinion leader research, formative research, rapid assessments, operations research, special studies, process evaluation, costing studies, Delphi studies and various forms of quality improvement or quality assurance.   In other words, ’implementation research’ is an umbrella term that is defined on the basis of its purpose (i.e. to inform specific implementation-relevant decisions and processes) and is flexible and eclectic in its methods, depending on the questions and the context.

Implementation Science

IS is a broader concept (than IR) and is perhaps the most practical and immediately useful source of knowledge for strengthening implementation.  For SISN’s purposes, IS (or “the science of implementation”) is defined as “an interdisciplinary body of theory, knowledge, frameworks, tools and approaches whose purpose is to strengthen implementation quality and impact.”

There are several important implications of this definition:

• A great deal is already known about implementation, such that many of the most common mistakes could be prevented by applying current knowledge rather than undertaking new investigations;
• Much of this current knowledge has already been packaged into practical tools, frameworks and guidelines that can be adapted and used in a variety of settings;
• The greatest ‘gap’ lies in knowledge utilization, rather than in generating new knowledge. This knowledge utilization gap exists in nutrition, health, education and most other sectors, and it exists in high-income countries as well as low- and middle-income countries;
• The most urgent need in nutrition implementation is to close this knowledge utilization gap by making these practical tools, frameworks and guidelines more readily accessible, through various forms of capacity building, technical assistance, coaching, knowledge brokering and dissemination.

Contextual Knowledge, Experience and Adaptation

In addition to the knowledge utilization gap one of the most difficult challenge being discussed in the IS literature relates to ‘contextual adaptation’.  Contextual adaptation is needed for interventions themselves (e.g. behaviour change communication (BCC) messages and package design for micronutrient powders, implementation strategies (e.g. the duration and design of training programs for frontline workers), capacity building modalities for national staff (e.g. the form, frequency and intensity of technical assistance), frameworks and tools (e.g. national capacity assessment frameworks and quality improvement approaches) and many other functions.   The literature is clear that such adaptation is necessary.  The difficulties lie in two areas: deciding how much adaptation is possible before the evidence-based intervention or strategy or principle loses its quality and effectiveness (e.g. how much can the duration or intensity of frontline worker training or infant and young child feeding (IYCF) counseling be reduced without compromising quality and effectiveness?); and how, in practical terms, can implementers and other actors with relevant contextual knowledge and experience collaborate with researchers or knowledge brokers to make these critically important adaptation decisions? The adaptation challenge is one of the many reasons why the IS literature emphasizes the need for such collaboration and why SISN membership includes both researchers and implementers.

Building a Science of Implementation in Nutrition

The SISN approach and strategic plan is based on the above concepts and a number of other themes in the literature.  SISN’s overarching framework consists of five goals (and associated strategies) that address five imperatives for achieving the vision of “a world where actions to improve nutrition are designed and implemented with the best available scientific knowledge and practical experience” (Figure 1). A description of our conceptual thinking supporting this framework was presented in our previous newsletter lead article “Leveraging Change: SISN’s Key Priorities” and is outlined in our Strategic Plan.

The first goal of SISN’s Strategic Plan is to “Advance the Theory, Methods and Conduct of Implementation Science in Nutrition”.  To that end, one important element of that framework is a typology for distinguishing among the many different forms and purposes of IR, taking account of the various domains, functional areas and objects of implementation described in this article.  It is hoped that the application of this typology will help advance the methods, conduct and capacities for IR and the accumulation of implementation knowledge over time.  I will be following up on this article in a few weeks with a webcast exploring the typology in more detail.  Over the coming months, we will be sharing a series of webcasts and blogs describing specific case studies as a set of examples that more clearly illustrate the focus and methods of research in the various cells of the typology. In addition, the typology will be used as the basis for a future knowledge management system, as well as in an upcoming collaborative project with the SUN secretariat.  The typology will be revised and refined on the basis of these experiences.

As we move through this process, SISN welcomes participation and feedback from its members regarding our strategic plan, our frameworks and constructs, the typology and the illustrative case studies.  We especially welcome additional case studies, exemplars or experiences that could illustrate additional research methods and/or strategies for closing the knowledge utilization gap.

If you have materials that you feel might be suitable or wish to contact us relating to any of our activities you can email us at implementnutrition@gmail.org. You can also comment on activities via Twitter and LinkedIn.

[ii] International Food Policy Research Institute. Global Nutrition Report 2016: From Promise to Impact – Ending Malnutrition by 2030. Available from: http://globalnutritionreport.org/the-report/

[iii] Bhutta ZA, Ahmed T, Black RE, Cousens S, Dewey K, Giugliani E, Haider BA, Kirkwood B, Morris SS, Sachdev HP, Shekar M; Maternal and Child Undernutrition Study Group. What works? Interventions for maternal and child undernutrition and survival. Lancet. 2008 Feb 2;371(9610):417-40. Available from: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(07)61693-6/fulltext

[iv] Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS; Bellagio Child Survival Study Group. How many child deaths can we prevent this year? Lancet. 2003 Jul 5;362(9377):65-71. Available from: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(03)13811-1/fulltext

[v]  Leroy JL, Habicht JP, Pelto G, Bertozzi SM. Current priorities in health research funding and lack of impact on the number of child deaths per year. Am J Public Health. 2007;97:219–223. Available from: http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2005.083287

[vi] Horton R  Maternal and child undernutrition: an urgent opportunity Lancet 2008  Volume 371 (9608) 179 Available from: http://www.thelancet.com/series/maternal-and-child-undernutrition

How can we optimize implementation quality and impact? SISN weighs in at EB!

If you are planning on heading to the Windy City next month for Experimental Biology (EB) 2017, please seek out and introduce yourself to our Board Members who can be identified by their SISN branded buttons.

As part of the American Society for Nutrition’s (ASN) scientific program, SISN will be presenting a symposium entitled “Implementation Research in Nutrition: Purposes, Methods and Applications”. Join us for this 75-minute session on Tuesday, April 25^th at 8am. Three engaging and expert speakers will be taking to the podium to illustrate how implementation science (IS) can be applied to improve the effectiveness, equity and efficiency of policies, programs and interventions within real-world settings.

As the first speaker, our President, Dr. David Pelletier will introduce the topic and a recently developed IS framework and typology, highlight the many ways in which IS can generate essential information to enhance implementation quality and scale, and describe new efforts underway at global and national levels to generate such information.

Dr. Lynnette Neufeld, from the Global Alliance for Improved Nutrition, will then illustrate how this IS framework and typology can be applied in practice by describing the implementation of a national infant and young child nutrition program.

Finally, we’re honored that Dr. Rachel Sturke, Director of the Fogarty Division of International Science Policy, Planning and Evaluation at the National Institutes of Health, has agreed to share the experiences in creating, structuring and supporting the NIH-PEPFAR PMTCT Implementation Science Alliance. The Alliance was formed to enhance effective implementation of evidence-based interventions to prevent mother-to-child-transmission of HIV (PMTCT), and thus can offer key lessons and recommendations on how SISN and the nutrition community might form a similar alliance for nutrition implementation in low- and middle-income countries. You may be interested in reading the articles in a recent special issue of the Journal of Acquired Immune Deficiency Syndrome that reported on the collective learning of the Alliance and important results of key IS studies.

The symposium will conclude with a panel discussion moderated by the co-chairs Dr. Mandana Arabi and Dr. David Pelletier. We hope that these open deliberations will illuminate key research priorities for systematizing and harmonizing the theory and practice of IS. As a member, this is a unique opportunity to contribute to this important dialogue and be involved in shaping the future agenda of our society. We hope to see you there!

For full details of ASN at EB, please click here.

Stakeholder Engagement: An Important Tool to Understanding and Improving Program Decision-Making

In 2012, SUNRAY an initiative to identify nutrition research priorities in sub-Saharan Africa, identified a number of research gaps: donors, rather than policy-makers and implementers drove research activities; research was not adequately linked to local priorities; and there was a substantial amount of research waste. These findings led to the formation of EVIDENT, a north-south partnership created to strengthen capacities to address the disparity between research and local needs in nutrition and health in Africa.

In pursuit of EVIDENT’s goals, 4 case studies were set up across Africa with Dr Richmond Aryeetey co-leading a team in Ghana with Dr Esi Colecraft from the University of Ghana. The Research Team aimed to understand the process of priority setting and decision-making in nutrition, and to identify the barriers and limitations for evidence utilization in this process.  To this end, they sought to engage relevant stakeholders as a source of in-depth information about current nutrition programing.

Stakeholders are individuals who are directly affected by or have an effect on the actions of an organization. Stakeholder engagement has been proposed as a method to help realign research with the needs of policymakers, implementers, and the local community; engaging stakeholders can improve the relevance, transparency and adoption of implementation research. In this instance, key stakeholders were identified by asking statutory government agencies working on nutrition (e.g. Ghana Health Service, Ministry of Trade and Industry) and other partners (e.g. UN agencies, academia, civil societies) to nominate their most relevant representatives to participate in the case study.

Data collection was guided by the ‘Net-Map’ research tool, produced by IFPRI. This innovative empirical methodology combines social network analysis with a power-mapping tool. ‘Net-Map’ provides qualitative and quantitative data on interactions within the network (in this case the nutrition program), goals of stakeholders, and their power and influence.

Using a participatory approach, the Research Team facilitated two stakeholder workgroup meetings and 16 key informant interviews.  Data collected from the first stakeholder workgroup meeting were analyzed and used to draft the stakeholder influence map for a specific nutrition program, as an example of a typical nutrition program in Ghana. The second stakeholder workgroup meeting was a validation workshop where findings from the key informant interviews and the draft stakeholder map were shared with stakeholders for their input.

Preliminary findings of stakeholder engagement suggest:

• Nutrition priorities are largely driven by external influences
• There is limited engagement between academia and decision making bodies, but interest to strengthen engagement
• Research agendas are not influenced by decision-making evidence need
• Ad hoc committees provide local contextual evidence
• Decision making rarely employs a comprehensive evidence review or contextualization to local political, economic, social, technological conditions.

Moving forward, stakeholders identified four key actions to strengthen decision-making capacity in nutrition across African countries. These were collaborative development of a nutrition research agenda in Ghana; development of a research registry led by EVIDENT; promotion of greater involvement of implementing agencies in research conceptualization; and conduct of systematic reviews leading to policy briefs targeted at implementing agencies.

Reflecting on these results Dr Aryeetey and his team concluded that “Our study demonstrates the value of stakeholder engagement to help identify and understand key issues in nutrition programming. These findings suggest that the observed research gaps are not simply know-do gaps; highlighting that first and foremost we need a framework to guide how to bring researchers and implementers together, so that decision-making is informed by research and vice versa. We welcome any initiatives that promote this agenda”.

Additional Resources: Stakeholder Engagement Research Tools

1. Schiffer E, Waale D (2008) IFPRI discussion paper 00772 Tracing Power and Influence in Networks: Net-Map as a Tool for Research and Strategic Network Planning Available at: http://ebrary.ifpri.org/cdm/ref/collection/p15738coll2/id/10491
2. Community Tool Box (2016) Tools to Change our World. In: Work Group for Community Health and Development, ed.Section 8. Identifying and Analyzing Stakeholders and Their Interests. Kansas: University of Kansas; Available At: http://ctb.ku.edu/en/table-of-contents/participation/encouraging-involvement/identify-stakeholders/main.)
3. Mind Mapping Available at:http://www.mindmapping.com

 

This case study was presented during the Plenary Session “Implementation Science in nutrition: purposes, forms, functions and country examples” at the Micronutrient Forum (MNF) Global Conference in Cancun, Mexico in October 2016. For the full case study click here. 

Have an idea or a comment on any of the issues discussed above? We welcome your feedback – you can comment on this post on our LinkedIn feed or write to us using the email address below. 

If you are interested in finding out more about implementation science (IS) or becoming a member of SISN to help us advance the use of IS in nutrition, you can contact us via our website (www.implementnutrition.org) or can email us at implementnutrition@gmail.com.

Leveraging Change – SISN’s Key Priorities

 

SISN’s Strategic Plan sets out our conceptual thinking and the steps which we are taking to achieve our vision in support of global and country efforts to scale-up nutrition. Fundamental to this plan are three priority areas for attention: the first is the ‘Implementation Spectrum’ – SISN’s expanded view of what need to be considered in implementation; the second is the ‘Implementation Knowledge Portfolio ‘  – our  wider perspective of what kind of knowledge types are of  value; and last, but not least, ‘Knowledge Utilization Strategies’ – the vital driver that leverages the first two.

Implementation Spectrum

It is a common view that implementation refers solely to the process of initiating, managing and expanding implementation (as seen in language like ‘rolling out’ and ‘scaling up’ programs). Whilst it is true that this represents the fundamental ‘nuts and bolts’ of on-the-ground implementation, SISN views this as a partial and limiting perspective. Our framework embraces the wider processes and decisions which may compromise the quality, impact and/or sustainability of implementation and identifies a variety of ways to address them, including but not limited to implementation research.  These wider decisions and processes include commitment-building, priority-setting, resource mobilization, intervention choices, detailed implementation planning and multi-sectoral coordination – all of which go beyond ‘initiating, managing and expanding’ on-the-ground and all of which could be strengthened through the ‘implementation knowledge portfolio’.

 

 

 

Implementation Knowledge Portfolio

SISN’s expanded view of implementation requires an equally expanded view of the types of knowledge that might support it. We refer to this expanded concept as the ‘Implementation Knowledge Portfolio’.  We make deliberate use of the term knowledge, as distinct from evidence, because the latter can limit our thinking into only considering formal scientific data as useful or relevant.  In particular, the nutrition community now is acutely aware that nutrition research agendas have focused on ‘what’ (what interventions might be efficacious) and much more research is needed on ‘how’ (how can these be implemented and effective at-scale and in real-world settings).

This distinction is the rationale for implementation science, which WHO has been defined as “the systematic approach to understanding and addressing barriers to effective and quality implementation of health interventions, strategies and policies”.[1] SISN’s framework acknowledges that the knowledge of implementation barriers and ways to address them comes from two sources (international and contextual) and it comes in several distinct forms. This knowledge might be from scientific publications, local or national surveys and capacity assessments, M&E data, stakeholder surveys and more.  But importantly, it may also come in the form of practical tools and guidelines, documented good or promising practices and the tacit experiential knowledge of seasoned planners and implementers, as all of these are also forms of knowledge.  Each can play important but distinctive roles in understanding and addressing implementation barriers and for that reason all of them are part of the Implementation Knowledge Portfolio.  Some of them may help address barriers in one portion of the Implementation Spectrum (e.g., priority setting and choosing interventions), while others may help address barriers on other portions of the spectrum (e.g., coordination or detailed implementation planning).  New empirical research (of varying types) is needed in some cases, but in other cases it is more appropriate and efficient to tap into existing knowledge, tools or guidelines.  The ‘portfolio’ concept is a constant reminder that this diversity exists and can provide practical ways to address many implementation barriers.  In addition, it calls attention to the fact that the production of implementation-relevant knowledge is not the exclusive domain of researchers: implementers also play important roles in that process, and both can play expanded roles in the future.

Knowledge Utilization Strategies

The key to connecting the ‘Implementation Spectrum’ with the ‘Implementation Knowledge Portfolio’ comes in our third priority, ‘Knowledge Utilization Strategies’.  Creating effective and efficient access to implementation knowledge is of paramount importance if we are to close the communication gap between knowledge generators, policy makers, planners, implementers and other stakeholders. Likewise, ensuring its appropriate interpretation and utilization in decision making is essential if implementation is to be effective, efficient and sustainable.

A great deal of implementation knowledge already exists, but is located across a large number of institutional spaces and is not readily accessible to country decision makers.  One of SISN’s strategic goals is to catalyze and support a global ‘one-stop knowledge hub’ to enable efficient and timely access to implementation-relevant knowledge, complemented with strategies to promote optimal utilization by planners, implementers and other stakeholders at country level. Some strategies under discussion with global organizations include Communities of Practice among researchers and implementers, a responsive consortium of knowledge support specialists to assist countries and the training and support of ‘knowledge brokers’ at country level, among others.

Connecting Knowledge with Action for Impact

SISN’s vision is “a world where actions to improve nutrition are designed and implemented with the best available scientific knowledge and practical experience”.  The three components described here are vital to move towards this vision. The ‘Implementation Spectrum’ reminds all stakeholders of the many decisions and processes that may need strengthening; the’ Implementation Knowledge Portfolio’ reminds us that many forms of knowledge are necessary and available; and the ‘Knowledge Utilization Strategies’ remind us that the biggest challenge is to facilitate appropriate utilization.  This is a broader, more robust and more scientifically-grounded perspective than ‘evidence-based policy’ and creates important roles for all stakeholders.  SISN looks forward to engaging with its broad and inclusive membership to move these components into reality.

For more details on how SISN is supporting change see our Strategic Plan.

[1] WHO/TDR Implementation Research Toolkit, 2014

Implementation Science – Unlocking the ‘middle ground’ between nutrition interventions and outcomes

There is a growing interest in implementation science (IS). The scope and complexity of this science means that in order to effectively scale-up nutrition, we need to engage key stakeholders to prioritize research questions, select and tailor methods to the local context, and raise awareness of the importance of evidence-based implementation amongst the nutrition community.

That was the take-home message from the Plenary Session on Friday October 28^th, 2016 at the Micronutrient Forum Global Conference in Cancun, Mexico. The session entitled “Implementation Science in nutrition: purposes, forms, functions and country examples” saw SISN President, Professor David Pelletier, take to the stage to define IS. He was followed by a series of presenters sharing real-world vignettes and a discussion on how we might start to influence positive change.

The session opened with USAID’s Nutrition Division Chief, Anne Peniston, reminding the audience that historically we have focused on the generation of evidence to establish proof of concept, and while this continues to be important, we also need to better understand how to introduce this evidence in programs within different ‘real-world’ contexts.

“Implementation science is needed to unlock the neglected middle ground between nutrition interventions and nutrition outcomes,” said Professor Pelletier, as he described the broad implementation spectrum.

Four implementers presented case studies as examples of evidence informed implementation at scale. In Guatemala, they used household surveys to track compliance with iodized salt. In Ghana they examined opportunities for utilizing evidence in prioritizing and making decisions in nutrition policies; In India, they developed a formal knowledge brokering system, that offers decision-makers efficient access to evidence and resources on maternal and child nutrition; In Zimbabwe they researched barriers to infant and young child feeding (IYCF) interventions in order to develop a robust pilot study and subsequently used pilot findings to inform actions at scale. These successful initiatives provided some insights into the ‘black box’ of implementation but “there are issues with alignment and collaboration” added Professor Pelletier.

There are many challenges to implementing at scale, but now is the time to bring together scientists, researchers, knowledge brokers, decision makers and front-line implementers to invest in a research strategy. The founding of SISN is a first step to achieving this goal.

Have an idea or a comment on any of the issues discussed above? We welcome your feedback – you can comment on this post on our LinkedIn feed (The Society for Implementation Science in Nutrition) or write to us using the email address below.

If you are interested in finding out more about implementation science (IS) or becoming a member of SISN to help us advance the use of IS in nutrition, you can contact us via our website (www.implementnutrition.org) or can email us at implementnutrition@gmail.com.

Multi-sectoral Consensus at the Micronutrient Forum – It’s time to embrace IR!

Our Symposium on implementation research (IR) at the Micronutrient Forum, co-sponsored with Sight & Life, was a unique opportunity to hear from four highly respected implementation stakeholders (representing government, NGO, donors and academia), about their sectors’ perspectives on IR.  What was striking about their reflections was not, as you might expect, the differences, but, the overwhelming similarities in their views. This is fertile ground on which to leverage change in terms of attitudes towards and application of IR.

Whilst the panelists highlighted some sector specific challenges, the following emerged as common issues across the sectors:

• IR is currently undervalued: IR must become embedded in the central activities of all nutrition stakeholder organizations.
• IR needs to build its credibility: IR needs greater respect and acceptance, and must become prioritized by research funders and peer-reviewed journals.
• Effective partnership is needed: Academia and implementers must collaborate so that research is relevant for improving outcomes in the ‘real-world’.
• Substantial resources are needed: Capacity must be strengthened for conducting research and to promote a culture of evidence-based decision-making.
• Flexible funding is required: Funders should allow research adaptation in light of emerging evidence, or support multistage projects (i.e. proof of concept, piloting, scale-up), with longer funding cycles to support these stages.
• A body of evidence on outcome improvements delivered by IR is needed: The cycle between evidence generation and field application needs to be shorter and whilst evidence should be published in peer-reviewed journals, some data can be used locally and immediately to great effect.

Canvassing the floor for opinion, session moderator, Dr. Meera Shekar (World Bank), established that there was also audience consensus on the above. However, there was split opinion ‘whether priorities for increasing capacity for IR should be at country (i.e. numerous small studies tailored to local context) vs. international (i.e. fewer larger scale generic studies) level’. The response indicates a need for thorough deliberation on the pros and cons of each approach.

As the session drew to its close, Dr. Shekar guided participants to voice their thoughts on possible solutions to the issues raised. The discussion centered on three topics.

1. Creating a country-driven harmonized research agenda

For IR to be relevant to the ‘real-world’, previous field experience, policy-context, and country specific systems and processes need to be considered during the study design stage. In relation to the latter, the feasibility of implementing interventions within such complex systems must be evaluated at the outset. Historically, formative research has been successful at the community and household level, however we need tools for conducting formative research in delivery systems themselves. 

2. Where are the ‘low-hanging fruit’?

We need to consider the ‘low hanging fruit’ i.e. where can we most easily achieve an impact? What areas have the greatest economies of scale?  For example, obesity is a critical global issue where many of the bottlenecks are common across countries and cultures, and where implementation strategies would have a very broad reach for application (and could be adapted for local use). There would also be opportunities for low-cost tools for formative research that could be applied by local stakeholders in different contexts. 

3. The role of the ‘knowledge broker’

Implementation is highly complex, with multiple concepts, contexts, systems and stakeholders to be considered. Is navigating this complexity and bridging between academia and practice a specialist role? SISN thinks so, and the session revealed that our panelists and audience concur. Such a specialist might be able to broker collaborations, interface with policy makers, ‘translate’ research into practical applications for implementers and provide expert guidance on program enhancements with relatively modest investments. Could this be one of, the ‘low-hanging fruit’ that Dr. Shekar asks us to consider, and if so what would be the scope of this role and how do we support its development, take-up and funding? These are questions that SISN will explore in a future blog.

Have an idea or a comment on any of the issues discussed above? We welcome your feedback – you can comment on this post on our LinkedIn feed (The Society for Implementation Science in Nutrition) or write to us using the email address above.

Interested in advancing the use of IS in nutrition?  Consider becoming a member of SISN.  Contact us via our website www.implementnutrition.org or by email at implementnutrition@gmail.com.

Strategic Plan 2016-20

In June, the first draft of the Society’s Strategic Plan was circulated to a large number of nutrition stakeholders for review and feedback. We can now announce that, thanks to the inclusion of their expert and extremely valuable input, the full Strategic Plan can be read here.  The Strategic Plan forms the bedrock of the Society’s operations and outlines the framework and values under which the Society can and will deliver against its numerous strategic goals.

Prioritized goals have been divided into sub-goals in the Strategic Plan and a number of Working Groups have already been initiated to develop and execute plans on how specific goals can be delivered.  Currently these are led by board members with some founding member involvement, but in the not-too-distant future we want to foster engagement  and participation from the wider membership to support us on the vast array of vital tasks that need to be undertaken to propel  the understanding, expansion and use of IS forward.

SISN at the Micronutrient Forum in Cancun

Another opportunity for member engagement is at the Micronutrient Forum in Cancun where most of the Board will be in attendance and the Society will present at two sessions. For full details on IR sessions during the Forum, please click here.

The Lazio Declaration

July 13th was an important milestone for the Society with the publication of the Lazio Declaration. The declaration is a culmination of the efforts of many of the board and founding members and highlights the critical nature of the current situation and why we need to put IS on the map. To read the full declaration, click here.