Implementation Research In Public Health: A Case Study On Lung Cancer Screening In Eastern Kentucky

Background

Q1. Does the research clearly aim to answer a question concerning implementation? 

Q2. Does the research clearly identify the primary audiences for the research and how they would use the research? 

Q3. Is there a clear description of what is being implemented (for example, details of the practice, program, or policy)? Does the research involve an implementation strategy? If so, is it described and examined in its fullness?

Q4. Is the research conducted in a “real world” setting? If so, is the context and sample population described in sufficient detail? Does the research appropriately consider implementation outcome variables?

Q5. Does the research appropriately consider context and other factors that influence implementation? Does the research appropriately consider changes over time and the level of complexity of the system, including unintended consequences?

Q6. Please identify an implementation research question that will support the controlling and elimination of schistosomiasis in Central Sulawesi Highlands, Indonesia.  Please discuss why you think that your question is an implementation research question? What would be your research objectives?

Q7. If you are asked to design a mixed methods research addressing your implementation research question on the controlling and elimination of schistosomiasis in Central Sulawesi Highlands, what type of mixed methods research will you go for? Please justify your selection for this particular type of mixed methods research. Please draw a diagram showing your mixed methods research design and explain that. 

Q8. What would be the primary outcome variable of your study, given this is an implementation research? Please justify your answer briefly. 

Q9. Who will be the target population, study population and study sample for this research?

Q10. Based on your research question and primary outcome variable, please mention whether you are considering a one-sample or two-sample situation, and why? What is the expected effect size? What are the other assumptions for calculating your sample size?

Q11. Please design a sampling for the quantitative part of your research. Please justify why you chose to go for this sampling strategy. Please consider the administrative structure of the controlling and elimination of schistosomiasis in Central Sulawesi Highlands when designing your sampling. 

Q12. Please design a purposive sampling for the qualitative component of your research. Please justify why you chose to go for this sampling scheme. 

Q13. What statistical tests are you going to do for data analysis? Please discuss each of these steps considering your research questions, outcome variables, data types.

Q14. In what form your qualitative data will be? How are you going to manage and analyse them? What underlying theory will you follow for your analysis of the qualitative data?  

Q15. How are you going to integrate the findings of your quantitative and qualitative research? Please discuss.

The field of implementation research is ever widening and it attempts to solve a wide range of implementation problems. It is being more preferentially defined as the scientific inquiry to questions which are concerned with intervention programs and the implementation of any healthcare policies and/or individual practices (Kirk et al,. 2015). All the terminologies associated with this field are still not unravelled completely and remains to be dicey but the advancement in this sector has been with respect to conceptualising the implementation research into further practice in the public health interventions.

While going through the entire paper, the first thing that got noticed that whether the paper had met all the policies of implementation research. In this case, the implementation outreach program had been conducted in two of the high-risk areas of Eastern Kentucky. This study also reports on the relational aspects of awareness and screening in the intervention areas as compared with that of the control setting. The sequential mixed methodological approach was being undertaken to design the screening campaign that effectively utilized messages being developed from the focused community groups (Palinkas et al,. 2015).

The social awareness campaign related with the community based approach was being made with the sole aim of identifying the target audience in the selected demographics who had been considered high risk for lung cancer. The paper also demonstrates the efficacy of the campaign entitled Terminate Lung Cancer (TLC) program which had been completely dependent on community awareness and screening for the low dose computed tomography (LDCT) orders in the selected demographics.

The primary audience identified by the research group for this research study were actually two focus groups in each region and since three distinctive regions had been identified the Eastern Kentucky region, this means that in total six focus groups had been identified. The study got conducted on October, 2014. The community health workers from the Kentucky Homeplace recruited individuals from their localities in order to identify the target audience using the established client files. The focus groups consisted of men and women within the age of 55-77 years with at least 30 pack-years of smoking and it comprised of either former smokers or current smokers. This was the criteria being made for the matching of lung cancer screening program and a total of 54 individuals with 61.1% female having more than 55 pack-year smoking history had participated.

The research data has got immense potential in improving the current scenario of the lethality being faced by the middle to old aged individuals in the depicted demographics with respect to acquiring lung cancer, as being suggested by the computerised tomography screening. The study mainly focused on the fact that social awareness and the efficacy of the already existing government guidelines need to be improvised in a profound manner in order to reduce the risk level and risk factors associated with smoking and terminally, lung cancer (Fixsen et al,. 2015).

Methods

This study had been successful in assessing the impact of the directly associated smokers and the dissemination of the social awareness on the reduction of their smoking regimen or by undertaking the LDCT therapeutics in order to reduce the chance of pulmonary cancer by a considerable extent. The awareness campaign had encouraged the target audience to speak with their health care provider regarding the appropriateness of the lung cancer screening technique for them. The study, with the help of population level comparative analyses has also demonstrated the considerable uptake of LDCTs in the targeted region as compared with that of the control region where no intervention had been sought for. This study also provided with relevant information in the primary level regarding the implementation of population approaches in order to demonstrate viability in the methodology for the dissemination of the newer guidelines amongst the population at risk (Brownson, 2017).

As being noted in the survey related with exposure and behaviourism of the target audiences, the lung cancer screening program inadvertently elicited though provoking mentality amongst the participants regarding smoking cessation. This study also made sure that the awareness campaign imposed severe mental awareness regarding the ill effects of smoking and that smoking might become one of the many primary reasons behind the onset of lung cancer.

The research had been conducted in the Eastern zones of Kentucky where the local community individuals had isolated several audiences from the specialized clientele files who had signified risk factor being associated with lung cancer. Six focus groups had been selected from three different zones of the chosen demographics.

Outcome variables suggested that the research provided preliminary evaluation of the success of the study as in the elicitance of mental blockage against further smoking and identifying the risk factors associated with it (Coburn, Hill & Spillane, 2016).

The study have effectively identified the consideration of low dose computed tomography and national lung screening trials for the identification of the target audience who had been at higher risk of acquiring lung cancer.

The unintended consequence of this study was the elicitance of though provoking environment amongst the target participants concerning smoking cessation. This demonstrates the fact that they were aware regarding the risk factors associated with chain smoking. The study relies on the mentality of the target respondents and the demographics being selected restrict the generalizability of the research outcome (Fernández et al,. 2014). The study had been biased towards a specific sect of people that could demonstrate complication regarding the reliability of the research in near future.  

Results

Conclusion

Implementation research aims at improving the public support against any specific risk factor and although it defined as a scientific theory, it still finds application in the real time scenario.

The implementation research question that can be proposed is as follows;

What are the influencing factors or conditions that might be thought to be responsible for restricting the reduction in schistosomiasis prevalence in Sulawesi Highlands?: A mixed methodological approach

The aforementioned research question has been idealized and framed up with the sole aim of identifying the factors that have been limiting the reduction rate in schistomiasis in the Sulawesi highlands after the administration of MDA drugs. The question would also highlight the hurdles being faced by the WHO delivered guidelines in the administration of praziquantel in attaining the controlling of 85% of the target population. The starting point of the article will be administered with an overview followed by the illumination of the gaps in the research or the intervention program being faced so far. As it is implicative in case of all types of research, the primary research question(s) imparts the crucial response and is capable of dictating the appropriate methods and assumptions required for the research in real-time scenario. The research objective would be to identify the potholes of the prevalent yet conventional schistomiasis prevention protocol and also to identify the possible mitigation in achieving the established goal (Widjaja et al,. 2017).

The design method that would be the best feasible counterpart for this research and in accomplishing the set objectives would be the undertaking of a sequential, exploratory research design with qualitative mode of data analysis. An exploratory research design allows the researcher in retrieving enough information regarding the phenomenon or persisting scenario and highlight towards the directional approach of the research after the complete clarification of the concepts of the research. Exploratory research design alone is not capable of fine-tuning the research findings in a skilful way until and unless an appropriate mode of data analysis technique acts as the assistance. The qualitative data estimation would eventually be poignant in restructuring the directional approach of the quantitative data analysis in a more profound way (Nurwidayati et al,. 2018). In such cases, the best suitable data analysis techniques would be health workers’ best practice, field study, ethnography and cross-sectional study.

According to Peters (2013), primary outcome variables are under the practice of analysing the deliverance of the intuitional actions under services. The factors that can be assessed for the appropriate evaluation of the implementation outcome variable are acceptability, appropriateness, adoption, fidelity, feasibility, coverage, implementation costing and sustainability (Satrija, Ridwan & Rauf, 2015).

Discussion

Some of the outcome variables which go at par with the current study are as follows;

Coverage: As the study depicts, the WHO target was to cover approximately 85% of the target population of the Central Sulawesi Highlands of Indonesia but on the contrary, the praziquantel in the form of Mass Drugs Administration (MDA) could only cover 60-65% of the individuals.

Appropriateness: If the medication does not support or retaliate the cultural beliefs of the local community people, then the drug administration program would not reach its proximity towards success or target.

Adoption: The MDA program would be fruitful only if all the healthcare workers and/or the field workers uptake the preferred strategy of the drug administration.

The target population and the study population of this research had been the inhabitants of the villages under the Lore Lindu National Park and Napu in the Central Indonesian rain forests. The target population is mainly the children who are at a higher risk because of lower immunity (Gunawan et al,. 2014). Study sample for this research would be the snails found in the marshy wetlands of the village.

Based on the research question and the primary outcome variable, the two-sample situation would be the most preferable situation which will analyse the efficacy of the drug on the drug-administered patient with respect to those who had been diagnosed with the disease but has not received the therapeutics yet (Attwood et al., 2015).

The expected sample size is justified with respect to those undertaking the treatment which will be 100 whereas those not under the treatment will be 50. Almost 21000 inhabitants of the area are under the risk of the disease.

Research suggests the concept of saturation with respect to the sample size for the qualitative research. This means that enough data have been collected for the data analysis. This can also vary with respect to the qualitative data analysis and more often. Grounded theory and ethnography policies can be undertaken for up to 50 respondents but since, the sample size in this case, 150, hence, saturation technique deems more suitable (Gauffre-Autelin et al,. 2017).

Purposive sampling has been done in order to prefer only those respondents who either had been undertaking the MDA treatment or those who had been diagnosed with the disease but is yet to start the medication (Boakye, de Souza & Bockarie, 2016). In this way, the exact loophole in the therapeutics over a particular sect of people can be identified.

Conclusion

Multiple regression analyses and hypothetical testing would be the two most profound techniques to be used in this case as because of the presence of two different type of sample along with hypothetical evidence that most people are unaware of the prevalent medication against schistosomiasis (Johnston, 2016).

The qualitative data of this research would be in the form of thematic analysis wherein, the subjects and the findings would be subdivided into distinctive themes reflecting different outcomes of the efficacy and the drawbacks of the drug administration.

The themes would be compiled with the help of case studies, data coding and familiarization (Gratz, 2018).

The appropriateness of the qualitative and quantitative data analysis needs to be ascertained before their integration into the research. Integration of both these analysis techniques can improve the efficacy and bring in the strengths of the mixed approach. Qualitative data validates the quantitative data whereas quantitative data explains the findings of the qualitative data. The following approaches can be effectively implemented for the integration purpose;

• Integration of the mixed approach at the study level
• Integration at the methodological instances
• Integration at the interpretation level (Khosravani, 2018)

References 

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