Implementation Science for Complementary and Integrative Health

Introduction and Explanation of Need

NCCIH supports the full continuum of the biomedical research pipeline, whereby a complementary nutritional, psychological, and/or physical health intervention moves from basic and mechanistic research through efficacy trials and through dissemination and implementation research. Currently, NCCIH’s research portfolio reflects a range of research to rigorously answer the question, “What complementary and integrative health interventions work?” However, once the evidence for an intervention has been demonstrated, there is a delay before its widespread uptake and adoption. Dissemination and implementation research is a field of science dedicated to decreasing this delay by asking, “How can we help these evidence-based interventions reach the people who would benefit from them?” Dissemination and implementation research, the final steps in the research continuum, intends to bridge the gap between research, practice, and policy by building a knowledge base about how health information, effective interventions, and new clinical practices, guidelines, and policies are communicated and integrated for public health and health care service use in specific settings.

Understanding the difference between implementation science and dissemination science is key for successfully moving interventions through the research pipeline from the laboratory to clinical practice settings. Dissemination research is the scientific study of targeted distribution of information and intervention materials to a specific public health or clinical practice audience. The intent is to understand how best to spread and sustain knowledge and the associated evidence-based interventions. Implementation science research is the scientific study of strategies to adopt and integrate evidence-based health interventions into clinical and community settings to improve patient outcomes and benefit population health.

What Does Success Look Like?

• An expansion of the NCCIH dissemination and implementation research portfolio to study and test strategies that facilitate uptake and adoption of complementary and integrative health interventions of proven effectiveness in real-world settings.
• Support of research that uses implementation/effectiveness hybrid designs⁠–⁠ these studies are designed to simultaneously demonstrate the effectiveness of the intervention in real-world settings and test strategies to increase adoption and uptake of the intervention.
• Promotion of a research framework that encourages investigators to start thinking about effective implementation strategies to scale up an intervention once the intervention has been determined to have sufficient evidence.
• Support of implementation science research evaluating how complementary and integrative health approaches can be used to de-implement drugs or other interventions that may be inappropriately used in clinical care, have significant side effects, or for which potential harms outweigh potential benefits.

Priorities

• Develop a robust portfolio of implementation science research for dietary, psychological, and physical complementary interventions.
• Examine potential differences in the use of implementation science frameworks (Consolidated Framework for Implementation Research [CFIR], Reach Effectiveness Adoption Implementation [Re-AIM], alone or in combination) for nutritional, psychological, and physical complementary interventions.
• Conduct research on the adaptation of implementation science frameworks to increase the use and reach of evidence-based complementary and integrative health interventions in multiple settings (schools, communities, health care, mobile health [mHealth]).
• Develop a balanced portfolio of implementation science and effectiveness-implementation hybrid designs that combine elements of clinical effectiveness and implementation research (i.e., hybrid type I, II, and III trials) of complementary and integrative health interventions where there is enough evidence and for which multiple independent research studies have been conducted. Investigators are encouraged to use the NCCIH framework for clinical research.
• When appropriate, promote the use of innovative study designs (randomized cluster trials, stepped-wedge designs, pragmatic trials in implementation science and hybrid effectiveness trials) for complementary and integrative health interventions.
• Increase implementation science studies that address disparities and evaluate strategies that make evidence-based complementary health interventions, including mHealth, available to health disparity and other vulnerable populations.
• Conduct research focused on tools and methods development specific for implementation science on complementary and integrative health approaches.
• Increase NCCIH training and career development opportunities in implementation science for complementary and integrative health researchers.