By Julie Leibach
Efforts to protect human health against climate change crises should consider drawing on implementation science, a field that studies how to promote adoption and sustainability of solutions to public health challenges, according to an article appearing in The Lancet Planetary Health. By analyzing real examples of climate-related health interventions that hit roadblocks, the authors suggest ways to avoid similar snags.
When it comes to deploying health interventions — a catch-all term for policies, programs, or individual practices to improve health — obstacles are practically inevitable, said first author Gila Neta, Ph.D., M.P.P., program director in implementation science at the National Cancer Institute.
“Just because you have evidence that an intervention works doesn’t mean that people are necessarily going to use it — and there all kinds of reasons why that might be,” Neta explained. “Implementation science is focused on supporting delivery of the intervention at all levels, with all people involved.”
For example, a health intervention may falter without local support, or if a community lacks expertise to maintain it. Understanding why an effort succeeds or fails can help researchers and stakeholders improve development, scale-up, and evaluation of efforts to protect health in the face of climate change.
Putting Ideas on Paper
In 2021, the NIEHS Global Environmental Health Program organized a satellite session on implementation science, held before the Consortium of Universities for Global Health’s 12th annual conference.
Moderated by former NIEHS Senior Advisor John Balbus, M.D., M.P.H., the event brought together climate and health researchers, public health practitioners, and implementation science experts to discuss how the field can inform health adaptation interventions. The current paper grew out of that session.
“There are many challenges — technical, political, structural — to successfully implementing interventions to protect people in the face of climate-related health threats. And yet the need for interventions is urgent. Implementation science is crucial to understanding barriers and assessing strategies to overcome them and implement successfully,” said Balbus, who is now acting director of the Office of Climate Change and Health Equity for the U.S. Department of Health and Human Services.
The paper described five case studies of early warning systems for potential infectious disease outbreaks — a health risk that climate change could exacerbate. Each example represented a geographic region — Africa, Asia, South America, Pacific Islands, and the Caribbean — that is disproportionately affected by climate change. The authors then examined the case studies through an implementation science lens, with the aim of informing future efforts to install and scale up such systems.
An early warning system is a tool for communicating information about hazards, such as hurricanes or disease outbreaks. To deliver its forecasts, an infectious disease early warning system incorporates various data, such as meteorological and epidemiological information. The idea is to mitigate potential harm by allowing people time to prepare. In the case of a looming dengue outbreak, for instance, protocol may entail covering water storage containers to reduce mosquito breeding habitat.
“Most of the co-authors on this paper were involved in developing the early warning systems and working locally to implement them. But they were not necessarily thinking about implementation science approaches and ran into a lot of challenges,” Neta explained.
For example, a case study in Ethiopia explored an early warning system for potential malaria outbreaks. After completing a pilot study of the system, researchers met with stakeholders to discuss scaling up the project. Only then did they learn that, though stakeholders had a strong desire to run and maintain the forecasting software tools, they would need substantial training in data science to do so.
Charting a Path
After analyzing each case study, the authors offered several recommendations to improve future deployment of early warning systems for infectious disease outbreaks.
Identifying, understanding, and anticipating challenges is an important early step, they noted. A shortage of skilled personnel to manage data, poorly defined health protocols for responding to forecasts, and lack of infrastructure are just a few common obstacles to successful early warning system implementation.
To navigate the constellation of challenges, the authors recommended following an implementation science framework — a conceptual roadmap of sorts — that guides understanding of the people and settings that could influence a given intervention. In the case of an early warning system, researchers might assess the technical capabilities of people charged with operating the system, as well as the political climate, among other considerations.
“There are different kinds of implementation science frameworks that serve different purposes,” Neta said. “Choosing one comes down to what question you’re trying to answer, or what problem you’re trying to solve.”
The authors also suggested that researchers collaborate with critical stakeholders, such as data analysts and ministry health officials, to strategize ways to surmount the identified challenges. Including key collaborators at the beginning of an intervention can ensure that the project meets their needs and can be equitably implemented.
Importantly, researchers should measure a strategy’s effectiveness at meeting a defined implementation challenge — and to do that, they must define and assess implementation outcomes. Was the strategy intended to enhance adoption of the early warning system? Was it designed to improve sustainability? Collecting data on implementation outcomes can inform modifications to a strategy or set of strategies — or to the early warning system itself — and ultimately inform scale-up and wider adoption.
For example, a case study in the Peruvian Amazon revealed how rapid turnover of members within the Ministry of Health affected the feasibility of an early warning system for malaria. Evaluating how well an implementation strategy helped address that specific barrier could improve uptake and sustainability of the system, the authors explained.
Balbus hopes his team’s paper reaches climate researchers who are developing solutions, as well as the climate health adaptation community.
“We want researchers to be more aware of the opportunities for incorporating data collection to help address implementation challenges in their study designs,” he said. “We also want people working in climate health adaptation to be aware of the field of implementation science, and to recognize that there is an academic approach to help them achieve success in their adaptation efforts.”