Implementation Science in Low-Resource Settings 

Interventions developed from evidence-based practices (EBPs) can take years to implement under the best of circumstances. Low-resource settings, such as rural areas, developing countries and disadvantaged urban neighborhoods, present added challenges. Funding, infrastructure and basic services like clean water, electricity and sanitation are often lacking in these areas. 

Here we’ll discuss some of these implementation barriers as well as current strategies and interventions being used by implementation science teams in their ongoing efforts. 

Challenges of Implementation Science in Low-Resource Settings 

While implementing health interventions can be challenging in any context, low-resource settings face more significant obstacles with deeper and more consequential impacts. These include: 

• Lack of cooperation from authorities. 
• Lack of community awareness for the problem’s gravity. 
• Distrust of implementation team’s motives among the community. 
• Inadequate community involvement in planning stages. 
• Lack of community participation in interventions. 
• Cost of implementation. 
• Acquisition and transportation of necessary resources. 
• Sustainability beyond initial efforts. 

Current Implementation Projects in Low-Resource Settings 

Rural Area Project: Tackling Colorectal Cancer in Appalachia 

The U.S. Appalachian region, encompassing 13 states, experiences some of the nation’s highest colorectal cancer (CRC) rates. Employment and education rates are low and poverty rates are high across these states: factors that can contribute to the elevated occurrence of the disease. Rural health centers are among the most likely to be left out of the research-to-practice loop. 

An implementation team has set out to find answers, with tactics and objectives including: 

• Using electronic health records to identify people who are due for CRC screening. 
• Instituting screening initiatives at primary care health centers in select counties. 
• Conducting random phone surveys of older residents to verify participation.   
• Ensuring follow-ups for patients with positive test results. 
• Educating providers. 
• Assessing the financial feasibility of implementations biannually. 

Developing Country Project: Combating Cholera in Nigeria 

A late 2021 report revealed that Nigeria accounted for 95% of nearly 100,900 cholera cases across seven West African nations. Though Nigeria is the most populous of those seven countries, its population is not the primary reason it has the most cholera cases in the region and globally. 

Through their research, implementation team members found a host of factors contributing to Nigeria’s cholera endemic, including: 

• Lack of government leadership. 
• Limited financial resources. 
• Insufficient monitoring and evaluation resources, such as labs. 
• Limited technological resources. 
• Noncompliance with existing guidelines by primary care personnel. 
• Cultural beliefs limiting community cooperation. 
• Boko Haram attacks deterring citizens from vaccination sites. 
• Overall lack of political will. 

The team is attempting to implement interventions including improved WASH (Water, Sanitation, Hygiene) habits and access, an oral vaccine, greater community engagement and better coordination of prevention efforts.  

Urban Area Project: Improving Health in Disadvantaged Paris Neighborhoods 

Paris evokes romance, art, history. Quaint sidewalk cafes and stately architecture. But like any major metropolitan area, Paris also has neighborhoods presenting challenges to the health and well-being of its residents. Most are socioeconomically disadvantaged and must contend with pollution, among other issues. 

Driven by an interdisciplinary consortium of specialists, the UrbASanté study is examining how urban interventions can influence “environmental exposures … health-related behaviors, and self-reported health using a natural experiment approach,” as well as the impact of urban redevelopment on social health inequalities. 

The interventions include: 

• Establishing new or refurbishing existing green spaces. 
• Creating bicycle and walking paths. 
• Widening sidewalks. 
• Developing new public transportation options, including bus service. 
• Monitoring air and noise pollution levels. 
• Assessing the nutritional value of local diets. 

The study will take place over several years, bookended by the 2024 Paris Olympics and 2030 Paralympic games. 

UF’s Implementation Science Program Is a Powerful Career Resource 

These noble implementation efforts and many more like them are currently underway in all corners of the globe. With expertise and respected credentials in implementation science, you could contribute to crucial endeavors like these, helping reverse problematic health trends and improve global health outcomes.   

The University of Florida’s online Implementation Science Graduate Certificate Program — offered through our LCME-accredited College of Medicine — prepares you for rewarding professional roles that contribute to the implementation of evidence-based practices in diverse settings. These are just a few of the possible career paths you can take. 

Enroll with confidence in our 11-credit online graduate certificate program and enjoy the following benefits: 

• No GRE requirement. 
• Just 11 credits — finish in as little as one year! 
• Work-friendly asynchronous online courses that enable flexible study schedules and locations.  
• Affordable tuition. 
• Unique, engaging courses focused on current concepts in the field. 
• Faculty composed of noted researchers and academics. 

Start your application now! 

Sources: 
https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00310-7/fulltext
https://implementationscience.biomedcentral.com/articles/10.1186/s13012-018-0847-1