Multilevel Adaptive Implementation Strategies and Associated Optimization Randomized Trials
Daniel Almirall
‍
Health interventions frequently fail to be implemented, delivered with fidelity, or sustained because of heterogeneous barriers that vary across care settings and system levels. Although a growing set of multilevel implementation strategies can address these challenges, no single strategy works universally, and a "kitchen sink" approach is cost-prohibitive and burdensome. What is needed instead is a sequentially-tailored approach in which implementation support professionals make repeated, context-sensitive decisions about how to begin, augment, intensify, or switch strategies as circumstances evolve across multiple levels. This talk introduces multilevel adaptive implementation strategies (MAISYs) as a flexible and replicable framework for guiding that kind of sequential, multilevel decision-making. Specifically, we define MAISYs and their components, offer rationale for their use, and present key design considerations and principle to ensure replicability. In addition, we describe the use of clustered, sequentially randomized trials (including Multilevel SMARTs) to answer open scientific questions aimed at constructing high-quality MAISYs. The result is a practical resource equipping intervention scientists to (i) articulate and operationalize a replicable MAISY for real-world practice settings; and (ii) conduct research about MAISYs.
‍

Scaling Up Digital Health and Telehealth Interventions to Improve Population Health
‍David Wetter

Digital health and telehealth interventions are transforming healthcare delivery by improving access, efficiency, and outcomes on a broad scale. These tools include mobile health apps, text messaging, chatbots, and virtual consultations. These approaches can be particularly effective for reaching low socioeconomic status and rural populations, as well as for low resource healthcare settings. This presentation provides an overview of a program of research using digital health and telehealth interventions to address health risk factors, cancer screening, and other conditions among community health centers (CHCs) and their patients across an entire state. These large pragmatic clinical trials test multi-level intervention approaches, generally utilizing Sequential Multiple Assignment Randomized Trials (SMARTs).