Using Systems Science Methods to Improve the Use of Research Evidence in Policymaking

Todd Combs, PhD
Washington University St. Louis

Douglas Luke, PhD
Washington University St. Louis

Katherine Nelson, PhD
Merck

Jonathan Purtle, PhD
New York University

Hunter McGuire, MPH
Washington University in St. Louis

ABSTRACT:
This presentation will focus on the methods and findings of a project that used surveys, interviews, and an agent-based model to shed new light on the determinants and dynamics of children’s mental health policymaking in state agencies. Jonathan Purtle (New York University) will provide a brief overview of the history of studying research use in policymaking and will present results from surveys and interviews with state and county mental health agency officials. Hunter McGuire (Washington University in St. Louis) will provide an overview of literature about the role of knowledge brokers in policymaking. Doug Luke and Todd Combs (Washington University in St. Louis) will then describe the REDMOD agent-based model, which was informed by survey and interview findings and the knowledge broker literature. The presentation will be moderated by Gracelyn Cruden (Oregon Social Learning Center).

PrEP Acceptability among Pregnant Women and Implications for HIV Prevention in Clinical Practice

Florence Momplaisir, PhD
University of Pennsylvania

ABSTRACT:
RATIONALE:

Of the 1,008,929 people in the U.S. who are diagnosed with HIV, 240,306 are women.1 In 2017, 7,401 women were diagnosed with HIV and more than 80% were women of color. Young women, including those of reproductive age, are significantly affected: nearly one-third of new infections (29%) among women occur among those aged 25-44, and 22% among women aged 13-24.1 Pregnancy and the postpartum period present a time period when women are vulnerable to HIV infection and HIV infection during this time is associated with an elevated risk for perinatal transmission. During pregnancy and the postpartum period, women experience physiologic changes including hormonal changes that induce systemic and genital mucosal changes that may increase susceptibility to HIV infection.2,3 In addition, associated with efforts to conceive, women are having condomless sex, which also increases the risk of acquiring sexual transmitted infections and acquiring HIV.

Oral pre-exposure prophylaxis (PrEP) containing tenofovir/emtricitabine (TDF/FTC) is safe and efficacious in preventing HIV infection among pregnant and lactating women.4,5 A recent systematic review showed no statistically significant differences between TDF and non-TDF regimens in pregnancy incidence, stillbirth, preterm delivery, low birth weight, small for gestational age, birth defects, or maternal mortality.6 Additionally, studies report that women at risk for HIV desire to use PrEP for HIV prevention.7 Long acting injectable PrEP have been shown to be safe, well-tolerated and acceptable in HPTN 077 (66% of enrollees were female). The use of long acting formulation during the postpartum period has great potential because it is a time when women struggle with adherence to medications.8 Currently, there are limited data on acceptability of oral PrEP in pregnancy and no data on acceptability of long acting injectable PrEP for women in the postpartum period.

STUDY AIM: In this study, we aim to assess knowledge, interest, beliefs and outcome expectancy about oral PrEP use in pregnancy and the use of long-acting injectable PrEP in the postpartum period. We also aim to assess acceptability and preference for oral PrEP versus long-acting injectable PrEP in the postpartum period. Our findings provide insight of how to best integrate PrEP in routine antenatal and postpartum care.

STUDY DESIGN: To accomplish our aims, we sampled and conducted in-depth interviews with 20 at risk participants (indicated by a recent sexually transmitted infection (STI)), from an urban obstetrics clinic. Interview questions focused on pregnant women's perceived HIV risk, their knowledge and perceptions of PrEP, and their preferences for different PrEP formulations. We used deductive and inductive codes to code the data, created matrices to explore patterns in findings based on participant's perceptions of their HIV risk, and wrote memos to interpret emergent themes.

Design for Digital Mental Health Interventions: Optimizing Engagement and Implementation

Andrea K. Graham, PhD
Northwestern University

ABSTRACT:
Efforts to translate evidence-based digital health interventions from research to real-world settings have struggled with sustained consumer engagement and the successful integration of these tools into their targeted systems of care. User-centered design involves collaborating with end-users throughout the process of intervention design, testing, and implementation to ensure the intervention meets consumers’ needs and preferences, to in turn increase uptake and engagement. This presentation will describe design methods that aim to increase engagement in intervention design and implementation, drawing on examples from applying these methods to mobile interventions for different mental and behavioral health problems.

Systems science modeling for implementation research: An application to tobacco smoking cessation for persons with serious mental illness

Takeru Igusa, PhD
Johns Hopkins University

Elizabeth Stuart, PhD
Johns Hopkins University

Gail Daumit, MD, MHS
Johns Hopkins University

ABSTRACT:
Implementation researchers have sought ways to use simulations to support the core components of implementation, which typically include assessing the need for change, designing implementation strategies, executing the strategies, and evaluating outcomes. The goal of this presentation is to explain how methods in systems science, with an emphasis on agent-based simulations, could fulfill this role. The presentation will include a discussion on explainability, in which modeling results are formulated in terms of constructs used in implementation science frameworks to facilitate the engagement of practitioners in the design and use of the models. This is part of an ongoing project focused on scaling up evidence-based tobacco smoking cessation practices in community mental health clinics in Maryland.

Rapid Cycle Systems Modeling and Decision Sampling to Inform Development and Implementation of System-Wide Innovations to Promote Pediatric Mental and Behavioral Health

Thomas I. Mackie, PhD, MPH
Rutgers School of Public Health

R. Christopher Sheldrick, PhD
Boston University School of Public Health

ABSTRACT:
Calls have been made for greater application of simulation modeling and decision sciences to expedite research evidence use into mental health policy. Funded by W.T. Grant Foundation, Drs. Mackie and Sheldrick will report on a study, entitled Research Evidence Adoption for Child Health (REACH), in which they propose the use of Rapid Cycle Systems Modeling (RCSM), as an implementation strategy that aims to assist local decision-makers in needs assessment and prioritization, knowledge exchange, and consensus building when developing system-wide innovations. RCSM requires that one (1) identify gaps in the information available and questions requiring resolve to inform stakeholders’ decisions, (2) build a simulation model and identify relevant estimates to parameterize the model (e.g., evidence reviews), and (3) conduct group facilitation sessions to asses model utility and need for further adaptation.

To demonstrate utility, we provide an illustrative case study from REACH in which we specifically sought to identify how decision-makers developed protocols to identify and treat the trauma of children entering foster care. In conducting the first step of RCSM, we identified information gaps by employing a “decision sampling” framework in qualitative interviews.  In this approach, we anchored key informants’ responses on a recent index decision to minimize recall and response bias and potential desirability of evidence use. Respondents (n=31) described a continuum of 14 decision points relevant to five domains when developing a system-wide approach to identify and address trauma, including: 1. reach of the screening protocol, 2. content of the screening tool, 3. threshold for referral, 4. resources for screening startup and sustainment, and 5. system capacity to respond to identified needs. In the second stage of RCSM, we built a Monte Carlos simulation model that responded to the gaps in available information identified across this decision continuum and used additional data collected in the interviews, coupled with evidence reviews, to inform the model structure and parameterization. Finally, we facilitated group interviews (n=4) learning that the model developed was assessed by relevant stakeholders to hold utility and face validity. We will present an overview of this work and the model to illustrate potential utility of RCSM and decision sampling in other research domains.