A Scholar’s Research Spans Implementation to Impact

Cancer researcher and behavioral scientist Rachel Shelton, ScD, was a freshly minted assistant professor at Columbia Mailman when she reached out to the National Witness Project about a collaboration. “The communities I was partnering with wanted more action, not just research describing the problem and how to address it,” says Shelton, who investigates population-level differences in cancer prevention, screening, diagnosis, treatment, and outcomes.

Established in the 1990s, the National Witness Project trains lay health advisors and cancer survivors to tell their stories in their communities, champion screening, and offer group-based education and patient navigation to address the needs of their local communities. But in the wake of the 2008 Great Recession, the organization struggled to keep their programs going nationally and faced many challenges. “They said, ‘We already have this evidence-based program that works; how do we sustain it,’” recalls Shelton, who credits that conversation with setting the course of her research agenda in implementation science.

In November, an analysis published by a leading Implementation Science Journal named Shelton—now a tenured and recently promoted full Professor of Sociomedical Sciences—one of the top 10 experts in her field in the U.S. Also Co-Director of the Irving Institute for Clinical and Translational Science, and director of its Implementation Science Initiative, Shelton leads a large and robust portfolio of National Institutes of Health-funded research to advance the implementation and sustainability of evidence-based interventions to promote health and address health inequities in cancer and other chronic diseases.

What is implementation science?

Shelton: About 20 years ago, in the U.S. context, it became increasingly recognized that we have a huge gap between research—all of the evidence-based interventions, treatments, programs, and practices that funding agencies invest in—and practice, what is routinely and widely delivered in most real-world public health, community, and clinical settings. The field of implementation science recognizes that we already know a lot about what is effective in enhancing health—the programs, interventions, and practices that have been shown to work)—and focuses more on how to get something routinely adopted, delivered, sustained, or scaled. Implementation science focuses on the strategies, methods, frameworks, and approaches needed to actively translate and integrate evidence-based programs into practice to enhance impact.

I can give a couple of examples. In a study on colorectal cancer screening, we found that combining patient and provider-focused implementation strategies in the form of patient navigation plus provider reminders significantly increased screening rates in underserved populations. Another study showed how partnerships between academic and healthcare organizations and leaders from faith-based and community organizations were critical for the successful sustainability of evidence-based screening programs for breast and cervical cancer nationally.

What was it like jumping into the field as it was just getting started?

Shelton: It was exciting. We were able to focus a whole research agenda on the needs and priorities of community partners by focusing on understanding what drives sustainability and the continued delivery of community-led programs. And by directing our work on advancing the science to sustain evidence-based programs, we knew that our work would have direct translation and a real impact in the communities we were partnering with.

Around the time that we were awarded our first National Institutes of Health grant in 2010, I also had the opportunity to develop an introductory course on dissemination and implementation (D&I) science for the Department of Sociomedical Sciences. It was one of the first courses of its kind at a school of public health and gave me the opportunity to learn the core foundations of the field to teach it. Since then, I have had the opportunity to be a mentor and faculty member for 15 implementation science training programs globally.

Has the field gained traction?

Shelton: When I started doing this work around the sustainability of evidence-based interventions, a mentor said, “Well we know that’s a problem, but you’re not going to fix that.” Now funders and community members are starting to ask how we can sustain progress once the funding is over and how will we disseminate what we have found to policymakers and local communities. This challenges us to think upfront about issues of future sustainability and dissemination.

Why does fine-tuning implementation matter?

Shelton: Implementation science applies to the whole world of science: practice, policy, and research. Plus, there are practical implications in local, state, and federal departments of health and health care systems. I believe the field provides training on an important skill set and principles that can enhance impact no matter where you are working across the translational science continuum or whether your focus is on research, practice, or policy.

I’ve been involved in a leadership role since 2018 at Columbia’s Irving Institute for Clinical and Translational Research which is home to our CTSA [Clinical and Translational Science Award] and recently stepped into the role of the co-director of the Institute. As one of 64 NCATS-funded [National Center for Advancing Translational Science] hubs across the U.S. that seek to enhance and improve the efficacy and impact of translational science, I have had the opportunity to help lead an implementation science initiative to address growing capacity-building needs in the field.

Through the Irving Institute, we have robust programs for students, trainees, and faculty at all levels to build awareness of the field, address training and capacity needs, support research collaborations, provide mentorship and consultations, as well as connections to funding. There are a lot of opportunities across the School and the Medical Center in this area. Currently, we have National Cancer Institute-funded Implementation grants focused on a range of issues, including testing sustainability strategies and the de-implementation of mammography over-screening among older women.

Were you surprised to learn that you are among the top 10 people in your field who are asked to give advice?

Shelton: I was really honored. A lot of the people on that list are my mentors, people I look up to, and who were so generous with their time in mentoring me. I was blown away to see that. I’ve been doing this work for almost 15 years, and my career has been focused a lot on mentorship and career development for D&I science nationally and globally, so it was nice to see that mentorship acknowledged. Growing the next generation of implementation science is a key area that I’m passionate about.

Building infrastructure and support for researchers, practitioners, community members, and trainees at all career stages to make sure this work isn’t just a niche, but that training and support in implementation science is widely available and accessible in public health and medicine, and that we are thinking about dissemination, implementation and sustainability principles as we are initially developing and evaluating programs, not just towards the end of our projects and research studies.

What advice would you give to early-career investigators in the fields of health equity and global health?

Shelton: Implementation science is more important than ever. We’ll have to be creative in thinking about ways to support this work and diversify funding streams, but we’ll always have the challenge of ensuring that science is translated broadly into practice, especially in communities that face numerous barriers to health. It’s important that implementation researchers collaborate with community, public health, and health care partners and continue to try to answer these questions, so we can be at the table to directly inform policy and practice.