Bridging Gaps to Improve Global Health with Amy Van Pelt, PhD, MPH

[00:00:00] Erin Spain, M: Welcome to Science in Translation, a podcast from NUCATS, Northwestern University Clinical and Translational Sciences Institute. I'm your host, Erin Spain. NUCATS members are making an impact on the field of global health. Last year, members of NUCATS collaborated with investigators from 50 different countries on projects, and their research has been cited hundreds of thousands of times by academic and policy experts around the world. But this research cannot serve to improve health and health equity if the new knowledge is not shared with all partners in formats that are understandable and actionable. Now, with a special focus on implementation science, NUCATS is positioned to accelerate and catalyze research across the translational continuum to improve public health and meet the needs of all people. Joining me to discuss the global impact of infusing implementation science methods into the mission of NUCATS is member Dr. Amy Van Pelt. She's an assistant professor in the Department of Medical Social Sciences and the Center for Dissemination and Implementation Science. She serves as the Associate Director of Research within the Havey Institute for Global Health and the Ryan Family Center for Global Primary Care here at Northwestern. Welcome to the podcast, Amy.

[00:01:21] Amy Van Pelt, PhD:Thank you. I'm excited to be here.

[00:01:22] Erin Spain, MS: Well first, let's start with your definition of implementation science. How do you explain what it is that you do in implementation science to people outside of the medical research world?

[00:01:33] Amy Van Pelt, PhD: Sure. So at the most basic level, implementation science is about moving the needle to make sure folks get the things that work. So we really focus on systematic processes to integrating evidence to these practices and to care.

[00:01:47] Erin Spain, MS: Tell me about your path to becoming an implementation scientist and epidemiologist, especially one who focuses on increasing the uptake of evidence based practices in resource limited settings, primarily low and middle income countries.

[00:01:59] Amy Van Pelt, PhD: Yeah, I think I took a bit of an untraditional path to implementation science. I started as a global health practitioner, so that meant I spent a lot of time in resource limited settings, primarily in low and middle income countries early in my career. And through those experiences, through living in various countries, I was really witnessing a lack of access to a lot of evidence based practices. And I just didn't understand why people were not using them. And then I discovered the field of public health and learned that implementation science is really the field that helps bridge that gap between access and care. So I pursued my MPH in global health and then went on to pursue a PhD in epidemiology. And still, I was noticing those delays in getting evidence based practices into care. It was great that we could design effective interventions through epidemiology, but there was still going to be the potential that intervention was just going to sit on our shelf and not actually get to folks who needed it. So then I did a rotation with Rinad Beidas at the University of Pennsylvania. And that was really when I dove all into implementation science and have been working in that space since 2016. At this point.

[00:03:03] Erin Spain, MS: And now Dr. Rinad Beidas is here at Northwestern, and she must have brought you along the way. I want to hear about that as well, but it seems that right now Northwestern University is the place to be for those who are interested in implementation science. Why is that?

[00:03:17] Amy Van Pelt, PhD: I completely agree with that. I feel like there's just such a commitment from the university level to go all in on implementation science. We recognize in the field that it's necessary to actually get interventions to folks. So there's been a great investment from leadership to really recruit implementation scientists. And I think that's where you've seen the influx. We mentioned Rinad and Dr. Sarah Becker. We have new faculty in CDIS, the Center for Dissemination Implementation Science. So there's a lot of enthusiasm. And I think the growth in the influx of new faculty is why it's really the place to be right now. There's a lot of thought leadership and a lot of really exciting initiatives going on here.

[00:03:54] Erin Spain, MS: And here at NUCATS, Implementation Science is now a core component of the institute. This is a new development supported by the latest seven year, 55 million NIH grant. Why do you think implementation science is becoming so important to the medical community at large?

[00:04:10] Amy Van Pelt, PhD: Yeah, I go back to the point that I made about if we design an effective intervention, it just sits on our shelf. What's the point? What purpose does it actually serve to our community? And there's literature that you may be familiar with that it takes on average 17 years to get an effective intervention actually integrated into care. And that's not acceptable at this point anymore. The focus on implementation science is really trying to close that gap

[00:04:32] Erin Spain, MS: As you mentioned, you started out as a global health researcher. You're still heavily involved in global health. Most implementation science resources are published in English. Now this can pose a problem in global settings and here in the U. S. in situations where English may not be the first language of the community that you're working with or trying to serve. Tell me about this issue and some of the research that you have done into the feasibility of translating implementation science resources into Spanish, for example.

[00:04:58] Amy Van Pelt, PhD: Yeah, that's a great question. I'm glad you raised that point. Implementation science has so many theories, models, and frameworks. We always talk about, do we need to develop a new one? And it's helpful, though, because we have this robust toolkit that helps us design rigorous studies and communicate across studies with one another. But, as you point out, most of them, if not the majority of them, are designed and developed in English, which creates linguistic barriers to our partners in other countries. So if they don't have the same access to apply those methods, systematically they may be doing research in different ways. So we recognize that given some of my work in Latin America, particularly related to the lack of Spanish tools for implementation science, we recently published a Spanish translation of the ERIC taxonomy, which is the Expert Recommendations for Implementing Change taxonomy, which is essentially a list of 73 implementation strategies that a lot of folks in implementation science use as a guide to figure out what strategies can they use for their specific research. So we went through a very intensive translation process following the WHO guidelines for translation and recently published that and got a lot of good feedback that this is a direction that we should continue to take. So we're working on some other frameworks right now and hoping to continue partnering with our colleagues in other countries, primarily in Latin America, to build up the repository of Spanish resources for implementation science and perhaps in other directions as well.

[00:06:22] Erin Spain, MS: So another consideration for advancing implementation science globally is evidence based practices must be adapted to fit local contexts. Tell me about that and how essential it is when taking a practice that works here in the U. S. and trying to implement it in Ethiopia, for example.

[00:06:38] Amy Van Pelt, PhD: I love that you mentioned Ethiopia. I'm traveling there next week. If you imagine if we developed an intervention here in Chicago, say it's an intervention that's focused on treating some sort of mental health disorder and we go and implement it in Ethiopia, the cultural considerations that we need to make for what Western perceptions of mental health look like may be very different in other countries. So it's not going to be successful if we just pick something up from Chicago and try to implement it into Ethiopia, for example. So what we're really focused on to use that case study is how we can translate it. So linguistic barriers again, but also some cultural considerations. Are there examples in the interventions that aren't going to be relevant? And I can pull from an example that we did in Botswana where we were implementing this battery or this computerized neurocognitive battery that had a lot of faces for one of the evaluation modules. But all of the faces were coming from Philadelphia. So feedback that we got was we should change the faces to have them more representative of individuals who live in Botswana. So all these very basic things, but will actually affect whether or not it's acceptable to the individuals in the settings in which we're trying to implement it. And then after that, we have to make sure it's still working right? Depending on the level of changes we're making, we need to make sure it's still effective at improving whatever the clinical outcome was originally designed to target.

[00:07:59] Erin Spain, MS: I know something that the Havey Institute for Global Health is really trying to do is build capacity in other countries with researchers there. Can you talk about how you have been able to work with scientists in other countries to bring implementation science to those places and teach them how to do this kind of work in their countries?

[00:08:17] Amy Van Pelt, PhD: So I think that could fall into two buckets. One, traditional capacity building and education, but also partnership on research. So to speak to the first bucket on education and capacity building, we, a lot of the folks in CDIS and Havey have facilitated workshops on implementation science. And an example from this past year, I went to Botswana and facilitated a two-day workshop on implementation science for our fellow faculty, staff, and colleagues at the University of Botswana. So I think that has been something that's a common model that a lot of our peers and colleagues have done, but I think it's important that we take the next step and actually partner in research, too, and not just train folks and say, good luck, but partner. And a lot of folks at Havey have grants where they have an MPI model, meaning someone from Northwestern and someone from an institution in another country are the leaders submitting the grant principal investigators together in submitting the and an example that Folks at Havey, Dr. Lisa Hirshhorn, she currently has a grant with folks at the University of Botswana that's focused all on implementation science and how can we get PrEP or Pre Exposure Prophylaxis across the general population in Botswana. So I think by partnering as well as doing some of that traditional capacity building is a way that we're trying to increase access to facilitating implementation research.

[00:09:37] Erin Spain, MS: Tell me about the projects that you're currently working on.

[00:09:40] Amy Van Pelt, PhD: Sure, so I have both a domestic and an international portfolio. Domestically, one of the main projects that my team and I are working on is related to ending the HIV epidemic. So we have colleagues here, Gregory Phillips, Brian Mustanski, Rinad Beidas, and Liz Caslen. We recently crowdsourced ideas to implement this new form of long acting injectable PrEP specifically for sexual minority men in the city. And we led this innovation tournament, had a great response, we had 73 ideas and we ended up picking one of the top ideas to operationalize into an intervention for rollout in the city. So currently we are finalizing that model and hope to work with the Chicago Department of Public Health to implement it and actually increase access in real life. Which is exciting because in Botswana where we're trying to increase access to PrEP for the general population across the whole country. So of course a much bigger scale, bigger scope, but we are integrating in some of these participatory methods like an innovation tournament to crowdsource ideas from the community in addition to the ideas that we're bringing in for implementation strategies. So a lot of the work has been in HIV. But I have, as a methodologist in implementation science, have been able to collaborate with other folks. So, I'm actually headed to Ethiopia next week to work on a project that is aimed at adapting and implementing suicide prevention for youth in Ethiopia. And we're hoping that we'll be able to expand Botswana and some other settings as well.

[00:11:13] Erin Spain, MS: Well, tell me more about your role with the Havey Institute for Global Health.

[00:11:16] Amy Van Pelt, PhD: Sure. So it's specifically the Associate Director of Research for the Ryan Family Center for Global Primary Care. So one of the centers within the larger Havey Institute. And the center as it's named is focused on primary care, but that's I feel like very inclusive and kind of a catch all because a lot of countries that we work in, primary care is the primary point of contact for many health services. Which creates a lot of opportunities for the integration of specialty services, which if you think about the goal of implementation science, I think there's a really natural partnership there and how can we use implementation science to help integrate specialty services into primary care. So my role specifically is focused on research. I have another colleague, Danielle, who's the Associate Director of Education and really focuses on creating opportunities for the medical students and the trainees at Northwestern. But my role is focused on increasing partnerships, collaboration, how can we facilitate additional research, and I have a little bit of a bias for implementation science, so we are focused on primary care at large, but most of my work in the center is trying to increase capacity for global implementation science.

[00:12:24] Erin Spain, MS: For NUCATS members who are listening and they're interested in how their research can make a global impact. What steps do you think they could take as they're designing research projects, thinking about what they're going to embark on next?

[00:12:37] Amy Van Pelt, PhD: So partnership is key. We don't want to just take what we're doing here in Chicago and say, we want to go and replicate that in another country. So I would say the first step would be to reach out to Havey and try to build some partnerships with perhaps other colleagues, other countries or other institutions and see what priorities they have. I know we get really excited about what we're doing, but it may not actually be a priority to the folks in our partner institutions. So that would be the most concrete step is reach out to Havey if you're interested in implementation science, feel free to reach out to me or Dr. Lisa Hirshhorn, and we can see if there are potential partners where you could expand your collaboration into other countries.

[00:13:18] Erin Spain, MS:  For folks who are really interested in the kind of work you're doing, I've heard that the Center for Dissemination and Implementation Science is planning a new Master's of Public Health Certificate, which will be directed by you. Tell me about this opportunity. Who is this certificate aimed towards and when will it launch?

[00:13:33] Amy Van Pelt, PhD: We're so excited about this. We are working with the program in public health here at Northwestern, and we are actually developing two initiatives. One is a concentration for the Master of Public Health, which will be a open only to MPH students. And the other initiative is a certificate in implementation science, which will be open to all affiliates of Northwestern as well as affiliates outside of Northwestern. The classes will be the same four core classes across the concentration and the certificate. And we have an additional class we're developing for the certificate folks that's in the works. We are hoping to cover a variety of topics from introduction to implementation science, more advanced topics as well as some specialty interdisciplinary classes that we hope will complement the curriculum related to user centered design and implementation science and really diving deep into the theories, models and frameworks in the field. So we hope that this will be launched in full by fall of 2026 and we'll be piloting and testing out a couple of the classes this upcoming year.

[00:14:38] Erin Spain, MS: So what message would you like to give to NUCATS members? Why should they possibly be interested in taking this program and getting the certificate?

[00:14:45] Amy Van Pelt, PhD: NUCATS previously facilitated an implementation science reading course, which we are in the process of facilitating for this year. And I think we've had a lot of interest from folks expressing that they want to dive deeper. And the reading course is a great introduction to the field. It's 10 weeks and gives you a high level. What are the basic foundational learnings for implementation science? But I think if you really want to lead implementation research yourself, you need to go a little bit deeper. And that's where the certificate or the MPH concentration can be really helpful because you'll get some of those advanced topics, you'll get a lot more course hours and be able to digest the material. So I would say for folks who want to pursue this work or even be collaborators on grants with folks that this could be an opportunity to have a deeper level of learning than the reading course, for example.

[00:15:34] Erin Spain, MS: So you're still considered an early stage investigator and mentors, as you mentioned, have played a big role in your career. That's something that's really important at NUCATS and to NUCATS members. What role has mentorship played in your career?

[00:15:46] Amy Van Pelt, PhD: Yeah, I've been very fortunate to have fantastic mentors throughout my entire career. I mentioned that I started as a global health practitioner and Juan Leon, Dr. Juan Leon at Emory, I would say is one of the quintessential mentors. And then for the past eight years, I've been working with Dr. Rinad Beidas. I've been really fortunate that I've had mentors who've empowered me to be very independent. So even starting with the mentor I mentioned at Emory, my MPH, all the way through my postdoc, they've been there to support me, help me troubleshoot, but really allowed me to lead my own independent portfolio. Speaking about my dissertation. I think that's a very classic example of you often work on your faculty advisors project, but I was able to get my own independent funding from NIH and really carve out my own path. And I know there's a lot of hidden curriculum in academia and I've been fortunate that my mentors have been not only there to support me, but also sort of to translate that hidden curriculum and help me submit my own grants and pursue my own research. So I do not think it would have been possible to be where I'm at in my current career without the support of my mentors.

[00:16:52] Erin Spain, MS: NUCATS is positioned around three aims: include, innovate, and implement. What do these aims mean to you?

[00:17:00] Amy Van Pelt, PhD:  I'm thinking of that from an implementation science perspective because, of course, all of those three pillars are relevant across the research trend, the continuum. But from my viewpoint as an implementation scientist "include", we cannot do this work without partners. Partnership is key from all the different constituent levels. I do a lot of global health work. So key partners are the Ministry of Health, so the highest level government all the way down to the folks who are on the front lines actually implementing our intervention. So that is crucial for the beginning of our partnership and building those teams. Innovate, we have this massive 17 year gap in getting interventions actually into practice. That lends itself to some of the crowdsourcing to come up with new ideas to help overcome these challenges. And implement that is the core of what we do as implementation scientists. We're trying to actually get the evidence based practices to folks.

[00:17:51] Erin Spain, MS: Well, Dr. Amy Van Pelt, thank you so much for coming on the show. It was so nice to meet you. I know you're still fairly new here to Northwestern, but we are looking forward to all the work to come.

[00:18:00] Amy Van Pelt, PhD: Thank you so much for having me.

[00:18:02] Erin Spain, MS: Subscribe to Science in Translation wherever you listen to your podcasts. To find out more about NUCATS, check out our website, NUCATS.northwestern.edu.