Proposing and Applying the Observational-Implementation Hybrid Approach

October 10, 2023

Justin Knox, PhD, MPH
Columbia University

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We recently proposed the observational-implementation hybrid approach, or the incorporation of implementation science elements into observational studies in order to collect information that will allow for anticipation, estimation, and/or inference about the effects of interventions and implementation strategies. We describe this approach, including examples of how we are applying it to an ongoing observational study among n=600 Black sexual minority (SMM) men in order to collect relevant implementation data regarding the use of evidence-based practices to support drinking reductions. An initial step for employing an observational-implementation hybrid approach is knowing about the state of the research on relevant interventions or policies that aim to address the modifiable constructs relevant to the research questions of the study, including their implementation. Evidence-based practices that have been shown to help individuals reduce their alcohol use that we will focus on include: electronic screening and brief intervention, motivational interviewing, HealthCall (an mHealth intervention for people living with HIV), and naltrexone. We will employ various approaches to collect information on how to deliver these alcohol interventions to Black SMM. We are using survey measures to collect factors related to transportability of the alcohol interventions that we selected (e.g., access to a primary care physician, insurance status, treatment-seeking). We are conducting a discrete choice experiment among n=240 participants who report heavy drinking (AUDIT-C score >4) in order to collect preference data on the delivery of the alcohol interventions. Among a HIV-status neutral sub-sample of participants who report heavy drinking (n=30), we are using a human-centered design approach to collect journey maps of their experiences accessing HIV prevention and care service in clinical settings that will identify opportunities for co-delivery of alcohol interventions in these settings. Lastly, we are conducting in-depth interviews with n=10 HIV prevention and care service providers to collect input on implementation factors related to co-locating alcohol interventions into HIV prevention and care services. Applying this observational-implementation hybrid approach provides an opportunity to conduct observational research in ways that will allow it to achieve more rapid translational gains in terms of understanding how to deliver evidence-based practices to support reductions in alcohol use among Black SMM.