Courtesy of Donna Spiegelman

The Yale School of Public Health’s Center for Methods in Implementation and Prevention Science, or CMIPs, was founded by professor of biostatistics Donna Spiegelman in 2018. Ever since, the center has continued to pioneer research in implementation science to improve public health practices worldwide. 

Hagaman explained that implementation science is generally the study of why some evidence-based practices, interventions or treatments do not have massive uptake on the clinical level. It is estimated that only about 14 percent of biomedical research is ever translated into practice, and it takes on average 17 years for these practices to actually be incorporated. 

“We have evidence that some intervention works well,” Ashley Hagaman, an assistant professor at YSPH and a primary faculty member of CMIPs, said. “In my work, we know that asking about suicide helps identify people that might be suicidal, but physicians and health practitioners don’t ask… It’s really about figuring out how we get evidence based practices to have more uptake at the implementer level.”

CMIPs is a multidisciplinary center, with faculty and staff having backgrounds in health policy, anthropology, biostatistics, longitudinal studies, psychiatry and other fields. The overall goal of CMIPs is to select key health issues and create intervention strategies, translating research findings into real-world applications to improve public health around the world. 

In addition to supporting research projects and research programs in topics including mental health promotion, qualitative methods innovation, triage algorithms and cost effective cancer screenings, the center also offers the option for YSPH master of science and doctorate students in biostatistics to pursue the Implementation Science Pathway — a track where students are trained in methods in implement research in their field of study. 

Spiegelman was a professor at the Harvard T.H. Chan School of Public Health before joining YSPH in 2018. She explained that she first became interested in implementation science when she was working as a statistician for the Nurses’ Health study at Harvard, which studied risk factors for chronic disease in women by regularly surveying subject participants every two years. During these surveys, researchers would ask the subjects questions about their physical activity, reproductive history and other medical issues.

The major aim of this study was to correlate epidemiological exposures found in the participants with negative health outcomes later in life. According to Spiegelman, the work she did involved utilizing mathematical and computational models to correct for bias in measurement errors and estimate the outcome of these exposures on health. 

However, Spiegelman felt like more could be done to their findings to affect real world outcomes.

“I did feel, after a certain point, that I wanted to be more involved in translating this knowledge, to actually directly improve health, both in the United States and even internationally,” Spiegelman said. 

Spiegelman met former YSPH Dean Sten Vermund in 2014. The two were both working on a study in Eswatini — formerly known as Swaziland — called MaxART, which aimed to evaluate the feasibility, affordability, clinical outcomes and overall practicality of offering anti-retroviral therapy to all HIV-positive individuals in Eswatini. 

There, the two discussed the idea of implementation science and Spiegelman’s vision for developing a center to help cultivate the implementation of research to improve public health conditions.

Later in 2014, Spiegelman received the National Institute of Health’s Director’s Pioneer Award, which supports creative scientists pursuing new research directions to develop approaches to challenges in biomedical, social science and behavioral research. At Harvard, Spiegelman received half a million dollars a year to redirect her career to a “high risk, high reward” area, which she had identified to be implementation science. 

When Vermund became the YSPH dean in 2017, the two reconnected and recalled their previous conversations on implementation science. Soon after, Spiegelman was invited to join the faculty at Yale to found CMIPs. 

“It was like a dream job, like an incredible offer that maximized the chance that this would be successful in terms of the various support that I got from Yale University and the YSPH and the Yale dean’s office,” Spiegelman said. 

In addition to a “generous” startup package to create the center, Spiegelman was given four tenure track faculty slots to recruit researchers to join her at the center as well as money to support current Yale faculty to devote their own work and collaborate with the center.

Currently, one up and coming study out of CMIPs was developed with a partnership with Unilever, a British multinational consumer goods company. The goal of the study is to help create a healthier work environment in their factories in South Africa, specifically through modifying food served in the company cafeteria to optimize health value and taste while minimizing sodium and other unhealthy components. 

“We’re measuring workers’ weights … blood pressure and … blood sugar,” Spiegelman explained. “Then let’s say 6 months later, 12 months later, we want to see, after these changes have been made to the cafeteria, whether we see positive changes in these markers for cardiovascular health.”

Drew Cameron is an assistant professor at the YSPH who has served as a primary faculty of CMIPs since joining Yale in 2020. Cameron — who noted that his favorite part of being involved with CMIPs was the chance for collaboration between scientists of different expertise — explained that his current project with CMIPs involved creating plans to integrate HIV and hypertension treatment in Perry Urban, Uganda. 

According to Cameron, the combining treatment access for both these conditions will have other benefits to the patient. 

“The hope is to sort of combine these services in a way that allow folks with comorbidities in HIV and hypertension to combine the visits for care that they have to take into a single facility, which hopefully will cut down on costs for them in terms of medication, but also transportation,” Cameron said. “[A] lot of the questions that I’m involved in asking and answering have to do with the costs that will be potentially saved by integrating these programs.”

Raul Hernandez-Ramirez is another primary faculty member of CMIPs, serving as a research scientist in biostatistics. Hernandez-Rameirez’s work focuses on implementation science in HIV/AIDs and cancer research, particularly in Mexico.

Hernandez-Ramirez, who provides trainings, lectures and technical assistance on design and methods in implementations science through CMIPs, explained that through his work, he aims to develop interventions to increase uptake of evidence based interventions for HIV and cancer. 

“For instance, in Mexico City, our study aims to identify multi-level barriers to follow up to abnormal cervical cancer screening results to then select and develop implementation strategies with the potential to address those barriers and increase follow up,” Hernandez-Rameriez wrote. 

Hagaman encourages students to attend workshops and seminars hosted by CMIPs on methods development and other topics central to the organization. 

For these seminars, scholars outside of Yale are often invited to come share methods they are developing in their own research. According to Hagan, this would give students ample opportunity to learn about how implementation science can be incorporated in their research.

The YSPH was founded on Nov. 1, 1915. 

Jessica Kasamoto covers the Yale School of Public Health for the SciTech desk. She is a graduate student in computational biology and bioinformatics.