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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Health Serv.</journal-id>
<journal-title>Frontiers in Health Services</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Health Serv.</abbrev-journal-title>
<issn pub-type="epub">2813-0146</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/frhs.2024.1515478</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Health Services</subject>
<subj-group>
<subject>Editorial</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Editorial: Learning for action in policy implementation</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author" corresp="yes"><name><surname>Su</surname><given-names>Yanfang</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
<xref ref-type="corresp" rid="cor1">&#x002A;</xref>
<uri xlink:href="https://loop.frontiersin.org/people/1155585/overview"/><role content-type="https://credit.niso.org/contributor-roles/conceptualization/"/><role content-type="https://credit.niso.org/contributor-roles/funding-acquisition/"/><role content-type="https://credit.niso.org/contributor-roles/writing-original-draft/"/><role content-type="https://credit.niso.org/contributor-roles/writing-review-editing/"/></contrib>
<contrib contrib-type="author"><name><surname>Bullock</surname><given-names>Heather L.</given-names></name>
<xref ref-type="aff" rid="aff3"><sup>3</sup></xref>
<xref ref-type="aff" rid="aff4"><sup>4</sup></xref><uri xlink:href="https://loop.frontiersin.org/people/1952559/overview"/><role content-type="https://credit.niso.org/contributor-roles/conceptualization/"/><role content-type="https://credit.niso.org/contributor-roles/writing-review-editing/"/></contrib>
<contrib contrib-type="author"><name><surname>Trisolini</surname><given-names>Michael</given-names></name>
<xref ref-type="aff" rid="aff5"><sup>5</sup></xref><uri xlink:href="https://loop.frontiersin.org/people/1718187/overview" /><role content-type="https://credit.niso.org/contributor-roles/conceptualization/"/><role content-type="https://credit.niso.org/contributor-roles/writing-review-editing/"/></contrib>
<contrib contrib-type="author"><name><surname>Emmons</surname><given-names>Karen M.</given-names></name>
<xref ref-type="aff" rid="aff6"><sup>6</sup></xref><uri xlink:href="https://loop.frontiersin.org/people/1527961/overview" /><role content-type="https://credit.niso.org/contributor-roles/conceptualization/"/><role content-type="https://credit.niso.org/contributor-roles/writing-review-editing/"/></contrib>
</contrib-group>
<aff id="aff1"><label><sup>1</sup></label><institution>Department of Global Health, School of Public Health, University of Washington</institution>, <addr-line>Seattle, WA</addr-line>, <country>United States</country></aff>
<aff id="aff2"><label><sup>2</sup></label><institution>Evans School of Public Policy and Governance, University of Washington</institution>, <addr-line>Seattle, WA</addr-line>, <country>United States</country></aff>
<aff id="aff3"><label><sup>3</sup></label><institution>Department of Health Research Methods, Evidence and Impact, McMaster University</institution>, <addr-line>Hamilton, ON</addr-line>, <country>Canada</country></aff>
<aff id="aff4"><label><sup>4</sup></label><institution>Waypoint Research Institute, Waypoint Centre for Mental Health Care</institution>, <addr-line>Penetanguishene, ON</addr-line>, <country>Canada</country></aff>
<aff id="aff5"><label><sup>5</sup></label><institution>Department of Public Health and Health Sciences, Northeastern University</institution>, <addr-line>Boston, MA</addr-line>, <country>United States</country></aff>
<aff id="aff6"><label><sup>6</sup></label><institution>Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health</institution>, <addr-line>Boston, MA</addr-line>, <country>United States</country></aff>
<author-notes>
<fn fn-type="edited-by"><p><bold>Edited and Reviewed by:</bold> Nick Sevdalis, National University of Singapore, Singapore</p></fn>
<corresp id="cor1"><label>&#x002A;</label><bold>Correspondence:</bold> Yanfang Su <email>yfsu@uw.edu</email></corresp>
</author-notes>
<pub-date pub-type="epub"><day>19</day><month>11</month><year>2024</year></pub-date>
<pub-date pub-type="collection"><year>2024</year></pub-date>
<volume>4</volume><elocation-id>1515478</elocation-id>
<history>
<date date-type="received"><day>22</day><month>10</month><year>2024</year></date>
<date date-type="accepted"><day>04</day><month>11</month><year>2024</year></date>
</history>
<permissions>
<copyright-statement>&#x00A9; 2024 Su, Bullock, Trisolini and Emmons.</copyright-statement>
<copyright-year>2024</copyright-year><copyright-holder>Su, Bullock, Trisolini and Emmons</copyright-holder><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/4.0/">
<p>This is an open-access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License (CC BY)</ext-link>. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</p></license>
</permissions>
<kwd-group>
<kwd>learning for action</kwd>
<kwd>evidence</kwd>
<kwd>policy</kwd>
<kwd>implementation science</kwd>
<kwd>implementation strategies</kwd>
</kwd-group>
<contract-num rid="cn001">K01HL166688, R25DK123008</contract-num><contract-sponsor id="cn001">NIH</contract-sponsor><counts>
<fig-count count="0"/>
<table-count count="0"/><equation-count count="0"/><ref-count count="6"/><page-count count="3"/><word-count count="0"/></counts><custom-meta-wrap><custom-meta><meta-name>section-at-acceptance</meta-name><meta-value>Implementation Science</meta-value></custom-meta></custom-meta-wrap>
</article-meta>
</front>
<body>
<related-article id="RA1" related-article-type="commentary-article" journal-id="Front. Health Serv." journal-id-type="nlm-ta" xlink:href="https://www.frontiersin.org/research-topics/39291/learning-for-action-in-policy-implementation" ext-link-type="uri"><bold>Editorial on the Research Topic</bold> <article-title>Learning for action in policy implementation</article-title></related-article>
<sec id="s1" sec-type="intro"><title>Introduction</title>
<p>Policy implementation science (IS) is an emerging field that intersects implementation science and public policy studies to support the translation of evidence into policy. As a multidisciplinary field, Policy IS uses methodologies and frameworks from economics, political science, sociology, public administration, knowledge translation, and other fields. Policy IS would benefit from broader consensus on definitions, theories, frameworks, methodologies, and outcomes, so that a wide range of studies could build on a common conceptual foundation and thus build scientific knowledge more rapidly. The objective of this Research Topic is to reach consensus and drive learning for action in policy implementation by strengthening connections among a range of policy IS working partners, including implementation scientists, policy researchers, technical advisers, policymakers, and policy implementation practitioners.</p>
<p>In this special collection, 82 authors contributed to publishing 12 manuscripts on topics relevant to the design, processes, and impacts of policy implementation. The collection includes one theoretical discussion on global context (<ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/frhs.2024.1292688">List and Agamile et al.</ext-link>); reviews on service integration (<ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/fpubh.2023.1219676">Tao et al.</ext-link>) and tobacco licensing (<ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/fpubh.2024.1369207">Bera et al.</ext-link>); methodological studies on equity-centered hybrid policy implementation studies (<ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/frhs.2023.1220629">Asada et al.</ext-link>), quantitative policy IS measures (<ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/frhs.2024.1322702">Smith et al.</ext-link>) and the integration of legal epidemiology and IS (<ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/frhs.2023.1291183">Lane and Stergachis</ext-link>); one measurement study on acceptability and feasibility of policy implementation strategies (<ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/frhs.2024.1304049">Purtle et al.</ext-link>); one qualitative comparative case study on policy intermediaries (<ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/frhs.2024.1371207">Bullock et al.</ext-link>); and one case study on food assistance policy implementation (<ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/frhs.2023.1286050">Kenney et al.</ext-link>); one quantitative evaluation effective communication related to policy IS (<ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/fpubh.2024.1246897">Dodson et al.</ext-link>); one mixed-method study on inter-sector care for the homeless (<ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/fpubh.2024.1356652">Martins et al.</ext-link>); one design study on participatory development of a target policy profile (<ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/frhs.2023.1310694">Means et al.</ext-link>). Reviewing the papers included in this Research Topic, we identified several themes salient to the future of policy IS.</p>
</sec>
<sec id="s2"><title>Working definitions of policy implementation</title>
<p>Policies include regulatory, promotional, and redistributive decisions and guidelines for implementing programs to achieve societal goals (<xref ref-type="bibr" rid="B1">1</xref>). <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/frhs.2023.1291183">Lane and Stergachis</ext-link> addressed the importance of systematic collection and coding of laws to enable policy implementation analysis. It is notable to observe that a consensus was implicitly reached in the 12 manuscripts regarding the importance of the evidence base for policy and practice (EBPP). The working definition of policy IS in the 12 manuscripts aligns with the National Cancer Institute definition of policy IS (<xref ref-type="bibr" rid="B2">2</xref>). However, from a policy perspective, research evidence is not the only input into policy decisions and that is why evidence-informed policies and practices (EIPP) was raised as a critical concept (<xref ref-type="bibr" rid="B3">3</xref>). In public administration, policy implementation is defined as a deliberate, sanctioned change to public policy legitimized by a political authority, with an emphasis on changing the status quo and adapting to diverse contexts (<xref ref-type="bibr" rid="B4">4</xref>). Scientific evidence is considered as one of multiple resources in implementation. Policy implementation strategies include information campaigns (<ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/frhs.2023.1286050">Kenney et al.</ext-link>), licensing (<ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/fpubh.2024.1369207">Bera et al.</ext-link>), as well as others (e.g., contracting, subsidies, accreditation). Through literature review and synthesis, <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/fpubh.2023.1219676">Tao et al.</ext-link> highlighted policy implementation strategies, including training, resource reallocation, and increased insurance coverage.</p>
</sec>
<sec id="s3"><title>Theories and conceptual frameworks for policy implementation</title>
<p>Policy IS has distinctive challenges in different settings and contexts (e.g., global vs. domestic). Incorporating contextual contingencies is important to address the factors affecting policy IS. <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/frhs.2024.1292688">List and Agamile et al.</ext-link> brought the discussion of global policy implementation in decolonizing global health. This includes the application of frameworks and processes through a global perspective that aligns with diverse governance, power, resources, stakeholder relationships and health systems. They highlighted opportunities for reimagining policy implementation science across the policy cycle from agenda setting and policy formulation, to policy implementation and evaluation using real world examples.</p>
<p>In synthesizing scientific evidence, conceptual frameworks are crucial to cluster the findings and aggregate knowledge, with the potential of theorization. Health Triangular Policy Framework by O&#x0027;Brien et al. was applied in the narrative review by <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/fpubh.2023.1219676">Tao et al.</ext-link>, with an emphasis on actor-relevant contexts, contents, and processes (<xref ref-type="bibr" rid="B5">5</xref>). Comparatively, <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/fpubh.2024.1369207">Bera et al.</ext-link> applied a framework for contextual analysis, categorizing strength, weaknesses, opportunities, and threats, in tobacco retailer licensing as a crucial policy implementation strategy in regulating tobacco access.</p>
<p>Several papers present examples of using policy IS frameworks to drive implementation evaluation and outcomes. For instance, <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/frhs.2023.1310694">Means et al.</ext-link>, <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/frhs.2023.1286050">Kenney et al.</ext-link>, and <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/frhs.2024.1322702">Smith et al.</ext-link> directly linked implemented policies to implementation outcomes (e.g., reach, adaptability) and final outcomes relevant to health and equity. <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/frhs.2023.1286050">Kenney et al.</ext-link> illustrated the utility of a policy IS framework by Bullock et al. through a case study (<xref ref-type="bibr" rid="B3">3</xref>). <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/frhs.2023.1220629">Asada et al.</ext-link>, <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/frhs.2024.1371207">Bullock et al.</ext-link> demonstrated how frameworks from related fields of political science, public policy, and IS can inform policy IS.</p>
</sec>
<sec id="s4"><title>Methods for studying policy implementation</title>
<p>This Research Topic represented a wide range of empirical evidence from surveys (e.g., <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/frhs.2024.1304049">Purtle et al.</ext-link>, <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/fpubh.2024.1246897">Dodson et al.</ext-link>), comparative case studies (e.g., <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/frhs.2024.1371207">Bullock et al.</ext-link>, <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/frhs.2024.1322702">Smith et al.</ext-link>), mixed-method studies (e.g., <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/fpubh.2024.1356652">Martins et al.</ext-link>) and design studies (<ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/frhs.2023.1310694">Means et al.</ext-link>).</p>
<p>In survey-based studies with policymakers and implementers, low response rates are a general challenge. For example, <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/fpubh.2024.1246897">Dodson et al.</ext-link> had a 4.5&#x0025; response rate in a national survey of local officials. Nonetheless, the results from these studies shed light on policy implementation practice. <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/fpubh.2024.1246897">Dodson et al.</ext-link> studied the strategies to deliver policy briefs to facilitate information dissemination to local policymakers. Their study found that the narrative policy briefs had the lowest score (42&#x0025;) related to strength in reasoning. In contrast, usual-care and risk-framing brief types had significantly higher scores to reflect strong reasoning (59&#x0025; and 52&#x0025;, respectively).</p>
<p>This Research Topic collected diverse studies to learn for action. <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/frhs.2024.1371207">Bullock et al.</ext-link> elaborated the role of intermediaries in implementing mental health policies through document analysis, site visits, and interviews in three distinctly different high-income countries. <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/frhs.2024.1322702">Smith et al.</ext-link> discussed four design considerations of policy implementation measures using three case studies. <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/fpubh.2024.1356652">Martins et al.</ext-link> used secondary quantitative data and documents as well as collected first-hand data through interviews and focus groups to study tailored inter-sector care in the COVID-19 pandemic among the homeless. <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/frhs.2023.1310694">Means et al.</ext-link> showcased the holistic development of a Target Policy Profile as a single document to guide future work.</p>
</sec>
<sec id="s5"><title>Looking forward</title>
<p>Challenges in policy IS include the complexity of developing overarching theories that address diverse contexts and evolving implementation partners. Contextual analysis often lacks direct causal links to outcomes, while randomized trials are difficult due to the nature and scale of policy implementation. Other useful policy IS methods include legal epidemiology (<ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/frhs.2023.1291183">Lane and Stergachis</ext-link>) and coincidence analysis (<xref ref-type="bibr" rid="B6">6</xref>). Additionally, measuring outcomes across macro, meso, and micro levels, accounting for both intended and unintended effects, remains complex.</p>
<p>A limitation of this Research Topic is that all of the manuscripts are in health and related domains such as food and nutrition (<ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/frhs.2023.1286050">Kenney et al.</ext-link>, <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/frhs.2024.1322702">Smith et al.</ext-link>) and housing instability (<ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/fpubh.2024.1356652">Martins et al.</ext-link>). We anticipate that future Research Topics will cover other social policies, such as unemployment, poverty, education, and LGBTQIA&#x002B; marriage. We also anticipate future studies on systematic reviews to understand the overarching landscape of policy implementation, modeling studies to predict policy impacts, costing methods for use in policy implementation, and others.</p>
</sec>
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<back>
<sec id="s6" sec-type="author-contributions"><title>Author contributions</title>
<p>YS: Conceptualization, Funding acquisition, Writing &#x2013; original draft, Writing &#x2013; review &#x0026; editing. HB: Conceptualization, Writing &#x2013; review &#x0026; editing. MT: Conceptualization, Writing &#x2013; review &#x0026; editing. KE: Conceptualization, Writing &#x2013; review &#x0026; editing.</p>
</sec>
<sec id="s7" sec-type="funding-information"><title>Funding</title>
<p>The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This project is funded through NIH grants (K01HL166688 and R25DK123008). The contents are the responsibility of the authors and do not reflect the views of the funders. The funders had no role in the study design, conduct of the study, analysis, or dissemination of findings.</p>
</sec>
<ack><title>Acknowledgments</title>
<p>We thank Bryan Weiner, Jeff Lane, Natalie Smith, Sara Hirschler, Ana Luisa Jorge Martins, Youyi Li, Anjuli Wagner, Kellie List, Sarah Masyuko for valuable comments. We also thank Erica Kenney, Roger Awan-Scully, Yuka Asad, and Arianna Means for reading the editorial before we send it for peer review.</p>
</ack>
<sec id="s8" sec-type="COI-statement"><title>Conflict of interest</title>
<p>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
<sec id="s9" sec-type="disclaimer"><title>Publisher&#x0027;s note</title>
<p>All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p>
</sec>
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