Table 3. Sample questions based on IR outcomes for a hypothetical One Health rabies intervention. (adapted from BMJ article20 sample questions have been added)
Implementation research outcome Working definition Sample questions for hypothetical One Health rabies intervention
Humanhealth intervention: Vaccinations for at-risk populations, public awareness campaigns, and post-exposure prophylaxis (PEP) for bite victims. Animalhealth intervention: Vaccinations for dogs and other reservoir species, promoting responsible pet ownership and rabies surveillance in animals. Environmental intervention: Management of stray dog populations, safe disposal of animal carcasses and monitoring of rabies in wildlife.
Acceptability The perception among stakeholders (for example, consumers, providers, managers, policy makers) that an intervention is agreeable. How do health care workers perceive the impact of the intervention on their workload and patient care? Do pet owners and farmers believe the intervention will negatively impact their productivity or costs? Are community workers willing to adopt new technologies and practices promoted by the intervention?
Adoption The intention, initial decision, or action to try to employ a new intervention. What factors influence health care facilities’ decision to implement rabies vaccination and PEP programmes? What incentives could encourage pet owners and farmers to participate in the animal vaccination initiatives? How can the intervention engage with local communities to promote safe disposal of animal carcasses?
Appropriateness The perceived fit or relevance of the intervention in a particular setting or for a particular target audience (for example, provider or consumer) or problem. Does the intervention address the specific rabies challenges faced by different types of health care facilities (e.g. hospitals, clinics)? Is the intervention tailored to the needs of different animal sectors (e.g. pets, livestock)? Are the environmental interventions relevant to the specific wildlife rabies challenges in the target area?
Feasibility The extent to which an intervention can be carried out in a particular setting or organization. Are the necessary resources (e.g. training, vaccines) for the intervention available in all health care settings? Can veterinary services effectively deliver the animal health interventions in remote areas? Are the financial and technical resources required for stray dog management and carcass disposal feasible?
Fidelity The degree to which an intervention was implemented as it was designed in an original protocol, plan or policy. Are health care workers adhering to the intervention’s rabies vaccination and PEP guidelines? Are pet owners and farmers following the intervention’s recommended vaccination schedules for animals? Are community workers implementing recommended procedures for stray dog management and carcass disposal?
Implementation cost The incremental cost of the implementation strategy (for example, how the services are delivered in a particular setting). The total cost of implementation would also include the cost of the intervention itself. What are the costs of implementing the rabies vaccination and PEP programmes in different health care settings? How does the cost of the intervention’s animal vaccination programmes compare to potential savings from reduced rabies cases? What are the costs and benefits of implementing the stray dog management and carcass disposal procedures?
Coverage The degree to which the population that is eligible to benefit from an intervention actually receives it. What proportion of the population has access to health care facilities participating in the intervention? What percentage of pets and livestock are covered by the vaccination programmes? What proportion of stray dogs and wildlife populations are being monitored and managed under the intervention?
Sustainability The extent to which an intervention is maintained or institutionalized in a given setting. How can the intervention ensure ongoing funding for rabies vaccination and PEP programmes? What strategies can be used to maintain pet owner and farmer engagement in the vaccination initiatives? How can long- term monitoring and maintenance of stray dog management and carcass disposal be ensured?
Case study 2: Sustainable control of tungiasis in rural Nigeria – a case for One Health20

Introduction: Tungiasis is a neglected tropical disease that causes sores on the skin of the feet and toes, it is most prevalent in marginalized, resource-poor populations.21 An integrated One Health approach is well-suited for sustainably controlling Tunga penetrans in endemic communities, considering the parasite’s life cycle, animal reservoirs, environmental breeding sites, and the strong link to poverty, poor hygiene, and individual behaviours.

Intervention: This study investigated the impact and sustainability of a One Health approach to tungiasis in a severely affected community in Lagos State, Nigeria. A 2006 baseline found high levels of infection in both the human population and domesticated and wild (sylvatic) animals.

The baseline study identified the human, animal and environmental causes of tungiasis in the community. Strategies were then put in place to address these risk factors including sealing floors with concrete, banning free-roaming pigs, promoting regular use of footwear and clearing waste from the streets.

Given the high burden of disease among schoolchildren, the local school was identified as a probable transmission ‘hot spot’ and its floors were concreted.

Previous studies had indicated that the disease was not considered important by affected populations, decision makers or health professionals. To address this, measures were implemented in collaboration with traditional leaders and community members, with researchers monitoring community uptake and acceptance of the intervention.

Results: A cross-sectional follow-up study in 2007 revealed a decrease in the prevalence of tungiasis from 45.2% to 21.3%. A further visit to the community 14 years later (2020) found no active cases of tungiasis. It was noted that urbanization could have also played a role in elimination.

Conclusion: The study found that a One Health approach can be effective in the long-term control of tungiasis. Community engagement and the sustained commitment of community leaders were cited as key factor in the intervention’s success.