Implementation Frameworks

Many interventions found to be effective in health services research studies fail to translate into meaningful patient care outcomes across multiple contexts. Implementation science developed out of the need to address challenges associated with the use of research to achieve more evidence-based practice (EBP) in health care and other areas of professional practice. Implementation science is the study of methods to improve the uptake, implementation, and translation of research findings into routine and common practices. It is based on understanding how change takes place.

A researcher’s must read: For many years, the UK Medical Research Council’s guide to developing and evaluating complex interventions was the go-to, but in 2021 it was updated to reflect the newest developments in the field. This new guidance, published jointly by the UK Medical Research Council and US National Institute for Health Research can be found here.

Context is important

Implementation science is focused on the effectiveness of implementation strategies, rather than interventions or evidence-based practices. Specifically, implementation science attends to the context in which strategies are applied, and how that context shapes effectiveness of implementation strategies. In essence, there are four main variables that interact to influence the adoption of new innovations, interventions or changes of practice.

  • External environment – where
  • Delivery system – how
  • Characteristics of the innovation, intervention or practice – what
  • The decision-making process – why

Health services researchers recognize the need to evaluate not only summative outcomes but also formative outcomes to assess the extent to which implementation is effective in a specific setting, prolongs sustainability, and promotes dissemination into other settings.

Core questions to be answered

Core implementation science questions include:

  • What are the most effective techniques to improve the distribution and receipt of evidence?
  • What are the most effective techniques to incorporate new discoveries and evidence-based practices into care delivery?
  • How do contextual factors influence implementation success or failure (and how can these contextual factors be modified to increase chances of success)?
  • What are the most effective techniques to de-implement practices that are no longer effective or were never effective in the first place?

Value of implementation frameworks

However, implementation research frameworks seek to solve the following types of issues and challenges or objectives as the starting point to implementation research.

  • Scaling up challenges
  • Sustainability and health maintenance challenges
  • Replication challenges
  • Programme integration challenges
  • Equitability challenges
  • Real world effectiveness, cost effectiveness and impact challenges
  • Efficiency
  • Unintended consequences

The main objectives of implementation research is to explore, describe, influence, explain or predict uptake of new practices. The types of problems that implementation science can address normally arise from contextual problems that inhibit implementation of a new practice. Eg.

  • Management, administrative, cultural, social, behavioural, economic and other factors that exist as bottlenecks to effective implementation.
  • Identify and solve programme problems in a more timely or equitable manner
  • Helping programme staff understand how their programmes work and how to improve them.

Common characteristics of implementation research

There are many frameworks for conducting implementation research. Depending on the context you work in, some frameworks may be more useful than others. While frameworks vary in some ways, there are common characteristics present in many of them:

  • Proven effectiveness – an evidence-based intervention with demonstrated effectiveness
  • Proven efficiency – delivering services at low cost and most sustainably
  • Context – local determinants of programme adoption and impact
  • Implementation – a plan for implementation, adaptation, innovation, and dissemination
  • Sustainability – assessed through monitoring, evaluation, and impacts
  • Stakeholder input – involvement of stakeholders early and throughout the entire process

BY YOLISWA NTSEPE (MA, PhD)
ADOLESCENT PROGRAMMES MANAGER

UPDATED NOV 22, 2023

TABLE OF CONTENTS:

  1. why adolescents?
  2. where do adults fit in?
  3. research methods and designs
  4. ethical concerns with adolescents
  5. protocol development
  6. adolescent friendly site assessment
  7. adolescent peer supporters
  8. implementation frameworks
  9. standard operating procedures
  10. data collection
  11. dissemination

REFERENCES & ADDITIONAL RESOURCES:

Beyond “implementation strategies”: classifying the full range of strategies used in implementation science and practice (Implementation Science, 2017)

Use of concept mapping to characterize relationships among implementation strategies and assess their feasibility and importance: results from the Expert Recommendations for Implementing Change (ERIC) study (Implementation Science, 2015)

Choosing implementation strategies to address contextual barriers: diversity in recommendations and future directions (Implementation Science, 2019)