Correspondence: Sobia Khan (RashidS@smh.ca)
Background
Over 60 implementation theories, models, and frameworks (TMFs) exist; however, there is little direction on how to apply these in a manner that meaningfully addresses the complexity of implementation. Our aim is to present a combination of TMFs, informed by implementation science, which can be used to guide real world implementation practice.
Materials and Methods
We identified TMFs for three linked, but distinct phases of implementation: 1) developing an intervention; 2) implementation, evaluation, and sustainability; and 3) spread/scale up. For each phase, we selected: a process model to outline implementation steps, a theory to describe mechanisms of change or the underlying program theory, and frameworks that describe factors affecting implementation and provide guidance on how to operationalize each implementation step [1]. Whenever possible, we used TMFs in which the content is based on a literature synthesis or constitutes a meta-TMF.
Results
We combined three process models, two theories, and seven frameworks to describe and operationalize critical implementation steps. For phase 1 (developing a program ) we selected the Knowledge-To-Action process model [2] to outline implementation steps such as conducting a barriers and facilitators assessment and selecting and operationalizing implementation strategies, used behaviour change theories (e.g., Capability, Opportunity, Motivation – Behaviour [3]), and chose frameworks (e.g., Theoretical Domains Framework [4]), and evidence for implementation strategies. For phase 2 (implementation, evaluation, and sustainability) we selected the Quality Implementation Framework [5] as our process model. We used frameworks (e.g., the Consolidated Framework for Implementation Research [6] and Interactive Systems Framework for Dissemination and Implementation [7]), to consider the context and determine roles for program implementation. We used the Ecological Framework [8] and RE-AIM [9] to evaluate implementation; and the Sustainability planning model [10] and the Dynamic Sustainability Framework [11] to inform sustainability planning. For phase 3, (spread/scale) we selected the Framework for Going to Full Scale [12] as our process model, Theory of Diffusion as the theory, and ExpandNet as the framework. We will provide an overview and visual representation of how the theories, models, and frameworks can be used to develop, implement, evaluate, sustain, and spread/scale programs.
Conclusions
Our method can be used by implementation researchers and practitioners to identify and combine selected TMFs pragmatically in real-world contexts. This method can be applied using TMFs of the implementer’s choosing, and can be applied across multiple implementation settings at the micro, meso, and macro levels.
References
1. Nilsen P. Making sense of implementation theories, models and frameworks. Implement Sci. 2015;10:(53). doi:10.1186/s13012-015-0242-0.
2. Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W, et al. Lost in knowledge translation: time for a map? J Contin Educ Health Prof. 2006;26(1):13-24. doi:10.1002/chp.47.
3. Michie S, van Stralen MM, West R. The behaviour change wheel: A new method for characterising and design- ing behaviour change interventions. Implement Sci. 2011;6(1):1-12. doi: 10.1186/1748-5908-6-42.
4. Cane J, O’Connor D, Michie S. Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci. 2012;7:37. doi: 10.1186/1748-5908-7-37.
3. Meyers DC, Durlak JA, Wandersman, Al. The Quality Implementation Framework: A Synthesis of Critical Steps in the Implementation Process. Am J Community Psychol. 2012;50:462-480. doi: 10.1007/s10464-012-9522-x.
4. Damschroder LJ, Aron, DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:50. doi:10.1186/1748-5908-4-50.
5. Wandersman A, Duffy J, Flashpohler P, et. al. Bridging the gap between prevention research and practice: The Interactive Systems Framework for dissemination and implementation. Am J Community Psychol. 2008; 41(3-4):171-181. doi: 10.1007/s10464-008-9174-z.
6. Durlak JA, DuPre EP. Implementation matters: A review of research on the influence of implementation on program outcomes and the factors affecting implementation. Am J Community Psychol. 2008;41(3-4):327-350. doi: 10.1007/s10464-008-9165-0.
7. Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 1999;89(9):1322-7.
8. Johnson K, Hays C, Center H, Daley C. Building capacity and sustainable prevention innovations: a sustain- ability planning model. Eval Program Planning. 2004;27:135-149. doi: 10.1016/j.evalprogplan.2004.01.002.
9. Chambers DA, Glasgow RE, Stange KC. The dynamic sustainability framework: addressing the paradox of sustainment amid ongoing change. Implement Sci. 2013;8(117):1-11. doi: 10.1186/1748-5908-8-117.
10. Barker PM, Reid A, Schall MW. A framework for scaling up health interventions: lessons from large-scale improvement initiatives in Africa. Implement Sci. 2016;11(1):12. doi: 10.1186/s13012-016-0374-x.
11. Rogers, Elliot M. New Product Adoption and Diffusion. J Consum Res Research. 1976;2(4):290-301. https://academic.oup.com/jcr/article-abstract/2/4/290/1820436/New-Product-Adoption-and-Diffusion. Accessed March 2, 2017.
12. Nine steps for developing a scaling up strategy. World Health Organization. www.who.int/ reproductivehealth/publications/strategic_approach/9789241500319/en/.2010. Accessed March 1, 2017.