Beyond “implementation strategies”: classifying the full range of strategies used in implementation science and practice

Details

• Alternative Title:
  Implement Sci
• Personal Author:
  Leeman, Jennifer ; Birken, Sarah A. ; Powell, Byron J. ; Rohweder, Catherine ; Shea, Christopher M.
• Description:
  Background
  
  Strategies are central to the National Institutes of Health’s definition of implementation research as “the study of strategies to integrate evidence-based interventions into specific settings.” Multiple scholars have proposed lists of the strategies used in implementation research and practice, which they increasingly are classifying under the single term “implementation strategies.” We contend that classifying all strategies under a single term leads to confusion, impedes synthesis across studies, and limits advancement of the full range of strategies of importance to implementation. To address this concern, we offer a system for classifying implementation strategies that builds on Proctor and colleagues’ (2013) reporting guidelines, which recommend that authors not only name and define their implementation strategies but also specify who enacted the strategy (i.e., the actor) and the level and determinants that were targeted (i.e., the action targets).
  
  Main body
  
  We build on Wandersman and colleagues’ Interactive Systems Framework to distinguish strategies based on whether they are enacted by actors functioning as part of a Delivery, Support, or Synthesis and Translation System. We build on Damschroder and colleague’s Consolidated Framework for Implementation Research to distinguish the levels that strategies target (intervention, inner setting, outer setting, individual, and process). We then draw on numerous resources to identify determinants, which are conceptualized as modifiable factors that prevent or enable the adoption and implementation of evidence-based interventions. Identifying actors and targets resulted in five conceptually distinct classes of implementation strategies: dissemination, implementation process, integration, capacity-building, and scale-up. In our descriptions of each class, we identify the level of the Interactive System Framework at which the strategy is enacted (actors), level and determinants targeted (action targets), and outcomes used to assess strategy effectiveness. We illustrate how each class would apply to efforts to improve colorectal cancer screening rates in Federally Qualified Health Centers.
  
  Conclusions
  
  Structuring strategies into classes will aid reporting of implementation research findings, alignment of strategies with relevant theories, synthesis of findings across studies, and identification of potential gaps in current strategy listings. Organizing strategies into classes also will assist users in locating the strategies that best match their needs.
  
  
• Subjects:
  Capacity-building Debate Dissemination Implementation Strategies Interactive Systems Framework Scale-up
• Source:
  Implement Sci. 12.
• Pubmed ID:
  29100551
• Pubmed Central ID:
  PMC5670723
• Document Type:
  Journal Article
• Funding:
  K01 MH113806/MH/NIMH NIH HHS/United States ; KL2 TR001109/TR/NCATS NIH HHS/United States ; U48 DP005017/DP/NCCDPHP CDC HHS/United States ; UL1 TR001111/TR/NCATS NIH HHS/United States
• Volume:
  12
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:9395a13eeda3c7302e73955211ecdfaf1976398cc20ec4b43373422698d0c343
• Download URL:
  https://stacks.cdc.gov/view/cdc/50142/cdc_50142_DS1.pdf
• File Type:
  [PDF - 567.50 KB ]