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

Abstract

BackgroundStrategies 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 bodyWe 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.ConclusionsStructuring 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.

The PM&R Journal Implements a Social Media Strategy to Disseminate Research and Track Alternative Metrics in Physical Medicine and Rehabilitation

“…Within implementation science are 2 distinct components that include dissemination research, which is the study of the distribution of evidence‐based medicine to clinical practice or public health audiences, and implementation research, which is the study of strategies used to adopt or integrate evidence‐based medicine into clinical or community settings [2]. An in‐depth discussion of the strategies [3] and resources available are beyond the scope of this report; notably, however, social media are a well‐described resource [4]. Although the field of implementation science is more than a decade old, it is still relatively young and evolving.…”

Community pharmacist patient care services: A systematic review of approaches used for implementation and evaluation

“…Leeman and colleagues have advocated for building on Proctor colleagues' reporting guidelines. Researchers should name and define implementation strategies utilized as well as describe who enacted them and the level and determinants they targeted …”

“…Numerous frameworks exist to guide implementation strategy selection, including the PARIHS framework, Replicating Effective Programs (REP), CFIR‐ERIC Strategy Matching Tool, and Active Implementation Frameworks (AIF), among others . Shoemaker and colleagues presented the first implementation framework specifically for community pharmacist patient care services based on CFIR .…”

“…Shoemaker and colleagues presented the first implementation framework specifically for community pharmacist patient care services based on CFIR . Selection of a framework or theory should be made based upon the goals and scope of the implementation effort and stages of implementation the effort will span . Using frameworks and theories enables strategic selection of implementation strategies based upon the unique contextual factors in community pharmacy practice and may result in more effective and efficient implementation of patient care services.…”

“…Leeman and colleagues have advocated for building on Proctor colleagues' reporting guidelines. Researchers should name and define implementation strategies utilized as well as describe who enacted them and the level and determinants they targeted 48. Pharmacy and implementation practitioners and researchers should utilize the established implementation strategy taxonomies and reporting guidelines when describing implementation strategies for community pharmacist patient care services.…”