Understanding the implementation of evidence-informed policies and practices from a policy perspective: a critical interpretive synthesis

Abstract

Background: The fields of implementation science and knowledge translation have evolved somewhat independently from the field of policy implementation research, despite calls for better integration. As a result, implementation theory and empirical work do not often reflect the implementation experience from a policy lens nor benefit from the scholarship in all three fields. This means policy-makers, researchers and practitioners may find it challenging to draw from theory that adequately reflects their implementation efforts.Methods: We developed an integrated theoretical framework of the implementation process from a policy perspective by combining findings from these fields using the critical interpretive synthesis method. We began with the compass question: how is policy currently described in implementation theory and processes and what aspects of policy are important for implementation success? We then searched 12 databases as well as grey literature and supplemented these documents with other sources to fill conceptual gaps. Using a grounded and interpretive approach to analysis, we built the framework constructs, drawing largely from the theoretical literature and then tested and refined the framework using empirical literature.Results: A total of 7850 documents were retrieved and assessed for eligibility and 34 additional documents were identified through other sources. Eighty-two unique documents were ultimately included in the analysis. Our findings indicate that policy is described as: 1) the context; 2) a focusing lens; 3) the innovation itself; 4) a lever of influence; 5) an enabler/facilitator or barrier; or 6) an outcome. Policy actors were also identified as important participants or leaders of implementation. Our analysis led to the development of a two-part conceptual framework, including process and determinant components. Conclusions: This framework begins to bridge the divide between disciplines and offers a new way of thinking about implementation processes at the systems level. It offers researchers, policy-makers and implementers with a new way of thinking about implementation and can be used for planning or evaluating implementation efforts.

Quantitative measures of health policy implementation determinants and outcomes: a systematic review

“…In the Consolidated Framework for Implementation Research (CFIR), Damschroder and colleagues articulate determinants of implementation including the domains of intervention characteristics, outer setting, inner setting of an organization, characteristics of individuals within organizations, and process [33]. Finally, Bullock developed the Policy Implementation Determinants Framework to present a balanced framework that emphasizes both internal setting constructs and external setting constructs including policy actor relationships and networks, political will for implementation, and visibility of policy actors [34]. The constructs identified in these frameworks were used to guide our list of implementation determinants and outcomes.…”

“…The authors developed the search strings and terms based on policy implementation framework reviews [34,35], additional policy implementation frameworks [21,22], labels and definitions of the eight implementation outcomes identified by Proctor et al [25], CFIR construct labels and definitions [9,33], and additional D&I research and search term sources [28,[36][37][38] (Table 1). The full study team provided three rounds of feedback on draft terms, and a library scientist provided additional synonyms and search terms.…”

“…There were several inclusion criteria: (1) empirical studies of the implementation of public policies already passed or approved that addressed physical or behavioral health, (2) quantitative self-report or archival measurement methods utilized, (3) published in peer-reviewed journals from January 1995 through April 2019, (4) published in the English language, (5) public policy implementation studies from any continent or international governing body, and (6) at least two transferable quantitative self-report or archival items that assessed implementation determinants [33,34] and/or IOF implementation outcomes [25]. This study sought to identify transferable measures that could be used to assess multiple policies and contexts.…”

A systematic review of school health policy measurement tools: Implementation determinants and outcomes

“…Both reviews followed procedures conducting a systematic review of implementation measurement tools (40), and adhered to PRISMA reporting guidelines (see Figure 1 and Supplemental Table S1) (41). The review was guided by three prominent D&I frameworks: the Implementation Outcomes Framework (IOF) by Proctor and colleagues (32); the Consolidated Framework for Implementation Research (CFIR) by Damschroder and colleagues (37); and the Policy Implementation Determinants Framework by Bullock and Davis (42,43).…”

A Systematic Review of School Health Policy Measurement Tools: Implementation Determinants and Outcomes

“…1 and Supplemental Table S1) (41). The review was guided by three prominent D&I frameworks: the Implementation Outcomes Framework (IOF) by Proctor and colleagues (32); the Consolidated Framework for Implementation Research (CFIR) by Damschroder and colleagues (37); and the Policy Implementation Determinants Framework by Bullock and Davis (42,43). Through a combination of constructs from these frameworks, we sought to gain a deeper understanding of the implementation outcomes, determinants, and processes for school health policy implementation which are assessed through measurement tools.…”