What is an implementation science question?

Implementation science is centrally focused on the effectiveness of 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.

To lay the foundation for research on the effectiveness of implementation strategies, it is important to understand the barriers and facilitators impacting the adoption and widespread use of evidence based practices. Early work in the field of implementation science focused largely on barriers and facilitators, but the field has now progressed to understanding this as a necessary, but only first step.

Beyond barriers and facilitators, implementation science questions should examine the context of the implementation strategy or strategies employed, how that context shapes the strategy or strategies, and/or focus on at least one relevant implementation outcome (see Proctor et al 2011 for a list of these outcomes and their definitions).

Key Implementation Science Questions

Core questions:

  • 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?
Graphic of many question marks.

In addition to these broad implementation science questions, there are other ways to frame your question. Authors of two publications (excerpted below) suggest using the challenge faced, or the objective sought, as the starting point for forming an implementation science question.

Questions stemming from the challenge of…*

Scaling up:

  • How can coverage and usage of a proven intervention be improved to meet set targets?
  • How can a program be scaled up to broader regions or populations?

Sustainability:

  • Why do established programs lose effectiveness over time?
  • How can sustainability or health maintenance be achieved?

Replication:

  • Why do tested programs exhibit unintended effects when transferred to a new setting or problem?
  • Why don’t tested programs work when transferred to new settings or work in some settings and not others?
  • How can implementation be improved to assure replicability?

Program integration:

  • How can multiple interventions be effectively packaged and delivered within health systems?
  • How can interventions be delivered to assure integration?

Equitability:

  • How could program or service delivery be more equitable in settings where financial and human resources are low, or where [differing] cultural and social norms affect health-seeking behaviors?
  • What is the impact across issues of race, class, education, gender, age, geography (urban-rural) and other relevant factors?

Real-world effectiveness:

  • Are there unintended consequences (positive or negative) of the program?
  • Under what conditions does the program work?
  • Is the tool, intervention, or strategy worth it? Is it cost-effective?
  • Does the program achieve the intended public health impact?

*Adapted from Fundamentals of Implementation Research (2012), by MEASURE Evaluation

Questions stemming from the objective…*

To explore:

  • What are the possible factors and agents responsible for good implementation of a health intervention? For enhancing or expanding a health intervention?

To describe:

  • What describes the context in which implementation occurs?
  • What describes the main factors influencing implementation in a given context?

To influence:

  • Is a health outcome due to implementation of the intervention?

To explain:

  • How and why does implementation of the intervention lead to effects on health behavior, services, or status in all its variations?

To predict:

  • What is the likely course of future implementation?

*Adapted from Implementation Research: What it is and how to do it, by Peters et al (2013)