Implementation Science at UW

Pick theory, model, or framework

Where to start? There are so many!

One of the cornerstones of implementation science is the use of theory.

Unfortunately, the vast number of theories, models, and frameworks available in the implementation science toolkit can make it difficult to determine which is the most appropriate to address or frame a research question. There are dozens of theories, models, and frameworks used in implementation science that have been developed across a wide range of disciplines, and more are published each year.

Two reviews provide schemas to organize implementation science theories, models, and frameworks and narrow the range of choices:

Bridging research and practice: models for dissemination and implementation research (Tabak, Khoong, Chambers, & Brownson, 2013)
Tabak et al’s schema organizes 61 dissemination and implementation models based on three variables: 1) construct flexibility, 2) focus on dissemination and/or implementation activities, and 3) socio-ecological framework level.

The authors argue that classification of a model based on these three variables will assist in selecting a model to inform D&I science study design and execution. For more information, check out this archived NCI webinar with presenters Dr. Rachel Tabak and Dr. Ted Skolarus:
💻 Applying Models and Frameworks to D&I Research: An Overview & Analysis.

Making sense of implementation theories, models, and frameworks (Nilsen, 2015)
Per Nilsen's schema sorts implementation science theories, models, and frameworks into five categories:
1) process models, 2) determinants frameworks, 3) classic theories, 4) implementation theories, and 5) evaluation frameworks.

Adapted from: Nilsen P. Making sense of implementation theories, models and frameworks. Implement Sci. 2015;10(1):1-13.

Below, we borrow from Nilsen’s schema to organize overviews of a selection of implementation science theories, models, and frameworks. In each overview, you will find links to additional resources.

Open Access articles will be marked with ✪
Please note some journals will require subscriptions to access a linked article.

Process Models

In 2013, Chambers, Glasgow, and Stange published ✪ The dynamic sustainability framework: addressing the paradox of sustainment amid ongoing change in the Open Access (✪) journal Implementation Science. The Dynamic Sustainability Framework arose from the need to better understand how the sustainability of health interventions can be improved.

Examples of Use

Determinant Frameworks

In 2005, the National Implementation Research Network (NIRN) published an Open Access (✪) monograph synthesizing transdisciplinary research on implementation evaluation. The resulting Active Implementation Frameworks (AIFs) include the following five elements: Usable Intervention Criteria, Stages of implementation, Implementation Drivers, Improvement Cycles, and Implementation Teams. A robust support and training website is maintained by NIRN, complete with activities and assessments to guide active implementation.

Learn More:

Classic Theories

In 2017 Dr. Sarah Birken and colleagues published their application of four organizational theories to published accounts of evidence-based program implementation. The objective was to determine whether these theories could help explain implementation success by shedding light on the impact of the external environment on the implementing organizations.

Their paper, ✪ Organizational theory for dissemination and implementation research, published in the journal Implementation Science utilized transaction cost economics theory, institutional theory, contingency theories, and resource dependency theory for this work.

In 2019, Dr. Jennifer Leeman and colleagues applied these same three organizational theories to case studies of the implementation of colorectal cancer screening interventions in Federally Qualified Health Centers, in ✪ Advancing the use of organization theory in implementation science (Preventive Medicine, 2019).

Implementation Theories

In 2011, Weiner, Belden, Bergmire, and Johnston published ✪ The meaning and measurement of implementation climate in Implementation Science to address the lack of theory behind the impact of climate in innovation implementation. They argued that implementation climate is distinct from constructs such as organizational climate, culture, or context in both its strategic focus on implementation and because it is innovation-specific.

Learn More:

Evaluation Frameworks

In their 2011 publication, Proctor and colleagues proposed that implementation outcomes should be distinct from service outcomes or clinical outcomes. They identified eight discrete implementation outcomes (acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability) and proposed a taxonomy to define them.

The framework development article, ✪ Outcomes for Implementation Research: Conceptual Distinctions, Measurement Challenges, and Research Agenda, is available through Administration and Policy in Mental Health and Mental Health Services Research.

In 2023, Dr. Proctor and several colleagues published Ten years of implementation outcomes research: a scoping review in the journal Implementation Science, a scoping review of 'the field’s progress in implementation outcomes research.'

Examples of Use