What is an implementation strategy?

^{Adapted from Proctor EK, Powell BJ, McMillen JC. Implementation strategies: Recommendations for specifying and reporting. Implement Sci. 2013;8(139).}

Visualizing Implementation Strategy Mechanisms

The study of causal mechanisms in implementation science focuses on understanding how and why specific strategies lead to desired outcomes when implementing evidence-based practices.

Researchers aim to identify the processes or events that drive these outcomes, often referred to as mechanisms of change. This involves developing causal models that link strategies to their effects, considering various factors such as context, barriers, and facilitators. To achieve this, researchers can use a combination of qualitative and quantitative methods to explore and validate these mechanisms.

One of the tools used to understand mechanisms of change are detailed causal pathway diagrams that map out the relationships between strategies and outcomes, including any moderators or preconditions that might influence these relationships. CPDs typically include elements such as implementation strategies, intermediate outcomes, moderators, and final outcomes, providing a clear and structured way to hypothesize and test how and why certain strategies work.

By illuminating these causal pathways, implementation scientists can provide more precise guidance on which strategies are most effective in different contexts. This helps practitioners select and tailor strategies to address specific implementation challenges, ultimately improving the delivery and impact of evidence-based practices. You can learn more about causal pathway diagramming in implementation science at ImpSciMethods.org.

In addition to causal pathway diagrams, several other methods are used to understand mechanisms of change in implementation science:

Logic Models: These are systematic and visual representations of the relationships between resources, activities, outputs, and outcomes. Logic models help in planning, implementing, and evaluating programs by clearly outlining the steps needed to achieve desired outcomes.

Implementation Mapping: This method involves a series of steps to identify and select appropriate implementation strategies. It includes conducting a needs assessment, defining outcomes and performance objectives, choosing theoretical methods, and developing implementation protocols. Implementation mapping ensures that strategies are tailored to the specific context and needs of the target population.

Mechanism Mapping: This approach focuses on identifying and understanding the specific mechanisms through which implementation strategies achieve their effects. It involves linking strategies to their mechanisms of action and evaluating these linkages through empirical research. Mechanism mapping helps in refining and optimizing implementation strategies for better effectiveness (see Kilbourne et al, 2023 for example).

Agile Science: This involves iterative testing and refinement of implementation strategies using rapid-cycle evaluation methods. Agile science emphasizes flexibility and adaptability, allowing researchers to quickly test hypotheses about mechanisms of change and adjust strategies based on real-time data.

These methods collectively enhance the precision and effectiveness of implementation strategies by providing a deeper understanding of the underlying mechanisms of change. By using these tools, implementation scientists can develop more targeted and context-specific strategies, ultimately improving the adoption and sustainability of evidence-based practices. For tools to create CPDs and to learn more about implementation mechanisms, visit ImpSciMethods.org.

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