What is an implementation strategy?

Implementation science is fundamentally concerned with identifying effective strategies for implementing evidence-based interventions. Therefore it is critical to understand the difference in what is meant by implementation strategies and evidence based interventions.

Implementation strategies are the actions taken to enhance adoption, implementation, and sustainability of evidence based interventions.

Evidence based interventions are programs, practices, principles, procedures, products, pills, or policies that have been demonstrated to improve health behaviors, health outcomes, or health-related environments.

Evidence based interventions are the what that is being implemented. Implementation strategies are how we seek to get evidence based interventions into normal practice in clinical or community settings. This distinction between “what” and “how” is useful for distinguishing implementation strategies from evidence based interventions.

For an in-depth explanation of implementation strategies, read Kirchner and colleagues' excellent introduction in Psychiatry Research (2019).

Examples of implementation strategies

Implementation strategies can target determinants at any level of the social ecological model. Implementation strategies can be a single strategy (e.g. training), or a bundle of strategies to address multiple implementation barriers (e.g. the use of both reminders and role revisions), or blended strategies that are multiple strategies packaged and branded for use (e.g. the Leadership and Organizational Change Intervention).

If implementation strategies are to be scientifically tested, communicated clearly in the literature, and accurately employed in actual healthcare practice, they must be specified both conceptually and operationally.

WATCH:

In 2015, the Expert Recommendations for Implementing Change (ERIC) project published a refined compilation of implementation strategy terms and definitions compiled by systematically gathering input from stakeholders across implementation science and clinical practice. The resulting table of 73 implementation strategies can be found here or in the original article in the journal Implementation Science.

Waltz and colleagues then used concept mapping to characterize relationships among the 73 implementation strategies and assess their feasibility and importance, resulting in nine clusters of implementation strategies. While not exhaustive, the figure below provides examples of the different strategies found in each of the nine distinct clusters.
 

Adapted from: Waltz, TJ., Powell, BJ., Matthieu, MM. et al. Use of concept mapping to .... Implementation Sci 10, 109 (2015) doi:10.1186/s13012-015-0295-0

Specifying and Reporting Implementation Strategies for Replicability

Proctor, Powell, and McMillen's stragegy for reporting implementation strategies in a manner that allows for measurement and replication.

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


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