Abstract
The field of implementation science was developed to better understand the factors that facilitate or impede implementation and generate evidence for implementation strategies. In this article, we briefly review progress in implementation science, and suggest five priorities for enhancing the impact of implementation strategies. Specifically, we suggest the need to: (1) enhance methods for designing and tailoring implementation strategies; (2) specify and test mechanisms of change; (3) conduct more effectiveness research on discrete, multi-faceted, and tailored implementation strategies; (4) increase economic evaluations of implementation strategies; and (5) improve the tracking and reporting of implementation strategies. We believe that pursuing these priorities will advance implementation science by helping us to understand when, where, why, and how implementation strategies improve implementation effectiveness and subsequent health outcomes.
Highlights
20 years ago, Grol and Grimshaw [1] asserted that evidence-based practice must be complemented by evidence-based implementation
The past two decades have been marked by significant progress, as the field of implementation science has worked to develop a better understanding of implementation barriers and facilitators and generate evidence for implementation strategies [2]
While we hope the proposed priorities are applicable to studies conducted in a wide range of contexts, we welcome discussion regarding potential applications and enhancements for contexts outside of healthcare, such as community and public health settings [3] that often involve different types of stakeholders, interventions, and implementation strategies
Summary
20 years ago, Grol and Grimshaw [1] asserted that evidence-based practice must be complemented by evidence-based implementation. Grimshaw et al [34] provide one possible explanation, emphasizing that the general lack of an a priori rationale for the selection of components (i.e., discrete strategies) in multifaceted implementation strategies makes it difficult to determine how these decisions were made They may have been selected thoughtfully to address prospectively identified determinants through theoreticallyor empirically-derived change mechanisms, or they may be the manifestation of a “kitchen sink” approach. Five priorities need to be addressed to increase the public health impact of implementation strategies: [1] enhance methods for designing and tailoring; [2] specify and test mechanisms of change; [3] conduct more effectiveness research on discrete, multifaceted, and tailored strategies; [4] increase economic evaluations; and [5] improve tracking and reporting. Table updated from Grimshaw et al [34], and draws upon Cochrane Reviews from the Effective Practice and Organization of Care (EPOC) group [38]
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