Abstract
BackgroundIdentifying feasible and effective implementation strategies that are contextually appropriate is a challenge for researchers and implementers, exacerbated by the lack of conceptual clarity surrounding terms and definitions for implementation strategies, as well as a literature that provides imperfect guidance regarding how one might select strategies for a given healthcare quality improvement effort. In this study, we will engage an Expert Panel comprising implementation scientists and mental health clinical managers to: establish consensus on a common nomenclature for implementation strategy terms, definitions and categories; and develop recommendations to enhance the match between implementation strategies selected to facilitate the use of evidence-based programs and the context of certain service settings, in this case the U.S. Department of Veterans Affairs (VA) mental health services.Methods/DesignThis study will use purposive sampling to recruit an Expert Panel comprising implementation science experts and VA mental health clinical managers. A novel, four-stage sequential mixed methods design will be employed. During Stage 1, the Expert Panel will participate in a modified Delphi process in which a published taxonomy of implementation strategies will be used to establish consensus on terms and definitions for implementation strategies. In Stage 2, the panelists will complete a concept mapping task, which will yield conceptually distinct categories of implementation strategies as well as ratings of the feasibility and effectiveness of each strategy. Utilizing the common nomenclature developed in Stages 1 and 2, panelists will complete an innovative menu-based choice task in Stage 3 that involves matching implementation strategies to hypothetical implementation scenarios with varying contexts. This allows for quantitative characterizations of the relative necessity of each implementation strategy for a given scenario. In Stage 4, a live web-based facilitated expert recommendation process will be employed to establish expert recommendations about which implementations strategies are essential for each phase of implementation in each scenario.DiscussionUsing a novel method of selecting implementation strategies for use within specific contexts, this study contributes to our understanding of implementation science and practice by sharpening conceptual distinctions among a comprehensive collection of implementation strategies.
Highlights
Identifying feasible and effective implementation strategies that are contextually appropriate is a challenge for researchers and implementers, exacerbated by the lack of conceptual clarity surrounding terms and definitions for implementation strategies, as well as a literature that provides imperfect guidance regarding how one might select strategies for a given healthcare quality improvement effort
Implementation research is a promising means of improving the quality of mental healthcare delivery, both by increasing our understanding of determinants of practice that can influence organizational, provider and patient behavior, and by building an evidence base for specific implementation strategies that can move evidence-based programs and practices (EBPPs) into routine care [1,2]
It has particular utility within contexts such as the U.S Department of Veterans Affairs (VA), in which the use of EBPPs has been mandated via requirements set forth in the Uniform Mental Health Services Handbook [3]
Summary
Context-specific recommendations for three phases of implementation (pre-implementation, active implementation, and sustainment), a series of MBC tasks will elicit expert recommendations for collections of recommended strategies to address the needs for each of three real-world implementation scenarios Aggregate data from this exercise will produce quantitative characterizations of high and low levels of consensus for individual strategies at each phase of implementation for each scenario. The structured use of technology in this process allows for experts to participate in the majority of activities on their own time, with only the webinars requiring real-time participation While this particular application of the ERIC process focuses on the implementation of EBPPs in mental health service settings within the VA, these methods are suitable for other practice areas. Gave feedback, and approved the final version of this manuscript
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