Abstract
Technology can improve implementation strategies' efficiency, simplifying progress tracking and removing distance-related barriers. However, incorporating technology is meaningful only if the resulting strategy is usable and useful. Hence, we must systematically assess technological strategies' usability and usefulness before employing them. Our objective was therefore to adapt the effort-vs-impact assessment (commonly used in systems science and operations planning) to decision-making for technological implementation strategies. The approach includes three components – assessing the effort needed to make a technological implementation strategy usable, assessing its impact (i.e., usefulness regarding performance/efficiency/quality), and deciding whether/how to use it. The approach generates a two-by-two effort-vs-impact chart that categorizes the strategy by effort (little/much) and impact (small/large), which serves as a guide for deciding whether/how to use the strategy. We provide a case study of applying this approach to design a package of technological strategies for implementing a 5 A's tobacco cessation intervention at a Federally Qualified Health Center. The effort-vs-impact chart guides stakeholder-involved decision-making around considered technologies. Specification of less technological alternatives helps tailor each technological strategy within the package (minimizing the effort needed to make the strategy usable while maximizing its usefulness), aligning to organizational priorities and clinical tasks. Our three-component approach enables methodical and documentable assessments of whether/how to use a technological implementation strategy, building on stakeholder-involved perceptions of its usability and usefulness. As technology advances, results of effort-vs-impact assessments will likely also change. Thus, even for a single technological implementation strategy, the three-component approach can be repeatedly applied to guide implementation in dynamic contexts.
Highlights
Technology shapes both interventions and strategies for implementing interventions
We present here a case study of the three-component approach’s application, and the approach is yet to be applied and evaluated across multiple behavioral health interventions
This method prompted stakeholders to identify additional implementation strategies that were digital (e.g., supervisor dashboard) and non-digital (e.g., a tailored clinic workflow plan, training integrated into the clinic workflow)
Summary
Technology shapes both interventions and strategies for implementing interventions. Technological interventions are receiving increased attention and undergoing enhanced specification [e.g., [1]]. Behavioral intervention technologies are being actively specified and evaluated for their potential to both broaden the interventions’ reach and deliver the interventions through previously unexplored modalities [2, 3]. Such specification is not yet available for technological implementation strategies, including when and how to use them. Our definition is a combination of WHO’s definition (which pertains to technology as it is used in health and health-related fields, without mention of implementation strategies) and Proctor and colleagues’ definition (which pertains to implementation strategies, without mention of technology). As our work discusses technological implementation strategies that are at the crosssection of the two concepts, our definition pulls together the two pre-existing definitions
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