Abstract
BackgroundEffective implementation of evidence-based practices (EBPs) remains a significant challenge. Numerous existing models and frameworks identify key factors and processes to facilitate implementation. However, there is a need to better understand how individual models and frameworks are applied in research projects, how they can support the implementation process, and how they might advance implementation science. This systematic review examines and describes the research application of a widely used implementation framework, the Exploration, Preparation, Implementation, Sustainment (EPIS) framework.MethodsA systematic literature review was performed to identify and evaluate the use of the EPIS framework in implementation efforts. Citation searches in PubMed, Scopus, PsycINFO, ERIC, Web of Science, Social Sciences Index, and Google Scholar databases were undertaken. Data extraction included the objective, language, country, setting, sector, EBP, study design, methodology, level(s) of data collection, unit(s) of analysis, use of EPIS (i.e., purpose), implementation factors and processes, EPIS stages, implementation strategy, implementation outcomes, and overall depth of EPIS use (rated on a 1–5 scale).ResultsIn total, 762 full-text articles were screened by four reviewers, resulting in inclusion of 67 articles, representing 49 unique research projects. All included projects were conducted in public sector settings. The majority of projects (73%) investigated the implementation of a specific EBP. The majority of projects (90%) examined inner context factors, 57% examined outer context factors, 37% examined innovation factors, and 31% bridging factors (i.e., factors that cross or link the outer system and inner organizational context). On average, projects measured EPIS factors across two of the EPIS phases (M = 2.02), with the most frequent phase being Implementation (73%). On average, the overall depth of EPIS inclusion was moderate (2.8 out of 5).ConclusionThis systematic review enumerated multiple settings and ways the EPIS framework has been applied in implementation research projects, and summarized promising characteristics and strengths of the framework, illustrated with examples. Recommendations for future use include more precise operationalization of factors, increased depth and breadth of application, development of aligned measures, and broadening of user networks. Additional resources supporting the operationalization of EPIS are available.
Highlights
Effective implementation of evidence-based practices (EBPs) remains a significant challenge
The promise of implementation science models and frameworks is that they may allow for cross-setting and cross-country comparison of factors associated with implementation, which can contribute to our understanding of optimal implementation strategies and generalizability of concepts and constructs, support the harmonization of measures and evaluation practices, and help advance the field of implementation science and implementation practice
We found a number of examples where mixed-methods approaches guided by the EPIS framework were able to provide more comprehensive evaluation of an implementation research problem
Summary
Effective implementation of evidence-based practices (EBPs) remains a significant challenge. This systematic review examines and describes the research application of a widely used implementation framework, the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. There are numerous frameworks, models, and theories that identify key factors, and sometimes processes, to facilitate EBP implementation [4–6]. Such implementation frameworks are commonly used to help select and structure research questions, methods, strategies, measures, and results. The present study is a systematic review of one highly cited and widely used implementation framework, the Exploration, Preparation, Implementation, Sustainment (EPIS) framework [8]. Until recently, this comprehensive framework has had limited prescriptive guidance for its use. This study will determine how EPIS has been applied and how widely the framework has been disseminated, adopted, and implemented in diverse health, allied health, and social care sectors, and further afield
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