Implementation Science: Theories & Models Paul A. Estabrooks, PhD Twitter: @paul_estabrooks Email: paul.estabrooks@unmc.edu Dr. Paul Estabrooks - 540-857-6664

Furthering Understanding of D&I Models present a systematic way of understanding events or behaviors by providing inter-related concepts, definitions, and propositions that explain or predict events by specifying relationships among variables. are strategic or action-planning models that provide a systematic way to develop, manage, and evaluate interventions. is used to describe theories and frameworks collectively. Theories Frameworks Models Tabak RG et al. Bridging Research and Practice: Models for Dissemination and Implementation Research Am J Prev Med, 2012, 43: 337-350;

Model Categories https://www.cdc.gov/prc/stories-prevention-research/stories/dissemination-and-implementation.htm

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Diffusions of Innovations Diffusion is a process where an innovation is communicated through certain channels over time among members of a social system Everett Rogers, 1962

The Innovation An idea, practice or object that is perceived as new by an individual or other unit of adoption.

The Innovation Characteristics of Innovation – Relative Advantage Compatability Complexity Trialability Observability

A Social System The social structure of the system affects the innovation’s diffusion in several ways. how the system’s social structure affects diffusion, the effect of norms on diffusion, the roles of opinion leaders

THE INNOVATION-DECISION PROCESS. THE INNOVATION-DECISION PROCESS - the process through which an individual passes from first knowledge of an innovation to forming an attitude toward the innovation, to a decision to adopt or reject it. Five stages in the innovation-decision process: (1) knowledge, (2) persuasion, (3) decision, (4) implementation, and (5) confirmation. Knowledge occurs when an individual (or other decision-making unit) learns of the innovation’s existence and gains some understanding of how it functions. Persuasion occurs when an individual (or other decision-making unit) forms a favourable or unfavourable attitude toward the innovation. Decision occurs when an individual (or other decision-making unit) engages in activities that lead to a choice to adopt or reject the innovation. Implementation occurs when an individual (or other decision-making unit) puts an innovation into use. Re-invention is especially likely to occur at the implementation stage. Confirmation occurs when an individual (or other decision-making unit) seeks reinforcement of an innovation-decision that has already been made, but the individual may reverse this previous decision if exposed to conflicting innovation.

Rate of Adoption Most innovations have an S-shaped rate of adoption.

Interactive Systems Framework for Dissemination and Implementation Wandersman et al., Am J Community Psychol (2008) 41:171–181

Synthesis and Translation Evidence synthesis Systematic review Integrative review Meta-analysis Review of literature State of the science review Translation: Identify key characteristics Identify core elements Highlight process for adaptation Package so core elements are implemented with fidelity to the program design. The description of "how" to implement interventions is often left out of research. In order for practitioners/end users to implement prevention interventions, they need this information to be synthesized and translated. Research can be synthesized in a variety of ways including evidence synthesis, systematic review, integrative review, meta-analysis, review of literature, and state of science review. Wandersman et al., Am J Community Psychol (2008) 41:171–181

Innovation Specific Capacity Examples Delivery System General Capacity Examples Innovation Specific Capacity Examples Culture Innovation-Specific knowledge, skills, and abilities Climate Program Champion Organizational Innovativeness Specific Implementation Supports Resource Utilization Interorganizational Relationships Leadership Structure Staff Capacity Wandersman, Advanced Topics in Implementation Science Research Webinar Series, April 2015

Innovation Specific Capacity Examples Support System General Capacity Examples Innovation Specific Capacity Examples Provision of social support Innovation-Specific Skill building techniques Tracking and monitoring Expertise in innovation content area Informational Ability to gather innovation specific materials Behavioral incentives Ability to adapt based on core elements Didactic instruction Problem solving techniques Staff Capacity Wandersman, Advanced Topics in Implementation Science Research Webinar Series, April 2015

Motivation for Innovation Potential Motivators Authors Relative Advantage Armenakis et al., 1993; Damschroder et al., 2009; Hall & Hord, 2010; Rafferty et al., 2013; Rogers, 2003; Weiner, 2009 Compatibility Chinman et al., 2004; Durlak & Dupre, 2008; Fetterman & Wandersman, 2005; Greenhalgh et al., 2004; Rogers, 2003; Simpson, 2002 Complexity Damschroder & Hagedorn, 2011; Fixsen et al., 2005; Greenhalgh et al., 2004; Meyers, Durlak & Wandersman, 2012; Wandersman et al., 2008. Trialability Armenakis et al., 1993; Greenhalgh et al., 2004; Rapkin et al., 2012; Rogers, 2003 Observability Beutler, 2001; Chinman et al., 2004; Damschroder et al., 2009; Ford et al., 2008; Rossi, Lipsey, & Freeman, 2004 Priority Armenakis & Harris, 2009; Greenhalgh et al., 2004; Flaspohler et al., 2008 Wandersman, Advanced Topics in Implementation Science Research Webinar Series, April 2015

Interactive Systems Framework for Dissemination and Implementation Wandersman et al., Am J Community Psychol (2008) 41:171–181

Consolidated Framework for Implementation Research Note the importance of Greenhalgh work. Move quickly to more recent efforts to provide frameworks for dissemination and implementation (QUERY-developed) CFIR Finally, few models propose the interaction between research practice collaboratives, support structures, and sustained implementation within the delivery systems. The model by Wandersman, best reflects the 3 phase approach of e-chip. Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implementation Science. Aug 2009;4.

Internal Context Soft Periphery Hard Core Soft Periphery Hard Core Intervention at Time0 Intervention at Time1 Internal Context Soft Periphery Soft Periphery Hard Core Hard Core Intervention Intervention External Context 19 Damschroder et al., 2009

Intervention Characteristics Intervention source (build or buy) Evidence strength and quality Relative advantate Adaptability Trialability Complexity Design quality and packaging Cost The description of "how" to implement interventions is often left out of research. In order for practitioners/end users to implement prevention interventions, they need this information to be synthesized and translated. Research can be synthesized in a variety of ways including evidence synthesis, systematic review, integrative review, meta-analysis, review of literature, and state of science review.  Damschroder et al, 2009: Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation sci

Inner setting Structural characteristics Networks and communication Culture Implementation climate Tension for change Compatibility Relative priority Organizational incentives Goals and feedback opportunities & learning climate Readiness for implementation (leadership; resources; access to information) Characteristics of individuals (e.g., knowledge and beliefs, self-efficacy to implement) The description of "how" to implement interventions is often left out of research. In order for practitioners/end users to implement prevention interventions, they need this information to be synthesized and translated. Research can be synthesized in a variety of ways including evidence synthesis, systematic review, integrative review, meta-analysis, review of literature, and state of science review.  Damschroder et al, 2009: Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation sci

Outer setting Patient (client) needs and resources Degree of networking with external organizations Pressure from competitive or similar external organizations External policies and incentives The description of "how" to implement interventions is often left out of research. In order for practitioners/end users to implement prevention interventions, they need this information to be synthesized and translated. Research can be synthesized in a variety of ways including evidence synthesis, systematic review, integrative review, meta-analysis, review of literature, and state of science review.  Damschroder et al, 2009: Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation sci

Processes Planning Engaging Opinion leaders Internal implementation leaders (formal) Champions External change agents Executing Reflecting and evaluating The description of "how" to implement interventions is often left out of research. In order for practitioners/end users to implement prevention interventions, they need this information to be synthesized and translated. Research can be synthesized in a variety of ways including evidence synthesis, systematic review, integrative review, meta-analysis, review of literature, and state of science review.  Damschroder et al, 2009: Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation sci

Measurement Resources

Measurement Resources

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