Advancing mechanisms of implementation to accelerate sustainable evidence-based practice integration: protocol for generating a research agenda

Abstract

IntroductionMechanisms explain how implementation strategies work. Implementation research requires careful operationalisation and empirical study of the causal pathway(s) by which strategies effect change, and factors that may amplify or weaken their effects. Understanding mechanisms is critically important to replicate findings, learn from negative studies or adapt an implementation strategy developed in one setting to another. Without understanding implementation mechanisms, it is difficult to design strategies to produce expected effects across contexts, which may have disproportionate effects on settings in which priority populations receive care. This manuscript outlines the protocol for an Agency for Healthcare Research and Quality-funded initiative to: (1) establish priorities for an agenda to guide research on implementation mechanisms in health and public health, and (2) disseminate the agenda to research, policy and practice audiences.Methods and analysisA network of scientific experts will convene in ‘Deep Dive’ meetings across 3 years. A research agenda will be generated through analysis and synthesis of information from six sources: (1) systematic reviews, (2) network members’ approaches to studying mechanisms, (3) new proposals presented in implementation proposal feedback sessions, (4) working group sessions conducted in a leading implementation research training institute, (5) breakout sessions at the Society for Implementation Research Collaboration’s (SIRC) 2019 conference and (6) SIRC conference abstracts. Two members will extract mechanism-relevant text segments from each data source and a third member will generate statements as an input for concept mapping. Concept mapping will generate unique clusters of challenges, and the network will engage in a nominal group process to identify priorities for the research agenda.Ethics and disseminationThis initiative will yield an actionable research agenda to guide research to identify and test mechanisms of change for implementation strategies. The agenda will be disseminated via multiple channels to solicit feedback and promote rigorous research on implementation mechanisms.

Harnessing the Single-Session Intervention approach to promote scalable implementation of evidence-based practices in healthcare

“…Grounding and testing novel S3 based on established implementation frameworks, such as the TDF (as outlined here), or other common implementation science frameworks that share similar elements (see [34] for an overview of relevant frameworks) may optimize their potential to shape individual-level barriers to clinician behavior change. One key advantage of theoretically grounded approaches, like S3, is that they clarify how implementation strategies are likely to work, in line with recent calls from thought leaders about mechanisms as the next frontier in implementation science [35]. This is consistent with other approaches used to develop implementation strategies such as implementation mapping [36].…”

Promises and pitfalls in implementation science from the perspective of US-based researchers: learning from a pre-mortem

“…This suggestion stems from our experience studying individual clinician behavior to state and national policies, and realization that balancing breadth and depth is important for the future of implementation. It also underscores the importance of being explicit about how and why an implementation strategy is intended to work (i.e., specifying hypothesized mechanisms) [ 16 , 25 , 26 ].…”

“…Approaches ideally incorporate existing partner input, evidence on strategy effectiveness, and formal or informal theory that hypothesizes mechanisms of strategy operation. Considering mechanisms can ensure that strategies are as efficient as possible and allow adjustment of poorly performing strategies in subsequent efforts [ 25 , 26 , 105 , 111 ]. Systematic methods [ 110 , 112 ] include intervention (or implementation) mapping, increasingly applied to systematically design and/or tailor implementation strategies [ 89 , 113 ].…”

Implementing traumatic brain injury screening in behavioral healthcare: protocol for a prospective mixed methods study

“…Specifically, we will examine theory-driven relationships between characteristics of providers and the acceptability, feasibility, and appropriateness of the innovation by capitalizing on two hypotheses to bridge proximal (i.e., intention to screen) and distal outcomes (i.e., actual screening behavior). Testing these theory-driven hypotheses is necessary to understand the mediators, moderators, and causal pathways that lead to innovation adoption [ 8 , 71 ]. This study moves the field of implementation science forward by testing these proposed hypotheses and identifying mediators and moderators that potentially influence the diffusion of a TBI screening innovation in behavioral health.…”