Common Elements Approaches to Implementation Research and Practice: Methods and Integration with Intervention Science

Abstract

We propose that common elements approaches can advance implementation research and practice and facilitate pragmatic use of intervention and implementation evidence. Common elements are practices or processes frequently shared by interventions or implementations. Traditional common elements methodologies use synthesis, distillation, and statistics to describe and evaluate the merit of common ingredients in effective interventions. Recent developments include identifying and testing common configurations of elements, processes, and context variables across the literature of effective interventions and implementations. While common elements thinking has grown popular in intervention science, it has rarely been utilized in implementation science, and specifically, combined with the intervention literature. The goals of this conceptual methodology paper are to (1) provide an overview of the common elements concept and how it may advance implementation research and usability for practice, (2) give a step-by-step guide to systematic common elements reviews that synthesizes and distills the intervention and implementation literature together, and (3) offer recommendations for advancing element-level evidence in implementation science. A narrative review of the common elements literature was conducted with attention to applications to implementation research. A six-step guide to using an advanced common elements methodology was provided. Examples of potential results are presented, along with a review of the implications for implementation research and practice. Finally, we reviewed methodological limitations in current common elements approaches, and identified steps towards realizing their potential. Common elements methodologies can (a) synthesize and distill the implementation science literature into practical applications, (b) generate evidence-informed hypotheses about key elements and determinants in implementation and intervention processes and mechanisms, and (c) promote evidence-informed precision tailoring of intervention and implementation to context. To realize this potential, common elements approaches need improved reporting of details from both successful and unsuccessful intervention and implementation research, more data availability, and more testing and investigation of causal processes and mechanisms of change from diverse theories.

A systematic review of experimentally tested implementation strategies across health and human service settings: evidence from 2010-2022

“…Therefore, the need to improve real-world implementation may outweigh the theoretical need to identify individual strategy effectiveness. In situations where it would be useful to isolate the impact of single strategies, we suggest that the same methods for documenting and analyzing the critical components (or core functions) of complex interventions [ 67 – 70 ] may help to identify core components of multifaceted implementation strategies [ 71 – 74 ].…”

“…Moreover, there were many studies evaluating numerous outcomes, risking data dredging. Further, the significant heterogeneity in the ways in which implementation outcomes are operationalized and reported is a substantial barrier to conducting large-scale meta-analytic approaches to synthesizing evidence for implementation strategies [ 67 ]. The field could look to others in the social and health sciences for examples in how to test, validate, and promote a common set of outcome measures to aid in bringing consistency across studies and real-world practice (e.g., the NIH-funded Patient-Reported Outcomes Measurement Information System [PROMIS], https://www.healthmeasures.net/explore-measurement-systems/promis ).…”

The core functions and forms paradigm throughout EPIS: designing and implementing an evidence-based practice with function fidelity

“…During Exploration and Preparation, we propose that prioritizing function fidelity is essential to carefully identifying the key hypothesized drivers of change that are feasible to be implemented in a local context. Although we were limited in our ability to review, evaluate, and select intervention components based on existing evidence in the literature, we would recommend that future adopters of this approach follow more rigorous guidelines for assessing candidate forms to establish evidence-informed inclusion criteria ( 19 , 58 ). Edmunds’ et al's (2022) Components & Rationales for Effectiveness (CORE) Fidelity Method for identifying key components of EBPs offers highly relevant guidance for augmenting our approach by providing systematic guidelines for gathering and synthesizing information to develop a CORE model that outlines the essential intervention components to fulfilling each function and the possible forms by which this might occur ( 14 ).…”

“…For example, Kirk and colleague's (2021) case study of applying the function-form framework to streamlining the process of hospice referrals was guided by a literature review that identified forms listed in candidate intervention protocols, followed by qualitative interviews that could inform the post hoc identification of underlying functions (19). This form fidelity approach parallels other advancing methods for disentangling the building blocks of interventions so that they can be reassembled for best fit with the implementation environment, such as the common elements approach (58).…”