Feasibility of Implementation Mapping for Integrative Medical Group Visits

Abstract

Objectives: Implementation science is key to translating complementary and integrative health intervention research into practice as it can increase accessibility and affordability while maximizing patient health outcomes. The authors describe using implementation mapping to (1) identify barriers and facilitators impacting the implementation of an Integrative Medical Group Visit (IMGV) intervention in an outpatient setting with a high burden of patients with chronic pain and (2) select and develop implementation strategies utilizing theory and stakeholder input to address those barriers and facilitators.Design: The authors selected a packaged, evidence-based, integrative pain management intervention, the IMGV, to implement in an outpatient clinic with a high burden of patients with chronic pain. The authors used implementation mapping to identify implementation strategies for IMGV, considering theory and stakeholder input. Stakeholder interviews with clinic staff, faculty, and administrators (n = 15) were guided by the Consolidated Framework for Implementation Research.Results: Based on interview data, the authors identified administrators, physicians, nursing staff, and scheduling staff as key stakeholders involved in implementation. Barriers and facilitators focused on knowledge, buy-in, and operational procedures needed to successfully implement IMGV. The implementation team identified three cognitive influences on behavior that would impact performance: knowledge, outcome expectations, and self-efficacy; and three theoretical change methods: cue to participate, communication, and mobilization. Implementation strategies identified included identifying and preparing champions, participation in ongoing training, developing and distributing educational materials, and organizing clinician implementation team meetings.Conclusions: This study provides an example of the application of implementation mapping to identify theory-driven implementation strategies for IMGV. Implementation mapping is a feasible method that may be useful in providing a guiding structure for implementation teams as they employ implementation frameworks and select implementation strategies for integrative health interventions.

Data-driven approach to implementation mapping for the selection of implementation strategies: a case example for risk-aligned bladder cancer surveillance

“…Our data-driven implementation mapping took about a year of part-time investigator and full-time research assistant effort. However, we were unable to quantify how much more effort was required for our approach compared to prior studies, as the authors of the prior studies did not report the amount of time, personnel, and expertise needed for their work [1,20,21]. We recognize that this level of rigor may not always be possible in our current era of rapid research or during routine operational activities.…”

“…Our approach is novel as the selection of implementation strategies was driven primarily by data. Prior work using implementation mapping employed advisory panels to select implementation strategies out of potential ERIC strategies [3,4], which is more subjective, or did not clearly report how the selection was handled [20]. To overcome this limitation, we created an implementation strategy matrix, cross-walking all potentially applicable ERIC strategies against all change objectives.…”

A Modified Implementation Mapping Methodology for Evaluating and Learning From Existing Implementation

“…As a participatory approach, it involves engaging intervention users and implementers in the respective setting. Implementation Mapping has been used for prospectively planning implementation in a variety of fields, such as cancer prevention and control ( 3 ) and chronic pain management ( 4 ). The process follows five steps: identifying stakeholders and conducting needs assessments, identifying implementation outcomes and determinants, designing implementation strategies, creating implementation protocols, and evaluating implementation outcomes ( 2 ).…”

“…Benefits of Implementation Mapping include a more transparent selection of implementation strategies that makes it easier to replicate selection processes in similar studies ( 3 ). Accordingly, reasons for choosing implementation strategies as well as these strategies' potential mechanisms of action are more explicitly documented ( 4 ), which is particularly helpful for presenting the results of the Implementation Mapping process to involved stakeholders ( 3 ). Working closely with and understanding the needs of stakeholders is another key element of Implementation Mapping ( 2 ).…”

Implementation mapping for tobacco cessation in a federally qualified health center

“…IM defines five change management steps (3). Despite being touted as a promising strategy (4, 5) and multiple examples of planned use via study protocols (4, 6, 7) there are few publicly accessible descriptions of applying the IM process (8)(9)(10) and among these only one reported use through all steps (8). This complete example effectively illustrates IM as a feasible and effective method, however, it was also bolstered by significant resources (a 4-year timeline and five funding sources).…”