Harnessing the power of theorising in implementation science

Kislov, Roman; Pope, Catherine; Martin, Graham; Wilson, Paul

doi:10.1186/s13012-019-0957-4

“…Why integrate theory with lived experience, speci cally behavioral insights theory, in implementation research? Scienti c theories organize empirical observation facilitating the emergence of knowledge "out of seeming chaos" and establish criteria by which to evaluate and revise the theories when they are implemented (53,54). Our study is proof of concept that behavioral insights can provide a coherent theoretical guide across the implementation research continuum (from identifying determinants to practical guidance for implementation strategy design and selection).…”

Section: Discussionmentioning

confidence: 67%

Using behavioral insights to design implementation strategies in public mental health settings: a qualitative study of clinical decision-making

Last

¹

,

Schriger

²

,

Timon

³

et al. 2020

Preprint

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Background: Trauma focused-cognitive behavioral therapy (TF-CBT) is an evidence-based intervention for youth with posttraumatic stress disorder. An important component of TF-CBT is the trauma narrative (TN), a phase in the intervention in which youth are guided to process the memories, thoughts, and feelings associated with their traumatic experience(s). Previous work has shown that only half of TF-CBT clinicians complete the TN with their clients. Drawing from the behavioral insights literature—an interdisciplinary field studying judgment and decision-making—the present study seeks to understand what determines clinician use of the TN and to generate strategies that target these determinants. Methods: Through semi-structured qualitative interviews, we sought the perspectives of trained TF-CBT clinicians working in public mental health settings across the city of Philadelphia (n=17) to understand their decisions to use the TN with clients. We analyzed the qualitative data using a coding approach informed by the behavioral insights literature. We used an iterative process of structured hypothesis generation, aided by a behavioral insights guide, and rapid validation informed by behavioral insights to uncover the determinants of TN use. We then generated implementation strategies that targeted these determinants using the “Easy Attractive Social Timely” framework, a behavioral insights design approach. Results: We generated and validated three broad themes about what determines clinician implementation of the TN: decision complexity, clinician affective experience, and agency norms. We hypothesized the behavioral insights that underlie these implementation determinants and generated a list of nine behavioral insights strategies that theoretically may facilitate TN implementation. Conclusions: Our study investigated why an effective component of an evidence-based intervention is often neglected. We leveraged robust scientific theories and empirical regularities from the behavioral insights literature to understand clinician perspectives on TN implementation. These factors were theoretically linked to implementation strategies. Our work revealed the potential for using behavioral insights in the diagnosis of evidence-based intervention determinants and the design of implementation strategies.

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“…Why integrate theory with lived experience, speci cally behavioral insights theory, in implementation research? Scienti c theories organize empirical observation facilitating the emergence of knowledge "out of seeming chaos" and establish criteria by which to evaluate and revise the theories when they are implemented (54,55). Our study is proof of concept that behavioral insights can provide a coherent theoretical guide across the implementation research continuum (from identifying determinants to practical guidance for implementation strategy design and selection).…”

Section: Discussionmentioning

confidence: 67%

Using Behavioral Insights to Design Implementation Strategies in Public Mental Health Settings: a Qualitative Study of Clinical Decision-Making

Last

¹

,

Schriger

²

,

Timon

³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Trauma focused-cognitive behavioral therapy (TF-CBT) is an evidence-based intervention for youth with posttraumatic stress disorder. An important component of TF-CBT is the trauma narrative (TN), a phase in the intervention in which youth are guided to process the memories, thoughts, and feelings associated with their traumatic experience(s). Previous work has shown that only half of TF-CBT clinicians complete the TN with their clients. Drawing from the behavioral insights literature—an interdisciplinary field studying judgment and decision-making—the present study seeks to understand what determines clinician use of the TN and to generate strategies that target these determinants. Methods: Through semi-structured qualitative interviews, we sought the perspectives of trained TF-CBT clinicians working in public mental health settings across the city of Philadelphia (n=17) to understand their decisions to use the TN with clients. We analyzed the qualitative data using a coding approach informed by the behavioral insights literature. We used an iterative process of structured hypothesis generation, aided by a behavioral insights guide, and rapid validation informed by behavioral insights to uncover the determinants of TN use. We then generated implementation strategies that targeted these determinants using the “Easy Attractive Social Timely” framework, a behavioral insights design approach. Results: We generated and validated three broad themes about what determines clinician implementation of the TN: decision complexity, clinician affective experience, and agency norms. We hypothesized the behavioral insights that underlie these implementation determinants and generated a list of nine behavioral insights strategies that theoretically may facilitate TN implementation. Conclusions: Our study investigated why an effective component of an evidence-based intervention is often neglected. We leveraged robust scientific theories and empirical regularities from the behavioral insights literature to understand clinician perspectives on TN implementation. These factors were theoretically linked to implementation strategies. Our work revealed the potential for using behavioral insights in the diagnosis of evidence-based intervention determinants and the design of implementation strategies.

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“…22 Analysis of the implementation of interventions originates as early as the 1930s 23 and therefore largely predates the current renewed interest. The present enthusiasm for implementation has been boosted by the development of implementation research, 24 which has a dedicated journal (Implementation Science 25 ) and prompted the development of methodological guides. 26 However, IS differs from implementation research, in that the latter focuses on methods for promoting the use of evidence in designing an intervention.…”

Section: Introductionmentioning

confidence: 99%

Using implementation science theories and frameworks in global health

Ridde

¹

,

Pérez

²

,

Robert

³

2020

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In global health, researchers and decision makers, many of whom have medical, epidemiology or biostatistics background, are increasingly interested in evaluating the implementation of health interventions. Implementation science, particularly for the study of public policies, has existed since at least the 1930s. This science makes compelling use of explicit theories and analytic frameworks that ensure research quality and rigour. Our objective is to inform researchers and decision makers who are not familiar with this research branch about these theories and analytic frameworks. We define four models of causation used in implementation science: intervention theory, frameworks, middle-range theory and grand theory. We then explain how scientists apply these models for three main implementation studies: fidelity assessment, process evaluation and complex evaluation. For each study, we provide concrete examples from research in Cuba and Africa to better understand the implementation of health interventions in global health context. Global health researchers and decision makers with a quantitative background will not become implementation scientists after reading this article. However, we believe they will be more aware of the need for rigorous implementation evaluations of global health interventions, alongside impact evaluations, and in collaboration with social scientists.

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Harnessing the power of theorising in implementation science

Cited by 144 publications

References 53 publications

Using behavioral insights to design implementation strategies in public mental health settings: a qualitative study of clinical decision-making

Using behavioral insights to design implementation strategies in public mental health settings: a qualitative study of clinical decision-making

Using Behavioral Insights to Design Implementation Strategies in Public Mental Health Settings: a Qualitative Study of Clinical Decision-Making

Using implementation science theories and frameworks in global health

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