Selecting and tailoring implementation interventions: a concept mapping approach

Abstract

Background: To improve the uptake of research into practice, knowledge translation frameworks recommend tailoring implementation strategies to address practice barriers. This study reports our experience pairing the Theoretical Domains Framework with information from multiple stakeholder groups to co-develop practiceinformed strategies for improving the implementation of an evidence-based outcome measurement tool across a large community health system for preschoolers with communication impairments. Methods: Concept mapping was used to identify strategies for improving implementation of the Focus on the Outcomes of Communication Under Six (FOCUS) in Ontario Canada's Preschool Speech and Language Program. This work was done in five stages. First, we interviewed 37 speech-language pathologists (clinicians) who identified 90 unique strategies to resolve practice barriers to FOCUS implementation. Second, clinicians (n = 34), policy-makers (n = 3), and members of the FOCUS research team (n = 6) sorted and rated the strategies by importance and feasibility. Third, stakeholders' sorting data were analyzed to generate a two-dimensional concept map. Based on the rating data from stakeholders, we prioritized a list of strategies that were rated as highly important and highly feasible, and summarized the practice barriers addressed by each of the prioritized strategies. Fourth, we validated these findings with stakeholders via an online survey. Fifth, the mechanisms of action of the prioritized list of strategies were considered based on available evidence from the Theoretical Domains Framework and associated behavior change literature. Results: Stakeholders categorized the 90 unique implementation strategies into a six-cluster concept map. Based on stakeholders' ratings, a list of 14 implementation strategies were prioritized. These implementation strategies were reported to resolve barriers within the environmental context and resources and beliefs about consequences domains of the Theoretical Domains Framework. All but one of the prioritized strategies have a demonstrated link in resolving existing barriers according to the behavioral change literature. Conclusions: Our study contributes to a growing literature that demonstrates the process of tailoring implementation strategies to specific barriers. Practical drawbacks and benefits of using concept mapping as a way to engage stakeholders in implementation research are discussed.

Examining the complementarity between the ERIC compilation of implementation strategies and the behaviour change technique taxonomy: a qualitative analysis

“…schools [17,18]), applied to particular types of interventions (e.g., digital mental health interventions [19]), and served as a foundation for expanding the range of specific implementation strategies (e.g., financing strategies [20]). However, several primary studies and reviews continue to note insufficient description of the content and format of popular strategies such as the use of local opinion leaders [21], continuing professional development [22], and development of education materials [23].…”

Tracking dynamic changes in implementation strategies over time within a hybrid type 2 trial of an electronic patient-reported oncology symptom and needs monitoring program

“…In most steppedwedge designs, it is important to have the same implementation strategy across clusters for internal validity (43). However, it can be difficult to achieve this in implementation trials as strategies are often tailored to some extent to align with the contextual factors of the participating clinics or other units (44,45). In this study, the contextual factors were relatively homogeneous across the regions and the centralized implementation support efforts further contributed to fewer region-level modifications to the protocol.…”

Developing a Tailored Implementation Action Plan for a Suicide Prevention Clinical Intervention in an Australian Mental Health Service: A Qualitative Study Using the EPIS Framework.

“…The large geographic areas covered by stakeholders in the present study (LHD coverage of 136,898 km 2 , which is more than the total area of Greece) and the CAMS trainers based in the United States meant that it was cost-prohibitive to arrange in-person meetings for all project activities. By using digital solutions to collaboration (via email, phone, and videoconferencing), the present study adds to growing evidence for the remote development of tailored implementation strategies and plans that are both evidence-and practice-informed (29). This methodology may therefore be useful in guiding future implementation efforts, with appropriate modi cations based on the innovation, setting and stage of implementation.…”