Systematic review of the Exploration, Preparation, Implementation, Sustainment (EPIS) framework

Abstract

BackgroundEffective implementation of evidence-based practices (EBPs) remains a significant challenge. Numerous existing models and frameworks identify key factors and processes to facilitate implementation. However, there is a need to better understand how individual models and frameworks are applied in research projects, how they can support the implementation process, and how they might advance implementation science. This systematic review examines and describes the research application of a widely used implementation framework, the Exploration, Preparation, Implementation, Sustainment (EPIS) framework.MethodsA systematic literature review was performed to identify and evaluate the use of the EPIS framework in implementation efforts. Citation searches in PubMed, Scopus, PsycINFO, ERIC, Web of Science, Social Sciences Index, and Google Scholar databases were undertaken. Data extraction included the objective, language, country, setting, sector, EBP, study design, methodology, level(s) of data collection, unit(s) of analysis, use of EPIS (i.e., purpose), implementation factors and processes, EPIS stages, implementation strategy, implementation outcomes, and overall depth of EPIS use (rated on a 1–5 scale).ResultsIn total, 762 full-text articles were screened by four reviewers, resulting in inclusion of 67 articles, representing 49 unique research projects. All included projects were conducted in public sector settings. The majority of projects (73%) investigated the implementation of a specific EBP. The majority of projects (90%) examined inner context factors, 57% examined outer context factors, 37% examined innovation factors, and 31% bridging factors (i.e., factors that cross or link the outer system and inner organizational context). On average, projects measured EPIS factors across two of the EPIS phases (M = 2.02), with the most frequent phase being Implementation (73%). On average, the overall depth of EPIS inclusion was moderate (2.8 out of 5).ConclusionThis systematic review enumerated multiple settings and ways the EPIS framework has been applied in implementation research projects, and summarized promising characteristics and strengths of the framework, illustrated with examples. Recommendations for future use include more precise operationalization of factors, increased depth and breadth of application, development of aligned measures, and broadening of user networks. Additional resources supporting the operationalization of EPIS are available.Electronic supplementary materialThe online version of this article (10.1186/s13012-018-0842-6) contains supplementary material, which is available to authorized users.

The Prospects for Sustaining Evidence-based Responses to the US Opioid Epidemic State Leadership Perspectives

“…Themes in this study heavily aligned with the outer context, similar to the emerging literature on policy determinants (8,36,37). However, a recent systematic review of the EPIS framework review found it makes up a lower proportion of implementation research overall (23).…”

“…Continued research must focus on improved understanding of organizational and political drivers of sustainment (4,5,23,44). The eld of addiction policy needs sustainment strategies developed from an understanding of key drivers (24,41,44,45).…”

Situational analysis of breast health care systems: Why context matters

“…Sociopolitical and funding issues, client advocacy, and interorganizational networks formed part of the outer context, whereas organizational characteristics, leadership, and individual adopter characteristics made up the inner context, with specific aspects of each affecting each of the phases. It is interesting to note that adaptation was identified as a necessary component of EPIS with respect to the outer and inner contexts, as well as to the implementation of the EBP 51 …”

Adapting parent engagement strategies for an evidence‐based parent‐mediated intervention for young children at risk for autism spectrum disorder

“…Project ImPACT for Toddlers (PI T ) was adapted specifically for toddlers 12‐36 months of age through a collaborative community partnered participatory research process by a group of researchers, providers, funders, and parents of children with ASD known as the BRIDGE Collaborative (Brookman‐Frazee, Stahmer, Lewis, Feder, & Reed, 2012; Rieth, Stahmer, et al, 2018; Stahmer et al, 2017). The team applied the exploration, preparation, implementation, sustainment (EPIS) framework (Aarons, Hurlburt, & Horwitz, 2011; Moullin, Dickson, Stadnick, Rabin, & Aarons, 2019) to guide adaptation efforts. In addition to specifying four distinct phases of the implementation process, EPIS identifies outer and inner context factors that are key to implementation.…”