Ten recommendations for using implementation frameworks in research and practice

Abstract

Background: Recent reviews of the use and application of implementation frameworks in implementation efforts highlight the limited use of frameworks, despite the value in doing so. As such, this article aims to provide recommendations to enhance the application of implementation frameworks, for implementation researchers, intermediaries, and practitioners. Discussion: Ideally, an implementation framework, or multiple frameworks should be used prior to and throughout an implementation effort. This includes both in implementation science research studies and in real-world implementation projects. To guide this application, outlined are ten recommendations for using implementation frameworks across the implementation process. The recommendations have been written in the rough chronological order of an implementation effort; however, we understand these may vary depending on the project or context: (1) select a suitable framework(s), (2) establish and maintain community stakeholder engagement and partnerships, (3) define issue and develop research or evaluation questions and hypotheses, (4) develop an implementation mechanistic process model or logic model, (5) select research and evaluation methods (6) determine implementation factors/determinants, (7) select and tailor, or develop, implementation strategy(s), (8) specify implementation outcomes and evaluate implementation, (9) use a framework(s) at micro level to conduct and tailor implementation, and (10) write the proposal and report. Ideally, a framework(s) would be applied to each of the recommendations. For this article, we begin by discussing each recommendation within the context of frameworks broadly, followed by specific examples using the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. Summary: The use of conceptual and theoretical frameworks provides a foundation from which generalizable implementation knowledge can be advanced. On the contrary, superficial use of frameworks hinders being able to use, learn from, and work sequentially to progress the field. Following the provided ten recommendations, we hope to assist researchers, intermediaries, and practitioners to improve the use of implementation science frameworks.

Experiences from implementation of internet-delivered cognitive behaviour therapy for insomnia in psychiatric health care: a qualitative study applying the NASSS framework

“…However, interest and attitudes among staff improved during the implementation process, suggesting that this might not be a barrier in the long-term or in a scale-up. Implementation determinants are linked to each other in complex relationships and are likely to vary across different implementation phases and evolve as the implementation process progresses [13]. As proposed in Roger's Diffusion of Innovation theory [17], innovations are not adopted by all individuals in a social system at the same time.…”

A More Practical Guide to Incorporating Health Equity Domains in Implementation Determinant Frameworks

“…We completed a consensus process to clarify steps for incorporating a health equity lens into an implementation determinant framework, situated within existing literature. We reviewed Moullin and colleagues' ten suggested steps for incorporating frameworks into an implementation effort, [61] and selected the ve steps applicable to an implementation determinant framework (vs. evaluation or process frameworks). The rst author (ENW) expanded those ve steps from Moullin and colleagues' [61] with steps on how to incorporate health equity domains and determinants.…”

“…We reviewed Moullin and colleagues' ten suggested steps for incorporating frameworks into an implementation effort, [61] and selected the ve steps applicable to an implementation determinant framework (vs. evaluation or process frameworks). The rst author (ENW) expanded those ve steps from Moullin and colleagues' [61] with steps on how to incorporate health equity domains and determinants. These steps were vetted with the authorship team through a process of oral discussions, reviewing written documents, and re ning steps until all agreed.…”

“…Below are suggested steps on how to use frameworks in an implementation effort [61] with a focus from our authorship team speci cally on health equity in an implementation determinant framework.…”

A Practical Guide to Incorporating Health Equity Domains in Implementation Frameworks

“…We will describe how to use the three health equity domains according to ten recommendations on using implementation frameworks in research and practice. [58] Practical tools are presented in additional les. Refer to Table 2 for an overview of all ten recommendations and de nitions.…”