The mechanics of implementation strategies and measures: advancing the study of implementation mechanisms

Abstract

Background There is a fundamental gap in understanding the causal mechanisms by which strategies for implementing evidence-based practices address local barriers to effective, appropriate service delivery. Until this gap is addressed, scientific knowledge and practical guidance about which implementation strategies to use in which contexts will remain elusive. This research project aims to identify plausible strategy-mechanism linkages, develop causal models for mechanism evaluation, produce measures needed to evaluate such linkages, and make these models, methods, and measures available in a user-friendly website. The specific aims are as follows: (1) build a database of strategy-mechanism linkages and associated causal pathway diagrams, (2) develop psychometrically strong, pragmatic measures of mechanisms, and (3) develop and disseminate a website of implementation mechanisms knowledge for use by diverse stakeholders. Methods For the first aim, a combination of qualitative inquiry, expert panel methods, and causal pathway diagramming will be used to identify and confirm plausible strategy-mechanism linkages and articulate moderators, preconditions, and proximal and distal outcomes associated with those linkages. For the second aim, rapid-cycle measure development and testing methods will be employed to create reliable, valid, pragmatic measures of six mechanisms of common strategies for which no high-quality measures exist. For the third aim, we will develop a user-friendly website and searchable database that incorporates user-centered design, disseminating the final product using social marketing principles. Discussion Once strategy-mechanism linkages are identified using this multi-method approach, implementation scientists can use the searchable database to develop tailored implementation strategies and generate more robust evidence about which strategies work best in which contexts. Moreover, practitioners will be better able to select implementation strategies to address their specific implementation problems. New horizons in implementation strategy development, optimization, evaluation, and deployment are expected to be more attainable as a result of this research, which will lead to enhanced implementation of evidence-based interventions for cancer control, and ultimately improvements in patient outcomes.

Contextual determinants influencing the implementation of fall prevention in the community: a scoping review

“…Insight into working mechanisms of implementation strategies may help to inform determinant-strategy matching and eventually create a more rational compilation of strategies that target local determinants and, therefore, fit contextual challenges. Research on mechanisms has been started recently ( 67 ), but precise guidance and knowledge on this matter are still unknown and future implementation research on this topic should be performed ( 68 ).…”

The Conditional Influences of Organizational Climate on the Relationship between the Number and Types of Implementation Strategies and Lupus Decision Aid Acceptability, Appropriateness, and Feasibility

“…Under some circumstances, increasing the number of implementation strategies may, in fact, have detrimental effects on implementation outcomes. For researchers, these ndings underscore the importance of more clearly documenting implementation strategies and their proposed mechanisms (35,36). Moreover, while implementation science as a discipline has tended to take context seriously, at least conceptually, empirically the work has tended to lag.…”

Understanding the theoretical underpinnings of preventative early parenting interventions: A theory-based evaluation

“…In this study, we aimed to articulate the theory of the PIN programme by documenting its underpinning causal mechanisms. Here, we define change mechanisms as the causal pathways that explain how implementation efforts achieve desired results (Lewis et al, 2022). This perspective frames causal mechanisms and change pathways as the interrelationships among implementation strategies and outcomes within a given implementation/intervention context (Lewis et al, 2018).…”