Using implementation science theories and frameworks in global health

Abstract

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.

Beyond the Science: Advancing the "Art and Craft" of Implementation in the Training and Practice of Global Health

“…Given the complexity of global health, approaches to improve implementation must be sensitive to such complex adaptive systems. 13 Most of the existing implementation science approaches originate from HICs, and often do not reflect the contexts, paradigms, priorities and systems operational in many LMICs. 2 Reflecting on the implications of political dynamics on implementation, one author posits that "all the most authoritative conceptualizations mentioned here were modelled on Western-style democratic governance systems. "…”

Commentary: Adapting and Operationalizing the RE-AIM Framework for Implementation Science in Environmental Health: Clean Fuel Cooking Programs in Low Resource Countries

“…For example, similar to Quinn et al, their stakeholders also asked for more system level constructs, as they had difficulties applying the construct patient needs with interventions that took place at district or national levels. The examples of Quinn et al and of Means et al highlight the necessity of being humble with our frameworks, and to examine carefully our definitions to avoid the ethnocentric bias of implementation studies (16).…”

Health system governance: a triangle of rules

“…In making the case for this complementary 'triangle of rules', I have pointed at potential middle-range theories, transferable insights and lines of inquiry, which may animate comparative analyses of health system governance and also inform efforts to strengthen it. [57][58][59] What I have tried to do in this editorial essay, as Ronald Coase once said, 'has been to urge the inclusion in our analysis, of features of the (health) system so obvious that… they have tended to be overlooked'. 60 The language of rules (or institutions) and their configurations (or arrangements), the middle-range theories they suggest, and the analytical stance they require, may yet improve our analysis of health system governance.…”