The article argues that such tools and instruments that assess the impact of policies on implementation are inadequate, which to me is a significant result and the authors perhaps need to stay with it a bit longer. The paper has to throw light not just on the deficiencies but what is the knowledge that published research is directing us to understand and how do these represent diverse economies and contexts. The authors may refer to the action plan released by WHO in October 2021 with indicative indicators for measuring the policy and implementation issues. The paper refers to WHO Action plans 2013 and the implementation of MHPPs across countries, but nowhere the authors mention the time frame used as inclusion and exclusion criteria for the literature search. In other words, the papers that were reviewed were coded on various parameters that the authors have developed without necessarily capturing the context of the country within the parameters.
HCD and implementation science are increasingly being integrated in health services research (Chen et al., 2021; Dopp et al., 2019a; Lyon et al., 2023). The Framework for Reporting Adaptations and Modifications to Evidence (FRAME)-based interventions is the most prominent example of a descriptive approach (Stirman et al., 2019). For instance, a coaching strategy might effectively increase the adoption and high-fidelity delivery of an evidence-based SEL program in a well-resourced school, but is less effective improving the implementation in a school with fewer resources in the same district. For instance, the theory of planned behavior (TPB)—which states that behavioral intentions are driven primarily by attitudes, perceived social norms, and self-efficacy (Ajzen, 1991)—is the most commonly applied socio-cognitive theory for developing and testing implementation strategies (Godin et al., 2008; Lewis et al., 2020).
Data availability
Additionally, agencies must consider the fit between the intervention and the agency context. During the implementation phase, training and coaching begin, and leadership provides guidance and support for intervention initiation. During the pre-implementation assessment, it is also useful to ask staff about relevant outcomes and programmatic indicators that should be monitored. Using this information, the agency may decide to focus on enhancing aspects of the implementation context, namely by improving relationships between officers and providers to facilitate the referral process.
Overview of the Implementation Science Framework and its Components
De-implementation is typically thought of as a systematic process focused on stopping the use of low-value, ineffective, or harmful practices (e.g., Johnson et al., 2018; Norton & Chambers, 2020). While “there is no implementation without adaptation” (Lyon & Bruns, 2019b), adaptations of EBP often occur reactively (vs. prospectively) which may impact the extent to which they are fidelity consistent (Pettersson et al., 2024; Stirman et al., 2019). Similarly, another study found that 57% of the variability in program start-up for 27 EBP focused on child, family, and adult well-being implemented across 1287 sites could be attributed to the programs’ characteristics (Alley et al., 2023). For instance, for a coaching strategy that involves feedback to school clinicians, the provision of feedback might be a component of strategy fidelity (i.e., delivery as intended) but would not be considered a mechanism through which the strategy is effective.
- As a response to the Maidan violence and ongoing war, Ukrainian mental health professionals have sought training in treatment of trauma-related concerns.
- (Rahman, 2007) Given the scarcity of health workers in rural Pakistan,particularly those trained in mental health, the researchers designed theintervention to be delivered by an existing cadre of community health workers,called Lady Health Workers, who already delivered home-based perinatal healthservices in the study region.
- Former fellows have obtained independent research funding in implementation science and are beginning to serve as mentors for more junior investigators.
- For example, a program may be appropriate for a service setting—in that it is compatible with the setting’s mission or service mandate, but may not be feasible due to resource or training requirements.
We acknowledge that our conceptual definition of mental models is not an operational definition that could be used to select concrete forms of representation, elicitation, and analysis, but rather a starting point for understanding and entry into its use in implementation science. We argue these mental models deserve attention, much like the attention that has been given to identifying challenges, such as having enough resources (money, time, people) to get an intervention to happen, or lack of knowledge or training. These models and frameworks consider categories of where implementation challenges may be found, such as in the intervention itself, the internal setting and/or infrastructure, or the change strategies. We review the concepts of mental models and illustrate how they pertain to implementation of an example intervention, shared decision making.
Taxonomy of Implementation Outcomes
Cost (incremental or implementation cost) is defined as the cost impact of an implementation effort. Again, a variety of stakeholders will likely have perceptions about a new treatment’s or program’s appropriateness to a particular service setting, mission, providers, and clientele. We preserve a distinction because a given treatment may be perceived as appropriate but not acceptable, and vice versa. Appropriateness is the perceived fit, relevance, or compatibility of the innovation or evidence based practice for a given practice setting, provider, or consumer; and/or perceived fit of https://www.nationalacademies.org/read/26809/chapter/5 the innovation to address a particular issue or problem. Haug et al. (2008) used pre-post items to capture substance abuse providers’ adoption of evidence-based practices, while Henggeler et al. (2008) report interview techniques to measure therapists’ adoption of contingency management.
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