Choosing implementation strategies to address contextual barriers: diversity in recommendations and future directions

Implementation Science

Laura J. Damschroder¹  María E. Fernández²  Byron J. Powell³  Thomas J. Waltz⁴  Brenton Abadie⁴ 

[1] Ann Arbor VA Center for Clinical Management Research;Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston;Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill;Eastern Michigan University;

关键词: Consolidated Framework for Implementation Research;    Expert Recommendations for Implementing Change;    Implementation;    Intervention mapping;    Implementation strategies;   

DOI  :  10.1186/s13012-019-0892-4

来源: DOAJ

【 摘 要 】

Abstract Background A fundamental challenge of implementation is identifying contextual determinants (i.e., barriers and facilitators) and determining which implementation strategies will address them. Numerous conceptual frameworks (e.g., the Consolidated Framework for Implementation Research; CFIR) have been developed to guide the identification of contextual determinants, and compilations of implementation strategies (e.g., the Expert Recommendations for Implementing Change compilation; ERIC) have been developed which can support selection and reporting of implementation strategies. The aim of this study was to identify which ERIC implementation strategies would best address specific CFIR-based contextual barriers. Methods Implementation researchers and practitioners were recruited to participate in an online series of tasks involving matching specific ERIC implementation strategies to specific implementation barriers. Participants were presented with brief descriptions of barriers based on CFIR construct definitions. They were asked to rank up to seven implementation strategies that would best address each barrier. Barriers were presented in a random order, and participants had the option to respond to the barrier or skip to another barrier. Participants were also asked about considerations that most influenced their choices. Results Four hundred thirty-five invitations were emailed and 169 (39%) individuals participated. Respondents had considerable heterogeneity in opinions regarding which ERIC strategies best addressed each CFIR barrier. Across the 39 CFIR barriers, an average of 47 different ERIC strategies (SD = 4.8, range 35 to 55) was endorsed at least once for each, as being one of seven strategies that would best address the barrier. A tool was developed that allows users to specify high-priority CFIR-based barriers and receive a prioritized list of strategies based on endorsements provided by participants. Conclusions The wide heterogeneity of endorsements obtained in this study’s task suggests that there are relatively few consistent relationships between CFIR-based barriers and ERIC implementation strategies. Despite this heterogeneity, a tool aggregating endorsements across multiple barriers can support taking a structured approach to consider a broad range of strategies given those barriers. This study’s results point to the need for a more detailed evaluation of the underlying determinants of barriers and how these determinants are addressed by strategies as part of the implementation planning process.

【 授权许可】

Unknown