Where is “policy” in dissemination and implementation science? Recommendations to advance theories, models, and frameworks: EPIS as a case example

Implementation Science

Debate

Erika L. Crable¹  Nicole A. Stadnick¹  Gregory A. Aarons¹  Joanna C. Moullin²  Rebecca Lengnick-Hall³ 

[1] Department of Psychiatry, University of California, La Jolla, 92093, San Diego, CA, USA;Child and Adolescent Services Research Center, San Diego, CA, USA;UC San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, La Jolla, San Diego, CA, USA;Faculty of Health Sciences, enAble Institute, Curtin University, Perth, WA, Australia;The Brown School, Washington University in St. Louis, St. Louis, MO, USA;

关键词: Theory;    Model;    Framework;    Policy;    Politics;    Context;   

DOI  :  10.1186/s13012-022-01256-x

 received in 2022-08-25, accepted in 2022-12-01,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundImplementation science aims to accelerate the public health impact of evidence-based interventions. However, implementation science has had too little focus on the role of health policy — and its inseparable politics, polity structures, and policymakers — in the implementation and sustainment of evidence-based healthcare. Policies can serve as determinants, implementation strategies, the evidence-based “thing” to be implemented, or another variable in the causal pathway to healthcare access, quality, and patient outcomes. Research describing the roles of policy in dissemination and implementation (D&I) efforts is needed to resolve persistent knowledge gaps about policymakers’ evidence use, how evidence-based policies are implemented and sustained, and methods to de-implement policies that are ineffective or cause harm. Few D&I theories, models, or frameworks (TMF) explicitly guide researchers in conceptualizing where, how, and when policy should be empirically investigated. We conducted and reflected on the results of a scoping review to identify gaps of existing Exploration, Preparation, Implementation, and Sustainment (EPIS) framework-guided policy D&I studies. We argue that rather than creating new TMF, researchers should optimize existing TMF to examine policy’s role in D&I. We describe six recommendations to help researchers optimize existing D&I TMF. Recommendations are applied to EPIS, as one example for advancing TMF for policy D&I.Recommendations(1) Specify dimensions of a policy’s function (policy goals, type, contexts, capital exchanged).(2) Specify dimensions of a policy’s form (origin, structure, dynamism, outcomes).(3) Identify and define the nonlinear phases of policy D&I across outer and inner contexts.(4) Describe the temporal roles that stakeholders play in policy D&I over time.(5) Consider policy-relevant outer and inner context adaptations.(6) Identify and describe bridging factors necessary for policy D&I success.ConclusionResearchers should use TMF to meaningfully conceptualize policy’s role in D&I efforts to accelerate the public health impact of evidence-based policies or practices and de-implement ineffective and harmful policies. Applying these six recommendations to existing D&I TMF advances existing theoretical knowledge, especially EPIS application, rather than introducing new models. Using these recommendations will sensitize researchers to help them investigate the multifaceted roles policy can play within a causal pathway leading to D&I success.

【 授权许可】

CC BY   
© The Author(s) 2022

【 图 表 】

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