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A Pragmatic Approach to Guide Implementation Evaluation Research: Strategy Mapping for Complex Interventions
INTRODUCTION: Greater specification of implementation strategies is a challenge for implementation science, but there is little guidance for delineating the use of multiple strategies involved in complex interventions. The Cardiovascular (CV) Toolkit project entails implementation of a toolkit desig...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5968102/ https://www.ncbi.nlm.nih.gov/pubmed/29868542 http://dx.doi.org/10.3389/fpubh.2018.00134 |
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author | Huynh, Alexis K. Hamilton, Alison B. Farmer, Melissa M. Bean-Mayberry, Bevanne Stirman, Shannon Wiltsey Moin, Tannaz Finley, Erin P. |
author_facet | Huynh, Alexis K. Hamilton, Alison B. Farmer, Melissa M. Bean-Mayberry, Bevanne Stirman, Shannon Wiltsey Moin, Tannaz Finley, Erin P. |
author_sort | Huynh, Alexis K. |
collection | PubMed |
description | INTRODUCTION: Greater specification of implementation strategies is a challenge for implementation science, but there is little guidance for delineating the use of multiple strategies involved in complex interventions. The Cardiovascular (CV) Toolkit project entails implementation of a toolkit designed to reduce CV risk by increasing women’s engagement in appropriate services. The CV Toolkit project follows an enhanced version of Replicating Effective Programs (REP), an evidence-based implementation strategy, to implement the CV Toolkit across four phases: pre-conditions, pre-implementation, implementation, and maintenance and evolution. Our current objective is to describe a method for mapping implementation strategies used in real time as part of the CV Toolkit project. This method supports description of the timing and content of bundled strategies and provides a structured process for developing a plan for implementation evaluation. METHODS: We conducted a process of strategy mapping to apply Proctor and colleagues’ rubric for specification of implementation strategies, constructing a matrix in which we identified each implementation strategy, its conceptual group, and the corresponding REP phase(s) in which it occurs. For each strategy, we also specified the actors involved, actions undertaken, action targets, dose of the implementation strategy, and anticipated outcome addressed. We iteratively refined the matrix with the implementation team, including use of simulation to provide initial validation. RESULTS: Mapping revealed patterns in the timing of implementation strategies within REP phases. Most implementation strategies involving the development of stakeholder interrelationships and training and educating stakeholders were introduced during the pre-conditions or pre-implementation phases. Strategies introduced in the maintenance and evolution phase emphasized communication, re-examination, and audit and feedback. In addition to its value for producing valid and reliable process evaluation data, mapping implementation strategies has informed development of a pragmatic blueprint for implementation and longitudinal analyses and evaluation activities. DISCUSSION: We update recent recommendations on specification of implementation strategies by considering the implications for multi-strategy frameworks and propose an approach for mapping the use of implementation strategies within complex, multi-level interventions, in support of rigorous evaluation. Developing pragmatic tools to aid in operationalizing the conduct of implementation and evaluation activities is essential to enacting sound implementation research. |
format | Online Article Text |
id | pubmed-5968102 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-59681022018-06-04 A Pragmatic Approach to Guide Implementation Evaluation Research: Strategy Mapping for Complex Interventions Huynh, Alexis K. Hamilton, Alison B. Farmer, Melissa M. Bean-Mayberry, Bevanne Stirman, Shannon Wiltsey Moin, Tannaz Finley, Erin P. Front Public Health Public Health INTRODUCTION: Greater specification of implementation strategies is a challenge for implementation science, but there is little guidance for delineating the use of multiple strategies involved in complex interventions. The Cardiovascular (CV) Toolkit project entails implementation of a toolkit designed to reduce CV risk by increasing women’s engagement in appropriate services. The CV Toolkit project follows an enhanced version of Replicating Effective Programs (REP), an evidence-based implementation strategy, to implement the CV Toolkit across four phases: pre-conditions, pre-implementation, implementation, and maintenance and evolution. Our current objective is to describe a method for mapping implementation strategies used in real time as part of the CV Toolkit project. This method supports description of the timing and content of bundled strategies and provides a structured process for developing a plan for implementation evaluation. METHODS: We conducted a process of strategy mapping to apply Proctor and colleagues’ rubric for specification of implementation strategies, constructing a matrix in which we identified each implementation strategy, its conceptual group, and the corresponding REP phase(s) in which it occurs. For each strategy, we also specified the actors involved, actions undertaken, action targets, dose of the implementation strategy, and anticipated outcome addressed. We iteratively refined the matrix with the implementation team, including use of simulation to provide initial validation. RESULTS: Mapping revealed patterns in the timing of implementation strategies within REP phases. Most implementation strategies involving the development of stakeholder interrelationships and training and educating stakeholders were introduced during the pre-conditions or pre-implementation phases. Strategies introduced in the maintenance and evolution phase emphasized communication, re-examination, and audit and feedback. In addition to its value for producing valid and reliable process evaluation data, mapping implementation strategies has informed development of a pragmatic blueprint for implementation and longitudinal analyses and evaluation activities. DISCUSSION: We update recent recommendations on specification of implementation strategies by considering the implications for multi-strategy frameworks and propose an approach for mapping the use of implementation strategies within complex, multi-level interventions, in support of rigorous evaluation. Developing pragmatic tools to aid in operationalizing the conduct of implementation and evaluation activities is essential to enacting sound implementation research. Frontiers Media S.A. 2018-05-18 /pmc/articles/PMC5968102/ /pubmed/29868542 http://dx.doi.org/10.3389/fpubh.2018.00134 Text en Copyright © 2018 Huynh, Hamilton, Farmer, Bean-Mayberry, Stirman, Moin and Finley. https://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Public Health Huynh, Alexis K. Hamilton, Alison B. Farmer, Melissa M. Bean-Mayberry, Bevanne Stirman, Shannon Wiltsey Moin, Tannaz Finley, Erin P. A Pragmatic Approach to Guide Implementation Evaluation Research: Strategy Mapping for Complex Interventions |
title | A Pragmatic Approach to Guide Implementation Evaluation Research: Strategy Mapping for Complex Interventions |
title_full | A Pragmatic Approach to Guide Implementation Evaluation Research: Strategy Mapping for Complex Interventions |
title_fullStr | A Pragmatic Approach to Guide Implementation Evaluation Research: Strategy Mapping for Complex Interventions |
title_full_unstemmed | A Pragmatic Approach to Guide Implementation Evaluation Research: Strategy Mapping for Complex Interventions |
title_short | A Pragmatic Approach to Guide Implementation Evaluation Research: Strategy Mapping for Complex Interventions |
title_sort | pragmatic approach to guide implementation evaluation research: strategy mapping for complex interventions |
topic | Public Health |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5968102/ https://www.ncbi.nlm.nih.gov/pubmed/29868542 http://dx.doi.org/10.3389/fpubh.2018.00134 |
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