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      Outcomes for Implementation Research: Conceptual Distinctions, Measurement Challenges, and Research Agenda

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          Abstract

          An unresolved issue in the field of implementation research is how to conceptualize and evaluate successful implementation. This paper advances the concept of “implementation outcomes” distinct from service system and clinical treatment outcomes. This paper proposes a heuristic, working “taxonomy” of eight conceptually distinct implementation outcomes—acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability—along with their nominal definitions. We propose a two-pronged agenda for research on implementation outcomes. Conceptualizing and measuring implementation outcomes will advance understanding of implementation processes, enhance efficiency in implementation research, and pave the way for studies of the comparative effectiveness of implementation strategies.

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          Most cited references 59

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          Making psychological theory useful for implementing evidence based practice: a consensus approach.

           ,  S Michie,  Mark Parker (2005)
          Evidence-based guidelines are often not implemented effectively with the result that best health outcomes are not achieved. This may be due to a lack of theoretical understanding of the processes involved in changing the behaviour of healthcare professionals. This paper reports the development of a consensus on a theoretical framework that could be used in implementation research. The objectives were to identify an agreed set of key theoretical constructs for use in (1) studying the implementation of evidence based practice and (2) developing strategies for effective implementation, and to communicate these constructs to an interdisciplinary audience. Six phases of work were conducted to develop a consensus: (1) identifying theoretical constructs; (2) simplifying into construct domains; (3) evaluating the importance of the construct domains; (4) interdisciplinary evaluation; (5) validating the domain list; and (6) piloting interview questions. The contributors were a "psychological theory" group (n = 18), a "health services research" group (n = 13), and a "health psychology" group (n = 30). Twelve domains were identified to explain behaviour change: (1) knowledge, (2) skills, (3) social/professional role and identity, (4) beliefs about capabilities, (5) beliefs about consequences, (6) motivation and goals, (7) memory, attention and decision processes, (8) environmental context and resources, (9) social influences, (10) emotion regulation, (11) behavioural regulation, and (12) nature of the behaviour. A set of behaviour change domains agreed by a consensus of experts is available for use in implementation research. Applications of this domain list will enhance understanding of the behaviour change processes inherent in implementation of evidence-based practice and will also test the validity of these proposed domains.
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            Evaluating the public health impact of health promotion interventions: the RE-AIM framework.

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              Evaluating the public health impact of health promotion interventions: the RE-AIM framework.

              Progress in public health and community-based interventions has been hampered by the lack of a comprehensive evaluation framework appropriate to such programs. Multilevel interventions that incorporate policy, environmental, and individual components should be evaluated with measurements suited to their settings, goals, and purpose. In this commentary, the authors propose a model (termed the RE-AIM model) for evaluating public health interventions that assesses 5 dimensions: reach, efficacy, adoption, implementation, and maintenance. These dimensions occur at multiple levels (e.g., individual, clinic or organization, community) and interact to determine the public health or population-based impact of a program or policy. The authors discuss issues in evaluating each of these dimensions and combining them to determine overall public health impact. Failure to adequately evaluate programs on all 5 dimensions can lead to a waste of resources, discontinuities between stages of research, and failure to improve public health to the limits of our capacity. The authors summarize strengths and limitations of the RE-AIM model and recommend areas for future research and application.
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                Author and article information

                Contributors
                +314-935-6660 , ekp@wustl.edu
                Journal
                Adm Policy Ment Health
                Administration and Policy in Mental Health
                Springer US (Boston )
                0894-587X
                1573-3289
                19 October 2010
                19 October 2010
                March 2011
                : 38
                : 2
                : 65-76
                Affiliations
                [1 ]George Warren Brown School of Social Work, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO 63130 USA
                [2 ]Division of Social Work, Roberts Wesleyan College, Rochester, USA
                [3 ]Department of Psychiatry, Washington University School of Medicine, St. Louis, MO USA
                [4 ]Department of Psychiatry, University of California, San Diego, La Jolla, CA USA
                [5 ]Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO USA
                319
                10.1007/s10488-010-0319-7
                3068522
                20957426
                © The Author(s) 2010
                Categories
                Original Paper
                Custom metadata
                © Springer Science+Business Media, LLC 2011

                Social policy & Welfare

                outcomes, implementation, evaluation, research methods

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