Implementability of healthcare interventions: an overview of reviews and development of a conceptual framework

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Abstract

Background

Implementation research may play an important role in reducing research waste by identifying strategies that support translation of evidence into practice. Implementation of healthcare interventions is influenced by multiple factors including the organisational context, implementation strategies and features of the intervention as perceived by people delivering and receiving the intervention. Recently, concepts relating to perceived features of interventions have been gaining traction in published literature, namely, acceptability, fidelity, feasibility, scalability and sustainability. These concepts may influence uptake of healthcare interventions, yet there seems to be little consensus about their nature and impact. The aim of this paper is to develop a testable conceptual framework of implementability of healthcare interventions that includes these five concepts.

Methods

A multifaceted approach was used to develop and refine a conceptual framework of implementability of healthcare interventions. An overview of reviews identified reviews published between January 2000 and March 2021 that focused on at least one of the five concepts in relation to a healthcare intervention. These findings informed the development of a preliminary framework of implementability of healthcare interventions which was presented to a panel of experts. A nominal group process was used to critique, refine and agree on a final framework.

Results

A total of 252 publications were included in the overview of reviews. Of these, 32% were found to be feasible, 4% reported sustainable changes in practice and 9% were scaled up to other populations and/or settings. The expert panel proposed that scalability and sustainability of a healthcare intervention are dependent on its acceptability, fidelity and feasibility. Furthermore, acceptability, fidelity and feasibility require re-evaluation over time and as the intervention is developed and then implemented in different settings or with different populations. The final agreed framework of implementability provides the basis for a chronological, iterative approach to planning for wide-scale, long-term implementation of healthcare interventions.

Conclusions

We recommend that researchers consider the factors acceptability, fidelity and feasibility (proposed to influence sustainability and scalability) during the preliminary phases of intervention development, evaluation and implementation, and iteratively check these factors in different settings and over time.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13012-021-01171-7.

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Most cited references 112

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Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science

Laura Damschroder, David Aron, Rosalind E Keith … (2009)

Background Many interventions found to be effective in health services research studies fail to translate into meaningful patient care outcomes across multiple contexts. Health services researchers recognize the need to evaluate not only summative outcomes but also formative outcomes to assess the extent to which implementation is effective in a specific setting, prolongs sustainability, and promotes dissemination into other settings. Many implementation theories have been published to help promote effective implementation. However, they overlap considerably in the constructs included in individual theories, and a comparison of theories reveals that each is missing important constructs included in other theories. In addition, terminology and definitions are not consistent across theories. We describe the Consolidated Framework For Implementation Research (CFIR) that offers an overarching typology to promote implementation theory development and verification about what works where and why across multiple contexts. Methods We used a snowball sampling approach to identify published theories that were evaluated to identify constructs based on strength of conceptual or empirical support for influence on implementation, consistency in definitions, alignment with our own findings, and potential for measurement. We combined constructs across published theories that had different labels but were redundant or overlapping in definition, and we parsed apart constructs that conflated underlying concepts. Results The CFIR is composed of five major domains: intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation. Eight constructs were identified related to the intervention (e.g., evidence strength and quality), four constructs were identified related to outer setting (e.g., patient needs and resources), 12 constructs were identified related to inner setting (e.g., culture, leadership engagement), five constructs were identified related to individual characteristics, and eight constructs were identified related to process (e.g., plan, evaluate, and reflect). We present explicit definitions for each construct. Conclusion The CFIR provides a pragmatic structure for approaching complex, interacting, multi-level, and transient states of constructs in the real world by embracing, consolidating, and unifying key constructs from published implementation theories. It can be used to guide formative evaluations and build the implementation knowledge base across multiple studies and settings.

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

Enola Proctor, Hiie Silmere, Ramesh Raghavan … (2010)

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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Validation of the theoretical domains framework for use in behaviour change and implementation research

James Cane, Denise O’Connor, Susan Michie (2012)

Background An integrative theoretical framework, developed for cross-disciplinary implementation and other behaviour change research, has been applied across a wide range of clinical situations. This study tests the validity of this framework. Methods Validity was investigated by behavioural experts sorting 112 unique theoretical constructs using closed and open sort tasks. The extent of replication was tested by Discriminant Content Validation and Fuzzy Cluster Analysis. Results There was good support for a refinement of the framework comprising 14 domains of theoretical constructs (average silhouette value 0.29): ‘Knowledge’, ‘Skills’, ‘Social/Professional Role and Identity’, ‘Beliefs about Capabilities’, ‘Optimism’, ‘Beliefs about Consequences’, ‘Reinforcement’, ‘Intentions’, ‘Goals’, ‘Memory, Attention and Decision Processes’, ‘Environmental Context and Resources’, ‘Social Influences’, ‘Emotions’, and ‘Behavioural Regulation’. Conclusions The refined Theoretical Domains Framework has a strengthened empirical base and provides a method for theoretically assessing implementation problems, as well as professional and other health-related behaviours as a basis for intervention development.

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Author and article information

Contributors

Marlena Klaic:

ORCID: http://orcid.org/0000-0003-2328-0503

marlena.klaic@unimelb.edu.au

Suzanne Kapp:

ORCID: http://orcid.org/0000-0002-5438-8384

suzanne.kapp@unimelb.edu.au

Peter Hudson:

ORCID: http://orcid.org/0000-0001-5891-8197

phudson@unimelb.edu.au

Wendy Chapman:

ORCID: http://orcid.org/0000-0001-8702-4483

wendy.chapman@unimelb.edu.au

Linda Denehy:

ORCID: http://orcid.org/0000-0002-2926-8436

l.denehy@unimelb.edu.au

David Story:

ORCID: http://orcid.org/0000-0002-6479-1310

dastory@unimelb.edu.au

Jill J. Francis:

ORCID: http://orcid.org/0000-0001-5784-8895

jillian.francis@unimelb.edu.au

Journal

Journal ID (nlm-ta): Implement Sci

Journal ID (iso-abbrev): Implement Sci

Title: Implementation Science : IS

Publisher: BioMed Central (London )

ISSN (Electronic): 1748-5908

Publication date (Electronic): 27 January 2022

Publication date PMC-release: 27 January 2022

Publication date Collection: 2022

Volume: 17

Electronic Location Identifier: 10

Affiliations

[1 ]GRID grid.1008.9, ISNI 0000 0001 2179 088X, The University of Melbourne, School of Health Sciences, ; Melbourne, Australia

[2 ]GRID grid.416153.4, ISNI 0000 0004 0624 1200, The Royal Melbourne Hospital, Allied Health Department, ; Melbourne, Australia

[3 ]GRID grid.1008.9, ISNI 0000 0001 2179 088X, The University of Melbourne, School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, Department of Nursing, ; Melbourne, Australia

[4 ]GRID grid.413105.2, ISNI 0000 0000 8606 2560, Centre for Palliative Care, St Vincent’s Hospital, ; Melbourne, Australia

[5 ]GRID grid.8767.e, ISNI 0000 0001 2290 8069, End-of-life Care Research Department, , Vrije Universiteit Brussel (VUB), ; Brussels, Belgium

[6 ]GRID grid.1008.9, ISNI 0000 0001 2179 088X, Centre for Digital Transformation of Health, , The University of Melbourne, ; Melbourne, Australia

[7 ]Department of Allied Health, Peter McCallum Cancer Centre, Melbourne, Australia

[8 ]GRID grid.1008.9, ISNI 0000 0001 2179 088X, Department of Critical Care, , The University of Melbourne, ; Melbourne, Australia

[9 ]GRID grid.410678.c, ISNI 0000 0000 9374 3516, Department of Anaesthesia, Austin Health, ; Melbourne, Australia

[10 ]GRID grid.412687.e, ISNI 0000 0000 9606 5108, Ottawa Hospital Research Institute, Clinical Epidemiology Program, ; Ottawa, Canada

[11 ]Department of Health Services Research, Peter McCallum Cancer Centre, Melbourne, Australia

Author information

Marlena Klaic http://orcid.org/0000-0003-2328-0503

Suzanne Kapp http://orcid.org/0000-0002-5438-8384

Peter Hudson http://orcid.org/0000-0001-5891-8197

Wendy Chapman http://orcid.org/0000-0001-8702-4483

Linda Denehy http://orcid.org/0000-0002-2926-8436

David Story http://orcid.org/0000-0002-6479-1310

Jill J. Francis http://orcid.org/0000-0001-5784-8895

Article

Publisher ID: 1171

DOI: 10.1186/s13012-021-01171-7

PMC ID: 8793098

PubMed ID: 35086538

SO-VID: b8b35364-98ee-4596-a4e5-6b29de70936a

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 21 May 2021

Date accepted : 2 November 2021

Custom metadata

ScienceOpen disciplines: Medicine

Keywords: implementation strategies,framework,scalability,sustainability,implementability,implementation science,implementation research,healthcare interventions

Data availability:

ScienceOpen disciplines: Medicine

Keywords: implementation strategies, framework, scalability, sustainability, implementability, implementation science, implementation research, healthcare interventions

Implementability of healthcare interventions: an overview of reviews and development of a conceptual framework

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Abstract

Background

Methods

Results

Conclusions

Supplementary Information

Related collections

Sex and gender-sensitive medicine

Most cited references 112

Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science

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

Validation of the theoretical domains framework for use in behaviour change and implementation research

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