---

Implementation Strategies - Detailed Guidance

Why it matters

we categorize interventions as the “thing”, often collectively known as the 7Ps (program, pill, practice, procedure, policy, product, or principle) that have been shown to improve health behavior and outcomes.

Clearly understanding what the intervention, the ‘thing’ -- is, and why it matters in your specific setting, is the first consideration before selecting implementation strategies.

Some good characteristics of effective interventions include efficiency, low burden, generalizable, adaptable, aligned with patient flow, and could be refined in collaboration with implementation staff.

Action to consider

Clearly document the problem or gap you aim to address with the proposed intervention.

Identify the source of evidence supporting your intervention.

Outline the key characteristics of the intervention to determine whether it is a good fit for addressing your health gap or problem.

If the intervention has not yet been tested in a real-world setting, assess potential barriers and facilitators to implement it in your specific context.

Tools and Resources

An Overview of Research and Evaluation Designs for Dissemination and Implementation, is a paper that described the 7 Ps mentioned above. Implementation strategies may vary depending on the type of P your intervention represents.

Curran et al, in Implementation science made too simple: a teaching tool. Simplify how we should conceptualize interventions, strategies, and outcomes.

Why it matters

Implementation strategies are methods applied to enhance not only adoption and implementation, but also sustainment and scale-up of your intervention. Hence, knowing which stage your strategy is intended to enhance is essential.

It is important to align your strategy with a stage, and think ahead about implications for later stages, that is if your efforts are not terminal stage implementation

Action to consider

Identify the stage of implementation for which you would like to develop a strategy

The stages below are adapted from the VA QUERI stages of implementation, with a modification that includes scale-up.

Tools and resources

Stages of Implementation Completion (SIC)[GR1] : outlines eight key stages and milestones in the implementation process, organized across three phases: pre-implementation, implementation, and sustainment.

The Exploration, Preparation, Implementation, Sustainment (EPIS) Framework: outlines four key phases of the implementation process and helps identify common and unique factors within both the broader system (outer context) and the organization (inner context). Starts from exploration phase to sustainment.

VA QUERI Implementation Roadmap: is a practical guide offering tools, case studies, and user-friendly methods to overcome barriers and speed up the adoption of proven care approaches[BF2] [BE3] .

The interactive PRISM Webtool pragmatically and iteratively guides users in assessing the alignment of an intervention context by integrating the PRISM framework’s multilevel domains—such as recipient characteristics, infrastructure, and external environment—with RE-AIM outcomes (Reach, Effectiveness, Adoption, Implementation, Maintenance).

Why it matters

Ensures everyone on the project understands how and why the strategy was picked

Specifying your strategy will be helpful to identify tools, resources, and which team members should implement the strategy

Actions to consider

Use Proctor's Implementation Strategy specification approach

By following the below figure, you could specify or describe you implementation strategy in relation to your overall program goal in detail

Tools and resources

Brownson et al book- title and chapter, [GR1] 

Weiner et al book- title and CHAPTER/pages

To learn more about the original paper that introduced the specification framework, check out Implementation strategies: recommendations for specifying and reporting It provides an in-depth explanation of the stages.

This paper includes a logical framework if you want to map your intervention to contextual factors like gaps and intended beneficiaries, this paper includes a tool to help you define the intervention and align it before routine use

Here’s another key paper with A refined compilation of implementation strategies: that lists 73 commonly used strategies in implementation research

If the list of 73 strategies feels overwhelming, another study has grouped them into 9 thematic areas based on similarity.

Actions for consider

Adaptation steps based on FRAME-IS framework

Do clinical, stakeholder, or empirical data suggest that an adaptation to the EBP/strategy is needed? Use the questions below to guide your adaptation process:

• What is the implementation strategy being adapted?
• When did the adaptation occur?
• Were adaptations planned?
• Who participated in the decision to adapt?
• What was the goal?
• What was modified?
• At what level of delivery was the adaptation made?
• What is the nature of the content modification?
• Reason for adaptation?

Are core elements or core functions of the EBP/strategy known? If so, was the adaptation consistent with this (these) functions? 

Can limitations of the EBP/strategy for this setting or population be addressed while preserving core elements or functions?

Does the timeframe of the proposed rollout of the EBP allow for a pilot study that includes proposed adaptations?

To what extent is the adapted EBP successful- on what outcome?

If the strategy is not successful, is “voltage drop” acceptable to stakeholders?

Tools and resources

Detailed guidance on the adaptation process using FRAME-IS, as shown above, can be found in the following resource. The FRAME-IS: a framework for documenting modifications to implementation strategies in healthcare

Rabin et.al. REDCap coding system