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Implementation Strategies - Detailed Guidance

We define an intervention as the “thing” that you are doing, often collectively known as the 7Ps (program, pill, practice, procedure, policy, product, or principle) that have been shown to improve health behavior and outcomes. This is the evidence-based practice.

Why it matters
Clearly understanding what the intervention is and why it matters in your specific setting, is the first step before selecting implementation strategies.

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

Actions to Enhance Success
Keep in mind the problem or gap you aim to address with the proposed intervention.

Identify the sources of evidence supporting your intervention.

Outline the key characteristics (we recommend thinking of the functions or key goals) 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 implementing and sustaining 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 7Ps 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. 
  
• Perez Jolles et. al. Functions and Forms Webtool discusses and provides examples of how to design strategies to achieve key goals or functions 
  

Implementation strategies are the how, methods applied to enhance not only adoption and implementation, but also sustainment and scale-up of your intervention.

There are 73 standardized implementation strategies in the field of implementation science. Among these, common strategies include education, incentives, audit/feedback, and policy change.

These are distinct from the intervention above that might be a program, procedure, etc.

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 and resources are needed and which team members should implement the strategy

Actions to Consider
Use Proctor's Implementation Strategy specification approach below

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

Example
Exercise is an evidence based practice for diabetes prevention and management. To promote its uptake among patients, several implementation strategies may be employed, including conducting educational meetings to increase patient understanding of the benefits of exercise, distributing educational materials (decision aid) that provide practical guidance on how to engage in physical activity, facilitating patient access to exercise resources, and providing incentives to motivate consistent participation.

There are four phases of implementation: Pre-implementation, Implementation, Sustainment, and Scale-up. Your implementation strategy(ies) should be chosen to target the corresponding stage: You will likely need different strategies for different phases. 

Why it Matters
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 end-stage implementation

Actions to Enhance Success
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): 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.

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).

Actions to consider

Consider if your strategy(ies) need to be adapted. Be sure to track these adaptations when they are made in a systematic way.

Do data suggest that an adaptation to the strategy is needed? What changes are needed?

If yes, adapt the implementation strategy and track the answers to these questions:

• 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 strategy known? If so, was the adaptation consistent with this (these) function(s)? 

Can limitations of the 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 strategy successful- on what outcome?

If the strategy is not successful, is it acceptable to stakeholders for the intervention to be less effective than originally planned? 

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

A multi-method, real-time longitudinal approach to systematically document adaptations during pre-implementation, implementation, and sustainment through a real-time tracking instrument, process maps, Implementation and Evaluation (I&E) team meeting minutes, and adaptation interviews

Kirchner JE, Waltz TJ, et al. (2023; 3rd edition). Implementation strategies. In R Brownson, G Colditz, E Proctor (Eds) Dissemination  and implementation research in health. Oxford Publishing: New York. Pages 119- 146.

Rabin, B.A., Cain, K.L., Glasgow, R.E. Adapting Public Health and Health Services Interventions in Diverse, Real-World Settings: Documentation and Iterative Guidance of Adaptations. Annu. Rev. Public Health 2025. 46:16.1–16.21. doi.org/10.1146/annurev-publhealth-071321-041652

Singh, RR, Saldana, L. How to implement evidence-based interventions. In Weiner, B.J., Lewis, C.C., Sher, K. (2023). Practical implementation science: Moving evidence into action. Springer Publishing, New York.  Pages 177- 202.