Implementation Science Theories Models Paul A Estabrooks Ph

Implementation Science: Theories & Models Paul A. Estabrooks, Ph. D Twitter: @paul_estabrooks Email: paul. estabrooks@unmc. edu

Furthering Understanding of D&I Models Theories present a systematic way of understanding events or behaviors by providing inter-related concepts, definitions, and propositions that explain or predict events by specifying relationships among variables. Frameworks Models are strategic or action-planning models that provide a systematic way to develop, manage, and evaluate interventions. is used to describe theories and frameworks collectively. Tabak RG et al. Bridging Research and Practice: Models for Dissemination and Implementation Research Am J Prev Med, 2012, 43: 337 -350;

Model Categories https: //www. cdc. gov/prc/stories-prevention-research/stories/dissemination-and-implementation. htm

Mode www. dissemination-implementation. org www. re-aim. org

Diffusions of Innovations Diffusion is a process where an innovation is communicated through certain channels over time among members of a social system Everett Rogers, 1962

The Innovation An idea, practice or object that is perceived as new by an individual or other unit of adoption.

The Innovation Characteristics of Innovation – Relative Advantage Compatability Complexity Trialability Observability

A Social System The social structure of the system affects the innovation’s diffusion in several ways. – how the system’s social structure affects diffusion, – the effect of norms on diffusion, – the roles of opinion leaders

THE INNOVATION-DECISION PROCESS - the process through which an individual passes from first knowledge of an innovation to forming an attitude toward the innovation, to a decision to adopt or reject it. Five stages in the innovation-decision process: (1) knowledge, (2) persuasion, (3) decision, (4) implementation, and (5) confirmation.

Rate of Adoption Most innovations have an S-shaped rate of adoption.

Interactive Systems Framework for Dissemination and Implementation Wandersman et al. , Am J Community Psychol (2008) 41: 171– 181

Synthesis and Translation • • Evidence synthesis Systematic review Integrative review Meta-analysis Review of literature State of the science review • • • Translation: o Identify key characteristics o Identify core elements o Highlight process for adaptation o Package so core elements are implemented with fidelity to the program design. Wandersman et al. , Am J Community Psychol (2008) 41: 171– 181

Delivery System General Capacity Examples Culture Climate Organizational Innovativeness Resource Utilization Innovation Specific Capacity Examples Innovation-Specific knowledge, skills, and abilities Program Champion Specific Implementation Supports Interorganizational Relationships Leadership Structure Staff Capacity Wandersman, Advanced Topics in Implementation Science Research Webinar Series, April 2015

Support System General Capacity Examples Provision of social support Tracking and monitoring Informational Behavioral incentives Innovation Specific Capacity Examples Innovation-Specific Skill building techniques Expertise in innovation content area Ability to gather innovation specific materials Ability to adapt based on core elements Didactic instruction Problem solving techniques Staff Capacity Wandersman, Advanced Topics in Implementation Science Research Webinar Series, April 2015

Motivation for Innovation Potential Motivators Authors Relative Advantage Armenakis et al. , 1993; Damschroder et al. , 2009; Hall & Compatibility Hord, 2010; Rafferty et al. , 2013; Rogers, 2003; Weiner, 2009 Chinman et al. , 2004; Durlak & Dupre, 2008; Fetterman & Wandersman, 2005; Greenhalgh et al. , 2004; Rogers, 2003; Simpson, 2002 Complexity Damschroder & Hagedorn, 2011; Fixsen et al. , 2005; Greenhalgh et al. , 2004; Meyers, Durlak & Wandersman, 2012; Wandersman et al. , 2008. Trialability Armenakis et al. , 1993; Greenhalgh et al. , 2004; Rapkin et al. , 2012; Rogers, 2003 Observability Beutler, 2001; Chinman et al. , 2004; Damschroder et al. , 2009; Ford et al. , 2008; Rossi, Lipsey, & Freeman, 2004 Priority Armenakis & Harris, 2009; Greenhalgh et al. , 2004; Flaspohler et al. , 2008 Wandersman, Advanced Topics in Implementation Science Research Webinar Series, April 2015

Interactive Systems Framework for Dissemination and Implementation Wandersman et al. , Am J Community Psychol (2008) 41: 171– 181

Consolidated Framework for Implementation Research Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implementation Science. Aug 2009; 4.

Intervention at Time 1 Internal Context Soft Periphery Hard Core Intervention at Time 0 External Context 19 Damschroder et al. , 2009

Intervention Characteristics • • Intervention source (build or buy) Evidence strength and quality Relative advantate Adaptability Trialability Complexity Design quality and packaging Cost Damschroder et al, 2009: Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation sci

Inner setting • • • Structural characteristics Networks and communication Culture Implementation climate • • • Tension for change Compatibility Relative priority Organizational incentives Goals and feedback opportunities & learning climate Readiness for implementation (leadership; resources; access to information) Characteristics of individuals (e. g. , knowledge and beliefs, self-efficacy to implement) Damschroder et al, 2009: Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation sci

Outer setting • • Patient (client) needs and resources Degree of networking with external organizations Pressure from competitive or similar external organizations External policies and incentives Damschroder et al, 2009: Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation sci

Processes • • Planning Engaging Opinion leaders Internal implementation leaders (formal) Champions External change agents Executing Reflecting and evaluating • • Damschroder et al, 2009: Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation sci

Measurement Resources 24

Measurement Resources 25

Mode www. dissemination-implementation. org www. re-aim. org