Using implementation science theories models and frameworks A

Using implementation science theories, models and frameworks: A brief introduction Dr Roman Kislov Manchester Metropolitan University NIHR ARC Greater Manchester r. kislov@mmu. ac. uk Twitter: @Roman. Kislov 15 th July 2021

Research – practice gap Ø Evidence Ø Research Ø Knowledge Clinical practice

Implementation Science as a bridge? Theories, models, frameworks Implementation strategies

Theory …Presents previously accumulated research knowledge about implementation in a way which is: …Can be useful for: • Concise • “Diagnosing” the context of implementation • Structured • Barriers and enablers • Systematic • Suggesting ways of addressing • Generalisable implementation barriers • Processual steps • Mechanisms of change • Viewing implementation (and its components) from different angles • Generating and testing hypotheses and propositions for future research … But is unlikely to provide simple ‘cookbook prescriptions’

Theoretical frameworks to be discussed in this presentation • Generic implementation theories • Determinant frameworks – e. g. CFIR • Process models – e. g. KTA • ‘Classic theories’ with an emphasis on mechanisms of action – e. g. NPT • An implementation framework with a focus on technology - NASSS More on classifying implementation theories, models and frameworks can be found here: Nilsen 2015 https: //implementationscience. biomedcentral. com/articles/10. 1186/s 13012 -0150242 -0

Other things to be discussed • Considerations when selecting implementation theories, models and frameworks for your research project • When to apply theory • Challenges and the way forward • Q&As

Consolidated Framework for Implementation Research • An example of a ‘determinant framework’ • Lists components that need to be taken into consideration • Helps identify enablers and barriers https: //cfirguide. org/

Knowledge-to-Action cycle • An example of a ‘process model’ • Outlines the stages involved in an (idealised) implementation process • Emphases the need to tailor implementation strategies depending on their context • Implementation needs to be sustainable over time… • …Until the knowledge (or innovation) becomes obsolete and needs to be de-implemented Graham et al. 2006 https: //doi. org/10. 1002/chp. 47

Normalisation Process Theory • An example of a ‘classic’ theory • Explains ‘how’ and ‘why’ a phenomenon (implementation) occurs • Draws attention to mechanisms of change required for successful implementation • Aims to bring determinants (enablers and barriers), processes and mechanisms together http: //www. normalizationprocess. org/

NASSS • Combines determinants with some processual elements • Focuses on implementation of technology • Explains non-adoption by ‘complexity’ across multiple domains • Proposed use: Ø Informing the design of new technology Ø Predicting, explaining and learning from nonadoption Ø Planning implementation, scaleup and roll-out of technologies

Selecting a theoretical approach: What to consider • Level of analysis: • Individual behaviour – Theoretical Domains Framework and Behaviour Change Wheel • Groups and organisations – approaches presented above • Your main focus: • Enablers and barriers – determinant frameworks • Implementation stages – process models • Mechanisms of action – classic theories • What approach do you (and your stakeholders) find comfortable? • It is okay (and often highly beneficial): • To combine different approaches • To borrow theories from other disciplines • To refine/modify your use of theory as your project develops

When can implementation science frameworks be used? Lynch et al. 2018 https: //link. springer. com/article/10. 1186 /s 12913 -018 -3671 -z

Challenges in applying implementation science frameworks Frameworks are like toothbrushes: Everyone's got one and no one wants to use anyone else's. . . • Dominance of determinant frameworks in the field of IS – focus on enablers and barriers rather than processes and mechanisms of implementation • Temptation to use theories as checklists • Perception of theories as ‘received wisdom’ that cannot be critiqued or modified • Finding what the framework is telling you to look for – and missing what’s novel in your empirical case

The way forward • Theoretically informative (rather than merely theoretically informed) empirical research • Going back between the empirical data and theory, explaining what the former means for the latter • Uncovering mechanisms of implementation (how do implementation strategies lead to implementation outcomes? ) • Focusing on a fewer number of determinants but exploring relationships between them in depth • What are the key ingredients of success in certain contexts/settings? • How are implementation determinants, processes and mechanisms interconnected? • How does this change over time? Kislov et al 2019 https: //implementationscience. biomedcentral. com/articles/10. 1186/s 13012 -019 -0957 -4