Choosing implementation strategies to address contextual barriers: diversity in recommendations and future directions

Thomas J Waltz, Byron J Powell, María E Fernández, Brenton Abadie, Laura J Damschroder, Thomas J Waltz, Byron J Powell, María E Fernández, Brenton Abadie, Laura J Damschroder

Abstract

Background: A fundamental challenge of implementation is identifying contextual determinants (i.e., barriers and facilitators) and determining which implementation strategies will address them. Numerous conceptual frameworks (e.g., the Consolidated Framework for Implementation Research; CFIR) have been developed to guide the identification of contextual determinants, and compilations of implementation strategies (e.g., the Expert Recommendations for Implementing Change compilation; ERIC) have been developed which can support selection and reporting of implementation strategies. The aim of this study was to identify which ERIC implementation strategies would best address specific CFIR-based contextual barriers.

Methods: Implementation researchers and practitioners were recruited to participate in an online series of tasks involving matching specific ERIC implementation strategies to specific implementation barriers. Participants were presented with brief descriptions of barriers based on CFIR construct definitions. They were asked to rank up to seven implementation strategies that would best address each barrier. Barriers were presented in a random order, and participants had the option to respond to the barrier or skip to another barrier. Participants were also asked about considerations that most influenced their choices.

Results: Four hundred thirty-five invitations were emailed and 169 (39%) individuals participated. Respondents had considerable heterogeneity in opinions regarding which ERIC strategies best addressed each CFIR barrier. Across the 39 CFIR barriers, an average of 47 different ERIC strategies (SD = 4.8, range 35 to 55) was endorsed at least once for each, as being one of seven strategies that would best address the barrier. A tool was developed that allows users to specify high-priority CFIR-based barriers and receive a prioritized list of strategies based on endorsements provided by participants.

Conclusions: The wide heterogeneity of endorsements obtained in this study's task suggests that there are relatively few consistent relationships between CFIR-based barriers and ERIC implementation strategies. Despite this heterogeneity, a tool aggregating endorsements across multiple barriers can support taking a structured approach to consider a broad range of strategies given those barriers. This study's results point to the need for a more detailed evaluation of the underlying determinants of barriers and how these determinants are addressed by strategies as part of the implementation planning process.

Keywords: Consolidated Framework for Implementation Research; Expert Recommendations for Implementing Change; Implementation; Implementation strategies; Intervention mapping.

Conflict of interest statement

Ethics approval and consent to participate

This evaluation was approved by the Institutional Review Board at the VA Ann Arbor Healthcare System.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Screenshot of the ranking task. Participants were instructed to drag and drop strategies from the left-hand column to the ranking box on the right. Once placed in the ranking box, the relative position of the strategies could be manipulated

References

    1. Meaney M, Pung C. McKinsey Global Survey results: creating organizational transformations. Seattle: McKinsey & Company; 2008. p. 1–7.
    1. Probst G, Raisch S. Organizational crisis: the logic of failure. Acad Manag Exec. 2005;19(1):90.
    1. Proctor EK, Powell BJ, McMillen JC. Implementation strategies: recommendations for specifying and reporting. Implement Sci. 2013;8:139. doi: 10.1186/1748-5908-8-139.
    1. Institute of Medicine . Initial national priorities for comparative effectiveness research. Washington, DC: The National Academies Press; 2009.
    1. Department of Health and Human Services . National Institutes of Health. 2017. Dissimination and implementation research in health (R01 clinical trial optional)
    1. Eccles MP, Armstrong D, Baker R, Cleary K, Davies H, Davies S, Glasziou P, Ilott I, Kinmonth A-L, Leng G, et al. An implementation research agenda. Implement Sci. 2009;4:18. doi: 10.1186/1748-5908-4-18.
    1. Newman K, Van Eerd D, Powell BJ, Urquhart R, Cornelissen E, Chan V, Lal S. Identifying priorities in knowledge translation from the perspective of trainees: results from an online survey. Implement Sci. 2015;10:92. doi: 10.1186/s13012-015-0282-5.
    1. Powell BJ, McMillen JC, Proctor EK, Carpenter CR, Griffey RT, Bunger AC, Glass JE, York JL. A compilation of strategies for implementing clinical innovations in health and mental health. Med Care Res Rev. 2012;69(2):123–157. doi: 10.1177/1077558711430690.
    1. Powell BJ, Beidas RS, Lewis CC, Aarons GA, McMillen JC, Proctor EK, Mandell DS. Methods to improve the selection and tailoring of implementation strategies. J Behav Health Serv Res. 2017;44(2):177–194. doi: 10.1007/s11414-015-9475-6.
    1. Powell BJ, Waltz TJ, Chinman MJ, Damschroder LJ, Smith JL, Matthieu MM, Proctor EK, Kirchner JE. A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project. Implement Sci. 2015;10:21. doi: 10.1186/s13012-015-0209-1.
    1. Grimshaw JM, Eccles MP, Lavis JN, Hill SJ, Squires JE. Knowledge translation of research findings. Implement Sci. 2012;7:50. doi: 10.1186/1748-5908-7-50.
    1. Mittman BS. Implementation science in health care. In: Brownson RC, Proctor EK, editors. Dissemination and implementation research in health: translating science to practice. New York: Oxford; 2012. pp. 400–418.
    1. Baker R, Cammosso-Stefinovic J, Gillies C, Shaw EJ, Cheater F, Flottorp S, Robertson N. Tailored interventions to overcome identified barriers to change: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2010;3(4):CD005470. 10.1002/14651858.CD005470.pub2.
    1. Wensing M, Oxman A, Baker R, Godycki-Cwirko M, Flottorp S, Szecsenyi J, Grimshaw J, Eccles M. Tailored implementation for chronic diseases (TICD): a project protocol. Implement Sci. 2011;6:103. doi: 10.1186/1748-5908-6-103.
    1. Wensing M, Bosch M, Grol R. Selecting, tailoring, and implementing knowledge translation interventions. In: STJ S, Graham ID, editors. Knowledge translation in health care: moving from evidence to practice. Oxford: Wiley-Blackwell; 2009. pp. 94–113.
    1. Baker R, Camosso-Stefinovic J, Gillies C, Shaw EJ, Cheater F, Flottorp S, Robertson N, Wensing M, Fiander M, Eccles MP, et al. Tailored interventions to address determinants of practice. Cochrane Database Syst Rev. 2015;4(4):Cd005470.
    1. Bosch M, Weijden T, Wensing MJP, Grol RPTM. Tailoring quality improvement interventions to identified barriers: a multiple case analysis. J Eval Clin Pract. 2007;13(2):161–168. doi: 10.1111/j.1365-2753.2006.00660.x.
    1. Grol R, Bosch M, Wensing M. Development and selection of strategies for improving patient care. In: Grol R, Eccles M, Davis D, editors. Improving patient care: the implementation of change in health care. 2. Chichester: Wiley; 2013. pp. 165–184.
    1. Kok G, Gottlieb NH, Peters G-JY, Mullen PD, Parcel GS, Ruiter RAC, Fernández ME, Markham C, Bartholomew LK. A taxonomy of behaviour change methods: an intervention mapping approach. Health Psychol Rev. 2016;10(3):297–312. doi: 10.1080/17437199.2015.1077155.
    1. Bartholomew Eldredge LK, Markham CM, Ruiter RAC, Fernández ME, Kok G, Parcel GS. Planning health promotion programs: an intervention mapping approach. 4. San Francisco: Jossey-Bass; 2016.
    1. Nilsen P. Making sense of implementation theories, models and frameworks. Implement Sci. 2015;10:53. doi: 10.1186/s13012-015-0242-0.
    1. 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. Implement Sci. 2009;4:50. doi: 10.1186/1748-5908-4-50.
    1. Tabak RG, Khoong EC, Chambers DA, Brownson RC. Bridging research and practice: models for dissemination and implementation research. Am J Prev Med. 2012;43(3):337–350. doi: 10.1016/j.amepre.2012.05.024.
    1. Fernandez ME, Walker TJ, Weiner BJ, Calo WA, Liang S, Risendal B, Friedman DB, Tu SP, Williams RS, Jacobs S, et al. Developing measures to assess constructs from the inner setting domain of the consolidated framework for implementation research. Implement Sci. 2018;13:52. doi: 10.1186/s13012-018-0736-7.
    1. Waltz TJ, Powell BJ, Matthieu MM, Damschroder LJ, Chinman MJ, Smith JL, Proctor EK, Kirchner JE. Use of concept mapping to characterize relationships among implementation strategies and assess their feasibility and importance: results from the Expert Recommendations for Implementing Change (ERIC) study. Implement Sci. 2015;10:109. doi: 10.1186/s13012-015-0295-0.
    1. Waltz TJ, Powell BJ, Chinman MJ, Damschroder LJ, Smith JL, Matthieu MM, Proctor EK, Kirchner JE. Structuring complex recommendations: methods and general findings. Implement Sci. 2016;11(Suppl 1):A23.
    1. Bunger AC, Powell BJ, Robertson HA, MacDowell H, Birken SA, Shea C. Tracking implementation strategies: a description of a practical approach and early findings. Health Res Policy Syst. 2017;15:15. doi: 10.1186/s12961-017-0175-y.
    1. Boyd MR, Powell BJ, Endicott D, Lewis CC. A method for tracking implementation strategies: an exemplar implementing measurement-based care in community behavioral health clinics. Behav Ther. 2018;49:525–537. doi: 10.1016/j.beth.2017.11.012.
    1. Rogal SS, Yakovchenko V, Waltz TJ, Powell BJ, Kirchner JE, Proctor EK, Gonzalez R, Park A, Ross D, Morgan TR, et al. The association between implementation strategy use and the uptake of hepatitis C treatment in a national sample. Implement Sci. 2017;12:60. doi: 10.1186/s13012-017-0588-6.
    1. Sandelowski M. What’s in a name? Qualitative description revisited. Res Nurs Health. 2010;33(1):77–84.
    1. Damschroder LJ, Reardon CM, Sperber N, Robinson CH, Fickel JJ, Oddone EZ. Implementation evaluation of the Telephone Lifestyle Coaching (TLC) program: organizational factors associated with successful implementation. Transl Behav Med. 2017;7(2):233–241. doi: 10.1007/s13142-016-0424-6.
    1. Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A, Griffey R, Hensley M. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health Ment Health Serv Res. 2011;38(2):65–76. doi: 10.1007/s10488-010-0319-7.
    1. Powell BJ, Fernandez ME, Williams NJ, Aarons GA, Beidas RS, Lewis CC, McHugh SM, Weiner BJ. Enhancing the impact of implementation strategies in healthcare: a research agenda. Front Public Health. 2019;7:3. doi: 10.3389/fpubh.2019.00003.
    1. Powell BJ, Garcia K, Fernández ME. Implementation strategies. In: Chambers D, Vinson C, Norton W, editors. Optimizing the cancer control continuum: advancing implementation research. New York: Oxford University Press; 2018.
    1. Lewis CC, Klasnja P, Powell BJ, Lyon AR, Tuzzio L, Jones S, Walsh-Bailey C, Weiner B. From classification to causality: advancing understanding of mechanisms of change in implementation science. Front Public Health. 2018;6:136. doi: 10.3389/fpubh.2018.00136.
    1. Klein KJ, Sorra JS. The challenge of innovation implementation. Acad Manag Rev. 1996;21:1055–1080. doi: 10.5465/amr.1996.9704071863.
    1. Weiner BJ, Lewis MA, Clauser SB, Stitzenberg KB. In search of synergy: strategies for combining interventions at multiple levels. J Natl Cancer Inst Monogr. 2012;2012(44):34–41. doi: 10.1093/jncimonographs/lgs001.
    1. Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D, Altman DG, Barbour V, Macdonald H, Johnston M, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ. 2014;348(mar07 3):g1687. doi: 10.1136/bmj.g1687.
    1. Colquhoun HL, Squires JE, Kolehmainen N, Fraser C, Grimshaw JM. Methods for designing interventions to change healthcare professionals’ behaviour: a systematic review. Implement Sci. 2017;12:30. doi: 10.1186/s13012-017-0560-5.
    1. Powell BJ, Aarons GA, Amaya-Jackson L, Haley A, Weiner BJ. The collaborative approach to selecting and tailoring implementation strategies (COAST-IS) Implement Sci. 2018;13((Suppl 3): A79):39–40.
    1. Bartholomew LK, Parcel GS, Kok G. Intervention mapping: a process for developing theory and evidence-based health education programs. Health Educ Behav. 1998;25(5):545–563. doi: 10.1177/109019819802500502.
    1. Bartholomew L. Kay, Cushman William C, Cutler Jeffrey A, Davis Barry R, Dawson Glenna, Einhorn Paula T, Graumlich James F, Piller Linda B, Pressel Sara, Roccella Edward J, Simpson Lara, Whelton Paul K, Williard Angela, ALLHAT Collaborative Research Group Getting clinical trial results into practice: design, implementation, and process evaluation of the ALLHAT Dissemination Project. Clinical Trials: Journal of the Society for Clinical Trials. 2009;6(4):329–343. doi: 10.1177/1740774509338234.
    1. van Nassau F, Singh AS, van Mechelen W, Paulussen TG, Brug J, Chinapaw MJ. Exploring facilitating factors and barriers to the nationwide dissemination of a Dutch school-based obesity prevention program “DOiT”: a study protocol. BMC Public Health. 2013;13:1201. doi: 10.1186/1471-2458-13-1201.
    1. Verloigne M, Ahrens W, De Henauw S, Verbestel V, Mårild S, Pigeot I, De Bourdeaudhuij I, Consortium I. Process evaluation of the IDEFICS school intervention: putting the evaluation of the effect on children's objectively measured physical activity and sedentary time in context. Obes Rev. 2015;16(S2):89–102. doi: 10.1111/obr.12353.
    1. van Schijndel-Speet M, Evenhuis HM, van Wijck R, Echteld MA. Implementation of a group-based physical activity programme for ageing adults with ID: a process evaluation. J Eval Clin Pract. 2014;20(4):401–407. doi: 10.1111/jep.12145.
    1. Peels DA, Bolman C, Golsteijn RH, De VH, Mudde AN, van Stralen MM, Lechner L. Differences in reach and attrition between web-based and print-delivered tailored interventions among adults over 50 years of age: clustered randomized trial. J Med Internet Res. 2012;14(6):e179. doi: 10.2196/jmir.2229.
    1. Fernandez ME, Gonzales A, Tortolero-Luna G, Williams J, Saavedra-Embesi M, Chan W, Vernon SW. Effectiveness of Cultivando La Salud: a breast and cervical cancer screening promotion program for low-income Hispanic women. Am J Public Health. 2009;99(5):936–943. doi: 10.2105/AJPH.2008.136713.
    1. Fernández ME, Gonzales A, Tortolero-Luna G, Partida S, Bartholomew LK. Using intervention mapping to develop a breast and cervical cancer screening program for Hispanic farmworkers: Cultivando la salud. Health Promot Pract. 2005;6(4):394–404. doi: 10.1177/1524839905278810.
    1. Peskin MF, Hernandez BF, Gabay EK, Cuccaro P, Li DH, Ratliff E, Reed-Hirsch K, Rivera Y, Johnson-Baker K, Emery ST, et al. Using intervention mapping for program design and production of iCHAMPSS: an online decision support system to increase adoption, implementation, and maintenance of evidence-based sexual health programs. Front Public Health. 2017;5:203. doi: 10.3389/fpubh.2017.00203.
    1. Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, Eccles MP, Cane J, Wood CE. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med. 2013;46:81–95. doi: 10.1007/s12160-013-9486-6.
    1. Garbutt JM, Dodd S, Walling E, Lee AA, Kulka K, Lobb R. Theory-based development of an implementation intervention to increase HPV vaccination in pediatric primary care practices. Implement Sci. 2018;13:45. doi: 10.1186/s13012-018-0729-6.

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