Systematic review of the Exploration, Preparation, Implementation, Sustainment (EPIS) framework

Joanna C Moullin, Kelsey S Dickson, Nicole A Stadnick, Borsika Rabin, Gregory A Aarons, Joanna C Moullin, Kelsey S Dickson, Nicole A Stadnick, Borsika Rabin, Gregory A Aarons

Abstract

Background: Effective implementation of evidence-based practices (EBPs) remains a significant challenge. Numerous existing models and frameworks identify key factors and processes to facilitate implementation. However, there is a need to better understand how individual models and frameworks are applied in research projects, how they can support the implementation process, and how they might advance implementation science. This systematic review examines and describes the research application of a widely used implementation framework, the Exploration, Preparation, Implementation, Sustainment (EPIS) framework.

Methods: A systematic literature review was performed to identify and evaluate the use of the EPIS framework in implementation efforts. Citation searches in PubMed, Scopus, PsycINFO, ERIC, Web of Science, Social Sciences Index, and Google Scholar databases were undertaken. Data extraction included the objective, language, country, setting, sector, EBP, study design, methodology, level(s) of data collection, unit(s) of analysis, use of EPIS (i.e., purpose), implementation factors and processes, EPIS stages, implementation strategy, implementation outcomes, and overall depth of EPIS use (rated on a 1-5 scale).

Results: In total, 762 full-text articles were screened by four reviewers, resulting in inclusion of 67 articles, representing 49 unique research projects. All included projects were conducted in public sector settings. The majority of projects (73%) investigated the implementation of a specific EBP. The majority of projects (90%) examined inner context factors, 57% examined outer context factors, 37% examined innovation factors, and 31% bridging factors (i.e., factors that cross or link the outer system and inner organizational context). On average, projects measured EPIS factors across two of the EPIS phases (M = 2.02), with the most frequent phase being Implementation (73%). On average, the overall depth of EPIS inclusion was moderate (2.8 out of 5).

Conclusion: This systematic review enumerated multiple settings and ways the EPIS framework has been applied in implementation research projects, and summarized promising characteristics and strengths of the framework, illustrated with examples. Recommendations for future use include more precise operationalization of factors, increased depth and breadth of application, development of aligned measures, and broadening of user networks. Additional resources supporting the operationalization of EPIS are available.

Keywords: Diffusion of innovations; Framework; Implementation; Inner context; Model; Outer context; Process; Systematic review; Theory.

Conflict of interest statement

Ethics approval and consent to participate

Ethics approval was not required for this systematic review.

Consent for publication

Not applicable.

Competing interests

GAA is an Associate Editor of Implementation Science; all decisions on this paper were made by another editor. The authors declare that they have no other competing interests.

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Figures

Fig. 1
Fig. 1
Exploration, Preparation, Implementation, Sustainment (EPIS) framework including phases, Outer/Inner Context, Bridging Factors, and Innovation factors
Fig. 2
Fig. 2
PRISMA Flow Diagram of paper selection [62]

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