What could your work change if evidence reliably reached practice?
Welcome to the GACD e-Hub Fundamentals Programme in implementation science.
We created this open-access online programme to help you address complex health challenges linked to non-communicable diseases (NCDs), wherever you are. Developed by leading experts, it guides you step-by-step through the core ideas and methods of implementation science.
Whether you’re beginning a research career, working in healthcare, or leading in your community, this is a practical place to start, especially for those in low- and middle-income settings and underserved communities.
There’s no sign-up and no prior experience required — simply jump in and learn at your own pace.
Below is the Fundamentals Programme map. This shows the six modules of the programme and the order in which you should move through them. Each module comprises multiple learning opportunities, including specially recorded lectures, recommended resources, and questions to get you thinking.
We’re glad you’re here and look forward to learning with you.
Begin your learning journey below
Fundamentals Programme
0% of programme complete
1A
Implementation as a science: key concepts, ideas, and issues
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- Evidence alone is insufficient to combat NCDs; a significant gap exists between knowledge and action in healthcare.
- Implementation science focuses on how to apply evidence-based interventions.
- Implementation science actively considers the real-world environment when introducing new interventions and practices.
- Implementation science made too simple: a teaching tool (Curran GM. 2020. Implement Sci Commun. 1:27).
- Implementation science: what is it and why should I care? (Bauer MS, Kirchner J. 2020. Psychiatry Res. 283:112376).
- Scoping implementation science for the beginner: locating yourself on the “subway line” of translational research (Lane-Fall MB et al. 2019. BMC Med Res Methodol. 19(1):133).
- What makes your project an implementation research project, rather than efficacy or effectiveness research?
- How can we effectively bridge the gap between research findings and real-world practice? What factors hinder the translation of knowledge into action?
- How can we balance the need for standardized evidence-based practices with the unique and often complex contexts in which implementations occur?
1B
Evidence-based intervention or implementation strategy?
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- Implementation strategies support implementation of evidence-based interventions (EBIs).
- It is important to first establish the difference between “what” you are implementing and “how” you plan to implement.
- You need more than an EBI to achieve impact.
- An Overview of Research and Evaluation Designs for Dissemination and Implementation (Brown CH et al. 2017. Annu Rev Public Health 38:1–22).
- A compilation of strategies for implementing clinical innovations (Powell BJ et al. 2012. Med Care Res Rev. 69(2):123–57).
- GRADE Working Group – Official website
- What is your EBI of interest?
- What type(s) of implementation strategies might work within your context to achieve adoption, implementation, and sustainment of your selected EBI?
1C
Approaches and disciplines for implementation research
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- Implementation research is transdisciplinary.
- We as researchers are trying to achieve a common language among multiple disciplines to address a common issue.
- There are multiple steps in an implementation research project. Each step can be transdisciplinary and the entirety of the project is transdisciplinary.
- Global Health Delivery and Implementation Research: A New Frontier for Global Health (Vedanthan R. 2011. Mt Sinai J Med. 78:303–305).
- Social determinants of health: the need for data science methods and capacity (Chunara R et al. 2024. Lancet Digit Health. 6(4):e235–e237).
- Cost-effectiveness of group medical visits and microfinance… in Kenya (Chay J et al. 2024. Lancet Glob Health. 12(8):e1331–e1342).
- What skills and knowledge do you have that can contribute to an implementation research team?
- From what disciplines and fields do you draw insight in your research project?
- What communication and interpersonal skills are essential for implementation research teams?
2A
Who, what, when, and why: the importance of stakeholders
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- Stakeholder engagement is critically important for implementation research in improving processes, outcomes, and sustainability.
- The 7 Ps framework of classifying stakeholders.
- Three levels of stakeholder engagement: non-participation, symbolic participation, and engaged participation.
- Identifying stakeholders through a stakeholder analysis.
- Stakeholder engagement is needed from onset to finish throughout the entire process.
- Engaging stakeholders. Chapter 6 in Practical Implementation Science (Pellecchia M et al. 2022. Springer. 133–54).
- A new taxonomy for stakeholder engagement in patient-centred outcomes research (Concannon TW et al. 2012. J Gen Intern Med 27: 985–991).
- The science of stakeholder engagement in research: classification, implementation, and evaluation (Goodman MS; Sanders Thompson VL. 2017. Transl Behav Med 7(3): 486–491).
- What are the benefits of involving stakeholders in decision-making and implementation processes? What are the potential consequences of inadequate or ineffective stakeholder engagement?
- Who is in each of the ‘7 Ps’ groupings for your research project or work?
- How can researchers effectively identify and engage stakeholders at different stages of the research process?
- What metrics or indicators can be used to assess the effectiveness of stakeholder engagement activities?
2B
Community participatory action research
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- The goal of community participatory action research is better health equity, driven by communities with a bottom-up approach.
- It is vital to create long-standing engagement by showing up and building social networks, supporting and accepting change, and allowing respect and recognition for frustration.
- Importantly, you must: (i) listen; (ii) invite all to mutually learn; and (iii) stay and keep listening.
- If you want to walk fast, go alone; if you want to walk far, walk with others.
- How does community participatory action research (CPAR) differ from other, more traditional research approaches?
- What strategies or techniques can researchers employ to effectively engage with community members to build trust and partnerships?
- What challenges might arise in involving diverse community members in CPAR projects and how can these challenges be addressed?
3A
TMF for implementation research
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- When conducting implementation research, any one TMF will not be sufficient – TMFs are needed to cover several functions and different levels.
- No single TMF is perfect nor the only right one to use.
- Findings from your needs assessment and earlier literature are your best guides.
- Good resources exist to help you identify and select TMFs.
- Which TMFs are you most familiar with? What function(s) do they serve in your research or work?
- What advantages and challenges would you expect when using multiple TMFs in the same implementation research project?
3B
Mechanisms of change
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- Capabilities, opportunities and motivation are necessary preconditions of behaviour; other theories specify how these operate.
- Many of the same theories could be applied to implementer behaviours.
- More research developing, applying, and testing theories in LMIC settings is needed.
- The behaviour change wheel: a new method for characterising and designing behaviour change interventions (Michie S et al. 2011. Implementation Science 6: 42).
- SMART2D – development and contextualization of community strategies to support self-management in prevention and control of type 2 diabetes in Uganda, South Africa, and Sweden (Absetz P et al. 2020. Translational Behavioral Medicine 10(1): 25–34).
- Cultural adaptation of a peer-led lifestyle intervention program for diabetes prevention in India (Mathews E et al. 2017. BMC Public Health 17: 974).
- How does your understanding of behaviour change theories (e.g., Social Cognitive Theory, Theory of Planned Behaviour) inform your approach to implementation research?
- Which behaviour change TMFs are you planning to explore more deeply and why?
3C
Practical application – CFIR
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- The Consolidated Framework for Implementation Research (CFIR) is a useful tool to guide the development and evaluation of evidence-based interventions (EBIs).
- CFIR-based process evaluation can answer the fidelity, adaptations, and contextual factors influencing the implementation and effectiveness of EBIs.
- Updated CFIR 2.0 addresses critiques of the CFIR by focusing on “innovation recipients” and “equity in implementation”.
- For which aspects of implementation research would you choose to use CFIR?
- Would CFIR be useful in your implementation project or work? Why or why not?
3D
Practical application – RE-AIM
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- The RE-AIM framework can be used for simple or for complex topics.
- The indicators should be formulated well ahead of the evaluation, to enable data collection during implementation.
- The mixed method approach of both quantitative and qualitative data requires a multidisciplinary team to perform the research.
- What are the strengths and limitations of using RE-AIM in implementation research?
- How would you address reach, effectiveness, adoption, implementation, and maintenance in your project?
3E
How to choose a TMF
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- Using a TMF builds evidence around the frameworks themselves (“Do it for the science”).
- Start with your research proposal and work towards selecting a suitable TMF; this ensures the chosen framework aligns with the research aim.
- Make a choice of TMF that is practical for the specific research context.
- Multiple TMFs are permissible: students should use a TMF (or more than one) when conducting their research.
- A TMF guides the evaluation of the intervention and provides ideas for implementation strategies.
- TMFs can be categorised by their primary function: Determinant Frameworks (influences/barriers), Process Models (guides translation/change over time), and Evaluation Frameworks (outcomes/change between times).
- Nilsen, P. Making sense of implementation theories, models and frameworks. Implementation Sci 10, 53 (2015).
- Peters, D. H., et al. Implementation research: what it is and how to do it. BMJ 2013; 347 :f6753.
- Updated CFIR Constructs (The Consolidated Framework for Implementation Research).
- RE-AIM (Reach Effectiveness Adoption Implementation Maintenance).
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Does your primary research question seek to:
- Explore / Describe: What are the barriers and facilitators (Determinant Framework, e.g., CFIR or TDF)?
- Explain: How and why does the change occur over time (Process Model, e.g., K2A or Ottawa Model)?
- Influence: What are the outcomes or change in coverage (Evaluation Framework, e.g., RE-AIM or PRECEDE-PROCEED)?
- Given your current research proposal, what is the best TMF to use, keeping in mind the need for a practical choice?
- If using multiple TMFs (e.g., PRISM and RE-AIM), how do the components align to address both a contextual factor/explanatory question and an influence/outcome question?
4A
Context in implementation research
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- However you define context, it is crucial to implementation success.
- Frameworks can be helpful to structure or inform your approach to context assessment, and applying mixed methods will provide a richer understanding.
- Working with (rather than against) context allows researchers to adapt intervention components and implementation strategies to local needs.
- Working with context to implement NCD programmes – GACD thematic workshop (2023).
- Making sense of complexity in context and implementation: the CICI framework (Pfadenhauer LM et al. 2017. Implementation Science 12(1): 21).
- The role of context in implementation research for non-communicable diseases: Answering the ‘how-to’ dilemma (Daivadanam M et al. 2019. PLoS One 14(4): e0214454).
- What are the boundaries of the context of your implementation efforts?
- What research methods would be most relevant and practical to assess the context of your study? Why?
- In what ways might contextual data and knowledge be useful beyond your implementation research project?
4B
Practical application — Context in Fiji’s national program to prevent NCDs
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- Context is Foundational:
Define and understand context prior to implementation using stakeholder engagement and document analysis. - Systemic Evaluation is Key:
Develop a mixed-method evaluation taking a systems approach to assess implementation fidelity and adoption. - Theory of Change for Scale-up:
Use a theory of change logic model to ensure efficient and effective scale-up of the programme. - Evidence for Policy Impact:
Provide policymakers with tangible evidence from real-life experiences to maximise program impact. - Strengthen Health System Pillars:
Scaling up the WHO-PEN programme requires strengthening health system components: Governance (leadership/policy), Medicines and Technology (supply chain/digital procurement), Human Resources (training/mentoring), and Information (digital patient data/risk calculation). - Address Patient Access Barriers:
Strengthen community outreach to overcome socio-economic barriers to care, such as distance and cost. - Skepticism and Resource Limits:
Implementation is challenged by staff scepticism about long-term patient impact and resource limitations (e.g., transport). - Involve Community Leadership:
Engage with the community's social hierarchy (e.g., village headman) as this can be a more effective way to deliver advice.
- Patel B. et al. (2025). Understanding implementation, adoption, and acceptability of the WHO Package of Essential Noncommunicable (PEN) disease interventions in FIJI: Evidence for scale-up. PLOS Glob Public Health.
- Carroll C., Patterson M., Wood S., Booth A., Rick J., Balain S. (2007). A conceptual framework for implementation fidelity. Implementation Science.
- May C.R., Johnson M., Finch T. (2016). Implementation, context and complexity. Implementation Science.
- Damschroder L.J., Aron D.C., Keith R.E., Kirsh S.R., Alexander J.A., Lowery J.C. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science.
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Implementation Process:
How did the implementation process occur (including WHO involvement, Steering Committee, and Clinical Working Group), and what resources (personnel, funding) were provided?- Documentation:
What documentation exists on the adaptation of PEN Protocol 1 and 2, staff training (including pre-service integration), and procurement processes?
- Documentation:
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Adoption and Uptake (Reach):
How many people were screened for CVD risk, and what were the numbers by division/region?- Programme Impact:
How has the programme affected the increase in pathology tests, clinical CVD data recording, and medication use?
- Programme Impact:
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Fidelity and Quality:
Do the available data sources (e.g., patient records, pathology, medication records) allow for comparison of clinical characteristics between PEN clients and the broader at-risk population?- Measurement Tools:
What tools (e.g., clinical audit tool, adherence form) were used to measure staff capability and patient response to treatment?
- Measurement Tools:
- Contextual Differences:
What are the contextual differences across communities, regions, and SOPDs that may affect the programme’s outcomes? - Patient Perspective:
What are the patient's experiences regarding financial barriers, patient acceptance of the care, and awareness of conditions like high blood pressure?
4C
Practical application – Context in the Access Cancer Care India project
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- Assessing and understanding context has been crucial to the success of the Access Cancer Care India project.
- Leveraging meaningful stakeholder engagement is the backbone of assessing context.
- Surveys, focus groups, in-depth interviews, and policy analyses can contribute to understanding context at different levels.
- A validated tool (linked here) with a three-step method has been developed to assess health system capacity, intended for use in lower resourced settings.
- How can you leverage stakeholder engagement in your project to help inform your understanding of context?
- What other tools have you used or can you find in the literature that would help you assess your project’s context?
5A
Implementation strategies
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- The creation of a shared language for implementation strategies helps compare research findings.
- Defining the specifics of implementation strategies increases transparency and enables replication.
- Local context will influence which strategies are needed and the tailoring required.
- A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project (Powell BJ et al. 2015. Implementation Science 10: 21).
- Beyond “implementation strategies”: classifying the full range of strategies used in implementation science and practice (Leeman J et al. 2017. Implementation Science 12(1): 125).
- Implementation strategies: recommendations for specifying and reporting (Proctor EK et al. 2013. Implementation Science 8: 139).
- What is the value in having a shared language for implementation strategies?
- Which types of strategies address implementation barriers relative to your “know–do” gap?
5B
Study designs for implementation research (1)
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- In implementation science, we use a broad range of study designs, both quantitative and qualitative, and most often, mixed-method approaches.
- Hybrid studies have a dual focus on implementation evaluation and clinical/health outcome effectiveness.
- There are three types of hybrid studies (1, 2 and 3).
- The difference between them relies on the hierarchy of clinical/health versus implementation outcomes.
- Effectiveness–implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact (Curran GM et al. 2012. Medical Care 50(3): 217–226).
- An overview of research and evaluation designs for dissemination and implementation (Brown CH et al. 2017. Annual Review of Public Health 38: 1–22).
- Pragmatic trials (Ford I, Norrie J. 2016. New England Journal of Medicine 375(5): 454–463).
- How do the characteristics of the intervention and the research question influence the selection of an appropriate study design?
- What are the trade-offs between different designs in terms of internal and external validity?
- How can we balance the need for methodological rigour with the desire to conduct research that is relevant to real-world implementation challenges?
- What are the potential challenges and benefits of using mixed-methods designs to combine quantitative and qualitative data?
5C
This lecture is not yet released
(Coming soon)
5D
Implementation outcomes
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- Implementation outcomes – such as adoption and feasibility – need to be measured distinct from intervention outcomes.
- Choosing which implementation outcomes to use in your research should be informed by the barriers of implementation adoption, the stage of implementation, and relevant theories.
- When reporting implementation outcomes, report the data source and the measurement.
- Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda (Proctor EK et al. 2011. Administration and Policy in Mental Health 38(2): 65–76).
- Quantitative measures of health policy implementation determinants and outcomes: a systematic review (Allen P et al. 2020. Implementation Science 15(1): 47).
- Outcomes for implementation science: an enhanced systematic review of instruments using evidence-based rating criteria (Lewis CC et al. 2015. Implementation Science 10: 155).
- What factors should be considered when assessing the feasibility of different outcome measures?
- What factors can affect the reliability of measurement, and how can we improve reliability?
- How can we evaluate the long-term effects of implementation strategies, particularly when considering sustainability and scalability?
6A
Connecting & collaborating across the IR community
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- Implementation research involves team science.
- There can be challenges when working across disciplines, countries, and cultures – but these challenges can be overcome.
- Multiple training opportunities are available.
- A multi-level systems perspective for the science of team science (Börner K et al. 2010. Science Translational Medicine 2(49): 49cm24).
- Mentorship is not enough: Exploring sponsorship and its role in career advancement in academic medicine (Ayyala MS et al. 2019. Academic Medicine 94(1): 94–100).
- Find more on our Resources Library, under “Career development resources”.
- What are the most challenging aspects for you when working across disciplines, countries, and cultures?
- What creative ways can you think of to overcome these challenges?
- Beyond a ‘mentor’, what sort of support is available to you in your team, in your institution, or in your wider network?
6B
The GACD funding model and grant applications
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- Make sure you are applying to the right funder.
- Read all available guidance thoroughly.
- Always ask for help if you need it!
- What do you think is the most important thing to consider when applying for funding?
6C
This lecture is not yet released
(Coming soon)
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