Implementation Science to Bridge the Gap Between Evidence and Practice
Although there is a long tradition of epidemiological research on population health and risk factors for chronic disease, and efficacy trials demonstrating effect of interventions that address these risk factors, wider implementation of the findings in real-life is slow, and programmes are rarely sustained in practice. One of the key barriers for putting evidence into practice is lack of rigorous scientific approach in design, implementation and evaluation of the programmes.
Implementation research applies scientific methods to investigate and address the various factors that affect how a new evidence-based policy or intervention may be adapted and implemented in real-life settings.
Questions addressed by implementation research include:
- Which evidence-based policy or intervention is best for a new context or a target group?
- What is the best way to implement it?
- How can the target population be reached?
- What factors might affect implementation and adoption?
- How can the costs of implementation be minimized?
- How can uptake and health outcomes be improved?
- How can the policies or programmes best be sustained and scaled-up?
Why Is Implementation Research Important?
One of the purposes of implementation research is to support the successful selection of policies and interventions that have been shown to be efficacious.(1) It also helps identify how to implement these policies and interventions in contexts where populations and/or resources may differ from that where they were initially formulated and evaluated and helps identify which components of a policy or intervention are needed to obtain intended outcomes. Moreover, when prevention and control efforts fail, implementation research can help identify whether failure was due to a policy/intervention being ineffective in the setting (intervention failure) or whether a so-called good policy/intervention was deployed incorrectly (implementation failure).(2)
In effect, implementation research is about learning how to optimize implementation, scale up promising strategies, evaluate impact and, importantly, how to sustain these strategies over the long term. Notably, implementation research has the potential to bridge the evidence-into-action gap.
How Is Implementation Research Conducted?
There is a growing number of theories and models describing implementation and the implementation research process.(3-6) Implementation typically involves a step-wise, cyclical process (See Figure above).
The first step is to work with key stakeholders in order to define the specific health need and then identify an appropriate policy or intervention to address that need. The second step is adaptation of the selected policy or intervention to the local context and undertaking some piloting. The third step involves implementation of the adapted policy or intervention. The fourth and final step is assessing if the adapted policy or intervention can be more widely implemented or scaled up and, if so, defining the resources and further steps that will be required to achieve this.(7,8)
In practice, the path from selection (step 1) through to scale up (step 4) is rarely direct, as it is usually determined by multiple stakeholders, the availability of resources and other contextual factors. Instead, it normally has numerous iterations involving going back and forth between two or more process steps.
- A guide to implementation research in the prevention and control of noncommunicable diseases. Geneva: World Health Organization; 2016. Licence: CC BY-NC-SA 3.0 IGO
- Proctor, E.K., et al., Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda. Administration and Policy in Mental Health and Mental Health Services Research, 2011. 38(2): p. 65-76.
- Davies, P., A.E. Walker, and J.M. Grimshaw, A systematic review of the use of theory in the design of guideline dissemination and implementation strategies and interpretation of the results of rigorous evaluations. Implementation Science, 2010. 5: p. 1-6.
- Michie, S., et al., Specifying and reporting complex behaviour change interventions: The need for a scientific method. Implementation Science, 2009. 4: p. 40.
- Damschroder, L.J., et al., Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science, 2009. 4: p. 50.
- McDonald, K.M., I.D. Graham, and J. Grimshaw, Toward a theoretical basis for quality improvement interventions, in Closing the quality gap: A critical analysis of quality improvement strategies, K.G. Shojania, et al., Editors. 2004, Agency for Healthcare Research and Quality: Rockville, MD.
- TDR Special Programme for Research and Training in Tropical Diseases, Implementation research toolkit. 2014: World Health Organization.
- Proctor, E.K., et al., Writing implementation research grant proposals: Ten key ingredients. Implementation Science, 2012. 7: p. 96.
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