A systematic review of empirical studies examining mechanisms of implementation in health
Abstract Background Understanding the mechanisms of implementation strategies (i.e., the processes by which strategies produce desired effects) is important for research to understand why a strategy did or did not achieve its intended effect, and it is important for practice to ensure strategies are...
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| Format: | Article |
| Language: | English |
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BMC
2020-04-01
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| Series: | Implementation Science |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13012-020-00983-3 |
| _version_ | 1811224211061997568 |
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| author | Cara C. Lewis Meredith R. Boyd Callie Walsh-Bailey Aaron R. Lyon Rinad Beidas Brian Mittman Gregory A. Aarons Bryan J. Weiner David A. Chambers |
| author_facet | Cara C. Lewis Meredith R. Boyd Callie Walsh-Bailey Aaron R. Lyon Rinad Beidas Brian Mittman Gregory A. Aarons Bryan J. Weiner David A. Chambers |
| author_sort | Cara C. Lewis |
| collection | DOAJ |
| description | Abstract Background Understanding the mechanisms of implementation strategies (i.e., the processes by which strategies produce desired effects) is important for research to understand why a strategy did or did not achieve its intended effect, and it is important for practice to ensure strategies are designed and selected to directly target determinants or barriers. This study is a systematic review to characterize how mechanisms are conceptualized and measured, how they are studied and evaluated, and how much evidence exists for specific mechanisms. Methods We systematically searched PubMed and CINAHL Plus for implementation studies published between January 1990 and August 2018 that included the terms “mechanism,” “mediator,” or “moderator.” Two authors independently reviewed title and abstracts and then full texts for fit with our inclusion criteria of empirical studies of implementation in health care contexts. Authors extracted data regarding general study information, methods, results, and study design and mechanisms-specific information. Authors used the Mixed Methods Appraisal Tool to assess study quality. Results Search strategies produced 2277 articles, of which 183 were included for full text review. From these we included for data extraction 39 articles plus an additional seven articles were hand-entered from only other review of implementation mechanisms (total = 46 included articles). Most included studies employed quantitative methods (73.9%), while 10.9% were qualitative and 15.2% were mixed methods. Nine unique versions of models testing mechanisms emerged. Fifty-three percent of the studies met half or fewer of the quality indicators. The majority of studies (84.8%) only met three or fewer of the seven criteria stipulated for establishing mechanisms. Conclusions Researchers have undertaken a multitude of approaches to pursue mechanistic implementation research, but our review revealed substantive conceptual, methodological, and measurement issues that must be addressed in order to advance this critical research agenda. To move the field forward, there is need for greater precision to achieve conceptual clarity, attempts to generate testable hypotheses about how and why variables are related, and use of concrete behavioral indicators of proximal outcomes in the case of quantitative research and more directed inquiry in the case of qualitative research. |
| first_indexed | 2024-04-12T08:44:36Z |
| format | Article |
| id | doaj.art-01c5e575d1c74f38992c03005781e01e |
| institution | Directory Open Access Journal |
| issn | 1748-5908 |
| language | English |
| last_indexed | 2024-04-12T08:44:36Z |
| publishDate | 2020-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science |
| spelling | doaj.art-01c5e575d1c74f38992c03005781e01e2022-12-22T03:39:44ZengBMCImplementation Science1748-59082020-04-0115112510.1186/s13012-020-00983-3A systematic review of empirical studies examining mechanisms of implementation in healthCara C. Lewis0Meredith R. Boyd1Callie Walsh-Bailey2Aaron R. Lyon3Rinad Beidas4Brian Mittman5Gregory A. Aarons6Bryan J. Weiner7David A. Chambers8Kaiser Permanente Washington Health Research InstituteDepartment of Psychology, University of California Los AngelesKaiser Permanente Washington Health Research InstituteDepartment of Psychiatry and Behavioral Sciences, School of Medicine, University of WashingtonDepartment of Psychiatry, Perelman School of Medicine, University of PennsylvaniaDepartment of Research and Evaluation, Kaiser Permanente Southern CaliforniaDepartment of Psychiatry, School of Medicine, University of California San DiegoDepartment of Health Services, University of WashingtonDivision of Cancer Control and Population Science, National Cancer InstituteAbstract Background Understanding the mechanisms of implementation strategies (i.e., the processes by which strategies produce desired effects) is important for research to understand why a strategy did or did not achieve its intended effect, and it is important for practice to ensure strategies are designed and selected to directly target determinants or barriers. This study is a systematic review to characterize how mechanisms are conceptualized and measured, how they are studied and evaluated, and how much evidence exists for specific mechanisms. Methods We systematically searched PubMed and CINAHL Plus for implementation studies published between January 1990 and August 2018 that included the terms “mechanism,” “mediator,” or “moderator.” Two authors independently reviewed title and abstracts and then full texts for fit with our inclusion criteria of empirical studies of implementation in health care contexts. Authors extracted data regarding general study information, methods, results, and study design and mechanisms-specific information. Authors used the Mixed Methods Appraisal Tool to assess study quality. Results Search strategies produced 2277 articles, of which 183 were included for full text review. From these we included for data extraction 39 articles plus an additional seven articles were hand-entered from only other review of implementation mechanisms (total = 46 included articles). Most included studies employed quantitative methods (73.9%), while 10.9% were qualitative and 15.2% were mixed methods. Nine unique versions of models testing mechanisms emerged. Fifty-three percent of the studies met half or fewer of the quality indicators. The majority of studies (84.8%) only met three or fewer of the seven criteria stipulated for establishing mechanisms. Conclusions Researchers have undertaken a multitude of approaches to pursue mechanistic implementation research, but our review revealed substantive conceptual, methodological, and measurement issues that must be addressed in order to advance this critical research agenda. To move the field forward, there is need for greater precision to achieve conceptual clarity, attempts to generate testable hypotheses about how and why variables are related, and use of concrete behavioral indicators of proximal outcomes in the case of quantitative research and more directed inquiry in the case of qualitative research.http://link.springer.com/article/10.1186/s13012-020-00983-3MechanismModeratorMediatorDeterminantImplementationCausal model |
| spellingShingle | Cara C. Lewis Meredith R. Boyd Callie Walsh-Bailey Aaron R. Lyon Rinad Beidas Brian Mittman Gregory A. Aarons Bryan J. Weiner David A. Chambers A systematic review of empirical studies examining mechanisms of implementation in health Implementation Science Mechanism Moderator Mediator Determinant Implementation Causal model |
| title | A systematic review of empirical studies examining mechanisms of implementation in health |
| title_full | A systematic review of empirical studies examining mechanisms of implementation in health |
| title_fullStr | A systematic review of empirical studies examining mechanisms of implementation in health |
| title_full_unstemmed | A systematic review of empirical studies examining mechanisms of implementation in health |
| title_short | A systematic review of empirical studies examining mechanisms of implementation in health |
| title_sort | systematic review of empirical studies examining mechanisms of implementation in health |
| topic | Mechanism Moderator Mediator Determinant Implementation Causal model |
| url | http://link.springer.com/article/10.1186/s13012-020-00983-3 |
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