A Pragmatic Approach to Guide Implementation Evaluation Research: Strategy Mapping for Complex Interventions
IntroductionGreater specification of implementation strategies is a challenge for implementation science, but there is little guidance for delineating the use of multiple strategies involved in complex interventions. The Cardiovascular (CV) Toolkit project entails implementation of a toolkit designe...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2018-05-01
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| Series: | Frontiers in Public Health |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fpubh.2018.00134/full |
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| author | Alexis K. Huynh Alison B. Hamilton Alison B. Hamilton Melissa M. Farmer Bevanne Bean-Mayberry Bevanne Bean-Mayberry Shannon Wiltsey Stirman Shannon Wiltsey Stirman Tannaz Moin Tannaz Moin Erin P. Finley Erin P. Finley |
| author_facet | Alexis K. Huynh Alison B. Hamilton Alison B. Hamilton Melissa M. Farmer Bevanne Bean-Mayberry Bevanne Bean-Mayberry Shannon Wiltsey Stirman Shannon Wiltsey Stirman Tannaz Moin Tannaz Moin Erin P. Finley Erin P. Finley |
| author_sort | Alexis K. Huynh |
| collection | DOAJ |
| description | IntroductionGreater specification of implementation strategies is a challenge for implementation science, but there is little guidance for delineating the use of multiple strategies involved in complex interventions. The Cardiovascular (CV) Toolkit project entails implementation of a toolkit designed to reduce CV risk by increasing women’s engagement in appropriate services. The CV Toolkit project follows an enhanced version of Replicating Effective Programs (REP), an evidence-based implementation strategy, to implement the CV Toolkit across four phases: pre-conditions, pre-implementation, implementation, and maintenance and evolution. Our current objective is to describe a method for mapping implementation strategies used in real time as part of the CV Toolkit project. This method supports description of the timing and content of bundled strategies and provides a structured process for developing a plan for implementation evaluation.MethodsWe conducted a process of strategy mapping to apply Proctor and colleagues’ rubric for specification of implementation strategies, constructing a matrix in which we identified each implementation strategy, its conceptual group, and the corresponding REP phase(s) in which it occurs. For each strategy, we also specified the actors involved, actions undertaken, action targets, dose of the implementation strategy, and anticipated outcome addressed. We iteratively refined the matrix with the implementation team, including use of simulation to provide initial validation.ResultsMapping revealed patterns in the timing of implementation strategies within REP phases. Most implementation strategies involving the development of stakeholder interrelationships and training and educating stakeholders were introduced during the pre-conditions or pre-implementation phases. Strategies introduced in the maintenance and evolution phase emphasized communication, re-examination, and audit and feedback. In addition to its value for producing valid and reliable process evaluation data, mapping implementation strategies has informed development of a pragmatic blueprint for implementation and longitudinal analyses and evaluation activities.DiscussionWe update recent recommendations on specification of implementation strategies by considering the implications for multi-strategy frameworks and propose an approach for mapping the use of implementation strategies within complex, multi-level interventions, in support of rigorous evaluation. Developing pragmatic tools to aid in operationalizing the conduct of implementation and evaluation activities is essential to enacting sound implementation research. |
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| institution | Directory Open Access Journal |
| issn | 2296-2565 |
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| publishDate | 2018-05-01 |
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| spelling | doaj.art-bab5c392239c4978aa9feb045ca6136f2022-12-21T19:30:09ZengFrontiers Media S.A.Frontiers in Public Health2296-25652018-05-01610.3389/fpubh.2018.00134350752A Pragmatic Approach to Guide Implementation Evaluation Research: Strategy Mapping for Complex InterventionsAlexis K. Huynh0Alison B. Hamilton1Alison B. Hamilton2Melissa M. Farmer3Bevanne Bean-Mayberry4Bevanne Bean-Mayberry5Shannon Wiltsey Stirman6Shannon Wiltsey Stirman7Tannaz Moin8Tannaz Moin9Erin P. Finley10Erin P. Finley11VA Greater Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA, United StatesVA Greater Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA, United StatesDavid Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United StatesVA Greater Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA, United StatesVA Greater Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA, United StatesDavid Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United StatesDepartment of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, United StatesVA Palo Alto Healthcare System, Menlo Park, CA, United StatesVA Greater Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA, United StatesDavid Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United StatesSouth Texas Veterans Healthcare System, San Antonio, TX, United StatesUT Health Science Center, San Antonio, TX, United StatesIntroductionGreater specification of implementation strategies is a challenge for implementation science, but there is little guidance for delineating the use of multiple strategies involved in complex interventions. The Cardiovascular (CV) Toolkit project entails implementation of a toolkit designed to reduce CV risk by increasing women’s engagement in appropriate services. The CV Toolkit project follows an enhanced version of Replicating Effective Programs (REP), an evidence-based implementation strategy, to implement the CV Toolkit across four phases: pre-conditions, pre-implementation, implementation, and maintenance and evolution. Our current objective is to describe a method for mapping implementation strategies used in real time as part of the CV Toolkit project. This method supports description of the timing and content of bundled strategies and provides a structured process for developing a plan for implementation evaluation.MethodsWe conducted a process of strategy mapping to apply Proctor and colleagues’ rubric for specification of implementation strategies, constructing a matrix in which we identified each implementation strategy, its conceptual group, and the corresponding REP phase(s) in which it occurs. For each strategy, we also specified the actors involved, actions undertaken, action targets, dose of the implementation strategy, and anticipated outcome addressed. We iteratively refined the matrix with the implementation team, including use of simulation to provide initial validation.ResultsMapping revealed patterns in the timing of implementation strategies within REP phases. Most implementation strategies involving the development of stakeholder interrelationships and training and educating stakeholders were introduced during the pre-conditions or pre-implementation phases. Strategies introduced in the maintenance and evolution phase emphasized communication, re-examination, and audit and feedback. In addition to its value for producing valid and reliable process evaluation data, mapping implementation strategies has informed development of a pragmatic blueprint for implementation and longitudinal analyses and evaluation activities.DiscussionWe update recent recommendations on specification of implementation strategies by considering the implications for multi-strategy frameworks and propose an approach for mapping the use of implementation strategies within complex, multi-level interventions, in support of rigorous evaluation. Developing pragmatic tools to aid in operationalizing the conduct of implementation and evaluation activities is essential to enacting sound implementation research.https://www.frontiersin.org/article/10.3389/fpubh.2018.00134/fullimplementation strategiesstrategy mappingcomplex interventionsimplementation blueprintevaluation |
| spellingShingle | Alexis K. Huynh Alison B. Hamilton Alison B. Hamilton Melissa M. Farmer Bevanne Bean-Mayberry Bevanne Bean-Mayberry Shannon Wiltsey Stirman Shannon Wiltsey Stirman Tannaz Moin Tannaz Moin Erin P. Finley Erin P. Finley A Pragmatic Approach to Guide Implementation Evaluation Research: Strategy Mapping for Complex Interventions Frontiers in Public Health implementation strategies strategy mapping complex interventions implementation blueprint evaluation |
| title | A Pragmatic Approach to Guide Implementation Evaluation Research: Strategy Mapping for Complex Interventions |
| title_full | A Pragmatic Approach to Guide Implementation Evaluation Research: Strategy Mapping for Complex Interventions |
| title_fullStr | A Pragmatic Approach to Guide Implementation Evaluation Research: Strategy Mapping for Complex Interventions |
| title_full_unstemmed | A Pragmatic Approach to Guide Implementation Evaluation Research: Strategy Mapping for Complex Interventions |
| title_short | A Pragmatic Approach to Guide Implementation Evaluation Research: Strategy Mapping for Complex Interventions |
| title_sort | pragmatic approach to guide implementation evaluation research strategy mapping for complex interventions |
| topic | implementation strategies strategy mapping complex interventions implementation blueprint evaluation |
| url | https://www.frontiersin.org/article/10.3389/fpubh.2018.00134/full |
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