Day 2: Strategies and Outcomes

Table of Contents

Day 2: Strategies and Outcomes

What are implementation strategies? #

  1. Grol, R. & Wensing, M. Selection of strategies for improving patient care. In: Wensing, R. Grol, & J. Grimshaw (Eds.). Improving Patient Care: The Implementation of Change in Health Care 3rd ed. Wiley-Blackwell; 2020. p.191-206. https://doi.org/10.1002/9781119488620.ch10
  2. Powell, B.J., Waltz, T.J., Chinman, M.J., Damschroder, L.J., Smith, J.L., Matthieu, M.M., Proctor, E.K, & Kircher, J.E. A refined compilation of implementation strategies: results from the Expert recommendations for Implementing Change (ERIC) project. Implementation Science. 2015; 10(1), 21. https://doi.org/10.1186/s13012-015-0209-1
  3. Proctor, E.K., Powell, B.J., & McMillen, J.C. Implementation Strategies: Recommendations for specifying and reporting. Implementation Science, 2013 Dec; 8(1):139. https://doi.org/10.1186/1748-5908-8-139
  4. Fernandez ME, Ten Hoor GA, Van Lieshout S, Rodriguez SA, Beidas RS, Parcel G, Ruiter RA, Markham CM, Kok G. Implementation mapping: using intervention mapping to develop implementation strategies. Frontiers in public health. 2019 Jun 18;7:158.
  5. Kirchner J. E., Waltz J. T., Powell B. J., Woodared J.L., & Proctor, E. K. Implementation Strategies. In R.C. Brownson, G.A Colditz, & E.K Proctor (Eds.). Dissemination and implementation research in health: Translating science to practice to Practice. Oxford University Press; 2023. p.119-146. https://doi.org/10.1093/oso/9780190683214.003.0015
  6. McHugh SM, Riordan F, Curran GM, Lewis CC, Wolfenden L, Presseau J, Lengnick-Hall R, Powell BJ. Conceptual tensions and practical trade-offs in tailoring implementation interventions. Front Health Serv. 2022 Nov 17;2:974095. PMID: 36925816; PMCID: PMC10012756.
  7. Powell BJ, Beidas RS, Lewis CC, Aarons GA, McMillen JC, Proctor EK, Mandell DS. Methods to improve the selection and tailoring of implementation strategies. The journal of behavioral health services & research. 2017 Apr;44:177-94.
  8. Riordan F, Kerins C, Pallin N, Albers B, Clack L, Morrissey E, Curran GM, Lewis CC, Powell BJ, Presseau J, Wolfenden L. Characterising processes and outcomes of tailoring implementation strategies in healthcare: a protocol for a scoping review. HRB Open Research. 2022 Sep 20;5(17):17.
  9. Waltz TJ, Powell BJ, Fernández ME, Abadie B, Damschroder LJ. Choosing implementation strategies to address contextual barriers: diversity in recommendations and future directions. Implementation science. 2019 Dec;14(1):1-5.
  10. Leeman, J., Birken, S.A., Powell, B.J., Rohweder, C., & Shea, C.M. Beyond “Implementation Strategies”: classifying the full range of strategies used in implementation science and practice. Implementation Science, 2017; 12(125).

Examples of strategies #

  1. Halpaap BM, Tucker JD, Mathanga D, Juban N, Awor P, Saravia NG, Han L, de Villiers K, Kitamura M, Cuervo LG, Peeling R, Reeder JC. Social innovation in global health: sparking location action. Lancet Glob Health. 2020 May;8(5):e633-e634. doi: 10.1016/S2214-109X(20)30070-X. PMID: 32353305. Link: https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30070-X/fulltext
  2. Byrne M, Tan RKJ, Wu D, Marley G, Hlatshwako TG, Tao Y, Bissram J, Nachman S, Tang W, Ramaswamy R, Tucker JD. Prosocial Interventions and Health Outcomes: A Systematic Review and Meta-Analysis. JAMA Netw Open. 2023 Dec 1;6(12):e2346789. doi: 10.1001/jamanetworkopen.2023.46789. PMID: 38064214; PMCID: PMC10709779. Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10709779/
  3. Beres LK, Simbeza S, Holmes CB, Mwamba C, Mukamba N, Sharma A, Munamunungu V, Mwachande. M., et al. Human-Centered Design Lessons for Implementation Science: Improving the Implementation of a Patient-Centered Care Intervention. J Acquir Immune Defic Syndr. 2019 Dec; 82 Suppl 3(3):S230-S243. PMID: 31764259; PMCID: PMC6880397.
  4. Dopp AR, Parisi KE, Munson SA, Lyon AR. Aligning implementation and user-centered design strategies to enhance the impact of health services: results from a concept mapping study. Implementation Science Communications. 2020 Dec;1(1):1-3.
  5. Valente TW. Network interventions. Science. 2012 Jul 6;337(6090):49-53.
  6. Tang W, Ritchwood TD, Wu D, Ong JJ, Wei C, Iwelunmor J, Tucker JD. Crowdsourcing to improve HIV and sexual health outcomes: a scoping review. Current HIV/AIDS Reports. 2019 Aug 15;16:270-8.
  7. Tang W, Wei C, Cao B, Wu D, Li KT, Lu H, Ma W, Kang D, Li H, Liao M, Mollan KR. Crowdsourcing to expand HIV testing among men who have sex with men in China: a closed cohort stepped wedge cluster randomized controlled trial. PLoS medicine. 2018 Aug 28;15(8):e1002645.
  8. Tang, Weiming, et al. “Crowdsourcing health communication about condom use in men who have sex with men in China: a randomised controlled trial.” The Lancet. 2016; S73 388.
  9. de Walque D. The use of financial incentives to prevent unhealthy behaviors: A review. Social Science & Medicine. 2020 Jul 27; 113236.
  10. Downs JA, Mwakisole AH, Chandika AB, Lugoba S, Kassim R, Laizer E, Magambo KA, Lee MH, Kalluvya SE, Downs DJ, Fitzgerald DW. Educating religious leaders to promote uptake of male circumcision in Tanzania: a cluster randomised trial. The Lancet. 2017 Mar 18;389(10074):1124-32.
  11. Hallsworth M, Chadborn T, Sallis A, Sanders M, Berry D, Greaves F, Clements L, Davies SC. Provision of social norm feedback to high prescribers of antibiotics in general practice: a pragmatic national randomised controlled trial. The Lancet. 2016 Apr 23;387(10029):1743-52.
  12. Ciapponi A, Lewin S, Herrera CA, Opiyo N, Pantoja T, Paulsen E, Rada G, Wiysonge CS, Bastias G, Dudley L, Flottorp S. Delivery arrangements for health systems in low‐income countries: an overview of systematic reviews. Cochrane Database of Systematic Reviews. 2017;(9).
  13. Bunger, A. C., Yousefi-Nooraie, R., Warren, K., Cao, Q., Dadgostar, P., & Bustos, T. E. (2023). Developing a typology of network alteration strategies for implementation: A scoping review and iterative synthesis. Implementation Science, 18(1), 10. https://doi.org/10.1186/s13012-023-01266-3
  14. Gillam SJ, Siriwardena AN, Steel N. Pay-for-performance in the United Kingdom: impact of the quality and outcomes framework—a systematic review. The Annals of Family Medicine. 2012 Sep 1;10(5):461-8.
  15. Kilbourne AM, Geng E, Eshun-Wilson I, Sweeney S, Shelley D, Cohen DJ, Kirchner JE, Fernandez ME, Parchman ML. How does facilitation in healthcare work? Using mechanism mapping to illuminate the black box of a meta-implementation strategy. Implementation science communications. 2023 May 16;4(1):53.
  16. Jamtvedt G, Young JM, Kristoffersen DT, O’Brien MA, Oxman AD. Does telling people what they have been doing change what they do? A systematic review of the effects of audit and feedback. BMJ Quality & Safety. 2006 Dec 1;15(6):433-6.

What are implementation outcomes? #

  1. Proctor, E., Silmere, H., Raghavan, R., Hovmand, P., Aarons, G., Bunger, A., Griffey, R., & Hensley, M. (2011). Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Administration and policy in mental health, 38(2), 65–76. https://doi.org/10.1007/s10488-010-0319-7
  2. Proctor, E.K., Bunger, A.C., Lengnick-Hall, R., Gerke, D.R., Martin, J.K., Phillips, R.J., and Swason, J.C. Ten Years of Implementation Outcomes Research: A Scoping Review. Implementation Science, 2023; 18:31 https://doi.org/10.1186/s13012-023-01286-z
  3. Sekhon, M., Cartwright, M. & Francis, J.J. Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework. BMC Health Serv Res. 2017; 17 88. https://doi.org/10.1186/s12913-017-2031-8
  4. Valentijn PP, Schepman SM, Opheij W, Bruijnzeels MA. Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care. Int J Integr Care. March 2013;13:e010. doi:10.5334/ijic.886
  5. Lengnick-Hall R, Gerke DR, Proctor EK, Bunger AC, Phillips RJ, Martin JK, Swanson JC. Six practical recommendations for improved implementation outcomes reporting. Implementation Science. 2022 Feb 8;17(1):16.
  6. Goss, C. W., Filiatreau, L. M., Hirschhorn, L. R., Huffman, M. D., Mody, A., Powell, B. J., Tetteh, E., Geng, E. H., & Mosepele, M. (2025). Conceptualizing patient-level adverse effects in implementation trials. Annals of epidemiology, 102, 55–61. https://doi.org/10.1016/j.annepidem.2024.12.012

Examples of Implementation Outcomes: Acceptability, Sustainability, Deimplementation #

  1. Weiner BJ, Lewis CC, Stanick C, et al. Psychometric assessment of three newly developed implementation outcome measures. Implement Sci. 2017;12(1):108. Published 2017 Aug 29. doi:10.1186/s13012-017-0635-3
  2. Bacon, C., Malone, S., Prewitt, K., Hackett, R., Hastings, M., Dexter, S., & Luke, D. A. (2022). Assessing the sustainability capacity of evidence-based programs in community and health settings. Frontiers in health services, 2, 1004167. https://doi.org/10.3389/frhs.2022.1004167
  3. Luke, D. A., Calhoun, A., Robichaux, C. B., Elliott, M. B., & Moreland-Russell, S. (2014). The Program Sustainability Assessment Tool: a new instrument for public health programs. Preventing chronic disease, 11, 130184. https://doi.org/10.5888/pcd11.130184
  4. CSAT: Clinical Sustainability Assessment Tool – Malone, S., Prewitt, K., Hackett, R., Lin, J. C., McKay, V., Walsh-Bailey, C., & Luke, D. A. (2021). The Clinical Sustainability Assessment Tool: measuring organizational capacity to promote sustainability in healthcare. Implementation science communications, 2(1), 77. https://doi.org/10.1186/s43058-021-00181-2
  5. Malone, S., Prewitt, K., McKay, V., Zabotka, L., Bacon, C., & Luke, D. A. (2024). Lowering the burden: Shorter versions of the Program Sustainability Assessment Tool (PSAT) and Clinical Sustainability Assessment Tool (CSAT). Implementation science communications, 5(1), 113. https://doi.org/10.1186/s43058-024-00656-y
  6. Irie, W. C., Kerkhoff, A., Kim, H. Y., Geng, E., & Eshun-Wilson, I. (2024). Using stated preference methods to facilitate knowledge translation in implementation science. Implementation science communications, 5(1), 32. https://doi.org/10.1186/s43058-024-00554-3
  7. McKay VR, Morshed AB, Brownson RC, Proctor EK, Prusaczyk B. Letting go: Conceptualizing intervention de‐implementation in public health and social service settings. American Journal of Community Psychology. 2018 Sep;62(1-2):189-202.
  8. NoMAD (Normalization Measure Development questionnaire) – Rapley, T., Girling, M., Mair, F. S., Murray, E., Treweek, S., McColl, E., Steen, I. N., May, C. R., & Finch, T. L. (2018). Improving the normalization of complex interventions: part 1 – development of the NoMAD instrument for assessing implementation work based on normalization process theory (NPT). BMC medical research methodology, 18(1), 133. https://doi.org/10.1186/s12874-018-0590-y
  9. Webb KA, Mavhu W, Langhaug L, Chitiyo V, Matyanga P, Charashika P, Patel D, Prost A, Ferrand RA, Bernays S, Cislaghi B. ‘I was trying to get there, but I couldn’t’: social norms, vulnerability and lived experiences of home delivery in Mashonaland Central Province, Zimbabwe. Health policy and planning. 2021 Nov 1;36(9):1441-50.
  10. Moreland-Russell S, Jost E, Gannon J. A conceptual model for building program sustainability in public health settings: Learning from the implementation of the program sustainability action planning model and training curricula. Frontiers in Health Services. 2023 Mar 29;3:1026484

Mechanisms #

  1. Sarkies, Mitchell N., et al. “Effectiveness of knowledge brokering and recommendation dissemination for influencing healthcare resource allocation decisions: A cluster randomised controlled implementation trial.” PLoS Medicine 2021;18:10 e1003833.
  2. Geng, E.H., Baumann, A.A., & Powell, B.J. Mechanism mapping to advance research on implementation strategies. PLoS Medicine. 2022; 19(2) https://doi.org/10.1371/journal.pmed.1003918
  3. Geng EH, Powell BJ, Goss CW, Lewis CC, Sales AE, Kim B. When the parts are greater than the whole: how understanding mechanisms can advance implementation research. Implementation Science. 2025 May 13;20(1):22.
  4. Lewis, C. C., Klasnja, P., Powell, B. J., Lyon, A. R., Tuzzio, L., Jones, S., et al. From classification to causality: advancing understanding of mechanisms of change in implementation science. Frontiers in public health. 2018;6 p.136.
  5. Lewis CC, Frank HE, Cruden G, Kim B, Stahmer AC, Lyon AR, Albers B, Aarons GA, Beidas RS, Mittman BS, Weiner BJ. A research agenda to advance the study of implementation mechanisms. Implementation Science Communications. 2024 Sep 16;5(1):98.
  6. Dhillon L, Vaca S. Refining theories of change. Journal of MultiDisciplinary Evaluation. 2018 Apr 13;14(30):64-87.
  7. Dixon‐Woods MA, Bosk CL, Aveling EL, Goeschel CA, Pronovost PJ. Explaining Michigan: developing an ex post theory of a quality improvement program. The Milbank quarterly. 2011 Jun;89(2):167-205.
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