Specifying and Reporting Implementation Strategies Used in a School-Based Prevention Efficacy Trial

Background: The ultimate impact of a health innovation depends not only on its effectiveness but also on its reach in the population and the extent to which it is implemented with high levels of completeness and fidelity. Implementation science has emerged as the potential solution to the failure to translate evidence from research into effective practice and policy evident in many fields. Implementation scientists have developed many frameworks, theories and models, which describe implementation determinants, processes, or outcomes; yet, there is little guidance about how these can inform the development or selection of implementation strategies (methods or techniques used to improve adoption, implementation, sustainment, and scale-up of interventions) (1, 2). To move the implementation science field forward and to provide a practical tool to apply the knowledge in this field, we describe a systematic process for planning or selecting implementation strategies: Implementation Mapping.Methods: Implementation Mapping is based on Intervention Mapping (a six-step protocol that guides the design of multi-level health promotion interventions and implementation strategies) and expands on Intervention Mapping step 5. It includes insights from both the implementation science field and Intervention Mapping. Implementation Mapping involves five tasks: (1) conduct an implementation needs assessment and identify program adopters and implementers; (2) state adoption and implementation outcomes and performance objectives, identify determinants, and create matrices of change objectives; (3) choose theoretical methods (mechanisms of change) and select or design implementation strategies; (4) produce implementation protocols and materials; and (5) evaluate implementation outcomes. The tasks are iterative with the planner circling back to previous steps throughout this process to ensure all adopters and implementers, outcomes, determinants, and objectives are addressed.Discussion: Implementation Mapping provides a systematic process for developing strategies to improve the adoption, implementation, and maintenance of evidence-based interventions in real-world settings.

ObjectiveThis scoping review aims to identify and map the empirical literature on the implementation strategies and outcomes of school-based programs for adolescent suicide prevention (SBASP).IntroductionSchool-based programs are preferred interventions for preventing suicide in adolescents, and their effectiveness has been well-systematized in several reviews. Implementation research is a growing field for prevention programs, making it possible to understand the nature of success or failure outcomes and maximize intervention benefits. However, there is a knowledge gap in the implementation research applied to adolescent suicide prevention in the educational context. We conduct a scoping review to provide the first overview of the scope of implementation research applied to adolescent suicide prevention programs in the school setting to know what implementation strategies and outcomes are reported by these programs and how they are evaluated.MethodsThe proposed scoping review will be conducted following six stages, including the definition of objectives. Studies must be empirical and address implementation strategies or implementation outcomes of school-based programs for adolescent suicide prevention. Studies that focused exclusively on clinical efficacy or effectiveness evaluation will be excluded. A preliminary search of PubMed was conducted to refine the initial search strings, followed by a final search of several other electronic databases. Finally, a gray literature search will identify unpublished literature and reduce location bias. There will be no limits to a specific date. Two independent reviewers will screen, select, and extract the retrieved records. The results will be presented using tabular forms and a narrative summary with attention to the review objectives and research questions and their implications for research and practice of school-based programs for adolescent suicide prevention.

BackgroundTo address the societal burden of low back pain (LBP), several health systems have adopted Models of Care (MoCs). These evidence-informed models aim for consistent care and outcomes. However, real-world applications vary, with each setting presenting unique challenges and nuances in the primary healthcare landscape. This scoping review aims to synthesize the available evidence regarding the use of implementation theories, models or frameworks, context-specific factors, implementation strategies and outcomes reported in MoCs targeting LBP in primary healthcare.MethodsMEDLINE(Pubmed), EMBASE, Cochrane Central Register of Controlled Trials, PEDro, Scopus, Web of Science and grey literature databases were searched. Eligible records included MoCs for adults with LBP in primary healthcare. Two reviewers independently extracted data concerning patient-related, system-related and implementation-related outcomes. The implementation processes, including guiding theories, models or frameworks, barriers and facilitators to implementation and implementation strategies were also extracted. The data were analysed through a descriptive qualitative content analysis and synthesized via both quantitative and qualitative approaches.ResultsEleven MoCs (n = 29 studies) were included. Implementation outcomes were assessed in 6 MoCs through quantitative, qualitative, and mixed methods approaches. Acceptability and appropriateness were the most reported outcomes. Only 5 MoCs reported underlying theories, models, or frameworks. Context-specific factors influencing implementation were identified in 3 MoCs. Common strategies included training providers, developing educational materials, and changing record systems. Notably, only one MoC included a structured multifaceted implementation strategy aligned with the evaluation of patient, organizational and implementation outcomes.ConclusionsThe implementation processes and outcomes of the MoCs were not adequately reported and lacked sufficient theoretical support. As a result, conclusions about the success of implementation cannot be drawn, as the strategies employed were not aligned with the outcomes. This study highlights the need for theoretical guidance in the development and implementation of MoCs for the management of LBP in primary healthcare.RegistrationOpen Science Framework Registries (https://osf.io/rsd8x).

Assessment of implementation strategies adopted for antimicrobial stewardship interventions in long-term care facilities: a systematic review

Medication adherence interventions in transplantation lack information on how to implement findings from randomized controlled trials in real-world settings: A systematic review

Learning collaboratives are a widely used implementation strategy for supporting the spread of complex innovations, but little is known about how learning collaboratives develop and sustain over time. The OncoPRO initiative, a PCORI-funded national learning collaborative focused on implementing remote symptom monitoring (RSM) using electronic patient-reported outcomes (ePROs) in oncology, provides a unique opportunity to explore this process. By examining how OncoPRO fosters collaboration, shares strategies, and adapts to diverse sites, this study offers critical insights into both the development of learning collaboratives and their ability to support the long-term success of complex healthcare initiatives. This study employed a multi-methods implementation science approach to examine the development and first year of the OncoPRO initiative. From conception through year 1 (March 2023-December 2024), OncoPRO provided support to 12 independent health systems. We identified cross-organizational barriers encountered during the development of a national learning collaborative, and the implementation strategies employed to address them, using field notes generated during all OncoPRO-related meetings, site-level communications, and site presentations during meetings. We systematically identified and categorized barriers and implementation strategies using the Consolidated Framework for Implementation Research (CFIR) 2.0 and the Expert Recommendations for Implementing Change (ERIC) frameworks. Strategies were then categorized into domains based on their alignment with each other and learning collaborative implementation components or processes. We identified 29 overarching barriers (e.g., lack of best practices; clinician buy-in) that were addressed through 37 foundational implementation strategies relevant to developing and facilitating the learning collaborative. These implementation strategies were organized into six domains: building a multi-level foundation, engaging and onboarding implementation sites, building shared learning structures, supporting technical rollout, embedding feedback loops and quality monitoring, and stimulating demand for RSM and collaborative participation. Most barriers were addressed using multiple strategies, and individual strategies often targeted several barriers simultaneously. Broad strategies addressing multiple barriers (e.g. build a coalition; identify early adopters) were deployed early to develop a base for the collaborative. As the initiative matured, strategies targeting specific barriers (e.g. develop and implement quality monitoring systems) were added to support site-level operationalization and continuous improvement. This study describes our approach to building a national learning collaborative for ePRO-enabled RSM implementation in oncology, focused on the initial phase of implementation. It offers a case study and potential roadmap for others involved in the initial development of large-scale collaboratives for complex interventions. This descriptive process analysis lays the groundwork for future analyses of implementation variation and strategy effectiveness across participating health systems, and highlights how learning collaboratives can support the implementation of complex quality initiatives like RSM in oncology.

Implementation strategies have unparalleled importance in implementation science, as they constitute the ‘how to’ component of changing healthcare practice. Yet, implementation researchers and other stakeholders are not able to fully utilize the findings of studies focusing on implementation strategies because they are often inconsistently labelled and poorly described, are rarely justified theoretically, lack operational definitions or manuals to guide their use, and are part of ‘packaged’ approaches whose specific elements are poorly understood. We address the challenges of specifying and reporting implementation strategies encountered by researchers who design, conduct, and report research on implementation strategies. Specifically, we propose guidelines for naming, defining, and operationalizing implementation strategies in terms of seven dimensions: actor, the action, action targets, temporality, dose, implementation outcomes addressed, and theoretical justification. Ultimately, implementation strategies cannot be used in practice or tested in research without a full description of their components and how they should be used. As with all intervention research, their descriptions must be precise enough to enable measurement and ‘reproducibility.’ We propose these recommendations to improve the reporting of implementation strategies in research studies and to stimulate further identification of elements pertinent to implementation strategies that should be included in reporting guidelines for implementation strategies.

Introduction: Youth-friendly health service (YFHS) interventions are a promising, cost-effective approaches to delivering sexual and reproductive services that cater to the developmental needs of young people. Despite a growing evidence-base, implementation of such interventions into practice have proven to be challenging in sub-Saharan Africa (SSA). Thus, the purpose of this review is to synthesize existing evidence on YFHS implementation in SSA and understand which implementation strategies were used, in what context, how they were used, and leading to which implementation outcomes.Methods: A comprehensive literature search in PubMed, Embase, Scopus, and CINAHL, was conducted to identify peer-reviewed research articles published from database inception up until August 2020. Eligible studies were required to include young people (ages 10–24 years) in sub-Saharan Africa. Studies that described implementation strategies, as conceptualized by the Expert Recommendations for Implementing Change (ERIC) project, used to enhance the implementation of YFHS were included. Implementation outcomes were extracted using Proctor and colleagues' 8 taxonomy of implementation outcomes.Results: We identified 18 unique interventions (reported in 23 articles) from an initial search of 630 articles, including seven from East Africa, seven from South Africa, and four from West Africa. In most studies (n = 15), youth-friendly health services were delivered within the context of a health facility or clinic setting. The most frequently reported categories of implementation strategies were to train and educate stakeholders (n = 16) followed by infrastructure change (n = 10), to engage consumers (n = 9), the use of evaluative and iterative strategies (n = 8), support clinicians (n = 8), and providing interactive assistance (n = 6). The effectiveness of the strategies to enhance YFHS implementation was commonly measured using adoption (n = 15), fidelity (n = 7), acceptability (n = 5), and penetration (n = 5). Few studies reported on sustainability (n = 2), appropriateness (n = 1), implementation cost (n = 1) and feasibility (n = 0).Conclusion: Results of the review emphasize the need for further research to evaluate and optimize implementation strategies for promoting the scale-up and sustainability of evidence-based, YFHS interventions in resource-constrained settings. This review also highlights the need to design robust studies to better understand which, in what combination, and in what context, can implementation strategies be used to effectively enhance the implementation of YFHS interventions.

Nutritional conditions and malnutrition commonly affect people diagnosed with cancer, leading to worse outcomes and reduced quality of life. An implementation science approach may improve the delivery of evidence-based nutrition in cancer. The aim of this review is to systematically evaluate published literature for implementation strategies that have been applied to improve delivery of nutritional interventions in cancer. A literature search of databases including MEDLINE, EMBASE, Global Health, APA PsychINFO, CINAHL, yielded 5164 articles, of which 37 were included, comprising 30 independent studies. Reported barriers were classified according to the updated Consolidated Framework for Implementation Research (CFIR 2.0). Implementation strategies were mapped to the Expert Recommendations for Implementing Change (ERIC). The CFIR-ERIC Implementation Matching Tool was used to evaluate the extent to which current implementation strategies align with existing evidence, and to identify future strategies. Lack of knowledge and awareness of nutritional guidelines among clinicians and available resources were the most frequently reported barriers. The implementation strategies "Audit and provide feedback" and "Conduct educational meetings" were the most widely used. Adoption and fidelity were the most frequently assessed (27/30, 90 % of studies) implementation outcomes, with 22 (81.5 %) studies reporting positive findings. Four out of five (80.0 %) studies measuring patient satisfaction reported improvements with implementation strategies. Deficits in knowledge and available resources are key barriers to implementation of nutritional interventions in cancer. The use of implementation strategies is associated with improved implementation, service, and patient-level outcomes. Key strategies to effective implementation include education, audit and feedback, and assessment of barriers and facilitators. Registry and registry number for systematic reviews and meta-analyses: This review protocol is registered with the PROSPERO group (CRD42023454210).

BackgroundDespite the increased risk of cervical cancer (CC) among women living with HIV (WLHIV), CC screening and treatment (CCST) rates remain low in Africa. The integration of CCST services into established HIV programs in Africa can improve CC prevention and control. However, the paucity of evidence on effective implementation strategies (IS) has limited the success of integration in many countries. In this study, we seek to identify effective IS to enhance the integration of CCST services into existing HIV programs in Nigeria.MethodsOur proposed study has formative and experimental activities across the four phases of the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework. Through an implementation mapping conducted with stakeholders in the exploration phase, we identified a core package of IS (Core) and an enhanced package of IS (Core+) mostly selected from the Expert Recommendations for Implementing Change. In the preparation phase, we refined and tailored the Core and Core+ IS with the implementation resource teams for local appropriateness. In the implementation phase, we will conduct a cluster-randomized hybrid type III trial to assess the comparative effectiveness of Core versus Core+. HIV comprehensive treatment sites (k = 12) will be matched by region and randomized to Core or Core+ in the ratio of 1:1 stratified by region. In the sustainment phase, we will assess the sustainment of CCST at each site. The study outcomes will be assessed using RE-AIM: reach (screening rate), adoption (uptake of IS by study sites), IS fidelity (degree to which the IS occurred according to protocol), clinical intervention fidelity (delivery of CC screening, onsite treatment, and referral according to protocol), clinical effectiveness (posttreatment screen negative), and sustainment (continued integrated CCST service delivery). Additionally, we will descriptively explore potential mechanisms, including organizational readiness, implementation climate, CCST self-efficacy, and implementation intentions.DiscussionThe assessment of IS to increase CCST rates is consistent with the global plan of eliminating CC as a public health threat by 2030. Our study will identify a set of evidence-based IS for low-income settings to integrate evidence-based CCST interventions into routine HIV care in order to improve the health and life expectancy of WLHIV.Trial registrationProspectively registered on November 7, 2023, at ClinicalTrials.gov no. NCT06128304. https://classic.clinicaltrials.gov/ct2/show/study/NCT06128304

Research steering committees (RSCs) are increasingly recognized as astrategy for stakeholder engagement. Drawing on the experiences of participants from three RSCs involved in health care implementation projects in Brazil, this study aims to examine the contributions of RSCs to implementation research based on their impact on implementation outcomes. This descriptive, exploratory, qualitative study was conducted between August and December 2024. Shared appreciation groups with eight researchers facilitated consensus on RSC operationalization. Additionally, semistructured interviews with 12RSC members from three research projects explored the contributions to stakeholder engagement and implementation outcomes. Data were analyzed using thematic content analysis. Thirteen discrete implementation strategies were identified within four categories: use evaluative and iterative strategies, adapt and tailor to context, develop stakeholder interrelationships, and train and educate stakeholders. The RSCs influenced six implementation outcomes: acceptability, adoption, appropriateness, feasibility, penetration, and sustainability. Appropriateness and feasibility emerged as the most prominent outcomes. Research steering committees constitute amultifaceted implementation strategy that fosters structured stakeholder engagement. By integrating multiple implementation strategies, they enhance collaboration, contextual adaptation, and shared governance. Their impact on appropriateness and feasibility highlights their relevance as asupport mechanism for implementation success and sustainability.

Implementation of evidence-based practice necessitates identification of barriers and facilitators as well as using effective implementation strategies tailored to these barriers and facilitators. Collaboration with stakeholders is an essential aspect of implementation, but there is limited guidance on how to combine input from stakeholders with other sources of information when designing implementation actions. In this study, we adapt and evaluate a novel stepwise procedure (based on Knapp et al, 2022) to combine multi-stakeholder input with best available evidence on matching barriers to implementation strategies. In the context of an implementation project for physiotherapist led Cognitive Behavior therapy for Insomnia (CBT-I) in patients with Knee Osteoarthritis (OA), stakeholders (physiotherapists (PTs), patients with OA and comorbid insomnia, general practitioners (GPs), orthopedic surgeons (OS), rheumatologists, and psychologists with expertise in CBT-I) participate in a rigorous, iterative process of identifying and prioritizing barriers, followed by a selection of implementation strategies to address identified barriers. In this process, stakeholder discussion or survey input is alternated with feedback from the research team, who are providing a summary of stakeholder perspectives and provide input based on findings from the implementation science literature. The process integrates aspects of user-centered design (Dopp et al., 2018; Dopp et al., 2020), a modified version of Delphi approach (Hasson et al., 2000), a participatory approach (Jagosh et al., 2012), and the Expert Recommendations for Implementing Change (ERIC) protocol (Powell et al., 2015; Waltz et al., 2015). Compared to Knapp et al. (2022) we have streamlined the development process into a six-step alternating procedure. Furthermore, we have broadened the categories of stakeholders participating in the stakeholder discussions, including patients and health care providers of different disciplines. In order to facilitate representation of patients and different disciplines of health care providers, we are conducting the first step stakeholder discussions in two parallel teams: (1) a team focusing on the determinants related to patient-PT interactions, the process of implementation, and the intervention itself; and (2) a team focusing on the determinants related to interactions between different health care providers, the referral patterns, and the structural aspects of healthcare. The first team consists of patients, psychologists, and physiotherapists. The second team involves various healthcare providers involved in the treatment of osteoarthritis, both first and second line. That is physiotherapists, GPs, orthopedic surgeons, and rheumatologists. The study is currently ongoing, and we will be discussing preliminary outcomes related to the methodology and design process, including evaluations at each stage of the project. The project can serve as a template for structured, multidisciplinary stakeholder engagement in the design of implementation actions. This work is integrated into a clinical trial that was funded by the Applied Biomedical Research Program, Research Foundation Flanders (Fonds voor Wetenschappelijk Onderzoek Vlaanderen), Belgium (FWO-TBM project no. TBM2021 - T000521N - 54252, “Towards PREcision MEdicine for Osteoarthritis: Added value of cognitive behavioural therapy for insomnia (the PREMEO trial).

Genetic nephrology has emerged as a distinct subspecialty within nephrology with growing evidence supporting its clinical utility and cost-effectiveness across diagnostic, prognostic, and management pathways. Yet significant implementation gaps such as undefined clinic models and outcomes, limited use of implementation science frameworks, ad hoc strategy development, and a narrow focus on diagnostic yield and clinical utility hinder its routine adoption and integration. This research programme aims to systematically design, implement, and evaluate a multidisciplinary kidney genetics clinic model, using a theory-informed and stakeholder-engaged implementation science approach, to translate genomic advances into improved service, patient-reported, and implementation outcomes, and to inform sustainable and scalable kidney genomics care policy. Using a interconnected four-part, mixed-methods, multi-frameworks design underpinned by implementation science theory, the research programme will (1) review global kidney genetics clinic models, outcomes, determinants of successful implementation, and implementation strategies; (2) assess local stakeholder perceptions, priorities and contextual determinants using Consolidated Framework for Implementation Research (CFIR)-guided qualitative inquiry; (3) co-design and refine tailored implementation strategies via Consolidated Framework for Implementation Research-Expert Recommendations for Implementing Change (CFIR-ERIC) mapping and hybrid participatory methods; and (4) evaluate the clinic’s service, patients, and implementation outcomes in a prospective effectiveness-implementation hybrid type 2 quasi-experimental interrupted time-series study design. Outcomes assessed include (1) service outcomes (diagnostic yield, clinical utility, and timeliness of care); (2) patient-reported outcomes (personal utility, patient-reported outcome measures); and (3) Proctor-defined implementation outcomes (acceptability, appropriateness, readiness, feasibility, and fidelity, and penetration). We will measure outcomes longitudinally across pre-implementation, implementation, and post-implementation phases, and analyse data using segmented regression analysis to assess changes in outcomes over time. The Implementation Research Logic Model (IRLM) will guide evaluation and adaptation throughout. This programme is designed to address critical implementation gaps between genomic evidence and clinical practice. Through four sequential studies, the programme will generate standardised kidney genetics clinic models and care pathways, evidence-informed implementation determinants, and context-tailored, co-designed implementation strategies. Taken together, this programme will establish a policy-relevant genetic nephrology care model with improved service, patient-reported, and implementation outcomes for the benefit of patients and families living with genetic kidney disease.

In this paper, the graduate students in university scientific research team as the research objects, their individual needs are analyzed and the practical incentive strategies that suitable for the scientific research team in China's colleges and universities are explored. In order to mobilize the enthusiasm of students in study and research, we should make full use of their research potential and steadily improve the quality of postgraduate training. The incentive strategies of material incentive, work design incentive, model incentive, academic innovation incentive and personal growth and development incentive are innovations of this paper, compared with the traditional teaching cultivation; the new methods have played

Evidence-based nursing is widely recognized as the critical foundation for quality care. To develop a middle-range theory on the process of evidence-based nursing implementation in Chinese context. A grounded theory study using unstructured in-depth individual interviews was conducted with 56 participants who were involved in 24 evidence-based nursing implementation projects in Mainland China from September 2015 to September 2016. A middle-range grounded theory of 'Taking Root' was developed. The theory describes the evidence implementation process consisting of four components (driving forces, process, outcome, sustainment/regression), three approaches (top-down, bottom-up and outside-in), four implementation strategies (patient-centred, nurses at the heart of change, reaching agreement, collaboration) and two patterns (transformational and adaptive implementation). Certain perspectives may have not been captured, as the retrospective nature of the interviewing technique did not allow for 'real-time' assessment of the actual implementation process. The transferability of the findings requires further exploration as few participants with negative experiences were recruited. This is the first study that explored evidence-based implementation process, strategies, approaches and patterns in the Chinese nursing practice context to inform international nursing and health policymaking. The theory of Taking Root described various approaches to evidence implementation and how the implementation can be transformational for the nurses and the setting in which they work. Nursing educators, managers and researchers should work together to improve nurses' readiness for evidence implementation. Healthcare systems need to optimize internal mechanisms and external collaborations to promote nursing practice in line with evidence and achieve clinical outcomes and sustainability.