What is implementation science?
Implementation science is commonly defined as the study of methods and strategies to promote the uptake of interventions that have proven effective into routine practice, with the aim of improving population health. Implementation science therefore examines what works, for whom and under what circumstances, and how interventions can be adapted and scaled up in ways that are accessible and equitable.
A commonly used definition of implementation research is that it is the scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice, and, hence, to improve the quality and effectiveness of health services and care (Eccles/Mittman 2006).
" The Global Alliance for Chronic Diseases puts implementation science at the core of each of its joint calls for applications and expects funded research projects to address implementation challenges in their particular settings.
Why is implementation science needed?
Implementation science is trying to address the
significant knowledge gap between interventions that research has shown to be
effective and their delivery to communities and translation into practice,
particularly in low- and middle-income countries. Implementation research is
needed to account for the complexities of the systems in which interventions are
implemented since other approaches often fail to address these. Results of
implementation research will support evidence-based policymaking that can build
robust programmes to improve public health.
Which factors can affect implementation?
Implementation success is determined by a variety of factors, including the characteristics of the intervention, the stakeholder groups involved and the context in which the intervention is carried out.
There are several characteristics of interventions that will have an impact on whether or not the intervention will be implemented. For example, this includes the costs relative to other similar interventions, its complexity and adaptability. Interventions have usually already proven to be effective and implementation research therefore can build on a solid understanding of what can work (efficacy) and what does work (effectiveness).
The involvement of different stakeholder groups is important for a number of reasons. Firstly, implementation relies on health care workers, policymakers and patients who adopt, carry out or benefit from interventions. Secondly, researchers need to understand the knowledge gaps and find answers to the challenges facing these groups. Successful implementation research therefore incorporates participatory approaches and engages in continuous, bidirectional communication between researchers and stakeholders.
Implementation science studies commonly focus on the external validity of their findings, i.e. whether they can be generalised across different settings and individuals. This can be achieved by examining context and the various factors that impact the effectiveness of an intervention in a specific setting. Implementation research therefore requires a systems thinking approach. Context can account for a number of barriers and facilitators that determine the success of implementing a particular intervention. Implementation also commonly requires the study of behaviour change among individuals or organisations and therefore a deeper understanding of the social, economic, institutional or cultural factors that shape this behaviour.
Resources for researchers in implementation science
There are a number of resources available, a small selection is provided here for guidance:
- Journals covering research in the area, e.g. Implementation Science
- Implementation Research in Health: A Practical Guide (Peters, D. et al 2013)
- Implementation research: what it is and how to do it (Peters, D. et al 2013)
- Writing implementation research grant proposals: ten key ingredients (Proctor, E. 2012)
- Dissemination and Implementation Research in Health: Translating Science to Practice (Brownson, R. et al 2012)
- A guide to implementation research in the prevention and control of noncommunicable diseases (World Health Organization 2016)
- Implementation research toolkit (WHO/TDR 2014)
- Nine steps for developing a scaling-up strategy (WHO 2010)
- RE-AIM Framework (Glasgow et al)
- An introduction to implementation science for the non-specialist (Bauer, M. et al 2015)