1. Implementation Science: Theories & Models
Paul A. Estabrooks, PhD
Dr. Paul Estabrooks

2. Furthering Understanding of D&I Models
present a systematic way of understanding events or behaviors by providing inter-related concepts, definitions, and propositions that explain or predict events by specifying relationships among variables.
are strategic or action-planning models that provide a systematic way to develop, manage, and evaluate interventions.
is used to describe theories and frameworks collectively.
Theories
Frameworks
Models
Tabak RG et al. Bridging Research and Practice: Models for Dissemination and Implementation Research Am J Prev Med, 2012, 43: ;

3. Model Categories

4. www.dissemination-implementation.org www.re-aim.org
Mode

6. Diffusions of Innovations
Diffusion is a process where an innovation is communicated through certain channels over time among members of a social system
Everett Rogers, 1962

7. The Innovation
An idea, practice or object that is perceived as new by an individual or other unit of adoption.

8. The Innovation Characteristics of Innovation – Relative Advantage
Compatability
Complexity
Trialability
Observability

9. A Social System
The social structure of the system affects the innovation’s diffusion in several ways.
how the system’s social structure affects diffusion,
the effect of norms on diffusion,
the roles of opinion leaders

10. THE INNOVATION-DECISION PROCESS.
THE INNOVATION-DECISION PROCESS - the process through which an individual passes from first knowledge of an innovation to forming an attitude toward the innovation, to a decision to adopt or reject it.
Five stages in the innovation-decision process:
(1) knowledge,
(2) persuasion,
(3) decision,
(4) implementation, and
(5) confirmation.
Knowledge occurs when an individual (or other decision-making unit) learns of the innovation’s existence and gains some understanding of how it functions.
Persuasion occurs when an individual (or other decision-making unit) forms a favourable or unfavourable attitude toward the innovation.
Decision occurs when an individual (or other decision-making unit) engages in activities that lead to a choice to adopt or reject the innovation.
Implementation occurs when an individual (or other decision-making unit) puts an innovation into use. Re-invention is especially likely to occur at the implementation stage.
Confirmation occurs when an individual (or other decision-making unit) seeks reinforcement of an innovation-decision that has already been made, but the individual may reverse this previous decision if exposed to conflicting innovation.

11. Rate of Adoption
Most innovations have an S-shaped rate of adoption.

12. Interactive Systems Framework for Dissemination and Implementation
Wandersman et al., Am J Community Psychol (2008) 41:171–181

13. Synthesis and Translation
Evidence synthesis
Systematic review
Integrative review
Meta-analysis
Review of literature
State of the science review
Translation:
Identify key characteristics
Identify core elements
Highlight process for adaptation
Package so core elements are implemented with fidelity to the program design.
The description of "how" to implement interventions is often left out of research. In order for practitioners/end users to implement prevention interventions, they need this information to be synthesized and translated. Research can be synthesized in a variety of ways including evidence synthesis, systematic review, integrative review, meta-analysis, review of literature, and state of science review.
Wandersman et al., Am J Community Psychol (2008) 41:171–181

14. Innovation Specific Capacity Examples
Delivery System
General Capacity Examples
Innovation Specific Capacity Examples
Culture
Innovation-Specific knowledge, skills, and abilities
Climate
Program Champion
Organizational
Innovativeness
Specific Implementation
Supports
Resource Utilization
Interorganizational Relationships
Leadership
Structure
Staff Capacity
Wandersman, Advanced Topics in Implementation Science Research Webinar Series, April 2015

15. Innovation Specific Capacity Examples
Support System
General Capacity Examples
Innovation Specific Capacity Examples
Provision of social support
Innovation-Specific Skill building techniques
Tracking and monitoring
Expertise in innovation content area
Informational
Ability to gather innovation specific materials
Behavioral incentives
Ability to adapt based on core elements
Didactic instruction
Problem solving techniques
Staff Capacity
Wandersman, Advanced Topics in Implementation Science Research Webinar Series, April 2015

16. Motivation for Innovation
Potential Motivators
Authors
Relative Advantage
Armenakis et al., 1993; Damschroder et al., 2009; Hall & Hord, 2010; Rafferty et al., 2013; Rogers, 2003; Weiner, 2009
Compatibility
Chinman et al., 2004; Durlak & Dupre, 2008; Fetterman & Wandersman, 2005; Greenhalgh et al., 2004; Rogers, 2003; Simpson, 2002
Complexity
Damschroder & Hagedorn, 2011; Fixsen et al., 2005; Greenhalgh et al., 2004; Meyers, Durlak & Wandersman, 2012; Wandersman et al., 2008.
Trialability
Armenakis et al., 1993; Greenhalgh et al., 2004; Rapkin et al., 2012; Rogers, 2003
Observability
Beutler, 2001; Chinman et al., 2004; Damschroder et al.,
2009; Ford et al., 2008; Rossi, Lipsey, & Freeman, 2004
Priority
Armenakis & Harris, 2009; Greenhalgh et al., 2004; Flaspohler et al., 2008
Wandersman, Advanced Topics in Implementation Science Research Webinar Series, April 2015

17. Interactive Systems Framework for Dissemination and Implementation
Wandersman et al., Am J Community Psychol (2008) 41:171–181

18. Consolidated Framework for Implementation Research
Note the importance of Greenhalgh work.
Move quickly to more recent efforts to provide frameworks for dissemination and implementation (QUERY-developed) CFIR
Finally, few models propose the interaction between research practice collaboratives, support structures, and sustained implementation within the delivery systems. The model by Wandersman, best reflects the 3 phase approach of e-chip.
Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implementation Science. Aug 2009;4.

19. Internal Context Soft Periphery Hard Core Soft Periphery Hard Core
Intervention at Time0
Intervention at Time1
Internal Context
Soft Periphery
Soft Periphery
Hard Core
Hard Core
Intervention
Intervention
External Context 19
Damschroder et al., 2009

20. Intervention Characteristics
Intervention source (build or buy)
Evidence strength and quality
Relative advantate
Adaptability
Trialability
Complexity
Design quality and packaging
Cost
The description of "how" to implement interventions is often left out of research. In order for practitioners/end users to implement prevention interventions, they need this information to be synthesized and translated. Research can be synthesized in a variety of ways including evidence synthesis, systematic review, integrative review, meta-analysis, review of literature, and state of science review.
 Damschroder et al, 2009: Fostering implementation of health services research findings into
practice: A consolidated framework for advancing implementation sci

21. Inner setting Structural characteristics Networks and communication
Culture
Implementation climate
Tension for change
Compatibility
Relative priority
Organizational incentives
Goals and feedback opportunities & learning climate
Readiness for implementation (leadership; resources; access to information)
Characteristics of individuals (e.g., knowledge and beliefs, self-efficacy to implement)
The description of "how" to implement interventions is often left out of research. In order for practitioners/end users to implement prevention interventions, they need this information to be synthesized and translated. Research can be synthesized in a variety of ways including evidence synthesis, systematic review, integrative review, meta-analysis, review of literature, and state of science review.
 Damschroder et al, 2009: Fostering implementation of health services research findings into
practice: A consolidated framework for advancing implementation sci

22. Outer setting Patient (client) needs and resources
Degree of networking with external organizations
Pressure from competitive or similar external organizations
External policies and incentives
The description of "how" to implement interventions is often left out of research. In order for practitioners/end users to implement prevention interventions, they need this information to be synthesized and translated. Research can be synthesized in a variety of ways including evidence synthesis, systematic review, integrative review, meta-analysis, review of literature, and state of science review.
 Damschroder et al, 2009: Fostering implementation of health services research findings into
practice: A consolidated framework for advancing implementation sci

23. Processes Planning Engaging Opinion leaders
Internal implementation leaders (formal)
Champions
External change agents
Executing
Reflecting and evaluating
The description of "how" to implement interventions is often left out of research. In order for practitioners/end users to implement prevention interventions, they need this information to be synthesized and translated. Research can be synthesized in a variety of ways including evidence synthesis, systematic review, integrative review, meta-analysis, review of literature, and state of science review.
 Damschroder et al, 2009: Fostering implementation of health services research findings into
practice: A consolidated framework for advancing implementation sci

24. Measurement Resources

25. Measurement Resources

26. www.dissemination-implementation.org www.re-aim.org
Mode