Bunger Alicia C, Powell Byron J, Robertson Hillary A, MacDowell Hannah, Birken Sarah A, Shea Christopher
College of Social Work, The Ohio State University, 1947 College Road, Columbus, OH, 43210, United States of America.
Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1105C McGavran-Greenberg Hall, Campus Box 7411, Chapel Hill, NC, 27599, United States of America.
Health Res Policy Syst. 2017 Feb 23;15(1):15. doi: 10.1186/s12961-017-0175-y.
Published descriptions of implementation strategies often lack precision and consistency, limiting replicability and slowing accumulation of knowledge. Recent publication guidelines for implementation strategies call for improved description of the activities, dose, rationale and expected outcome(s) of strategies. However, capturing implementation strategies with this level of detail can be challenging, as responsibility for implementation is often diffuse and strategies may be flexibly applied as barriers and challenges emerge. We describe and demonstrate the development and application of a practical approach to identifying implementation strategies used in research and practice that could be used to guide their description and specification.
An approach to tracking implementation strategies using activity logs completed by project personnel was developed to facilitate identification of discrete strategies. This approach was piloted in the context of a multi-component project to improve children's access to behavioural health services in a county-based child welfare agency. Key project personnel completed monthly activity logs that gathered data on strategies used over 17 months. Logs collected information about implementation activities, intent, duration and individuals involved. Using a consensus approach, two sets of coders categorised each activity based upon Powell et al.'s (Med Care Res Rev 69:123-57, 2012) taxonomy of implementation strategies.
Participants reported on 473 activities, which represent 45 unique strategies. Initial implementation was characterised by planning strategies followed by educational strategies. After project launch, quality management strategies predominated, suggesting a progression of implementation over time. Together, these strategies accounted for 1594 person-hours, many of which were reported by the leadership team that was responsible for project design, implementation and oversight.
This approach allows for identifying discrete implementation strategies used over time, estimating dose, describing temporal ordering of implementation strategies, and pinpointing the major implementation actors. This detail could facilitate clear reporting of a full range of implementation strategies, including those that may be less observable. This approach could lead to a more nuanced understanding of what it takes to implement different innovations, the types of strategies that are most useful during specific phases of implementation, and how implementation strategies need to be adaptively applied throughout the course of a given initiative.
已发表的实施策略描述往往缺乏精确性和一致性，限制了可复制性并减缓了知识积累。最近关于实施策略的出版指南要求对策略的活动、剂量、基本原理和预期结果进行更完善的描述。然而，要详细记录到这种程度的实施策略具有挑战性，因为实施责任往往分散，而且随着障碍和挑战的出现，策略可能会灵活应用。我们描述并展示了一种实用方法的开发与应用，该方法用于识别研究和实践中使用的实施策略，可用于指导对这些策略的描述和规范。
开发了一种利用项目人员填写的活动日志来跟踪实施策略的方法，以促进对离散策略的识别。该方法在一个多组件项目中进行了试点，该项目旨在改善一个县级儿童福利机构中儿童获得行为健康服务的机会。关键项目人员每月填写活动日志，收集17个月内使用的策略数据。日志收集了有关实施活动、意图、持续时间和相关人员的信息。采用共识方法，两组编码人员根据鲍威尔等人（《医疗保健研究与评论》69:123 - 57，2012年）的实施策略分类法对每项活动进行分类。
参与者报告了473项活动，代表45种独特策略。初始实施阶段以规划策略为主，随后是教育策略。项目启动后，质量管理策略占主导地位，这表明实施过程随时间推移有所进展。这些策略总共耗费了1594人时，其中许多是由负责项目设计、实施和监督的领导团队报告的。
这种方法能够识别随时间使用的离散实施策略、估计剂量、描述实施策略的时间顺序，并确定主要实施参与者。这些详细信息有助于清晰报告一系列完整的实施策略，包括那些可能不太容易观察到的策略。这种方法可能会使人们对实施不同创新所需的条件、在实施特定阶段最有用的策略类型以及在给定倡议的整个过程中如何适应性地应用实施策略有更细致入微的理解。
