Clinical Epidemiology, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.
School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.
BMC Med Res Methodol. 2022 Aug 4;22(1):212. doi: 10.1186/s12874-022-01682-x.
Models, theories, and frameworks (MTFs) provide the foundation for a cumulative science of implementation, reflecting a shared, evolving understanding of various facets of implementation. One under-represented aspect in implementation MTFs is how intersecting social factors and systems of power and oppression can shape implementation. There is value in enhancing how MTFs in implementation research and practice account for these intersecting factors. Given the large number of MTFs, we sought to identify exemplar MTFs that represent key implementation phases within which to embed an intersectional perspective.
We used a five-step process to prioritize MTFs for enhancement with an intersectional lens. We mapped 160 MTFs to three previously prioritized phases of the Knowledge-to-Action (KTA) framework. Next, 17 implementation researchers/practitioners, MTF experts, and intersectionality experts agreed on criteria for prioritizing MTFs within each KTA phase. The experts used a modified Delphi process to agree on an exemplar MTF for each of the three prioritized KTA framework phases. Finally, we reached consensus on the final MTFs and contacted the original MTF developers to confirm MTF versions and explore additional insights.
We agreed on three criteria when prioritizing MTFs: acceptability (mean = 3.20, SD = 0.75), applicability (mean = 3.82, SD = 0.72), and usability (median = 4.00, mean = 3.89, SD = 0.31) of the MTF. The top-rated MTFs were the Iowa Model of Evidence-Based Practice to Promote Quality Care for the 'Identify the problem' phase (mean = 4.57, SD = 2.31), the Consolidated Framework for Implementation Research for the 'Assess barriers/facilitators to knowledge use' phase (mean = 5.79, SD = 1.12), and the Behaviour Change Wheel for the 'Select, tailor, implement interventions' phase (mean = 6.36, SD = 1.08).
Our interdisciplinary team engaged in a rigorous process to reach consensus on MTFs reflecting specific phases of the implementation process and prioritized each to serve as an exemplar in which to embed intersectional approaches. The resulting MTFs correspond with specific phases of the KTA framework, which itself may be useful for those seeking particular MTFs for particular KTA phases. This approach also provides a template for how other implementation MTFs could be similarly considered in the future.
Open Science Framework Registration: osf.io/qgh64.
模型、理论和框架（MTF）为实施的累积科学提供了基础，反映了对实施各个方面的共同的、不断发展的理解。在实施 MTF 中，一个代表性不足的方面是如何交织的社会因素和权力与压迫的系统可以塑造实施。增强实施研究和实践中的 MTF 如何解释这些交织因素是有价值的。鉴于 MTF 的数量众多，我们试图确定代表性的 MTF，以嵌入一个交叉视角。
我们使用五步流程来优先考虑具有交叉视角的 MTF 增强。我们将 160 个 MTF 映射到知识转化行动（KTA）框架的三个先前优先考虑的阶段。接下来，17 名实施研究人员/实践者、MTF 专家和交叉性专家就每个 KTA 阶段内 MTF 优先排序的标准达成一致。专家们使用修改后的 Delphi 流程就三个优先考虑的 KTA 框架阶段中的每一个达成了代表性 MTF 的共识。最后，我们就最终的 MTF 达成了共识，并联系了原始 MTF 开发人员，以确认 MTF 版本并探索其他见解。
当优先考虑 MTF 时，我们达成了三个标准：MTF 的可接受性（均值=3.20，标准差=0.75）、适用性（均值=3.82，标准差=0.72）和可用性（中位数=4.00，均值=3.89，标准差=0.31）。评分最高的 MTF 是爱荷华模式的循证实践，以促进“识别问题”阶段的优质护理（均值=4.57，标准差=2.31）、综合实施研究框架，以促进“评估知识应用的障碍/促进因素”阶段（均值=5.79，标准差=1.12）和行为改变车轮，以促进“选择、调整、实施干预”阶段（均值=6.36，标准差=1.08）。
我们的跨学科团队进行了严格的流程，就反映实施过程特定阶段的 MTF 达成共识，并对每个 MTF 进行优先排序，以作为嵌入交叉方法的范例。由此产生的 MTF 与 KTA 框架的特定阶段相对应，对于那些为特定的 KTA 阶段寻找特定的 MTF 的人来说，KTA 框架本身可能是有用的。这种方法还为如何在未来类似地考虑其他实施 MTF 提供了模板。
开放科学框架注册：osf.io/qgh64。
