Czosnek Louise, Zopf Eva M, Cormie Prue, Rosenbaum Simon, Richards Justin, Rankin Nicole M
Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
Cabrini Cancer Institute, The Szalmuk Family Department of Medical Oncology, Cabrini Health, Melbourne, Australia.
Implement Sci Commun. 2022 Aug 16;3(1):90. doi: 10.1186/s43058-022-00337-8.
Implementation science frameworks explore, interpret, and evaluate different components of the implementation process. By using a program logic approach, implementation frameworks with different purposes can be combined to detail complex interactions. The Implementation Research Logic Model (IRLM) facilitates the development of causal pathways and mechanisms that enable implementation. Critical elements of the IRLM vary across different study designs, and its applicability to synthesizing findings across settings is also under-explored. The dual purpose of this study is to develop an IRLM from an implementation research study that used case study methodology and to demonstrate the utility of the IRLM to synthesize findings across case sites.
The method used in the exemplar project and the alignment of the IRLM to case study methodology are described. Cases were purposely selected using replication logic and represent organizations that have embedded exercise in routine care for people with cancer or mental illness. Four data sources were selected: semi-structured interviews with purposely selected staff, organizational document review, observations, and a survey using the Program Sustainability Assessment Tool (PSAT). Framework analysis was used, and an IRLM was produced at each case site. Similar elements within the individual IRLM were identified, extracted, and re-produced to synthesize findings across sites and represent the generalized, cross-case findings.
The IRLM was embedded within multiple stages of the study, including data collection, analysis, and reporting transparency. Between 33-44 determinants and 36-44 implementation strategies were identified at sites that informed individual IRLMs. An example of generalized findings describing "intervention adaptability" demonstrated similarities in determinant detail and mechanisms of implementation strategies across sites. However, different strategies were applied to address similar determinants. Dependent and bi-directional relationships operated along the causal pathway that influenced implementation outcomes.
Case study methods help address implementation research priorities, including developing causal pathways and mechanisms. Embedding the IRLM within the case study approach provided structure and added to the transparency and replicability of the study. Identifying the similar elements across sites helped synthesize findings and give a general explanation of the implementation process. Detailing the methods provides an example for replication that can build generalizable knowledge in implementation research.
实施科学框架探索、解释和评估实施过程的不同组成部分。通过使用项目逻辑方法，可以将具有不同目的的实施框架结合起来，详细说明复杂的相互作用。实施研究逻辑模型（IRLM）有助于开发促成实施的因果路径和机制。IRLM的关键要素在不同的研究设计中各不相同，其在跨环境综合研究结果方面的适用性也尚未得到充分探索。本研究的双重目的是从一项采用案例研究方法的实施研究中开发一个IRLM，并展示IRLM在跨案例地点综合研究结果方面的效用。
描述了范例项目中使用的方法以及IRLM与案例研究方法的一致性。案例是使用复制逻辑特意挑选的，代表了已将运动纳入癌症或精神疾病患者常规护理的组织。选择了四个数据源：对特意挑选的工作人员进行的半结构化访谈、组织文件审查、观察以及使用项目可持续性评估工具（PSAT）进行调查。采用框架分析方法，在每个案例地点生成一个IRLM。识别、提取并重新生成各个IRLM中相似的要素，以综合跨地点的研究结果，并呈现出普遍适用的跨案例研究结果。
IRLM被嵌入到研究的多个阶段，包括数据收集、分析和报告透明度。在为各个IRLM提供信息的地点，识别出了33 - 44个决定因素和36 - 44个实施策略。一个描述“干预适应性”的普遍适用研究结果示例表明，各地点在决定因素细节和实施策略机制方面存在相似之处。然而，针对相似的决定因素采用了不同的策略。依赖关系和双向关系沿着影响实施结果的因果路径发挥作用。
案例研究方法有助于解决实施研究的重点问题，包括开发因果路径和机制。将IRLM嵌入案例研究方法中，为研究提供了结构，增强了研究的透明度和可重复性。识别跨地点的相似要素有助于综合研究结果，并对实施过程给出一般性解释。详细说明方法为复制提供了一个示例，可在实施研究中建立可推广的知识。
