Leeman Jennifer, Wangen Mary, Kegler Michelle, Lee Matthew, O'Leary Meghan C, Ko Linda K, Fernández María E, Birken Sarah A
School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
Center for Health Promotion / Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
Front Health Serv. 2022 May 26;2:889786. doi: 10.3389/frhs.2022.889786. eCollection 2022.
Despite its widely acknowledged influence on implementation, limited research has been done on how the external environment (i.e., outer setting) determines when organizations adopt and implement new interventions. Determinant frameworks identify several outer setting-level factors such as funding streams, inter-organizational relationships, and peer pressure. However, these frameworks do not explain how or why outer-setting factors influence implementation. To advance research in this area, we argue for the importance of deriving theory-based propositions from organization theory to explain how outer setting factors influence organizations. Drawing on the work of the Organization Theory in Implementation Science (OTIS) project, we identified 20 propositions from five classic organization theories-Complexity Theory, Contingency Theory, Institutional Theory, Resource Dependence Theory, and Transaction Cost Economics. We then applied those propositions to hypothesize relationships among outer setting factors, implementation strategies, and implementation outcomes in five case studies of evidenced-based tobacco control interventions. The five case studies address the implementation of smoke-free policies, community health worker-led tobacco education and cessation programs, 5 A's (Ask, Advise, Assess, Assist, and Arrange), point-of-sale tobacco marketing policy interventions, and quitlines. The case studies illustrate how propositions may be used to guide the selection and testing of implementation strategies. Organization theories provide a menu of propositions that offer guidance for selecting and optimizing high-leverage implementation strategies that target factors at the level of outer setting. Furthermore, these propositions suggest testable hypotheses regarding the mechanisms underlying the influence of outer-setting factors on how and why organizations adopt and implement interventions.
尽管其对实施的影响已得到广泛认可，但关于外部环境（即外部背景）如何决定组织何时采用和实施新干预措施的研究却很有限。决定因素框架确定了几个外部背景层面的因素，如资金流、组织间关系和同行压力。然而，这些框架并未解释外部背景因素如何或为何影响实施。为推动该领域的研究，我们主张从组织理论中推导基于理论的命题，以解释外部背景因素如何影响组织的重要性。借鉴实施科学中的组织理论（OTIS）项目的工作，我们从五个经典组织理论——复杂性理论、权变理论、制度理论、资源依赖理论和交易成本经济学中确定了20个命题。然后，我们将这些命题应用于五个基于证据的烟草控制干预案例研究，以假设外部背景因素、实施策略和实施结果之间的关系。这五个案例研究涉及无烟政策的实施、社区卫生工作者主导的烟草教育和戒烟项目、5A's（询问、建议、评估、协助和安排）、销售点烟草营销政策干预以及戒烟热线。这些案例研究说明了如何利用命题来指导实施策略的选择和测试。组织理论提供了一系列命题，为选择和优化针对外部背景层面因素的高影响力实施策略提供指导。此外，这些命题还提出了关于外部背景因素影响组织采用和实施干预措施的方式及原因的潜在机制的可测试假设。
