Balis Laura E, Houghtaling Bailey
Gretchen Swanson Center for Nutrition, Omaha, NE, 68514, USA.
Department of Human Nutrition, Virginia Tech, Foods, and Exercise, Blacksburg, VA, 24061, USA.
Implement Sci Commun. 2023 Nov 21;4(1):144. doi: 10.1186/s43058-023-00532-1.
Implementation science aims to improve the integration of evidence-based interventions in real-world settings. While its methods and models could potentially apply to any field with evidence-based interventions, most research thus far has originated in clinical settings. Community settings often have fewer resources, missions beyond health, and a lack of support and expertise to implement evidence-based interventions when compared to many clinical settings. Thus, selecting and tailoring implementation strategies in community settings is particularly challenging, as existing compilations are primarily operationalized through clinical setting terminology. In this debate, we (1) share the process of using an existing match tool to select implementation strategies to increase uptake of nutrition and physical activity policy, systems, and environment interventions in community settings and (2) discuss the challenges of this process to argue that selecting implementation strategies in community settings has limited transferability from clinical settings and may require a unique implementation strategy compilation and pragmatic matching tool.
The impetus for this debate paper came from our work selecting implementation strategies to improve the implementation and eventual scaling of nutrition and physical activity policy, systems, and environment interventions in a community settings. We conducted focus groups with practitioners and used the Consolidated Framework for Implementation Research-Expert Recommendations for Implementing Change match tool to select potential implementation strategies to overcome prominent barriers. There was limited congruence between tool outputs and optimal strategies, which may in part be due to differences in context between clinical and community settings. Based on this, we outline needs and recommendations for developing a novel and pragmatic matching tool for researchers and practitioners in community settings.
More work is needed to refine the implementation barrier-strategy matching process to ensure it is relevant, rapid, and rigorous. As leading implementation strategy scholars note, as more researchers document contextual factors and strategies selected to address them, the knowledge base will increase, and refined mapping processes can emerge.
实施科学旨在促进循证干预措施在现实环境中的整合。虽然其方法和模式可能适用于任何采用循证干预措施的领域，但迄今为止，大多数研究都源自临床环境。与许多临床环境相比，社区环境往往资源较少，使命超越健康范畴，且缺乏实施循证干预措施所需的支持和专业知识。因此，在社区环境中选择和调整实施策略极具挑战性，因为现有的汇编主要是通过临床环境术语来实施的。在这场辩论中，我们（1）分享使用现有匹配工具来选择实施策略以提高社区环境中营养与身体活动政策、系统及环境干预措施采用率的过程，（2）讨论这一过程中面临的挑战，以论证在社区环境中选择实施策略与临床环境的可转移性有限，可能需要独特的实施策略汇编和实用的匹配工具。
这篇辩论文章的灵感来源于我们在社区环境中选择实施策略以改善营养与身体活动政策、系统及环境干预措施的实施及最终推广工作。我们与从业者进行了焦点小组讨论，并使用实施研究综合框架 - 实施变革专家建议匹配工具来选择潜在的实施策略，以克服突出障碍。工具输出结果与最佳策略之间的一致性有限，这可能部分归因于临床和社区环境在背景方面的差异。基于此，我们概述了为社区环境中的研究人员和从业者开发新颖实用的匹配工具的需求和建议。
需要开展更多工作来完善实施障碍 - 策略匹配过程，以确保其相关性、快速性和严谨性。正如领先的实施策略学者所指出的，随着越来越多的研究人员记录背景因素以及为应对这些因素而选择的策略，知识库将会增加，进而可以形成完善的映射过程。
