Department of Nursing, Midwifery & Health, Northumbria University, Newcastle Upon Tyne, NE7 7XA, UK.
Department of Social Work, Education & Community Wellbeing, Northumbria University, Newcastle Upon Tyne, NE7 7XA, UK.
Implement Sci. 2024 Jul 11;19(1):48. doi: 10.1186/s13012-024-01380-w.
The process of tailored implementation is ill-defined and under-explored. The ItFits-toolkit was developed and subsequently tested as a self-guided online platform to facilitate implementation of tailored strategies for internet-based cognitive behavioural therapy (iCBT) services. In ImpleMentAll, ItFits-toolkit had a small but positive effect on the primary outcome of iCBT normalisation. This paper investigates, from a qualitative perspective, how implementation teams developed and undertook tailored implementation using the toolkit within the trial.
Implementation teams in thirteen sites from nine countries (Europe and Australia) used the ItFits-toolkit for six months minimum, consistent with the trial protocol. A qualitative process evaluation was conducted. Descriptive data regarding goals, barriers, strategies, and implementation plans collected within the toolkit informed qualitative data collection in real time. Qualitative data included remote longitudinal interviews (n = 55) with implementation team members (n = 30) and observations of support calls (n = 19) with study sites. Qualitative data were analysed thematically, using a team-based approach.
Implementation teams developed and executed tailored implementation projects across all steps in the toolkit process. Working in a structured way but with room for flexibility, decisions were shaped by team members' ideas and goals, iterative stakeholder engagement, internal and external influences, and the context of the ImpleMentAll project. Although teams reported some positive impacts of their projects, 'time', both for undertaking the work, and for seeing project impacts, was described as a key factor in decisions about implementation strategies and assessments of success.
This study responds directly to McHugh et al.'s (2022) call for empirical description of what implementation tailoring looks like in action, in service settings. Self-guided facilitation of tailored implementation enables implementers in service settings to undertake tailoring within their organisations. Implementation tailoring takes considerable time and involves detailed work but can be supported through the provision of implementation science informed guidance and materials, iterative and ongoing stakeholder engagement, and working reflectively in response to external influencing factors. Directions for advancement of tailored implementation are suggested.
定制实施的过程尚未明确，也未得到充分探索。ItFits 工具包是作为一个自我引导的在线平台开发的，用于促进基于互联网的认知行为疗法 (iCBT) 服务的定制策略的实施。在 ImpleMentAll 中，ItFits 工具包对 iCBT 正常化的主要结果有一个较小但积极的影响。本文从定性角度调查了实施团队如何在试验中使用该工具包制定和进行定制实施。
来自九个国家（欧洲和澳大利亚）的 13 个地点的实施团队使用 ItFits 工具包至少六个月，符合试验方案。进行了定性的过程评估。工具包中收集的关于目标、障碍、策略和实施计划的描述性数据实时为定性数据收集提供了信息。定性数据包括与实施团队成员（n=30）进行的远程纵向访谈（n=55）和与研究地点进行的支持电话观察（n=19）。定性数据采用基于团队的方法进行主题分析。
实施团队在工具包流程的所有步骤中制定并执行了定制实施项目。团队以结构化的方式工作，但具有灵活性，决策受到团队成员的想法和目标、迭代式利益相关者参与、内部和外部影响以及 ImpleMentAll 项目背景的影响。尽管团队报告了他们项目的一些积极影响，但“时间”，无论是用于开展工作，还是用于看到项目影响，都被描述为实施策略决策和成功评估的关键因素。
本研究直接响应了 McHugh 等人（2022 年）对服务环境中实施定制的实际描述的呼吁。在服务环境中，自我引导的定制实施促进了实施者在其组织内进行定制。实施定制需要相当多的时间和详细的工作，但可以通过提供实施科学的指导和材料、迭代和持续的利益相关者参与以及有针对性地应对外部影响因素来支持。提出了推进定制实施的方向。
