Cruden Gracelyn, Powell Byron J, Frerichs Leah, Lanier Paul, Brown C Hendricks, Saldana Lisa, Lich Kristen Hassmiller
Chestnut Health Systems, Lighthouse Institute- Oregon Group, 1255 Pearl St, Eugene, 97401, USA.
Center for Mental Health Services Research, Brown School, Washington University in St. Louis, St. Louis, USA.
Implement Sci Commun. 2024 Dec 2;5(1):134. doi: 10.1186/s43058-024-00660-2.
Implementation strategies can help support the adoption and implementation of health interventions that are appropriate for a local context and acceptable to decision makers and community members. Implementation strategies should be designed to handle the complexity of the multi-level, dynamic contexts in which interventions are implemented. Systems science theories and methods explicitly attend to complexity and can be valuable for specifying implementation strategies. Group Model Building (GMB) combines research partner engagement strategies with systems science to support researchers' and partners' learning about complex problems and to identify solutions through consensus. This paper specifies how GMB can operationalize implementation strategies - methods for supporting evidence implementation in real-world practice - and describes how GMB can aid in selecting and tailoring both health interventions and implementation strategies. A case study in child maltreatment prevention planning is provided to illustrate how GMB was used to specify the "actions" - strategy activities - for three implementation strategies (conduct local consensus discussions; build a coalition; model and simulate change) during the earliest implementation phases, with the goal of supporting intervention selection decisions. Examples are provided of generalizable research products that can be produced concurrently through GMB, in addition to contextually-driven implementation support.
Participants (n = 8) were engaged over four sessions using tailored GMB activities. Participants generated a qualitative system dynamics model that described their theory of change for how to prevent child maltreatment in their communities. This theory of change reflected a dynamic understanding of the interconnected determinants of child maltreatment.
GMB was acceptable to participants and resulted in products that could be used for implementation planning (e.g., to model and simulate change) and future research. GMB fostered trust and idea sharing between participants.
GMB can facilitate learning about which outcomes are (or are not) impacted by interventions, which resources and approaches are required for quality implementation (e.g., implementation strategies), and tradeoffs in outcomes and resources between interventions. GMB also provides a structured, effective process to generate a shared implementation vision amongst participants. Lessons learned include methods for developing trust with and between participants, and the need for researchers to tailor GMB actions for participant and project needs.
实施策略有助于支持采用和实施适合当地情况且为决策者和社区成员所接受的卫生干预措施。实施策略应设计用于应对实施干预措施的多层次、动态环境的复杂性。系统科学理论和方法明确关注复杂性，对于确定实施策略可能很有价值。群体模型构建（GMB）将研究伙伴参与策略与系统科学相结合，以支持研究人员和伙伴了解复杂问题并通过共识确定解决方案。本文详细说明了GMB如何将实施策略（即在实际实践中支持证据实施的方法）付诸实践，并描述了GMB如何有助于选择和调整卫生干预措施及实施策略。提供了一个预防儿童虐待规划的案例研究，以说明在实施的最初阶段，GMB如何用于确定三种实施策略（进行当地共识讨论；建立联盟；建模和模拟变化）的“行动”（即策略活动），目标是支持干预措施选择决策。除了根据具体情况提供实施支持外，还给出了可通过GMB同时产生的可推广研究产品的示例。
通过使用量身定制的GMB活动，在四个环节中让8名参与者参与。参与者生成了一个定性系统动力学模型，该模型描述了他们关于如何在其社区预防儿童虐待的变革理论。这种变革理论反映了对儿童虐待相互关联的决定因素的动态理解。
GMB为参与者所接受，并产生了可用于实施规划（如建模和模拟变化）及未来研究的产品。GMB促进了参与者之间的信任和想法分享。
GMB有助于了解干预措施对哪些结果有（或没有）影响、高质量实施（如实施策略）需要哪些资源和方法，以及干预措施在结果和资源之间的权衡。GMB还提供了一个结构化、有效的过程，以在参与者之间形成共同的实施愿景。吸取 的经验教训包括与参与者建立信任以及参与者之间建立信任的方法，以及研究人员需要根据参与者和项目需求调整GMB行动。
