Commentary on “A methodology for generating a tailored implementation blueprint: An exemplar from a youth residential setting.”
Commentary: A key question in implementation science is how we can identify, develop, and apply implementation strategies that promote the use of evidence-based practices and improved health. Given that implementation barriers often emerge at multiple levels and phases of implementation, there is increasing attention to how implementation strategies can be thoughtfully tailored to address the needs of a given context.1,2 There is some evidence that tailored implementation strategies can be effective;1 however, the methods used to identify and prioritize barriers to change and to select implementation strategies to address them are not well established.1,3 Ideally, tailoring would be guided by theory, evidence, stakeholder involvement, and a robust understanding of the context of implementation.4 Lewis and colleagues’5 methodology paper exemplifies these ideals by demonstrating an approach to developing a tailored implementation blueprint in close partnership with a community partner. They engaged in a multistep process that involved a theory-driven, mixed methods analysis of implementation barriers and facilitators; stakeholder-driven prioritization of implementation barriers and strategies based upon the mixed methods analysis and a consideration of the implementation literature; the formation of implementation teams; and the development of a tailored implementation blueprint. In addition to describing their novel methodology, they report an implementation blueprint for three different implementation phases: pre-implementation, implementation, and sustainment. The article addresses a key priority related to the development of rigorous and replicable methods for enhancing the linkage between identified barriers and implementation strategies,1,3,6 and adds to a growing list of candidate methods that can be used for this purpose.4,7 Many questions remain about efficiently identifying barriers and facilitators, prioritizing those that should be explicitly addressed, and linking strategies to barriers. We also have much to learn about the level, timing, and cost of tailoring. Ultimately, empirical tests of alternative approaches are needed to determine whether they improve implementation and health outcomes. In the meantime, let’s continue to share ways of approaching the challenge of identifying and applying contextually appropriate implementation strategies.
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References:
1Baker R, Comosso-Stefinovic J, Gillies C, et al. Tailored interventions to address determinants of practice. Cochrane Database Syst Rev. 2015;4(CD005470):1-118. doi:10.1002/14651858.CD005470.pub3
2Wensing M. The Tailored Implementation in Chronic Diseases (TICD) project: Introduction and main findings. Implement Sci. 2017;12(5):1-4. doi:10.1186/s13012-016-0536-x
3Bosch M, van der Weijden T, Wensing M, Grol R. Tailoring quality improvement interventions to identified barriers: A multiple case analysis. J Eval Clin Pract. 2007;13:161-168. doi:10.1111/j.1365-2753.2006.00660.x
4Powell BJ, Beidas RS, Lewis CC, et al. Methods to improve the selection and tailoring of implementation strategies. J Behav Health Serv Res. 2017;44(2):177-194. doi:10.1007/s11414-015-9475-6
5Lewis CC, Scott K, Marriott BR. A methodology for generating a tailored implementation blueprint: An exemplar from a youth residential setting. Implement Sci. 2018;13(68):1-13. doi:10.1186/s13012-018-0761-6
6Grol R, Bosch M, Wensing M. Development and selection of strategies for improving patient care. In: Grol R, Wensing M, Eccles M, Davis D, eds. Improving Patient Care: The Implementation of Change in Health Care. 2nd ed. Chichester: John Wiley & Sons, Inc.; 2013:165-184.
7Colquhoun HL, Squires JE, Kolehmainen N, Grimshaw JM. Methods for designing interventions to change healthcare professionals’ behaviour: A systematic review. Implement Sci. 2017;12(30):1-11. doi:10.1186/s13012-017-0560-5