Commentary on “Beyond ‘implementation strategies’: classifying the full range of strategies used in implementation science and practice”
Commentary: The recent article in Implementation Science by esteemed colleagues at the University of North Carolina (Leeman et al., 2017) develop a system for classifying implementation strategies. Although non-implementation scientists still seem to struggle with the difference between the intervention and the proposed implementation strategies, the authors note the difficulties in synthesizing results when using the blanket term “implementation strategies” and suggest a classification system that builds upon existing work rather than creating new taxonomies.
The classification system includes strategies’ actor and action targets. To differentiate categories of actors, the authors included the three systems described in the Interactive Systems Framework (ISF) for dissemination and implementation: the delivery system, the support system, and synthesis and translation.1 Action targets include both the determinant and the level that an implementation strategy targets. The process of identifying actors and action targets resulted in five conceptually distinct classes of strategies: dissemination, implementation process, integration, capacity-building, and scale-up, all linked to a specific system in the ISF framework. The paper also includes outcomes used to assess strategy effectiveness and an example of how each class would apply to strategies to improve colorectal cancer screening rates in Federally Qualified Health Centers.
It is important to highlight this work as this classification system adds greater conceptual clarity to the often generalized concept of implementation strategies. As noted by the authors, this system can not only help encourage collaboration and aid in ensuring a common understanding between implementation scientists and clinical practitioners, but can also aid in the synthesizing of evidence across studies to ensure results are comparable. This study also provides an important example of how to build upon existing taxonomies and frameworks that are already being utilized in creating a new classification system. Not only are the terms from these frameworks already in the implementation science lexicon, but given the wealth of existing frameworks and taxonomies out there, limiting the new concepts introduced will also aid in greater conceptual clarity for the field as it continues to grow.
Read the abstract.
1Wandersman, A., Duffy, J., Flaspohler, P., Noonan, R., Lubell, K., Stillman, L., et al. (2008). Bridging the gap between prevention research and practice: The interactive systems framework for dissemination and implementation. American Journal of Community Psychology, 41(3-4), 171-181.