Choosing implementation strategies to address contextual barriers

Diversity in recommendations and future directions

Bibliographic Data

ID23348971
AuthorsThomas J Waltz (0000-0001-7976-430X, Eastern Michigan University), Byron J Powell (0000-0001-5245-1186, University of North Carolina at Chapel Hill), Maria E Fernandez (0000-0002-4820-821X, The University of Texas Health Science Center at Houston), Brenton Abadie (Eastern Michigan University), Laura J Damschroder (0000-0002-3657-8459, VA Center for Clinical Management Research, corresponding author)
Year2019
Volume14
Issue1
Pages42-42
Publication date2019-12-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueImplementation Science (JOURNAL)
Journal identifiersISSN: 1748-5908 • E-ISSN: 1748-5908
PublisherSpringer Science and Business Media LLC (PUBLISHER)
DOI10.1186/s13012-019-0892-4
PMID31036028
OpenAlexW2947410237
LanguageEN
Citations received75
References cited41

BACKGROUND: A fundamental challenge of implementation is identifying contextual determinants (i.e., barriers and facilitators) and determining which implementation strategies will address them. Numerous conceptual frameworks (e.g., the Consolidated Framework for Implementation Research; CFIR) have been developed to guide the identification of contextual determinants, and compilations of implementation strategies (e.g., the Expert Recommendations for Implementing Change compilation; ERIC) have been developed which can support selection and reporting of implementation strategies. The aim of this study was to identify which ERIC implementation strategies would best address specific CFIR-based contextual barriers. METHODS: Implementation researchers and practitioners were recruited to participate in an online series of tasks involving matching specific ERIC implementation strategies to specific implementation barriers. Participants were presented with brief descriptions of barriers based on CFIR construct definitions. They were asked to rank up to seven implementation strategies that would best address each barrier. Barriers were presented in a random order, and participants had the option to respond to the barrier or skip to another barrier. Participants were also asked about considerations that most influenced their choices. RESULTS: Four hundred thirty-five invitations were emailed and 169 (39%) individuals participated. Respondents had considerable heterogeneity in opinions regarding which ERIC strategies best addressed each CFIR barrier. Across the 39 CFIR barriers, an average of 47 different ERIC strategies (SD = 4.8, range 35 to 55) was endorsed at least once for each, as being one of seven strategies that would best address the barrier. A tool was developed that allows users to specify high-priority CFIR-based barriers and receive a prioritized list of strategies based on endorsements provided by participants. CONCLUSIONS: The wide heterogeneity of endorsements obtained in this study's task suggests that there are relatively few consistent relationships between CFIR-based barriers and ERIC implementation strategies. Despite this heterogeneity, a tool aggregating endorsements across multiple barriers can support taking a structured approach to consider a broad range of strategies given those barriers. This study's results point to the need for a more detailed evaluation of the underlying determinants of barriers and how these determinants are addressed by strategies as part of the implementation planning process.

Diversity (politics) · Health administration · Health services research · Political science · Public health · Public relations · Complex Systems and Decision Making · Evaluation and Performance Assessment · Health Informatics · Health Policy Implementation Science · Medicine · Nursing · Health Policy