Research Implementation

For years, people have joked, “Implementation frameworks are like toothbrushes; everyone wants one, but they don’t want to use anyone else’s.” Now that frameworks are being increasingly used in implementation practice and support, that no longer seems to be the case.

The people we talk to are eager to use someone else’s framework. But they struggle to figure out which one to use or complain that a framework doesn’t work or isn’t helpful. But we’ve started to wonder – maybe it’s not the framework that isn’t working. My husband recently said, “You can’t cut wood with a screwdriver. You can’t hammer a nail with a wrench – well, it might work, but it won’t be pretty”. Are we trying to do the same thing with some of our implementation frameworks?

Imagine how much easier picking a framework would be if it were easy to understand its purpose and function. Imagine what would happen if we used appropriate frameworks to guide our implementation practice and research. Imagine what it would feel like if frameworks were always helpful tools instead of barriers to getting things done. That’s our goal – to make using frameworks feel much more accessible!

PRISM is the contextually expanded, updated version of RE-AIM. It adds key contextual factors that often are associated with implementation and program outcomes- especially the 5 RE-AIM outcomes of Reach, Effectiveness Adoption, Implementation, and Maintenance.

PRISM is both a determinant and evaluation framework in the classification suggested by Nilsen , and has also more recently been used as a process model to guide implementation adaptation

There are several resources to find out more about PRISM, including:

• A review article on PRISM by Rabin et al
• A brief video description of key points by Dr. Rabin
• A power point presentation by Dr. Glasgow
• View the interview of Dr. Glasgow by Dr. Harden on common issues in and questions about applying PRISM and RE-AIM

The goal of RE-AIM is to encourage program planners, evaluators, readers of journal articles, funders, and policy-makers to pay more attention to essential program elements including external validity that can improve the sustainable adoption and implementation of effective, generalizable, evidence-based interventions.

The five steps to translate research into action are:

• Reach the target population
• Effectiveness or efficacy
• Adoption by target staff, settings, systems and communities
• Implementation consistency, costs and adaptions made during delivery
• Maintenance/sustainment of intervention effects in individuals and settings over time

The Navigating Implementation Science series aims to help researchers develop an understanding of implementation science in practice. Each seminar has a theoretical component, illustrated by practical examples from a clinician researcher.

Titles include:

Co-designing for Impact; De-implementing low value health care – harnessing evidence and the electronic medical record; How do implementation science frameworks work?; A transdisciplinary approach to implementation; The Holy Grail of Scale.

An overview of JBI-endorsed approaches to getting evidence into practice and step-by-step guidance for implementing evidence.

This presentation focuses on facilitation as a strategy in evidence implementation. In particular, techniques for facilitation which span the phases of pre-implementation, implementation and sustainability are presented. The JBI Evidence Implementation Framework, and its 7 phases, is explained.

Ensuring that research findings are translated into practice involves a systematic approach from the beginning when you are designing your research. Implementation science bridges the gap between developing and evaluating effective interventions and implementation and de-implementation in routine practice. This seminar covers key elements of implementation research; theoretical approaches, research designs, involvement of stakeholders, behaviour change interventions.

Dr Kylie Porritt presents a JBI LIVE webinar which provides tips for success in evidence implementation. The Getting Research into Practice (GRiP) framework is explored, together with the Five “rights” for implementation.

In this video, Dr John Wakefield offers his unique perspective as a clinician driving reform across the health system. John describes his role in fostering an environment that brings together clinicians and researchers to solve today’s challenges affecting sustainable healthcare delivery.

Allied Health – Translating Research into Practice (AH-TRIP) is an initiative that aims to embed knowledge translation from research within the usual business of Hospital and Health Services (HHSs) by building the capacity of the health practitioner workforce. Although entitled AH, it is applicable to multi-disciplines. It covers topics including identifying a clinical problem; evidence to support change; planning for change; implementation; evaluating change; sustainability.

The Research Impact webinar series covers a range of content including:
• Impact definitions and impact types
• Engaging with stakeholders and aligning expectations for impact
• Using a logic model or framework to plan and measure impact
• Communicating impact and how to present impact information for different audiences. Additional links to frameworks and templates, websites and videos, case studies and impact stories

Knowledge translation plays a critical role in evidence-based healthcare and improving health outcomes. Dr Straus discusses how to approach sustainability of knowledge translation interventions and research in the context of COVID-19.

The 9 Research Impact Things program is a self-directed learning tool developed for researchers at any stage of their career who want to know more about creating, tracking, evaluating, and demonstrating their engagement i.e. research impact beyond academia. It is important to consider how you generate and demonstrate impact from the beginning of the research process. This program provides information and practical tools to help you get started.

This article describes how to incorporate appropriate research into decision making based on practice-relevant questions, and considers the strengths and limitations of using different types of research.