Table 2 Five classifications for implementation strategies
Classification | Category of actor [10] | Action target (determinants and levels) | Example strategies | Outcomes used to assess effectiveness | Example strategy lists/descriptions |
|---|---|---|---|---|---|
Dissemination strategies | All 3 ISF systems | Awareness, attitude, knowledge, and intention to adopt a specific EBI Targets levels of intervention and individual | • Develop EBI messaging, packaging, and pricing customized to audience • Distribute customized EBI messages and packages through channels with optimal reach | Distribution reach to target audience EBI awareness, knowledge, attitude, and intention to adopt | Dearing & Kreuter (2010) [26] Kreuter & Bernhartdt (2009) [27] |
Implementation process strategies | Delivery system | How well teams execute activities required to select, adapt, and integrate EBIs generally Targets level of process | • Engage stakeholders • Assess context (need, capacity) • Establish goals and objectives • Select EBI and implementation strategies that fit • Adapt EBI, strategies, and context • Evaluate processes and outcomes | Extent, quality, and timeliness of the completion of activities related to specific implementation process strategies | Aarons et al. (2011) [30] Chinman et al. (2004) [32] Institute for Healthcare Improvement [38] Meyers et al. (2012) [33] |
Integration strategies | Delivery system | Factors that facilitate or impede optimal integration of a specific EBI into a specific setting Targets levels of individual and inner setting | For a specific EBI: • Institute reminder systems • Revise professional roles • Provide supervision • Modify medical record systems • Implement tools for quality monitoring | Individuals’ motivation, capability, and opportunity to implement an EBI Team coordination/ communication Fidelity, feasibility, acceptability | Fixsen et al. (2009) [48] Mazza et al. (2013) [3] Powell et al. (2015) [2] |
Capacity-building strategies | Support system | Motivation and capability to engage in implementation process strategies (in general, not related to a specific EBI) Targets levels of individual and processes | Across multiple settings: • Training to build general capacity • Technical assistance and facilitation for implementation processes • Tools to support implementation processes | Individual and collective self-efficacy and motivation to engage in implementation process strategies Team completion of implementation process strategies | Leeman et al. (2015) [6] Jacobs et al. (2014) [39] Wandersman et al. (2012) [49] |
Scale-up strategies | Support system | Motivation and capacity to integrate a specific EBI into practice Targets level of individual, inner setting, and outer setting | Across multiple settings: • Training to build EBI-specific capacity • Technical assistance and facilitation (EBI specific) • Implementation toolkits • Quality improvement collaboratives • Benchmarking • Recognition systems • Infrastructure development • Changes to fee for service lists/formularies | Motivation and capacity to implement, and actual implementation of an EBI across multiple settings | Barker et al. (2016) [43] Milat et al. (2016) [42] |