Table 7 Model tested
From: A systematic review of empirical studies examining mechanisms of implementation in health
Study | Independent variable (X) | Intervening variable (M) | Dependent variable (Y) |
|---|---|---|---|
Qualitative | |||
Bardosh et al. 2017 [16] | Mobile and text follow up with patients | Service organization at clinic level, clinician norms and practices, availability of local champions staff, adaptability and co-design of strategy, receptivity and capacity of local management | Culture of care |
Brewster et al. 2015 [17] | Patient education, follow-up phone calls to patients after discharge, discharge planning, collaboration with post-acute providers | Intrinsic reward to staff --> shift in norms and attitudes | Reduced hospital readmissions |
Carrera and Lambooij 2015 [18] | None reported | Mediators: perceived usefulness, perceived ease of use, self-efficacy, attitudes,social norm Moderator: enabling conditions | Intervention acceptability (providers and patients) |
Frykman et al. 2014 [19] | Senior manager and consultant-driven teamwork strategy, senior manager and staff-driven teamwork strategy | Direction, communication, opportunity, motivation | Change in staff behavior |
Wiener-Ogilvie et al. 2008 [20] | Guideline implementation | Practice organization (delegation of work to nurses) | Compliance with guidelines |
Quantitative—randomized | |||
Atkins et al. 2008 [21] | Training and consultation | Key opinion leader instrumental supportmental health professional instrumental support | Teacher self-reported used of ADHD guidelines |
Baer et al. 2009 [22] | Climate for organizational change | Post training agency activities to support use of Motivational Interviewing | Fidelity to intervention (Motivational Interviewing spirit and response to question ratio) |
Bonetti et al. 2005 [23] | Audit and feedback | Decision difficulty, behavioral control | Simulated behavior |
Garner et al. 2011 [24] | Pay for performance | 1. Subjective norms 2. Attitudes toward intervention 3. Perceived control | 1. Therapists’ intention to achieve monthly competence 2. Therapists’ intention to achieve targeted threshold |
Glisson et al. 2010 [25] | Availability responsiveness and continuity (ARC) Intervention + Multisystemic Therapy quality assurance, pay for performance | Fidelity to multisystemic therapy | Rate of change in child behavior out of home placements |
Holth et al. 2011 [26] | Workshop + manual, intensive quality assurance + workshop + manual | Adherence to contingency management and cognitive behavioral therapy techniques | Youth cannabis use |
Lee et al. 2018 [27] | Implementation strategy bundles (varied across studies) | Knowledge, skills, social/professional role and identity, environmental resources | Nutrition guideline implementation |
Lochman et al. 2009 [28] | Intensive training + feedback, basic training | # of sessions attended, # of objectives completed, # of contacts with trainers, counselor engagement w/clients | Client externalizing behaviors, client social skills, client study skills, client expectancies re: aggression, consistent parenting, client assaultive acts |
Rapkin et al. 2017 [29] | Indicators of program activities: cumulative local programs, attendance at local programs, time since most recent local program, personal awareness of programs, cumulative outside programs | Mediators: awareness of free/low cost cancer screening, cancer knowledge, cancer information seeking, having health insurance, annual physical moderator: frequency of library use | Cancer screening attempts to quit smokingtobacco cessation |
Rohrbach et al. 1993 [30] | 1. Teacher training 2. Principal support intervention | 1a. Teacher self-efficacy, 1b. enthusiasm, 1c. preparedness 2a. Principal encouragement, 2b. Principal beliefs about program | Quantity of program implementation |
Seys et al. 2018 [31] | Care pathway implementation | Adherence to evidence-based recommendations, level of competence, team climate for innovation, burnout, level of organized care | 30-day hospital readmission |
Williams et al. 2014 [32] | Information packets and Motivational Interviewing webinar | Attitudes towards EBPs, pressure for change, barriers to EBPs, resources, organizational climate, management support | Motivational Interviewing adoption |
Williams et al. 2017 [33] | Availability,Responsiveness, and Continuity (ARC) intervention implementation | Proficiency culture --> evidence-based practice intention, barrier reduction | EBP adoption, EBP use |
Quantitative—non-randomized | |||
Aarons et al. 2009 [34] | Agency type | 1. organizational support for EBP --> provider attitudes towards EBP 2, 3 organizational support for EBP organizational support for EBP | 1,3 provider EBP use2. provider EBP attitudes |
Becker et al. 2016 [35] | Training as usual, training + ongoing technical assistance, support from in-house champion, specialized training on change process, monthly conference calls and online forum to support change | Organizational readiness to change (motivation for change, adequacy of resources, staff attributes, organizational climate),perceived intervention characteristics (relative advantage, observability, trialability, compatibility, and complexity) | Adoption |
Beenstock et al. 2012 [36] | Main place of work | Propensity to act | Referral of women to smoking cessation services |
Beets et al. 2008 [37] | Perception of school climate | 1. Beliefs about responsibility to teach program 2. beliefs about responsibility to teach program --> attitudes towards program --> curriculum delivered | 1. Attitudes towards program 2. curriculum delivered to schoolwide material usage |
Bonetti et al. 2009 [38] | Behavioral intention | Action planning | Placing fissure sealants |
Chou et al. 2011 [39] | Receipt of individual performance feedback, clinician input into guideline implementation and quality improvement, clinician expectancy, clinician self-efficacy | Agreement with guidelines, adherence to guidelines, improved knowledge, practice delivery | Fidelity to screening patients for depression |
Cummings et al. 2017 [40] | Culture, feedback, leadership and resources | Manager support, coaching conversations, job satisfaction | Conceptual research use, persuasive research use, instrumental research use |
David and Schiff 2017 [41] | Child-parent psychotherapy social network Child-parent psychotherapy supervision | Self-efficacy | Number of child-parent psychotherapy cases, intention to use child-parent psychotherapy |
Edmunds et al. 2014 [42] | Time following training | Time spent in consultation | Knowledge of cognitive behavioral therapy for anxiety, attitudes towards EBPs |
Gnich et al. 2018 [43] | Pay-per item financial incentive | Knowledge, skills, social/professional role and identity, beliefs about consequences, motivation and goals (intention), environmental context and resources, social influences (norms), emotion, behavioral regulation | Fluoride varnish delivery |
Guerrero et al. 2018 [44] | Top manager transformational leadership | Middle managers’ implementation leadership | Employee attitudes towards EBPs, EBP implementation |
Huis et al. 2013 [45] | individual and organization targeted strategies (education, reminders, feedback), individual and organizational targeted strategies + team and leader strategy | Social influence, leadership, performance feedback | Handwashing fidelity |
Little et al. 2015 [46] | Community priority, organizational support, program champion | beliefs about effectiveness of interventions --> funding to adopt program | Adoption |
Llasus et al. 2014 [47] | EBP knowledge | Self confidence in one's EBP competencies (defined as readiness) | EBP implementation behaviors |
Nelson and Steele 2007 [48] | EBP training, openness of clinical setting to EBPs | Positive attitudes towards treatment research, negative attitudes towards treatment research | EBP use |
Potthoff et al. 2017 [49] | Action planning, coping planning | Habit | Clinical behaviors (prescribing, advising, examining) |
Presseau et al. 2016 [50] | Printed informational materials | Attitudes toward prescribing, subjective norms, perceived behavioral control, intention to prescribe | Self-reported prescribing behavior |
Simmonds et al. 2012 [51] | Intolerance of uncertainty | Treatment orientation toward back pain | Recommendations to return to work 2. recommendations to return to usual activities,estimated risk of back pain disability |
Stockdale et al. 2018 [52] | Health care team communication | Patient-provider communication | Patient satisfaction with primary care provider |
Wanless et al. 2015 [53] | Use of responsive classroom practices, global emotional support, self-efficacy, collective responsibility | Teacher training engagement | Fidelity to intervention |
Yamada et al. 2017 [62] | Instrumental research use, conceptual research use | Organizational context: leadership, culture, evaluation, social capital, informal interactions, formal interactions, resources, slack space, slack staff, slack time | Pain assessment, evidence-based pain procedure use, pain intensity |
Mixed methods | |||
Armson et al. 2018 [54] | Implementation tools (printed education materials, informational video, decision aid) | Evidence-based information in guideline, evidence-based information in screening module, discussions with peers, application of implementation tools, discussions with patients, lack of evidence about benefits, patients' screening expectations, fear of misdiagnosis, problems with having patient materials available | Use of breast cancer screening guidelines |
Birken et al. 2015 [55] | 1. Top manager support 2. Performance reviews 3. Human resources | Mediators: 1a. Performance reviews 1b. Human resources 1c. Training 1d. Funding 1e. Local social network involvement Moderator: 2/3. top manager support | 1, 2, 3 middle manager commitment to innovation |
Kauth et al. 2010 [56] | Facilitation + workshop, workshop | Job-related barriers, # of contacts with facilitator, time spent in facilitation | % time conducting Cognitive Behavioral Therapy |
Lukas et al. 2009 [57] | Higher management support, group culture, hierarchical culture | Team effectiveness | Extent of implementation |
Panzano et al. 2012 [58] | 1. Strategic fit of intervention 2. Climate for innovation | 1. Climate for innovation2. Fidelity to intervention | 1. Fidelity to intervention 2. Assimilation |
Rangachari et al. 2015 [59] | Emails containing intervention information and unit level adherence feedback + brief weekly training | Proactive communication between nurses and physicians emergence of champions | Number of catheter days |
Shrubsole et al. 2018 [60] | Tailored training intervention targeting information provision | Mechanisms of Intervention 1 targeting information provision implementation): knowledge, beliefs about consequences, social influence, beliefs about capabilities, environmental context and resources Mechanisms of Intervention 2 targeting implementation of goal setting): beliefs about consequences, social influences, beliefs about capabilities, environmental context and resources | Information provisiongoal setting |