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Table 7 Model tested

From: A systematic review of empirical studies examining mechanisms of implementation in health

StudyIndependent variable (X)Intervening variable (M)Dependent variable (Y)
Qualitative
Bardosh et al. 2017 [16]Mobile and text follow up with patientsService organization at clinic level, clinician norms and practices, availability of local champions staff, adaptability and co-design of strategy, receptivity and capacity of local managementCulture of care
Brewster et al. 2015 [17]Patient education, follow-up phone calls to patients after discharge, discharge planning, collaboration with post-acute providersIntrinsic reward to staff --> shift in norms and attitudesReduced hospital readmissions
Carrera and Lambooij 2015 [18]None reportedMediators: 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 strategyDirection, communication, opportunity, motivationChange in staff behavior
Wiener-Ogilvie et al. 2008 [20]Guideline implementationPractice organization (delegation of work to nurses)Compliance with guidelines
Quantitative—randomized
Atkins et al. 2008 [21]Training and consultationKey opinion leader instrumental supportmental health professional instrumental supportTeacher self-reported used of ADHD guidelines
Baer et al. 2009 [22]Climate for organizational changePost training agency activities to support use of Motivational InterviewingFidelity to intervention (Motivational Interviewing spirit and response to question ratio)
Bonetti et al. 2005 [23]Audit and feedbackDecision difficulty, behavioral controlSimulated behavior
Garner et al. 2011 [24]Pay for performance1. 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 performanceFidelity to multisystemic therapyRate of change in child behavior out of home placements
Holth et al. 2011 [26]Workshop + manual, intensive quality assurance + workshop + manualAdherence to contingency management and cognitive behavioral therapy techniquesYouth cannabis use
Lee et al. 2018 [27]Implementation strategy bundles (varied across studies)Knowledge, skills, social/professional role and identity, environmental resourcesNutrition 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/clientsClient 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 programsMediators: awareness of free/low cost cancer screening, cancer knowledge, cancer information seeking, having health insurance, annual physical moderator: frequency of library useCancer 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 implementationAdherence to evidence-based recommendations, level of competence, team climate for innovation, burnout, level of organized care30-day hospital readmission
Williams et al. 2014 [32]Information packets and Motivational Interviewing webinarAttitudes towards EBPs, pressure for change, barriers to EBPs, resources, organizational climate, management supportMotivational Interviewing adoption
Williams et al. 2017 [33]Availability,Responsiveness, and Continuity (ARC) intervention implementationProficiency culture --> evidence-based practice intention, barrier reductionEBP adoption, EBP use
Quantitative—non-randomized
Aarons et al. 2009 [34]Agency type1. 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 changeOrganizational 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 workPropensity to actReferral of women to smoking cessation services
Beets et al. 2008 [37]Perception of school climate1. 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 intentionAction planningPlacing fissure sealants
Chou et al. 2011 [39]Receipt of individual performance feedback, clinician input into guideline implementation and quality improvement, clinician expectancy, clinician self-efficacyAgreement with guidelines, adherence to guidelines, improved knowledge, practice deliveryFidelity to screening patients for depression
Cummings et al. 2017 [40]Culture, feedback, leadership and resourcesManager support, coaching conversations, job satisfactionConceptual research use, persuasive research use, instrumental research use
David and Schiff 2017 [41]Child-parent psychotherapy social network
Child-parent psychotherapy supervision
Self-efficacyNumber of child-parent psychotherapy cases, intention to use child-parent psychotherapy
Edmunds et al. 2014 [42]Time following trainingTime spent in consultationKnowledge of cognitive behavioral therapy for anxiety, attitudes towards EBPs
Gnich et al. 2018 [43]Pay-per item financial incentiveKnowledge, skills, social/professional role and identity, beliefs about consequences, motivation and goals (intention), environmental context and resources, social influences (norms), emotion, behavioral regulationFluoride varnish delivery
Guerrero et al. 2018 [44]Top manager transformational leadershipMiddle managers’ implementation leadershipEmployee 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 strategySocial influence, leadership, performance feedbackHandwashing fidelity
Little et al. 2015 [46]Community priority, organizational support, program championbeliefs about effectiveness of interventions --> funding to adopt programAdoption
Llasus et al. 2014 [47]EBP knowledgeSelf confidence in one's EBP competencies (defined as readiness)EBP implementation behaviors
Nelson and Steele 2007 [48]EBP training, openness of clinical setting to EBPsPositive attitudes towards treatment research, negative attitudes towards treatment researchEBP use
Potthoff et al. 2017 [49]Action planning, coping planningHabitClinical behaviors (prescribing, advising, examining)
Presseau et al. 2016 [50]Printed informational materialsAttitudes toward prescribing, subjective norms, perceived behavioral control, intention to prescribeSelf-reported prescribing behavior
Simmonds et al. 2012 [51]Intolerance of uncertaintyTreatment orientation toward back painRecommendations 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 communicationPatient-provider communicationPatient satisfaction with primary care provider
Wanless et al. 2015 [53]Use of responsive classroom practices, global emotional support, self-efficacy, collective responsibilityTeacher training engagementFidelity to intervention
Yamada et al. 2017 [62]Instrumental research use, conceptual research useOrganizational 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 availableUse 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, workshopJob-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 cultureTeam effectivenessExtent of implementation
Panzano et al. 2012 [58]1. Strategic fit of intervention
2. Climate for innovation
1. Climate for innovation2. Fidelity to intervention1. Fidelity to intervention
2. Assimilation
Rangachari et al. 2015 [59]Emails containing intervention information and unit level adherence feedback + brief weekly trainingProactive communication between nurses and physicians emergence of championsNumber of catheter days
Shrubsole et al. 2018 [60]Tailored training intervention targeting information provisionMechanisms 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
  1. Numbering is used to denote match variables across models; not all models tested the same sets of variables