Table 1 Selected terminology related to evidence and implementation science
From: Revisiting concepts of evidence in implementation science
Type | Element | Definition | Sample indicators and outcomes |
|---|---|---|---|
Type 1 evidence: Etiology and burden | Descriptive epidemiology | The study of the occurrence of disease or other health-related characteristics in human populations, often classified under the headings of person, place, and time. | Incidence, prevalence mortality |
Burden | The impact of disease on a population | Excess risk in patients, populations, subgroups, costs | |
Access | The ability to connect patients to healthcare practitioners and healthcare services | Incidence of preventable diseases, early detection, treatment | |
Disparity | A particular type of health difference that is closely linked with economic, social, or environmental disadvantage | Incidence, prevalence mortality | |
Etiology | The study of the causes of diseases | Effect sizes and other indicators of effect | |
Social determinants and structural factors | Conditions in which people are born, grow, live, work, and age as well as the complex, interrelated social structures, and economic/political systems that shape these health outcomes and conditions | Effect sizes and other indicators of effect | |
Type 2 evidence: Effectiveness of interventions | Effectiveness of interventions (programs, guidelines, and policies) | Activities designed to assess, improve, maintain, promote, or modify health, health behaviors, functioning, or health conditions | Effect sizes and other indicators of effect (including heterogeneity of results) |
Effectiveness of healthcare | The study of the structure, processes, and organization of healthcare services | Performance, quality, effectiveness, efficiency, patient centeredness, equity, safety | |
Practice guidelines | A standardized set of information based on scientific evidence of the effectiveness and efficiency of the best practices for addressing health issues commonly encountered in public health or clinical practice. | Recommendation (e.g., recommended, not recommended, insufficient evidence), applicability across populations and settings | |
Economic evaluation | The comparative analysis of alternative courses of action in terms of both their costs and consequence (e.g., cost-effectiveness analysis) | Intervention and implementation strategy costs, cost-effectiveness ratio, return on investment, budget impact analyses, opportunity and replication costs | |
Type 3 evidence: Implementation and context | Context | A set of circumstances or unique factors related to the setting or community that surround a particular implementation effort | Policies, regulations, incentives, changes in priorities, setting factors, organizational characteristics, history, social, and environmental factors |
External validity | The extent to which inferences reported in one study can be applied to different populations, setting, treatments, and outcomes | Staff participation, setting participation, representativeness by geography and population, cost | |
Implementation strategy | The processes or methods, techniques, activities, and resources that support the adoption, integration, and sustainment of evidence-based interventions into usual settings (e.g., ERIC taxonomy) | Acceptability, adoption, appropriateness, cost, feasibility, cost, penetration, sustainability | |
Implementation mechanism | The process or event through which an implementation strategy operates to affect desired implementation outcomes | Acceptability, adoption, appropriateness, cost, feasibility, cost, penetration, sustainability | |
Equity in implementation | The degree to which explicit attention is paid to the culture, history, values, and needs of the community during implementation, including any social and structural factors that may contribute to health inequities and equitable or inequitable implementation | Inequities or differences across settings or populations in acceptability, adoption, appropriateness, cost, feasibility, reach, implementation delivery/fidelity, penetration, sustainability; social determinants (e.g., living conditions, socioeconomic indicators) unintended consequences related to implementation | |
Adaptation | The degree to which an evidence-based intervention is changed or modified by a user before, during, and after adoption and implementation to (a) suit the needs of the setting/local conditions; (b) respond to emerging evidence; or (c) respond to changing context | Fit with recipients, reach, data, resources, capacity, satisfaction, engagement | |
Replication and transportability | The ability to transfer an evidence-based intervention to a new setting, balancing fidelity with adaptation | Acceptability, adoption, appropriateness, cost, feasibility, cost, penetration | |
Scale-up | The ability to expand the coverage of successful interventions, including the financial, human, and capital resources necessary for the expansion | Usability, utility, feasibility, fidelity, adoption | |
Sustainability | The ability to create structures and processes to allow an implemented EBI to be maintained and adapted in an organization or system and continue to produce benefits over time | Penetration, institutionalization, normalization, integration, capacity, infrastructure, costs, maintenance of EBI/strategy delivery, and/or continuation of health benefits |