Designing theoretically-informed implementation interventions The Improved Clinical Effectiveness through Behavioural Research Group (ICEBeRG)
Designing theoretically-informed implementation interventions The Improved Clinical Effectiveness through Behavioural Research Group (ICEBeRG)
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DOI：
10.1186/1748-5908-1-4
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发表时间：
2006-01-01
影响因子：
7.2
通讯作者：
Tetroe, Jacqueline
中科院分区：
文献类型：
--
作者：
Angus, Doug;Brouwers, Melissa;Tetroe, Jacqueline
临床和保健服务研究不断产生新的发现，可能有助于有效和高效的病人护理。然而，将研究成果转化为实践是不可预测的，可能是一个缓慢而偶然的过程。理想情况下，实施策略的选择将基于随机对照试验的证据或对给定实施策略的系统评价。不幸的是，对实施战略的审查总是报告某些方面的有效性，但不是所有时候；在最初的研究中，研究人员很少报告或测量这种差异的可能原因。因此，由于缺乏对个人、干预措施和试验环境的关键因素的影响的理解，任何从研究环境推断到现实世界的尝试都受到阻碍。明确使用理论提供了一种解决这些问题的方法，并具有许多优势，例如提供：一个概括的框架，在其中表示实施研究所涉及的维度，一个为干预措施的开发和交付提供信息的过程，评估时的指南，以及一种允许探索潜在因果机制的方法。然而，由于多种原因，在设计实施干预措施时使用理论在方法上具有挑战性，包括在理论之间进行选择和忠实地将理论结构转化为干预措施。在促进更好地理解实施干预措施的普遍性和可复制性方面，明确使用理论提供了潜在的优势。然而，这是一个相对未开发的方法论领域。
Clinical and health services research is continually producing new findings that may contribute to effective and efficient patient care. However, the transfer of research findings into practice is unpredictable and can be a slow and haphazard process. Ideally, the choice of implementation strategies would be based upon evidence from randomised controlled trials or systematic reviews of a given implementation strategy. Unfortunately, reviews of implementation strategies consistently report effectiveness some, but not all of the time; possible causes of this variation are seldom reported or measured by the investigators in the original studies. Thus, any attempts to extrapolate from study settings to the real world are hampered by a lack of understanding of the effects of key elements of individuals, interventions, and the settings in which they were trialled. The explicit use of theory offers a way of addressing these issues and has a number of advantages, such as providing: a generalisable framework within which to represent the dimensions that implementation studies address, a process by which to inform the development and delivery of interventions, a guide when evaluating, and a way to allow for an exploration of potential causal mechanisms. However, the use of theory in designing implementation interventions is methodologically challenging for a number of reasons, including choosing between theories and faithfully translating theoretical constructs into interventions. The explicit use of theory offers potential advantages in terms of facilitating a better understanding of the generalisability and replicability of implementation interventions. However, this is a relatively unexplored methodological area.