A Pragmatic Approach to Guide Implementation evaluation Research: strategy Mapping for Complex Interventions
A Pragmatic Approach to Guide Implementation evaluation Research: strategy Mapping for Complex Interventions
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DOI：
10.3389/fpubh.2018.00134
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发表时间：
2018-05-18
影响因子：
5.2
通讯作者：
Finley, Erin P.
中科院分区：
文献类型：
--
作者：
Huynh, Alexis K.;Hamilton, Alison B.;Finley, Erin P.
更详细地说明实施策略是实施科学面临的挑战，但在描述复杂干预中涉及的多种策略的使用方面，几乎没有指导。心血管（CV）工具包项目需要实施一个工具包，旨在通过增加妇女对适当服务的参与来降低心血管风险。CV工具包项目遵循基于证据的实施策略“复制有效项目”（REP）的增强版本，通过四个阶段实施CV工具包：前提条件、实施前、实施、维护和演变。我们目前的目标是描述一种实时映射实现策略的方法，作为CV工具包项目的一部分。该方法支持对捆绑策略的时间和内容的描述，并为制定实施评估计划提供了一个结构化的过程。方法：我们进行了一个策略映射的过程，以应用Proctor及其同事的实现策略规范的准则，构建一个矩阵，在这个矩阵中，我们确定了每个实现策略，它的概念组，以及它发生的相应REP阶段。对于每个战略，我们还指定了涉及的参与者、采取的行动、行动目标、实施战略的剂量和预期的结果。我们与实现团队一起迭代地改进矩阵，包括使用模拟来提供初始验证。结果：映射揭示了在REP阶段实施策略的时间模式。大多数涉及发展利益相关者相互关系以及培训和教育利益相关者的实施战略都是在前提条件或实施前阶段引入的。在维护和发展阶段引入的策略强调沟通、重新检查、审计和反馈。除了它对产生有效和可靠的过程评价数据的价值之外，绘制实施战略还为实施和纵向分析和评价活动的实用蓝图的发展提供了信息。讨论：我们通过考虑对多战略框架的影响，更新了最近关于实施战略规范的建议，并提出了一种在复杂的多层次干预措施中绘制实施战略使用情况的方法，以支持严格的评估。制定实用的工具，以协助实施和评价活动的运作，这对于开展健全的实施研究至关重要。
Introduction: Greater specification of implementation strategies is a challenge for implementation science, but there is little guidance for delineating the use of multiple strategies involved in complex interventions. The Cardiovascular (CV) Toolkit project entails implementation of a toolkit designed to reduce CV risk by increasing women's engagement in appropriate services. The CV Toolkit project follows an enhanced version of Replicating Effective Programs (REP), an evidence-based implementation strategy, to implement the CV Toolkit across four phases: pre-conditions, pre-implementation, implementation, and maintenance and evolution. Our current objective is to describe a method for mapping implementation strategies used in real time as part of the CV Toolkit project. This method supports description of the timing and content of bundled strategies and provides a structured process for developing a plan for implementation evaluation.Methods: We conducted a process of strategy mapping to apply Proctor and colleagues' rubric for specification of implementation strategies, constructing a matrix in which we identified each implementation strategy, its conceptual group, and the corresponding REP phase(s) in which it occurs. For each strategy, we also specified the actors involved, actions undertaken, action targets, dose of the implementation strategy, and anticipated outcome addressed. We iteratively refined the matrix with the implementation team, including use of simulation to provide initial validation.Results: Mapping revealed patterns in the timing of implementation strategies within REP phases. Most implementation strategies involving the development of stakeholder interrelationships and training and educating stakeholders were introduced during the pre-conditions or pre-implementation phases. Strategies introduced in the maintenance and evolution phase emphasized communication, re-examination, and audit and feedback. In addition to its value for producing valid and reliable process evaluation data, mapping implementation strategies has informed development of a pragmatic blueprint for implementation and longitudinal analyses and evaluation activities.Discussion: We update recent recommendations on specification of implementation strategies by considering the implications for multi-strategy frameworks and propose an approach for mapping the use of implementation strategies within complex, multi-level interventions, in support of rigorous evaluation. Developing pragmatic tools to aid in operationalizing the conduct of implementation and evaluation activities is essential to enacting sound implementation research.