Tracking implementation strategies: a description of a practical approach and early findings.
Tracking implementation strategies: a description of a practical approach and early findings.
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DOI：
10.1186/s12961-017-0175-y
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发表时间：
2017-02-23
影响因子：
4
通讯作者：
Shea C
中科院分区：
文献类型：
--
作者：
Bunger AC;Powell BJ;Robertson HA;MacDowell H;Birken SA;Shea C
已发表的实施策略描述往往缺乏精确性和一致性，限制了可复制性并减缓了知识的积累。最近出版的实施战略指南要求改进对战略的活动、剂量、基本原理和预期结果的描述。然而，捕获如此详细的实施策略可能具有挑战性，因为实施责任往往是分散的，并且随着障碍和挑战的出现，可以灵活地应用策略。我们描述并演示了一种实用方法的开发和应用，用于确定研究和实践中使用的实施策略，这些策略可用于指导其描述和规范。开发了一种使用项目人员完成的活动日志来跟踪实施策略的方法，以促进离散策略的识别。这种方法是在一个多组成部分项目的背景下进行试点的，该项目旨在改善儿童在县级儿童福利机构获得行为健康服务的机会。主要项目人员完成了每月的活动日志，收集了 17 个月内使用的策略的数据。日志收集有关实施活动、意图、持续时间和参与人员的信息。使用共识方法，两组编码人员根据 Powell 等人 (Med Care Res Rev 69:123–57, 2012) 的实施策略分类法对每项活动进行分类。参与者报告了 473 项活动，代表了 45 项独特的策略。最初实施的特点是规划策略和随后的教育策略。项目启动后，质量管理策略占主导地位，这表明随着时间的推移，实施工作会取得进展。这些策略总共占用了 1594 个工时，其中许多是由负责项目设计、实施和监督的领导团队报告的。这种方法可以识别随着时间的推移使用的离散实施策略，估计剂量，描述实施策略的时间顺序，并查明主要实施参与者。这一细节有助于清晰报告全方位的实施战略，包括那些可能不易观察到的战略。这种方法可以使人们更细致地了解实施不同创新所需的内容、在实施的特定阶段最有用的策略类型，以及如何在整个给定计划的过程中适应性地应用实施策略。本文的在线版本 (doi:10.1186/s12961-017-0175-y) 包含补充材料，可供授权用户使用。
Published descriptions of implementation strategies often lack precision and consistency, limiting replicability and slowing accumulation of knowledge. Recent publication guidelines for implementation strategies call for improved description of the activities, dose, rationale and expected outcome(s) of strategies. However, capturing implementation strategies with this level of detail can be challenging, as responsibility for implementation is often diffuse and strategies may be flexibly applied as barriers and challenges emerge. We describe and demonstrate the development and application of a practical approach to identifying implementation strategies used in research and practice that could be used to guide their description and specification. An approach to tracking implementation strategies using activity logs completed by project personnel was developed to facilitate identification of discrete strategies. This approach was piloted in the context of a multi-component project to improve children’s access to behavioural health services in a county-based child welfare agency. Key project personnel completed monthly activity logs that gathered data on strategies used over 17 months. Logs collected information about implementation activities, intent, duration and individuals involved. Using a consensus approach, two sets of coders categorised each activity based upon Powell et al.’s (Med Care Res Rev 69:123–57, 2012) taxonomy of implementation strategies. Participants reported on 473 activities, which represent 45 unique strategies. Initial implementation was characterised by planning strategies followed by educational strategies. After project launch, quality management strategies predominated, suggesting a progression of implementation over time. Together, these strategies accounted for 1594 person-hours, many of which were reported by the leadership team that was responsible for project design, implementation and oversight. This approach allows for identifying discrete implementation strategies used over time, estimating dose, describing temporal ordering of implementation strategies, and pinpointing the major implementation actors. This detail could facilitate clear reporting of a full range of implementation strategies, including those that may be less observable. This approach could lead to a more nuanced understanding of what it takes to implement different innovations, the types of strategies that are most useful during specific phases of implementation, and how implementation strategies need to be adaptively applied throughout the course of a given initiative. The online version of this article (doi:10.1186/s12961-017-0175-y) contains supplementary material, which is available to authorized users.