The case for prioritizing implementation strategy fidelity measurement: benefits and challenges.
The case for prioritizing implementation strategy fidelity measurement: benefits and challenges.
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DOI：
10.1093/tbm/ibab138
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发表时间：
2022-02-16
影响因子：
3.6
通讯作者：
Go V
中科院分区：
文献类型：
--
作者：
Akiba CF;Powell BJ;Pence BW;Nguyen MXB;Golin C;Go V
执行战略是改善循证干预措施的采纳和可持续性的系统方法。他们经常专注于通过提供培训、指导和审计和反馈等干预措施来改变提供商的行为。实施策略通常会影响中间行为结果，如提供商指南的遵守情况，进而改善患者的结果。执行战略交付的忠诚度被定义为执行战略按设计执行的程度。执行战略忠诚度衡量不够完善和报告不足，报告质量随着时间的推移而下降。保真度测量的好处包括探索观察到的影响在多大程度上受到保真度的影响，以及有关第三类研究错误的关键信息，或实施战略保真度失败导致无效结果的可能性。对实施战略效力的审查经常报告在不同研究之间存在较大差异，通常要求增加实施战略保真度衡量，以帮助解释差异。尽管严格的保真度测量在方法论上有好处，但实施研究人员面临着多层次的挑战和复杂性。挑战包括复杂变量的测量、具有不同精度和成本的多种数据收集方式，以及保真度测量需要与适应同步变化。在这份立场文件中，我们权衡了这些成本和收益，并最终主张在实施战略的试验中改进实施战略保真度的衡量和报告。我们为研究人员提供实用的解决方案，以便他们立即做出改进，如使用混合方法或创新的数据收集和分析技术，在报告指南中纳入实施战略保真度评估，以及在实施战略的演变过程中分阶段开发保真度工具。我们还呼吁对执行战略忠诚度衡量的障碍和促进者进行更多研究，以进一步澄清最佳的前进道路。执行战略的忠诚度，即执行战略按设计执行的程度，发展不足，报告不足，报告质量随着时间的推移而下降。这份立场文件描述了实施战略忠诚度的成本和收益。我们最终呼吁继续并改进执行战略的忠诚度衡量，同时为所指出的挑战提供务实的解决办法。关于实施策略保真度测量和报告的障碍和促进者，实施策略保真度测量的成本和成本效益，以及实施策略保真度与实施和临床结果之间的关系，未来需要进行研究。
Implementation strategies are systematic approaches to improve the uptake and sustainability of evidence-based interventions. They frequently focus on changing provider behavior through the provision of interventions such as training, coaching, and audit-and-feedback. Implementation strategies often impact intermediate behavioral outcomes like provider guideline adherence, in turn improving patient outcomes. Fidelity of implementation strategy delivery is defined as the extent to which an implementation strategy is carried out as it was designed. Implementation strategy fidelity measurement is under-developed and under-reported, with the quality of reporting decreasing over time. Benefits of fidelity measurement include the exploration of the extent to which observed effects are moderated by fidelity, and critical information about Type-III research errors, or the likelihood that null findings result from implementation strategy fidelity failure. Reviews of implementation strategy efficacy often report wide variation across studies, commonly calling for increased implementation strategy fidelity measurement to help explain variations. Despite the methodological benefits of rigorous fidelity measurement, implementation researchers face multi-level challenges and complexities. Challenges include the measurement of a complex variable, multiple data collection modalities with varying precision and costs, and the need for fidelity measurement to change in-step with adaptations. In this position paper, we weigh these costs and benefits and ultimately contend that implementation strategy fidelity measurement and reporting should be improved in trials of implementation strategies. We offer pragmatic solutions for researchers to make immediate improvements like the use of mixed methods or innovative data collection and analysis techniques, the inclusion of implementation strategy fidelity assessment in reporting guidelines, and the staged development of fidelity tools across the evolution of an implementation strategy. We also call for additional research into the barriers and facilitators of implementation strategy fidelity measurement to further clarify the best path forward. Implementation strategy fidelity, or the extent to which an implementation strategy is carried out as it was designed, is under-developed and under-reported, and the quality of reporting is decreasing over time. This position paper describes the costs and benefits of implementation strategy fidelity. We ultimately call for the continuation and improvement of implementation strategy fidelity measurement while offering pragmatic solutions to noted challenges. Future research is needed regarding the barriers and facilitators to implementation strategy fidelity measurement and reporting, the costs and cost-benefits of implementation strategy fidelity measurement, and the relationship between implementation strategy fidelity and implementation and clinical outcomes.
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