MECHANISMS: The MECHANics of Implementation Strategies and MeasureS

项目摘要 在理解实施战略的因果机制方面存在着根本性的差距， 循证做法可消除当地在提供有效、适当服务方面的障碍。继续存在 这一差距是一个重要的问题，因为在解决这一问题之前， 关于在何种情况下使用何种实施战略的指导仍然是难以捉摸的。长期 目标是通过各种机制发展执行科学的证据基础和实际效用- 重点实施研究。该应用程序的目的是克服关键问题阻塞 通过确定合理的战略机制联系，在执行科学和实践方面取得进展， 为机制评估开发因果模型，制定评估此类机制所需的措施， 这些模式、方法和措施可在一个方便用户的网站上查阅。的理由 一旦确定了战略机制之间的联系，实施科学家就可以制定出 实施战略，并就哪些战略在哪些领域最有效提供更有力的证据， contexts.此外，从业人员将能够更好地选择实施战略，以解决他们的具体问题。 执行问题。具体目标是：（1）建立战略-机制联系数据库， 相关的因果路径图;（2）发展心理测量学上强大的，务实的措施， （3）开发和传播一个关于执行机制知识的网站， 不同的利益相关者，通过应用迭代的以用户为中心的设计和社会营销原则。 对于第一个目标，定性研究、小组命名技术、德尔菲法和因果关系图将 用于识别和确认合理的战略-机制联系和阐明调节者， 前提条件以及与这些联系相关的近端和远端结果。对于第二个目标，快速- 将采用循环测量开发和测试方法， 在这方面，需要对六项机制采取措施，但不存在高质量的措施。第三个目标，我们将制定一个 通过以用户为中心的设计，建立用户友好的网站和可搜索的数据库，并利用社会 营销原则。这个项目是创新的，因为它改变了目前的模式，从评估 执行战略的一般效力，以一种机制知情的办法，承诺加快 科学进步。拟议的研究对于纵向推进实施具有重要意义 通过发展微观理论，方法和措施，机制识别和评价科学。 预计执行战略的制定、优化、评价和部署将出现新的局面 这将导致加强执行循证干预措施， 癌症控制，并最终改善患者的预后。

PROJECT SUMMARY There is a fundamental gap in understanding the causal mechanisms by which strategies for implementing evidence-based practices address local barriers to effective, appropriate service delivery. Continued existence of this gap represents an important problem because, until it is addressed, scientific knowledge and practical guidance about which implementation strategies to use in which contexts will remain elusive. The long-term goal is to develop the evidence base and practical utility of implementation science through mechanisms- focused implementation research. The objective of this application is to overcome critical problems blocking progress in implementation science and practice by identifying plausible strategy-mechanism linkages, developing causal models for mechanism evaluation, producing the measures needed to evaluate such linkages, and making these models, methods, and measures available in a user-friendly website. The rationale is that, once strategy-mechanism linkages are identified, implementation scientists can develop tailored implementation strategies and generate more robust evidence about which strategies work best in which contexts. Moreover, practitioners will be better able to select implementation strategies to address their specific implementation problems. The specific aims are: (1) build a database of strategy-mechanism linkages and associated causal pathway diagrams; (2) develop psychometrically strong, pragmatic measures of mechanisms; and (3) develop and disseminate a website of implementation mechanisms knowledge for use by diverse stakeholders, through the application of iterative user-centered design and social marketing principles. For the first aim, qualitative inquiry, Group Nominal Technique, Delphi methods, and causal diagramming will be used to identify and confirm plausible strategy-mechanism linkages and articulate moderators, preconditions, and proximal and distal outcomes associated with those linkages. For the second aim, rapid- cycle measure development and testing methods will be employed to create reliable, valid, pragmatic measures of six mechanisms for which no high-quality measures exist. For the third aim, we will develop a user-friendly website and searchable database via user-centered design and disseminate those using social marketing principles. This project is innovative because it shifts the current paradigm from evaluating implementation strategy general effectiveness to a mechanisms-informed approach that promises accelerated scientific progress. The proposed research is significant for its potential to vertically advance implementation science by developing micro-theories, methods, and measures for mechanism identification and evaluation. New horizons in implementation strategy development, optimization, evaluation, and deployment are expected to be attainable as a result, which will lead to enhanced implementation of evidence-based interventions for cancer control, and ultimately improvements in patient outcomes.