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Table 1 Summary of ten commonly applied theoretical approaches to implementation

From: “There is nothing so practical as a good theory”: a pragmatic guide for selecting theoretical approaches for implementation projects

Knowledge to Action [11]
 Purpose (as described by authors) A framework to conceptualise the process of knowledge translation which integrates the roles of knowledge creation and knowledge application. Provide conceptual clarity by offering a framework to elucidate the key elements of the knowledge translation process
 Brief description: This approach provides an overview to help guide and understand how knowledge is created and synthesised, and tools (like clinical guidelines) are developed, then how these tools are applied in clinical settings through tailoring and adaptation, implementation, monitoring and sustaining. Assumes that action plans will be realised (underpinned by assumption that actions are rational). Takes a systems approach – recognises that knowledge producers and users are situated within a larger social system
 How developed: Developed by reviewing literature of > 30 planned action theories, identified common elements. Added to planned action model a knowledge creation process and labelled the combined models the knowledge to action cycle.
 Changes/developments over time: No
 Ease of use: clear and easy to understand, intuitive. No specific guidance on how to do each step of the action cycle but provides some guidance on important elements to consider.
 Additional resources: no specific resources currently available on how to action each step of cycle
Theoretical Domains Framework (TDF) [7, 8]
 Purpose (as described by authors): An integrative theoretical framework, developed for cross-disciplinary implementation and other behaviour change research to assess implementation and other behavioural problems and to inform intervention design.
 Brief description: provides a holistic list of factors that influence behaviour – application of TDF can give researcher confidence that factors influencing an individual’s behaviour will be identified, which in turn can identify factors that need to be addressed in order for behaviour change to occur (i.e. can be used to inform behaviour change strategy development/selection). Can be used in conjunction with Behaviour Change Wheel to develop and deliver behaviour change strategy
 How developed: through an expert consensus process and synthesis of 33 theories and 128 key theoretical constructs related to behaviour change.
 Changes/developments over time: Validity was investigated by behavioural experts sorting theoretical constructs using closed and open sort tasks. Validation study demonstrated good support for the basic structure of the TDF and led to refinements, leading to publication of new iteration of framework in 2012
 Ease of use: Quite straightforward to apply, can be time consuming to use for analysis – potential to overwhelm novice researcher given the 14 domains and 84 component constructs. COM-B and Behaviour Change Wheel work together with TDF.
 Additional resources: interview guides provided in publications [7, 30] assist ease of data collection and illustrate domains. Subject of thematic series in Implementation Science journal, guide to use of TDF published 2017 [31].
RE-AIM framework [14, 17]
 Purpose (as described by authors): Originally developed as a framework to guide consistent reporting of evaluations regarding the public health impact of health promotion interventions, thereby providing a framework for determining what programs are worth sustained investment and for identifying those that work in real-world environments.
 Brief description: Reporting checklist for public health interventions (what patient groups are receiving intervention, have patient outcomes changed, what health professionals/ health professional groups are providing intervention, are they delivering intervention as intended, will the program be sustained in the long term) to evaluate real world impact. Can be used when designing or evaluating a public health intervention.
 How developed: Through inductive thinking building on results of previous research
 Changes/developments over time: “E” was initially efficacy [14], then effectiveness [17]
 Ease of use: Easy, interventions can be rated on the five dimensions, providing a score. Some of the reporting points (in particular Reach and Adoption) are not being interpreted and reported as developers intended
 Additional resources: dedicated website with online tools, examples [33]
Consolidated Framework for Implementation Research [6]
 Purpose (as described by authors): Framework to promote implementation theory development and verification about what works, where and why.
 Brief description: list of factors (5 domains and 37 constructs) that can influence an implementation project, can be used in planning or in evaluation stages (does not guide how to implement). Research focus in contrast to doing/practitioner focus
 How developed: Published theories which sought to facilitate translation of research findings into practice in the healthcare sector were reviewed. Team identified constructs that had evidence that they influenced implementation and could be measured. Some constructs were streamlined and combined, whereas other constructs were separated and delineated.
 Changes/developments over time: No
 Ease of use: Clear, but may be difficult to digest language if new to area of implementation science
 Additional resources: dedicated website that provides examples, templates and tools to assist in developing and evaluating implementation projects, collecting and analysing data [28]
Conceptual model of evidence-based practice implementation in public service sectors [15]
 Purpose (as described by authors): A multi-level, four phase model of the implementation process that can be used in public service sectors.
 Brief description: Conceptual model of factors that can influence implementation in the unique context of public sector services (focus on role of service delivery organisations and the services in which they operate) at each of the 4 implementation stages: Exploration, Adoption/Preparation, Implementation, Sustainment (EPIS). Explicitly recognises that different variables play crucial roles at different points in the implementation process. Does not provide guidance on how to move through different stages of implementation.
 How developed: based on literature and authors’ experience of public service sectors, funded by the National Institute of Mental Health
 Changes/developments over time: No
 Ease of use: Little clarity on how to operationalise different factors, potential to be confusing for those unfamiliar with implementation
 Additional resources: California Evidence-Based Clearinghouse for Child Welfare have developed webinars regarding use of EPIS framework. Freely available from
Conceptual model of implementation research [19]
 Purpose (as described by authors) a heuristic skeleton model for the study of implementation processes in mental health services, identifying the implications for research and training.
 Brief description: Guides how implementation research can be organised, how it fits/aligns with evidence-based practices. May be useful for complete novice who needs clarity between clinical interventions, implementation strategies, and working through how to measure clinical and implementation effectiveness. Various theories can be placed upon the model to help explain aspects of the broader phenomena.
 How developed: drawn from 3 extant frameworks: stage pipeline model, multi-level models of change and models of health service use.
 Changes/developments over time: No
 Ease of use: Clear and easy to understand
 Additional resources: No
Implementation effectiveness model [16]
 Purpose (as described by authors): an integrative model to capture and clarify the multidetermined, multilevel phenomenon of innovation implementation
 Brief description: A list of constructs that can influence implementation effectiveness, based on the premise that implementation effectiveness is a function of an organisation’s climate for implementing a given innovation and the targeted organisational members’ perceptions of the fit of the innovation to their values. Does not provide specific guidance for how to implement, was not designed specifically for the context of health care. Likely to be most useful for projects with a clear organisational approach.
 How developed: from authors’ personal experience with reference to literature
 Changes/developments over time: No
 Ease of use: Main manuscript very wordy (text-based). Concepts are clear.
 Additional resources: No
Promoting Action on Research Implementation in Health Services (PARIHS) [9, 10]
 Purpose (as described by authors): Organisational or conceptual framework to help explain and predict successful implementation of evidence into practice and to understand the complexities involved.
 Brief description: Conceptualises how evidence can be successfully implemented in health care settings using the process of facilitation. Underlying premise is that facilitation will enable people to apply evidence in their local setting, which is situated within a broader organisational and societal context. Framework strives to capture the complexities involved in implementation, so most useful in more complex projects.
 How developed: from authors’ experience working as facilitators and researchers on quality improvement activities and health service research projects.
 Changes/developments over time: Has had several iterations since first publication in 1998 in response to findings from empirical testing. Revised to integrated or i-PARIHS framework in 2015 [10]
 Ease of use: Does not operationalise its constructs, so may be difficult for novice to understand and apply, particularly when not being supported by expert facilitator. Facilitator’s toolkit easy to apply to conduct pre- and post-implementation evaluation. For people experienced in implementation, framework provides guidance on all of the things to consider when implementation is complex.
 Additional resources: Facilitator’s Toolkit in book associated with 2015 iteration of PARIHS guides user through how to assess, facilitate and evaluate [32]
Interactive Systems Framework [13]
 Purpose (as described by authors): Heuristic to help clarify the issues related to how to move what is known about prevention (particularly prevention of youth violence and child maltreatment) into more widespread use.
 Brief description: Framework regarding translating findings from prevention research to clinical practice. The framework comprises three systems: the Innovation Synthesis and Translation System (which distils information about innovations and translates it into user-friendly formats); the Innovation Support System (which provides training, technical assistance or other support to users in the field); and the Innovation Delivery System (which implements innovations in the world of practice).
 How developed: Collaborative development of the framework by Division of Violence Protection staff members, university faculty and graduate students, with input from practitioners, researchers, and funders.
 Changes/developments over time: No
 Ease of use: Easy to understand, no clear guidance available regarding how to apply framework
 Additional resources: No
Normalization Process Model, Normalization Process Theory (NPT) [12]
 Purpose (as described by authors): provides a conceptual framework for understanding and evaluating the processes by which new health technologies and other complex interventions are routinely operationalized in everyday work, and sustained in practice.
 Brief description: NPT is an Action Theory, which means that it is concerned with explaining what people do rather than their attitudes or beliefs. Proposes that for successful sustained use: individuals & groups must work collectively to implement intervention; work of implementation occurs via 4 particular processes; continuous investment carrying forward in space and time required. Can be helpful to understand and evaluate how new health technologies/complex interventions are routinely operationalised sustained in practice. Not designed to guide implementation.
 How developed: in iterations, based on experiences of authors. Initially, developers mapped the elements of embedding processes and developed the concept of normalization. Next a robust applied theoretical model of Collective Action was produced, and applied to trials, government processes and healthcare systems. The final stage focused on building a middle-range theory that explains how material practices become routinely embedded in their social contexts.
 Changes/developments over time: Through its focus on being a theory, the authors continually refine and test NPT to ensure its validity. More recently, NPT has been extended towards a more general theory of implementation.
 Ease of use: easy to apply with use of specifically developed resources
 Additional resources: dedicated website with toolkit, examples. Interactive toolkit can be used to plan project or analyse data [29].