Jerome C. Hill: Implementation research: What is it, what do we know and how can we use it?

Implementation science and research is a growing field that focuses on the implementation of programs, treatments and policy – and the relevant factors and variables. This represents a growing recognition that successful dissemination and implementation is an essential part of evidence-based practice and can have significant impact on outcomes in health care.

What is implementation research?

As mentioned, implementation research focuses on the actual implementation of policies, programmes and treatments. It has been defined as:

the scientific inquiry into questions concerning implementation – the act of carrying an intention into effect, which in health research can be policies, programmes, or individual practices

(Peters, Adam, Alonge, Agyepong, & Tran, 2013, p. 1).

Implementation studies span from evaluations of evidence-based care and programs within mental health and health care, to social services, education, and a range of other fields.

The field of implementation science reflects an increasing attention and energy spent on factors that affect the successful implementation of practice and care. As noted by Proctor et al (2009), there has been (and is) a gap between what we know is effective (e.g. a specific therapy) and the care that is in fact delivered (e.g. in the hospital). Most research focuses on the effectiveness of different treatments in health care settings: fewer studies have focused on how this treatment is implemented in practice, and how it is experienced by consumers. A heavily cited American study from 2003, found results indicating that just about half of the participants received the care that was recommended for their medical conditions (McGlynn et al., 2003). Thus, this study and similar papers illustrate the (often) vast gap between research findings and knowledge about effective procedures and care, and what is actually implemented and delivered to patients and clients in the real world.

How does one do implementation research?

Implementation research spans from evaluations of cost-effectiveness to the efficacy of leadership strategies and other implementation variables. A range of different implementation outcomes can be assessed. Proctor et al. (2011) for instance, list 8 different outcome variables that can be used to evaluate the implementation of a treatment, program or service: Acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability. These are all measures that can say something about the degree to which a service or program has been successfully implemented in a practice or clinical context. The Proctor et al paper represents an attempt to develop a taxonomy of implementation outcomes, in order to clarify and advance research in this area.

A range of different research methods can be used in implementation research, from hybrid trials, that assess the effectiveness of both an intervention and an implementation strategy, to pragmatic trials and quality improvement studies (Peters et al., 2013). Many studies also use mixed methods designs to investigate implementation efforts, that combine qualitative and quantitative techniques. These research methods can be applied to evaluate the previously mentioned outcome variables, but also to investigate other relevant questions, like the cultural appropriateness of a program or therapy in different cultures and populations (e.g. Self-Brown et al., 2011).

How can we apply findings from implementation research in real-world settings?

Findings and knowledge produced by implementation research can have large implications for the fields of study, and is of great importance in the contexts of health care and mental health. This area of research focuses on understanding and knowledge of implementation in real world settings and under real world conditions. While much of basic science can be said to be at quite a distance from clinical realities, implementation research is often much more practically oriented. Thus, findings within this area of research can be of great utility for, in particular, clinicians and those implementing evidence-based programs, policies and practice. Additionally, successful implementation is beneficial for the recipients of these programs and care.