Implementing or scaling-up an option
This stage aims to address issues related to the implementation of a given option. It is structured in two different goals that may need to be achieved (A and B). In total, six different types of questions that may need to be answered to achieve the goal are included in this stage.
Open the goal that is mostly related to your specific query, and a list of types of questions will be displayed. More details about each type of questions will be provided, including examples and the methodological approaches to address each question.
A. Planning and describing the implementation of an option
Can it be done and what needs to happen to implement?
This goal aims to plan and describe the implementation of a given option by identifying who has to do what to implement an option, what role the context has in the implementation process and what is the implementation level of a given option.
This goal looks at variables and conditions required for a given option to be implemented. These can be structured in behavioral (e.g., what individuals need to do for the option to be implemented) and contextual variables (that are often split in inner and outer settings). This can also be interpreted as what conditions are needed for an option to be feasible to be implemented.
Similarly, this goal would plan the implementation process, potentially designing pilot and proofs of concepts, and assessing the feasibility in scaling and spreading a given option.
Question A1. Identifying who has to do what to implement an option
This type of question aims to find stakeholders’ behavioural variables that are required for an option to be implemented (i.e., what people need to do to implement an option).
Some examples of this type of question are:
- What is the role that healthcare workers should play in implementing DRGs in a hospital?
- What should social workers do to adapt existing poverty guidelines measurements?
- What key actions should nurses conduct to implement mobile breast cancer screening?
Study designs to address question A1
- Delphi studies (to get consensus from experts)
- Cross-sectional study (survey, point-in-time or snapshot study or analysis) of people's experiences
- Qualitative inductive (from particular to general i.e., creating theory) methods to describe a phenomenon (e.g., grounded theory)
- Qualitative deductive (from general to particular i.e., testing theory) methods to describe a phenomenon (e.g., qualitative description, narrative approaches)
Methodological approaches (forms of evidence) to address question A1
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| Identifying behavioural variables to understand how an intervention can be implemented or scaled-up in a given context. |
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Question A2. Identifying the context in which the option could be implemented
Scale and spread
This type of question aims to find variables related to the inner or outer setting (or context) in which an option is feasible to be implemented (including the political climate).
Some examples of this type of question are:
- What contextual variables should be present to successfully implement DRGs in a given healthcare facility?
- What is the role of context in implementing new guideline measurements for poverty?
- In what contexts the implementation of a mobile breast cancer screening unit is feasible?
Study designs to address question A2
- Jurisdictional scan (comparative analysis) to understand what other jurisdictions have identified as contextual variables
- Qualitative deductive (from general to particular i.e., testing theory) methods to describe a phenomenon (e.g., qualitative description, narrative approaches)
- Cross-sectional study (survey, point-in-time or snapshot study or analysis) of people's experiences
- Delphi studies (to get consensus from experts)
Methodological approaches (forms of evidence) to address question A2
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| Identifying contextual variables to understand how an intervention can be implemented or scaled-up in a given context. |
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Question A3. Describing whether implementation of an option is underway and at what stage level
Scale and spread
This type of question aims to assess the level of implementation of an option (or group of options) in a given moment of time (or over time) in a concrete setting.
Some examples of this type of question are:
- What is the implementation level of universal health coverage in a given region?
- Have integrated care been implemented in regional hospitals in a given country?
- How much of the educational reform to improve teacher quality has been implemented in a given country?
Methodological approaches to address question A3
- Cross-sectional study (survey, point-in-time or snapshot study or analysis) of people's experiences
- Descriptive (not predicting) time-series analysis (including trend analysis)
- Qualitative deductive (from general to particular i.e., testing theory) methods to describe/critically analyze a phenomenon (e.g., qualitative case studies)
- Qualitative deductive (from general to particular i.e., testing theory) methods to describe a phenomenon (e.g., qualitative description, narrative approaches, documentary review of public speeches, etc.)
Methodological approaches (forms of evidence) to address question A3
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| This question is also connected with the implementation fidelity (i.e., the degree to which an intervention is implemented in its planned form). |
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B. Setting up a sustainable implementation process by identifying barriers, enablers and implementation strategies
How can implementation be improved?
This goal aims to find barriers and enablers, and implementation strategies that could address and take advantage of them, respectively. Barriers and enablers can come from different domains (inner and outer settings, individuals (e.g., skills and capacities), etc.), from different levels (e.g., government, policy, system, etc.), and across different type of actors (e.g., service providers, users or patients, organizations, etc.).
Additionally, it is not always clear whether a given variable constitutes a barrier or enabler, or to whether a given variable could be framed in a positive (enabler) or negative (barrier) way. Then, we can also call barriers and enabler as implementation considerations.
The implementation process entails identifying strategies to ensure a sustainable implementation of an option. Implementation strategies can take the form of interventions to address or take advantage of barriers and enablers, or they could also be mitigation measures for the potential risks of implementing an option (e.g., risk-control or risk-management strategies).
Open the question that is mostly related to your specific query, and more details about the question, examples and methodological approaches will be displayed.
Question B1. Identifying and understanding barriers and enablers to implement and option
This type of question aims to find barriers (variables that could block or delay the implementation of a given option), and enablers (variables that could make the implementation of a given option easier). This type of question includes the identification of barriers and enablers, as well as understanding how they block, delay or enable the implementation process.
Some examples of this type of question are:
- What barriers exist to implementing an audit and feedback system in hospitals?
- What barriers and facilitators have been reported by health systems reform to implement independent surveillance agencies?
- Is the awareness of healthcare professionals a barrier to implementing a universal vaccine mandate?
- What facilitators exist to implement an audit and feedback system in hospitals of a given jurisdiction?
- Is having easy access to a police station a facilitator to implement a crime prevention program?
Study designs to address question B1
Three clusters of study designs (in order of suitability) can be used:
- First choice/higher rank:
- Cross-sectional study (survey, point-in-time or snapshot study or analysis) of people's experiences
- Qualitative deductive (from general to particular i.e., testing theory) methods to describe/critically analyze a phenomenon (e.g., qualitative case studies)
- Second choice/Middle rank:
- Social network analysis (mapping network analysis) to identify barriers and implementation strategies
- Qualitative deductive (from general to particular i.e., testing theory) methods to describe a phenomenon (e.g., qualitative description, narrative approaches)
- Qualitative inductive (from particular to general i.e., creating theory) methods to describe a phenomenon (e.g., grounded theory)
- Bottom rank:
- Cross-sectional study of other jurisdictions (comparative analysis) to understand what barriers and implementation
Methodological approaches (forms of evidence) to address question B1
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Question B2. Identifying and understanding implementation strategies to deal or take advantage of barriers and enablers
This type of question aims to find implementation strategies that could address barriers and take advantage of enablers. This type of question includes the identification of implementation strategies, as well as understanding how they address the barriers and take advantage of enablers.
Some examples of this type of question are:
- What implementation strategies can be applied in schools to maintain social distancing during COVID-19 requirements?
- How do reminders can be used to strengthen population compliance norms about behaviour during hurricanes?
Study designs to address question B2
Three clusters of study designs (in order of suitability) can be used:
- First choice/higher rank: Using some type of structured discussion/dialogue in a:
- Qualitative deductive (from general to particular i.e., testing theory) methods to describe/critically analyze a phenomenon (e.g., qualitative case studies)
- Qualitative deductive (from general to particular i.e., testing theory) methods to describe a phenomenon (e.g., qualitative description, narrative approaches)
- Qualitative inductive (from particular to general i.e., creating theory) methods to describe a phenomenon (e.g., grounded theory)
- Second choice/Middle rank:
- Cross-sectional study (survey, point-in-time or snapshot study or analysis) of people's experiences
- Social network analysis (mapping network analysis) to identify implementation strategies
- Bottom rank:
- Cross-sectional study of other jurisdictions (comparative analysis) to understand what implementation strategies have been identified by other jurisdictions.
Methodological approaches (forms of evidence) to address question B2
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Question B3. Prioritizing barriers, enablers and implementation strategies
This type of question aims to assess the importance of barriers and/or enablers, and implementation strategies in the implementation of a given option in a specific setting or context.
Some examples of this type of question are:
- What are the most important barriers and enablers to implementing an audit and feedback system in hospitals of a given jurisdiction?
- What are the preferred implementation strategies to increase awareness of healthcare personnel in a massive vaccination campaign?
- What are the most important barriers and enablers of implementing a new curricular change for schools?
Study designs to address question B3
Three clusters of study designs (in order of suitability) can be used:
- First choice/higher rank (in case we want to prioritize implementation strategies):
- Randomized-controlled study (randomized experiment or randomized trial) of implementation issues (e.g., implementation trial)
- Second choice/Middle rank:
- Delphi study (to get consensus from experts)
- Discrete choice experiment (stated preferences)
- Multi-criteria (objective) decision analysis
- Cross-sectional study (survey, point-in-time or snapshot study or analysis)
- Retrospective cohort study of individual-level data (retrospective or historical longitudinal, or panel study)
- Single before-and-after study of aggregated data (pre-post or pretest-posttest study)
- Economic evaluations (cost-effectiveness, cost-utility, cost-benefit analyses)
- Controlled before-and-after study of aggregated data (including difference-in-differences study and non-equivalent control group designs)
- Prospective cohort study of individual-level data (prospective longitudinal or panel study)
- Case-control study (case-comparison study)
- Bottom rank:
- Modelling to predict or estimate the importance of barriers, facilitators and implementation strategies
Methodological approaches (forms of evidence) to address question B3
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Assuming that one potential decision of a new option might be to conduct a pilot or a implementing an option at small-scale, this goal also aims to draw on lessons learned from the early implementation of a given option to plan the scale-up of it.
Take a look at the demand-driven approach used to create the Matching Q-M tool, as well as a list and explanation of all methodological approaches included.