SMA implementation science seminar

1. Bridging the gap
between research and
implementation
Introduction to implementation science
(Day 1)
Dr Abdirahman Moallim Ibrahim, MBChB, MPH(IS)
Affiliated with WHO TDR and Cochrane Collaboration

2. Brief biography
Dr. Abdirahman Moallim Ibrahim
Educational profile
• MBBS graduate at Jazeera University (2016-2017)
(2016-2017)
• PgCert of Global Health and Humanitarian Medicine
Medicine (GHHM) at MSF UK (2021-2022)
• Master of Public Health in Implementation Science
Science [MPH(IS)] at SD Gupta School of Public Health,
Public Health, IIHMR University, India.
Interest area and specialization
• Implementation research (IR) on the context of Tropical
context of Tropical diseases, Routine immunization and
immunization and Digital health
Research projects involved
• WHO TDR projects (3 projects)
• Cochrane Collaboration (2 projects)
• EMPHINET (polio and routine immunization project)

3. Why implementation
science/research?
• The acknowledged persistent failure to
implement interventions (Evidence based) that
are known to be effective.
• Patients continue to receive unnecessary and/or
harmful care.
• Overuse, underuse or misuse of available
resources.
• New evidence is slow, or innovations are
becoming challenged to be reliably normalized.
Grol R. Successes and failures in the implementation of evidence-based guidelines for clinical practice. Med Care 2001; 39: (8
Suppl 2): 1146–1154.
Cahill LS, Carey LM, Lannin NA, Turville M, Neilson CL, Lynch EA, et al. Implementation interventions to promote the
uptake of evidence-based practices in stroke rehabilitation. Cochrane Database Syst Rev 2020; 10 (10):Cd012575.

4. The need for
implementation
science/research
• Bridging the gap between existing evidence-based
interventions (What do we know) and “real world ”
implementation (What do we do)

5. Dickersin,
1987
Koren, 1989
Balas, 1995
Poynard, 1985
Balas & Boren, 2000
variab
le
0.3
year
6 - 13
years
0.6 year
0.5 year
9.3
years
Kumar, 1992
Kumar, 1992
Poyer, 1982
Antman, 1992
“PUBLICATION PATHWAY”
Negative
results Submission
Acceptance
Implementation
Reviews,guidelines,textbook
Publication
Original Research
Inconsistent
indexing
Lack of
numbers
Bibliographic databases
Expert
opinion
50%
46%
18%
35%
It takes 17 years to turn 14
percent of original research to
the benefit of patient care

6. Need for Implementation
Science

7. Alternati
ve Key
terms
• Dissemination and
implementation science (D&I
Science) (NIH)
• Knowledge Translation (KT)
(CIHR)
• De-implementation science
(NIH)
• Re-implementation science
(NIH)
• Real World Evidence (RWE)
• Translational science
• Improvement Science

8. Definition of Terms
Implementation Science: The
scientific study of methods to
to promote the systematic uptake of
uptake of Evidence based
interventions into routine health
health setting to improve the quality
the quality and effectiveness of
effectiveness of health services and
services and care.
Implementation Research: Aims to
understand how and why evidence-
evidence-based health interventions
interventions work in real world
world settings and how they can be
can be improved and scaled up.
up.
Eccles, M. P., & Mittman, B. S. (2006). Welcome to implementation science. Implementation Science, 1:1.
Sally,T., et al. (2018). Implementation research: New imperatives and opportunities in global health. Lancet, 392, p2214-2228.

9. From efficacy to effectiveness
EFFECTIVENESS
=
CONTEXT
X
EFFICACY
Example: ACTs treatment in malaria patients
https://doi.org/10.1371/journal.pmed.1002454.

10. Definitions

11. Basic Components of #Impsci or
#IR
Evidence-Based
Intervention
Implementation
Theory, Model,
or Framework
Implementation
Strategies
Implementation
Outcomes
Stakeholder
Engagement

12. Component 1: ‘THE
THING’

13. Component 1: The Evidence-Based
Intervention
• First identify “what is the thing”
• Should be sufficient evidence from research to
establish it as:
An ‘Evidence-based Practice” (EBP)
A ‘best practice’
An ‘evidence-based recommendation’
‘Guideline recommendation’
• The 7EBPs = Programs, practices, principles,
procedures, products, pills and policies

14. Component 2:Implementation
Theories, Models & Frameworks
(TMFs)
Evidence-Based
Intervention
Implementation
Theory, Model,
or Framework
Implementation
Strategies
Implementation
Outcomes
Stakeholder
Engagement

15. Component 2:
A Roadmap for how to get
people to “DO THE THING”

16. Component 2: Theory, Model, Framework
(TMF)
Process Models
EPIS Framework
Knowledge to Action Framework
Iowa Implementation for Sustainability
Framework
Determinant Frameworks
CFIR
i-PARIHS
Knowledge Integration Process
Evaluation Frameworks
RE-AIM
Implementation Outcomes Framework
PRECEDE-PROCEED
Classic Theories
Roger Diffusion of Innovation
Social Cognitive Theory
Transtheoretical Model of Behavior
Change
Adapted from: Nilsen P. Making sense of
implementation theories, models, and frameworks.
Implementation Science 2015; 10(1): 1-13.
HOW WE
IMPLEMENT
FACTORS THAT
INFLUENCE
IMPLEMENTATION
HOW WE SEE IF
IMPLEMENTATION
IS WORKING
APPROACHES TO
BEHAVIOR CHANGE
Implementation Theories
Implementation Climate Theory
Absorptive Capacity
Organizational Readiness
COM-B
SPECIFIC
THEORY ON
IMPLEMENTATION

17. (Damschroder et al., 2009)
Example of Determinant Framework:
Factors that Influence Implementation
Consolidated Framework for Implementation Research
(CFIR)
Factors that
influence if
people to ‘do
the thing’

19. Example of Evaluation Framework: RE-AIM
Glasgow, et al. Front. Public Health, 29 March 2
Sec. Public Health Education and Promotion
Volume 7 - 2019 | https://doi.org/10.3389/fpubh.
How to evaluate
how well and how
often ‘people
are doing the
thing’

20. Example of EPIS Framework
https://episframework.com/
Moullin, J.C.,
Dickson, K.S.,
Stadnick, N.A. et
al. Systematic
review of the
Exploration,
Preparation,
Implementation,
Sustainment (EPIS)
framework.
Implementation Sci
14, 1 (2019).
https://doi.org/10.
1186/s13012-018-
0842-6

21. Basic Components of
Implementation Research
Evidence-Based
Intervention
Implementation
Theory, Model,
or Framework
Implementation
Strategies
Implementation
Outcomes
Stakeholder
Engagement

22. Implementation
Strategies
Methods and techniques
used to enhance the
adoption, implementation,
sustainment, and scale-up
of a program or practice
Discrete Strategy: single
action or process (e.g.,
reminders, audit and
feedback, supervision)
Multi-faceted strategy or
implementation
intervention: Combination
of multiple discrete
strategies Powell et al. (2012; 2015;2019). PMC3524416; PMC4328074; PMC630272;
Proctor et al. (2013).

23. Implementation Science
Interventions
(73 Consensus-Based Interventions called
ERIC Strategies)

24. Selecting & Specifying
Strategies
Name the Strategy Define the Strategy
Specify The Strategy
The Actor: Who Will Do It
The Action: What Will They Do
The Target: Who Will Receive It
Temporality: When Will It Happen
Dose: How Long and How Often Will it
Happen
Evaluate Outcome Affected This Strategy
Justify the Strategy Selected
Can Select Strategies Based On
Identified Barriers
https://cfirguide.org/choosing-
strategies/

25. Strategy Definition Actor Action Target Temporality &
Dose
Implementation
Outcome Affected
Conduct Local
Needs
Assessment
Plan for an conduct training
in the clinical innovation
in an ongoing way for all
individuals involved with
implementation
Study
Coordinator
Evaluate site-specific
barriers and
facilitators for
implementation, and use
information to tailor
implementation
blueprint
Participating
study sites
Prior to
study
initiation,
one time
Feasibility
Acceptability
Adoption
Penetration-
baseline
Develop
Implementatio
n Blueprint
Develop a formal
implementation blueprint
that includes goals and
strategies. It should
include: Aim of
implementation, score of the
change, timeframe and
milestones,
performance/progress
metrics.
Study
Investigator
s
Creation and
disseminate a tailored
implementation plan for
study sites to use to
schedule their
implementation
activities and evaluate
metrics.
Participating
study sites
Administered
at study
initiation;
re-evaluated
every 2
months
Fidelity
Penetration
Develop
Educational
Materials
Develop and format manuals,
toolkits, and other
supporting materials to make
it easier for stakeholders
to learn about the
innovation and for
clinicians to learn how to
deliver the clinical
innovation.
Educational
Team Members
of Study
Create evidence-based
educational materials
to share with study
sites prior to
implementation.
End-user
(nurses,
physicians) at
each study
site
Prior to
study
initiation,
create
powerpoint
and written
materials one
time.
Penetration
Adoption
Conduct
Educational
Meetings
Hold meetings targeted
toward educating multiple
stakeholder groups about
implementation of the
Site
Champions
and Study
Investigator
Schedule and offer
educational sessions
with end users at
participating study
End-users
(nurses,
physicians) at
each study
At study
launch for 60
minutes, then
every 2
Number of
clinicians
educated
Penetration
Selecting & Specifying Strategies

26. Selecting & Specifying
Strategies

27. Basic Components of
Implementation Research
Evidence-Based
Intervention
Implementation
Theory, Model,
or Framework
Implementation
Strategies
Implementation
Outcomes
Stakeholder
Engagement

28. Component 4: Implementation Outcomes
How much and how well they “do the
thing”

29. Comparison of
Outcomes
Clinical / Health
Services Research Implementation Research

30. Implementation
Outcomes
Peters DH, Adam T, Alonge O, Agyepong IA, Tran N. Implementation research: what it is and how to do
it. BMJ. Published online 2017.

31. Resources
31

32. Methods
• Qualitative
• Quantitative
• Mixed Methods
(both)

33. Learn More:
https://societyforimplementationresearchcollaboration.org/

34. Learn More:
https://thecenterforimplementatio
n.com/

35. Journals

36. Additional
Resources
• Online Resources:
• https://fuld.nursing.osu.edu/
• Implementing and Sustaining EBP Using an Implementation
Science Approach online modular program:
https://fuld.nursing.osu.edu/implement-and-sustain-ebp-
modular-program
• Webinar on Implementation Science in Clinical Settings:
https://fuld.nursing.osu.edu/fuld-free-
webinars?tag=3002#freewebinararchive
• Introduction on Implementation Science Study Designs &
Methods for Clinical Investigations online modular program:
https://fuld.nursing.osu.edu/introduction-implementation-
science-study-designs-and-methods-clinical-investigations
• NIH introduction to Implementation
Science: https://cancercontrol.cancer.gov/IS/training-
education/orientation.html
• Online tools for selecting TMF:

37. Additional Reading Resources
• Bauer MS, Damschroder L, Hagedorn H, Smith J, Kilbourne AM. An introduction to
implementation science for the non-specialist. BMC psychology. 2015;3(1):32.
• Bauer MS, Kirchner J. Implementation science: What is it and why should I care?
Psychiatry Research 2020;283:112376.
• Eccles MP, Mittman BS. Welcome to implementation science. Implementation Science
2006;1:1.
• Grol R, Grimshaw J. Evidence-based implementation of evidence-based medicine. Jt Comm J
Qual Improv 1999;25:503-513.
• McNett M, Masciola R, Sievert D, Tucker S. Advancing Evidence-Based Practice Through
Implementation Science: Critical Contributions of Doctor of Nursing Practice- and
Doctor of Philosophy-Prepared Nurses. 2021;18(2):93-101.
• Nilsen P. Making sense of implementation theories, models and frameworks.
Implementation Science 2015;10:53.
• Powell BJ, Fernandez ME, Williams NJ, et al. Enhancing the impact of implementation
strategies in healthcare: A research agenda. Frontiers In Public Health 2019;7:3.
• Powell BJ, Waltz TJ, Chinman MJ, et al. A refined compilation of implementation
strategies: results from the Expert Recommendations for Implementing Change (ERIC)
project. Implementation Science 2015;10:21.
• Proctor E, Silmere H, Raghavan R, et al. Outcomes for implementation research:
conceptual distinctions, measurement challenges, and research agenda. Administration
And Policy In Mental Health 2011;38:65-76.
• Tucker S, McNett M, Melnyk B, Hanrahan K, Hunter S, Kim B, Cullen L, Kitson A.
Implementation Science: Application of evidence-based practice models to improve
healthcare quality. Worldviews on Evidence-Based Nursing, 2021. doi: