A pragmatic approach to guide implementation evaluation research: Strategy mapping for complex interventions

Alexis K. Huynh, Alison B. Hamilton, Melissa M. Farmer, Bevanne Bean-Mayberry, Shannon Wiltsey Stirman, Tannaz Moin, Erin P. Finley

Research output: Contribution to journalArticle

12 Scopus citations

Abstract

Introduction: Greater specification of implementation strategies is a challenge for implementation science, but there is little guidance for delineating the use of multiple strategies involved in complex interventions. The Cardiovascular (CV) Toolkit project entails implementation of a toolkit designed to reduce CV risk by increasing women's engagement in appropriate services. The CV Toolkit project follows an enhanced version of Replicating Effective Programs (REP), an evidence-based implementation strategy, to implement the CV Toolkit across four phases: pre-conditions, pre-implementation, implementation, and maintenance and evolution. Our current objective is to describe a method for mapping implementation strategies used in real time as part of the CV Toolkit project. This method supports description of the timing and content of bundled strategies and provides a structured process for developing a plan for implementation evaluation. Methods: We conducted a process of strategy mapping to apply Proctor and colleagues' rubric for specification of implementation strategies, constructing a matrix in which we identified each implementation strategy, its conceptual group, and the corresponding REP phase(s) in which it occurs. For each strategy, we also specified the actors involved, actions undertaken, action targets, dose of the implementation strategy, and anticipated outcome addressed. We iteratively refined the matrix with the implementation team, including use of simulation to provide initial validation. Results: Mapping revealed patterns in the timing of implementation strategies within REP phases. Most implementation strategies involving the development of stakeholder interrelationships and training and educating stakeholders were introduced during the pre-conditions or pre-implementation phases. Strategies introduced in the maintenance and evolution phase emphasized communication, re-examination, and audit and feedback. In addition to its value for producing valid and reliable process evaluation data, mapping implementation strategies has informed development of a pragmatic blueprint for implementation and longitudinal analyses and evaluation activities. Discussion: We update recent recommendations on specification of implementation strategies by considering the implications for multi-strategy frameworks and propose an approach for mapping the use of implementation strategies within complex, multi-level interventions, in support of rigorous evaluation. Developing pragmatic tools to aid in operationalizing the conduct of implementation and evaluation activities is essential to enacting sound implementation research.

Original languageEnglish (US)
Article number134
JournalFrontiers in Public Health
Volume6
Issue numberMAY
DOIs
StatePublished - May 18 2018

Keywords

  • Complex interventions
  • Evaluation
  • Implementation blueprint
  • Implementation strategies
  • Strategy mapping

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

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    Huynh, A. K., Hamilton, A. B., Farmer, M. M., Bean-Mayberry, B., Stirman, S. W., Moin, T., & Finley, E. P. (2018). A pragmatic approach to guide implementation evaluation research: Strategy mapping for complex interventions. Frontiers in Public Health, 6(MAY), [134]. https://doi.org/10.3389/fpubh.2018.00134