Example of a table describing* an implementation strategy compiled from Kilbourne et al19 description of the implementation of life goals (LG): a clinical intervention for patients with mood disorders
| Name of discrete strategies | Assess for readiness to adopt LG intervention. Recruit champions and train for leadership | Develop and distribute educational materials, manuals, toolkits and an implementation blueprint | Educational meetings, outreach visits, clinical supervision, technical assistance, ongoing consultation | Facilitation (external and internal) and continuous implementation advice |
|---|---|---|---|---|
| Actors | Investigators, representatives from practices and community | Investigators, trainers and LG providers designated at each site | Trainers and LG providers. | Investigators, external and internal facilitators (EF and IF), LG providers |
| Actions | Preimplementation meetings with site representatives for inservice marketing and dissemination of the LG programme: overview of LG evidence, benefits of LG and how to implement LG. Identify in each site at least one potential LG providers with a mental health background and internal facilitators. Identify champions. Assess readiness, barriers and facilitators | Packaging LG protocol and provider manual (identifying candidate patients; scripts for session and follow-up calls; registry for tracking patients’ progress). Design implementation: Implementation manual describing the ‘Replicating Effective Programs’ (REP) package. Patients’ workbook (exercises on behaviour change goals, symptom assessment, coping strategies…) | Training for LG providers: evidence behind LG, core elements and step-by-step walk through LG components; patient tracking and monitoring over time and continuous education via LG website. Programme assistance and LG uptake monitoring via LG website, support by study programme assistant, biweekly monitoring form, feedback reports and newsletters | Initiation and benchmarking: EF and LG providers identify barriers, facilitators, and goals. Leveraging: IF and LG providers identify priorities, other LG champions, and added value of LG to site providers. Coaching: IF, EF and LG providers phone to develop rapport and address barriers. Ongoing marketing: IF, leaders and LG providers summarise progress and develop business plans |
| Targets | Awareness of evidence-based interventions, engagement and settings’ readiness to change | Environmental context and resources, information and access to interventions | Build knowledge, beliefs, skills and capabilities: problem solving, decision-making, interest | Strengths and influences of LG provider. Measurable objectives and outcomes in implementing LG |
| Temporality | 1st step: preimplementation | 2nd step: REP implementation | 3rd step: training and start up | 4th step: maintenance/evolution |
| Dose | One informative meeting | For continuous use with every patient, as needed | 1-day 8 hour training programme+continuous assistance and monitoring | 2-day training programme EF and continuous facilitation activities |
| Implementation outcomes addressed/affected | Barriers, facilitators, specific uptake goals; organisational factors: ie, Implementation Leadership Scale, Implementation Climate Scale, resources, staff turnover, improved organisational capacity to implement, organisational support… | Organisational factors associated with implementation. Quality of the supporting materials, packaging and bundling of the intervention. Association of available materials’ quality with actual implementation Providers’ knowledge, skills trust | RE-AIM framework (Reach, Effectiveness, Adoption, Implementation and Maintenance) and LG performance measures of routine clinical care process: ie, sessions completed by patient, percentage completing 6 sessions… | IF, EF and LG provider's perceptions, strengths and opportunities to influence site activities and overcome barriers. Adaptation and fidelity monitoring: ie, number of meetings, opportunities to leverage LG uptake. Quality and costs |
| Theoretical justification | CDC's Research to Practice Framework. Social learning theory | REP framework and implementation strategy for community-based settings (includes Rogers’ Diffusion of Innovations and Social Learning Theory) | Adaptive implementation.PARiHS framework | |
*Using Proctor et al's15 framework..