From Classification to Causality: Advancing Understanding of Mechanisms of Change in Implementation Science

By C. Lewis, Predrag V. Klasnja, Byron J. Powell, Aaron R. Lyon, L. Tuzzio, Salene M. W. Jones, Callie Walsh-Bailey, Bryan J. Weiner. Frontiers in Public Health, 2018

452 citations recorded by the source corpus.

Background The science of implementation has offered little toward understanding how different implementation strategies work. To improve outcomes of implementation efforts, the field needs precise, testable theories that describe the causal pathways through which implementation strategies function. In this perspective piece, we describe a four-step approach to developing causal pathway models for implementation strategies. Building causal models First, it is important to ensure that implementation strategies are appropriately specified. Some strategies in published compilations are well defined but may not be specified in terms of its core component that can have a reliable and measureable impact. Second, linkages between strategies and mechanisms need to be generated. Existing compilations do not offer mechanisms by which strategies act, or the processes or events through which an implementation strategy operates to affect desired implementation outcomes. Third, it is critical to identify proximal and distal outcomes the strategy is theorized to impact, with the former being direct, measurable products of the strategy and the latter being one of eight implementation outcomes (1). Finally, articulating effect modifiers, like preconditions and moderators, allow for an understanding of where, when, and why strategies have an effect on outcomes of interest. Future directions We argue for greater precision in use of terms for factors implicated in implementation processes; development of guidelines for selecting research design and study plans that account for practical constructs and allow for the study of mechanisms; psychometrically strong and pragmatic measures of mechanisms; and more robust curation of evidence for knowledge transfer and use.

Subfields: General Health Professions, Management Science and Operations Research, Sociology and Political Science

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In General Health Professions

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Citations in the corpus

Clarity out of chaos: Use of theory in implementation research. (2020, background): “, 2014) and explanatory models or models of change (Kazdin, 2007; Lewis et al., 2018; Sofaer et al., 2003).”
Implementation Mapping: Using Intervention Mapping to Develop Implementation Strategies (2019, background): “They suggest the need to link strategies to barriers and describe not only the desired proximal and distal outcomes but also the processes or mechanisms through which implementation strategies are effective (71).”
RE-AIM Planning and Evaluation Framework: Adapting to New Science and Practice With a 20-Year Review (2019, background): “First, there have been recent calls to more explicitly describe strategies and context (80, 81) as well as test mediating relationships between implementation strategies and implementation outcomes (82).”
Enhancing the Impact of Implementation Strategies in Healthcare: A Research Agenda (2019, background): “Developing a more nuanced understanding of mechanisms will require researchers to thoroughly assess the context of implementation and describe causal pathways by which strategies exert their effects, moving beyond a broad identification of determinants and articulating mediators, moderators, precond”
The Implementation Research Logic Model: a method for planning, executing, reporting, and synthesizing implementation projects (2020, methodology): “Determinants may act as moderators, “effect modifiers,” or mediators, thus indicating that they are links in a chain of causal mechanisms [12].”
An Introduction to Effectiveness-Implementation Hybrid Designs (2019, background): “Further, there are growing expectations to hypothesize about and measure expected mechanisms of action for the implementation strategies (Lewis et al., 2018; Pintello, 2019; Williams and Beidas, 2019).”