Implementation research uses specific frameworks, study designs, and outcomes to assess how evidence-based interventions are implemented. While traditional evaluations focus on whether a program works or not, an implementation research lens provides insight into why the program outcomes were achieved or not. Implementation research recognizes that program implementation is a dynamic process. Some of the commonly used implementation research outcomes are: 1) Adoption; 2) feasibility; 3) reach; 4) acceptability; 5) appropriateness.
Exploring which strategies will guide implementation is a critical step in implementation research. Implementation strategies are different than intervention strategies. For example, an organization is preparing for a new program to promote use breastfeeding. The intervention strategies include information on benefits of breastfeeding, a couples-based session to enhance support, and digital reminders. These are intervention strategies. Prior to introducing a new program, an organization may enhance their infrastructure, hire and train staff, and gain buy-in from all stakeholders. These steps are implementation strategies.
PRISM
The implementation research activities in CROWN are guided by the Practical, Robust Implementation and Sustainability Model (PRISM). PRISM is an implementation framework that builds on the long-standing REAIM framework.1 The REAIM framework focuses on the following outcomes:
| Reach | Effectiveness | Adoption | Implementation | Maintenance |
|---|---|---|---|---|
| The number of individuals who participate or are willing to participate in a program. | The impact of an intervention based on health and client outcomes. | Willingness to try a new program. | Program Implementation and intervention fidelity. | The extent to which a program becomes integrated into their existing programming. |
PRISM expands REAIM by incorporating contextual factors pertaining to the intervention, program and organization recipients, implementation infrastructure and external environment.
In order to be successful, programs need to consider both organization and client perspective of program implementation. The table below list some of the key constructs that should be considered from the intervention and recipients of the intervention at both organization and client perspective.
| Organization and staff | Client | |
|---|---|---|
| Intervention |
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| Recipients |
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As a program is being implemented internal and external factors will determine the success of the program. Influential factors in the External Environment include:
- Competition with other programs
- Cultural beliefs and values
- Norms
- Funder Satisfaction
- Community resources
Finally, each organization will reflect on their implementation infrastructure and make any enhancements. Features of a productive implementation infrastructure include:
- Dedicated team
- Ongoing support and training
- Organization infrastructure
- Communication
- Planning for sustainability
- Flexible protocols and procedures
References
Glasgow, R.E., Vogt, T.M, & Boles, S.M. (1999). Evaluating the public health impact of health promotion interventions: the RE-AIM framework. American Journal of Public Health 89, 1322-1327. https://doi.org/10.2105/AJPH.89.9.1322