Making sense of implementation theories, models and frameworks
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DEBATE
Open Access
Making sense of implementation theories, models and frameworks Per Nilsen
Abstract Background: Implementation science has progressed towards increased use of theoretical approaches to provide better understanding and explanation of how and why implementation succeeds or fails. The aim of this article is to propose a taxonomy that distinguishes between different categories of theories, models and frameworks in implementation science, to facilitate appropriate selection and application of relevant approaches in implementation research and practice and to foster cross-disciplinary dialogue among implementation researchers. Discussion: Theoretical approaches used in implementation science have three overarching aims: describing and/or guiding the process of translating research into practice (process models); understanding and/or explaining what influences implementation outcomes (determinant frameworks, classic theories, implementation theories); and evaluating implementation (evaluation frameworks). Summary: This article proposes five categories of theoretical approaches to achieve three overarching aims. These categories are not always recognized as separate types of approaches in the literature. While there is overlap between some of the theories, models and frameworks, awareness of the differences is important to facilitate the selection of relevant approaches. Most determinant frameworks provide limited “how-to” support for carrying out implementation endeavours since the determinants usually are too generic to provide sufficient detail for guiding an implementation process. And while the relevance of addressing barriers and enablers to translating research into practice is mentioned in many process models, these models do not identify or systematically structure specific determinants associated with implementation success. Furthermore, process models recognize a temporal sequence of implementation endeavours, whereas determinant frameworks do not explicitly take a process perspective of implementation. Keywords: Theory, Model, Framework, Evaluation, Context
Background Implementation science was borne out of a desire to address challenges associated with the use of research to achieve more evidence-based practice (EBP) in health care and other areas of professional practice. Early implementation research was empirically driven and did not always pay attention to the theoretical underpinnings of implementation. Eccles et al. ([1]:108) remarked that this research seemed like “an expensive version of trial-anderror”. A review of guideline implementation strategies by Davies et al. [2] noted that only 10% of the studies identified provided an explicit rationale for their strategies. Mixed results of implementing EBP in various settings were often attributed to a limited theoretical Correspondence: [email protected] Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
basis [1,3-5]. Poor theoretical underpinning makes it difficult to
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