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Summary HEP4205 Implementation and Evaluation Tutorials
Complete summary of all tutorials and most lectures
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Voorbeeld 4 van de 102 pagina's
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Lecture 1Intervention timeline: development (1) – implementation (2) – evaluation (3)– scaling up (4)
Which factors have impact on the implementation of an intervention. I.e., which questions are
of importance regarding the implementation of an intervention?
• Who wants/ needs to pay for the intervention?
• Who is the owner?
• How can we assure quality of the intervention?
• What about fidelity and/or adaptation?
• Who is responsible for the distribution of the program?
• How can the program be implemented?
• How can the intervention be scaled up?
• What is needed to be able to scale up?
Implementation science: ‘the scientific study of methods to promote the systematic uptake of
research findings and other evidence-based practices into routine practice. It includes the
study of influences on healthcare professionals and organisational behaviour’
Planned and systemic approach à
What is key to successful health promotion?
1. Effective innovation
X
2. Dissemination and implementation
= Impact
1
,Problematic à only 5 to 15% of the potential effects of health promotion reached (i.e., limited
impact in real life) because:
- Evidence-based interventions are based on theories and empirical data
- They are often tested in efficacy trials (focus on internal validity).
For instance, drug development in medical research. This can be tested under high artificial
conditions and with highly motivated participants, therefore the effectiveness would not equal
to the effectiveness in real life.
In the real world, you do not have these controlled conditions, which raises issues like voltage
drop (= decrease in effectiveness when moving from a controlled (efficacy trials) to more
uncontrolled setting (effectiveness trial) because of heterogenous patients, settings and
providers. Regarding the providers, the intervention might for instance be modified or not
completely delivered) and program drift (= decrease or increase in effectiveness during
implementation because the intervention is not implemented as intended, for instance, the
intervention is implemented in another target group.
In addition, there is a gap between researchers (intervention developers) and practitioners
(those who will deliver the intervention) à practitioners claim the lack of relevance and fit of
evidence. I.e., they claim that the intervention does not fit with the target group and that these
methods are too expensive.
• Dissemination as the targeted distribution of information and intervention materials to
a specific public health audience.
• Implementation then refers to increasing the integration of EBIs into routing real-world
practices.
2
, For the exam:
1. Study the frameworks
2. State the differences and similarities between the frameworks
3. Apply the frameworks to an intervention of choice (for example,
Case 1 the 10,000 steps project or the MiLes-intervention)
Learning goals case 1:
1. What is dissemination and implementation? (in general)
Lecture 1:
Dissemination as the targeted distribution of information and intervention materials to a
specific public health audience. Implementation then refers to increasing the integration of
Evidence Based Interventions (EBIs) into routing real-world practices (Brownson et al., 2018).
Bessems et al.
- Diffusion = the spread of an innovation occurs spontaneously and without planned
control form the outside (passive & unplanned)
- Dissemination = implementation processes in which effort is made to spread the
message among certain groups/ settings (active & planned)
- Upscaling = organization of a good infrastructure to facilitate and sustain
dissemination of the innovation on a larger scale.
a. What are the different phases of implementation?
Bessems et al.
Intermediaries or intermediate users: people who implement or supervise the intervention
in practice such as teachers at school. The intervention developers often collaborate with the
intermediate users to reach the intended target population. However, these intermediate users
operate in a context that influences the implementation process.
It is a wrong idea that new interventions will directly be embraced by intermediate users
as they either do not see the added value of the new intervention when compared to the
continued use of current approaches or they adapt the intervention in such a way that it is less
effective. Rogers described the process of innovations in his ‘’classical model of diffusion of
innovations’’.
è Rogers is a form of a classical theory, which aims to understand implementation.
Diffusion of innovation by 4 key elements:
1 An innovation (= information that is new for the recipient. Innovations refer to ideas
or products as long as these are experiences as new by the recipient)
2 Is communicated through certain communication channels (= ways in which
information is transferred from one person to another via for instance mass media, but
also interpersonal)
3 During a certain time-interval (= implementation is phased in time and there is
variation in the moment when recipients become aware of the innovation and decide
to use it)
4 Among members of a social network (= people are part of a social network in which
members influence each other, but also characteristics of the work such as normative
expectations.
Other definitions:
• Implementation strategy = all planned activities that developers can deploy to
promote the intended implementation process among intermediate users.
• De-implementation = the process of discontinuing, removing, reducing, or replacing
a harmful, ineffective, or low-value clinical practice or intervention.
• Mis-implementation = the state in which effective interventions are prematurely
ended (mis-termination) or, alternatively, ineffective interventions remain in place (mis-
continuation)
• Reach = extent to which the audience comes in contact with the intervention
3
, Ø Rogers distinguished 3 phases of the implementation process; the process that people
go through to implement an innovation:
1. Adoption - people learn about the innovation, weigh up the expected pros and cons
of using it and decide whether or not to use it (adoption decision).
2. Implementation – a positive adoption decision leads to the first use of the innovation
(initial implementation).
3. Continuation – users decide whether or not to continue with the innovation on the
basis of their initial user experiences.
b. What are the steps of dissemination and implementation? (case example)
“The 10,000 Steps project includes multiple community-based strategies to promote physical
activity in the adult population and its development was guided by the socio- ecological model.
The first step would be the dissemination (based on the theory by Fleuren et al.),
meaning the spread of information about the intervention and relevant intervention materials
to the specific public health audience. In the example of the 10,000 steps project, this would
mean spreading information about this intervention to relevant adults.
The next step would be the adoption of the 10,000 steps project (based on the theory
by Fleuren et al. and the theory by Rogers et al.). This would mean that the targeted adults
learn about the intervention and weigh up the pros and cons of using it and subsequently
decide whether or not to use it (adoption decision).
After this, the next step would be the implementation of the 10,000 steps project (based
on the theory by Fleuren et al. and the theory by Rogers et al.). Based on the theory by
Damschroder et al., the implementation of the project is determined by the intervention
characteristics, the outer setting, the inner setting and the characteristics of the individuals.
The last step would be the continuation of the 10,000 steps project (based on the
theory by Fleuren et al. and the theory by Rogers et al.). The users of the project decide
whether or not to continue with the innovation on the basis of their initial user experience.
2. What factors and implementation determinants are important in the process of
dissemination and implementation?
Bessems et al.
Rogers identified 5 innovation characteristics (= innovation attributes) that can increase the
chances of innovation, adoption, implementation and continuation
• Relative advantage – the extent to which the innovation had advantages over existing
practice (e.g., costs)
• Compatibility – the extent to which an innovation fits with the prevailing norms and
attitudes of intermediate users (but also needs and past experiences)
• Complexity – the extent to which the innovation is considered complex to use.
• Trialability – the extent to which (parts of) the innovation can be tested without having
far-reaching consequences for the intermediate users of their organizations.
• Observability – the extent to which the outcomes of the innovation are visible to the
intermediate users and other direct stakeholders (e.g., colleagues).
This is not about objective intervention characteristics, but about subjective characteristics of
the intermediate users. If people expect a new intervention to have relative advantages such
as to be easy to fit, not too complex, easy to try out, and with visible effects, they are more
likely to adopt it than if their expectations are predominantly negative.
For the exam, apply these determinants on a project as example (for instance, Miles)
The intervention should have a relative advantage over the existing practice. For the MiLes-intervention, this
could be the fact that more workers return to work which increases the quality of life and reduces the costs. In
addition, it should be compatible, meaning that the intervention fits with the norms of the implementers.
Besides, the intervention should not be too complex to use (e.g., few mouse clicks to access it). Furthermore,
the intervention should be tried, meaning a free period (e.g. 1 month) in which the implementers can access
the intervention materials freely. Finally, the intervention should have observable outcomes such as satisfied
workers or reduced costs.
4
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