A Conceptual Model of Implementation Research

By Rachel Presskreischer posted 25 Aug, 2019 20:33

  

The title of the AED Research-Practice Think Tank at the 2019 ICED was Bringing Evidence-Based Practices to the People and Places that Need Them: Diverse Perspectives on Implementation Science. Recognizing that implementation research is a new concept for many people in the eating disorders field, in this post we follow up on this important topic and encourage ongoing and new conversations among AED members.

In their article, An Introduction to Implementation Science for the Non-Specialist, Bauer et al. explain that implementation science arose to facilitate the uptake of evidence-based interventions (EBIs) into routine clinical care for mental and physical health conditions (Bauer, Damschroder, Hagedorn, Smith, & Kilbourne, 2015). To accomplish this goal, the scope for implementation research is broader than traditional clinical research – including provider, organization and policy-level factors in addition to individuals.  Implementation research also utilizes interdisciplinary teams with members not usually seen in clinical research. Some examples of members include: health services researchers, economists, sociologists, anthropologists, organizational researchers, and front-line partners such as administrators, clinicians and patients (Bauer et al., 2015).

Below is a conceptual model of implementation research which is contingent on the context in which the evidence-based interventions are implemented.2 The model shows the general flow of how an EBI ultimately translates to health outcomes, depending on a set of implementation strategies and outcomes. More specific information about the components of this framework can be found in Implementation Research in Mental Health Services (Proctor et al., 2009) and Implementation Research: What it is and how to do it (Peters, Adam, Alonge, Agyepong, & Tran, 2013).

 

 

Many Think Tank panelists identified barriers to accessing and implementing EBIs aligned with the implementation and service outcomes listed in this conceptual model. These components are an integral part of implementation science and represent factors that can impede or facilitate successful implementation of an EBI.

Panelists Stephanie Covington-Armstrong, Shalini Wickramatilake, and Rachel Milner raised issues of equity, patient-centeredness, and acceptability. Stephanie and Shalini shared personal challenges of engaging with treatment while being unrepresented racially, ethnically, and culturally among providers and other patients. Rachel explained that inherent weight bias in the design, research, and delivery of interventions undercuts acceptability, uptake, effectiveness, equity, patient-centeredness, and emotional safety. These cases highlight that consideration of diverse patient needs and exploration of implicit biases at the intervention design, research, and delivery stages are crucial to many implementation and service outcomes.

While discussing implementation challenges, Eva Trujillo described adapting interventions due to feasibility, fidelity in settings with varied resources, and consideration of cultural differences to increase acceptability, patient-centeredness, and equity. Josie Gellar addressed similar issues in the context of research– sharing her experiences including patients and clinicians as co-investigators. She explained that their participation in deriving research questions improved the probability that they investigated questions of consequence to those affected, and that the product of the research was more broadly patient-centered, equitable, feasible, and acceptable.

One takeaway from the panel is that successful implementation of interventions requires a coordinated effort between researchers, clinicians, and patients. If the field remains siloed such that researchers and clinician-researchers are designing interventions, clinicians are delivering them, and patients are then supposed to receive them – we assume we can skip from the “what” part of the model to “health outcomes” without considering the “how”. Ideally, leveraging interdisciplinary knowledge and diverse perspectives of researchers, clinicians, and patients/families will allow the field to design interventions that are clinically effective, deliverable, and provide the greatest benefit for the most patients.

A special thank you to the Think Tank panelists:

Stephanie Covington-Armstrong

Brooklyn, New York, USA

Josie Geller, PhD, RPsych, FAED

Vancouver, British Columbia, Canada

Rachel Millner, PsyD, CEDS-S

Philadelphia, Pennsylvania, USA

Abby Sarrett-Cooper, MA, LPC

West Orange, New Jersey, USA

Eva Trujillo, MD, CEDS, FAED, FAAP, Fiaedp

Garza García, Nuevo León, Mexico

Shalini Wickramatilake, MHS

Washington, District of Columbia, USA

  

Works Cited

Bauer, M. S., Damschroder, L., Hagedorn, H., Smith, J., & Kilbourne, A. M. (2015). An introduction to implementation science for the non-specialist. BMC Psychology, 3(1), 32. https://doi.org/10.1186/s40359-015-0089-9

Peters, D. H., Adam, T., Alonge, O., Agyepong, I. A., & Tran, N. (2013). Implementation research: What it is and how to do it. BMJ (Online), 347(November), 1–7. https://doi.org/10.1136/bmj.f6753

Proctor, E. K., Landsverk, J., Aarons, G., Chambers, D., Glisson, C., & Mittman, B. (2009). Implementation research in mental health services: an emerging science with conceptual, methodological, and training challenges. Administration and Policy in Mental Health, 36(1), 24–34. https://doi.org/10.1007/s10488-008-0197-4

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