Week 5: Implementation Outcomes Flashcards by Arriz Panopio

A framework that categorizes implementation outcomes into different types (e.g., adoption, implementation, fidelity, sustainability).

Proctor’s Taxonomy

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Deliberate and purposive actions to implement new treatments, practices and services.

Implementation Outcomes

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3 Functions of Implementation Outcomes

1) Serve as indicators of implementation success
2) Proximal indicators of implementation processes
3) Key intermediate outcomes

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Also referred to as the Implementation Outcomes Framework.

Aims to bring consistency and comparability to the field.

Proctor’s Taxonomy of Implementation Outcomes

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Proctor’s 8 Taxonomy of Implementation Outcomes

1) Acceptability
2) Adoption
3) Appropriateness
4) Feasibility
5) Fidelity
6) Implementation Costs
7) Coverage/Reach
8) Sustainability

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Perception amongst stakeholders that new intervention is agreeable.

Acceptability

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Intention to apply or the application of a new intervention.

Adoption

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Extent to which an intervention can be applied.

Feasibility

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Perceived relevance of intervention to a setting, audience, or problem.

Appropriateness

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Extent to which an intervention gets applied as originally designed/intended.

Fidelity

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Costs of the delivery strategy, including the costs of the intervention itself.

Implementation Costs

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Extent to which eligible patients/population actually receive intervention.

Coverage/Reach

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Extent to which a new intervention becomes routinely available/is maintained post-introduction.

Sustainability

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3 Types of Outcomes

1) Implementation outcomes: The “how” of the intervention
2) Service outcomes: The “quality” of the intervention
3) Patient/Client outcomes: The “impact” of the intervention

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Focus on the process of implementing a new intervention, such as its adoption, fidelity, and sustainability.

Implementation Outcomes

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Relate to the quality and efficiency of the intervention’s delivery, including factors like timeliness, safety, and equity.

Service Outcomes

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Aims to understand and/or explain influences on implementation outcomes.

It assesses 39 constructs over five domains. The five domains include intervention characteristics, outer setting, inner setting, characteristics of individuals, and the process of implementation.

Consolidated Framework of Implementation Research (CFIR)

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Measure the impact of the intervention on individuals, such as changes in their health, behavior, or well-being.

Patient/Client Outcomes

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5 Domains in the Consolidated Framework for Implementation Research (CFIR)

Intervention characteristics (i.e., adaptability or complexity)
Outer setting (i.e., policy, regulations)
Inner construct (i.e., readiness for implementation)
Characteristics of individuals (i.e., staffattitudes, skills)
Process of implementation

Aims to encourage greater attention to intervention elements that can improve the sustainable adoption and implementation of evidence-based interventions.

RE-AIM

5 Dimensions Across Individual, Organizational, and Community Level (RE-AIM)

Reach
Effectiveness
Adoption
Implementation (i.e., fidelity)
Maintenance

Key Considerations in Measuring Implementation Outcomes

Researcher Experience: The familiarity of researchers with different methods can influence their choice.

Available Resources: Time, budget, and expertise can constrain the options.

How do we measure Implementation Outcomes?

1) Qualitative Interviews or Focus Groups
2) Surveys or Questionnaires
3) Observation
4) Routinely Collected Data

Depth: Ideal for exploring in-depth perspectives from various stakeholders.
Resource-Intensive: Requires time, expertise, and analysis skills.

Qualitative Interviews or Focus Groups

Efficiency: Can collect data from a larger sample. Less Depth: Provides less detailed information than qualitative methods.

Surveys or Questionnaires

Direct Assessment: Directly observes implementation practices. Time-Consuming: Requires careful planning and observation.

Observation

Efficiency: Leverages existing data sources. Limitations: May not capture all relevant aspects of implementation.

Routinely Collected Data

Key Considerations in Analyzing Implementation Outcomes

1) Level of Analysis 2) Implementation Stage 3) Measuring at Multiple Stages 4) Selecting measurement Tools

Why do we validate implementation outcome instruments?

- Lack of Consensus on which instruments used for measuring the same outcome - Inconsistencies in the outcomes reported - Variability in the quality of instruments - Optimal instrument uncertainty - Evidence-based hindrance

This is the ability of a measure to detect change in an individual over time.

Responsiveness

Refers to the consistency and dependability of a measurement tool. A reliable instrument produces similar results when used repeatedly under the same conditions. In other words, it is free from random error.

Reliability

Refers to the accuracy of a measurement tool. A valid instrument measures what it is intended to measure. In other words, it is free from systematic error.

Is a type of error that occurs due to chance or unpredictable factors. It can cause a measurement to deviate from the true value in either a positive or negative direction.

Random Error

Is a type of error that occurs consistently in the same direction. It causes measurements to deviate from the true value in a predictable way. Systematic errors are often caused by:

Systematic Error

Consistency of scores over time.

Test-Retest Reliability

Consistency of items within a questionnaire.

Internal Consistency

The extent to which the instrument measures the intended construct.

Content Validity

The extent to which the instrument measures the theoretical construct.

Construct Validity

The correlation between the instrument and a criterion measure.

Criterion Validity

Key Points on Reliability and Validity

Reliability Precedes Validity: A measure must be reliable before it can be valid. Focus on Validity: Researchers often prioritize assessing validity over reliability. Reliability is Necessary but Not Sufficient: A measure must be reliable (consistent) before it can be valid. Reliability Does Not Imply Validity: A reliable measure may not necessarily be valid.

The process of ensuring that a measurement instrument is appropriate and valid across different cultural groups.

Cross-cultural Validation

Choose instruments that are practical, feasible, and appropriate for your research context.

Pragmatism

Crowd-Sourced: Instrument developers add their own instruments. No Validation Requirement: Any measure can be added, regardless of validation.

Grid Enabled Measures (GEM) Database

Population: Mental health instruments. Coverage: Includes instruments for all 39 CFIR constructs. Access: Fee-paying members only (but instruments listed in open-access publications).

Society of Implementation Research Collaboration (SIRC)

Is a comprehensive checklist designed to evaluate the methodological quality of psychometric studies. These studies examine the reliability and validity of measurement instruments, such as questionnaires, surveys, or tests.

ConPsy (Construct Psychology)

Focus: Physical health instruments. Features: Search by implementation outcome, view instrument summary, methodological quality assessment, ConPsy checklist, usability rating, and access to psychometric studies and instruments (where permitted).