Week 5: Implementation Outcomes Flashcards
A framework that categorizes implementation outcomes into different types (e.g., adoption, implementation, fidelity, sustainability).
Proctor’s Taxonomy
Deliberate and purposive actions to implement new treatments, practices and services.
Implementation Outcomes
3 Functions of Implementation Outcomes
1) Serve as indicators of implementation success
2) Proximal indicators of implementation processes
3) Key intermediate outcomes
Also referred to as the Implementation Outcomes Framework.
Aims to bring consistency and comparability to the field.
Proctor’s Taxonomy of Implementation Outcomes
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
Perception amongst stakeholders that new intervention is agreeable.
Acceptability
Intention to apply or the application of a new intervention.
Adoption
Extent to which an intervention can be applied.
Feasibility
Perceived relevance of intervention to a setting, audience, or problem.
Appropriateness
Extent to which an intervention gets applied as originally designed/intended.
Fidelity
Costs of the delivery strategy, including the costs of the intervention itself.
Implementation Costs
Extent to which eligible patients/population actually receive intervention.
Coverage/Reach
Extent to which a new intervention becomes routinely available/is maintained post-introduction.
Sustainability
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
Focus on the process of implementing a new intervention, such as its adoption, fidelity, and sustainability.
Implementation Outcomes
Relate to the quality and efficiency of the intervention’s delivery, including factors like timeliness, safety, and equity.
Service Outcomes
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)
Measure the impact of the intervention on individuals, such as changes in their health, behavior, or well-being.
Patient/Client Outcomes
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).
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).
