Implementation Research (IR)

 

Implementation research (IR) is a growing field of health research and practice that aims to improve public health and clinical policies and programs (Peters et al., 2013). IR attempts to assess and solve a wide range of issues that can arise during service delivery by developing a scientific approach and by formulating questions related to the implementation of a program, policy, or practice.

 

Implementation Research (IR) assesses many aspects of an implementation: the factors affecting it (e.g., institutional capacity, the commitment of stakeholders, funding availability, among others), the processes of implementation (coherence and sequence of activities conducted), and implementation results. The goal is to understand what, why, and how interventions work in “real world” settings and to identify various approaches to improve them.

 

As opposed to traditional process evaluations, IR is wholly concerned with users - it goes beyond purely assessing implementation progress or implementation bottlenecks. Indeed, the method recognizes that users have great knowledge (and deeper insight) about programs and policies that could lead researchers to be more effective. Users of program may include: program managers, medical practitioners involved in service delivery, funders, policymakers who need to be informed about programs, practitioners who need to be convinced about the effectiveness of an intervention, beneficiaries, and communities of practice. IR involves all these actors in the identification and design phases of research projects instead of using them merely as research inputs or targets for the dissemination of research results (McKibbon and Lokker, 2012). 

 

The backbone of IR is, therefore, the development of a consultative process to identify research questions that are relevant and pertinent to the users or clients. As indicated by Peters et al. (2009) and Habicht (1999); research questions can often be classified according to their research objective into five main categories: to explore, describe, test, explain, or predict. Once research questions (or implementation problems) are identified as well as their primary objective, researchers assess each issue (i) a theory of change, (ii) data availability and (ii) research methods required to answer this questions – which could be qualitative and quantitative. As such, in the context of IR, a research question dictates the research methods and assumptions to be used (Tabak et al., 2012).[1]

 

The second characteristic of IR is that it assesses implementation "actions" systematically using Implementation Outcome Variables (IOVs) across implementation activities and processes (Peters et al., 2013). IOVs contribute to assessing the implementation of “actions” according to a series of criteria – such as acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, coverage, and sustainability.

 

Figure 1: Main Component of Implementation Research

 

The third characteristic of IR is that it assesses overall implementation strategies of policies and programs. Implementation strategies refer to methods that are used to either communicate or enhance the adoption of policies and programs. For instance, in the context of a public health intervention, an implementation strategy could be the promotion of patient’s outreach campaigns, supervision checklists, service scorecards, training, and other similar interventions that intend to improve coverage and quality of the program. Finally, IR evaluates “Implementation Influencing Factors”, which are factors that influence policy implementation (clarity of objectives, causal theory, implementing personnel, support of interest groups, and managerial authority and resources). As a result, IR provides a holistic view of program and policy implementation (Figure 1). 

 

 


[1] Much of evidence-based medicine is concerned with the objective of influence, or whether an intervention produces an expected outcome, which can be broken down further by the level of certainty in the conclusions drawn from the study. The nature of the inquiry (for example, the amount of risk and considerations of ethics, costs, and timeliness), and the interests of different audiences should determine the degree of uncertainty. Research questions concerning programmatic decisions about the process of an implementation strategy may justify a lower level of certainty for the manager and policymaker, using research methods that would support an adequacy or plausibility inference.

 

Note: Implementation is understood as the act of carrying an intention effectively (policy, program, or practice).