How to Operationalize Implementation Strategies: Introducing “Intentions”
By Dr. Sobia Khan, Director of Implementation
4-min read
For many years, we have been teaching people how to use implementation science to select change strategies for their initiatives. We refer to “implementation strategies” as “change strategies”, since this term resonates more with practitioners. Much of the focus in implementation science is on how to connect strategies with underlying determinants of change – innovations like the Behavior Change Wheel, the CFIR-ERIC Mapping tool, Implementation Mapping and our very own StrategEase tool were designed to support people to make these links.
Why selecting implementation strategies is not enough
Our experience has been that once the determinant or barrier-to-strategy linkage clicks with people, the process of selecting a strategy can become easier. Where there tends to be a challenge is thinking through what happens next. In other words, “we selected strategies, now what?” We have jokingly called this “falling off the cliff” because this is what it feels like. Teams work so hard to select strategies, only to realize that you now have to bring them to life – often without clear guidance on how to make that happen.
Common challenges after strategy selection
Reverting to familiar strategies
In practice, we have seen a few things happen after selecting strategies. We frequently see teams revert to familiar strategies, even after carefully linking barriers to strategies. For example, education and audit & feedback are widely used strategies, and people tend to continue to use these strategies even after going through the barrier-strategy linkage process. Our view is that this is fine if the barrier-strategy link is maintained (i.e., the strategy you typically rely on has a strong theoretical rationale). Where it becomes problematic is when we revert to strategies that won’t really address the barriers we are experiencing.
Difficulty visualizing what strategies look like in practice
Another thing that we have seen frequently is that people move forward with the strategies that they have selected, but they have difficulty imagining what they will look like and how they can be better operationalized. To make strategies come alive, it is necessary to envision how people will experience the strategies and what types of change mechanisms the strategies will foster to help address the determinant of change you identified.
For example, education strategies are the most common types of strategies used in any implementation work, often to overcome knowledge barriers. But the way that we enact education can help tackle knowledge barriers in different ways. Providing materials usually implies that we are outlining facts or knowledge, and that we are communicating this in clear ways appropriate for the audience. Educational sessions can achieve other things, such as fostering sensemaking about what the knowledge means to people, or unifying people around that knowledge. This additional layer, the way a strategy is experienced and the mechanism it activates, is what we call “intentions”.
How intentions can enhance how we operationalize change strategies in implementation science
Our ideas about intentions arose for different reasons. For many years, we had been using a list of “intervention functions” from the Behaviour Change Wheel to describe the broad categories of strategies, but were finding this limiting as it became difficult to categorize all strategies we encountered into these functions. We were also taking part in a lot of work where we were thinking deeply about why strategies were effective or not effective.
For example, I was part of a team that was responsible for planning a monthly community of practice. There were insufficient intervention functions to describe the purpose of the community of practice (for example, we could say there is an education component, but no intervention functions existed to sufficiently describe the connection component). When we deconstruct how we designed the community of practice, we realized there was no clear way to describe the mechanisms shaping participants’ experiences to achieve the underlying purposes – mechanisms such as creating a sense of belonging, diversifying, and supporting emotional well-being were vital to processes of establishing connection. This led to our new thinking about how to select and describe strategies. Together, purposes and intentions create a more complete pathway from barrier identification to strategy enactment.
What are the “purpose of strategies”?
Purposes of strategies: the linkage between barriers to strategies – the underlying purpose or function that a strategy aims to achieve. We included a broader list of purposes (formerly referred to as “functions”) to encompass more strategy types.
What are the “intentions” of change strategies?
Intentions describe how the strategy will operate in practice, the mechanisms that shape how people experience it and how change is activated. Intentions help you to think more deeply about what the strategy will look like. We truly think this additional level of intention is important because this describes how people engage with a strategy and how it leads to change.
For example, audit and feedback could be designed to simply monitor and provide feedback. Research shows that audit and feedback is a more effective strategy when additional intentions are embedded, making it actionable, such as using the opportunity to educate, remind, reinforce, or normalize behaviours.
StrategEase 2.0: A practical tool for selecting and operationalizing implementation strategies
Our new thinking is reflected in the next version of the StrategEase tool, currently in development. In StrategEase 2.0, we have broadened our list of purposes (previously referred to as functions), expanded the range of strategies to better reflect relational and culturally responsive approaches, and embedded intentions directly within each strategy. By linking strategies to both their purposes and their intentions, the tool is designed to help teams move beyond selection and toward thoughtful, context-sensitive operationalization. Rather than “falling off the cliff” after strategy selection, teams can move forward with clarity about not only what they are doing, but how and why it will create change.
Selecting change strategies is an important step. But real change happens in how those strategies are designed, experienced, and enacted. By pairing clear purposes with intentions, we can move from choosing strategies to operationalizing them in ways that are theoretically grounded and more likely to create meaningful change.
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