Featured Framework: Implementation Mapping
By Maria E. Fernandez, PhD, Professor, Health Promotion and Behavioral Science, Director, Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston,
Tim J Walker, PhD, Assistant Professor, Health Promotion and Behavioral Science, Director, Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston, and
Aaron Rome, Development Consultant, Rome Specialties, Inc
Aaron Rome is a consultant that assists with translating scientific language into plain language. He has been assisting on the new edition of the Intervention Mapping book and assisted in writing this piece.
People aiming to improve healthcare and public health often find themselves in a challenging position: they have health problems to improve and known evidence-based interventions (EBIs) to address the health problems yet, they have little guidance for how best to adopt, implement and sustain the EBIs in their setting. Many questions arise:
How do we best identify barriers and facilitators to implementation?
How do we go from learning about barriers and facilitators to selecting or developing implementation strategies to address them?
How do we use theory, evidence, and new data to inform decisions about what to do to improve implementation?
These are common questions that come up when practitioners try to make informed decisions on how to improve implementation but the answers are often difficult to come by. Implementation Mapping can help.
What is Implementation Mapping?
Implementation Mapping is a step-by-step process for developing or - selecting and tailoring - strategies to increase adoption, implementation, and sustainment of evidence-based interventions, practices, and policies. Implementation Mapping brings together the principles of Intervention Mapping (a systematic intervention development approach) with the principles of Implementation Science to help bridge the research-to-practice gap. Implementation Mapping is a step-by-step process that can help practitioners design, develop, and tailor implementation strategies to improve the delivery of EBIs. Implementation Mapping guides the use of theory, empirical evidence, and stakeholder input to ensure implementation strategies are scientifically sound, appropriate for the setting, and feasible to use.
Implementation Mapping consists of five tasks (see table). Task 1 helps planners identify who is involved with EBI implementation as well as the potential barriers and facilitators to implementation. Task 2 guides planners by identifying who has to do what in order to implement the EBI, and the reasons why they would do it. Tasks 3 and 4 focus on the how, or the methods and strategies used to influence implementation behaviors and conditions within a setting. Task 5 guides planners through developing an evaluation plan so they can answer the question: is this implementation strategy is working?
Components of Implementation Mapping
Description
Task
Provides planners with a fuller understanding of the context that may affect their implementation strategies/ outcomes
Facilitates consideration of how implementation may be affected by certain determinants (which may be individual- or external/ contextual-based). In this step we state what needs to change and who has to do what for implementation to happen, and why they would do it
In this step we focus on the how to accomplish the change – that is what methods and practical applications of those methods would influence implementation behaviors and outcomes. This step also provides a structure which allows planners to incorporate established theory into their plan, better ensuring validity and providing more confidence in the resulting strategies selected
May include implementation guidelines, educational materials, training design, etc. to improve acceptance by implementers, and efficacy
Provides important feedback to planners allowing them to assess the impact of their implementation strategies; this is an evaluation of the process of implementation rather than measuring potential impact on a population
Conduct a needs and asset assessment and identify adopters and implementers
Identify adoption and implementation outcomes, performance objectives and determinants, and create matrices of change
Choose theoretical methods; select or create implementation strategies
Produce implementation protocols and materials
Plan evaluation of implementation outcome
Countless resources have been invested into developing and testing interventions to improve health outcomes. However, the EBIs developed from this work too often go unused in practice, in part, because of the challenges in implementing them. Implementation Mapping can be used to help planners overcome the very real challenge of translating what - on paper - may be a very effective intervention, to one which can be implemented in a real-world setting.
Additional Resources
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