How to Link Barriers to Implementation Strategies: Implementation Strategy Functions
By Dr. Julia E. Moore, Executive Director
6-min read
Why linking barriers and facilitators to implementation strategies is difficult
Choosing strategies that directly address underlying barriers and facilitators can be very challenging for teams, even when they have identified them and mapped them to existing frameworks. Once teams identify barriers and facilitators to implementation using frameworks such as the Theoretical Domains Framework (TDF), the Consolidated Framework for Implementation Research (CFIR), or the Context Compass Framework (CCF), they want to select a change strategy that directly addresses those barriers and facilitators. In our work supporting implementation across healthcare, education, and social systems, we often talk about this step as “falling off the cliff”. This is where implementation science meets the art of implementation.
Note that while the term "implementation strategies" is widely used in academic literature, it doesn't always resonate with people doing the day-to-day work of change. For several years, here at TCI, we have referred to them as "change strategies", which we use here interchangeably with "implementation strategies".
So many people have shared that the StrategEase 1.0: Foundational tool was so helpful in making this process seem less daunting. There are other tools that help with this linkage, but they are mostly designed for researchers, and so those who are doing implementation, support, or practice are confined to them, disconnected from the more practical questions and approaches that they are trying to use. One of the big missing steps is clarifying exactly what the strategy is trying to accomplish.
To help people make sense of this process, we use change strategy functions.
What are implementation strategy functions?
Strategy functions describe the intended function or purpose that a change strategy can serve. Functions clarify what a strategy is meant to accomplish – this ideally links to the underlying mechanisms by which the HOWs create change. This forms the connection between barriers and facilitators to change strategies.
Why TCI expanded beyond Behaviour Change Wheel “functions”
In our original StrategEase 1.0: Foundational tool, our work was based on the Behavior Change Wheel, which used the concept of intervention functions, but we found the original list of functions limiting. It was very focused on individual functions, from a top-down, somewhat paternalistic and colonial world-view. We wanted to expand the functions beyond that original list to include functions that capture change across relationships, teams, organizations, settings, and systems. We wanted equity embedded, a greater focus on the relational aspects of implementation, and to include more organization and system-level factors. By creating an expanded list of functions, we believe that this can better embody the full spectrum of implementation strategies that we have seen in practice.
How are functions different from mechanisms?
A common question we have received is how functions are similar or different from mechanisms. “Implementation mechanisms are defined as processes or events through which implementation strategies operate to affect one or more implementation outcomes; or how and why strategies work.” (Vejnoska et al., 2022). Functions describe the intended purpose or function that a strategy is designed to serve. So the functions describe the purpose we hope a strategy will serve, and the mechanism describes how the strategy actually produces change.
Sometimes there might be overlap across functions and mechanisms, which can be confusing to many people, but this speaks to the complexity of understanding how some types of strategies produce change. For example, relationship building can be seen as a process, a change strategy function, a mechanism, and in some cases, an outcome. This is why developing logic models or theories of change can be helpful in your implementation work to help you think about how a strategy works.
There are also linkages between functions and the clusters of ERIC strategies.
How functions connect barriers/facilitators and implementation strategies
Using this expanded list of functions, people can connect barriers and facilitators to change strategies by asking, “What needs to happen to address this barrier?” This can lead people to identify the underlying function they want the strategy to serve.
Our StrategEase 2.0: Advanced tool guides people through this process for individual and contextual barriers and facilitators.
First, you want to understand the barriers and facilitators to change. This is understanding what is preventing or enabling a change from happening, at the individual, setting, or system level. We map these to a framework like the CCF, TDF, or CFIR.
Next, people can identify the underlying function that they want a strategy to accomplish. This is the intended function or purpose they want that strategy to serve.
Based on the function, people can select change strategies that serve that purpose.
Once a strategy is selected, or to help select one, people may consider the intentions they want a strategy to serve. Intentions describe how the strategy will operate in practice; these are similar to the mechanisms. These intentions shape how people experience it and how the changes are activated. Intentions help you think more deeply about what the strategy will look like.
The 14 functions of strategies
Pulling from the literature on functions, mechanisms, and clusters of implementation strategies, we have identified 14 functions.
| Function | Definition |
|---|---|
| Build knowledge and skills | To increase understanding, competence, and confidence. |
| Communicate and disseminate | To share information clearly and strategically so the right messages reach the right audiences at the right time. |
| Develop a competent workforce and staffing | To ensure the right people, with the right mix of skills and roles, are available to do the work. |
| Enhance engagement | To increase interest, involvement, and perceived relevance of the initiative. |
| Foster relationship building | To build strong working relationships. |
| Improve or restructure environment or organization | To modify processes, workflows, or physical/environmental structures. |
| Network | To intentionally create, expand, or strengthen connections among people or organizations. |
| Provide implementation support and develop infrastructure | To provide implementation supports, processes, and structures to enhance implementation and sustainability. |
| Provide supervision and support | To offer ongoing guidance, feedback, accountability, and emotional support. |
| Secure and allocate financial resources | To obtain, distribute, and manage funding and other resources. |
| Strengthen data and information systems | To generate, access, and use data to guide decision-making, learning, and improvement. |
| Strengthen leadership and organizational commitment | To increase visible leadership support and commitment to the initiative. |
| Support collective decision-making and address power dynamics | To enable shared decision-making, clarify roles, and intentionally surface and address power imbalances. |
| Support motivation and intentional action | To motivate and inspire people, or to use approaches to support initial and sustained behavior change. |
How functions help teams select more appropriate implementation strategies
Because the process of moving from barriers and facilitators to strategies can feel challenging, it’s important to give people concrete ways to connect these pieces. There’s also such an extensive list of change strategies that it can be overwhelming to look at. But there are only 14 functions of strategies (right now), and not all of them are relevant to all categories of barriers or facilitators. Therefore, we have identified the relevant functions for different types of barriers and facilitators using the Theoretical Domains Framework (TDF) and the Context Compass Framework (CCF). So once people have mapped their barriers and facilitators to the TDF or CCF, there’s a smaller list of functions to choose from. From there, people can select strategies that serve that function, making the process feel at least a little less daunting (though we should note that selecting strategies will never be easy).
The bottom line
There’s still a lot of work to be done in the implementation science field to build evidence that links barriers and facilitators to specific strategies. We see functions as one important way to form and test these linkages – we might find hundreds of unique strategies that can facilitate change, but these hundreds of strategies may tap into only a relatively small number of functions. Therefore, functions may be the answer to not only making strategy selection more manageable, but also making strategies more testable.
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