Project Spotlight: Better Together: Integrating Taxonomies to Describe Implementation Strategies
By Sheena McHugh, Senior Lecturer and HRB Research Leader, School of Public Health, University College Cork, Ireland
Justin Presseau, Associate Professor at the School of Epidemiology & Public Health, University of Ottawa and Scientist with the Clinical Epidemiology Program, Ottawa Hospital Research Institute,
Courtney Luecking, Assistant Extension Profession and Extension Specialist in Food and Nutrition, Department of Dietetics and Human Nutrition, College of Agriculture, Food and Environment, University of Kentucky, and
Byron J. Powell, Assistant Professor, Center for Mental Health Services Research, Brown School and School of Medicine, Washington University in St. Louis.
Over time people become attached to particular implementation frameworks, terms, and approaches. This could result in silos and missed opportunities to learn across implementation efforts. We are a group of researchers from Ireland, the United States, and Canada examining the potential to combine two taxonomies used for describing and classifying implementation strategies in implementation science – the Expert Recommendations for Implementing Change (ERIC) compilation [1] and Behaviour Change Technique Taxonomy [2].
More information is needed on implementation strategies to apply them in practice
When people want to identify, apply, and describe implementation strategies to enhance implementation of their practice or program, using an agreed-upon list of strategies can help to ensure consistency and evidence cumulation. The ERIC compilation of implementation strategies was developed in part to serve those purposes. It includes labels and definitions for 73 different strategies that operate at the team, organisation, and/or system level [1]. However, there is a need to clarify which particular techniques, actions, and processes are part of an ERIC-defined strategy to apply it in practice [3]. Without this information, one is left to make assumptions about what constitutes a given implementation strategy, which may lead to inconsistent application.
Potential of integrating taxonomies to operationalise strategies
One potential solution when designing the content of an implementation strategy is to draw on another taxonomy to describe the specific activities. The Behaviour Change Technique (BCT) Taxonomy defines 93 techniques that have the potential to change the behaviour of people at multiple levels [2]. Since BCTs are considered to be the replicable and irreducible parts of an intervention, this taxonomy has the potential to inform the content of implementation strategies and limit inconsistent application. There is intuitive appeal to combine these two approaches that describe the ‘how to’ of implementation but at seemingly different levels. Each have emerged from different disciplines and groups within implementation science and there is an opportunity to explore their complementarity.
We examined the type and extent of overlap between the ERIC compilation and the BCT Taxonomy and whether the ERIC strategies could be further specified using BCTs. We coded the definitions and descriptions of the 73 ERIC strategies using the 93 techniques in the BCT Taxonomy and categorised the type of overlap between the two taxonomies. We distinguished between instances where a BCT(s) was clearly indicated in the ERIC strategy description, and instances where a BCT(s) was probable, meaning that BCT was logical as part of the ERIC strategy but was not clearly described, and other BCTs were possible depending on how the strategy was operationalised.
We identified a couple of examples of direct overlap between ERIC strategies and BCTs. However, most ERIC strategy descriptions included a blend of clearly indicated BCTs and others that were probable. We also identified examples where the implementation strategy was more specific in the level and format of change than the corresponding BCT(s). The links from strategies to BCTs could indicate the mechanisms by which strategies effect change [4]. We are currently finalising our results and describing other patterns of overlap between ERIC strategies and BCTs.
Our work is the first step towards moving from general descriptions of implementation strategies to full and consistent descriptions of their active ingredients, leveraging the important advances in intervention descriptions made over the last decade.
This work is funded initially by the Fulbright-Health Research Board (HRB) Health Impact Award. Dr McHugh is now funded by the Irish HRB Research Leader Award.
References
[1] Powell BJ, Waltz TJ, Chinman MJ, et al. A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project. Implement Sci 2015 101 2015;10:1–14. doi:10.1186/S13012-015-0209-1
[2] Michie S, Richardson M, Johnston M, et al. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med 2013;46:81–95. doi:10.1007/s12160-013-9486-6
[3] Proctor EK, Powell BJ, McMillen JC. Implementation strategies: recommendations for specifying and reporting. Implement Sci 2013 81 2013;8:1–11. doi:10.1186/1748-5908-8-139
[4] Lewis CC, Klasnja P, Powell BJ, et al. From Classification to Causality: Advancing Understanding of Mechanisms of Change in Implementation Science. Front Public Heal 2018;6:136. doi:10.3389/fpubh.2018.00136
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