A Path Forward: Using Process Models to Apply Implementation Science
By Lauren Tessier, Implementation Support Consultant
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Process models are one of the key elements that make up the architecture of applying implementation science because they specify the steps or stages of putting research into practice. However, what is often overlooked, and subsequently greatly impacts the effectiveness of process models, is that applying implementation science can and should be broken down into two component parts or types of processes: 1) designing for implementation, and 2) implementation, spread, and scale. There are different process models for each of these components. Neglecting the existence of these different components, and their respective process models, can result in use of the wrong process model and a mismatch between what you’re doing vs. what your process model says you should be doing. This is self-defeating and can lead one to question the usefulness of process models and even abandon them. Fear not – we are here to clear up the confusion!
Implementation process models
Process models for designing for implementation outline the steps involved in creating an initiative aimed at putting research evidence into practice. These are useful for researchers who are designing an initiative to test its effectiveness, as well as for implementers who don’t have an off-the-shelf evidence-based program to use, and therefore have to start from the ground up in designing an evidence and theory-informed initiative to implement. Process models for implementation, spread, and scale outline the steps involved in implementing the initiative you’ve designed (or picked up from the literature).
Key process models for designing for implementation include, but are not limited to, Intervention Mapping and Knowledge-to-Action. Intervention Mapping was developed in public health, specifically health promotion, and draws heavily from psychology. It is complex and very structured. Knowledge-to-Action was developed in healthcare based on a systematic review of other theories, models, and frameworks to guide how we put research evidence into practice. It is less structured than Initiative Mapping, but allows for more flexibility to use other theories, modes, and frameworks.
Key process models for implementation, spread, and scale include, but are not limited to, Getting-to-Outcomes, Active Implementation, the Quality Implementation Framework, and the EPIS model. Getting-to-Outcomes is well-known and widely used and works well in community implementation. Active Implementation is also widely known and well-used, particularly in social services and education. The Quality Implementation Framework is based on a systematic review of the literature related to identifying the steps involved in implementing evidence-based programs. It is easy to understand and easy to adapt, making it great for beginners. Finally, the EPIS model was developed in mental health. It is complex and detailed, typically aligning with the needs of researchers looking to implement.
You may look at these process models and think, “those steps are so obvious” or “we already do that” – and both of those are likely true. However, using an existing process model (particularly one developed based on consolidating the literature) may add in one or two small elements that turn out to be instrumental for success. For example, in working with experts in quality improvement to integrate implementation science and quality improvement, one step of the implementation, spread, and scale process models they had not previously completed was assessing readiness. As readiness is instrumental and predictive of implementation success, even just considering this additional stage of implementation planning can change the trajectory of an initiative or project. So even if you first look at the process models and think you are already following them, take a moment to look closely – are there any elements that you could adopt that could enhance your own efforts?
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