What Theory Are You Using to Create Change?
By Dr. Julia E. Moore, Executive Director
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The foundations of applying implementation science involve using theories, models, and frameworks. These are developed in implementation science, but are extremely useful for implementation practice. By using theories, models, and frameworks to guide our implementation activities, we are setting ourselves up for the best chance of success. Process models provide the steps or stages in putting evidence into practice. Theories describe the mechanism of change, how we will create the change we are looking for. Frameworks present factors that affect different aspects of implementation, for example the context or sustainability.
People implementing gravitate towards using process models, as they provide a roadmap for where the implementation project is going. For example, people might use the quality implementation framework, active implementation, or the knowledge to action. Frameworks also have a lot of appeal; people naturally think about barriers and facilitators or aspects of the context, and frameworks give them away to organize their thoughts.
People are most reluctant to use theories, although theories are the most integral component to implementation success. All programs have a theory, whether it is stated or not, because all of the strategies we select are expected to impact change in some way – the theory is how we assume that change is occurring. Not having an explicit theory is a barrier to effective implementation and it’s happening all the time. There’s lots of research to show that people are developing and implementing evidence without using an explicit theory up front (Davies, Walker & Grimshaw, 2010, Davidoff et al., 2015., and Colquhoun et al., 2013).
Theories can be confusing, because they exist at multiple different levels. Imagine you want to change the public, patients, or providers (e.g., doctors, nurses, teachers, social workers). In this situation you would need an individual theory of change. For example the trans-theoretical model or the theory of planned behavior. If you are looking to create organization-level change, then you would need an organization-level theory. For example organizational learning theory or institutional theory. If you want to create system-level change, then you will need a system-level theory of change. A commonly used system theory is Roger’s diffusion of innovation, which describes how the innovations spread.
Depending on the project, you may need an individual, and organizational, and a system-level theory of change. What level are you trying to produce change? Do you have a theory of change to describe how you will create the change you’re looking for? Thinking early on about how change will be created, and using a theory of change up front, can improve how you plan for and action implementation.
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