Affiliation:
1. Division of Infectious Diseases, Department of Medicine; and Center for Dissemination and Implementation, Institute for Public Health; Washington University in St. Louis, St. Louis, Missouri, USA;
2. Center for Mental Health Services Research, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
Abstract
In many cases, implementation approaches (composed of one or more strategies) may need to change over time to work optimally. We use a literature review to inform a mechanistic analysis of such on-the-go adaptations. We suggest that such adaptations of implementation strategies consist of three necessary steps. The first component is the initial effect of the implementation approach on intended implementation, service delivery, or clinical outcomes. Second, these initial effects must in turn be used to modify, alter, intensify, or otherwise change the implementation approach. Third, the modified approach itself has effects. Conceiving of adaptation as all three steps implies that a full understanding of adaptation involves ( a) a sense of initial effects, ( b) conceptualizing and documenting content and rationale for changes in approach (e.g., alteration, intensification), and ( c) the effects of the changed approach (including how the latter effects depend on initial effects). Conceptualizing these steps can help researchers ask questions about adaptation (e.g., thresholds for change, dosing, potentiation, sequencing) to advance our understanding of implementation strategies.
Subject
Public Health, Environmental and Occupational Health,General Medicine
Cited by
3 articles.
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