Byron Powell, Gillings School of Global Public Health
Widespread concerns about the quality of health and social services has led to the prioritization of implementation science, and the identification, development, and testing of implementation strategies. Over 70 discrete implementation strategies (e.g., audit and feedback, supervision) have been identified, and interventions comprised of multiple discrete strategies have been developed and tested. There is increasing consensus that multiple discrete implementation strategies may be needed to effectively address implementation determinants (i.e., barriers/facilitators) across multiple levels and phases of implementation. Ideally, the selection and tailoring of strategies would be guided by theory, evidence, and input from relevant stakeholders. However, we currently lack rigorous methods to guide that process, which limits our ability to effectively implement EBPs. For example, a study of implementation as usual in children’s mental health organizations’ found that strategies were not often guided by theory and evidence, applied with sufficient frequency and intensity, or targeted to key determinants. A review of 20 studies found that investigators explicitly attempting to tailor strategies often failed to effectively match them to determinants. While supporting the effectiveness of tailored strategies, a recent review noted methodological limitations and prioritized the development and testing of rigorous methods to guide selection and tailoring. Failing to develop these methods may lead to continued implementation failures that ultimately prolong the suffering of those who would benefit from effective interventions. The purpose of this talk is to highlight the need for tailored approaches to implementation and share ongoing work to advance the methods of selecting and tailoring implementation strategies.