What is implementation science?
Implementation science creates generalizable knowledge that can be applied across settings and contexts to answer central questions. Why do established programs lose effectiveness over days, weeks, or months? Why do tested programs sometimes exhibit unintended effects when transferred to a new setting? How can multiple interventions be effectively packaged to capture cost efficiencies and to reduce the splintering of health systems into disease-specific programs?
As defined by the Annual NIH Conference on Implementation and Dissemination, implementation is the use of strategies to adopt and integrate evidence-based health interventions and change practice patterns within specific settings. Research on implementation addresses the level to which health interventions can fit within real-world public health and clinical service systems.
At Fogarty, we also want to emphasize the importance of bringing research evidence to policy as well, so we broaden the definition:
Implementation science is the study of methods to promote the integration of research findings and evidence into healthcare policy and practice. It seeks to understand the behavior of healthcare professionals and other stakeholders as a key variable in the sustainable uptake, adoption, and implementation of evidence-based interventions.
As a newly emerging field, the definition of implementation science and the type of research it encompasses may vary according setting and sponsor. However, the intent of implementation science and related research is to investigate and address major bottlenecks (e.g. social, behavioral, economic, management) that impede effective implementation, test new approaches to improve health programming, as well as determine a causal relationship between the intervention and its impact.
What are some examples of implementation science research?
- Comparisons of multiple evidence-based interventions
- Identification of strategies to encourage provision and use of effective health services
- Identification of strategies to promote the integration of evidence into policy and program decisions.
- Appropriate adaptation of interventions according to population and setting
- Identification of approaches to scale-up effective interventions
- Development of innovative approaches to improve healthcare delivery
- Setting up an impact evaluation for a population based intervention
What organizations have supported and/or conducted implementation science?
Within the U.S. government, the NIH, OGAC, USAID, and CDC currently support and/or conduct implementation science. Many of these agencies are expanding their implementation science portfolios in recognition of the need for such research to address barriers to implementation and improved health outcomes.
In the international area, the Global Fund, World Bank, and the World Health Organization have identified the importance of implementation science in identifying and scaling up evidence-based interventions.
Why should we invest in implementation science?
Implementation science recognizes and address the multitude of gaps that impede evidence-based interventions from producing optimal health outcomes. These knowledge and practice gaps include:
- "Research-to-policy" gaps which exist when research evidence is not adequately or appropriately considered and integrated in the development of health outcomes.
- "Research-to-program" gaps which exist when research evidence is not adequately or appropriately considered and integrated in the development of health policy.
For specific health programs, implementation research – including impact evaluation - can be conducted to identify and solve problems in a timely fashion, inform policymakers and implementers to make evidence-based program decisions, and improve program quality and performance using scientific methods
What are the challenges facing the field of implementation science research?
New, developing field
- Existing efforts are comprised of fragmented small-scale studies with little coordination and communication for broader dissemination of results, best practices, and lessons learned.
- There is little consensus on optimal scientific methodology for implementation science research.
Interdisciplinary and Multidisciplinary approach
- Implementation science and effective implementation require interdisciplinary and multidisciplinary collaboration between researchers, implementers, policymakers, civil society, and others. There are few established communication channels and forums for such coordination.
- Even within this field, there is often a gap between the expectations of researchers who generate and report implementation science results and implementers who use them.
Rethinking scientific rigor
- Researchers and funders must recognize the value of research results from less tightly controlled real-world settings for effective implementation of health interventions.
- Scientific rigor must be balanced with a need to conduct research that applies to real world settings. In this context, research rigor should not be confused with the quality of research. Rather, this form of research may not produce results with the same precision than other forms of research.
- We may need to use both qualitative and quantitative methods, perhaps modified from various fields such as economics and business, to evaluate the implementation of health interventions.
What is needed to advance the field of implementation science?
Advancing the field of implementation science will require training and mentoring a new generation of researchers, improving methods to disseminate findings, building partnerships and linkages between researchers, program implementers, and policymakers, and setting a research agenda to identify implementation science priorities.
What are the opportunities for Implementation Science research and training at NIH and Fogarty?
To specifically conduct implementation research, the NIH offers three RFAs related to Dissemination and Implementation Research that could be conducted in LMICs. Fogarty is a co-sponsor of the R03.
At Fogarty, implementation science research and research training can be a component of any of the programs as evidenced by the broad diversity of program representation at the "Implementation Science and Global Health" satellite meeting.
Specifically, the ICOHRTA-NCD and ICOHRTA-AIDS/TB, which focuses on training for clinical, operations, and health services research aligns well with the objectives of implementation science research and training.
Note: This document compiled information from a limited number of sources to help answer commonly asked questions on implementation science that we have heard from our grantees. It is not the result of an exhaustive or comprehensive survey of the literature. In fact, this is a living, modifiable document.
1.Madon T, Hofman KJ, Kupfer L, Glass RI. Public health. Implementation science. Science. 2007 Dec 14;318(5857):1728-9.
2. Framework for Operations and Implementation Research in Health and Disease Control Programs. http://apps.who.int/tdr/svc/publications/training-guideline-publications/framework-operation-research .
3. Report from the Expert Consultation on Implementation Science Research. A Requirement for Effective HIV/AIDS Prevention and Treatment Scale-up. Capetown, South Africa. July23-24, 2009.
Updated May 2013