Cited by 137Health Policy Implementation ScienceHealth Sciences Research and EducationClinical practice guidelines implementation

A Method for Tracking Implementation Strategies: An Exemplar Implementing Measurement-Based Care in Community Behavioral Health Clinics

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Boyd, Meredith R., Powell, Byron J., Endicott, David, Lewis, Cara C.·2018·Behavior Therapy

Abstract

Implementation experts suggest tailoring strategies to the intended context may enhance outcomes. However, it remains unclear which strategies are best suited to address specific barriers to implementation, in part because few measurement methods exist that adhere to recommendations for reporting. In the context of a dynamic cluster randomized trial comparing a standardized to tailored approach to implementing measurement-based care (MBC), this study aimed to (a) describe a method for tracking implementation strategies, (b) demonstrate the method by tracking strategies generated by teams tasked with implementing MBC at their clinics in the tailored condition, and (c) conduct preliminary examinations of the relation between strategy use and implementation outcomes (i.e., self-reported fidelity to MBC). The method consisted of a coding form based on Proctor, Powell, and McMillen (2013) implementation strategy reporting guidelines and Powell et al.'s (2012) taxonomy to facilitate specification of the strategies. A trained research specialist coded digitally recorded implementation team meetings. The method allowed for the following characterization of strategy use. Each site generated 39 unique strategies across an average of six meetings in five months. There was little variability in the use of types of implementation strategies across sites with the following order of prevalence: quality management (50.00%), restructuring (16.53%), communication (15.68%), education (8.90%), planning (7.20%), and financing (1.69%). We identified a new category of strategies not captured by the existing taxonomy, labeled "communication." There was no evidence that number of implementation strategies enacted was statistically significantly associated with changes in self-reported fidelity to MBC-however, financing strategies were associated with increased fidelity. This method has the capacity to yield rich data that will inform investigations into tailored implementation approaches.

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Crossref · 10.1016/j.beth.2017.11.012

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  • Changes to implementation strategies are likely to occur within and between implementing sites in research studies and applied efforts.

    “These changes are likely to occur within and between implementing sites in research studies and applied efforts (50, 51), and without rigorous methods for tracking implementation strategy use, efforts to understand what strategies were used and whether or not they were effective are stymied.”

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Authors
Boyd, M. R., Powell, B. J., Endicott, D., & Lewis, C. C.
Affiliations
  • Indiana University (US)
  • University of North Carolina at Chapel Hill (US)
  • Kaiser Permanente Washington Health Research Institute (US)
Corresponding author
Boyd, Meredith R.
Venue
Behavior Therapy
Publisher
Elsevier BV
Published
2018-07
Volume
49
Issue
4
Pages
525-537
ISSN
0005-7894 (ISSN-L)
OpenAlex
W2772841284
Cited by
137
References
62
Citations by year
2026: 7 · 2025: 5 · 2024: 14 · 2023: 25 · 2022: 23 · 2021: 20 · 2020: 29 · 2019: 11 · 2018: 3
FWCI
18.98
Type
journal article
Language
en
Open access
Locations
  • Behavior Therapy (acceptedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
  • UNC Libraries
Funders
National Institute of Mental Health of the National Institutes of Health (R01MH103310)
Topics
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
Keywords
measurement-based care, implementation strategies, implementation fidelity, tailored implementation, implementation outcomes, financing strategy, quality management, communication strategies, implementation barriers
MeSH terms
Adult, Community Mental Health Centers, Female, Patient Care, Health Plan Implementation, Humans, Male, Middle Aged, Psychiatry, Cluster Analysis

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