Implementation of Implementation Science Knowledge: The Research‐Practice Gap Paradox
Open accessAbstract
A person who wants to find a solution to a public health problem has a different task than someone who wants to create or test a theory. (Eldredge, Markham, Ruiter, Kok, & Parcel, 2016, p. 8) The challenges in improving health care are considerable, as are the efforts made to develop and deliver best practice (Grol, Wensing, Eccles, & Davis, 2013). Different interventions with evidence of effectiveness are continuously made available for potential improvement of health care. However, the difficulties in implementing and using such evidence are well known (Greenhalgh, Robert, Macfarlane, Bate, & Kyriakidou, 2004). The knowledge-practice gap in health care refers to the gap between scientific knowledge and its application in routine healthcare practice. Implementation science has developed in the 2000s in response to this gap, with the ambition to generate knowledge to promote a better uptake of evidence for improvements in the quality and safety of health care. The body of implementation knowledge comprises a rapidly growing amount of empirical studies as well as countless theories, frameworks, and models, contributing to an understanding of factors associated with successful implementation of evidence-based interventions within a variety of settings (Tabak, Khoong, Chambers, & Brownson, 2012). The multitude of empirical implementation studies, as well as theories, models, and frameworks developed in implementation science, reflect a growing evidence-based concerning implementation (Brownson, Colditz, & Proctor, 2018). However, despite the rapid progress of implementation science, the knowledge-practice gap in health care is still substantial, as shown in studies that describe difficulties in achieving desirable change in healthcare practice. Low rates of adoption and limited use of evidence-based interventions are persistent problems. Thus, the challenges of reducing the knowledge-practice gap still remain after more than two decades of research. The aim of this editorial is to address the knowledge-practice gap by means of increasing awareness of a parallel knowledge-practice gap (i.e., the somewhat paradoxical gap between scientific knowledge concerning implementation and actual real-life implementation and use of this knowledge in healthcare practice). This editorial is based on findings and conclusions presented in a doctoral thesis by the first author, which investigated the resemblance between available scientific knowledge on implementation and implementation strategies used in healthcare practice in three large improvement efforts in Sweden (Westerlund, 2018). An overall conclusion of the thesis was that there exists a parallel knowledge-practice gap between scientific knowledge on implementation and the use of this knowledge in implementation efforts in healthcare practice (Westerlund, 2018; Westerlund et al., 2017). The findings showed that implementation knowledge was not transferred to healthcare practice (and practitioners) to a sufficient extent, thus restricting the systematic use of implementation knowledge in practice. Implementation science has a twofold aim: to produce knowledge sufficiently generalizable to contribute to scientific knowledge accumulation and to produce knowledge applicable for improved practice (Fixsen, Blase, & Van Dyke, 2019). The question of use, applicability, and impact of implementation science has been highlighted previously, and the need to make implementation science knowledge more relevant and widely disseminated has been called for in the literature (Armson, Roder, Elmslie, Khan, & Straus, 2018; McIsaac et al., 2018). Implementation knowledge is not taught in healthcare practitioners' basic training and only seldom in continuing professional education. Although the literature on evidence-based implementation is expanding and courses are increasingly being made available, these do not focus on practical issues or guidance on how to actually use implementation science knowledge in implementation endeavors (Nilsen, Neher, Ellström, & Gardner, 2017). Ovretveit, Mittman, Rubenstein, and Ganz (2017) have noted that healthcare practitioners are not expected to be knowledgeable about implementation science. Although implementation science is widely considered an applied science, the extent to which knowledge produced in this field is actually used by practitioners is not known. There are few empirical studies concerning if or how scientific knowledge on implementation is being used in healthcare practice (Armson et al., 2018). As implementation researchers, we need to ask ourselves if our research findings and evidence on implementation have reached the world of practice to a sufficient degree. There are many analytical tools aimed at supporting researchers' use of implementation science in their research endeavors (Simpson et al., 2013). When approaching the implementation knowledge field, phrases such as the following are frequently encountered:"Theories and framewo
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Implementation research often does not represent typical practice.
“but scholars increasingly warn that implementation research often does not represent typical practice [60].”
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Sustainable implementation efforts in physio- and occupational therapy: a scoping review
Fritz, J., Stridsberg, S. L., & Holopainen, R. (2024) · Implementation Science Communications · doi:10.1186/s43058-024-00676-8 · Cited by 5 · see citing works
Zhu, E. M., Buljac‐Samardžić, M., Ahaus, K., & Huijsman, R. (2025) · Health Research Policy and Systems · doi:10.1186/s12961-024-01266-9 · Cited by 5 · see citing works
Pauling, S., Cook, C., Pekel, K., Larson, M. F., & Zhang, Y. (2021) · Leadership and Policy in Schools · doi:10.1080/15700763.2021.1998545 · Cited by 5 · see citing works
Telehealth Readiness Assessment of Perinatal Nurses
Talmont, E., & Vitale, T. R. (2022) · Nursing for Women s Health · doi:10.1016/j.nwh.2022.01.004 · Cited by 5 · see citing works
McCleary, N., Laur, C. V., Presseau, J., Dobell, G., Lam, J. M. C., Gushue, S., Hagel, K., Bevan, L., Salach, L., Desveaux, L., et al. (2023) · Implementation Research and Practice · doi:10.1177/26334895231206569 · Cited by 5 · see citing works
Implementation Science Competencies for Policy Transformation Framework (ISCPT)
Al‐Moteri, M., Aljuaid, J., Alqurashi, H. M., Otayni, M. M., Al-Jaid, M. H., Ahmed, A. M. H., Sufyani, B. O. A., Almalki, S. A., Cagoco, A. D., Bamansur, R. M., et al. (2025) · Healthcare · doi:10.3390/healthcare13070723 · Cited by 5 · see citing works
Engell, T., Varsi, C., Graverholt, B., & Egeland, K. M. (2021) · Global Implementation Research and Applications · doi:10.1007/s43477-021-00027-y · Cited by 5 · see citing works
Butler, J., Asbridge, H., & Stringer, H. (2023) · International Journal of Language & Communication Disorders · doi:10.1111/1460-6984.12880 · Cited by 5 · see citing works
Hawke, L. D., Zhu, N., Relihan, J., Darnay, K., & Henderson, J. L. (2022) · The Canadian Journal of Addiction · doi:10.1097/cxa.0000000000000148 · Cited by 5 · see citing works
Reszel, J., Daub, O., Leese, J., Augustsson, H., Bellows, D. M., Cassidy, C. E., Crowner, B. E., Dunn, S., Goodwin, L. B., Hoens, A. M., et al. (2023) · Implementation Science Communications · doi:10.1186/s43058-023-00525-0 · Cited by 5 · see citing works
Allen, M. J., Carter, H. E., Cyarto, E., Meyer, C., Dwyer, T., Oprescu, F., Aitken, C., Farrington, A., Shield, C., Rowland, J. T. J., et al. (2023) · BMC Geriatrics · doi:10.1186/s12877-023-04491-z · Cited by 5 · see citing works
McConnell, T., Blair, C., Reid, J., & Wong, G. (2025) · BMC Health Services Research · doi:10.1186/s12913-025-12779-6 · Cited by 4 · see citing works
Riley, Y., Stitt, J., Hill, C. M., Stutzman, S. E., Venkatachalam, A. M., Aguilera, V., & Ifejika, N. L. (2021) · Journal of Neuroscience Nursing · doi:10.1097/jnn.0000000000000593 · Cited by 4 · see citing works
Middle-Level Managers: Untapped Champions of Evidence-Based Practice?
Grandbois, K., Penrod, S., McGrath, S., & Douglas, N. (2024) · Perspectives of the ASHA Special Interest Groups · doi:10.1044/2023_persp-23-00099 · Cited by 4 · see citing works
Costea, V.-A., Bäck, A., Bergström, A., Lundin, A., Hasson, H., & Eriksson, L. (2024) · Frontiers in Health Services · doi:10.3389/frhs.2024.1408801 · Cited by 4 · see citing works
Campbell, A., & Cassidy, C. E. (2024) · Journal of Advanced Nursing · doi:10.1111/jan.16651 · Cited by 4 · see citing works
NIH-supported implementation science and nutrition research: a portfolio review of the past decade
Vorkoper, S., Korn, A. R., Maruvada, P., Nicastro, H. L., & Shi, S. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1235164 · Cited by 4 · see citing works
González, S. A., Adlakha, D., Cabas, S., Sánchez-Franco, S., Rubio, M. A., Ossa, N., Martínez, P. A., Montagut, N. E., & Sarmiento, O. L. (2023) · Journal of Aging and Physical Activity · doi:10.1123/japa.2022-0236 · Cited by 6 · see citing works
Implementation Strategies for Quality Improvement in Palliative Care: A Scoping Review
Dai, Y., Daveson, B. A., Gan, L., Ding, J., Chen, Y., & Johnson, C. E. (2024) · Health Expectations · doi:10.1111/hex.14151 · Cited by 4 · see citing works
Pratap, K. N., Dhungana, R., Emily, G., Davis, S. F., Visick, M. K., & Clark Robert, B. (2022) · International Journal of Pediatric Research · doi:10.23937/2469-5769/1510087 · Cited by 4 · see citing works
Stewart-Tufescu, A., Kurbatfinski, S., Ross, K. M., Pohl, C., Graham, I. D., & Letourneau, N. (2025) · Child Protection and Practice · doi:10.1016/j.chipro.2025.100116 · Cited by 3 · see citing works
Mckenzie, E., Barnett, P., Parker, G., & Pilling, S. (2025) · BJPsych Open · doi:10.1192/bjo.2025.10075 · Cited by 3 · see citing works
Implementing research findings into nursing homes: A mixed-methods study
Muller-Schoof, I. J. M., Meekes, W. M. A., Raaijmakers, N., Schellekens, M., Rocdi, Y. A., & Luijkx, K. G. (2025) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2025.105179 · Cited by 3 · see citing works
Loudon, E., Neary, J., McAteer, B., Higgins, K., & Chapman, C. J. (2023) · Children & Society · doi:10.1111/chso.12815 · Cited by 3 · see citing works
Jaffe, S., Meghani, A., Shearer, J., Karlage, A., Ivankovich, M. B., Hirschhorn, L. R., Semrau, K. E. A., & McCarville, E. E. (2024) · Global Health Science and Practice · doi:10.9745/ghsp-d-23-00343 · Cited by 3 · see citing works
Becker, J. E., Shebl, F. M., Losina, E., Wilson, A. C., Levison, J. H., Donelan, K., Fung, V., Trieu, H. D., Panella, C., Qian, Y., et al. (2024) · Implementation Science Communications · doi:10.1186/s43058-024-00593-w · Cited by 3 · see citing works
Martínez, C., Guillem, F. C., Gónzalez-Viana, A., Sánchez, Á., Tigova, O., & Fernández, E. (2024) · Atención Primaria · doi:10.1016/j.aprim.2024.103077 · Cited by 3 · see citing works
McAlpine, L., Ramjohn, C., Faught, E. L., Popeski, N., Keogh, E., & Zimmermann, G. L. (2025) · Implementation Science Communications · doi:10.1186/s43058-025-00715-y · Cited by 3 · see citing works
Vroom, E. B., Massey, O. T., Akbari, Z., Bristol, S. C., Cook, B., Green, A. L., Levin, B. L., Tyson, D. M., & Johnson, M. E. (2021) · Journal of Community Psychology · doi:10.1002/jcop.22749 · Cited by 3 · see citing works
- Authors
- Westerlund, A., Nilsen, P., & Sundberg, L.
- Affiliations
- Umeå University (SE)
- Department of Medical and Health Sciences Division of Community Medicine Linköping University Linköping Sweden
- Corresponding author
- Westerlund, Anna
- Venue
- Worldviews on Evidence-Based Nursing
- Publisher
- Wiley
- Published
- 2019-10
- Volume
- 16
- Issue
- 5
- Pages
- 332-334
- ISSN
- 1545-102X (ISSN-L)
- 1741-6787
- PMC
- PMC6899530
- OpenAlex
- W2979483631
- Cited by
- 225
- References
- 19
- Citations by year
- 2026: 43 · 2025: 44 · 2024: 47 · 2023: 30 · 2022: 36 · 2021: 17 · 2020: 8
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Worldviews on Evidence-Based Nursing (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- KTH Publication Database DiVA (KTH Royal Institute of Technology) (submittedVersion, other-oa)
- DiVA at Umeå University (Umeå University) (submittedVersion, other-oa)
- 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
- knowledge-practice gap, implementation science, evidence-based interventions, implementation strategies, health care practices
- MeSH terms
- Professional Practice Gaps, Implementation Science, Humans, Evidence-Based Practice
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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