Implementation of Implementation Science Knowledge: The Research‐Practice Gap Paradox

Abstract

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