Refining a taxonomy for guideline implementation: results of an exercise in abstract classification
Open accessAbstract
BACKGROUND: To better understand the efficacy of various implementation strategies, improved methods for describing and classifying the nature of these strategies are urgently required. The aim of this study was to develop and pilot the feasibility of a taxonomy to classify the nature and content of implementation strategies. METHODS: A draft implementation taxonomy was developed based on the Cochrane Effective Practice and Organisation of Care (EPOC) data collection checklist. The draft taxonomy had four domains (professional, financial, organisational and regulatory) covering 49 distinct strategies. We piloted the draft taxonomy by using it to classify the implementation strategies described in the conference abstracts of the implementation stream of the 2010 Guideline International Network Conference. Five authors classified the strategies in each abstract individually. Final categorisation was then carried out in a face-to-face consensus meeting involving three authors. RESULTS: The implementation strategies described in 71 conference abstracts were classified. Approximately 15.5% of abstracts utilised strategies that could not be categorised using the draft taxonomy. Of those strategies that could be categorised, the majority were professionally focused (57%). A total of 41% of projects used only one implementation strategy, with 29% using two and 31% three or more. The three most commonly used strategies were changes in quality assurance, quality improvement and/or performance measurement systems, changes in information and communication technology, and distribution of guideline materials (via hard-copy, audio-visual and/or electronic means). CONCLUSIONS: Further refinement of the draft taxonomy is required to provide hierarchical dimensions and granularity, particularly in the areas of patient-focused interventions, those concerned with audit and feedback and quality improvement, and electronic forms of implementation, including electronic decision support.
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Several resources can inform the use of implementation strategies, including established taxonomies of implementation strategies and behavior change techniques, repositories of systematic reviews, methods for selecting and tailoring implementation strategies, and reporting guidelines that promote replicability.
“Several resources can inform the use of implementation strategies, including established taxonomies of implementation strategies (6, 7, 24, 25) and behavior change techniques (27, 28), repositories of systematic reviews (38, 103, 104), methods for selecting and tailoring implementation strategies (40, 55, 56), and reporting guidelines that promote replicability (4, 98–100).”
From Enhancing the Impact of Implementation Strategies in Healthcare: A Research Agenda (2019) · cites this paper as [25]
Some authors test and refine their taxonomy/model by selecting relevant research studies and categorizing the intervention according to the taxonomy.
“Some authors test and refine their taxonomy/model by selecting relevant research studies and categorizing the intervention according to the taxonomy (e.g., [33]).”
From Towards a common terminology: a simplified framework of interventions to promote and integrate evidence into health practices, systems, and policies (2014) · cites this paper as [33]
Definitions of "implementation strategies" by Powell et al. and Mazza et al. suggest that implementation begins with a predefined program/practice or guideline and have the potential to perpetuate the field's historic focus on a push model of implementation.
“These definitions suggest that implementation begins with a predefined “program or practice” or “guideline” and have the potential to perpetuate the field’s historic focus on a “push” model of implementation that begins with the identification of a specific evidence-based intervention (EBI) that is then “pushed” into practice [10].”
From Beyond “implementation strategies”: classifying the full range of strategies used in implementation science and practice (2017) · cites this paper as [3]
Outcomes used to assess effectiveness of integration strategies are individuals' motivation, capability, and opportunity to implement an EBI; team coordination/communication; and fidelity, feasibility, acceptability.
“Individuals’ motivation, capability, and opportunity to implement an EBITeam coordination/ communicationFidelity, feasibility, acceptability”
From Beyond “implementation strategies”: classifying the full range of strategies used in implementation science and practice (2017) · cites this paper as [3]
Integration strategies target factors that facilitate or impede optimal integration of a specific EBI into a specific setting.
“Factors that facilitate or impede optimal integration of a specific EBI into a specific setting”
From Beyond “implementation strategies”: classifying the full range of strategies used in implementation science and practice (2017) · cites this paper as [3]
Integration strategies target levels of individual and inner setting.
“Targets levels of individual and inner setting”
From Beyond “implementation strategies”: classifying the full range of strategies used in implementation science and practice (2017) · cites this paper as [3]
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References 41 · Cited by 173
Research works printed but not linked: 3
- Cochrane Effective Practice and Organisation of Care Review Group: Data Collection Checklist. Ontario Institute of Population Health 2011 University of Ottawa
- Guidelines International Network Guidelines International Network Conference 2010 Abstract Supplement Operat Tech Otolaryngol Head Neck Surg 2010 143 1S1
- Medical Subject Headings [ http://www.ncbi.nlm.nih.gov/mesh]
- Authors
- Mazza, D., Bairstow, P., Buchan, H., Chakraborty, S. P., Van Hecke, O., Grech, C., & Kunnamo, I.
- Affiliations
- Monash University (AU)
- Royal Perth Hospital (AU)
- Australian Commission on Safety and Quality in Health Care (AU)
- Finnish Medical Society Duodecim (FI)
- Corresponding author
- Mazza, Danielle
- Venue
- Implementation Science
- Published
- 2013-03-15
- Volume
- 8
- Issue
- 1
- Pages
- 32-32
- ISSN
- 1748-5908 (ISSN-L)
- PMC
- PMC3606141
- OpenAlex
- W2134964371
- Cited by
- 173
- References
- 41
- Citations by year
- 2026: 6 · 2025: 5 · 2024: 18 · 2023: 17 · 2022: 23 · 2021: 16 · 2020: 28 · 2019: 11 · 2018: 9 · 2017: 8 · 2016: 6 · 2015: 17 · 2014: 4 · 2013: 5
- FWCI
- 19.22
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Implementation Science (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
- Keywords
- implementation strategies, taxonomy (general classification scheme), guideline implementation, implementation research, professional strategies, organizational strategy, financial strategy, regulatory strategy, quality improvement, audit and feedback, information and communication technologies, electronic decision support
- MeSH terms
- Classification, Feasibility Studies, Pilot Projects, Practice Guidelines as Topic, Evidence-Based Medicine, Guideline Adherence, Checklist
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