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Cited by 544Health Policy Implementation ScienceHealth Sciences Research and EducationClinical practice guidelines implementation

Beyond “implementation strategies”: classifying the full range of strategies used in implementation science and practice

Open access
Leeman, Jennifer, Birken, Sarah A., Powell, Byron J., Rohweder, Catherine, Shea, Christopher M.·2017·Implementation Science
DOI 10.1186/s13012-017-0657-xPMC PMC5670723
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Abstract

BACKGROUND: Strategies are central to the National Institutes of Health's definition of implementation research as "the study of strategies to integrate evidence-based interventions into specific settings." Multiple scholars have proposed lists of the strategies used in implementation research and practice, which they increasingly are classifying under the single term "implementation strategies." We contend that classifying all strategies under a single term leads to confusion, impedes synthesis across studies, and limits advancement of the full range of strategies of importance to implementation. To address this concern, we offer a system for classifying implementation strategies that builds on Proctor and colleagues' (2013) reporting guidelines, which recommend that authors not only name and define their implementation strategies but also specify who enacted the strategy (i.e., the actor) and the level and determinants that were targeted (i.e., the action targets). MAIN BODY: We build on Wandersman and colleagues' Interactive Systems Framework to distinguish strategies based on whether they are enacted by actors functioning as part of a Delivery, Support, or Synthesis and Translation System. We build on Damschroder and colleague's Consolidated Framework for Implementation Research to distinguish the levels that strategies target (intervention, inner setting, outer setting, individual, and process). We then draw on numerous resources to identify determinants, which are conceptualized as modifiable factors that prevent or enable the adoption and implementation of evidence-based interventions. Identifying actors and targets resulted in five conceptually distinct classes of implementation strategies: dissemination, implementation process, integration, capacity-building, and scale-up. In our descriptions of each class, we identify the level of the Interactive System Framework at which the strategy is enacted (actors), level and determinants targeted (action targets), and outcomes used to assess strategy effectiveness. We illustrate how each class would apply to efforts to improve colorectal cancer screening rates in Federally Qualified Health Centers. CONCLUSIONS: Structuring strategies into classes will aid reporting of implementation research findings, alignment of strategies with relevant theories, synthesis of findings across studies, and identification of potential gaps in current strategy listings. Organizing strategies into classes also will assist users in locating the strategies that best match their needs.

AI snapshot

Written from the paper’s full text.

TL;DR

The paper argues that classifying all strategies under the single term “implementation strategies” creates confusion and impedes synthesis, and proposes instead a classification system based on who enacts a strategy (actor) and what it targets (action targets). Identifying actors and action targets yielded five conceptually distinct classes: dissemination, implementation process, integration, capacity-building, and scale-up.

Key findings

  • Identifying actors and action targets resulted in five conceptually distinct classes of implementation strategies: dissemination, implementation process, integration, capacity-building, and scale-up.
  • Dissemination strategies can be enacted by all three Interactive Systems Framework (ISF) systems and target awareness, attitude, knowledge, and intention to adopt a specific evidence-based intervention (EBI); implementation process strategies are delivery-system enacted and target the process level; integration strategies are delivery-system enacted and target individual and inner-setting determinants for a specific EBI; capacity-building strategies are support-system enacted and target motivation and capability to execute implementation process strategies; scale-up strategies are support-system enacted and target individual, inner-setting, and outer-setting determinants to implement a specific EBI across multiple settings.
  • The paper builds on Proctor et al.’s (2013) reporting guidelines, Wandersman and colleagues’ ISF, and Damschroder and colleague’s Consolidated Framework for Implementation Research (CFIR); it notes that Lokker et al. identified 23 models, frameworks, and taxonomies for classifying strategies.
  • It illustrates each class with strategies to improve colorectal cancer screening rates in Federally Qualified Health Centers.

Methods

  • Conceptual/classification paper; no empirical data, sample, or statistical analysis are reported.
  • The classification was developed by drawing on Proctor et al.’s reporting guidelines, the ISF’s Delivery, Support, and Synthesis and Translation Systems, CFIR levels (intervention, inner setting, outer setting, individual, and process), and numerous resources identifying determinants.
  • The authors describe each class by actor, action targets (levels and determinants), outcomes used to assess effectiveness, and example strategy lists, then apply the classes to colorectal cancer screening in Federally Qualified Health Centers.

Limitations

  • The paper states no formal limitations section; it proposes next steps including mapping the framework to existing taxonomies, conducting a literature review and/or Delphi approach to generate strategy lists for underrepresented classes, exploring whether additional classes are needed (e.g., for de-escalation or sustainment), and refining outcome taxonomies for each class.
  • Evident from the text: the proposed classification is conceptual and has not been empirically validated; no data are presented on its reliability, validity, or utility.
  • Evident from the text: the colorectal cancer screening example is illustrative only, and the framework has not yet been mapped to existing taxonomies or tested in practice.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/s13012-017-0657-x

Cites

47 of 47 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 68 cited sources checked · 0 supported · 0 flagged

  • Findingreasoning

    Identifying actors and action targets resulted in five conceptually distinct classes of implementation strategies: dissemination, implementation process, integration, capacity-building, and scale-up.

    “Identifying actors and targets resulted in five conceptually distinct classes of implementation strategies: dissemination, implementation process, integration, capacity-building, and scale-up.”
    • Also stated in: § Classifying implementation strategies · plain
      “As further described below, identifying actors and action targets resulted in five conceptually distinct classes of strategies: dissemination, implementation process, integration, capacity-building, and scale-up (See Fig. 1 and Table 1).”
    Quote in the paperSubstantial claim
  • Interpretationreasoning

    Use of the single term "implementation strategy" increases the risk that some strategies essential to implementation science will be overlooked.

    “The use of the single term “implementation strategy” also increases the risk that some of the strategies essential to implementation science will be overlooked.”
    Quote in the paperNot a substantial claim
  • Premisecitation

    Distinctions between strategies used to support implementation and strategies used to integrate screening EBIs into practice are important when selecting and reporting strategies because the evidence base and underlying theory differ for these two types.

    “We contend that these distinctions are important when selecting and reporting strategies for use in research and practice because the evidence base and, to a large extent, the underlying theory, differ for strategies used to support implementation (e.g., [6, 7]) as compared to strategies used to integrate screening EBIs into practice (e.g., [8, 9]).”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [6] Leeman J, Calancie L, Hartman M, Escoffery C, Hermann A, Tague L, et al. What strategies are used to build practitioners’ capacity to implement community-based interventions and are they effective?: a systematic review. Implement Sci. 2015;10:80. source

      Not checked in the free run.

    • cites [7] Leeman J, Calancie L, Kegler M, Escoffery C, Hermman A, Thatcher E, Hartman M, Fernandez M. Developing theory to guide the design of strategies to build practitioners’ capacity to adopt and implement evidence-based interventions. Health Educ Behav. 2017;44:59–69. source

      Not checked in the free run.

    • cites [8] Baron RC, Melillo S, Rimer BK, Coates RJ, Kerner J, Habarta N, et al. Intervention to increase recommendation and delivery of screening for breast, cervical, and colorectal cancers by healthcare providers a systematic review of provider reminders. Am J Prev Med. 38(1):110–7. S0749-3797(09)00635-7 source

      Not checked in the free run.

    • cites [9] Steinmo S, Fuller C, Stone SP, Michie S. Characterising an implementation intervention in terms of behaviour change techniques and theory: the ‘Sepsis Six’ clinical care bundle. Implement Sci. 2015;10:111. source

      Not checked in the free run.

  • Premisecitation

    Efforts to synthesize findings across studies continue to be challenging despite work to name and define strategies.

    “Despite the valuable work that has been done to name and define strategies, efforts to synthesize findings across studies continue to be challenging [4].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [4] Lokker C, McKibbon KA, Colquhoun H, Hempel S. A scoping review of classification schemes of interventions to promote and integrate evidence into practice in healthcare. Implement Sci. 2015;10(1):220. source

      Not checked in the free run.

  • Premisecitation

    Capacity-building strategies target motivation and capability to engage in implementation process strategies (in general, not related to a specific EBI).

    “Motivation and capability to engage in implementation process strategies(in general, not related to a specific EBI)”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [6] Leeman J, Calancie L, Hartman M, Escoffery C, Hermann A, Tague L, et al. What strategies are used to build practitioners’ capacity to implement community-based interventions and are they effective?: a systematic review. Implement Sci. 2015;10:80. source

      Not checked in the free run.

    • cites [39] Jacobs JA, Duggan K, Erwin P, Smith C, Borawski E, Compton J, et al. Capacity building for evidence-based decision making in local health departments: scaling up an effective training approach. Implement Sci. 2014;9(1):124. source

      Not checked in the free run.

    • cites [49] Wandersman A, Chien VH, Katz J. Toward an evidence-based system for innovation support for implementing innovations with quality: tools, training, technical assistance, and quality assurance/quality improvement. Am J Community Psychol. 2012;50:445–59. source

      Not checked in the free run.

  • Classified as probably not a substantial claim. 29
  • May combine two claims. 13

  • Classified as probably not a substantial claim.

    Findingreasoning

    The broad use of the term "implementation strategy" creates confusion for the authors' team because it does not distinguish what practice facilitators are doing to support implementation from what primary care staffs are doing to integrate EBIs into routine practice.

    “The broad use of the term “implementation strategy” creates confusion for our team because it does not distinguish what the practice facilitators are doing to support implementation from what primary care staffs are doing to integrate EBIs into routine practice.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Classifying all strategies under a single term may constrain efforts to synthesize findings across tests of strategy effectiveness and limit advancement of the full range of strategies of importance to implementation science and practice.

    “We contend that classifying all strategies under a single term leads to confusion, impedes synthesis across studies, and limits advancement of the full range of strategies of importance to implementation.”
    • Also stated in: § Background · hedged
      “We contend that classifying all strategies under a single term may constrain efforts to synthesize findings across tests of strategy effectiveness and limit advancement of the full range of strategies of importance to implementation science and practice.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Synthesis of findings across studies is essential to building the evidence base for what, how, and when implementation strategies work to improve which implementation outcomes.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationcitation

    Using a more consistent approach to operationalizing strategies has potential to foreground the full range of strategies used in implementation science.

    “Using a more consistent approach to operationalizing strategies also has potential to foreground the full range of strategies used in implementation science.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Proctor et al. recommended that authors not only name and define their implementation strategies but also describe how they operationalized the strategy, specifying who enacted the strategy (actor), the level and determinants targeted (action targets), and the intended implementation outcomes.

    “Proctor et al. [5] recommended that authors not only name and define their implementation strategies but also describe how they operationalized the strategy in their study. Specifically, they recommended specifying who enacted the strategy (i.e., the actor), the level and determinants that were targeted (action targets), and the intended implementation outcomes.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [5] Proctor EK, Powell BJ, McMillen JC. Implementation strategies: recommendations for specifying and reporting. Implement Sci. 2013;8:139. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationreasoning

    The creation, promotion, and distribution of EBI menus require dissemination strategies.

    “The creation, promotion, and distribution of these EBI menus require dissemination strategies—yet another set of strategies of importance to implementation.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Structuring strategies into classes will aid reporting of implementation research findings.

    “Structuring strategies into classes will aid reporting of implementation research findings, alignment of strategies with relevant theories, synthesis of findings across studies, and identification of potential gaps in current strategy listings.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Synthesis of findings across studies is essential to building the evidence base for what, how, and when implementation strategies work to improve which implementation outcomes.

  • Classified as probably not a substantial claim.

    Premisecitation

    Many scholars have called for more research that applies a "pull" model, with the goal of building practice-level capacity to select, adapt, and implement EBIs needed to address locally identified needs.

    “Many scholars have called for more research that applies a “pull” model, with the goal of building practice-level capacity to select, adapt, and implement the EBIs they need to address locally identified needs [10, 11].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [10] Wilson MG, Lavis JN, Travers R, Rourke SB. Community-based knowledge transfer and exchange: helping community-based organizations link research to action. Implement Sci. 2010;5:33. source

      Not checked in the free run.

    • cites [11] Flaspohler P, Duffy J, Wandersman A, Stillman L, Maras MA. Unpacking prevention capacity: an intersection of research-to-practice models and community-centered models. Am J Community Psychol. 2008;41(3–4):182–96. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Names and definitions of implementation strategies do not adequately differentiate who enacted the strategies or for what purpose, resulting in findings that are not readily comparable or amenable to synthesis.

    “Names and definitions do not adequately differentiate who enacted the strategies or for what purpose, resulting in findings that are not “readily comparable” or amendable to the synthesis needed to build the evidence base for their use [5].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [5] Proctor EK, Powell BJ, McMillen JC. Implementation strategies: recommendations for specifying and reporting. Implement Sci. 2013;8:139. source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    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].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [2] Powell BJ, Waltz TJ, Chinman MJ, Damschroder LJ, Smith JL, Matthieu MM, et al. A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project Implement Sci. 2015;10:21. source

      Not checked in the free run.

    • cites [3] Mazza D, Bairstow P, Buchan H, Chakraborty SP, Van Hecke O, Grech C, et al. Refining a taxonomy for guideline implementation: results of an exercise in abstract classification. Implement Sci. 2013; 8:32. source

      Not checked in the free run.

    • cites [10] Wilson MG, Lavis JN, Travers R, Rourke SB. Community-based knowledge transfer and exchange: helping community-based organizations link research to action. Implement Sci. 2010;5:33. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    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”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [48] Fixsen DL, Blase KA, Naoom SF, Wallace F. Core implementation components. Res Soc Work Pract. 2009;19:531–40. source

      Not checked in the free run.

    • cites [3] Mazza D, Bairstow P, Buchan H, Chakraborty SP, Van Hecke O, Grech C, et al. Refining a taxonomy for guideline implementation: results of an exercise in abstract classification. Implement Sci. 2013; 8:32. source

      Not checked in the free run.

    • cites [2] Powell BJ, Waltz TJ, Chinman MJ, Damschroder LJ, Smith JL, Matthieu MM, et al. A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project Implement Sci. 2015;10:21. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Implementation process strategies may begin prior to the selection of an EBI and typically are EBI-agnostic.

    “Implementation process strategies may begin prior to the selection of an EBI and typically are EBI-agnostic.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationcitation

    The proposed classification system adds greater conceptual clarity to definitions of implementation strategies by classifying strategies according to who enacts them (actor) and the levels and determinants they target (action targets).

    “Building on Proctor et al.’s [5] reporting guidelines, the proposed classification system adds greater conceptual clarity to these definitions by classifying strategies according to who enacts them (actor) and the levels and determinants they target (action targets).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [5] Proctor EK, Powell BJ, McMillen JC. Implementation strategies: recommendations for specifying and reporting. Implement Sci. 2013;8:139. source

      Not checked in the free run.

    • Rests on an assumption: Existing taxonomies provide both names and definitions for their lists of implementation strategies.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Structuring strategies into classes will aid identification of potential gaps in current strategy listings.

    “Structuring strategies into classes will aid reporting of implementation research findings, alignment of strategies with relevant theories, synthesis of findings across studies, and identification of potential gaps in current strategy listings.”
    • Also stated in: § Background · plain
      “Structuring strategies into classes will aid in aligning strategies with relevant theories (i.e., those that pertain to related determinants), synthesizing findings across studies, and identifying potential gaps in current strategy listings.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Synthesis of findings across studies is essential to building the evidence base for what, how, and when implementation strategies work to improve which implementation outcomes.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Capacity-building strategies include training, technical assistance, tools, and opportunities for peer networking.

    “Capacity-building strategies include training, technical assistance, tools, and opportunities for peer networking, among others [6].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] Leeman J, Calancie L, Hartman M, Escoffery C, Hermann A, Tague L, et al. What strategies are used to build practitioners’ capacity to implement community-based interventions and are they effective?: a systematic review. Implement Sci. 2015;10:80. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Implementation process strategies target how well teams execute activities required to select, adapt, and integrate EBIs generally.

    “How well teams execute activities required to select, adapt, and integrate EBIs generally”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [30] Aarons GA, Hurlburt M, Horwitz SM. Advancing a conceptual model of evidence-based practice implementation in public service sectors. Admin Pol Ment Health. 2011;38(1):4–23. source

      Not checked in the free run.

    • cites [32] Chinman M, Early D, Ebener P, Hunter S, Imm P, Jenkins P, et al. Getting to outcomes: a community-based participatory approach to preventive interventions. J Interprof Care. 2004;18(4):441–3. source

      Not checked in the free run.

    • cites [33] Meyers DC, Durlak JA, Wandersman A. The quality implementation framework: a synthesis of critical steps in the implementation process. Am J Community Psychol. 2012;50(3–4):462–80. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    The classifications will assist systematic reviewers in aggregating findings across implementation strategies by providing an additional scheme for identifying studies with comparable findings.

    “Finally, the classifications will assist systematic reviewers in aggregating findings across implementation strategies by providing an additional scheme for identifying studies with comparable findings.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    Organizing strategies into classes will assist users in locating the strategies that best match their needs.

    “Organizing strategies into classes also will assist users in locating the strategies that best match their needs.”
    • Also stated in: § Background · plain
      “Organizing strategies into classes also will assist users in locating the strategies that best match their needs.”
    • Also stated in: § Conclusions · plain
      “Organizing strategies into classes also will assist users in locating the strategies that best match their needs.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The classification is applicable to implementation strategies related to policy EBIs and environmental EBIs.

    “Although our illustration applied the classification to a clinical EBIs, we easily could have illustrated their applicability to implementation strategies related to policy EBIs (e.g., to regulate tobacco marketing) or to environmental EBIs (e.g., to increase access to healthy foods and beverages).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationcitation

    Implementation researchers could advance understanding of the mechanisms through which implementation strategies influence EBI adoption, implementation, scale-up, and sustainment by facilitating the alignment of strategies to theories that explain how they work.

    “They also could advance understanding of the mechanisms through which implementation strategies influence EBI adoption, implementation, scale-up, and sustainment by facilitating the alignment of strategies to theories that explain how they work [46].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [46] Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ. 2008;337:a1655. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

    Interpretationnone given

    Structuring strategies into classes has potential to add and facilitate clearer reporting of implementation research findings, alignment of strategies with relevant theories, synthesis of findings across studies, and identification of potential gaps in current strategy listings.

    “Structuring strategies into classes has potential to add and facilitate clearer reporting of implementation research findings, alignment of strategies with relevant theories, synthesis of findings across studies, and identification of potential gaps in current strategy listings.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationnone given

    Scale-up strategies are enacted by support system actors with the goal of getting multiple settings to implement a specific EBI.

    “Scale-up strategies are enacted by support system actors with the goal of getting multiple settings to implement a specific EBI.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Numerous authors have proposed planning stages and recommended processes required to complete those stages such as assessing context, engaging stakeholders, prioritizing goals, selecting and adapting an EBI, evaluating, and sustaining integration.

    “Numerous authors have proposed planning stages and recommended the processes required to complete those stages such as assessing the context, engaging key stakeholders, prioritizing goals and objectives, selecting and adapting an EBI to fit the context, evaluating processes and outcomes, and sustaining EBI integration over time [31–33].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [31] Graham I, Logan J, Harrison M, Straus S, Tetroe J, Caswell W, et al. Lost in knowledge translation: time for a map? J Contin Educ Heal Prof. 2006;26:13–24. source

      Not checked in the free run.

    • cites [32] Chinman M, Early D, Ebener P, Hunter S, Imm P, Jenkins P, et al. Getting to outcomes: a community-based participatory approach to preventive interventions. J Interprof Care. 2004;18(4):441–3. source

      Not checked in the free run.

    • cites [33] Meyers DC, Durlak JA, Wandersman A. The quality implementation framework: a synthesis of critical steps in the implementation process. Am J Community Psychol. 2012;50(3–4):462–80. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    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”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [48] Fixsen DL, Blase KA, Naoom SF, Wallace F. Core implementation components. Res Soc Work Pract. 2009;19:531–40. source

      Not checked in the free run.

    • cites [3] Mazza D, Bairstow P, Buchan H, Chakraborty SP, Van Hecke O, Grech C, et al. Refining a taxonomy for guideline implementation: results of an exercise in abstract classification. Implement Sci. 2013; 8:32. source

      Not checked in the free run.

    • cites [2] Powell BJ, Waltz TJ, Chinman MJ, Damschroder LJ, Smith JL, Matthieu MM, et al. A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project Implement Sci. 2015;10:21. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationnone given

    Outcomes of scale-up strategies focus on individual or setting-level changes such as increased motivation or capacity to implement or actual implementation of a specific EBI across multiple settings.

    “The outcomes of scale-up strategies focus on individual or setting-level changes such as increased motivation or capacity to implement or actual implementation of a specific EBI across multiple settings.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    At the outer setting level, scale-up strategies may target public policy; human and material resources; and cross-setting learning, collaboration, and competition.

    “At the level of the outer setting, scale-up strategies may target public policy; human and material resources; and cross-setting learning, collaboration, and competition [41].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [41] Rabin BA, Brownson R. In:Developing the terminology for dissemination and implementation research. Brownson R, Colditz G, Proctor E, editors. Dissemination and implementation research in health. New York, New York: Oxford University Press; 2012. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    The distinctions of the classification system will aid communication among those engaged in implementation science and practice, who will be able to identify their need for or use of implementation strategies as aligning with one or more of the five classes.

    “These distinctions will aid communication among those engaged in both implementation science and practice, who will now be able to identify their need for or use of implementation strategies as aligning with one (or more) of the five classes.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Implementation process strategies target level of process.

    “Targets level of process”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [30] Aarons GA, Hurlburt M, Horwitz SM. Advancing a conceptual model of evidence-based practice implementation in public service sectors. Admin Pol Ment Health. 2011;38(1):4–23. source

      Not checked in the free run.

    • cites [32] Chinman M, Early D, Ebener P, Hunter S, Imm P, Jenkins P, et al. Getting to outcomes: a community-based participatory approach to preventive interventions. J Interprof Care. 2004;18(4):441–3. source

      Not checked in the free run.

    • cites [33] Meyers DC, Durlak JA, Wandersman A. The quality implementation framework: a synthesis of critical steps in the implementation process. Am J Community Psychol. 2012;50(3–4):462–80. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Outcomes of capacity-building strategies focus on individual and collective self-efficacy and motivation to execute implementation process strategies and on actual completion (extent, quality, timeliness) of those implementation process strategies.

    “The outcomes of capacity building strategies focus on individual and collective self-efficacy and motivation to execute implementation process strategies and on their actual completion (extent, quality, timeliness) of those implementation process strategies [6, 35, 36].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [6] Leeman J, Calancie L, Hartman M, Escoffery C, Hermann A, Tague L, et al. What strategies are used to build practitioners’ capacity to implement community-based interventions and are they effective?: a systematic review. Implement Sci. 2015;10:80. source

      Not checked in the free run.

    • cites [35] Chinman M, Hunter SB, Ebener P, Paddock SM, Stillman L, Imm P, et al. The getting to outcomes demonstration and evaluation: an illustration of the prevention support system. Am J Community Psychol. 2008;41(3–4):206–24. source

      Not checked in the free run.

    • cites [36] Chamberlain P, Brown CH, Saldana L. Observational measure of implementation progress in community based settings: the stages of implementation completion (SIC). Implement Sci. 2011;6:116. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Examples of scale-up strategies include train-the-trainer initiatives, infrastructure development (supply chains, data systems), quality improvement collaboratives, benchmarking, policy advocacy, and recognition systems.

    “Examples of scale-up strategies include train-the-trainer initiatives, infrastructure development (supply chains, data systems), quality improvement collaboratives, benchmarking, policy advocacy, and recognition systems [42, 43].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [42] Milat AJ, Bauman A, Redman S. Narrative review of models and success factors for scaling up public health interventions. Implement Sci. 2015;10:113. source

      Not checked in the free run.

    • cites [43] Barker PM, Reid A, Schall MW. A framework for scaling up health interventions: lessons from large-scale improvement initiatives in Africa. Implement Sci. 2016;11:12. source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationnone given

    Capacity-building strategies are delivered by support systems and target individuals' general capacity (motivation, self-efficacy) to execute implementation process strategies.

    “Capacity-building strategies are delivered by support systems and target individuals’ general capacity (motivation, self-efficacy) to execute implementation process strategies (described above).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Diffusion of Innovations Theory identifies interpersonal connections as particularly important to promoting the spread of new innovations.

    “Diffusion of Innovations Theory identifies interpersonal connections as particularly important to promoting the spread of new innovations [28].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] Rogers EM. Diffusion of innovations. New York: Free Press; 2003.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Placing strategies into five broad classes will assist those seeking implementation strategies, whether for research or practice.

    “Placing strategies into five broad classes will also assist those who are seeking implementation strategies, whether for research or practice.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Structuring strategies into classes will aid alignment of strategies with relevant theories.

    “Structuring strategies into classes will aid reporting of implementation research findings, alignment of strategies with relevant theories, synthesis of findings across studies, and identification of potential gaps in current strategy listings.”
    • Also stated in: § Background · plain
      “Structuring strategies into classes will aid in aligning strategies with relevant theories (i.e., those that pertain to related determinants), synthesizing findings across studies, and identifying potential gaps in current strategy listings.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Synthesis of findings across studies is essential to building the evidence base for what, how, and when implementation strategies work to improve which implementation outcomes.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Structuring strategies into classes will aid synthesis of findings across studies.

    “Structuring strategies into classes will aid reporting of implementation research findings, alignment of strategies with relevant theories, synthesis of findings across studies, and identification of potential gaps in current strategy listings.”
    • Also stated in: § Background · plain
      “Structuring strategies into classes will aid in aligning strategies with relevant theories (i.e., those that pertain to related determinants), synthesizing findings across studies, and identifying potential gaps in current strategy listings.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Synthesis of findings across studies is essential to building the evidence base for what, how, and when implementation strategies work to improve which implementation outcomes.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    Dissemination strategies are the primary strategies that synthesis and translation systems use but also are used by actors in both support and delivery systems.

    “Dissemination strategies are the primary strategies that synthesis and translation systems use but also are used by actors in both support and delivery systems.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    By identifying targeted determinants and measuring strategies' effects on those determinants, implementation researchers can begin to disentangle the contributions of discrete strategies when multiple strategies are used in combination.

    “By identifying the targeted determinants and measuring strategies’ effects on those determinants, implementation researchers can begin to disentangle the contributions of discrete strategies when multiple strategies are used in combination.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Outcomes used to assess effectiveness of scale-up strategies are motivation and capacity to implement, and actual implementation of an EBI across multiple settings.

    “Motivation and capacity to implement, and actual implementation of an EBI across multiple settings”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [43] Barker PM, Reid A, Schall MW. A framework for scaling up health interventions: lessons from large-scale improvement initiatives in Africa. Implement Sci. 2016;11:12. source

      Not checked in the free run.

    • cites [42] Milat AJ, Bauman A, Redman S. Narrative review of models and success factors for scaling up public health interventions. Implement Sci. 2015;10:113. source

      Not checked in the free run.

37 of 37

  • The paper relies on this without support.

    Synthesis of findings across studies is essential to building the evidence base for what, how, and when implementation strategies work to improve which implementation outcomes.

    “The ability to synthesize findings across studies is essential to building the evidence base for what, how, and when implementation strategies work to improve which implementation outcomes.”

  • The paper relies on this without support.

    Existing taxonomies provide both names and definitions for their lists of implementation strategies.

    “Existing taxonomies provide both names and definitions for their lists of implementation strategies.”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Powell and Mazza references are misnumbered in the conclusions

    Minor

    The conclusions cite Powell as [3] and Mazza as [4], whereas the paper earlier identifies them as [2] and [3], respectively.

  • Milat reference has conflicting publication years

    Minor

    Table 2 dates the cited Milat paper to 2016, but reference [42] lists it as published in 2015.

  • Table 2 cites the wrong source for actor categories

    Minor

    The table attributes its actor categories to [10], while the text says they come from the Interactive Systems Framework [12].

3 of 3

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Related

Authors
Leeman, J., Birken, S. A., Powell, B. J., Rohweder, C., & Shea, C. M.
Affiliations
University of North Carolina at Chapel Hill (US)
Corresponding author
Leeman, Jennifer
ORCID
Venue
Implementation Science
Publisher
Springer Science and Business Media LLC
Published
2017-11-03
Volume
12
Issue
1
Pages
125-125
ISSN
1748-5908 (ISSN-L)
DOI
10.1186/s13012-017-0657-x
PMC
PMC5670723
OpenAlex
W2766863832
Semantic Scholar
220f2224ce3cbec6aaec4db41cab3b84d7faea03
Cited by
544
References
47
Citations by year
2026: 38 · 2025: 49 · 2024: 82 · 2023: 90 · 2022: 90 · 2021: 52 · 2020: 92 · 2019: 35 · 2018: 14 · 2017: 1
FWCI
62.32
Type
journal article
Language
en
Open access
Licence
Locations
  • Implementation Science (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • UNC Libraries
Funders
  • National Institutes of Health (UL 1TR001111)
  • Centers for Disease Control and Prevention (U48 DP005017-SIP)
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
implementation strategies, Consolidated Framework for Implementation Research, Interactive Systems Framework, dissemination, implementation process, integration, capacity building, scale-up, implementation factors, colorectal cancer screening, federally qualified health centers, reporting guidelines
MeSH terms
Health Plan Implementation, Health Services Research, Humans

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.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-06.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-06.

Statistics and arithmetic are recomputed, not judged.

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