Cited by 1,223Health Policy Implementation ScienceHealth Sciences Research and EducationClinical practice guidelines implementation

Systematic review of the Exploration, Preparation, Implementation, Sustainment (EPIS) framework

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Moullin, Joanna C., Dickson, Kelsey S., Stadnick, Nicole A., Rabin, Borsika, Aarons, Gregory A.·2019·Implementation Science

Abstract

BACKGROUND: Effective implementation of evidence-based practices (EBPs) remains a significant challenge. Numerous existing models and frameworks identify key factors and processes to facilitate implementation. However, there is a need to better understand how individual models and frameworks are applied in research projects, how they can support the implementation process, and how they might advance implementation science. This systematic review examines and describes the research application of a widely used implementation framework, the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. METHODS: A systematic literature review was performed to identify and evaluate the use of the EPIS framework in implementation efforts. Citation searches in PubMed, Scopus, PsycINFO, ERIC, Web of Science, Social Sciences Index, and Google Scholar databases were undertaken. Data extraction included the objective, language, country, setting, sector, EBP, study design, methodology, level(s) of data collection, unit(s) of analysis, use of EPIS (i.e., purpose), implementation factors and processes, EPIS stages, implementation strategy, implementation outcomes, and overall depth of EPIS use (rated on a 1-5 scale). RESULTS: In total, 762 full-text articles were screened by four reviewers, resulting in inclusion of 67 articles, representing 49 unique research projects. All included projects were conducted in public sector settings. The majority of projects (73%) investigated the implementation of a specific EBP. The majority of projects (90%) examined inner context factors, 57% examined outer context factors, 37% examined innovation factors, and 31% bridging factors (i.e., factors that cross or link the outer system and inner organizational context). On average, projects measured EPIS factors across two of the EPIS phases (M = 2.02), with the most frequent phase being Implementation (73%). On average, the overall depth of EPIS inclusion was moderate (2.8 out of 5). CONCLUSION: This systematic review enumerated multiple settings and ways the EPIS framework has been applied in implementation research projects, and summarized promising characteristics and strengths of the framework, illustrated with examples. Recommendations for future use include more precise operationalization of factors, increased depth and breadth of application, development of aligned measures, and broadening of user networks. Additional resources supporting the operationalization of EPIS are available.

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  1. [46]Proceedings from the 10th Annual Conference on the Science of Dissemination and Implementation. In Science of Dissemination and Implementation; 2018; Arlington, VA. Implementation Science; 2017: 728.
  2. [49]Aarons GA Farahnak LR Ehrhart MG Sklar M Aligning leadership across systems and organizations to develop strategic climate to for evidence-based practice implementation Annu Rev Public Health 2014 35 255 274 10.1146/annurev-publhealth-032013-182447 24641560 PMC4348088 · DOI · Paper page
  3. [72]Aarons G: Organizational climate for evidence-based practice implementation: development of a new scale. Proceedings of the Annual Association for Behavioral and Cognitive Therapies: November 2011: Toronto 2011.

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Authors
Moullin, J. C., Dickson, K. S., Stadnick, N. A., Rabin, B., & Aarons, G. A.
Affiliations
  • Curtin University (AU)
  • San Diego State University (US)
  • University of California San Diego (US)
Corresponding author
Aarons, Gregory A.
Venue
Implementation Science
Published
2019-01-05
Volume
14
Issue
1
Pages
1-1
ISSN
1748-5908 (ISSN-L)
OpenAlex
W2907482335
Cited by
1,223
References
84
Citations by year
2026: 184 · 2025: 218 · 2024: 200 · 2023: 208 · 2022: 153 · 2021: 152 · 2020: 74 · 2019: 32
FWCI
18.83
Type
journal article
Language
en
Open access
Locations
  • Implementation Science (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, other-oa)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
  • eScholarship (California Digital Library) (submittedVersion, cc-by)
  • eSpace (Curtin University) (submittedVersion, cc-by)
Funders
  • National Institute on Drug Abuse (R01DA038466, U01DA036233)
  • National Institute of Mental Health (R01MH072961, K23MH110602)
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 research, evidence-based practice implementation, implementation framework, innovation drivers, implementation outcomes, implementation strategies
MeSH terms
Implementation Science, Diffusion of Innovation, Humans, Models, Theoretical, Public Health, Research Design, Evidence-Based Practice

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