Specifying and comparing implementation strategies across seven large implementation interventions: a practical application of theory
Open accessAbstract
BACKGROUND: The use of implementation strategies is an active and purposive approach to translate research findings into routine clinical care. The Expert Recommendations for Implementing Change (ERIC) identified and defined discrete implementation strategies, and Proctor and colleagues have made recommendations for specifying operationalization of each strategy. We use empirical data to test how the ERIC taxonomy applies to a large dissemination and implementation initiative aimed at taking cardiac prevention to scale in primary care practice. METHODS: EvidenceNOW is an Agency for Healthcare Research and Quality initiative that funded seven cooperatives across seven regions in the USA. Cooperatives implemented multi-component interventions to improve heart health and build quality improvement capacity, and used a range of implementation strategies to foster practice change. We used ERIC to identify cooperatives' implementation strategies and specified the actor, action, target, dose, temporality, justification, and expected outcome for each. We mapped and compiled a matrix of the specified ERIC strategies across the cooperatives, and used consensus to resolve mapping differences. We then grouped implementation strategies by outcomes and justifications, which led to insights regarding the use of and linkages between ERIC strategies in real-world scale-up efforts. RESULTS: Thirty-three ERIC strategies were used by cooperatives. We identified a range of revisions to the ERIC taxonomy to improve the practical application of these strategies. These proposed changes include revisions to four strategy names and 12 definitions. We suggest adding three new strategies because they encapsulate distinct actions that were not described in the existing ERIC taxonomy. In addition, we organized ERIC implementation strategies into four functional groupings based on the way we observed them being applied in practice. These groupings show how ERIC strategies are, out of necessity, interconnected, to achieve the work involved in rapidly taking evidence to scale. CONCLUSIONS: Findings of our work suggest revisions to the ERIC implementation strategies to reflect their utilization in real-work dissemination and implementation efforts. The functional groupings of the ERIC implementation strategies that emerged from on-the-ground implementers will help guide others in choosing among and linking multiple implementation strategies when planning small- and large-scale implementation efforts. TRIAL REGISTRATION: Registered as Observational Study at www.clinicaltrials.gov ( NCT02560428 ).
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The ERIC taxonomy has been widely adopted and further refined.
“The ERIC taxonomy has been widely adopted and further refined [6–13].”
From A systematic review of experimentally tested implementation strategies across health and human service settings: evidence from 2010-2022 (2024) · cites this paper as [6]
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Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009) · Implementation Science · doi:10.1186/1748-5908-4-50 · Cited by 14,496 · see citing works
Self-citationAudit and feedback: effects on professional practice and healthcare outcomes
Ivers, N., Jamtvedt, G., Flottorp, S., Young, J. M., Odgaard-Jensen, J., French, S. D., O'Brien, M. A., Johansen, M., Grimshaw, J., & Oxman, A. D. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd000259.pub3 · Cited by 5,485 · see citing works
Powell, B. J., Waltz, T. J., Chinman, M. J., Damschroder, L. J., Smith, J. L., Matthieu, M. M., Proctor, E. K., & Kirchner, J. E. (2015) · Implementation Science · doi:10.1186/s13012-015-0209-1 · Cited by 4,963 · see citing works
Self-citationMaking sense of implementation theories, models and frameworks
Nilsen, P. (2015) · Implementation Science · doi:10.1186/s13012-015-0242-0 · Cited by 4,447 · see citing works
McLeod, J. (1999) · SAGE Publications Ltd eBooks · doi:10.4135/9781849209588.n8 · Cited by 3,964 · see citing works
Implementation strategies: recommendations for specifying and reporting
Proctor, E. K., Powell, B. J., & McMillen, J. C. (2013) · Implementation Science · doi:10.1186/1748-5908-8-139 · Cited by 2,585 · see citing works
Development of a theory of implementation and integration: Normalization Process Theory
May, C. R., Mair, F., Finch, T., MacFarlane, A., Dowrick, C., Treweek, S., Rapley, T., Ballini, L., Ong, B. N., Rogers, A., et al. (2009) · Implementation Science · doi:10.1186/1748-5908-4-29 · Cited by 1,409 · see citing works
Bridging Research and Practice
Tabak, R. G., Khoong, E. C., Chambers, D. A., & Brownson, R. C. (2012) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2012.05.024 · Cited by 1,386 · see citing works
Harvey, G., & Kitson, A. (2015) · Implementation Science · doi:10.1186/s13012-016-0398-2 · Cited by 1,271 · see citing works
Waltz, T. J., Powell, B. J., Matthieu, M. M., Damschroder, L. J., Chinman, M. J., Smith, J. L., Proctor, E. K., & Kirchner, J. E. (2015) · Implementation Science · doi:10.1186/s13012-015-0295-0 · Cited by 1,108 · see citing works
Self-citationA compilation of strategies for implementing clinical innovations in health and mental health
Powell, B. J., McMillen, J. C., Proctor, E. K., Carpenter, C. R., Griffey, R. T., Bunger, A. C., Glass, J. E., & York, J. L. (2012) · Medical Care Research and Review · doi:10.1177/1077558711430690 · Cited by 1,069 · see citing works
Getting evidence into practice: the role and function of facilitation
Harvey, G., Loftus‐Hills, A., Rycroft‐Malone, J., Titchen, A., Kitson, A., McCormack, B., & Seers, K. (2002) · Journal of Advanced Nursing · doi:10.1046/j.1365-2648.2002.02126.x · Cited by 730 · see citing works
Demystifying theory and its use in improvement
Davidoff, F., Dixon-Woods, M., Leviton, L., & Michie, S. (2015) · BMJ Quality & Safety · doi:10.1136/bmjqs-2014-003627 · Cited by 714 · see citing works
Leeman, J., Birken, S. A., Powell, B. J., Rohweder, C., & Shea, C. M. (2017) · Implementation Science · doi:10.1186/s13012-017-0657-x · Cited by 544 · see citing works
Practice Feedback Interventions: 15 Suggestions for Optimizing Effectiveness
Brehaut, J., Colquhoun, H. L., Eva, K. W., Carroll, K. A., Sales, A. E., Michie, S., Ivers, N. M., & Grimshaw, J. (2016) · Annals of Internal Medicine · doi:10.7326/m15-2248 · Cited by 489 · see citing works
Ivers, N. M., Sales, A., Colquhoun, H., Michie, S., Foy, R., Francis, J. J., & Grimshaw, J. M. (2014) · Implementation Science · doi:10.1186/1748-5908-9-14 · Cited by 400 · see citing works
Ivers, N. M., Grimshaw, J., Jamtvedt, G., Flottorp, S. A., O’Brien, M. A., French, S. D., Young, J. M., & Odgaard‐Jensen, J. (2014) · Journal of General Internal Medicine · doi:10.1007/s11606-014-2913-y · Cited by 378 · see citing works
Why (we think) facilitation works: insights from organizational learning theory
Berta, W., Cranley, L., Dearing, J. W., Dogherty, E. J., Squires, J. E., & Estabrooks, C. A. (2015) · Implementation Science · doi:10.1186/s13012-015-0323-0 · Cited by 286 · see citing works
Dogherty, E. J., Harrison, M. B., & Graham, I. D. (2010) · Worldviews on Evidence-Based Nursing · doi:10.1111/j.1741-6787.2010.00186.x · Cited by 215 · see citing works
Tracking implementation strategies: a description of a practical approach and early findings
Bunger, A. C., Powell, B. J., Robertson, H. A., MacDowell, H., Birken, S. A., & Shea, C. (2017) · Health Research Policy and Systems · doi:10.1186/s12961-017-0175-y · Cited by 208 · see citing works
Taylor, E. F., Machta, R. M., Meyers, D. S., Genevro, J., & Peikes, D. (2013) · The Annals of Family Medicine · doi:10.1370/afm.1462 · Cited by 155 · see citing works
Foy, R., Ovretveit, J., Shekelle, P. G., Pronovost, P. J., Taylor, S. L., Dy, S., Hempel, S., McDonald, K. M., Rubenstein, L. V., & Wachter, R. M. (2011) · BMJ Quality & Safety · doi:10.1136/bmjqs.2010.047993 · Cited by 148 · see citing works
Practice facilitators: a review of the literature.
Nagykaldi, Z. J., Mold, J. W., & ASPY, C. B. (2005) · PubMed · Cited by 143 · see citing works
Boyd, M. R., Powell, B. J., Endicott, D., & Lewis, C. C. (2018) · Behavior Therapy · doi:10.1016/j.beth.2017.11.012 · Cited by 137 · see citing works
Huynh, A. K., Hamilton, A. B., Farmer, M. M., Bean‐Mayberry, B., Stirman, S. W., Moin, T., & Finley, E. P. (2018) · Frontiers in Public Health · doi:10.3389/fpubh.2018.00134 · Cited by 100 · see citing works
Rogal, S. S., Yakovchenko, V., Waltz, T. J., Powell, B. J., Kirchner, J. E., Proctor, E. K., Gonzalez, R., Park, A., Ross, D., Morgan, T. R., et al. (2017) · Implementation Science · doi:10.1186/s13012-017-0588-6 · Cited by 98 · see citing works
Lessard, S., Bareil, C., Lalonde, L., Duhamel, F., Hudon, É., Goudreau, J., & Lévesque, L. (2015) · Implementation Science · doi:10.1186/s13012-016-0458-7 · Cited by 93 · see citing works
Facilitating improvement in primary care: the promise of practice coaching.
Grumbach, K., Bainbridge, E. D., & Bodenheimer, T. S. (2012) · PubMed · Cited by 66 · see citing works
Cohen, D. J., Balasubramanian, B. A., Gordon, L., Marino, M., Ono, S. S., Solberg, L. I., Crabtree, B. F., Stange, K. C., Davis, M. M., Miller, W. L., et al. (2015) · Implementation Science · doi:10.1186/s13012-016-0449-8 · Cited by 57 · see citing works
Self-citationOnline Diaries for Qualitative Evaluation
Cohen, D. J., Leviton, L. C., Isaacson, N. F., Tallia, A. F., & Crabtree, B. F. (2006) · American Journal of Evaluation · doi:10.1177/1098214006288448 · Cited by 54 · see citing works
Self-citationGold, R. B., Bunce, A., Cohen, D. J., Hollombe, C., Nelson, C. A., Proctor, E. K., Pope, J., & DeVoe, J. E. (2016) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2016.03.014 · Cited by 36 · see citing works
Self-citationTaking Innovation To Scale In Primary Care Practices: The Functions Of Health Care Extension
Ono, S. S., Crabtree, B. F., Hemler, J. R., Balasubramanian, B. A., Edwards, S. T., Green, L. A., Kaufman, A., Solberg, L. I., Miller, W. L., Woodson, T. T., et al. (2018) · Health Affairs · doi:10.1377/hlthaff.2017.1100 · Cited by 33 · see citing works
Self-citation
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Cited by
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Varsi, C., Solberg Nes, L., Kristjansdottir, O. B., Kelders, S. M., Stenberg, U., Zangi, H. A., Børøsund, E., Weiss, K. E., Stubhaug, A., Asbjørnsen, R. A., et al. (2019) · Journal of Medical Internet Research · doi:10.2196/14255 · Cited by 148 · see citing works
Cooper, J., Murphy, J., Woods, C., Van Nassau, F., McGrath, A., Callaghan, D., Carroll, P., Kelly, P., Murphy, N., Murphy, M., et al. (2021) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-021-01177-w · Cited by 114 · see citing works
Ashcraft, L. E., Goodrich, D. E., Hero, J., Phares, A., Bachrach, R. L., Quinn, D. A., Qureshi, N., Ernecoff, N. C., Lederer, L. G., Scheunemann, L. P., et al. (2024) · Implementation Science · doi:10.1186/s13012-024-01369-5 · Cited by 89 · see citing works
Kilbourne, A. M., Geng, E., Eshun-Wilson, I., Sweeney, S., Shelley, D., Cohen, D. J., Kirchner, J. E., Fernandez, M. E., & Parchman, M. L. (2023) · Implementation Science Communications · doi:10.1186/s43058-023-00435-1 · Cited by 75 · see citing works
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Hooley, C., Amano, T., Markovitz, L., Yaeger, L., & Proctor, E. (2020) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-019-00965-8 · Cited by 42 · see citing works
Lovero, K. L., Kemp, C. G., Wagenaar, B. H., Giusto, A., Greene, M. C., Powell, B. J., & Proctor, E. K. (2023) · Implementation Science · doi:10.1186/s13012-023-01310-2 · Cited by 52 · see citing works
Yakovchenko, V., Chinman, M. J., Lamorte, C., Powell, B. J., Waltz, T. J., Merante, M., Gibson, S., Neely, B., Morgan, T. R., & Rogal, S. S. (2023) · Implementation Science Communications · doi:10.1186/s43058-023-00409-3 · Cited by 38 · see citing works
A Taxonomy for External Support for Practice Transformation
Solberg, L. I., Kuzel, A., Parchman, M. L., Shelley, D. R., Dickinson, W. P., Walunas, T. L., Nguyen, A. M., Fagnan, L. J., Cykert, S., Cohen, D. J., et al. (2021) · The Journal of the American Board of Family Medicine · doi:10.3122/jabfm.2021.01.200225 · Cited by 18 · see citing works
Self-citation
- Authors
- Perry, C. K., Damschroder, L. J., Hemler, J. R., Woodson, T. T., Ono, S. S., & Cohen, D. J.
- Affiliations
- Oregon Health & Science University (US)
- VA Center for Clinical Management Research (US)
- Rutgers, The State University of New Jersey (US)
- Corresponding author
- Perry, Cynthia K.
- ORCID
- Venue
- Implementation Science
- Published
- 2019-03-21
- Volume
- 14
- Issue
- 1
- Pages
- 32-32
- ISSN
- 1748-5908 (ISSN-L)
- PMC
- PMC6429753
- OpenAlex
- W2924329130
- Cited by
- 288
- References
- 32
- Citations by year
- 2026: 23 · 2025: 29 · 2024: 64 · 2023: 51 · 2022: 55 · 2021: 44 · 2020: 14 · 2019: 6 · 2016: 2
- FWCI
- 40.56
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Implementation Science (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Agency for Healthcare Research and Quality (1R01HS023940-01)
- 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, Expert Recommendations for Implementing Change, primary care, scale-up, multicomponent intervention, taxonomic revision, evidence translation
- MeSH terms
- Diffusion of Innovation, Health Personnel, Health Plan Implementation, Heart Diseases, Humans, Health Knowledge, Attitudes, Practice, Medical Informatics, Primary Health Care, United States, Capacity Building
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