Cited by 87Health Policy Implementation ScienceEvaluation and Performance AssessmentHealth Sciences Research and Education

The relative value of Pre-Implementation stages for successful implementation of evidence-informed programs

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Alley, Zoe M., Chapman, Jason E., Schaper, Holle, Saldana, Lisa·2023·Implementation Science

Abstract

Background: Most implementations fail before the corresponding services are ever delivered. Measuring implementation process fidelity may reveal when and why these attempts fail. This knowledge is necessary to support the achievement of positive implementation milestones, such as delivering services to clients (program start-up) and competency in treatment delivery. The present study evaluates the extent to which implementation process fidelity at different implementation stages predicts achievement of those milestones. Methods: Implementation process fidelity data—as measured by the Stages of Implementation Completion (SIC)—from 1287 implementing sites across 27 evidence-informed programs were examined in mixed effects regression models with sites nested within programs. Implementation process fidelity, as measured by the proportion of implementation activities completed during the three stages of the SIC Pre-Implementation phase and overall Pre-Implementation (Phase 1) and Implementation (Phase 2) proportion scores, was assessed as a predictor of sites achieving program start-up (i.e., delivering services) and competency in program delivery. Results: The predicted probability of start-up across all sites was low at 35% (95% CI [33%, 38%]). When considering the evidence-informed program being implemented, that probability was nearly twice as high (64%; 95% CI [42%, 82%]), and 57% of the total variance in program start-up was attributable to the program. Implementation process fidelity was positively and significantly associated with achievement of program start-up and competency. The magnitude of this relationship varied significantly across programs for Pre-Implementation Stage 1 (i.e., Engagement) only. Compared to other stages, completing more Pre-Implementation Stage 3 (Readiness Planning) activities resulted in the most rapid gains in probability of achieving program start-up. The predicted probability of achieving competency was very low unless sites had high scores in both Pre-Implementation and Implementation phases. Conclusions: Strong implementation process fidelity—as measured by SIC Pre-Implementation and Implementation phase proportion scores—was associated with sites’ achievement of program start-up and competency in program delivery, with early implementation process fidelity being especially potent. These findings highlight the importance of a rigorous Pre-Implementation process.

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  1. [11]Goodrich DE, Miake-Lye I, Braganza MZ, Wawrin N, Kilbourne AM. The QUERI Roadmap for Implementation and Quality Improvement. Washington (DC): Department of Veterans Affairs (US); 2020. Available from: https://www.ncbi.nlm.nih.gov/books/NBK566221. 33400452

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Authors
Alley, Z. M., Chapman, J. E., Schaper, H., & Saldana, L.
Affiliations
Oregon Social Learning Center (US)
Corresponding author
Saldana, Lisa
Venue
Implementation Science
Published
2023-07-21
Volume
18
Issue
1
Pages
30-30
ISSN
1748-5908 (ISSN-L)
OpenAlex
W4385063898
Cited by
86
References
34
Citations by year
2026: 32 · 2025: 30 · 2024: 20 · 2023: 4
FWCI
30.81
Type
journal article
Language
en
Open access
Locations
  • Implementation Science (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
National Institute on Drug Abuse (R01DA044745-05)
Topics
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Social Sciences › Decision Sciences › Management Science and Operations Research › Evaluation and Performance Assessment
  • Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
Keywords
pre-implementation phase, implementation failure, engagement
MeSH terms
Knowledge, Evidence-Based Practice

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