Cited by 56Health Policy Implementation ScienceClinical practice guidelines implementationHealth Sciences Research and Education

Application of the Expert Recommendations for Implementing Change (ERIC) compilation of strategies to health intervention implementation in low- and middle-income countries: a systematic review

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Lovero, Kathryn L., Kemp, Christopher G., Wagenaar, Bradley H., Giusto, Ali, Greene, M. Claire, Powell, Byron J., Proctor, Enola K.·2023·Implementation Science

Abstract

Background: The Expert Recommendations for Implementing Change (ERIC) project developed a compilation of implementation strategies that are intended to standardize reporting and evaluation. Little is known about the application of ERIC in low- and middle-income countries (LMICs). We systematically reviewed the literature on the use and specification of ERIC strategies for health intervention implementation in LMICs to identify gaps and inform future research. Methods: We searched peer-reviewed articles published through March 2023 in any language that (1) were conducted in an LMIC and (2) cited seminal ERIC articles or (3) mentioned ERIC in the title or abstract. Two co-authors independently screened all titles, abstracts, and full-text articles, then abstracted study, intervention, and implementation strategy characteristics of included studies. Results: The final sample included 60 studies describing research from all world regions, with over 30% published in the final year of our review period. Most studies took place in healthcare settings ( n = 52, 86.7%), while 11 (18.2%) took place in community settings and four (6.7%) at the policy level. Across studies, 548 distinct implementation strategies were identified with a median of six strategies (range 1–46 strategies) included in each study. Most studies ( n = 32, 53.3%) explicitly matched implementation strategies used for the ERIC compilation. Among those that did, 64 (87.3%) of the 73 ERIC strategies were represented. Many of the strategies not cited included those that target systems- or policy-level barriers. Nearly 85% of strategies included some component of strategy specification, though most only included specification of their action (75.2%), actor (57.3%), and action target (60.8%). A minority of studies employed randomized trials or high-quality quasi-experimental designs; only one study evaluated implementation strategy effectiveness. Conclusions: While ERIC use in LMICs is rapidly growing, its application has not been consistent nor commonly used to test strategy effectiveness. Research in LMICs must better specify strategies and evaluate their impact on outcomes. Moreover, strategies that are tested need to be better specified, so they may be compared across contexts. Finally, strategies targeting policy-, systems-, and community-level determinants should be further explored. Trial registration: PROSPERO, CRD42021268374.

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  • Much of the evidence for individual or groups of ERIC strategies remains narrowly focused, with prior systematic reviews and meta-analyses generally focusing on a specific strategy, subpopulation, disease, outcome, service setting, or geography.

    “However, much of the evidence for individual or groups of ERIC strategies remains narrowly focused. Prior systematic reviews and meta-analyses have assessed strategy effectiveness, but have generally focused on a specific strategy, (e.g., Audit and Provide Feedback) [14–16], subpopulation, disease (e.g., individuals living with dementia) [16], outcome [15], service setting (e.g., primary care Clin”

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  1. [42]Covidence systematic review software, Veritas Health Innovation, Melbourne, Australia. Available at www.covidence.org.
  2. [48]Merrill M. First principles of Instruction in CM Reigeluth & Carr (Eds.) Instructional design Theories and Models: Building a Common knowledge Base (Vol. III). New York: Routledge Publishers; 2009.

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Authors
Lovero, K. L., Kemp, C. G., Wagenaar, B. H., Giusto, A., Greene, M. C., Powell, B. J., & Proctor, E. K.
Affiliations
  • Columbia University Irving Medical Center (US)
  • Johns Hopkins University (US)
  • University of Washington (US)
  • Columbia University (US)
  • Washington University in St. Louis (US)
Corresponding author
Lovero, Kathryn L.
Venue
Implementation Science
Published
2023-10-30
Volume
18
Issue
1
Pages
56-56
ISSN
1748-5908 (ISSN-L)
OpenAlex
W4388021132
Cited by
52
References
57
Citations by year
2026: 21 · 2025: 14 · 2024: 16 · 2023: 1
FWCI
2.65
Type
journal article
Language
en
Open access
Locations
  • Implementation Science (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Digital Commons@Becker (Washington University School of Medicine) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • National Institute of Mental Health (K01MH120258, K23 MH128742, K01MH129572, R25MH080916, P50MH126219, R01MH124914)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD103902)
  • National Cancer Institute (P50CA19006, R01CA262325)
  • Agency for Healthcare Research and Quality (R13HS025632)
  • National Institute on Drug Abuse (R01DA047876, P50DA054072)
  • National Heart, Lung, and Blood Institute (U24HL154426, R01HL157255)
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
Expert Recommendations for Implementing Change, implementation strategies, low- and middle-income countries, healthcare settings
MeSH terms
Developing Countries, Health Plan Implementation, Humans

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