Implementation science: Relevance in the real world without sacrificing rigor
Open accessAbstract
The need for implementation science in health is now broadly recognized, and a working understanding of the qualities that make an implementation study "good" is needed more than ever before.As defined by Mittman and Eccles, implementation research "is the scientific study of methods to promote the systematic uptake of research findings and other evidencebased practices into routine practice, and, hence, to improve the quality and effectiveness of health services.It includes the study of influences on healthcare professional and organizational behavior" [1].The scope of implementation science is broad, ranging from observational studies seeking to characterize and understand evidence-practice gaps, to proof-ofconcept studies of efficacy, to large-scale implementation and effectiveness trials of complex interventions.Certainly, if findings in this field are not internally valid (i.e., wrong within the source population), they won't be of use to anyone.But even if findings are internally valid, to be of value, they must be applicable and useful for implementers (e.g., governments, organizations, health care workers, and communities) in diverse real-world contexts.What kinds of findings in implementation science are most useful?Must a trade-off exist between rigor and relevance?If so, what is the right balance between rigor and applicability in a variety of contexts?The tension between rigor and relevance across contexts is at the center of two conversations in implementation research.One conversation is among investigators immersed in the traditional scientific principles of rigorous human subject research (e.g., sampling, measurement, and confounding) and who must sometimes be persuaded of the importance of usability, applicability, and, therefore, relevance across varied real-world practice contexts.The second conversation is among implementers and evaluators embedded in real-world programs, settings, and populations.Some from this group must be persuaded that rigorous evaluation is needed and that scientific fundamentals, with accompanying effort and planning, are requisite when implementation research is the goal.Fig 1, adapted from Andersen's heuristic [2] of the Four Ps, summarizes these two conversations.The first conversation-moving researchers who hail from traditional rigorous clinical investigation toward relevance-is in high gear [3] but faces formidable challenges.Resistance may stem in part from the fact that rules for rigor are well established (and summarized in systems such as Grading of Recommendations Assessment, Development, and Evaluation [GRADE]) [4], while the perspectives for "relevance" (such as Glasgow's Reach, Effectiveness, Adoption, Implementation, and Maintenance [RE-AIM] framework) [5] are more recent, often require some conjecture, and may seem, to some, flimsy and unscientific.In addition, traditional approaches to rigor in clinical research are sometimes at direct odds with findings
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Mechanism measurement and evaluation is critical to increase the rigor and relevance of implementation science.
“Mechanism measurement and evaluation is critical to increase the rigor and relevance of implementation science [46].”
From Ten recommendations for using implementation frameworks in research and practice (2020) · cites this paper as [46]
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- Authors
- Geng, E. H., Peiris, D., & Kruk, M. E.
- Affiliations
- San Francisco General Hospital (US)
- The University of Sydney (AU)
- Harvard University (US)
- Corresponding author
- Geng, Elvin H.
- Venue
- PLOS Medicine
- Publisher
- Public Library of Science (PLoS)
- Published
- 2017-04-25
- Volume
- 14
- Issue
- 4
- Pages
- e1002288
- ISSN
- 1549-1277 (ISSN-L)
- 1549-1676
- PMC
- PMC5404833
- OpenAlex
- W2610057828
- Cited by
- 106
- References
- 24
- Citations by year
- 2026: 8 · 2025: 7 · 2024: 14 · 2023: 11 · 2022: 11 · 2021: 15 · 2020: 10 · 2019: 16 · 2018: 10 · 2017: 4
- FWCI
- 17.66
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- National Institute of Mental Health (P30MH062246)
- 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, applicability, knowledge-practice gap, RE-AIM framework, internal validity, complex interventions, evidence-based practice uptake, health services quality
- MeSH terms
- Humans, Publishing, Research Personnel, Science, Editorial Policies, Translational Research, Biomedical
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