The Implementation Research Logic Model (IRLM) was developed to enhance the rigor, transparency, and reproducibility of implementation research by integrating key elements of implementation research and practice—contextual factors/determinants, implementation strategies, mechanisms, and implementation and health outcomes—into a unified framework. Since its publication in 2020, the IRLM has been widely applied to plan, evaluate, and communicate implementation research. This paper synthesizes diverse IRLM use cases to advance its application and accelerate discovery in implementation science. We conducted a citation analysis and systematic scoping review to assess the uptake, application, and adaptation of the IRLM. A forward citation search identified 331 citing articles, and a scoping review identified 124 additional studies using other logic models. Articles were coded for IRLM use, phase of application, construct linking, data sources, community engagement, and framework integration. Descriptive statistics and thematic/pattern analysis were used to summarize findings. Of the 331 citing articles, 118 included a completed IRLM. Most were used during the planning phase (68

BACKGROUND:Many implementation studies focus on assessing the effectiveness of implementation strategies without investigating the mechanisms explaining their effects. This study investigates the specific mechanisms through which a multifaceted implementation strategy is hypothesized to improve guideline fidelity. This is done by tracing the specific mechanisms through which each discrete strategy achieved proximal outcomes that precede guideline fidelity. METHODS:Process tracing with comparative case studies was used to analyze qualitative data from a subsample of 16 implementers participating in a cluster-randomized controlled trial exploring the mechanisms by which a multifaceted strategy affects fidelity to a guideline for prevention of mental problems in schools. The study involved four steps: (1) Organizing a traceable process theory of change; (2) Gathering data to validate, modify, or expand the theory; (3) Coding data through qualitative content analysis; and (4) Causal analysis to articulate the theory's mechanisms, including temporal order and key contextual conditions that explain success or failure. The unit of analysis was implementers who were members of the schools' implementation teams, with each implementer representing a case. RESULTS:The analyses illuminated distinct pathways that explain how each of the five discrete strategies led to implementation success. (1) Organizing Implementation Teams enabled participation in implementation activities, as principals created an environment with dedicated resources, enabling social influences; (2) Educational meetings influenced the decision to implement the guideline through the educators' who promoted knowledge acquisition among the implementers and shaped their beliefs about the implementation; (3) Ongoing Training influenced the intention for implementation and enactment of activities through educators' engaged processes around ongoing acquisition and refinement of skills, which gradually built belief in implementation capability; (4) Small Cyclical Tests of Change influenced behavioral regulation as the workshops engaged repeated engagement in goal setting, action planning, reflection, and adjustment; (5) Facilitation supported implementers' goal setting and prioritization by creating an environmental context, enabling implementers' social influence through receiving social support from facilitators. Unsuccessful pathways for each strategy were also identified and explained. CONCLUSIONS:This study traced the specific sequences of actions and interactions through which five discrete implementation strategies contributed to guideline implementation. The findings illustrate how the mechanisms of the multifaceted strategy can be successfully engaged and why they may fail under certain conditions. TRIAL REGISTRATION:The trial was registered the 9th of August 2021 at Clinicaltrials.gov with Trial registration number: NCT05019937.

Workforce training for providers in the public mental health system serving children and youth is a significant investment of state tax dollars. This is especially true for evidence-based treatments. Between 2023 and 2025 New York State partnered with New York University’s McSilver Institute for Poverty Policy and Research to scale EBTs for children, youth and families. To inform the roll-outs of these initiatives and identify key elements that could be replicated to strengthen the children’s mental health workforce in other publicly funded systems, we conducted a scoping review of current published literature on state-sponsored, children’s mental health workforce training initiatives in the U.S. This review was informed by the first five steps of Arksey and O’Malley’s methodological framework and follows the approach of iteratively refining study selection and data extraction decisions used in other health services-related scoping reviews. In the 31 included articles, initiatives were located in seventeen states and New York was the most frequently represented. The majority of articles described initiatives as originating out of an identified system need. The children’s diagnosis and evidence-based practice most frequently addressed were trauma and TF-CBT. Training activities varied widely. Eligibility criteria for participating also varied, and incentives were reported in less than half of the articles. Observational designs with a single data collection timepoint were most common, and reporting on training-related outcomes was inconsistent and unsystematic. To strengthen state-sponsored mental health workforce training requires use of consistent designs, characterization of training types, and standardized data collection procedures.

Occupational guidelines exist to support workplaces with the prevention of mental health problems (MHP) among their staff. However, knowledge of effective implementation strategies to support their implementation is limited. This study experimentally tested whether a multifaceted implementation strategy – comprising an educational meeting, five workshops, implementation teams, small cyclical tests of change, and facilitation – improves fidelity to a guideline for preventing MHP in a school setting through the pathway of change of the Capability Opportunity Motivation-Behavior (COM-B)-model. To gain a more granular understanding of the mechanisms of change, the Theoretical Domains Framework (TDF) was used to specify mediators related to capability, opportunity, and motivation. This study tested whether the multifaceted strategy versus a discrete strategy (1) improves fidelity, (2) enhances capability, opportunity, and motivation over time, and (3) if the strategy’s effect on fidelity is mediated by capability, opportunity, and motivation. Fifty-five schools were randomly assigned to a multifaceted strategy or a discrete strategy. Fidelity was measured by questionnaires at baseline and 12 months, while capability, opportunity, and motivation were assessed three times within this period (directly after the educational meeting and at three and nine months). The Determinants of Implementation Behavior Questionnaire was used to assess TDF hypothesized mediators corresponding to the COM-B components. Separate pathways were analyzed for each mediator. Linear Mixed Modeling was employed to test the strategy’s effect on fidelity, and mediation analyses were conducted using the PROCESS Macro. The multifaceted strategy led to improved fidelity at 12 months (B = 2.81, p < .001). Multifaceted schools reported higher scores for all mediators after nine months compared to schools receiving the discrete strategy. The effect of the multifaceted strategy on fidelity was partially mediated by all TDF mediators (p = < .05) except for beliefs about consequences. Capability-related mediators, including skills (Proportion-mediated = 41

BackgroundAlthough the management of psychosocial risks in the work environment represents an evidence-based approach to the prevention of mental health problems, its implementation is limited, including in schools, and knowledge on how to support better implementation is scarce. This study compares the effectiveness of a multifaceted vs. a discrete implementation strategy on fidelity to an occupational guideline for the prevention of mental health problems. Dual perspectives were used to assess fidelity, an important aspect of the measurement agenda.Methods A cluster-randomized controlled trial was conducted among 55 schools in Sweden. A multifaceted strategy (educational meeting, implementation teams, ongoing training, Plan-Do-Study-Act cycles, and facilitation) was compared with a discrete strategy (teams participating in the educational meeting). Fidelity to the guideline's recommendations from the recipients' perspective was measured by questionnaire (Baseline n = 2276; 12 months n = 1891). Fidelity from the implementers' perspective (n = 54) was assessed via a checklist at 12 months. Linear mixed modeling was used. A qualitative approach was applied to analyze the open-ended responses to the checklist.Results Absolute changes in recipient fidelity were observed in all three indicators of the guideline's recommendation 1 (Multifaceted: 13.2 to 19.5%, Discrete: 10.4 to 13.2%). A statistically significant effect was found favoring the multifaceted strategy (d = 0.16). The indicator of recommendation 2 also supported the effect of the multifaceted strategy (Multifaceted: 9.2%, Discrete: 5.0%; d = 0.16). The largest difference between the strategies was observed for recommendation 3, for six indicators (Multifaceted: 0.7 to 13.9%, Discrete:-3.2 to 0.0%; d = 0.19 to 0.41). Convergence was observed between the two perspectives in support of the multifaceted strategy's favorable effect on guideline fidelity compared to the discrete strategy. The findings complemented each other, with implementers describing the activities that were enacted and recipients quantifying the change in fidelity over time.ConclusionsThe multifaceted strategy was more effective than the discrete strategy in fidelity attainment after 12 months. Assessing fidelity from the implementer and recipient perspectives provided an understanding of the contextual functioning of the strategies, highlighting the variation in fidelity and the importance of examining the need for adaptations of strategies during the implementation process.Trial registrationThe trial was registered the 9th of August 2021 at Clinicaltrials.gov with Trial registration number: NCT05019937.

BackgroundLocal public health departments in the United States are responsible for implementing cancer-related programs and policies in their communities; however, many staff have not been trained to use evidence-based processes, and the organizational climate may be unsupportive of evidence-based processes. A promising approach to address these gaps is through academic-public health department (AHD) partnerships, in which practitioners and academics collaborate to improve public health practice and education through joint research projects and educational opportunities. Prior research has demonstrated the benefits of AHD partnerships to public health practice and education. However, knowledge about how AHD partnerships should be structured to support implementation of programs and policies is sparse.MethodsThis is a mixed methods, two-phase study, guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS) Framework, in which AHD partnerships are a relational type of bridging factor. A positive deviance approach will be used to understand how AHD partnerships are best structured and supported. In the formative phase, we will survey academics and local health department staff (n = 500) to characterize AHD partnerships and understand contextual influences. We will conduct in-depth interviews with eight AHD partnerships (four high and four low engagement), to identify differences between high and low engagement partnerships. The second, experimental phase will be a paired group randomized trial with 28 AHD partnerships (n = 14 randomized to implementation arm and n = 14 to the control arm). A menu of strategies will be refined through survey and interview findings, literature, and our team's previous work. The trial will assess whether these strategies can be used to strengthen partnerships and improve adoption of cancer prevention and control programs and policies. We will evaluate changes in AHD partnership engagement and implementation of evidence-based programs and policies.DiscussionThis first-of-its-kind study will focus on collaborations that leverage complementary expertise of health department staff and academics to improve public health practice. Our results can impact the field by identifying new, sustainable models for how public health practitioners and academics can work together to meet common goals, increase the use of evidence-based programs and policies, and expand our understanding of bridging factors within the EPIS framework.Trial registrationProspective registered on 9/17/2024 at clinicaltrials.gov no. NCT06605196 (https://clinicaltrials.gov/study/NCT06605196).

IntroductionThe Implementation Research Logic Model (IRLM) aids users in combining, organizing, and specifying the relationships between important constructs in implementation research. The goal of the IRLM is to improve the rigor, reproducibility, and transparency of implementation research projects. The article describing the IRLM was published September 25, 2020 (Implement Sci, Vol 15); it has since been highly cited and included as a required element in multiple funding opportunity announcements from federal agencies. The proliferation of IRLM use across dissemination and implementation research projects and practice provides an excellent opportunity to examine applications across a variety of different contexts. This protocol will result in a description of the impact of the IRLM on the field of dissemination and implementation science and guidance on refinements to the IRLM to increase its utility and impact through (1) a citation analysis, (2) a scoping review, and (3) user surveys and interviews.Methods and analysisThis protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review reporting guidelines (PRISMA-ScR). We plan to conduct a citation search and analysis of the Smith et al. 2020 article and a scoping review. The review search will be conducted in Medline, Embase, CINAHL Complete, Cochrane Library, APA PsycINFO4, ProQuest Dissertations & Theses Global, Scopus and Web of Science Core Collection., and grey literature will be searched to identify studies that use alternative logic models for implementation research. A survey will be developed from the findings of the scoping review and administered to individuals who used the IRLM. Semi-structured interviews will then be conducted with a sample of survey respondents to provide an opportunity for sequential mixed-methods analysis to achieve a deeper understanding of needed IRLM refinements and recommendations.Ethics and disseminationEthics approval for the scoping review and citation analysis is not applicable as only data from published literature will be used and no original data will be collected. For the survey, IRB will be completed once items are developed from the results of the scoping review and citation analysis. Results will be disseminated through peer-reviewed publications, conference presentations, and via online tools. Registration detailsThis protocol was registered with OSF, https://osf.io/y94bj (1).

BackgroundOpinion leadership, educational outreach visiting, and innovation championing are commonly used strategies to address barriers to implementing innovations and evidence-based practices in healthcare settings. Despite voluminous research, ambiguities persist in how these strategies work and under what conditions they work well, work poorly, or work at all. The current paper develops middle-range theories to address this gap.MethodsConceptual articles, systematic reviews, and empirical studies informed the development of causal pathway diagrams (CPDs). CPDs are visualization tools for depicting and theorizing about the causal process through which strategies operate, including the mechanisms they activate, the barriers they address, and the proximal and distal outcomes they produce. CPDs also clarify the contextual conditions (i.e., preconditions and moderators) that influence whether, and to what extent, the strategy's causal process unfolds successfully. Expert panels of implementation scientists and health professionals rated the plausibility of these preliminary CPDs and offered comments and suggestions on them.FindingsTheoretically, opinion leadership addresses potential adopters' uncertainty about likely consequences of innovation use (determinant) by promoting positive attitude formation about the innovation (mechanism), which results in an adoption decision (proximal outcome), which leads to innovation use (intermediate outcome). As this causal process repeats, penetration, or spread of innovation use, occurs (distal outcome). Educational outreach visiting addresses knowledge barriers, attitudinal barriers, and behavioral barriers (determinants) by promoting critical thinking and reflection about evidence and practice (mechanism), which results in behavioral intention (proximal outcome), behavior change (intermediate outcome), and fidelity, or guideline adherence (distal outcome). Innovation championing addresses organizational inertia, indifference, and resistance (determinants) by promoting buy-in to the vision, fostering a positive implementation climate, and increasing collective efficacy (mechanisms), which leads to participation in implementation activities (proximal outcome), initial use of the innovation with increasing skill (intermediate outcome) and, ultimately, greater penetration and fidelity (distal outcomes). Experts found the preliminary CPDs plausible or highly plausible and suggested additional mechanisms, moderators, and preconditions, which were used to amend the initial CPD.DiscussionThe middle-range theories depicted in the CPDs furnish testable propositions for implementation research and offer guidance for selecting, designing, and evaluating these social influence implementation strategies in both research studies and practice settings.

Accreditation is gaining ground in human services as leaders find ways to demonstrate the quality and legitimacy of services. This study examined site-level accreditation for SafeCare®, an evidence-based practice designed to prevent and reduce child maltreatment. We leveraged two waves of qualitative data to explore the perspectives of trainers, organizational and system leaders, and program developers who participated in an initial rollout of a site-level accreditation process for SafeCare. Institutional theory was used to frame accreditation’s potential benefits, burden, and impact. Findings highlight specific considerations for the human service environment, including the inherent resource scarcity, interdependence among organizations, and the impact of cost and slow-moving bureaucratic processes.

Abstract Social service systems are uniquely positioned to implement health prevention and intervention protocols given their mission to support vulnerable populations in the communities where they live. However, social service organizations deliver complex services, with scarce resources, under significant external pressure from communities, funders, and regulatory bodies. This requires careful consideration in designing dissemination and implementation (D&I) strategies. While several well-developed, blended implementation strategies are being used in social services, they all require additional documentation, research, and refinement. Nonetheless, the lessons learned in the social services may help organizations in other systems better implement health interventions with consumers with complex service needs.

INTRODUCTION:A 2011 paper proposed a working taxonomy of implementation outcomes, their conceptual distinctions and a two-pronged research agenda on their role in implementation success. Since then, over 1100 papers citing the manuscript have been published. Our goal is to compare the field's progress to the originally proposed research agenda, and outline recommendations for the next 10 years. To accomplish this, we are conducting the proposed scoping review. METHODS AND ANALYSIS:Our approach is informed by Arksey and O'Malley's methodological framework for conducting scoping reviews. We will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. We first aim to assess the degree to which each implementation outcome has been investigated in the literature, including healthcare settings, clinical populations and innovations represented. We next aim to describe the relationship between implementation strategies and outcomes. Our last aim is to identify studies that empirically assess relationships among implementation and/or service and client outcomes. We will use a forward citation tracing approach to identify all literature that cited the 2011 paper in the Web of Science (WOS) and will supplement this with citation alerts sent to the second author for a 6-month period coinciding with the WOS citation search. Our review will focus on empirical studies that are designed to assess at least one of the identified implementation outcomes in the 2011 taxonomy and are published in peer-reviewed journals. We will generate descriptive statistics from extracted data and organise results by these research aims. ETHICS AND DISSEMINATION:No human research participants will be involved in this review. We plan to share findings through a variety of means including peer-reviewed journal publications, national conference presentations, invited workshops and webinars, email listservs affiliated with our institutions and professional associations, and academic social media.

Abstract Taken as a whole, both organizational characteristics and specific organizational strategies are important for the effective dissemination and implementation of evidence-based practices (EBPs) in health and allied healthcare settings, as well as mental health, alcohol/drug treatment, and social service settings. One of the primary goals of this chapter is to support implementers and leaders within organizations in attending to and shaping the context in which implementation takes place in order to increase the likelihood of implementation success and long-term sustainment. The chapter summarizes some of the most critical organizational factors and strategies likely to impact successful EBP implementation. There are myriad approaches to supporting organizational development and change; this chapter focuses on issues supported by relevant scientific literatures, particularly those germane to EBP implementation in healthcare and related settings.

BackgroundAlthough healthcare is delivered in inherently multilevel contexts, implementation science has no widely endorsed methodological standards defining the characteristics of rigorous, multilevel implementation research. We identify and describe eight characteristics of high-quality, multilevel implementation research to encourage discussion, spur debate, and guide decision-making around study design and methodological issues.RecommendationsImplementation researchers who conduct rigorous multilevel implementation research demonstrate the following eight characteristics. First, they map and operationalize the specific multilevel context for defined populations and settings. Second, they define and state the level of each construct under study. Third, they describe how constructs relate to each other within and across levels. Fourth, they specify the temporal scope of each phenomenon at each relevant level. Fifth, they align measurement choices and construction of analytic variables with the levels of theories selected (and hypotheses generated, if applicable). Sixth, they use a sampling strategy consistent with the selected theories or research objectives and sufficiently large and variable to examine relationships at requisite levels. Seventh, they align analytic approaches with the chosen theories (and hypotheses, if applicable), ensuring that they account for measurement dependencies and nested data structures. Eighth, they ensure inferences are made at the appropriate level. To guide implementation researchers and encourage debate, we present the rationale for each characteristic, actionable recommendations for operationalizing the characteristics in implementation research, a range of examples, and references to make the characteristics more usable. Our recommendations apply to all types of multilevel implementation study designs and approaches, including randomized trials, quantitative and qualitative observational studies, and mixed methods.ConclusionThese eight characteristics provide benchmarks for evaluating the quality and replicability of multilevel implementation research and promote a common language and reference points. This, in turn, facilitates knowledge generation across diverse multilevel settings and ensures that implementation research is consistent with (and appropriately leverages) what has already been learned in allied multilevel sciences. When a shared and integrated description of what constitutes rigor is defined and broadly communicated, implementation science is better positioned to innovate both methodologically and theoretically.

BACKGROUND:Engaging policy actors in research design and execution is critical to increasing the practical relevance and real-world impact of policy-focused dissemination and implementation science. Identifying and selecting which policy actors to engage, particularly actors involved in "Big P" public policies such as laws, is distinct from traditional engaged research methods. This current study aimed to develop a transparent, structured method for iteratively identifying policy actors involved in key policy decisions-such as adopting evidence-based interventions at systems-scale-and to guide implementation study sampling and engagement approaches. A flexible policy actor taxonomy was developed to supplement existing methods and help identify policy developers, disseminators, implementers, enforcers, and influencers.METHODS:A five-step methodology for identifying policy actors to potentially engage in policy dissemination and implementation research was developed. Leveraging a recent federal policy as a case study-The Family First Prevention Services Act (FFPSA)-publicly available documentation (e.g., websites, reports) were searched, retrieved, and coded using content analysis to characterize the organizations and individual policy actors in the "room" during policy decisions.RESULTS:The five steps are as follows: (1) clarify the policy implementation phase(s) of interest, (2) identify relevant proverbial or actual policymaking "rooms," (3) identify and characterize organizations in the room, (4) identify and characterize policy actors in the "room," and (5) quantify (e.g., count actors across groups), summarize, and compare "rooms" to develop or select engagement approaches aligned with the "room" and actors. The use and outcomes of each step are exemplified through the FFPSA case study.CONCLUSIONS:The pragmatic and transparent policy actor identification steps presented here can guide researchers' methods for continuous sampling and successful policy actor engagement. Future work should explore the utility of the proposed methods for guiding selection and tailoring of engagement and implementation strategies (e.g., research-policy actor partnerships) to improve both "Big P" and "little p" (administrative guidelines, procedures) policymaking and implementation in global contexts.

Abstract Policy dissemination research seeks to understand how research evidence can be most effectively communicated to policymakers and integrated into policymaking processes. These studies may aim to describe attributes of a population of policymakers, identify discrete audience segments of policymakers, test the effects of dissemination strategies, characterize the use of research evidence in policymaking, and identify factors associated with the diffusion of policies across jurisdictions. Policy implementation research seeks to understand how the rollout of policies can be optimized to maximize health benefits. Such studies may aim to describe the process through which a policy was implemented, assess stakeholders’ perceptions of implementation and appetite for implementation strategies, and determine the effect of a policy on implementation outcomes, the moderating effect of policy implementation outcomes on policy effectiveness outcomes, or the main effect of policy implementation strategies on policy implementation and/or effectiveness outcomes. The study of evidence-to-policy translation and policy implementation has a rich history but is still an emerging area in the field of dissemination and implementation (D&I) science in health. Developing policy D&I research is critical to maximizing the public health impact of the field of implementation science and also has potential to improve population health and enhance health equity. Policy-focused D&I research is also important to developing effective strategies to combat the effects of actors who seek to influence policies in ways that are diametrically opposed to the goals of public health and health equity.

Background Implementation science aims to accelerate the public health impact of evidence-based interventions. However, implementation science has had too little focus on the role of health policy — and its inseparable politics, polity structures, and policymakers — in the implementation and sustainment of evidence-based healthcare. Policies can serve as determinants, implementation strategies, the evidence-based “thing” to be implemented, or another variable in the causal pathway to healthcare access, quality, and patient outcomes. Research describing the roles of policy in dissemination and implementation (D&I) efforts is needed to resolve persistent knowledge gaps about policymakers’ evidence use, how evidence-based policies are implemented and sustained, and methods to de-implement policies that are ineffective or cause harm. Few D&I theories, models, or frameworks (TMF) explicitly guide researchers in conceptualizing where, how, and when policy should be empirically investigated. We conducted and reflected on the results of a scoping review to identify gaps of existing Exploration, Preparation, Implementation, and Sustainment (EPIS) framework-guided policy D&I studies. We argue that rather than creating new TMF, researchers should optimize existing TMF to examine policy’s role in D&I. We describe six recommendations to help researchers optimize existing D&I TMF. Recommendations are applied to EPIS, as one example for advancing TMF for policy D&I. Recommendations (1) Specify dimensions of a policy’s function (policy goals, type, contexts, capital exchanged). (2) Specify dimensions of a policy’s form (origin, structure, dynamism, outcomes). (3) Identify and define the nonlinear phases of policy D&I across outer and inner contexts. (4) Describe the temporal roles that stakeholders play in policy D&I over time. (5) Consider policy-relevant outer and inner context adaptations. (6) Identify and describe bridging factors necessary for policy D&I success. Conclusion Researchers should use TMF to meaningfully conceptualize policy’s role in D&I efforts to accelerate the public health impact of evidence-based policies or practices and de-implement ineffective and harmful policies. Applying these six recommendations to existing D&I TMF advances existing theoretical knowledge, especially EPIS application, rather than introducing new models. Using these recommendations will sensitize researchers to help them investigate the multifaceted roles policy can play within a causal pathway leading to D&I success.

Tailored interventions have been shown to be effective and tailoring is a popular process with intuitive appeal for researchers and practitioners. However, the concept and process are ill-defined in implementation science. Descriptions of how tailoring has been applied in practice are often absent or insufficient in detail. This lack of transparency makes it difficult to synthesize and replicate efforts. It also hides the trade-offs for researchers and practitioners that are inherent in the process. In this article we juxtapose the growing prominence of tailoring with four key questions surrounding the process. Specifically, we ask: (1) what constitutes tailoring and when does it begin and end?; (2) how is it expected to work?; (3) who and what does the tailoring process involve?; and (4) how should tailoring be evaluated? We discuss these questions as a call to action for better reporting and further research to bring clarity, consistency, and coherence to tailoring, a key process in implementation science.