Presentation designed by Valéry Ridde for a symposium held on April 14, 2017 at San Diego State University. The symposium was organised by The Global Health Program at the SDSU's Graduate School of Public Health.
6. Definitions of implementation science in HIV/AIDS Odeny, Thomas A et al. The Lancet HIV , Volume 2 , Issue 5 , e178 - e180
69 articles 96-2013
73 definitions
8. DEFINITIONS
• Scientific investigation of factors associated
with effective implementation(Franks and Schroder, 2013)
• implementation = process of putting an
intervention into use - either evidence-based
or theory-based – in a setting(Damschroder et al., 2009; Nash
et al., 2006; Thompson et al., 2003)
13. BLACK BOX AND TYPE 3 ERROR
INTERVENTION
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15. There was no global effect of the availability of ORI on
facility-based delivery rates, nor on the use of antenatal and
postnatal care services, except for qualified antenatal
services.
17. THE TREE THAT HIDES THE DRILL
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Fins de mois
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• Informal payment
• Past experiences
• Perceived quality
• Geographical access
Belaid et Ridde, 2015
18.
19. DIFFERENT TYPES OF THEORIES
• “Hypotheses on which people, consciously or
unconsciously, build their program plans and
actions.” (Weiss, 1997)
Program theory
• “Basic, usable structure of ideas, less abstract
than grand theory, and more abstract than
empirical generalizations or micro-range
theory.” (Stinchcombe, 1968, quoted by Moore et al., 2012)
Middle-range
theory
• “Unified theory that will explain all the
observed uniformities of social behavior, social
organization, and social change.” (Merton,
1969)
Grand theory
Ladderofabstraction
What about the Theory of Change? Or the Implementation Theory? Or the Logic Model?
Robert and Ridde, 2016
35. HP AND POLICY SCIENCE : 1986-2006
E. Breton and E. de Leeuw, 2010
● 7% of HP article are PP studies
● 18% are referring to a theoretical framework
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36. “We are not even close to a well-
developed theory of policy
implementation’” Saetren’s (2005, p. 573)
« The theoretical base for
implementation is relatively new and
needs to be tested and
operationalized in real-world
settings. » Franks & Schroeder (2013, p.12)
61. WHAT EVERYONE SHOULD KNOW
1. Quality Implementation Is the Sine Qua Non of Effective Programs
2. Monitoring Implementation Is an Essential Component
3. It Is Extremely Costly to Ignore Implementation
4. Implementation Is a Multidimensional Concept
5. Implementation Exists along a Continuum
6. Adaptations Are Common and May Improve Program Outcomes
7. Effective Professional Development Services Are Essential
8. Multiple Factors Affect Implementation
9. at Least 14 Related Steps to Achieving Quality Implementation
10. Quality Implementation Requires Collaboration among Multiple
Stakeholders
11. The Same Factors That Influence Quality of Implementation Also Influence
Sustainability
Durlak, 2015; pp. 395–405
Hinweis der Redaktion
Figure: Relatedness of definitions of implementation science in scientific literatureDefinitions are shown as nodes and citations as arrows. We classified each definition as either a definition (or exact meaning of the term) in pink; a characterization (general description of qualities or features of the term) in blue, or both in green.8
Definitions of implementation science in HIV/AIDS
Almost all definitions of implementation science and research referred explicitly or implicitly to the gap between knowledge and evidence from research findings
Implementation science is a multidisciplinary specialty that seeks generalisable knowledge about the behaviour of stakeholders, organisations, communities, and individuals in order to understand the scale of, reasons for, and strategies to close the gap between evidence and routine practice for health in real-world contexts.
IS can be defined as the scientific investigation of factors associated with effective implementation » Franks and Schroder, 2013
Implementation science studies the use of strategies to adapt and use evidence-based interventions in targeted settings to sustain im- provements to population health. Annu. Rev. Public Health 2013. 34:235–51
implementati- on emerged as an actively planned and deliberately in- itiated effort with the intention to bring a given object into policy and/ or practice. fadenhauer et al., 2015).
implementation is defined as the process, constellation of processes or means of as- similating or putting an intervention into use - either evidence-based or theory-based – in an organisation or a setting (Damschroder et al., 2009; Nash et al., 2006; Thompson et al., 2003)
IS = The science of putting ideas into action—the science of implementation
Implemenattion has been described as the .science, practice and policy of getting science into practice and policy » Kixsen, 2011
Using Rogers’ (2003) classic model, implementation is one of five crucial stages in the wide-scale diffusion of inno- vations: (1) dissemination (conveying information about
123
Am J Community Psychol (2012) 50:462–480
465
the existence of an innovation to potentially interested parties), (2) adoption (an explicit decision by a local unit or organization to try the innovation), (3) implementation (executing the innovation effectively when it is put in place), (4) evaluation (assessing how well the innovation achieved its intended goals), and (5) institutionalization (the unit incorporates the innovation into its continuing practices).
vortex, whirlpool, whirlwind, swirl, whirl, eddy
4 son of a single rope
Type III error: evaluating a program that has not been adequately implemented
Obstetric Risk Insurance package (ORI) focusing on maternal and perinatal health has been progressively implemented at the health district level since 2002.
The scheme is based on a flat fee pre-payment. = 18$
ny woman attending antenatal care is given the choice to enrol on a voluntary basis.
demographic and health survey data between 2002 and 2011.
There was no global effect of the availability of ORI on facility-based delivery rates, nor on the use of antenatal and postnatal care services, except for qualified antenatal services.
Maternity-related care for the ORI membership included at least: four antenatal visits; all prophylactic treatments; one blood test (haemoglobin level, blood group and rhesus); one urine test (pro- teinuria, glycosuria) at each antenatal visit; one ultrasound scan dur- ing the first trimester; treatment for any pathologies related to pregnancy and delivery, skilled delivery and emergency obstetrical care (EmoC) if needed, including caesarean section; ambulance transportation to a higher level of health care; hospital care if trans- ferred; and one postnatal visit
The ORI was firstly implemented in 2002 in two health districts of Nouakchott (Sebkha and El Mina) and since then, has extended still further in other districts outside of the capital. At the end of 2014, the ORI was available in 144 out of 627 public health care facilities
HETEROGENEITY
Weiss : Theory of Change = Program theory + Implementation theory
Marchal : TOC is essentially prospective (Dickinson, 2006) and seeks to establish the links between intervention,
context and outcome (Barnes et al., 2003; Mason and Barnes, 2007; Weiss, 1995). It does
so through development and testing of logic models (Douglas et al., 2010).
Breuer: approach which describes how a programme brings about spe- cific long-term outcomes through a logical sequence of intermediate outcomes
distinct from sociological or psychological the-ories which describe why change occurs
RE = uncovering underlying programme theories. These theories are often more abstract than the theories developed through ToC or logic models [18].
Flexibilité : « la capacité d’un système à s’adapter aisément à l’environnement ».
Adaptabilité : capacité de l’organisation à modifier sa
Niveau de l’intervention
Niveau de l’OMS
Dinstinguer pourquoi on soutient le DP (modèle théorique) vs. comment on soutient le DP (modèle opérationnel)
Renforcer la gouvernance sanitaire = alignement des bailleurs, leadership des MoH et formuler du NHPSP robustes et complets
Alignement = maillage et mise en commun des ressources
identify quantitative instruments of implementation outcomes relevant to mental or behavioral health settings
We identified 104 instruments across eight constructs, with nearly half (n = 50) assessing acceptability and 19
identified for adoption , with all other implementation outcomes revealing fewer than 10 instruments. Only one
instrument demonstrated at least minimal evidence for psychometric strength on all six of the evidence-based
assessment criteria. The majority of instruments had no information regarding responsiveness or predictive validity.
that the majority of instruments consisting of between 11 and 49 items (a rating reflecting “ good” ) may actually reflect unfeasible instrument length in a practical implementation context.
Pressman, Jeffrey L. and Wildavsky, Aaron B. (1973)
Titile and abstratc
Total de 724 articles depuis 1970 sur pérennité et 953 sur mise en œuvre
Seulement 6%
Frequency of eligible policy-related articles published in eleven journals pursuing the scholarly development of health promotion (Jan 1986 - Jun 2006
« all the most authoritative conceptualizations mentioned here were modelled on Western-style democratic governance systems »
TOTAL 119 = Referring to a theoretical framework? 39 = Of these, from political science 21
3 générations :
*70 et avant = quali, explo, sans théorie
*80 : premier cadre d’analyse
*fin 80 = plus recherche, comparative, théorie, longitudinale,
Les acteurs s’adaptent aux failles du système = épisio remboursé plus car acc dysto mais pas dans les faits
There is little doubt that Kingdon’s Agendas, Alternatives, and Public Policies (1984) remains a key influence on the study of public policy.
Kingdon’s Multiple Streams Approach:
three separate “streams” must come together at the same time—and they must do so during a brief “window of oppor- tunity”—for policy to change markedly:
Ambiguity (there are many ways to frame any policy problem);
Competition for attention (few problems reach the top of the agenda);
An imperfect selection process (new information is difficult to gather and sub- ject to manipulation);
Actors have limited time (which forces people to make choices before their pref- erences are clear); and,
Decision-making processes are neither “comprehensively rational” nor linear.
25 reviewed frameworks
8 dimensions de l’implantation :
Fidélité, qualité, dosage, adaptation, participant, engagement, couverture, différenciation, suivi de conditions de comparaisons
20 facteurs contextuels (e.g., various features of the interven- tion, front-line providers, and the organization hosting the in- tervention;)
1-Community-level factors2-Characteristics of staff delivering the program
3-Features of the program to be offered4- Features of the host organization and its operating systems
5- Features of Professional Development services
14 critical steps in the Quality Implementation Framework
ABLE 26.1. Examples of Factors That Influence Quality of Implementation
Community-level factorsa. Theory and research in the relevant area b. Political/administrator pressuresc. Fundingd. Educational policy and curriculum
mandates
Characteristics of staff delivering the program
a. Perceived need for the programb. Perceived program benefitsc. Sense of self-efficacy or self-confidence d. Mastery of new skills
Features of the program to be offereda. Compatibility or fit with the host setting b. Flexibility or adaptability of the program
Features of the host school and its operating systems
a. Positive work climate
Organizational norms related to openness
to change
How well the program fits with usual
school practices
Shared vision regarding buy-in and
commitment to the new program
Shared decision making and supporting
collaboration among stakeholders
Working partnerships with other agencies
Effective communication practices
Effective formulation of workgroups and
tasks
Strong leadership
A program champion advocating for the
program
Administrator support
Features of Professional Development services
a. Quality of preprogram trainingb. Quality of ongoing technical assistance
PHASE ONE: INITIAL CONSIDERATIONS REGARDING THE HOST SETTING ASSESSMENT STRATEGIES
1. Conducting a needs and resources assessment 2. Conducting a fit assessment3. Conducting a capacity/readiness assessment
Decisions about adaptation 4. Possibility for adaptation
Capacity-building strategies
5. Obtaining explicit buy-in from critical stakeholders and fostering a supportive community/organizational climate
6. Building general/organizational capacity 7. Staff recruitment/maintenance8. Effective pre-innovation staff training
PHASE TWO: CREATING A STRUCTURE FOR IMPLEMENTATION STRUCTURAL FEATURES FOR IMPLEMENTATION
9. Creating implementation teams
10. Developing an implementation planPHASE THREE: ONGOING STRUCTURE ONCE IMPLEMENTATION BEGINS
Ongoing implementation support strategies11. Technical assistance/coaching/supervision 12. Process evaluation13. Supportive feedback mechanism
PHASE FOUR: IMPROVING FUTURE APPLICATIONS
14. Learning from experience
five major domains : intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation
37 constructs
26 articles (6 % of 429) were included in the final sample.
This figure includes only studies which specified CFIR constructs used (n=15).
Nine studies specified only domains that were used and no constructs.
Two studies made no explicit reference to any CFIR domains or constructs
Esther qui utile le CFIR + Étape Durlak pour compléter
se strength?: System Strengthening Lessons From Applying the CFIR to Maternal Health Positive Deviance Cases in Nampula, Mozambique
Mise en oeuvre correspond aux activités de vérification et de détermination et paiement des subsides. La dimension ‘autres’ comportent les activités de recherche-action.
Fidélité de couverture
an overview of reviews
C,est donc un très vieux débat et les écrits en SP sont très nombreux, quels sont ils donc en santé mondiale ?
Unintended consequences : "changes for which there is a lack of purposeful action or causation that occur to a social system as a result of the
innovation" (Ash et al., 2007)
Design: Multiple case study
Data collection
• 6healthcarecenters• Fieldwork for ~ 2 weeks/center
Falsification of community verification
records
Staged supervisions
Dissatisfaction
Loss of patient confidentiality
Work overload created by patient sampling
Inconclusive process for identifying fictitious patients
Fear and apprehension among patients regarding community verification
Fear of and conflicts regarding payment modalities