| Acceptability/feasibility |
Acceptability: Perception among implementation stakeholders that a treatment, service, practice or innovation is agreeable, palatable, or satisfactory....[D]different from the larger construct of service satisfaction...it is more specific, referencing a particular treatment or set of treatments, while satisfaction typically references the general service experience." Stakeholders need specific knowledge about aspects or components of the treatment/innovation are needed in order for acceptability to be assessed. Acceptability should be considered in conjunction with other constructs throughout the implementation process (e.g. acceptability must be considered for adoption during the early stages).
Feasibility: The extent to which a new treatment, or an innovation, can be successfully used or carried out within a given agency or setting. Related to appropriateness but may include other concerns specific to an agency or organization like resources or staff training needs. Feasibility should be considered during the early stages of implementation during adoption. |
12 |
GEM D&I link: Acceptability
GEM D&I link: Feasibility |
| Adaptation and evolution |
For the success of D&I, interventions often need to be adapted to fit the local context (i.e., needs and realities). Adaptation is defined as the degree to which an evidence-based intervention is changed or modified by a user during adoption and implementation to suit the needs of the setting or to improve the fit to local conditions. The need for adaptation and understanding of context has been called Type 3 evidence (i.e., the information needed to adapt and implement an evidence-based intervention in a particular setting or population). Ideally, adaptation will lead to at least equal intervention effects as is shown in the original efficacy or effectiveness trial. To reconcile the tension between fidelity and adaptation, the core components (or essential features) of an intervention (i.e., those responsible for its efficacy/effectiveness) must be identified and preserved during the adaptation process. |
26 |
GEM D&I link: Adaptation and Evolution |
| Adopter/implementer/decision maker characteristics |
The characteristics, attitudes, and behaviors of individuals within an adopting organization include position in the organization, education, individual concerns and motivations and may determine the uptake and use of an innovation. Rogers classifies the individual adopters according to their degree of innovativeness into five categories: (1) innovators, (2) early adopters, (3-4) early and late majority, and (5) laggards. |
34 |
GEM D&I link: Adoption
GEM D&I link: Adopter Attitudes |
| Adoption |
The intention, initial decision, or action to try or employ an innovation or evidence-based practice. Adoption also may be referred to as ‘‘uptake.’’ Adoption occurs in the early to mid implementation stage and is assessed from the organizational or provider perspective. |
28 |
GEM D&I link: Adoption |
| Awareness |
|
10 |
|
| Barriers and facilitators |
Individual characterstics and contextual factors and strategies that enhance or impede the dissemination and implementation of evidence-based interventions. |
27 |
|
| Champion/field agent |
Champion: Effective, influential individuals at the implementation site who can facilitate the implementation of the intervention by mobilizing internal support for the presence of strong champions, often correlated with large implementation fidelity.
Change agent: Change agents are representatives of change agencies that are external to an organization or community, and their goal is to influence the innovation decisions of members of the organization or community. Change agents often use opinion leaders from an organization or community to facilitate the dissemination and adoption process.18 |
14 |
|
| Communication |
Formal or informal channels, which employ mass
media, social media, and which may involve personalized face-to-face contact. Links those with knowledge of innovation with those who don't possess knowledge. Mass-media channels: radio, television, newspaper.
Interpersonal channels: face-to-face interaction
Interactive communication channels: internet |
13 |
GEM D&I link: Communication |
| Communication channels |
Route of message delivery (e.g., mass media, community, interpersonal) or pathways by which intervention is delivered to participants (e.g., face-to-face; small group; telephone). |
23 |
|
| Compatibility |
The degree of tangible fit between meaning and values attached to the intervention by involved individuals, how those align with individuals’ own norms, values, and perceived risks and needs, and how the intervention fits with existing workflows and systems. |
6 |
GEM D&I link: Compatibility |
| Complexity |
Perceived difficulty of implementation, reflected by duration, scope, radicalness, disruptiveness, centrality, and intricacy and number of steps required to implement |
7 |
GEM D&I link: Complexity |
| Context |
Contextual factors may include the political, social, and organizational setting for the implementation of the intervention and include social support, legislations and regulations, social networks, and norms and culture. Understanding the delivery context for the intervention is essential for the success of the D&I and closely linked to the concepts of fidelity and adaptation. |
16 |
|
| Context – Inner setting |
Inner setting includes features of structural, political, and cultural contexts through which the implementation process will proceed. Edited by Jon 7/12/21 |
44 |
GEM D&I link: Context - Inner setting |
| Context – Outer setting |
Outer setting includes the economic, political, and social context within which an implementing organization resides.Edited by Jon 7/12/21 |
11 |
GEM D&I link: Context - Outer setting |
| Cost |
Cost can refer to multiple aspects of the development, testing, and implementation of an intervention including the intervention's cost-effectiveness, the cost around intervention development, implementation of the intervention, and recruitment of subjects into a trial. Cost information can inform adoption decisions and contribute to comparative effectiveness considerations. |
10 |
GEM D&I link: Cost |
| Development of an Intervention |
|
18 |
GEM D&I link: Intervention Characteristics
GEM D&I link: Planning |
| Dissemination |
Active and planned efforts to persuade target groups to adopt an innovation. |
20 |
GEM D&I link: Dissemination |
| Dose |
The amount of the intervention/program delivered |
2 |
|
| Engagement |
Involving appropriate individuals in the implementation and use of the intervention through a combined strategy of social marketing, education, role modeling, training, and other similar activities. |
10 |
GEM D&I link: Engaging |
| Evaluation |
Assessment of the efficacy, effectiveness, dissemination, or implementation of an intervention. |
41 |
GEM D&I link: Reflecting and Evaluating |
| External Validity/Generalizability |
External validity is concerned with the generalizability or real-world applicability of findings from a study and determines whether the results and inferences from the study can be applied to the target population and settings. Standardized and detailed reporting on factors that influence external validity (such as the ones recommended in the RE-AIM framework) can contribute to more successful D&I efforts. |
3 |
|
| Fidelity |
Degree to which an intervention was implemented as it was prescribed in the original protocol or as it was intended by the program developers." Fidelity of the intervention as it is implemented in a "real world" setting may be compared to the fidelity from the original evidence based intervention. Fidelity should be considered within the early and middle implementation stages. |
10 |
GEM D&I link: Fidelity |
| Fit |
The degree to which the characteristics of all evidence-based interventions are compatible with the delivery system structure and values. |
12 |
|
| Goals |
|
3 |
GEM D&I link: Goals |
| Health Equity |
Health equity means that everyone has a fair and just opportunity to be as healthy as possible. This requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care.
For the purposes of measurement, health equity means reducing and ultimately eliminating disparities in health and its determinants that adversely affect excluded or marginalized groups. Update by Jon |
10 |
|
| Identification |
|
18 |
GEM D&I link: Identification |
| Implementation |
At the setting level, implementation refers to the intervention agents' fidelity to the various elements of an intervention's protocol. This includes consistency of delivery as intended and the time and cost of the intervention. |
34 |
GEM D&I link: Implementation |
| Innovation characteristics |
The objects of D&I activities are interventions with proven efficacy and effectiveness (i.e., evidence-based). Interventions within D&I research should be defined broadly and may include programs, practices, processes, policies, and guidelines. In D&I research, we often encounter with complex interventions (e.g., interventions using community-wide education) where the description of core intervention components and their relationships involve multiple settings, audiences, and approaches. |
40 |
|
| Knowledge and Knowledge Synthesis |
|
31 |
|
| Knowledge Transfer and Utilization |
Knowledge transfer is a commonly used term both within and outside of the health care sector and is defined as the process of getting (research) knowledge from producers to potential users (i.e., stakeholders). This term is often criticized for its linear (unidirectional) notion and its lack of concern with the implementation of transferred knowledge.
Knowledge utilization refers to the use of broadly defined knowledge including not only research evidence but also scholarly practice and programmatic interventions. It can be regarded as an overarching term that encompasses both research utilization and evidence-based practice. |
1 |
|
| Maintenance and Sustainability |
Maintenance: The extent to which a program or policy becomes institutionalized or part of the routine organizational practices and policies. Maintenance in the RE-AIM framework also has referents at the individual level. At the individual level, maintenance has been defined as the long-term effects of a program on outcomes after 6 or more months after the most recent intervention contact.
Sustainability: "Extent to which a newly implemented treatment is maintained or institutionalized within a service setting’s ongoing, stable operations." A part of late implementation stages, sustainability of a treatment/innovation can be observed within aspects of organizational culture through "policies and practices." Often there is high sustainability when penetration is strong.
Sustainability is also defined as the existence of structures and processes which allow a program to leverage resources to most effectively implement evidence-based policies and activities over time. |
26 |
GEM D&I link: Maintenance and sustainability |
| Observability |
Degree to which the results of an intervention are visible to others |
3 |
|
| Outcomes |
Outcome variables, the end results of evidence-based interventions, in D&I research are often different from those in traditional health research and have to be defined broadly, including short- and long-term outcomes, individual and organizational- or population-level outcomes, impacts on quality of life, adverse consequences, and economic evaluation. Although individual-level variables can also be important (e.g., behavior change variables such as smoking or physical activity), outcome measures in D&I research are typically measured at organizational, community, or policy level (e.g., organizational change, community readiness for change). |
9 |
|
| Outcomes – Health/QOL/Satisfaction/Clinical |
|
13 |
|
| Outcomes – Implementation |
The effects of deliberate and purposive actions to implement new treatments, practices, and services. Implementation outcomes have three important functions. First, they serve as indicators of the implementation success. Second, they are proximal indicators of implementation processes. And third, they are key intermediate outcomes in relation to service system or clinical outcomes in treatment effectiveness and quality of care research. Because an intervention or treatment will not be effective if it is not implemented well, implementation outcomes serve as necessary preconditions for attaining subsequent desired changes in clinical or service outcomes. |
13 |
|
| Outcomes – Quality Improvement/Practice or Policy Change |
|
16 |
|
| Patient/target audience characteristics and needs |
Individuals who will be impacted by the intervention. For health care and public health interventions, these are often patients, consumers, or community members. These individuals can be, but are most often not, the user of the intervention. |
17 |
|
| Pre-implementation |
|
13 |
GEM D&I link: Planning |
| Process |
|
18 |
|
| Reach |
The absolute number, proportion, and representativeness of individuals who are willing to participate in a given initiative. |
9 |
GEM D&I link: Reach |
| Readiness |
|
16 |
GEM D&I link: Readiness for Implementation
GEM D&I link: Organizational Readiness for Change |
| Relative advantage |
Stakeholders’ perception of the advantage of implementing the intervention versus an alternative solution. This construct includes the concept of visibility or observability of the benefits. |
8 |
GEM D&I link: Relative Advantage |
| Stakeholders |
|
58 |
|
| Strategies |
Dissemination strategies describe mechanisms and approaches that are used to communicate and spread information about interventions to targeted users. Dissemination strategies are concerned with the packaging of the information about the intervention and the communication channels that are used to reach potential adopters and target audience. Passive dissemination strategies include mass mailings, publication of information including practice guidelines, and untargeted presentations to heterogeneous groups. Active dissemination strategies include hands on technical assistance, replication guides, point-of-decision prompts for use, and mass media campaigns. It is consistently stated in the literature that dissemination strategies are necessary but not sufficient to ensure wide-spread use of an intervention.
Implementation strategies refer to the systematic processes, activities, and resources that are used to integrate interventions into usual settings. Some authors refer to implementation strategies as core implementation components or implementation drivers and list staff selection, pre-service and in-service training, ongoing consultation and coaching, staff and program evaluation, facilitative administrative support, and systems interventions as components. |
42 |
|
| Translation |
Knowledge translation is the term used by the Canadian Institutes of Health Research (CIHR) to denote "a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically sound application of knowledge."Knowledge translation occurs within a complex social system of interactions between researchers and knowledge users and with the purpose of improving population health, providing more effective health services and products, and strengthening the health care system. |
3 |
|
| Trialability |
The ability to test the intervention on a small scale in the organization, and to be able to reverse course (undo implementation) if warranted. |
5 |
GEM D&I link: Trialability |
