Date of Award

May 2024

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Department

Public Health

First Advisor

Paul Florsheim

Committee Members

Lance Weinhardt, Young Cho, Rose Hennessy, Shawna Smith

Keywords

CFIR, Health services, Implementation Science, Outcomes, Questionnaire development, systematic review

Abstract

Background: Implementation science advances public health by studying the process of implementing evidence-based practices in real-world settings. While our knowledge surrounding determinants (factors affecting the implementation process) and outcomes (measures of implementation success) has grown exponentially, it remains difficult to determine which determinants have the greatest impact on the implementation process, as well as their relationship with implementation outcomes. Research is needed to identify 1) key determinants that affect the implementation process, or those found to play the biggest role in the implementation process most frequently and 2) their relationship with implementation outcomes.Methods: The relationship between key determinants and implementation outcomes was examined through a three-step process. First, a systematic review was conducted to identify key determinants from the Consolidated Framework for Implementation Research (CFIR) affecting the implementation process. Second, using the results from the systematic review, a questionnaire (Implementation Determinants and Outcomes Questionnaire; IDOQ) examining the relationship between key determinants and implementation outcomes (from the Implementation Outcomes Framework) was created and refined through face validity. Third, implementation researchers were recruited to complete the IDOQ. Data was collected online via Qualtrics. The relationship between key determinants and outcomes were examined with multiple regression analyses. Results: Eight key determinants from the CFIR were identified in the systematic review: Leadership Engagement, Formally Appointed Internal Implementation Leaders, Compatibility, Available Resources, External Change Agents, Champions, Relative Advantage, and Key Stakeholders. Five experienced implementation researchers helped refine the IDOQ, including narrowing down the eight key determinants to five, through one on one face validity meetings. The IDOQ examined the relationship between five key determinants (Available Resources, Compatibility, Leadership Engagement, Formally Appointed Internal Implementation Leaders, External Change Agents) and five outcomes (Feasibility, Adoption, Fidelity, Penetration, Sustainability). In total, 208 implementation researchers completed the IDOQ. They reported on a wide variety of health related implementation projects. All five determinants were found to be significant predictors of at least one implementation outcome, with roughly half of the determinants functioning as a barrier and half as a facilitator. Organizational level determinants (Available Resources, Compatibility) more frequently predicted outcomes than individual/people focused determinants (Leadership Engagement, External Change Agents, Formally Appointed Internal Implementation Leaders). Implications and next steps are discussed. Significance: This study contributes to an emerging body of research on the relationship between implementation determinants and outcomes as well as recent efforts to assess implementation science more systematically. By narrowing down the vast number of determinants to identify those that have the greatest impact on the implementation process, and examining their relationship with implementation outcomes, we can improve the efficiency and effectiveness of implementation science.

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