Implementation science is defined as “the scientific study of methods to promote the systematic uptake of research findings and other evidence‐based practices into routine practice and, hence, to improve the quality and effectiveness of health services and care”(p.1) (Eccles & Mittman 2006). This field of inquiry emerged out of a need to address the ongoing difficulties associated with getting research into practice (Nilsen, P 2015). It is well documented that existing barriers are a main contributor to the discrepancy between evidence-based recommendations and practice (Rainbird 2006; Pearson, Field & Jordan 2007). The findings of a systematic review identified three overarching domains related to barriers and facilitators of implementing evidence into practice: system, staff and intervention (Geerligs et al. 2018). System-level barriers and facilitators include environmental context (staff time, workload, workflow, space and staff turnover), culture (attitude to change, commitment, motivation, roles/trust and champions), communication processes and external requirements (reporting, standards and guidelines) (Geerligs et al. 2018). Staff-level barriers and facilitators include staff commitment and attitude, understanding and awareness, identification of individual roles, skills, ability and confidence. (Geerligs et al. 2018) Barriers and facilitators related to the intervention include the ease of integration (complexity, costs and required resources), validity of the evidence base, safety, legal and ethical concerns, and supportive components such as education and training, marketing and awareness (Geerligs et al. 2018).
Implementation science seeks to understand these barriers and facilitators, and to empower health professionals to utilise evidence-based approaches with the end goal of improving the quality and service of healthcare (Tabak et al. 2012). Implementation has been defined as “the methods to promote the systematic uptake of clinical research findings and other evidence-based practices into routine practice and hence improve the quality and effectiveness of healthcare policy and practice” (p.1) (Eccles & Mittman 2006).
A variety of theoretical approaches, models and frameworks are prescribed within this field, with the central aim to assist in developing a better understanding and explanation of why and how implementation succeeds or fails (Atkins et al. ; Ayanian & H. 2016; Brown & McCormack 2005; Gardner, Gardner & O'Connell 2014; Graham et al. 2006; Khalil 2017; Kitson, Harvey & McCormack 1998; Nilsen, 2015; Prochaska & DiClemente 1983; Rogers 1995; Rycroft-Malone & Bucknall 2010; Rycroft-Malone et al. 2002). Table 1 below details some of the existing frameworks and models available to assist with the implementation of evidence into practice. The list is by no means a comprehensive list of all existing frameworks and models, but it does highlight the complexity involved in getting evidence into practice. A recent review examining the differences and similarities of research translation frameworks identified 41 frameworks and models, with the four most published and cited frameworks being the Reaching Effectiveness Adoption Implementation Management (RE-AIM) framework, Knowledge to Action (KTA) framework, knowledge translation continuum models, or “T” models, and the PARiHS frameworks. All identified frameworks described the gap that exists between research knowledge and its application into policy and practice, and all acknowledged the importance and difficulty in closing this gap (Milat & Li 2017). A plethora of published information is available on the different frameworks and models.
Table 1: Description of Implementation Theories, Models and Frameworks
Theory / Model / Framework
Diffusion of innovation model
Health education theory model
JBI implementation framework
Knowledge to action (KTA) framework
Research implementation expressed as a function of the relationships among evidence, context and facilitation:
The model is cyclic comprising four stages:
Social theory model
Theoretical domains framework
The triple C model
Translation research continuum or “T’” models