Although progress has been made in conceptualising implementation research over the past decade,1 considerable confusion persists about its terminology and scope.2 3 4 The word “implement” comes from the Latin “implere,” meaning to fulfil or to carry into effect.5 This provides a basis for a broad definition of implementation research that can be used across research traditions and has meaning for practitioners, policy makers, and the interested public: “Implementation research is the scientific inquiry into questions concerning implementation—the act of carrying an intention into effect, which in health research can be policies, programmes, or individual practices (collectively called interventions).”. Implementation research in health: a practical guide. Read more on How to Write a Research Paper. The best time to writing a research plan is soon after you’ve completed your research paper proposal, while you are immersed in learning about your topic. Implementation research can consider any aspect of implementation, including the factors affecting implementation, the processes of implementation, and the results of implementation, including how to introduce potential solutions into a health system or how to promote their large scale use and sustainability. Designing and conducting mixed methods research. Other factors that influence implementation may need to be considered in implementation research. If you intend to explore these differences, state your goal clearly in the research plan so you can discuss it later with your professor. The large array of contextual factors that influence implementation, interact with each other, and change over time highlights the fact that implementation often occurs as part of complex adaptive systems.10 Some implementation strategies are particularly suitable for working in complex systems. Mixed methods research uses both qualitative and quantitative methods of data collection and analysis in the same study. The compact edition of the Oxford English dictionary. Copyright © 2020 BMJ Publishing Group Ltd 京ICP备15042040号-3, Implementation research: what it is and how to do it, http://whatiskt.wikispaces.com/Implementation+Research, Hounslow and Richmond Community Healthcare NHS Trust: 2 x Consultant Paediatrician, Worcestershire Acute Hospitals NHS Trust: Consultant Radiologists, University Hospitals of Leicester NHS Trust: Consultant Rheumatologist, Milton Keynes University Hospital NHS Foundation Trust: Clinical Oncologist Breast and Urology, University Hospitals of Leicester NHS Trust: Consultant Gastroenterologist, Women’s, children’s & adolescents’ health. This might include testing the effectiveness of a package of delivery and postnatal care in under-served areas, as well testing several strategies for providing the care. Give the answers if you have them, or say plainly that you don’t know so your instructor can help. The box gives a set of basic questions to guide the design or reporting of implementation research that can be used across methods. This paper has identified a range of qualitative, quantitative, and mixed methods that can be used according to the specific research question, as well as several research designs that are particularly suited to implementation research. Now you have an understanding of how to write a case study paper. The field of implementation research is growing, but it is not well understood despite the need for better research to inform decisions about health policies, programmes, and practices. Assessing the evidence base. Your instructor can be a great source of feedback here. OA prepared the original figure. You will probably develop this research strategy gradually and, if you are like the rest of us, you will make some changes, large and small, along the way. Does the research clearly aim to answer a question concerning implementation? Answer: Research implications basically refer to impact that your research might have on future research or policy decision or the relevant field of interest of your study. In some situations, a research paper is also called a "lab report." Effectiveness-implementation hybrid designs are intended to assess the effectiveness of both an intervention and an implementation strategy.7 These studies include components of an effectiveness design (for example, randomised allocation to intervention and comparison arms) but add the testing of an implementation strategy, which may also be randomised. Sage Publications, 2011. Curran and colleagues defined an “implementation intervention” as a method to “enhance the adoption of a ‘clinical’ intervention,” such as the use of job aids, provider education, or audit procedures.7 The concept can be broadened to any type of strategy that is designed to support a clinical or population and public health intervention (for example, outreach clinics and supervision checklists are implementation strategies used to improve the coverage and quality of immunisation). Are you being served? Next, turn to the heart of this exercise, your proposed research strategy. New tools for measuring service delivery. DHP and OA did the literature reviews, and DHP wrote the original outline and the draft manuscript, tables, and boxes. A wide range of qualitative and quantitative research methods can be used in implementation research (table 2⇑). They may have changed a bit since your original proposal. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. With your instructor’s help, you should make some basic decisions about what information to collect and what methods to use in analyzing it. You also need to clear this research in advance with the appropriate authorities at your school, such as the committee that reviews proposals for research on human subjects. Likewise, in the humanities, you might consider how different theories offer different insights and contrasting perspectives on the particular novel or film you are studying. Contributors: All authors contributed to the conception and design, analysis and interpretation, drafting the article, or revising it critically for important intellectual content, and all gave final approval of the version to be published. This is usually the case when the investigation in question pertains to an experiment that was conducted in lab-like conditions. Implementation research is a growing but not well understood field of health research that can contribute to more effective public health and clinical policies and programmes. Tashakkori A, Teddlie C. Mixed methodology: combining qualitative and quantitative approaches. Be concrete. In: Amin S, Das J, Goldstein M, eds. If so, then you might want to explore these differences in your thesis and explain why some theories work better (or worse) in this particular case. Does the research involve an implementation strategy? If you plan to use case studies, say whether you have already selected them or settled on the criteria for choosing them. Although most participatory action methods involve qualitative methods, quantitative and mixed methods techniques are increasingly being used, such as for participatory rural appraisal or participatory statistics.25 26. Implementation research questions can cover a wide variety of topics and are frequently organised around theories of change or the type of research objective (examples are in supplementary table C).12 13. What test instruments or observational techniques will you use? 'How will your research affect the targeted community or subject field' is the question that implications will answer. The structure of the health systems (for example, the roles played by governments, non-governmental organisations, other private providers, and citizens) is particularly important for implementation research on health. You can search for specific help, or browse resources by category. Health Facility Assessment Technical Working Group. Develop a tentative research plan early in the project. Does the research appropriately consider implementation outcome variables? Addresses the main questions you propose in your thesis; Relies on materials to which you have access; Can be accomplished within the time available; Divide your topic into smaller projects and do research on each in turn. This is followed by a typical implementation research question based on each objective. Finally, we describe a set of research methods for each type of research question. You should also discuss whether your research requires any special skills and, of course, whether you have them. Peters DH, Tran N, Adam T, Ghaffar A. Then, follow the structure of a problem solution paper and polish the paper so it is at its best when you turn it in. Because implementation activities and effects are not usually static or linear processes, research designs often need to be able to observe and analyse these sometimes iterative and changing elements at several points in time and to consider unintended consequences. They may have changed a bit since your original proposal. How reliable and valid are they? One thing that all proposal essays have in common is that they present the audience with an issue or problem and propose an action or solution. How will you recruit your test subjects, and how many will be included in your sample? Is the research conducted in a “real world” setting? Implementation research uses these variables to assess how well implementation has occurred or to provide insights about how this contributes to one’s health status or other important health outcomes. But you are further along now, and you can flesh out your answers. technical support for your product directly (links go to external sites): Thank you for your interest in spreading the word about The BMJ. However, sometimes you need to write a case study within hours. Dissemination and implementation research in health: translating science to practice. Does the research appropriately consider changes over time and the level of complexity of the system, including unintended consequences? Most likely, you’ve addressed some of these issues in your proposal. Such strategies have implications for research, as the study methods need to be sufficiently flexible to account for changes or adaptations in what is actually being implemented.8 11 Research designs that depend on having a single and fixed intervention, such as a typical randomised controlled trial, would not be an appropriate design to study phenomena that change, especially when they change in unpredictable and variable ways. Your essay will be about implementing your solution. The nature of the inquiry (for example, the amount of risk and considerations of ethics, costs, and timeliness), and the interests of different audiences, should determine the level of uncertainty.8 14 Research questions concerning programmatic decisions about the process of an implementation strategy may justify a lower level of certainty for the manager and policy maker, using research methods that would support an adequacy or plausibility inference.14 Where a high risk of harm exists and sufficient time and resources are available, a probability study design might be more appropriate, in which the result in an area where the intervention is implemented is compared with areas without implementation with a low probability of error (for example, P< 0.05). World Health Organization, 2012. In: Research design: qualitative, quantitative and mixed methods approaches. What will be most rewarding and interesting to me?”. World Bank, 2008:19-66. If these questions bear on a particular theory or analytic perspective, state that briefly. What will be most productive?” At a more personal level: “What kinds of research best fit my skills and training? Write it down and share it with your instructor. We do not capture any email address. These include strategies to provide feedback to key stakeholders and to encourage learning and adaptation by implementing agencies and beneficiary groups. Context can include the social, cultural, economic, political, legal, and physical environment, as well as the institutional setting, comprising various stakeholders and their interactions, and the demographic and epidemiological conditions. If you plan to conduct tests, experiments, or surveys, discuss them, too. Assessment of health facility performance: an introduction to data and measurement issues. Implementation outcome variables describe the intentional actions to deliver services.6 These implementation outcome variables—acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, coverage, and sustainability—can all serve as indicators of the success of implementation (table 1⇓). Oxford University Press, 1971. DHP is supported by the Future Health Systems research programme consortium, funded by DFID for the benefit of developing countries (grant number H050474). Improving health services in developing countries: from evidence to action. You can—and should—tailor your work to fit your skills. This implies working with populations that will be affected by an intervention, rather than selecting beneficiaries who may not represent the target population of an intervention (such as studying healthy volunteers or excluding patients who have comorbidities). This article provides a broad definition of implementation research and outlines key principles for how to do it. A review of ways to improve health service delivery in low and middle income countries identified a wide range of successful implementation strategies (supplementary table B).8 Even in the most resource constrained environments, measuring change, informing stakeholders, and using information to guide decision making were found to be critical to successful implementation. This article focuses on the context and factors affecting implementation, the key audiences for the research, implementation outcome variables that describe various aspects of how implementation occurs, and the study of implementation strategies that support the delivery of health services, programmes, and policies. Write informally as you do research; do not postpone this prewriting until all your research is complete. Many different schemes exist for describing different types of mixed methods research, on the basis of the emphasis of the study, the sampling schemes for the different components, the timing and sequencing of the qualitative and quantitative methods, and the level of mixing between the qualitative and quantitative methods.27 28 Broad guidance on the design and conduct of mixed methods designs is available.29 30 31 A scheme for good reporting of mixed methods studies involves describing the justification for using a mixed methods approach to the research question; describing the design in terms of the purpose, priority, and sequence of methods; describing each method in terms of sampling, data collection, and analysis; describing where the integration has occurred, how it has occurred, and who has participated in it; describing any limitation of one method associated with the presence of the other method; and describing any insights gained from mixing or integrating methods.32, Implementation research aims to cover a wide set of research questions, implementation outcome variables, factors affecting implementation, and implementation strategies.
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