PDF(Pubmed)
Abstract：
Implementation strategies are systematic approaches to improve the uptake and sustainability of evidence-based interventions. They frequently focus on changing provider behavior through the provision of interventions such as training, coaching, and audit-and-feedback. Implementation strategies often impact intermediate behavioral outcomes like provider guideline adherence, in turn improving patient outcomes. Fidelity of implementation strategy delivery is defined as the extent to which an implementation strategy is carried out as it was designed. Implementation strategy fidelity measurement is under-developed and under-reported, with the quality of reporting decreasing over time. Benefits of fidelity measurement include the exploration of the extent to which observed effects are moderated by fidelity, and critical information about Type-III research errors, or the likelihood that null findings result from implementation strategy fidelity failure. Reviews of implementation strategy efficacy often report wide variation across studies, commonly calling for increased implementation strategy fidelity measurement to help explain variations. Despite the methodological benefits of rigorous fidelity measurement, implementation researchers face multi-level challenges and complexities. Challenges include the measurement of a complex variable, multiple data collection modalities with varying precision and costs, and the need for fidelity measurement to change in-step with adaptations. In this position paper, we weigh these costs and benefits and ultimately contend that implementation strategy fidelity measurement and reporting should be improved in trials of implementation strategies. We offer pragmatic solutions for researchers to make immediate improvements like the use of mixed methods or innovative data collection and analysis techniques, the inclusion of implementation strategy fidelity assessment in reporting guidelines, and the staged development of fidelity tools across the evolution of an implementation strategy. We also call for additional research into the barriers and facilitators of implementation strategy fidelity measurement to further clarify the best path forward.
摘要：
实施战略是改善循证干预措施的吸收和可持续性的系统方法。他们经常通过提供培训等干预措施来改变提供者的行为，Coaching,以及审计和反馈。实施策略通常会影响中间行为结果，例如提供者指南的依从性，反过来改善患者的预后。实施战略交付的保真度定义为实施战略按照设计执行的程度。实施策略保真度测量的开发不足和报告不足，报告质量随着时间的推移而下降。保真度测量的好处包括探索保真度在多大程度上缓和了观察到的效果，以及关于III型研究错误的关键信息，或实现策略保真度失败导致空发现的可能性。对实施战略有效性的评论经常报告不同研究的差异很大，通常要求增加实施策略的保真度测量，以帮助解释变化。尽管严格的保真度测量在方法学上有好处，实施研究人员面临多层次的挑战和复杂性。挑战包括复杂变量的测量，具有不同精度和成本的多种数据收集方式，以及保真度测量需要随着适应而变化。在这份立场文件中，我们权衡这些成本和收益,并最终认为在实施策略试验中,实施策略保真度测量和报告应得到改进.我们为研究人员提供务实的解决方案，以立即进行改进，例如使用混合方法或创新的数据收集和分析技术，将实施战略忠诚度评估纳入报告指南，以及在实施策略的演变过程中分阶段开发保真度工具。我们还呼吁对实施战略保真度衡量的障碍和促进者进行更多研究，以进一步阐明最佳前进道路。
