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Abstract：
BACKGROUND: The process of tailored implementation is ill-defined and under-explored. The ItFits-toolkit was developed and subsequently tested as a self-guided online platform to facilitate implementation of tailored strategies for internet-based cognitive behavioural therapy (iCBT) services. In ImpleMentAll, ItFits-toolkit had a small but positive effect on the primary outcome of iCBT normalisation. This paper investigates, from a qualitative perspective, how implementation teams developed and undertook tailored implementation using the toolkit within the trial.
METHODS: Implementation teams in thirteen sites from nine countries (Europe and Australia) used the ItFits-toolkit for six months minimum, consistent with the trial protocol. A qualitative process evaluation was conducted. Descriptive data regarding goals, barriers, strategies, and implementation plans collected within the toolkit informed qualitative data collection in real time. Qualitative data included remote longitudinal interviews (n = 55) with implementation team members (n = 30) and observations of support calls (n = 19) with study sites. Qualitative data were analysed thematically, using a team-based approach.
RESULTS: Implementation teams developed and executed tailored implementation projects across all steps in the toolkit process. Working in a structured way but with room for flexibility, decisions were shaped by team members\' ideas and goals, iterative stakeholder engagement, internal and external influences, and the context of the ImpleMentAll project. Although teams reported some positive impacts of their projects, \'time\', both for undertaking the work, and for seeing project impacts, was described as a key factor in decisions about implementation strategies and assessments of success.
CONCLUSIONS: This study responds directly to McHugh et al.\'s (2022) call for empirical description of what implementation tailoring looks like in action, in service settings. Self-guided facilitation of tailored implementation enables implementers in service settings to undertake tailoring within their organisations. Implementation tailoring takes considerable time and involves detailed work but can be supported through the provision of implementation science informed guidance and materials, iterative and ongoing stakeholder engagement, and working reflectively in response to external influencing factors. Directions for advancement of tailored implementation are suggested.
METHODS: Implementation teams in thirteen sites from nine countries (Europe and Australia) used the ItFits-toolkit for six months minimum, consistent with the trial protocol. A qualitative process evaluation was conducted. Descriptive data regarding goals, barriers, strategies, and implementation plans collected within the toolkit informed qualitative data collection in real time. Qualitative data included remote longitudinal interviews (n = 55) with implementation team members (n = 30) and observations of support calls (n = 19) with study sites. Qualitative data were analysed thematically, using a team-based approach.
RESULTS: Implementation teams developed and executed tailored implementation projects across all steps in the toolkit process. Working in a structured way but with room for flexibility, decisions were shaped by team members\' ideas and goals, iterative stakeholder engagement, internal and external influences, and the context of the ImpleMentAll project. Although teams reported some positive impacts of their projects, \'time\', both for undertaking the work, and for seeing project impacts, was described as a key factor in decisions about implementation strategies and assessments of success.
CONCLUSIONS: This study responds directly to McHugh et al.\'s (2022) call for empirical description of what implementation tailoring looks like in action, in service settings. Self-guided facilitation of tailored implementation enables implementers in service settings to undertake tailoring within their organisations. Implementation tailoring takes considerable time and involves detailed work but can be supported through the provision of implementation science informed guidance and materials, iterative and ongoing stakeholder engagement, and working reflectively in response to external influencing factors. Directions for advancement of tailored implementation are suggested.
摘要：
背景：定制实施的过程定义不明确，探索不足。ItFits工具包被开发并随后作为一个自我指导的在线平台进行了测试，以促进实施基于互联网的认知行为治疗（iCBT）服务的量身定制策略。在ImpleMentAll,ItFits-toolkit对iCBT正常化的主要结果有很小但积极的影响。本文调查了,从定性的角度来看，实施团队如何使用试验中的工具包开发和进行量身定制的实施.
方法：来自9个国家（欧洲和澳大利亚）的13个站点的实施团队使用ItFits工具包至少6个月，与试验方案一致。进行了定性过程评估。关于目标的描述性数据，障碍,战略,和实施计划中收集的工具包通知实时的定性数据收集。定性数据包括与实施团队成员（n=30）的远程纵向访谈（n=55）和对研究地点的支持电话（n=19）的观察。定性数据进行了主题分析，使用基于团队的方法。
结果：实施团队在工具包流程的所有步骤中开发并执行了量身定制的实施项目。以结构化的方式工作，但有灵活性的空间，决策是由团队成员的想法和目标决定的，迭代的利益相关者参与，内部和外部影响，以及ImpleMentAll项目的上下文。尽管团队报告了他们项目的一些积极影响，\'时间\',都是为了承担这项工作，看到项目的影响，被描述为决定实施战略和评估成功的关键因素。
结论：本研究直接响应McHugh等人。(2022)呼吁对实施定制在行动中的样子进行实证描述，在服务设置中。定制实施的自我指导促进使服务环境中的实施者能够在其组织内进行定制。实施定制需要相当长的时间，涉及详细的工作，但可以通过提供实施科学指导和材料来支持，迭代和持续的利益相关者参与，并对外部影响因素做出反应。建议了推进定制实施的方向。
方法：来自9个国家（欧洲和澳大利亚）的13个站点的实施团队使用ItFits工具包至少6个月，与试验方案一致。进行了定性过程评估。关于目标的描述性数据，障碍,战略,和实施计划中收集的工具包通知实时的定性数据收集。定性数据包括与实施团队成员（n=30）的远程纵向访谈（n=55）和对研究地点的支持电话（n=19）的观察。定性数据进行了主题分析，使用基于团队的方法。
结果：实施团队在工具包流程的所有步骤中开发并执行了量身定制的实施项目。以结构化的方式工作，但有灵活性的空间，决策是由团队成员的想法和目标决定的，迭代的利益相关者参与，内部和外部影响，以及ImpleMentAll项目的上下文。尽管团队报告了他们项目的一些积极影响，\'时间\',都是为了承担这项工作，看到项目的影响，被描述为决定实施战略和评估成功的关键因素。
结论：本研究直接响应McHugh等人。(2022)呼吁对实施定制在行动中的样子进行实证描述，在服务设置中。定制实施的自我指导促进使服务环境中的实施者能够在其组织内进行定制。实施定制需要相当长的时间，涉及详细的工作，但可以通过提供实施科学指导和材料来支持，迭代和持续的利益相关者参与，并对外部影响因素做出反应。建议了推进定制实施的方向。
