背景:实现科学框架探索,解释,并评估实施过程的不同组成部分。通过使用程序逻辑方法,可以组合具有不同目的的实现框架来详细说明复杂的交互。实施研究逻辑模型(IRLM)有助于实现因果路径和机制的发展。IRLM的关键要素因不同的研究设计而异,其对跨环境综合调查结果的适用性也未得到充分探索。这项研究的双重目的是从使用案例研究方法的实施研究中开发IRLM,并证明IRLM在案例站点中综合发现的实用性。
方法:描述了示例项目中使用的方法以及IRLM与案例研究方法的一致性。病例是使用复制逻辑故意选择的,代表在癌症或精神疾病患者的常规护理中嵌入锻炼的组织。选择了四个数据来源:与故意选择的工作人员进行半结构化访谈,组织文件审查,观察,以及使用计划可持续性评估工具(PSAT)进行的调查。使用了框架分析,每个病例点都制作了IRLM。确定了单个IRLM中的类似元素,提取,并重新制作以综合各站点的发现,并代表广义的,跨案例调查结果。
结果:IRLM被嵌入研究的多个阶段,包括数据收集,分析,报告透明度。在通知个体IRLM的站点确定了33-44个决定因素和36-44个实施策略。描述“干预适应性”的一般性发现的示例证明了跨站点实施策略的决定因素细节和机制的相似性。然而,不同的策略被用来解决类似的决定因素。依赖性和双向关系沿着影响实施结果的因果途径运作。
结论:案例研究方法有助于解决实施研究的优先事项,包括发展因果途径和机制。将IRLM嵌入案例研究方法中提供了结构,并增加了研究的透明度和可复制性。确定各个站点的相似元素有助于综合发现并对实施过程进行一般性解释。详细介绍这些方法为复制提供了一个示例,该示例可以在实施研究中构建可概括的知识。
BACKGROUND: Implementation science frameworks explore, interpret, and evaluate different components of the implementation process. By using a program logic approach, implementation frameworks with different purposes can be combined to detail complex interactions. The Implementation Research Logic Model (IRLM) facilitates the development of causal pathways and mechanisms that enable implementation. Critical elements of the IRLM vary across different study designs, and its applicability to synthesizing findings across settings is also under-explored. The dual purpose of this study is to develop an IRLM from an implementation research study that used
case study methodology and to demonstrate the utility of the IRLM to synthesize findings across
case sites.
METHODS: The method used in the exemplar project and the alignment of the IRLM to
case study methodology are described. Cases were purposely selected using replication logic and represent organizations that have embedded exercise in routine care for people with cancer or mental illness. Four data sources were selected: semi-structured interviews with purposely selected staff, organizational document review, observations, and a survey using the Program Sustainability Assessment Tool (PSAT). Framework analysis was used, and an IRLM was produced at each
case site. Similar elements within the individual IRLM were identified, extracted, and re-produced to synthesize findings across sites and represent the generalized, cross-case findings.
RESULTS: The IRLM was embedded within multiple stages of the study, including data collection, analysis, and reporting transparency. Between 33-44 determinants and 36-44 implementation strategies were identified at sites that informed individual IRLMs. An example of generalized findings describing \"intervention adaptability\" demonstrated similarities in determinant detail and mechanisms of implementation strategies across sites. However, different strategies were applied to address similar determinants. Dependent and bi-directional relationships operated along the causal pathway that influenced implementation outcomes.
CONCLUSIONS: Case study methods help address implementation research priorities, including developing causal pathways and mechanisms. Embedding the IRLM within the case study approach provided structure and added to the transparency and replicability of the study. Identifying the similar elements across sites helped synthesize findings and give a general explanation of the implementation process. Detailing the methods provides an example for replication that can build generalizable knowledge in implementation research.