What is the difference between implementation and intervention

As already noted, establishing a firm theoretical foundation for clinical and implementation interventions can leverage potential synergies and address challenges [ 40 , 41 ].

There is a substantial body of literature on models and frameworks available, highlighting core concepts and distinguishing features running across multiple implementation frameworks [ 40 , 42 — 44 ]. However, it is important to note that, at this point, frameworks are mostly descriptive, rather than predictive or prescriptive [ 44 ]. Nevertheless, they offer a useful way to understand the potential greyness that can influence outcomes when clinical interventions and implementation interventions are studied together as hybrids, as presented in the falls prevention and stroke rehabilitation examples.

In the case of the falls prevention example, the clinical intervention is based on evidence from clinical trials testing for example the influence of restraints, medications, or balance exercise [ 20 ], and for stroke rehabilitation, different types of exercise and team compositions [ 28 ].

This demonstrates what we have found to be common, namely that the clinical intervention does not necessarily come with a theory, but with robust evidence corresponding to the type C scenario in the 2x2 , whereas the implementation intervention in our case is emphasized by a careful selection of theories [ 33 ]. To inform the testing of implementation strategies, hypotheses based on theory can support the identification of potential influences between the clinical intervention and the implementation intervention a priori, during or after a study with dual foci - and can thus assist in teasing out potential greyness.

Yet, many implementation projects do not consider or incorporate theory in a systematic way; Davies et al.

Yet, we have found that implementation interventions are reinforced by theories related to the content of the implementation and by process frameworks to guide the logistics of the implementation. If well integrated in the design of the project, theory can guide the direction of the study, and support the analysis and reporting of the process and its outcomes, which is beneficial for both the health care research and clinical communities.

Frameworks and models related to clinical intervention and implementation research have some key differences that can be used to address various variables [ 43 , 44 ].

At a minimum, being aware of the characteristics will clarify what to look for when selecting frameworks. Generally speaking, clinical intervention frameworks tend to address innovation factors in a comprehensive way, whilst implementation frameworks typically have more stages, address sustainability, and cover more details about the degree and depth of strategies and evaluation [ 44 ].

Inclusion of the core components of the implementation intervention could be helpful in cases where the clinical intervention itself is more clearly defined or has more evidence than the implementation intervention, as in the falls prevention and stroke rehabilitation examples. Researchers can then look to implementation frameworks to ensure comprehensive coverage of aspects informing implementation and evaluation [ 43 ].

Similarly, in both the falls prevention and stroke rehabilitation examples, attention was given to details like the pre-implementation activities needed to secure leadership support, as well as evaluation of the implementation intervention. This can assist in detecting and understanding potential links between the clinical intervention and the implementation intervention.

Another aid in identifying and reporting greyness between clinical and implementation interventions is consistent reporting of clinical and implementation intervention studies.

With challenges of testing and reporting findings from clinical interventions and implementation interventions equally well-documented [ 45 — 51 ], determinants of both healthcare practice and implementation have been outlined [ 40 , 42 ].

The EQUATOR network database provides a useful reference point for guidelines that could be helpful in the reporting of hybrid clinical intervention-implementation intervention studies [ 40 , 42 — 44 ]. With a limited number of guidelines to help address the potential greyness, we have examined two reporting guidelines for potential use with hybrid clinical and implementation interventions: the Criteria for Reporting the Development and Evaluation of Complex Interventions in healthcare CReDECI2 andcbv the Template for Intervention Description and Replication TIDieR.

The CReDECI2 allows for a broad range of study designs and captures elements important to the contextual aspects of implementation [ 55 ].

Likewise, TIDieR does not map onto a particular study design but focuses on healthcare interventions, requiring an explanation of theory, context, intermediaries, and outcomes [ 56 ]. The latter provides a useful template for illustrating the greyness between clinical and implementation interventions by enabling a clearer picture of the details that distinguish the intervention from others like it, and the distinctions that are important for implementation.

By comparison, CReDECI would draw out the core components for example, stroke rehabilitation , along with the theory underpinning the implementation intervention in this case the Promoting Action on Research Implementation in Health Services framework and the Ottawa Model of Implementation Leadership [ 38 ].

Further, in the stroke rehabilitation study, the national stroke guidelines were assessed for feasibility and usefulness, and data on context was collected, including for example leadership, culture, and organizational structure, in alignment with the criteria of CReDECI related to facilitators, barriers, and external factors that influence implementation.

Had they been reported, further transparency would have been provided on the applicability of a clinical intervention and how the implementation intervention worked in the particular context. The item checklist of STaRI focuses on defining the intervention: details, core components, and adaptations along with their relationship to treatment outcomes, implementation outcomes, and adverse events [ 48 ]. The implementation focus of STaRI covers a breadth of factors including setting, participants, providers, and generalisability and transferability to other contexts, with an explicit distinction between clinical outcomes and implementation outcomes.

Considering the comprehensiveness of reporting guidelines, CReDECI2 and STaRI stand out in terms of the explicit reporting they require with regards to: theory underpinning both the clinical intervention and implementation intervention; outcomes intervention impact and process implementation ; context internal and external , and; level of detail for the intervention, fidelity, costs, and adaptations during the project.

While we have applied neither of these guidelines in the clinical intervention and implementation intervention studies presented in this paper, we suggest that both of these reporting tools offer promising routes to tease out potential greyness in clinical and implementation interventions in the future.

The initial semantic exercise of this discussion proposes clarity of definitions as a primary means to avoid greyness in terms of intervention and implementation. Further, adding appropriate attributes would help distinguish a clinical intervention from an implementation intervention.

Our discourse implies that researchers should address both deliberate and unintentional aspects of study processes and outcomes, in order to provide the most thorough illustration possible. This would support health care professionals to better judge whether or not particular findings apply, and scientists to make informed choices.

We suggest a simple exercise such as the 2x2 matrix can aid in assessing what is the current state of the evidence regarding the clinical intervention and the implementation intervention , indicating opportunities and measures required in hybrid design studies. As further illustrated, by means of the clinical interventions and implementation intervention examples, there are designs, theories, frameworks and models that can aid in addressing what is what, and any potential greyness prior to, throughout, and post a hybrid clinical-implementation intervention study.

In addition, while there is a call for theoretical foundations to be reported in terms of the clinical intervention and implementation details see Table 3 , we have found no clear, one-size-fits-all approach either to theories, frameworks and models, or reporting guidelines.

This paper is a reflection on clinical interventions and implementation interventions, and the potential greyness in between. While semantics illustrate similarity, we suggest that the terms are not synonymous. Our falls prevention and stroke rehabilitation cases illustrate potential greyness as to what is a clinical intervention and what is an implementation intervention, with opportunities to tease out some of the ambiguities.

We suggest that using appropriate designs, frameworks and models, alongside reporting guidelines that lend themselves to hybrid clinical-implementation intervention studies offers a way to add clarity to the design, conduct and evaluation. This input may be beneficial to scholars and healthcare professionals alike.

To conclude, we hope that this paper stimulates further clinical and academic exploration and discourse. Kitson, University of Adelaide, Australia for sharing the initial 2x2-illustration and providing opportunities for discussing its role in the paper. ACE constructed a full paper, uniting and reforming the manuscript.

All authors read and approved the final manuscript. Ann Catrine Eldh, Email: es. Joan Almost, Email: ac. Kara DeCorby-Watson, Email: ac. Wendy Gifford, Email: ac. Gill Harvey, Email: ua.

Henna Hasson, Email: es. Deborah Kenny, Email: ude. Sheila Moodie, Email: ac. Lars Wallin, Email: es. Jennifer Yost, Email: ac. National Center for Biotechnology Information , U. Published online Jan 7. Author information Article notes Copyright and License information Disclaimer. Corresponding author. Received Jul 15; Accepted Dec This article has been cited by other articles in PMC. Abstract Background There is increasing awareness that regardless of the proven value of clinical interventions, the use of effective strategies to implement such interventions into clinical practice is necessary to ensure that patients receive the benefits.

Discussion To begin, we consider the similarities, differences and potential greyness between clinical interventions and implementation interventions through an overview of concepts. Background There is increasing global awareness among scientists, healthcare professionals, and decision-makers, that regardless of how valuable clinical interventions may be, they scarcely implement themselves.

Main text The suggested greyness: when and why it occurs, and how does it show? Table 1 Definitions to the verb Intervene, and to the noun Intervention. Term Exclusive definitions Intervene To occur, fall, or come between points of time or events [ 6 , 7 ] To interfere with the outcome or course, esp. Open in a separate window. Table 2 Definitions to the verb Implement, and the noun Implementation. Stroke rehabilitation — a clinical intervention For a person affected by stroke with a residual limitation in activities of daily life ADL , training in ADL in the home setting after discharge is a top priority [ 27 ]; the evidence is as credible for this clinical intervention as it is for the commencement of intravenous thrombolytic treatment within 3 h of the stroke onset [ 28 ].

An implementation intervention applied to clinical interventions for falls prevention and stroke rehabilitation The decisions healthcare leaders make about priorities, commitments and support are critical for staff to change clinical practice and adopt new innovations [ 30 — 33 ]. Consistent with previous research and theory on leadership for change [ 31 — 36 ], an implementation intervention focusing on leadership could include: creating a sense of urgency to address the clinical issue in this case: falls, and associated risks for injuries and mortality, and stroke rehabilitation practices , understanding the gap between current practice and effective practice e.

Home Learn What is Implementation Science? Who Uses Implementation Science? What is Implementation Science? An Introduction to the Science Interventions and evidence based practices that are poorly implemented — or not implemented at all — do not produce expected health benefits.

Please note that some articles will require a journal subscription to access the full text. Defining Implementation Science As it is a fairly new field of study, there are many published definitions of implementation science which range from narrow to broad. Implementation science is fundamentally concerned with identifying effective strategies for implementing evidence-based interventions. Therefore it is critical to understand the difference in what is meant by implementation strategies and evidence based interventions.

Implementation strategies are the actions taken to enhance adoption, implementation, and sustainability of evidence based interventions. Evidence based interventions are programs, practices, principles, procedures, products, pills, or policies that have been demonstrated to improve health behaviors, health outcomes, or health-related environments.

Evidence based interventions are the what that is being implemented. Implementation strategies are how we seek to get evidence based interventions into normal practice in clinical or community settings. The aim of this article is to propose a taxonomy that distinguishes between different categories of theories, models and frameworks in implementation science, to facilitate … BMC Health Serv Res.

Sustainability of intervention components changed thorough the implementation period within centers. The implementation strategy used showed moderate-to-good performance on process indicators related to adoption, reach, and implementation of the evidence-based healthy lifestyle promotion intervention in the context of routine primary care. This effect can be determined through the conduct of individual studies or knowledge syntheses for example, systematic reviews , and knowledge tools e.

Can you put polyurethane on a laminate floor? Rather, the use of effective strategies to implement evidence-based clinical interventions into practice is necessary to ensure that patients receive the benefits. Springfield, Mass. CAS What are the 5 steps in cleaning kitchen premises? The EQUATOR network database provides a useful reference point for guidelines that could be helpful in the reporting of hybrid clinical intervention-implementation intervention studies [40, 42—44].

It embraces change as a central influence on sustainability and anchors its model around seven evidence-based tenants: 1 evidence collected in one narrow context cannot be expected to apply in a vastly different context, so an intervention should not be optimized before implementation; 2 interventions are not static and can be continually improved; 3 evaluation measures need to be relevant to patient outcomes and sensitive to the fit between intervention … summative i.

This conversation should be informed by the 2. J Safety Res. Specializes in Step-down, cardiac. How do different substances have different amounts of calories? Consequently, is implication and implementation the same? Intervention vs. Greenland struggles with a high prevalence of smoking, alcohol and drug abuse.

Implementing Effective Interventions is a process of assuring that key aspects of promising approaches are put into practice as intended and to meet local needs. Implementation research is important in global health because it addresses the challenges of the know—do gap in real-world settings and the practicalities of achieving national and global health goals.

All authors read and approved the final manuscript. A systematic review of the use of theory in the design of guideline dissemination and implementation strategies and interpretation of the results of rigorous evaluations. Such hybrid designs may increase the potential ambiguity in relation to what comprises the clinical intervention and the implementation intervention.

Found inside — Page When comparing the degree of implementation for different interventions , inferential