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The application of implementation science theories for population health: A critical interpretive synthesis

1 Healthy Populations Institute, Dalhousie University, Canada
2 Faculty of Education, Mount Saint Vincent University, Canada
3 Faculty of Health, Dalhousie University, Canada
4 Faculty of Medicine, Dalhousie University, Canada
5 Faculty of Dentistry, Dalhousie University, Canada

Background and Purpose: Over the last decade, the field of implementation science (IS) has yielded an array of theoretical approaches to clarify and understand how factors influence the application and scaling-up of evidence-based practice in health care. These developments have led to questions about whether IS theories and frameworks might be of value to population health researchers and decision makers. The purpose of this research was to conduct a critical interpretive synthesis to explore, if, and how, key IS theories and frameworks might inform population health interventions aimed at reducing the burden of illness across populations. Methods: An initial list of theories and frameworks was developed based on previous published research and narrowed to focus on theories considered as formative for the field of IS. A standardized data extraction form was used to gather key features of the theories and critically appraise their relevance to population health interventions. Results: Ten theories were included in the review and six deemed most applicable to population health based on their consideration of broader contextual and system-level factors. The remaining four were determined to have less relevant components for population health due to their limited consideration of macro-level factors, often focusing on micro (individual) and meso (organizational) level factors. Conclusions: Theories and frameworks are important to guide the implementation and sustainability of population health interventions. The articulation of meso level factors common in IS theories may be of value to interventions targeted at the population level. However, some of the reviewed theories were limited in their consideration of broader contextual factors at the macro level (community, policy or societal). This critical interpretive synthesis also found that some theories lacked provision of practical guidance to address interventions targeting structural factors such as key social determinants of health (e.g., housing, income).
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Keywords implementation science; population health; theory; framework; critical review

Citation: Jessie-Lee McIsaac, Grace Warner, Logan Lawrence, Robin Urquhart, Sheri Price, Jacqueline Gahagan, Mary McNally, Lois A Jackson. The application of implementation science theories for population health: A critical interpretive synthesis. AIMS Public Health , 2018, 5(1): 13-30. doi: 10.3934/publichealth.2018.1.13


  • 1. Grimshaw JM, Eccles MP, Lavis JN, et al. (2012) Knowledge translation of research findings. Implement Sci.
  • 2. Eccles MP, Mittman BS (2006) Welcome to implementation science. Implement Sci 1: 1.    
  • 3. Nilsen P (2015) Making sense of implementation theories, models and frameworks. Implement Sci 10: 53.    
  • 4. Tabak RG, Khoong EC, Chambers DA, et al. (2012) Bridging research and practice: Models for dissemination and implementation research. Am J Prev Med 43: 337–350.    
  • 5. Hawe P, Potvin L (2009) What is population health intervention research? Can J Public Health 100: 8–14.
  • 6. Breuer E, Lee L, Silva MD, et al. (2015) Using theory of change to design and evaluate public health interventions: A systematic review. Implement Sci 11: 63.    
  • 7. Glasgow RE, Klesges LM, Dzewaltowski DA, et al. (2006) Evaluating the impact of health promotion programs: Using the RE-AIM framework to form summary measures for decision making involving complex issues. Health Educ Res 21: 688–694.    
  • 8. Birken SA, Powell BJ, Presseau J, et al. (2017) Combined use of the Consolidated Framework for Implementation Research (CFIR) and the Theoretical Domains Framework (TDF): A systematic review. Implement Sci 12: 2.    
  • 9. Kirk MA, Kelley C, Yankey N, et al. (2015) A systematic review of the use of the Consolidated Framework for Implementation Research. Implement Sci 11: 72.    
  • 10. Public Health Agency of Canada, What is the Population Health Approach, 2012. Available from: http://www.phac-aspc.gc.ca/ph-sp/approach-approche/index-eng.php.
  • 11. Edwards N, Barker PM (2014) The importance of context in implementation research. J Acquired Immune Defic Syndr 67: S157–S162.    
  • 12. Edwards N, Di RE (2011) Exploring which context matters in the study of health inequities and their mitigation. Scand J Public Health 39: 43–49.    
  • 13. Armstrong R, Waters E, Roberts H, et al. (2006) The role and theoretical evolution of knowledge translation and exchange in public health. J Public Health Oxf Engl 28: 384–389.    
  • 14. Brownson RC, Fielding JE, Maylahn CM (2009) Evidence-Based Public Health: A Fundamental Concept for Public Health Practice. Annu Rev Public Health 30: 175–201.    
  • 15. Rose G (2001) Sick individuals and sick populations. Int J Epidemiol 30: 427–432.    
  • 16. Public Health Agency of Canada, What Determines Health? 2001. Available from: http://www.phac-aspc.gc.ca/ph-sp/determinants/#What.
  • 17. Mikkonen J, Raphael D (2010) Social Determinants of Health: The Canadian Facts. Toronto: York University School of Health Policy and Management.
  • 18. Tricco AC, Antony J, Soobiah C, et al. (2016) Knowledge synthesis methods for generating or refining theory: A scoping review reveals that little guidance is available. J Clin Epidemiol 73: 36–42.    
  • 19. Kitson AL, Rycroftmalone J, Harvey G, et al. (2008) Evaluating the successful implementation of evidence into practice using the PARiHS framework: Theoretical and practical challenges. Implement Sci 3: 1.    
  • 20. Wacker J (1998) A definition of theory: Research guidelines for different theory-building research methods in operations management. J Oper Manag 16: 361–385.    
  • 21. Sabatier P, Weible C (2014) Theories of the Policy Process. Westview Press, 389–396.
  • 22. Hawe P, Di RE, Cohen E (2012) Frequently asked questions about population health intervention research. Can J Public Health Rev Can Sante Publique 103: e468–e471.
  • 23. United States National Library of Medicine, Population Health Search Strategy, 2016. Available from: https://www.nlm.nih.gov/services/queries/population_health_strategy.html.
  • 24. Lamari M, Ziam S (2015) Profile of knowledge brokering in the Web 2.0 era: Empirical evidences of emerging practices in the health sector in Quebec, Canada. Int Conf Inf Soc 2015: 344–352.
  • 25. Chambers BD, Ma A (2016) Applying an intervention framework to assess North Carolina's adolescent pregnancy prevention efforts. Sex Reprod Healthc 8: 102–104.    
  • 26. Horner RH, Kincaid D, Johnson N, et al. (2014) Scaling up School-Wide Positive Behavioral Interventions and Supports: Experiences of Seven States with Documented Success. J Posit Behav Interv 4: 197–208.
  • 27. Mckay VR, Margaret DM, Hoffer LD (2017) The dynamics of de-adoption: A case study of policy change, de-adoption, and replacement of an evidence-based HIV intervention. Transl Behav Med 2017: 1–11.
  • 28. Dogar O, Elsey H, Khanal S, et al. (2016) Challenges of Integrating Tobacco Cessation Interventions in TB Programmes: Case Studies from Nepal and Pakistan. J Smok Cessat 11:108–115.    
  • 29. Huang KY, Nakigudde J, Calzada E, et al. (2014) Implementing an early childhood school-based mental health promotion intervention in low-resource Ugandan schools: Study protocol for a cluster randomized controlled trial. Trials 15: 471.    
  • 30. Nathan N, Wiggers J, Wyse R, et al. (2017) Factors associated with the implementation of a vegetable and fruit program in a population of Australian elementary schools. Health Educ Res 32: 197–205.    
  • 31. Northridge ME, Kavathe R, Zanowiak J, et al. (2017) Implementation and dissemination of the Sikh American Families Oral Health Promotion Program. Transl Behav Med 7: 435–443.    
  • 32. Selove R, Foster M, Mack R, et al. (2017) Using an Implementation Research Framework to Identify Potential Facilitators and Barriers of an Intervention to Increase HPV Vaccine Uptake. J Public Health Manag Pract JPHMP 23: e1–e9.
  • 33. Mcmullen H, Griffiths C, Leber W, et al. (2015) Explaining high and low performers in complex intervention trials: A new model based on diffusion of innovations theory. Trials 16: 242.    
  • 34. Valaitis R, Macdonald M, Kothari A, et al. (2016) Moving towards a new vision: Implementation of a public health policy intervention. BMC Public Health 16: 412.    
  • 35. Aidoo M, Harpham T (2001) The explanatory models of mental health amongst low-income women and health care practitioners in Lusaka, Zambia. Health Policy Plan 16: 206–213.    
  • 36. Rogers AL, Weke E, Kwena Z, et al. (2016) Implementation of repeat HIV testing during pregnancy in Kenya: A qualitative study. BMC Pregnancy Childbirth 16: 1–11.    
  • 37. Price A, Schwartz R, Cohen J, et al. (2017) Assessing Continuous Quality Improvement in Public Health: Adapting Lessons from Healthcare. Healthc Policy Polit Sante 12: 34–49.    
  • 38. Lewis A, Kitson A, Harvey G (2016) Improving oral health for older people in the home care setting: An exploratory implementation study. Australas J Ageing 35: 273–280.    
  • 39. Roberge R, Louise F, Hélène B, et al. (2013) Implementing a knowledge application program for anxiety and depression in community-based primary mental health care: A multiple case study research protocol. Implement Sci 8: 26.    
  • 40. Spassiani NA, Harris SP, Hammel J, (2016) Exploring How Knowledge Translation Can Improve Sustainability of Community-based Health Initiatives for People with Intellectual/Developmental Disabilities. J Appl Res Intellect Disabil 29: 433–444.    
  • 41. Amemori M, Korhonen T, Michie S, et al. (2013) Implementation of tobacco use cessation counseling among oral health professionals in Finland. J Public Health Dent 73: 230–236.    
  • 42. Nicole N, Lin YS, Rachel S, et al. (2016) Effectiveness of a multicomponent intervention to enhance implementation of a healthy canteen policy in Australian primary schools: A randomised controlled trial. Int J Behav Nutr Phys Act 13: 106.    
  • 43. Weatherson KA, Gainforth HL, Jung ME (2017) A theoretical analysis of the barriers and facilitators to the implementation of school-based physical activity policies in Canada: A mixed methods scoping review. Implement Sci 12: 41.    
  • 44. Templeton AR, Young L, Bish A, et al. (2016) Patient-, organization-, and system-level barriers and facilitators to preventive oral health care: A convergent mixed-methods study in primary dental care. Implement Sci 11: 1–14.
  • 45. Durlak JA, Dupre EP (2008) Implementation matters: A review of research on the influence of implementation on program outcomes and the factors affecting implementation. Am J Community Psychol 41: 327–350.    
  • 46. Fixsen DL, Naoom SF, Blase KA, et al. (2005) Implementation research: A synthesis of the literature. Tampa Florida University of South Florida Louis De La Parte Florida Mental Health Institute National Implementation Research Network.
  • 47. Greenhalgh T, Robert G, Macfarlane F, et al. (2004) Diffusion of Innovations in Service Organizations: Systematic Review and Recommendations. Milbank Q 82: 581–629.    
  • 48. Ferlie EB, Shortell SM (2001) Improving the quality of health care in the United Kingdom and the United States: A framework for change. Milbank Q 79: 281–315.    
  • 49. Damschroder LJ, Aron DC, Keith RE, et al. (2009) Fostering implementation of health services research findings into practice: A consolidated framework for advancing. Implement Sci 4: 50.    
  • 50. Michie S, Johnston M, Abraham C, et al. (2005) Making psychological theory useful for implementing evidence based practice: A consensus approach. Qual Saf Health Care 14: 26–33.    
  • 51. Michie S, Stralen MMV, West R (2011) The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implement Sci 6: 42.    
  • 52. Kitson A, Harvey G, Mccormack B (1998) Enabling the implementation of evidence based practice: A conceptual framework. Qual Health Care QHC 7: 149–158.    
  • 53. Zahra SA, George G (2002) Absorptive capacity: A review, reconceptualization, and extension. Acad Manage Rev 27: 185–203.
  • 54. Klein KJ, Sorra JS (1996) The Challenge of Innovation Implementation. Acad Manage Rev 21: 1055–1080.
  • 55. Szulanski G (1996) Exploring internal stickiness: Impediments to the transfer of best practice within the firm: Exploring Internal Stickiness. Strateg Manag J 17: 27–43.    
  • 56. Goes JB, Friedman L, Seifert N, et al. (2000) A turbulent field: Theory, research, and practice on organizational change in health care. Adv Health Care Manage 1: 143–180.    
  • 57. Rogers EM (2003) Diffusion of Innovations, 5th edition. New York, NY: Free Press.
  • 58. Michie S, Atkins L, West R, (2014) The Behaviour Change Wheel: A Guide to Designing Interventions. Psychol 27: 709–710.
  • 59. West R (2006) Theory of Addition. Oxford, UK: Blackwell Publishing Ltd.
  • 60. Dobrow MJ, Goel V, Lemieux-Charles L, et al. (2006) The impact of context on evidence utilization: A framework for expert groups developing health policy recommendations. Soc Sci Med 63: 1811–1824.    
  • 61. Gagliardi AR, Webster F, Brouwers MC, et al. (2014) How does context influence collaborative decision-making for health services planning, delivery and evaluation? BMC Health Serv Res 14: 545.    
  • 62. Birken SA, Powell BJ, Shea CM, et al. (2017) Criteria for selecting implementation science theories and frameworks: Results from an international survey. Implement Sci 12: 124.    
  • 63. Flottorp SA, Oxman AD, Krause J, et al. (2013) A checklist for identifying determinants of practice: A systematic review and synthesis of frameworks and taxonomies of factors that prevent or enable improvements in healthcare professional practice. Implement Sci 8: 35.    
  • 64. Wu X, Ramesh M, Howlett M (2015) Policy capacity: A conceptual framework for understanding policy competences and capabilities. Policy Soc 34: 165–171.    
  • 65. Pawson R (2007) Evidence-based policy: A realist perspective. Aust New Zealand J Public Health 31: 193–196.


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