Table 1 Theoretical application within the study and operational definitions/measures for implementation outcomes
Framework | Application to research study | ||
|---|---|---|---|
Consolidated Framework for Implementation Research (CFIR) | The CFIR is applied in this study to identify and describe the determinants that influenced implementation at each site. The semi-structured interview guide was developed with reference to the CFIR interview building tool. During data analysis, each CFIR construct was established as a code and as examples were identified, they were indexed to the relevant determinant. | ||
Expert Recommendations for Implementing Change (ERIC) | The ERIC taxonomy is applied in the study to develop consistent descriptions of the actions undertaken at each case site used to facilitate implementation. The ERIC—discrete implementation strategy compilation with ancillary material (Additional file 6)—provided a reference tool that aided data collection and interpretation of data sources. During data analysis, each ERIC strategy was applied as a code. As examples were identified, they were indexed to the relevant ERIC strategy. | ||
Implementation outcomes framework | The Implementation Outcomes Framework defines 8 implementation outcomes, of which this study focused on 4: acceptability, fidelity, penetration, and sustainability. Each implementation outcome was operationalized and a measure defined which guided data collection (see below). During data analysis each implementation outcome was established as a code and as examples were identified, they were indexed to the relevant implementation outcome. | ||
Operational definition for implementation outcome | Measure | ||
Acceptability | How is exercise EBI perceived in the organization? | Direct question | |
Fidelity | Comparison of exercise EBI protocol with what is delivered as measured by dose/amount and quality of program delivery | Dose/amount Quality | Sessions/duration per week Total program delivered versus intended amount (dose delivered) Attendance rates (dose received) Evidence of training to support delivery |
Penetration | Measured at the service level (reach) and at the organizational system level (policies/procedures that evidence the EBI) | Reach System level penetration | Number of people who use the service versus total population Evidence of job descriptions, budget, and strategic plans that reference the exercise EBI |
Sustainability | Evidence of continued health benefit, program components and evolution overtime | Health benefits Program components Evolution | Process exits to measure health benefits in patients Survey (PSAT) Survey (PSAT) |