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Fig. 1 | Implementation Science Communications

Fig. 1

From: Identifying core strategies and mechanisms for spreading a national medicines optimisation programme across England—a mixed-method study applying qualitative thematic analysis and Qualitative Comparative Analysis

Fig. 1

Causal diagram showing the connection between TCAM spread strategies/mechanisms and contextual determinants. The causal diagram shows the connection between cross-case themes for contextual determinants on the right (light grey) and themes for spread strategies and mechanisms on the left (dark grey). Themes for strategies and mechanisms are grouped by second-order theme and divided into sub-categories of key first-order themes for spread strategies. Themes for contextual determinants are grouped following the Consolidated Framework for Implementation Research (CFIR) [33] into outer contextual factors differentiated by national and local levels, characteristics of the innovation (TCAM), and individual stakeholder characteristics. Sub-categories of contextual determinants were classified as either pre-condition, moderator, or mediator explaining further how they are influencing strategies/mechanisms [19]. Arrows are showing the connection or influence between the groups (not between specific sub-categories). A clear mediator was the inclusion of TCAM into standard contracts at the end of the national programme, making it de facto mandatory to implement TCAM for adopters which reportedly started to increase the adoption rate and impacted the effectiveness or need for spread strategies. There are a few contextual factors that were classified as pre-conditions such as financial resources provided to AHSNs to fund spread strategies and scientific and real-world evidence about TCAM which were the backbone of dissemination and capacity-building activities. The other contextual factors can be seen as moderators affecting the speed and success of spread strategies such as, for example, availability of implementation guidance provided by the national leadership team, the availability of a local need for TCAM, the level of capacity and readiness of adopters for TCAM (both of organisations and individual stakeholders), the flexibility of the TCAM software allowing for adaptation, and the possibilities to share learning among spread facilitators

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Implementation Science Communications

ISSN: 2662-2211