Table 2 Published examples of systems analysis methods being used to study implementation mechanisms

Agent-based modeling

Computational modeling that simulates actions and interactions of actors (e.g., individuals, groups, and/or organizations) within a system, as well as system behavior and outcomes emerging from the interactions of these actors and each actor’s assigned characteristics [30]

Testing the hypothesis that actors strongly identifying with their organizations is a mechanism that drives intraorganizational behavioral divergence and network polarization for the implementation of evidence-based practices [31]

[32, 33]

Causal pathway diagramming

Visual representation of causal, dynamic interrelations among variables and outcomes of interest in a given context [4]

Specifying the mechanisms of action of implementation strategies used to improve acute stroke treatment practices [34]

[35, 36]

Participatory system dynamics

Use of a participatory epistemology to develop and integrate modeling of complex systems to support decisions that are currently least supported and to empower those who are typically the least empowered; models therefore are developed, reviewed, and acted upon in partnership with individuals who are affecting and affected by the system being modeled [37]

Determining the mechanisms through which past actions taken either enabled or constrained clinical guidelines implementation [38]

[25, 39]

Process evaluation

Assessment and documentation of the developed, planned, and delivered implementation strategy [40]

Ascertaining what characteristics of front-line staff and leadership served as mechanisms for hand hygiene improvement [41]

[42,43,44]

Realist evaluation

Generation of a theory-driven and practice-informed model that connects context, mechanisms, and outcome patterns [45]

Studying contextual factors and causal mechanisms that enabled or hindered evidence-based interventions’ sustainability [46]

[47, 48]

Ripple effects mapping

Participatory evaluation that generates a visualization of causes and their cascaded effects radiating from each cause, along with participants’ first-hand experiences [49]

Establishing context-mechanism-outcome configurations based on mixed-methods data for an intervention to increase physical activity [50]

[51, 52]

Simulation modeling

Creation and analysis of a computational model of a system to replicate and anticipate the system’s real-world behavior [53]; of note, some of the other listed methods (e.g., agent-based modeling and participatory system dynamics) are subsumed under this method

Articulating and refining implementation actors’ articulation of hypotheses regarding causal mechanisms of the intervention and implementation strategies [24]

[29]

Structural equation modeling

Mathematical representation of a phenomenon to investigate aspects of the phenomenon that are statistically and/or causally related to one another and to the phenomenon [54]

Examining the mediators of hospitals’ escalation prevention potential as mechanisms for successful electronic health record implementation [55]

[56,57,58]