Table 2 Integration of research methods, implementation science (IS) frameworks, and implementation strategies by INSPIRE phase
INSPIRE ACTION | RESEARCH METHODS UTILIZED | IS FRAMEWORKS | IMPLEMENTATION STRATEGIES | |
|---|---|---|---|---|
INSPIRE HUB | 1. Define problem situation with stakeholders | Soft systems methodology | CFIR Domain 1: intervention source | Build buy-in (involve existing governance structures, ID champions) Develop relationships (build coalitions, resource-sharing agreements, formal commitments, academic partnerships) |
CFIR Domain 5: engaging | ||||
2. Launch the project | ||||
PHASE 1: UNDERSTAND THE SYSTEM | 3. Developmental models of the system | AIIM SAST stage 1 with key informant interviews and focus group discussions KAP surveys Audits of current system outcomes Pathway analysis visually represented by flow charts and swim-lane diagrams | CFIR Domain 3: defining structural characteristics, networks, & communications | Gather information (needs assessment, readiness to change) |
Involve patient/consumers and family members | ||||
4. Establish narrative and stakeholder perceptions of the system | ||||
CFIR Domain 2: culture & implementation climate | ||||
Audit current system behavior Capture and share local knowledge | ||||
CFIR Domain 3: patient needs and resources CFIR Domain 3: external policies & incentives | ||||
CFIR Domain 4: knowledge & beliefs about the intervention | ||||
CFIR Domain 4: understand self-efficacy, individual stage of change and other attributes | ||||
5. Make the system visible | ||||
PHASE 2: FIND LEVERAGE | 6. Engage stakeholders in group model building | SAST Stage 2 – design workshops Dialectic debate and group model building (facilitated with goal to balance desirability and feasibility guided by reflection on implementation outcomes such as feasibility, cost, acceptability, sustainability, etc.) Scenario analysis | CFIR Domain 1: review characteristics of the intervention and options (evidence strength and quality, relative advantage, complexity, cost) & assess adaptability and trialability of alternatives CFIR Domain 3: assess cosmopolitanism, peer pressure, influence of external policies/incentives CFIR Domain 4: assess KAB about intervention options CFIR Domain 4: Group level stage of change | Assess readiness and identify barriers Get feedback from audit of current system behavior Purposefully re-examine the intervention Tailor strategies to overcome barriers and honor preferences Model and simulate change Conduct local consensus discussions Distribute educational materials and conduct educational meetings Make training/education dynamic and participatory Inform local opinion leaders Create a learning collaborative Consider restructuring strategies as leverage opportunities Consider financing strategies as leverage opportunities Mandate change |
7. Share, test, revise system/process maps | ||||
8. Define and localize system behaviors contributing to problem situation | ||||
9. Find leverage for change | ||||
PHASE 3: ACT STRATEGICALLY | 10. Stakeholder designed implementation plan 11. Infrastructure modifications, training, dissemination plan development 12. Implement changes | Work group soft systems methodology with research team facilitation | CFIR Domain 1: design quality CFIR Domain 1: complexity CFIR Domain 5: planning CFIR Domain 5: executing | Develop a formal implementation blueprint Tailor strategies to overcome barriers and honor preferences Stage implementation scale-up Involve patients/consumers and family members Recruit, designate, and train for leadership Obtain formal commitments Develop effective educational materials relevant to mandated change Develop a glossary of implementation (including new models) Distribute educational materials Conduct ongoing, dynamic training Conduct educational outreach visits Use train-the-trainer strategies Provide ongoing consultation Place new interventions on fee for service lists/formularies Develop supply chain management Revise professional roles Create new clinical teams Change services sites Change equipment Change records systems Develop and organize quality monitoring systems Develop tools for quality monitoring Use advisory boards and work groups Conduct cyclical tests of change Create or change credentialing and/or licensure standards |
PHASE 4: LEARN AND ADAPT | 13. Ongoing M&E using stakeholder defined implementation outcome metrics 14. Share M&E with stakeholder group 15. Re-initiate INSPIRE cycle where indicated by identification and localization of new or unresolved problem situation | M&E for primary implementation outcomes SAST with KII and FGD Design workshops | RE-AIM CFIR Domain 5: Reflecting and evaluating | Provide ongoing consultation Sustain a learning collaborative Use mass media to increase reach (only after system behavior is stabilized post-implementation) Use advisory boards and working groups Organize clinical implementation team meetings |