Table 2 Description of implementation strategies
Strategy | Classification | Category of actor(s) | Action | Dose | Action target (determinant and level) | Temporalitya | Outcome measure |
|---|---|---|---|---|---|---|---|
Integral strategies in the Integrated Knowledge Translation ( IKT-K) model | |||||||
Engage stakeholders and utilize local knowledge | Process strategy | All systems | Stakeholders are in collaborative partnership to address mutually understood need for practice improvement | To utilize local knowledge on all levels and facilitate stakeholder buy-in and ownership on provider and organization levels | All | Feasibility | |
Use facilitation | Process strategy | Support system | An assigned facilitator objectively guides co-creation discussions, promotes knowledge exchange, and minds equal participation and power imbalances | Five 4-h workshopsb with each co-creation team, additional meetings if necessary | Facilitate collaborative problem-solving and promote mutual consultations among stakeholders to ensure integration of different forms of knowledge on organizational and provider levels | Co-creation, implementation, evaluation, and sustainment | Feasibility |
Develop glossary | Process and dissemination strategy | Support system | Develop a glossary of frequent, difficult, and potentially ambiguous terms, and ban potentially offensive terms. Align project documents with glossary | 4-h introduction workshop with each co-creation team | Promote equal understanding and participation and prevent the use of offensive terms. At organizational level | Co-creation | Feasibility |
Assess context | Process strategy | Delivery system and support system | Implementation climate and readiness for change assessed by online survey to all staff. Determinants discussed in co-creation teams | 10–15-min online survey, 4-h implementation workshop with each co-creation team | To assess readiness and identify barriers and facilitators to implementation at all levels | Co-creation | Climate for implementing evidence-based practice (EBP), readiness for change |
Tailor intervention | Process strategy | Support system and delivery system | Local knowledge and experience utilized to tailor components of the intervention to fit daily practice and address needs at each site | Two 4-h intervention workshops with each co-creation team, feedback from practitioners during and after training and piloting. One 4-h adjustments workshop | To develop a feasible and appropriate intervention on client, provider, and organizational levels | Co-creation | Feasibility, appropriateness, acceptability, fidelity, reach |
Tailor strategies | Process strategy | Support system | Local knowledge and experience utilized to tailor implementation strategies to context | 4-h implementation workshop with each co-creation team. 4-h adjustments workshop | To tailor strategies to address barriers and leverage facilitators identified through context assessments and knowledge exchange in co-creation teams. On provider and organizational levels | Co-creation | Feasibility, fidelity, reach |
Develop a formal implementation plan | Integration and capacity-building strategy | Delivery- and support system | A formal implementation plan has been created describing implementation infrastructure, goals, procedures, strategies, and adaptations to each site | One formal implementation plan, site-specific implementation manuals with adaptations to each site, continuous registration of adaptations | Guide and organize implementation processes on organizational and provider levels with appropriate and structured adaptations | Developed during co-creation, adaptations throughout all phases | Feasibility, fidelity, reach |
Additional strategies based on the intervention, context assessment, and knowledge exchange in co-creation teams | |||||||
Make intervention dynamic and flexible | Dissemination strategy | Synthesis and translation system | Common elements of effective interventions have been used as basis for the intervention components to enable dynamic and flexible delivery | Systematic review, common elements analysis | To utilize the best available empirical evidence and improve intervention feasibility, appropriateness, and acceptability at all levels | Synthesis, co-creation | Feasibility, appropriateness, acceptability, fidelity |
Train champions | Capacity-building strategy | Support system and delivery system | Champions have received additional training in the intervention, knowledge translation, implementation strategies, and behavior change | 7-h group training | Build local implementation and coaching capacity on provider and organizational levels | Implementation | Feasibility, fidelity, reach |
Use ongoing coaching | Capacity-building strategy and integration strategy | Delivery system and support system | Intervention practitioners receive group coaching from external implementation team and champions. Individual coaching is provided upon request or in cases of fidelity drift | Bimonthly from external implementation team, monthly from champions, and individually on request (registered) | Promote learning and integration of the intervention in practitioners and champions on provider and organizational levels | Implementation, evaluation, sustainment | Fidelity, reach, perceived competence |
Use continuous support | Capacity-building and integration strategy | Support system | Group consultations, booster sessions, telephone support, training of new practitioners, recruiters, and champions | Bimonthly meetings with practitioners, recruiters, and champions, 4-h booster session every 6 months, telephone support, visiting support and training on request (registered) | Provide support and boost engagement, implementation qualityc, and recruitment at the provider and organizational levels | Implementation, evaluation, sustainment | Feasibility, fidelity, reach, perceived competence |
Develop contingency plans | Capacity-building strategy | Support system and delivery | In cases of turnover, sick leaves, fidelity drift, or adverse events, specific plans of engagement are described for champions in their implementation plans | Use monitored | Prepare and plan for barriers and other events that threaten implementation at organizational and provider levels | Developed during co-creation, adaptations throughout all phases | Feasibility, fidelity, reach |
Develop and distribute educational material | Integration strategy | Support system | Created and distributed intervention handbooks, planning material, and pedagogical material | Approx. 50 handbooks, 150 copies of planning material, 200 copies of sponsored reading and math material | Promote intervention implementation and effectiveness at the provider and client levels | Developed in co-creation, used in implementation, evaluation, and sustainment | Acceptability and appropriateness of material, fidelity, primary effectiveness outcomes |
Develop and distribute implementation resources | Capacity-building strategy | Support system | Created and distributed implementation and recruitment manuals, implementation checklists/posters to champions, and recruitment flyers in 4 languages | Three site-specific implementation manuals, recruitment manuals, and implementation checklists/posters, approx. 500 flyers | Promote recruitment at client level and EAS implementation qualityc at organizational and provider levels | Developed in co-creation, used in implementation and evaluation | Feasibility, fidelity, reach |
Use implementation audit and feedback | Integration strategy | Support system | Double-informant measures of fidelity, user satisfaction and user involvement | Audit after each intervention session. Group-level feedback to practitioners bimonthly | Motivate and engage practitioners and prevent fidelity drift at the provider level | Evaluation | Fidelity, primary effectiveness outcomes |