Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jul 21;18(1):30.
doi: 10.1186/s13012-023-01285-0.

The relative value of Pre-Implementation stages for successful implementation of evidence-informed programs

Zoe M Alley  1 , Jason E Chapman  1 , Holle Schaper  1 , Lisa Saldana  2
Affiliations

The relative value of Pre-Implementation stages for successful implementation of evidence-informed programs

Zoe M Alley et al. Implement Sci. .

Abstract

Background: Most implementations fail before the corresponding services are ever delivered. Measuring implementation process fidelity may reveal when and why these attempts fail. This knowledge is necessary to support the achievement of positive implementation milestones, such as delivering services to clients (program start-up) and competency in treatment delivery. The present study evaluates the extent to which implementation process fidelity at different implementation stages predicts achievement of those milestones.

Methods: Implementation process fidelity data-as measured by the Stages of Implementation Completion (SIC)-from 1287 implementing sites across 27 evidence-informed programs were examined in mixed effects regression models with sites nested within programs. Implementation process fidelity, as measured by the proportion of implementation activities completed during the three stages of the SIC Pre-Implementation phase and overall Pre-Implementation (Phase 1) and Implementation (Phase 2) proportion scores, was assessed as a predictor of sites achieving program start-up (i.e., delivering services) and competency in program delivery.

Results: The predicted probability of start-up across all sites was low at 35% (95% CI [33%, 38%]). When considering the evidence-informed program being implemented, that probability was nearly twice as high (64%; 95% CI [42%, 82%]), and 57% of the total variance in program start-up was attributable to the program. Implementation process fidelity was positively and significantly associated with achievement of program start-up and competency. The magnitude of this relationship varied significantly across programs for Pre-Implementation Stage 1 (i.e., Engagement) only. Compared to other stages, completing more Pre-Implementation Stage 3 (Readiness Planning) activities resulted in the most rapid gains in probability of achieving program start-up. The predicted probability of achieving competency was very low unless sites had high scores in both Pre-Implementation and Implementation phases.

Conclusions: Strong implementation process fidelity-as measured by SIC Pre-Implementation and Implementation phase proportion scores-was associated with sites' achievement of program start-up and competency in program delivery, with early implementation process fidelity being especially potent. These findings highlight the importance of a rigorous Pre-Implementation process.

Keywords: Implementation fidelity; Pre-Implementation; Stages of implementation completion.

PubMed Disclaimer

Conflict of interest statement

LS is the primary developer of the Stages of Implementation Completion (SIC) and holds a license agreement with OSLC to access, utilize, and grant permission to use the SIC repository and its associated data. As such, Dr. Saldana is not involved in the data collection, entry, management, manipulation, or analysis for this or other manuscripts.

Figures

Fig. 1
Fig. 1
The predicted probability of achieving program start-up based on the proportion of Universal SIC activities completed in a given stage of the Pre-Implementation phase. Note. For each of the three stage proportion scores, the predicted probabilities are based on a separate mixed-effects logistic regression model
Fig. 2
Fig. 2
The predicted probability of achieving competency based on the proportion of Universal SIC activities completed in Phase 1: Pre-Implementation by Phase 2: Implementation Proportion. Note. This figure graphically represents Phase 1 and Phase 1 × 2 proportion scores predicting site competency status
See this image and copyright information in PMC

References

    1. Duff J, Cullen L, Hanrahan K, Steelman V. Determinants of an evidence-based practice environment: an interpretive description. Implement Sci Commun. 2020;1(1):85–94. doi: 10.1186/s43058-020-00070-0. - DOI - PMC - PubMed
    1. Tucker S, McNett M, Melnyk BM, Hanrahan K, Hunter SC, Kim B, et al. Implementation science: application of evidence-based practice models to improve healthcare quality. Worldviews Evid Based Nurs. 2021;18(2):76–84. doi: 10.1111/wvn.12495. - DOI - PubMed
    1. Wong DR, Schaper H, Saldana L. Rates of sustainment in the Universal Stages of Implementation Completion. Implement Sci Commun. 2022;3(1):2. doi: 10.1186/s43058-021-00250-6. - DOI - PMC - PubMed
    1. Mihalic S, Irwin K, Elliott D, Fagan A, Hansen D. Blueprints for violence prevention. for the Study and Prevention of Violence, University of Colorado. National Scientific Council on the Developing Child; 2004.
    1. Curran GM, Bauer M, Mittman B, Pyne JM, Stetler C. Effectiveness-implementation Hybrid Designs: combining elements of clinical effectiveness and implementation research to enhance public health impact. Med Care. 2012;50(3):217–226. doi: 10.1097/MLR.0b013e3182408812. - DOI - PMC - PubMed

Publication types