Proposal of the Implementation Theory Selection Model and exemplar application in fall injury prevention

Introduction

The use of theories, models and/or frameworks (TMFs) in implementation research and practice is essential for developing useful and testable implementation strategies. Recommendations and tools exist to aid implementation groups in selecting TMFs, but they do not explicitly outline a systematic method for identifying and selecting TMFs. This paper aimed to (1) propose a systematic consensus-based method to select TMFs to support implementation processes, and to (2) demonstrate the use of this novel method in the context of researching the implementation of hip protectors for fracture prevention in long-term care (LTC).

Materials & methods

We developed a systematic, consensus-based method for selecting TMFs, referred to as the Implementation Theory Selection Model (ITSM). The ITSM comprises five steps: (1) identify potentially relevant TMFs; (2) narrow the pool of TMFs; (3) appraise the relevance of eligible TMFs; (4) prioritize a short-list of TMFs for further, in-depth consideration; and (5) select TMFs through consensus with investigators and research user partners. We operationalized each step of the ITSM through a project investigating determinants of hip protector use and organizational readiness for implementation in a LTC organization in Ontario, Canada.

Results

Using the ITSM in our case example, we identified 66 TMFs (Step 1). Of these, 23 met our eligibility criteria (Step 2) and were appraised twice, by five appraisers (Step 3). Six TMFs (Step 4) advanced to the consensus meeting, which was attended by nine investigators and three research users, including two organizational partners and one older adult. Three rounds of voting yielded a tie between the TMFs the group felt would be most appropriate. Research users from our partner LTC organization made the final selection preferring the combination of the Practical, Robust Implementation and Sustainability Model and Consolidated Framework for Implementation Research (Step 5).

Conclusions

The ITSM offers a step-by-step guide for implementation groups to adopt a rigorous, transparent and reproducible method for TMF selection. Although we have demonstrated the feasibility of operationalizing each step of the ITSM in our case example, continued research is needed to evaluate and refine the ITSM to ensure it is appropriate for a wide variety of implementation contexts.