3.4 Implementation strategies

Implementation strategies can be defined as methods to enhance the adoption, implementation and sustainability of a policy or intervention.(92, 93) For example, they can include methods for training implementers, intervention-specific toolkits, checklists and algorithms as well as formal practice protocols and guidelines.

It is crucial that implementation strategy-related efforts are assessed when evaluating implementation. For example, the training of healthcare workers may be an implementation support strategy when implementing a community-based intervention to control hypertension; in this case the evaluation protocol would assess the training provided (e.g. its frequency, duration, perceived quality), its effect on workers’ knowledge and skills, and other contextual factors such as pre-existing skills.

Successful implementation strategies have been identified in a review on ways to improve health service delivery in LMICs;(94) a list of these can be downloaded from the Open Knowledge Repository.

Frameworks are available to enable you to systematically determine the barriers and enablers of implementation. One such commonly used framework is the Theoretical Domains Framework. The framework assesses 14 broad domains including: ‘knowledge’, ‘skills’, ‘social/professional roles’, ‘environmental contexts and resources’ and ‘social influences’.(95)