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Medicina clínica y social

On-line version ISSN 2521-2281

Med. clín. soc. vol.6 no.3 Santa Rosa del Aguaray Dec. 2022 


Implementation science research as a tool for public health research

Derlis Gustavo Adolfo Duarte-Zoilán1

1Universidad de Antioquía, Medellín, Colombia

Public health strategies, programs or plans are interventions created to promote health, prevent disease or improve the quality of life of people who are already sick. These interventions are called: "Evidence-Based Practices" (EBP) which were created, designed and put into practice in controlled environments, thus showing their effectiveness as an intervention. Such EBPs can be as “simple”, such as increasing the use of a single medication, or as “complex”, such as instituting psychotherapies, including multi-component, multi-sectoral and interdisciplinary care.

According to several authors, effective EBP interventions take too long to be integrated, an average of 17 years in routine clinical practice to benefit patients1, although these years do not ensure full effectiveness and meet the objectives set by EBP, having an example of several interventions that have been in the health system for years, but still continue with low coverage.

Identifying appropriate EBPs, implementing them and then maintaining them in clinical practice is a complex task, since the intervention must be adapted to the context and clinical processes, selecting and executing strategies so that they are routinely used2. There is a gap in the research of these interventions in the real world and how this affects effectiveness, evidencing problems, for example, patient adherence, deliberate and intentional actions of the implementer (health service) in applying or not applying the intervention, low coverage, unnecessary expenses to the system, among others. Issues that generate several unknowns; “Could it be that they are being implemented correctly? Are all aspects of the process to adopt the intervention taken into account? From the perspective of organization (health system), provider (who directly delivers the medical intervention, nurse, community agent), family (companion), and end user (patient) who will directly benefit from the intervention?

Historically, the need for implementation research that has a more direct impact on public health has been recognized and has somewhat broadened the academic mindset, thus promoting studies from efficacy trials to effectiveness trials, however such trials by alone they offer little guarantee of impact on public health3. Dilemma that is reflected in the term: "valley of death" (valley of death in English) that characterizes the abyss between evidence-based scientific discoveries and the patients or users who need them, thus giving birth to this scientific discipline called research of implementation (Implementation Research in English)2 which can be defined as “the scientific study of methods to promote the systematic incorporation of research results and other evidence-based practices into routine practice and, therefore, , to improve the quality and effectiveness of health services"4, this new discipline allows us to have a broader scope than that offered by traditional research, since it allows us to investigate the entire process, and not just the patient as such. . Its theoretical, conceptual, well-founded foundations allow the development of generalizable knowledge, and that can be widely applied in various contexts, it uses various types of study designs, but mainly mixed, quantitative and qualitative designs that allow identifying and understanding factors that impact acceptance, adoption, operation and success of said intervention.

Implementation science research is measured by “implementation outcomes” as mentioned by Enola Proctor and defined as the effects of deliberate and intentional actions to implement new treatments, practices, and services; this allows us three important functions: to have indicators of implementation successes, proximate indicators of the implementation process, and are key intermediate outcomes in relation to the service system or clinical outcomes in research on treatment efficacy and quality of care. attention. The Framework of the implementation results can be distinguished both individually but also correlated between them, some can be: acceptability, suitability, adoption, fidelity or penetration that are implementation outcomes that can be measured to understand the process as such, This can range from the perception of accepting a new EBP (acceptability) to fidelity, which is defined as how faithful the intervention is to how it is prescribed by the developers of the intervention, if it is done as is5. Implementation science is gaining so much popularity in the academic world of world-renowned universities and being widely disseminated in postgraduates as a new research tool for masters, doctorates, and postdocs with the possibility of accessing funding for their development, as well as the TDR, the Special Program for Research and Training in Tropical Diseases, which is based at the World Health Organization and co-sponsored by UNICEF, UNDP, the World Bank and WHO


1. Morris ZS, Wooding S, Grant J. The answer is 17 years, what is the question: understanding time lags in translational research. J R Soc Med. 2011;104(12):510-20. 10.1258/jrsm.2011.110180 [ Links ]

2. Damschroder LJ. Clarity out of chaos: Use of theory in implementation research. Psychiatry Research. 2020;283:112461. 10.1016/j.psychres.2019.06.036 [ Links ]

3. Bauer MS, Damschroder L, Hagedorn H, Smith J, Kilbourne AM. An introduction to implementation science for the non-specialist. BMC Psychol. 2015;3(1):32. 10.1186/s40359-015-0089-9 [ Links ]

4. National Academies of Sciences. Implementation Science: A Background. Applying an Implementation Science Approach to Genomic Medicine: Workshop Summary. National Academies Press (US); 2016. [ Links ]

5. Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A, et al. Outcomes for Implementation Research: Conceptual Distinctions, Measurement Challenges, and Research Agenda. Adm Policy Ment Health. 2011;38(2):65-76. 10.1007/s10488-010-0319-7 [ Links ]

Received: September 05, 2022; Revised: September 06, 2022; Accepted: September 15, 2022

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