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Recent scholarship in conservation biology has pointed to the existence of a “research‐implementation” gap and has proposed various solutions for overcoming it. Some of these solutions, such as evidence‐based conservation, are based on the assumption that the gap exists primarily because of a communication problem in getting reliable and needed technical information to decision makers. First, we identify conceptual weaknesses with this framing, supporting our arguments with decades of research in other fields of study. We then reconceptualize the gap as a series of crucial, productive spaces in which shared interests, value conflicts, and complex relations between scientists and publics can interact. Whereas synonyms for “gap” include words such as “chasm,” “rift,” or “breach,” the word “space” is connected with words such as “arena,” “capacity,” and “place” and points to who and what already exists in a specific context. Finally, we offer ways forward for applying this new understanding in practice.

Background In 2009, Damschroder et al. developed the Consolidated Framework for Implementation Research (CFIR), which provides a comprehensive listing of constructs thought to influence implementation. This systematic review assesses the extent to which the CFIR’s use in implementation research fulfills goals set forth by Damschroder et al. in terms of breadth of use, depth of application, and contribution to implementation research. Methods We searched Scopus and Web of Science for publications that cited the original CFIR publication by Damschroder et al. (Implement Sci 4:50, 2009) and downloaded each unique result for review. After applying exclusion criteria, the final articles were empirical studies published in peer-review journals that used the CFIR in a meaningful way (i.e., used the CFIR to guide data collection, measurement, coding, analysis, and/or reporting). A framework analysis approach was used to guide abstraction and synthesis of the included articles. Results Twenty-six of 429 unique articles (6 %) met inclusion criteria. We found great breadth in CFIR application; the CFIR was applied across a wide variety of study objectives, settings, and units of analysis. There was also variation in the method of included studies (mixed methods ( n  = 13); qualitative ( n  = 10); quantitative ( n  = 3)). Depth of CFIR application revealed some areas for improvement. Few studies ( n  = 3) reported justification for selection of CFIR constructs used; the majority of studies ( n  = 14) used the CFIR to guide data analysis only; and few studies investigated any outcomes ( n  = 11). Finally, reflections on the contribution of the CFIR to implementation research were scarce. Conclusions Our results indicate that the CFIR has been used across a wide range of studies, though more in-depth use of the CFIR may help advance implementation science. To harness its potential, researchers should consider how to most meaningfully use the CFIR. Specific recommendations for applying the CFIR include explicitly justifying selection of CFIR constructs; integrating the CFIR throughout the research process (in study design, data collection, and analysis); and appropriately using the CFIR given the phase of implementation of the research (e.g., if the research is post-implementation, using the CFIR to link determinants of implementation to outcomes).

Background Organizational readiness assessments have a history of being developed as important support tools for successful implementation. However, it remains unclear how best to operationalize readiness across varied projects or settings. We conducted a synthesis and content analysis of published readiness instruments to compare how investigators have operationalized the concept of organizational readiness for change. Methods We identified readiness assessments using a systematic review and update search. We mapped individual assessment items to the Consolidated Framework for Implementation Research (CFIR), which identifies five domains affecting implementation (outer setting, inner setting, intervention characteristics, characteristics of individuals, and implementation process) and multiple constructs within each domain. Results Of 1370 survey items, 897 (68%) mapped to the CFIR domain of inner setting, most commonly related to constructs of readiness for implementation ( n  = 220); networks and communication ( n  = 207); implementation climate ( n  = 204); structural characteristics ( n  = 139); and culture ( n  = 93). Two hundred forty-two items (18%) mapped to characteristics of individuals (mainly other personal attributes [ n  = 157] and self-efficacy [ n  = 52]); 80 (6%) mapped to outer setting; 51 (4%) mapped to implementation process; 40 (3%) mapped to intervention characteristics; and 60 (4%) did not map to CFIR constructs. Instruments were typically tailored to specific interventions or contexts. Discussion Available readiness instruments predominantly focus on contextual factors within the organization and characteristics of individuals, but the specificity of most assessment items suggests a need to tailor items to the specific scenario in which an assessment is fielded. Readiness assessments must bridge the gap between measuring a theoretical construct and factors of importance to a particular implementation.

Abstract Implementation strategies are systematic approaches to improve the uptake and sustainability of evidence-based interventions. They frequently focus on changing provider behavior through the provision of interventions such as training, coaching, and audit-and-feedback. Implementation strategies often impact intermediate behavioral outcomes like provider guideline adherence, in turn improving patient outcomes. Fidelity of implementation strategy delivery is defined as the extent to which an implementation strategy is carried out as it was designed. Implementation strategy fidelity measurement is under-developed and under-reported, with the quality of reporting decreasing over time. Benefits of fidelity measurement include the exploration of the extent to which observed effects are moderated by fidelity, and critical information about Type-III research errors, or the likelihood that null findings result from implementation strategy fidelity failure. Reviews of implementation strategy efficacy often report wide variation across studies, commonly calling for increased implementation strategy fidelity measurement to help explain variations. Despite the methodological benefits of rigorous fidelity measurement, implementation researchers face multi-level challenges and complexities. Challenges include the measurement of a complex variable, multiple data collection modalities with varying precision and costs, and the need for fidelity measurement to change in-step with adaptations. In this position paper, we weigh these costs and benefits and ultimately contend that implementation strategy fidelity measurement and reporting should be improved in trials of implementation strategies. We offer pragmatic solutions for researchers to make immediate improvements like the use of mixed methods or innovative data collection and analysis techniques, the inclusion of implementation strategy fidelity assessment in reporting guidelines, and the staged development of fidelity tools across the evolution of an implementation strategy. We also call for additional research into the barriers and facilitators of implementation strategy fidelity measurement to further clarify the best path forward. Implementation strategy fidelity, or the extent to which an implementation strategy is carried out as it was designed, is under-developed and under-reported, and the quality of reporting is decreasing over time. This position paper describes the costs and benefits of implementation strategy fidelity. We ultimately call for the continuation and improvement of implementation strategy fidelity measurement while offering pragmatic solutions to noted challenges. Future research is needed regarding the barriers and facilitators to implementation strategy fidelity measurement and reporting, the costs and cost-benefits of implementation strategy fidelity measurement, and the relationship between implementation strategy fidelity and implementation and clinical outcomes.

Spatial conservation prioritization is used globally to guide decision making with the aim of delivering the best conservation gain per unit investment. However, despite many publications on the topic, the extent to which this approach is used by decision makers has been unclear. To investigate the degree to which prioritization has been adopted by practitioners to guide conservation implementation, we conducted an online survey, collecting data on the approaches used to develop prioritizations and the reported extent of translation to on‐the‐ground action. Using a cluster analysis, we identified two categories of prioritizations, those developed to advance the field (42% of responses) and those intended for implementation (58% of responses). Respondents reported 74% of the prioritizations intended for implementation had translated to on‐the‐ground action. Additionally, we identified strong collaboration between academics and practitioners in prioritization development, suggesting a bridging of the theory‐practice gap. We recommend continued collaboration and research into the effectiveness of prioritizations in delivering conservation impacts.

Suboptimal use of antimicrobials is a driver of antimicrobial resistance in West Africa. Clinical decision support systems (CDSSs) can facilitate access to updated and reliable recommendations. This study aimed to assess contextual factors that could facilitate the implementation of a CDSS for antimicrobial prescribing in West Africa and Central Africa and to identify tailored implementation strategies. This qualitative study was conducted through 21 semistructured individual interviews via videoconference with health care professionals between September and December 2020. Participants were recruited using purposive sampling in a transnational capacity-building network for hospital preparedness in West Africa. The interview guide included multiple constructs derived from the Consolidated Framework for Implementation Research. Interviews were transcribed, and data were analyzed using thematic analysis. The panel of participants included health practitioners (12/21, 57%), health actors trained in engineering (2/21, 10%), project managers (3/21, 14%), antimicrobial resistance research experts (2/21, 10%), a clinical microbiologist (1/21, 5%), and an anthropologist (1/21, 5%). Contextual factors influencing the implementation of eHealth tools existed at the individual, health care system, and national levels. At the individual level, the main challenge was to design a user-centered CDSS adapted to the prescriber's clinical routine and structural constraints. Most of the participants stated that the CDSS should not only target physicians in academic hospitals who can use their network to disseminate the tool but also general practitioners, primary care nurses, midwives, and other health care workers who are the main prescribers of antimicrobials in rural areas of West Africa. The heterogeneity in antimicrobial prescribing training among prescribers was a significant challenge to the use of a common CDSS. At the country level, weak pharmaceutical regulations, the lack of official guidelines for antimicrobial prescribing, limited access to clinical microbiology laboratories, self-medication, and disparity in health care coverage lead to inappropriate antimicrobial use and could limit the implementation and diffusion of CDSS for antimicrobial prescribing. Participants emphasized the importance of building a solid eHealth ecosystem in their countries by establishing academic partnerships, developing physician networks, and involving diverse stakeholders to address challenges. Additional implementation strategies included conducting a local needs assessment, identifying early adopters, promoting network weaving, using implementation advisers, and creating a learning collaborative. Participants noted that a CDSS for antimicrobial prescribing could be a powerful tool for the development and dissemination of official guidelines for infectious diseases in West Africa. These results suggest that a CDSS for antimicrobial prescribing adapted for nonspecialized prescribers could have a role in improving clinical decisions. They also confirm the relevance of adopting a cross-disciplinary approach with participants from different backgrounds to assess contextual factors, including social, political, and economic determinants.

Background In India, despite several effective interventions being implemented, pneumonia persists as a major cause of under-five mortality. We explore barriers and facilitators to implementing a childhood pneumonia management program in a North Indian district. The study aims to inform the development of effective implementation strategies for pneumonia management in resource-constrained settings. Methods This mixed-method study was conducted during the formative phase of an ongoing pre-post quasi-experimental implementation study. Data collection followed the Consolidated Framework for Implementation Research, encompassing surveys on implementation climate and attitudes toward evidence-based-treatment for childhood pneumonia, as well as in-depth interviews to uncover implementation barriers and facilitators with healthcare staff. Additionally, a baseline cross-sectional facility inventory survey was conducted in 26 government healthcare facilities. We present descriptive statistics from the surveys along with deductive analysis findings from qualitative interviews. Results Several barriers were observed, like deficient infrastructure and limited space, privacy concerns, inadequate examination tables, disrupted medicine supply, non-maintenance of under-five children’s records, inadequate utilization of the digital portal for pneumonia case registration, lack of specific budget allocation for medicine procurement, absence of functional equipment, staff shortages, lack of training, referral linkage issues, and limited accessibility to guideline materials. The absence of incentives demotivated community healthcare workers (CHWs), while coordination issues, power dynamics, and unclear job responsibilities affected the motivation of other healthcare staff. Community reluctance to seek care from government facilities and diminishing community-level trust in CHWs posed implementation challenges. Facilitators included committed healthcare and community workers, problem-solving skills, community engagement, and untied funds from the district government. Implementation climate scores were mildly positive, yet provider attitudes towards Evidence-Based Practices Adoption were neutral. Conclusions We propose a multi-pronged approach including healthcare provider training, task sharing, budget reallocation promoting medication access, performance monitoring, digitalization of the record system, and community engagement to optimize program effectiveness. Trial registration This research was prospectively registered in the clinical trial registry CTRI202103031622 [Registered on: 01/03/2021].

Background Clinical trials advance science, benefit society, and provide optimal care to individuals with some conditions, such as cancer. However, clinical trials often fail to reach their endpoints, and low participant enrollment remains a critical problem with trial conduct. In these ways, clinical trials can be considered beneficial evidence-based practices suffering from poor implementation. Prior approaches to improving trials have had difficulties with reproducibility and limited impact, perhaps due to the lack of an underlying trial improvement framework. For these reasons, we propose adapting implementation science frameworks to the clinical trial context to improve the implementation of clinical trials. Main text We adapted an outcomes framework (Proctor’s Implementation Outcomes Framework) and a determinants framework (the Consolidated Framework for Implementation Research) to the trial context. We linked these frameworks to ERIC-based improvement strategies and present an inferential process model for identifying and selecting trial improvement strategies based on the Implementation Research Logic Model. We describe example applications of the framework components to the trial context and present a worked example of our model applied to a trial with poor enrollment. We then consider the implications of this approach on improving existing trials, the design of future trials, and assessing trial improvement interventions. Additionally, we consider the use of implementation science in the clinical trial context, and how clinical trials can be “test cases” for implementation research. Conclusions Clinical trials can be considered beneficial evidence-based interventions suffering from poor implementation. Adapting implementation science approaches to the clinical trial context can provide frameworks for contextual assessment, outcome measurement, targeted interventions, and a shared vocabulary for clinical trial improvement. Additionally, exploring implementation frameworks in the trial context can advance the science of implementation through both “test cases” and providing fertile ground for implementation intervention design and testing.

It is widely accepted that there is a considerable gap between the science of conservation biology and the design and execution of biodiversity conservation projects in the field and science is failing to inform the practice of conservation. There are many reasons why this implementation gap exists. A high proportion of papers published in scientific journals by conservation biologists are seldom read outside of the academic world and there are few incentives for academics to convert their science into practice. In turn, field practitioners rarely document their field experiences and experiments in a manner that can meaningfully inform conservation scientists. Issues related to access to scientific literature, scientific relevance in multidisciplinary environments, donor expectations and a lack of critical analysis at all levels of conservation theory and practice are factors that exacerbate the divide. The contexts in which conservation biologists and field practitioners operate are also often highly dissimilar, and each has differing professional responsibilities and expectations that compromise the ability to learn from each other's expertise. Building on recent debate in the literature, and using case studies to illustrate the issues that characterize the divide, this paper draws on the authors' experiences of project management as well as academic research. We identify five key issues related to information exchange: access to scientific literature, levels of scientific literacy, lack of interdisciplinarity, questions of relevance and lack of sharing of conservation-related experiences and suggest new ways of working that could assist in bridging the gap between conservation scientists and field practitioners.

Dementia is a leading cause of disability and dependency in older people worldwide. As the number of people affected increases, so does the need for innovative care models. Dementia care management (DCM) is an empirically validated approach for improving the care and quality of life for people with dementia (PwD) and caregivers. The aim of this study is to investigate the influencing factors and critical pathways for the implementation of a regionally adapted DCM standard in the existing primary care structures in the German region of Siegen-Wittgenstein (SW). Utilizing participatory research methods, five local health care experts as co-researchers conducted N = 13 semi-structured interviews with 22 local professionals and one caregiver as peer reviewers. Data collection and analysis were based on the Consolidated Framework for Implementation Research (CFIR). Our results show that among the most mentioned influencing factors, three CFIR constructs can be identified as both barriers and facilitators: Patients’ needs and resources, Relative advantage, and Cosmopolitanism. The insufficient involvement of relevant stakeholders is the major barrier and the comprehensive consideration of patient needs through dementia care managers is the strongest facilitating factor. The study underlines the vital role of barrier analysis in site-specific DCM implementation.