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IMPLEMENTATION SCIENCE (the general approach of theory and method in…
IMPLEMENTATION SCIENCE
the general approach of theory and method in implementation science is caught between interpretivist and positivist methodologies, which obscures criticism (Boulton, 2020)
Such dialogues seem to be solely on the level of judging the reconcilability of social science methodologies with evidence-based methodologies. The problem, however, is that many of these traditions are founded precisely on their irreconcilability with positivism and are more readily sceptical or critical of the boundaries of the evidence-based movement.
Any attempts to make the field compatible are inevitably at the expense of understanding the irreconcilability of many of these methodologies and the need for independent critical perspectives
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For example, terms like: knowledge transfer, knowledge translation, knowledge mobilisation, improvement science or quality and safety are all used in applied health care research
more and more concern is being raised by researchers working with qualitative data in the field, especially around variability and reaching consensus over best evidence and how criticisms are accounted for (exemplified in agencies such as“the Alliance for Useful Evidence”: Nutley, Powell, and Davies 2013). In these concerns, the strain on the paradigm of making research findings conform to being forms of‘evidence’can be seen to increase.
Implementation science achieves operationality through the recognition of the need for evidence beyond that which is quantifiable.
The field of implementation science has become possible due to a change in trends as to what constitutes evidence in medicine
Rather than demonstrating implementation science as emerging from academic or research concerns, it highlights implementation as a large-scale political and economic manoeuvre and demonstrates how the focus of this endeavour has been the pragmatic coordination between relevant institutions and bodies. The effect of such manoeuvres put implementation in danger of being normative in its approach and obscures wider questions of in whose interest’s implementation is serving. Boulton, 2020
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This highlights the reasons why implementation science has found such a use for middle-rangetheories, as it allows for inconsistencies between theories (Takian et al. 2012; Bate et al. 2014).
according to Merton and Boudon middle-range theories do not have to add up to one comprehensive theory nor are they necessarily hierarchical or cumulative.Therefore, a contradiction in the field exists concerning theory building, which begs the question as to why the aging (and some would say superseded) middle-ranged theory is so heavily emphasised in the face of decades of further developments in STS and of a whole host of other critical or reflexive methodologies?
Without independent criticism, cumulative understandings of‘research evidence’and the goals of ‘closing the implementation gap’and‘effectiveness’–that evidence-based methodologies are designed to bring about—are self-fulfilling ad hominem arguments.
Much emphasis is placed upon measurement in the field, but the danger is that implementation science theory has no perspective with which to interpret improvement or efficiency outside of a concept of evidence.
implementation science is in danger of being self-serving, or politically serving the interests of those with a vested interest in the field. (Boulton 2020)
models
Diffusion of Innovations in Service Organisations(Greenhalgh et al. 2004)
Rationale:Aims to offer a way "to define and measure the diffusion of innovations in organisations" (p581).cited in Boulton 2020
Normalisation Process Theory(NPT)
(May & Finch, 2009)Rationale:"Puts forwards a theory how and why things become, or don't become, routine and normal components of everyday work" (p535). The model "provides a set of sociological tools to understand and explain the social processes that frame the implementation of material practices" (p540).
Proposes a theory of 5 components.Method: Revised over two iterations "from secondary analyses of multiple qualitative studies in health caresettings".
The most recent second iteration "focuses on general processes by which material practices come to be embedded in their social contexts [...]using as exemplars ethnographic and other studies of the development implementation, and evaluation of a tele-dermatology service" (p539)
Theoretical Domains Framework(TDF)(Cane et al. 2012) to simplify Behaviour Change Theory and make it accessible across disciplines
Framework
MRC’s (2008) Framework for Developing and Evaluating Complex Interventions (the most current iteration of UK policy and guidance for practitioners planning health interventions) endorses importance of qualitative evidence depending on the research question
Implementation science’s current approach to evidence, epitomised by the MRC’s Guidance on Complex Interventions (2008), recognises the need to draw on qualitative methodologies but does so in the pragmatic instrumented style of quantitative methods more established in the evidence-based movement.
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