Implementation science

What is implementation science, and how can it be used to improve the adoption of suicide prevention research into practice?

What is implementation science?

Implementation science is the bridge between research and practice.

It takes approximately 17 years for evidence-based practice to be implemented into routine care.¹ This phenomenon is called the 'research-to-practice gap’; it is the space between knowledge gained through research and what is actioned in the real world.

Implementation science aims to reduce the gap between what we know and what we do. By formal definition, it is “The scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice, and, hence, to improve the quality and effectiveness of health services".²

The research-to-practice gap is not a new problem; research has historically out-stripped society’s adaptive capacity. For example, in 1747 citrus was first observed to act as a cure for scurvy research, however the British Navy did not adopt the preventative measure for almost 50 years.¹

Despite this long-standing problem in public health, implementation science has gained more traction in suicide prevention of late.

“The explicit adoption of implementation science frameworks and concepts is a relatively recent but rapidly increasing phenomenon in suicide prevention” – (Reifels, Krishnamoorthy, Kõlves, & Francis, 2022, p. 1).

Implementation science in suicide prevention

Suicide is a complex phenomenon with many intertwining factors at play. This complexity makes it increasingly important to ensure that current practice is evidence-based and up to date.

Additionally, the decision to implement a certain program or service is rarely driven by evidence alone. Resources, equity considerations, population needs, and financial demands are also key players.

In suicide prevention, research-to-practice gaps can manifest in many ways. Interventions may be known to be highly effective yet delivered poorly. Conversely, interventions with limited evidence could be highly resourced and implemented well. We need research on interventions and innovative practice to demonstrate both effectiveness and implementability in practice.³

Implementation strategies

Many different implementation strategies exist. They include, but are not limited to:

• Broad, 'top-down' implementation strategies. These includes policy changes, financial incentives, practice guidelines, etc.
• Bottom-up, 'behavioural' approaches. These match implementation barriers to solutions. For example, if a barrier is knowledge, then education may be the aim of the intervention.

Each strategy aims to enhance a practice's adoption, implementation, and sustainability. The success of implementation can be conceptualised and measured with respect to key outcomes, including:⁴

• Acceptability
• Adoption
• Appropriateness
• Costs
• Feasibility
• Fidelity
• Penetration
• Sustainability.⁴

What are some common frameworks and models?

In a review, Tabak et al. (2012) identified 61 models and frameworks used in implementation research. For brevity, three commonly used frameworks are listed below:

• Consolidated Framework for Implementation Research (CFIR)
• Proctor’s conceptual model for implementation research
• Taxonomy of behaviour change techniques.⁵

Each framework or model has its positives and negatives, and some may be better suited to specific contexts.

The field of suicide prevention attempts to deliver interventions, programs and initiatives across a multitude of settings to various population groups. Implementation science provides a systematic method to ensure research is effectively translated into practice and ultimately enhances the care of those at risk of suicide.