RELATIONSHIP OF BEHAVIORAL INTERVENTION RESEARCH TO IMPLEMENTATION SCIENCE
An emerging exciting, important, and unique area of inquiry is implementation science. As a complementary and synergistic relationship exists between behavioral intervention research and implementation science, it is important to clarify the scope and processes of each and their relationship to each other. Figure 1.1 maps this relationship and the connections to changing health, education, and/or human service practices, the ultimate goal of both of these domains of science.
Behavioral intervention research is directed at generating evidence in the form of tested and proven programs, protocols, interventions, and strategies. In contrast, implementation science has been variably defined, but basically examines the best strategies for implementing proven programs or evidence in specific practice and/ or service contexts (Brownson et al., 2012). It also aims to identify roadblocks (e.g., social, economic, organizational) that impede the implementation of a proven program or evidence base into practice. Specifically, implementation science represents an emerging, important, and dynamic field of inquiry that systematically examines how programs or interventions can be embedded or implemented and sustained in real-world settings and conditions.
Implementation science starts where behavioral intervention research has traditionally ended. It is based on the premise that there is a well-developed, tested, and proven program or intervention, and its goal is to systematically move “it” into community and/or clinical settings. In contrast, behavioral intervention research, and the focus of this book, is about the “it”—designing, evaluating, and building the evidence base for intervention protocols that have the potential for implementation in real-world settings.
Figure 1.1 also suggests that, to optimize the impact of behavioral intervention research on health and health care outcomes, we must begin with the end in mind or some idea of where our interventions will reside if effective. By understanding the downstream challenges and complexities of implementing evidence into a practice environment, we may be able to design and evaluate interventions upfront in more thoughtful, systematic ways that enhance their implementation and scalability potential once they are proven to be beneficial. In this way, knowledge gleaned from implementation science can help guide behavioral intervention research from the inception of an intervention idea through to its evaluation and translation for a practice setting. Starting with the end in mind requires a firm understanding of the characteristics of target populations, communities, organizations, work flow, and systems of care. For example, designing and implementing an Internet-based intervention requires some degree of technology literacy and computer/Internet access among the intervention recipients as well as broadband connectivity in the neighborhood/community. Understanding these challenges upfront is essential for
Figure 1.1 Relationship of behavioral intervention research to implementation science and practice change.
designing an intervention protocol, selecting the technology, identifying training requirements, and evaluating costs. Designing an intervention for delivery in a social service agency requires an understanding of the agency and, in particular, its staffing and work flow patterns to ensure compatibility with the delivery characteristics of the intervention.
In line with this way of thinking, many of the chapters in this book promote a new and necessary synergy between implementation science and the design and evaluation of behavioral intervention research. We discuss downstream challenges of implementation (e.g., readiness of individuals or organizations to change; workforce considerations for delivering an intervention) when appropriate to help inform the upstream work of behavioral intervention design and evaluation.
Our message is that changing behaviors and health and human service practices is complex. If we seek to have our interventions integrated in and used in real practice settings by health and human service professionals, and individuals and their families, then our interventions must be informed in part by implementation considerations and this emerging science.