Improving the uptake of research findings in clinical practice

While research has demonstrated the effectiveness of evidence-based interventions for youth with psychiatric disorders, these are rarely used in community settings. It takes 17 years for 14 per cent of research to make its way into practice (Balas & Boren, 2000).

Implementation science is the study of methods to promote the uptake of research findings within routine practice and to thereby improve the effectiveness and quality of health services (Eccles & Mittman, 2006). Implementation science is a major priority area for research funders. Williams and Beidas (2019) conducted a review of the state of implementation science in child psychology and provided suggestions to advance the field.

Implementation research has examined determinants of and barriers to adoption of evidence-based interventions, but existing theories do not adequately explain the causal relationship between determinants and implementation outcomes. This makes it difficult to understand the processes that lead to increased adoption and intervention, and the long-term use of it in routine practice. The review authors recommend that new integrated, multi-level theories that test associations between determinants and implementation outcomes need to be developed and tested to explain implementation of interventions.

As there are a large number (more than 600) of potential determinants of implementation, the authors advocate for the implementation science field to develop guidelines for researchers and/or professionals on how to develop a set of core determinants (e.g., clinician motivation, organisational culture) that are relevant to assess in a particular implementation context.

Implementation research needs to clearly specify the theory underlying the study design as well as the targets, mechanisms and outcomes. This includes explaining how an implementation strategy will activate the target and how the target will influence implementation outcomes. This will facilitate prioritisation of the most promising implementation strategies. Core components and sequences of evidence-based interventions also need to be clearly operationalised. For example, successfully implementing cognitive behaviour therapy for depression requires understanding of each of the steps and techniques needed to be implemented and in what sequences. A lack of clarity about the components of interventions has made it difficult to apply theories to access their implementation.

Finally, the authors emphasise the need for agreement on standard measures for assessing the success of implementation. Existing implementation research has included inconsistent measures and often investigator-created ones. One promising implementation outcome measure is the Stages of Implementation Completion (SIC) measure (Chamberlain, Brown & Saldana, 2011).

Application of these recommendations will help achieve the promise of implementation science and work towards improvement of the health of children and youth by encouraging uptake of evidence-based interventions. These recommendations are also likely to be applicable to encouraging uptake of psychological interventions in other community health settings.

doi:10.1111/jcpp.12960