D. Application Dimensions
Parts A to C describe what an approach addresses. This part describes where, when, why and for whom you apply it.
Classification by Health-System Level
| Level | Main implementation focus | Illustrative approaches |
|---|---|---|
| Individual | Caregiver, patient and health worker behaviour | COM-B, TDF, Health Belief Model |
| Interpersonal | Relationships, communication and influence | Social Network Theory, Social Cognitive Theory |
| Facility/organisational | Organisational readiness, climate, practices and service delivery | CFIR, ORIC, NPT |
| Community | Community structures, participation and demand | Social Ecological Model, Diffusion of Innovations |
| LGA/district | Management, coordination, supervision and programme performance | EPIS, CFIR, Model for Improvement |
| State/subnational | Governance, financing, resource allocation and implementation variation | Institutional Theory, CFIR, Systems Thinking |
| National | Policy, institutionalisation, scale-up and national implementation arrangements | Policy Triangle, EPIS, ExpandNet |
| Health system | Interdependence, integration, resilience and systemic change | WHO Health Systems Framework, Systems Theory, Complexity Theory |
The levels overlap. Some frameworks work across several levels by design.
Classification by Implementation Phase
| Implementation phase | Main activities | Relevant approaches |
|---|---|---|
| Exploration | Identify problems, assess needs, understand context and determine intervention suitability | EPIS, CFIR, TDF |
| Preparation | Assess readiness, develop implementation plans, mobilise resources and prepare stakeholders | QIF, ORIC, Implementation Mapping |
| Implementation | Introduce interventions, deliver strategies, monitor progress and address implementation barriers | CFIR, ERIC, NPT, i-PARIHS |
| Sustainment | Institutionalise practices, maintain implementation capacity and adapt interventions over time | Dynamic Sustainability Framework, RE-AIM, EPIS |
The phases do not always run in a straight line. In complex PHC and immunization settings, teams often return to earlier phases as circumstances change.
Classification by Implementation Research Purpose
Use this table to pick frameworks for a research question.
| Research purpose | What researchers want to understand | Relevant approaches |
|---|---|---|
| Problem identification | What is going wrong with implementation? | CFIR, TDF |
| Context assessment | What contextual factors influence implementation? | CFIR, EPIS, i-PARIHS |
| Behavioural analysis | Why are individuals not adopting recommended practices? | COM-B, TDF |
| Organisational analysis | Why are organisations adopting or rejecting interventions? | ORIC, Institutional Theory |
| Implementation planning | How should we organise implementation? | EPIS, QIF, Implementation Mapping |
| Strategy selection | Which strategies address the identified determinants? | ERIC, Behaviour Change Wheel |
| Process evaluation | How is implementation unfolding? | CFIR, NPT |
| Adaptation analysis | What is changing during implementation, and why? | FRAME, FRAME-IS |
| Outcome evaluation | Did implementation succeed? | Proctor, RE-AIM |
| Scale-up | How do we expand effective interventions? | ExpandNet, ISF |
| Sustainability | What enables continued implementation? | Dynamic Sustainability Framework, RE-AIM |
Programme or Service Area
The master classification lists programme area as an application dimension. This site uses six programme areas, and the problem pathways draw on them.
| Programme area | Nigerian examples |
|---|---|
| Routine immunization | Fixed and outreach sessions, defaulter tracing, REW microplanning |
| New vaccine introduction | HPV, R21 malaria vaccine, MenFive |
| Campaigns and outbreak response | Supplementary immunization activities, emergency campaigns |
| PHC integration | Immunization with antenatal, postnatal, nutrition and sick-child services |
| Digital health | Electronic registers, DHIS2 data use, decision-support tools |
| Quality improvement | Facility QI programmes, missed opportunities for vaccination |
Intended Users
Suggested entry points by user group. This grouping is a site design choice.
| User group | Who | Start with |
|---|---|---|
| Frontline implementers | Officers-in-charge, vaccinators, community health extension workers (CHEWs), ward focal persons | Course, templates, pathways |
| Programme managers | LIOs, state immunization and PHC teams, partner programme staff | Pathways, application dimensions, inventory |
| Policymakers | Federal and state decision-makers | Domains 1 and 4, scale-up and sustainability dimensions |
| Researchers and evaluators | Implementation researchers, M&E specialists | Full inventory, method and rules, reporting guidelines |