Strategy, Adaptation, Measurement and Methodological Tools
Knowing what influences implementation is not sufficient. Researchers and programme managers also need to know what to do about those influences, how to document their actions and how to measure implementation. This page holds catalogue section D (items 136 to 170). Do not confuse it with Part D of the architecture, the application dimensions.
D1. Implementation Strategy Taxonomies and Selection Tools
| No. | Approach | Main purpose | PHC and immunization application |
|---|---|---|---|
| 136 | Expert Recommendations for Implementing Change (ERIC) | Classifying implementation strategies | Selecting strategies to address immunization implementation barriers |
| 137 | Behaviour Change Wheel (BCW) | Linking behavioural diagnosis to intervention functions and policy categories | Designing health worker behaviour-change interventions |
| 138 | Behaviour Change Technique Taxonomy (BCTTv1) | Specifying active behaviour-change components | Designing interventions for providers and caregivers |
| 139 | Leeman Implementation Strategy Taxonomy | Organising implementation strategies by actor and target | Distinguishing delivery-system and external-support strategies |
| 140 | Strategy Mapping Framework | Matching strategies to implementation determinants | Selecting strategies for identified programme barriers |
| 141 | Implementation Strategy Specification Framework | Describing strategy actors, actions, targets, temporality, dose, outcomes affected and justification | Developing reproducible implementation plans |
| 142 | Implementation Strategy Selection Frameworks | Selecting strategies according to contextual determinants | Designing facility and district-level improvement interventions |
| 143 | Intervention Mapping | Designing theory-informed behavioural and environmental interventions | Developing interventions addressing immunization uptake |
ERIC is especially important. It contains 73 discrete implementation strategies organised into nine conceptual clusters, including stakeholder engagement, education, interactive assistance, infrastructure changes, financial strategies and evaluative approaches.
Do not select ERIC strategies mechanically. Select them based on identified determinants, their proposed mechanisms, feasibility and the level at which the problem operates.
D2. Adaptation and Contextual Responsiveness
| No. | Approach | Main purpose | PHC and immunization application |
|---|---|---|---|
| 144 | Framework for Reporting Adaptations and Modifications-Expanded (FRAME) | Documenting intervention adaptations | Recording changes to immunization interventions |
| 145 | FRAME-IS | Documenting adaptations to implementation strategies | Recording changes to strategies during campaign implementation |
| 146 | Stirman Adaptation Framework | Understanding intervention adaptation and modification | Examining adaptation across facilities and districts |
| 147 | Dynamic Sustainability Framework | Understanding adaptation during sustained implementation | Maintaining programme relevance as contexts change |
| 148 | Adaptome Framework | Organising knowledge about intervention adaptation | Synthesising adaptation evidence across implementation settings |
| 149 | Cultural Adaptation Frameworks | Adapting interventions to cultural and social contexts | Tailoring community engagement and vaccination approaches |
| 150 | Human-Centred Design (HCD) | Designing solutions around end-user needs | Co-designing accessible immunization services |
| 151 | Contextual Adaptation and Fidelity Frameworks | Balancing fidelity to core functions with local adaptation | Maintaining intervention integrity while adapting delivery |
Keep FRAME and FRAME-IS apart. FRAME documents modifications to interventions. FRAME-IS focuses on modifications to implementation strategies.
D3. Implementation Outcomes and Measurement Instruments
| No. | Approach | Main purpose | PHC and immunization application |
|---|---|---|---|
| 152 | Proctor's Implementation Outcomes Framework | Defines implementation outcomes | Evaluating implementation success |
| 153 | Acceptability of Intervention Measure (AIM) | Measuring acceptability | Assessing acceptability of new immunization delivery approaches |
| 154 | Intervention Appropriateness Measure (IAM) | Measuring appropriateness | Assessing perceived fit of interventions |
| 155 | Feasibility of Intervention Measure (FIM) | Measuring feasibility | Assessing operational feasibility of digital immunization tools |
| 156 | Organizational Readiness for Implementing Change (ORIC) Scale | Measuring organisational readiness | Assessing facility readiness |
| 157 | NoMAD Instrument | Measuring Normalization Process Theory constructs | Assessing integration of new practices into routine work |
| 158 | Normalization MeAsure Development (NOMAD) | Measuring normalization processes | Evaluating implementation of new clinical practices |
| 159 | CFIR Assessment Tools | Assessing implementation determinants | Conducting facility and district implementation assessments |
| 160 | RE-AIM Evaluation Measures | Measuring reach, adoption, implementation and maintenance | Evaluating PHC interventions |
| 161 | Organizational Readiness for Change Assessment | Assessing readiness for organisational change | Assessing readiness for new programme implementation |
AIM, IAM and FIM are measurement instruments, not independent theories. They operationalise particular implementation outcomes and are especially useful when those outcomes are central to a feasibility or implementation study.
Entries 157 and 158 name the same instrument. The inventory holds one profile.
D4. Fidelity, Process Evaluation and Reporting
| No. | Approach | Main purpose | PHC and immunization application |
|---|---|---|---|
| 162 | Carroll's Implementation Fidelity Framework | Assessing fidelity and moderating factors | Assessing fidelity of immunization delivery interventions |
| 163 | Borrelli Treatment Fidelity Framework | Assessing intervention fidelity | Evaluating adherence to intervention protocols |
| 164 | NIH Behaviour Change Consortium Treatment Fidelity Framework | Standardising intervention fidelity | Assessing intervention delivery and implementation integrity |
| 165 | Medical Research Council Process Evaluation Framework | Evaluating complex intervention processes | Understanding how PHC interventions operate |
| 166 | StaRI (Standards for Reporting Implementation Studies) | Reporting implementation studies | Improving transparency of immunization implementation research |
| 167 | TIDieR Checklist | Describing interventions adequately | Reporting intervention components and delivery |
| 168 | SQUIRE Guidelines | Reporting healthcare quality improvement | Publishing PHC and immunization QI initiatives |
| 169 | CONSORT Extension for Pragmatic Trials | Reporting pragmatic trials | Reporting pragmatic implementation-related evaluations |
| 170 | PRECIS-2 | Assessing trial pragmatism | Designing pragmatic trials in routine PHC settings |
These approaches are complementary. Fidelity frameworks assess whether teams delivered interventions as intended. Process evaluation examines how and why implementation unfolded. Reporting guidelines improve the transparency and reproducibility of research.
Beyond the Catalogue: Designs and Practice Issues
Six topics recur in implementation work and sit outside the numbered catalogue. Examples are illustrative.
| Topic | What it means | Immunization example | Source |
|---|---|---|---|
| Hybrid effectiveness-implementation designs | Type 1 tests the intervention and gathers information on implementation. Type 2 tests the intervention and the implementation strategy together. Type 3 tests the implementation strategy and gathers information on the intervention's effects. | Type 3: compare two defaulter-tracing strategies for a vaccine with proven efficacy. | Curran and colleagues, 2012 |
| Adaptation and fidelity | Core functions are the purposes of the change process. Forms are the activities carrying them out, and teams customise forms to local context. Hold functions steady, adapt forms, and log each change with FRAME or FRAME-IS. | Function: every caregiver knows the return date. Forms: a card entry in one ward, a town-announcer reminder in another. | Perez Jolles and colleagues, 2019 |
| De-implementation | Reducing or stopping inappropriate practices to limit harm and wasted resources. It needs its own determinants, strategies and outcomes. | Stop sending eligible children home on days without a scheduled immunization session. | Norton and Chambers, 2020 |
| Sustainability assessment | The Program Sustainability Assessment Tool has 40 items in eight domains: environmental support, funding stability, partnerships, organisational capacity, programme evaluation, programme adaptation, communications and strategic planning. Cronbach's alpha ranged from 0.79 to 0.92 in US chronic disease programmes. | Rate a partner-funded outreach programme a year before transition to LGA funding. | Luke and colleagues, 2014 |
| Short outcome measures | AIM, IAM and FIM have four items each. Cronbach's alpha ranged from 0.85 to 0.91 and test-retest reliability from 0.73 to 0.88 in a US counsellor sample. Check translation and reliability with local respondents before comparing scores. | Pilot a Hausa version of the FIM with vaccinators before a digital register rollout. | Weiner and colleagues, 2017 |
| Equity lens | Name equity determinants explicitly and report results for each group as well as overall. | Report reach by settlement, sex of child and nomadic or settled status. Use HEIF or EquIR to explain gaps. | Woodward and colleagues, 2019 Eslava-Schmalbach and colleagues, 2019 |