Specifying and reporting implementation strategies used in a school-based prevention efficacy trial

Abstract

Background The implementation strategies used to enhance the implementation of interventions during efficacy and effectiveness studies are rarely reported. Tracking and reporting implementation strategies during these phases has the potential to improve future research studies and real-world implementation. We present an exemplar of how this might be executed by specifying and reporting the implementation strategies that were used during a school-based efficacy trial, Project POWER, which tested a trauma-informed prevention program delivered by a university research team, community members, and school staff facilitators in 29 schools. Methods Following the conclusion of the 4-year trial, core Project POWER research team members identified the implementation strategies that supported intervention delivery during the trial using an established taxonomy of school-based implementation strategies. The actors, actions, action targets, temporality, dose, and implementation outcomes were specified using established implementation strategies reporting guidelines. Results The research team identified 37 implementation strategies that were used during the Project POWER trial. Most strategies fell within the categories of Train and Educate Stakeholders, Use Evaluative and Iterative Strategies, and Develop Stakeholder Interrelationships. Actors included members of the research team and partner schools. Strategies were used multiple times during the preparation and implementation phases. Action targets were most often characteristics of individuals, implementation process, and characteristics of the inner setting. Strategies predominantly targeted the implementation outcomes of fidelity, acceptability, feasibility, and adoption. Conclusions This study provided evidence that implementation strategies are used and can be identified in efficacy research using a retrospective approach. Identifying and specifying implementation strategies used during the initial phases of the translational research pipeline can inform the implementation strategies that are carried forward, adapted, or discontinued in future trials and routine practice to improve implementation and effectiveness outcomes. Plain Language Abstract Intervention development and testing often occurs separately from implementation planning. However, evaluating an intervention without considering how it will be subsequently used in real-world settings is a major factor contributing to the research-to-practice gap. During the rigorous testing of interventions, research teams invest significant effort and resources to ensure their program is delivered as intended and so that beneficial outcomes can be assessed. However, the methods or techniques used to support implementation (i.e., implementation strategies) are often not measured or specified to be used and evaluated during later research or included with intervention materials that are distributed to stakeholders; this is a missed opportunity. This study identifies and describes the implementation strategies used during a large school-based research trial of a universal trauma-informed prevention program delivered by a university research team, community members, and school staff. In collaboration with the trial’s research team, we identified 37 implementation strategies that were used during the trial and defined how each strategy was used, including: the actions (i.e., things done), people who carried out the strategies, the targets of the actions, when and how often during the implementation process the strategies were used, and which implementation outcome(s) the strategy was expected to impact. Explicating implementation strategies during early phases of intervention research in schools can inform which implementation supports to carry forward, adapt, or discontinue in future studies and routine practice.