ISのレビュー | Making sense of implementation theories, models and frameworks (2015)

エビデンスに基づいた介入やその実装に関する理論・モデル・フレームワークが多数発表されている中、Nilsen(2015)は、実装科学(とその周辺領域)で使われる理論/モデル/フレームワーク（※）を5カテゴリに分類し、さらに3つの目的にタイプ分けしたものを提示しました．

（※）理論・モデル・フレームワークは、一般的にそれぞれ異なる定義がありますが、ISの研究ではしばしば区別せずに用いられている、と述べられています．

Nilsenの分類を知っておくことは、様々な理論/モデル/フレームワークの取捨選択において有用です．また、エビデンスに基づいた介入やその実装を考えるうえで、自分は何を知りたいのか？ 何に注目したいのか？今の現状をどう整理したいのか？といったことをロジカルに組み立てるうえでも役立つように思います．

また、本文をじっくり読むことで、実際の研究計画等において、どのあたりのことまでが研究のスコープに入っていて、どこに焦点を当てようとしているのかの理解が深まります．これについては、abstractのdiscussionにも凝縮されていますので、一部抜粋します．

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Most determinant frameworks provide limited "how-to" support for carrying out　implementation endeavours since the determinants usually are too generic to provide　sufficient detail for guiding an implementation process. And while the relevance of　addressing barriers and enablers to translating research into practice is mentioned in many　process models, these models do not identify or systematically structure specific　determinants associated with implementation success. Furthermore, process models　recognize a temporal sequence of implementation endeavours, whereas determinant　frameworks do not explicitly take a process perspective of implementation.

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以下、Nilsenが提案した5カテゴリと3つの目的を紹介します．

「目的別」のISの理論・モデル・フレームワークの分類

（Figure1. Three aims of the use of theoretical approaches in implementation science and the five categories of theories, models and frameworks　より）

■ Describing and /or guiding the process of translating research into practice

• Process model

■ Understanding and/or explaining what influences implementation outcomes

• Determinant frameworks
  
• Classic theories
  
• Implementation theories

■ Evaluating implementation

• Evaluation frameworks
  

ISの理論・モデル・フレームワークのの5つのカテゴリ

（Table 1 Five categories of theories, models and frameworks used in implementation science より一部抜粋）

• 【Process models】  Specify steps (stages, phases) in the process of translating research into practice, including the implementation and use of research. The aim of process models is to describe and/or guide the process of translating research into practice. An action model is a type of process model that provides practical guidance in the planning and execution of implementation endeavours and/or implementation strategies to facilitate implementation. Note that the terms “model” and “framework” are both used, but the former appears to be the most common
• Ex.) the CIHR Model of Knowledge Translation, the K2A Framework, the Stetler Model, the ACE Star Model of Knowledge Transformation, the Knowledge-to-Action Model, the Iowa Model, the Ottawa Model, the Quality Implementation Framework

• 【Determinant frameworks】 Specify types (also known as classes or domains) of determinants and individual determinants, which act as barriers and enablers (independent variables) that influence implementation outcomes (dependent variables). Some frameworks also specify relationships between some types of determinants. The overarching aim is to understand and/or explain influences on implementation outcomes, e.g. predicting outcomes or interpreting outcomes retrospectively
• Ex.) PARIHS, Active Implementation Frameworks, Understanding-User-Context Framework, Conceptual Model, Theoretical Domains Framework
• 【Classic theories】Theories that originate from fields external to implementation science, e.g. psychology, sociology and organizational theory, which can be applied to provide understanding and/or explanation of aspects of implementation
• Ex.) Theory of Diffusion,social cognitive theories, theories concerning cognitive processes and decision making, social networks theories, social capital theories, communities of practice, professional theories, organizational theories
• 【Implementation theories】 Theories that have been developed by implementation researchers (from scratch or by adapting existing theories and concepts) to provide understanding and/or explanation of aspects of implementation
• Ex.) Implementation Climate, Absorptive Capacity, Organizational Readiness, COM-B , Normalization Process Theory
• 【Evaluation frameworks】 Specify aspects of implementation that could be evaluated to determine implementation success
• Ex.) RE-AIM, PRECEDE-PROCEED

※なおこの論文は、BioMed Central Ltd のライセンスに基づき、クリエイティブ コモンズ表示ライセンス (http://creativecommons.org/licenses/by/4.0)の条件のもとで公開されています．

Reference.

Nilsen P. Making sense of implementation theories, models and frameworks. Implement Sci. 2015;10:53. doi:10.1186/s13012-015-0242-0 https://pubmed.ncbi.nlm.nih.gov/25895742/