4.1 Introduction
Theories, Models, and Frameworks (TMFs) are critical ingredients of pragmatic research studies.
While we often reference them as a collective group (TMFs), each type will have different use and purpose.
- Theories are generally specific and predictive, with directional relationships between concepts making them suitable for hypothesis testing.
- Models are specific, more often prescriptive, strategic or action-planning to provide a systematic way to develop, manage, and evaluate interventions.
- Frameworks organize, explain, or describe information and the range and relationships between concepts, including some which delineate processes, and therefore are useful for communication.
TMFs should and can be used through the entire research project and can inform planning, research questions, program implementation, and evaluation.
- Tabak RG, Khoong EC, Chambers DA, Brownson RC. Bridging research and practice: models for dissemination and implementation research. Am J Prev Med. 2012;43(3):337-350. doi:10.1016/j.amepre.2012.05.024
- Strifler L, Cardoso R, McGowan J, et al. Scoping review identifies significant number of knowledge translation theories, models, and frameworks with limited use. J Clin Epidemiol. 2018;100:92-102. doi:10.1016/j.jclinepi.2018.04.008
4.2 Choosing a TMF
Identify one or more TMFs that reflect the levels of change and contextual or setting characteristics relevant to your research. Some commonly-used pragmatic research frameworks are summarized below.
You may also consider creating a logic model to guide the selection of models and frameworks for your project. For guidance on creating a logic model, visit the Plan section of the D&I webtool.
- Moullin, J.C., Dickson, K.S., Stadnick, N.A. et al. Ten recommendations for using implementation frameworks in research and practice. Implement Sci Commun 1, 42 (2020). https://doi.org/10.1186/s43058-020-00023-7
- Smith JD, Li DH, Rafferty MR. The Implementation Research Logic Model: a method for planning, executing, reporting, and synthesizing implementation projects. Implement Sci. 2020;15(1):84. doi:10.1186/s13012-020-01041-8
- Field B, Booth A, Ilott I, Gerrish K. Using the Knowledge to Action Framework in practice: a citation analysis and systematic review. Implement Sci. 2014;9:172. Published 2014 Nov 23. doi:10.1186/s13012-014-0172-2
- Graham ID, Logan J, Harrison MB, et al. Lost in knowledge translation: time for a map?. J Contin Educ Health Prof. 2006;26(1):13-24. doi:10.1002/chp.47
4.2.1
The Practical, Robust Implementation and Sustainability Model and the Reach Effectiveness, Adoption, Implementation and Maintenance Framework (PRISM/RE-AIM)
- Glasgow RE, Harden SM, Gaglio B, et al. RE-AIM Planning and Evaluation Framework: Adapting to New Science and Practice With a 20-Year Review. Front Public Health. 2019;7:64. Published 2019 Mar 29. doi:10.3389/fpubh.2019.00064
-
McCreight MS, Rabin BA, Glasgow RE, et al. Using the Practical, Robust Implementation and Sustainability Model (PRISM) to qualitatively assess multilevel contextual factors to help plan, implement, evaluate, and disseminate health services programs. Transl Behav Med. 2019;9(6):1002-1011. doi:10.1093/tbm/ibz085
-
Harden SM, Smith ML, Ory MG, Smith-Ray RL, Estabrooks PA, Glasgow RE. RE-AIM in Clinical, Community, and Corporate Settings: Perspectives, Strategies, and Recommendations to Enhance Public Health Impact. Front Public Health. 2018;6:71. Published 2018 Mar 22. doi:10.3389/fpubh.2018.00071
4.2.2
The Exploration, Preparation, Implementation, and Sustainment (EPIS) Framework
- Moullin JC, Dickson KS, Stadnick NA, Rabin B, Aarons GA. Systematic review of the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. Implement Sci. 2019;14(1):1. Published 2019 Jan 5. doi:10.1186/s13012-018-0842-6
4.2.3
The Consolidated Framework for Implementation Research (CFIR)
- Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009 Aug 7;4:50. doi:10.1186/1748-5908-4-50
4.2.4
The Knowledge-to-Action Framework (KTA)
- Field B, Booth A, Ilott I, Gerrish K. Using the Knowledge to Action Framework in practice: a citation analysis and systematic review. Implement Sci. 2014 Nov 23;9:172. doi:10.1186/s13012-014-0172-2
- Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W, Robinson N. Lost in knowledge translation: time for a map? J Contin Educ Health Prof. 2006 Winter;26(1):13-24. doi:10.1002/chp.47
4.2.5
The MOST Framework
- Guastaferro K, Collins LM. Achieving the Goals of Translational Science in Public Health Intervention Research: The Multiphase Optimization Strategy (MOST). Am J Public Health. 2019;109(S2):S128-S129. doi:10.2105/AJPH.2018.304874
- Collins, L. M. (2018). Optimization of behavioral, biobehavioral, and biomedical interventions: The multiphase optimization strategy (MOST). New York: Springer.
4.2.6
Small P Policy Framework
4.2.7
Normalization Process Theory
- Murray E, Treweek S, Pope C, MacFarlane A, Ballini L, Dowrick C, Finch T, Kennedy A, Mair F, O’Donnell C, Ong BN, Rapley T, Rogers A, May C. Normalisation process theory: a framework for developing, evaluating and implementing complex interventions. BMC Med. 2010 Oct 20;8:63. doi:10.1186/1741-7015-8-63
4.2.8
Diffusion of Innovations
- Rogers EM. Diffusion of Innovations, 5th Edition. New York: Free Press; 2003.
- Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q. 2004;82(4):581-629. doi:10.1111/j.0887-378X.2004.00325.x
4.3 Frameworks for Complexity & Systems Science
Despite broad recognition of the need to account for complexity in pragmatic research, many available conceptual tools and frameworks are linear or categorical. Diagramming approaches from systems science such as causal-loop modeling and stock-and-flow diagramming can be used to visually describe how an intervention is believed to act on multilevel contextual factors to produce outcomes.
The talks and handouts linked in this section provide more detail about a variety of systems-science approaches that may be useful.
- Apostolopoulos Y, Lich KH, Lemke MK, eds. Complex Systems and Population Health. 1st edition. Oxford University Press; 2020.
- Sterman, J. Business Dynamics: Systems Thinking and Modeling for a Complex World. Irwin/McGraw Hill. (2000).
-
Ballard E, Werner K, Priyadarshini P. Boundary objects in translation: the role of language in participatory system dynamics modeling. System Dynamics Review. 2021;37(4):310-332. doi:10.1002/sdr.1694
-
Ballard E, Farrell A, Long M. Community-Based System Dynamics for Mobilizing Communities to Advance School Health. J Sch Health. 2020 Dec;90(12):964-975. doi:10.1111/josh.12961
-
Langellier BA, Kuhlberg JA, Ballard EA, et al. Using community-based system dynamics modeling to understand the complex systems that influence health in cities: The SALURBAL study. Health Place. 2019 Nov;60:102215. doi:10.1016/j.healthplace.2019.102215
- Hovmand, P. S. (2013). Community Based System Dynamics. Springer Business.
-
Király G, Miskolczi P. Dynamics of participation: System dynamics and participation-An empirical review. Systems Research and Behavioral Science. 2019;36(2):199-210. doi:10.1002/sres.2580
- Meadows, D. (2008). Thinking in Systems: A Primer. Chelsea Green Publishing.
- Vennix, JAM. Group model-building: tackling messy problems. System Dynamics Review. 1999;15(4):379-401. doi:/10.1002/(sici)1099-1727(199924)15:4%3C379::aid-sdr179%3E3.0.co;2-e
-
Richardson GP. Reflections on the foundations of system dynamics. System Dynamics Review. 2011;27(3):219-243. doi:10.1002/sdr.462
-
Paina L, Peters DH. Understanding pathways for scaling up health services through the lens of complex adaptive systems. Health Policy and Planning. 2011;27(5):365-373. doi:10.1093/heapol/czr054
4.4 Pragmatic Research Frameworks – Key Questions
Questions to ask as you identify which pragmatic research TMF(s) you will use to plan your study:
4.4.1
How might my selected TMF(s) guide the process of planning pragmatic research, adapting and refining interventions and study protocols, and establishing implementation, dissemination, and sustainability plans?
- Reference title, authors, etc. url to reference
- Reference title, authors, etc. url to reference
4.4.2
How might my selected TMF(s) inform the outcomes and measures (including intermediate or process outcomes, mechanisms of change, or determinants/factors related to implementation) I want to study?
- Reference title, authors, etc. url to reference
- Reference title, authors, etc. url to reference
4.4.3
Do I need to combine TMFs? There are many occasions when selecting just one TMF will not address all your needs for guiding the planning, design, implementation, and evaluation activities. Nilsen classified implementation science TMFs into five broad categories based on their primary purpose: process models, determinant frameworks, classic theories, implementation frameworks, and evaluation frameworks. When one TMF does not suffice, you might decide to select multiple TMFs and combine them.
- Nilsen P. Making sense of implementation theories, models and frameworks. Implement Sci. 2015;10:53. Published 2015 Apr 21. doi:10.1186/s13012-015-0242-0
4.4.4
Do I need to adapt a TMF? There may not be a comprehensive model that will perfectly fit your study, so it may be necessary to further adapt the TMF(s) you identified for your study context.