Debate

Designing theoretically-informed implementation interventions: Fine in theory, but evidence of effectiveness in practice is needed

Onil Bhattacharyya¹, Scott Reeves^2,3,4, Susan Garfinkel⁵ and Merrick Zwarenstein^1,5,6*

• * Corresponding author: Merrick Zwarenstein merrick.zwarenstein@ices.on.ca

Author Affiliations

¹ Department of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada

² Department of Family & Community Medicine, University of Toronto, Ontario, Canada

³ Centre for Faculty Development, St. Michael's Hospital, Toronto, Ontario, Canada

⁴ Wilson Centre for Research in Education, University of Toronto, Ontario, Canada

⁵ Sunnybrook and Women's College Health Sciences Centre, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada

⁶ Knowledge Translation Programme, University of Toronto at St. Michael's Hospital, Toronto, Ontario, Canada

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Implementation Science 2006, 1:5 doi:10.1186/1748-5908-1-5

Published: 23 February 2006

Abstract

The Improved Clinical Effectiveness through Behavioural Research Group (ICEBeRG) authors assert that a key weakness in implementation research is the unknown applicability of a given intervention outside its original site and problem, and suggest that use of explicit theory offers an effective solution. This assertion is problematic for three primary reasons. First, the presence of an underlying theory does not necessarily ease the task of judging the applicability of a piece of empirical evidence. Second, it is not clear how to translate theory reliably into intervention design, which undoubtedly involves the diluting effect of "common sense." Thirdly, there are many theories, formal and informal, and it is not clear why any one should be given primacy. To determine whether explicitly theory-based interventions are, on average, more effective than those based on implicit theories, pragmatic trials are needed. Until empirical evidence is available showing the superiority of theory-based interventions, the use of theory should not be used as a basis for assessing the value of implementation studies by research funders, ethics committees, editors or policy decision makers.