Abstract
Background: Reduction or elimination of inappropriate, ineffective, or potentially harmful healthcare services and public health programs can help to ensure limited resources are used effectively. Frameworks and models (FM) are valuable tools in conceptualizing and guiding the study of de-implementation. This scoping review sought to identify and characterize FM that can be used to study de-implementation as a phenomenon and identify gaps in the literature to inform future model development and application for research. Methods: We searched nine databases and eleven journals from a broad array of disciplines (e.g., healthcare, public health, public policy) for de-implementation studies published between 1990 and June 2020. Two raters independently screened titles and abstracts, and then a pair of raters screened all full text records. We extracted information related to setting, discipline, study design, methodology, and FM characteristics from included studies. Results: The final search yielded 1860 records, from which we screened 126 full text records. We extracted data from 27 articles containing 27 unique FM. Most FM (n = 21) were applicable to two or more levels of the Socio-Ecological Framework, and most commonly assessed constructs were at the organization level (n = 18). Most FM (n = 18) depicted a linear relationship between constructs, few depicted a more complex structure, such as a nested or cyclical relationship. Thirteen studies applied FM in empirical investigations of de-implementation, while 14 articles were commentary or review papers that included FM. Conclusion: De-implementation is a process studied in a broad array of disciplines, yet implementation science has thus far been limited in the integration of learnings from other fields. This review offers an overview of visual representations of FM that implementation researchers and practitioners can use to inform their work. Additional work is needed to test and refine existing FM and to determine the extent to which FM developed in one setting or for a particular topic can be applied to other contexts. Given the extensive availability of FM in implementation science, we suggest researchers build from existing FM rather than recreating novel FM. Registration: Not registered.
| Original language | English (US) |
|---|---|
| Article number | 100 |
| Journal | Implementation Science |
| Volume | 16 |
| Issue number | 1 |
| DOIs | |
| State | Published - Dec 2021 |
Funding
This work was supported in part by the National Cancer Institute (number P50CA244431 and T32CA190194), the National Institute of Diabetes and Digestive and Kidney Diseases (numbers P30DK092950 and R25DK123008), the Centers for Disease Control and Prevention (number U48DP006395), and the Foundation for Barnes-Jewish Hospital. Although interest in de-implementation is growing, opportunities to advance this area of inquiry remain few []. Through 2016, only 20 federally-funded grants from the National Institutes of Health and the Agency for Healthcare Research and Quality focused explicitly on de-implementation []. Moullin and colleagues suggest several purposes and benefits of using FM to inform research and practice, including: defining the issue of interest and developing research or evaluation questions, selecting appropriate research or evaluation methods, discerning relevant determinants to de-implementation, selecting and tailoring strategies to support de-implementation, and to specify key outcomes to target []. Implementation science is a field that draws upon diverse disciplines, and there are numerous examples of FM that have been developed by scholars from a variety of fields (e.g., Theoretical Domains Framework developed by implementation scientists and behavioral researchers []). However, future work is still needed to determine the extent to which FM from other fields (e.g., cognitive psychology, organizational behavior) can be applied to de-implementation of healthcare interventions and public health policies and programs, as well as the transferability of FM from one content area to another (e.g., diabetes to cancer or prevention to treatment). Furthermore, additional investigation is needed to determine the extent to which FM for implementation are applicable to de-implementation. There may be opportunities to learn from previous implementation FM development work and to adapt implementation models for de-implementation. The field would benefit from a publicly available repository of de-implementation FM and associated literature, such as the resource available here: https://dissemination-implementation.org/ .
Keywords
- De-adoption
- De-implementation
- Disinvestment
- Framework
- Health
- Low-value
- Model
- Obsolescence
- Scoping review
ASJC Scopus subject areas
- Health Policy
- Health Informatics
- Public Health, Environmental and Occupational Health
