Struggling to use a framework? Maybe your framework is at the wrong level

By Dr. Julia Moore , Executive Director

When people first learn about implementation frameworks, it’s pretty common to enter with a combination of excitement and trepidation. After teaching thousands of people about implementation, I’ve found that it’s easiest to start at the individual level and work your way up. First, you think about individual-level changes; then, you work on organization-level changes; then, you think about system-level changes. Since changes at the individual level are the least complex (i.e., there are fewer factors affecting an individual change than a system-level change), it’s easy to envision how those will play out.

While this might be a fairly logical sequence to learn about implementation, real-world implementation efforts are not as clear-cut. In fact, many implementation projects start at a systems level or an organization level, and people may only think about individual-level change as an afterthought. This is likely because people are tasked with change at those levels, so only think about the level of change at which they work, even though change at each level is linked.

Another common occurrence is for people to come across a framework (e.g., the theoretical domains framework) and feel like it does not fit their project. They may then push back and say that implementation science does not provide the answers they need or that frameworks are not useful tools. But just because one framework does not help in a particular situation does not mean the framework is not helpful; it means that the framework is not the right fit for what you were trying to accomplish. The theoretical domains framework is a very individual framework, so it’s not going to be as helpful if you are trying to understand organizational or system-level factors.

Frameworks are like tools in your toolbox. A screwdriver is amazing if you are inserting a screw, but if you have a nail, it’s going to feel like a useless tool. That doesn’t mean you throw out your screwdriver; it means you return to your toolbox and figure out what is a better tool for this situation. Implementation frameworks are just like these tools. They each have a function.?

If you want to figure out what framework you should use, figure out what you were trying to accomplish and then find the appropriate tools (i.e., implementation framework) to fit that function.?

• If you are looking for an individual-level framework, check out the theoretical domains framework (TDF).?
• If you want to understand the organizational context better, the consolidated framework for implementation research is a fabulous place to start.?
• If you want to consider system-level factors, the ABLe change framework is one to consider.

What tools do you like to use in your toolbox?

Note: An earlier version of this article originally appeared in the April 2019 issue of our Implementation in Action bulletin. Subscribe here to receive our next issue.