Curran¹ uses a teaching tool that outlines five points to help individuals think like implementation scientists: (1) describing the ‘thing’ (describing the intervention), (2) analyzing if the ‘thing’ works (utilizing effectiveness research), (3) understanding how to do the ‘thing’ (conducting implementation research), (4) what we do to help do the ‘thing’ (applying implementation strategies), and (5) how much and how well the ‘thing’ is done (analyzing implementation outcomes). I consider this one of the most straightforward explanations of implementation science.

Let us explore this concept using oral rehydration salts (ORS), regarded as the most significant medical discovery of the 20th century for its ability to reduce deaths from childhood diarrhea by over 90%.²

 The ‘thing’ (Evidenced-based intervention):

The ‘thing’ here refers to ORS, an evidence-based intervention used to treat dehydration caused by diarrhea.

Does the ‘thing’ work? (Effectiveness Research):

The ‘thing’ (ORS) works. Since 1978, the World Health Organization (WHO) has widely implemented ORS in many countries to treat diarrhea and has saved more than 70 million lives since its first use in the 1960s.³

 Understanding how to do the ‘thing’ (Implementation research):

Implementation research analyzes ORS through a local context, studying factors such as packaging and communication strategies for clinicians and caregivers to improve uptake. The goal is to understand the gaps and how best to overcome them (“do the thing”), improving ORS integration into clinical and community settings for improved individual outcomes and population health outcomes.

What we do to help do the ‘thing’ (Implementation strategies):

Implementation strategies to support ORS utilization might include public awareness campaigns to address negative beliefs regarding ORS treatment, engaging stakeholders, creating incentives, and ensuring the intervention design applies to specific communities. Other approaches include increased subsidization and investment in ORS supply and social franchising programs.⁴ Even having ORS designated as an essential medicine by the WHO can be considered a strategy to improve its uptake.   

 How much and how well the ‘thing’ is done (Implementation outcomes):

At this stage, we assess discrete implementation outcomes, such as acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration/coverage, and sustainability⁵. The goal is to evaluate the success of implementation activities and compare the effectiveness of strategies. Specifically, we are looking at how these strategies enhance the implementation of ORS within routine public health practice. A good example is the acceptability of ORS by caregivers in a community.

Although Curran’s five points might seem too simplistic, they help clarify how an evidence-based intervention fits into the context of implementation science and effectiveness research and provide a quick explanation of implementation science through the last three points.

 References      

1. Curran, G.M. Implementation science made too simple: a teaching tool. Implement Sci Commun 1, 27 (2020). https://doi.org/10.1186/s43058-020-00001-z
2. Munos, M. K., Walker, C. L., & Black, R. E. (2010). The effect of oral rehydration solution and recommended home fluids on diarrhoea mortality. International journal of epidemiology, 39 Suppl 1(Suppl 1), i75–i87. https://doi.org/10.1093/ije/dyq025
3. Dadonaite, B. (2019) – “Oral rehydration therapy: a low-tech solution that has saved millions of lives” Published online at OurWorldInData.org. Retrieved from: ‘https://ourworldindata.org/oral-rehydration-therapy’ [Online Resource]
4. Ezezika, O., Ragunathan, A., El-Bakri, Y., & Barrett, K. (2021). Barriers and facilitators to implementation of oral rehydration therapy in low- and middle-income countries: A systematic review. PloS one, 16(4), e0249638. https://doi.org/10.1371/journal.pone.0249638
5. Proctor, E., Silmere, H., Raghavan, R., Hovmand, P., Aarons, G., Bunger, A., Griffey, R., & Hensley, M. (2011). Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Administration and policy in mental health, 38(2), 65–76. https://doi.org/10.1007/s10488-010-0319-7