When the parts are greater than the whole: how understanding mechanisms can advance implementation research
Abstract Background Does the importance of context in implementation imply that generalizing about the effects of strategies is ultimately limited? Conceptual approaches for generalizing in the presence of significant contextual heterogeneity could advance implementation research but require novel p...
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| Format: | Article |
| Language: | English |
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BMC
2025-05-01
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| Series: | Implementation Science |
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| Online Access: | https://doi.org/10.1186/s13012-025-01427-6 |
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| _version_ | 1849310297642237952 |
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| author | Elvin H. Geng Byron J. Powell Charles W. Goss Cara C. Lewis Anne E. Sales Bo Kim |
| author_facet | Elvin H. Geng Byron J. Powell Charles W. Goss Cara C. Lewis Anne E. Sales Bo Kim |
| author_sort | Elvin H. Geng |
| collection | DOAJ |
| description | Abstract Background Does the importance of context in implementation imply that generalizing about the effects of strategies is ultimately limited? Conceptual approaches for generalizing in the presence of significant contextual heterogeneity could advance implementation research but require novel perspectives. Main body Drawing from perspectives from Realist approaches, Pearl’s transportability framework and philosophy of science, this paper outlines a mechanism-based approach to generalizing about the effects of implementation strategies. We suggest that understanding mechanisms creates a conceptual bridge between the effects of a strategy and the influence of the implementation context. Using directed acyclic graphs to represent the mechanisms of strategies, we show how conceptualizing mediators of overall effects offer a basis for considering the effects of context. Hence, theorizing and testing a mechanistic understanding enriches the ways in which we can consider how context could change those effects. Such an approach allows us to understand how a strategy works within a given implementation context, determine what information from new contexts are needed to infer across contexts, and if that information is available, what those effects would be — thereby advancing generalizing in implementation research. We consider particular implementation strategies (e.g., Community Adherence Groups and practice facilitation) as examples to illustrate generalizing into different contexts. Conclusion Mechanisms can help implementation research by simultaneously accommodating the importance of context as well as the imperative to generalize. A shift towards a mechanism-focused approach that goes beyond identifying barriers and facilitators can enhance the value of implementation research. |
| format | Article |
| id | doaj-art-b21ee5eabb0b4c7bb6a053e3173d0e8b |
| institution | Kabale University |
| issn | 1748-5908 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science |
| spelling | doaj-art-b21ee5eabb0b4c7bb6a053e3173d0e8b2025-08-20T03:53:46ZengBMCImplementation Science1748-59082025-05-0120111210.1186/s13012-025-01427-6When the parts are greater than the whole: how understanding mechanisms can advance implementation researchElvin H. Geng0Byron J. Powell1Charles W. Goss2Cara C. Lewis3Anne E. Sales4Bo Kim5Department of Medicine, Division of Infectious Diseases, Washington University in St. LouisCenter for Dissemination and Implementation in the Institute for Public Health, Washington University in St. LouisInstitute for Informatics, Data Science and Biostatistics, Washington University in St. LouisKaiser Permanente Washington Health Research InstituteSinclair School of Nursing and Department of Family and Community Medicine, University of MissouriVA Boston Healthcare System and Department of Psychiatry, Harvard Medical School, Center for Healthcare Organization and Implementation ResearchAbstract Background Does the importance of context in implementation imply that generalizing about the effects of strategies is ultimately limited? Conceptual approaches for generalizing in the presence of significant contextual heterogeneity could advance implementation research but require novel perspectives. Main body Drawing from perspectives from Realist approaches, Pearl’s transportability framework and philosophy of science, this paper outlines a mechanism-based approach to generalizing about the effects of implementation strategies. We suggest that understanding mechanisms creates a conceptual bridge between the effects of a strategy and the influence of the implementation context. Using directed acyclic graphs to represent the mechanisms of strategies, we show how conceptualizing mediators of overall effects offer a basis for considering the effects of context. Hence, theorizing and testing a mechanistic understanding enriches the ways in which we can consider how context could change those effects. Such an approach allows us to understand how a strategy works within a given implementation context, determine what information from new contexts are needed to infer across contexts, and if that information is available, what those effects would be — thereby advancing generalizing in implementation research. We consider particular implementation strategies (e.g., Community Adherence Groups and practice facilitation) as examples to illustrate generalizing into different contexts. Conclusion Mechanisms can help implementation research by simultaneously accommodating the importance of context as well as the imperative to generalize. A shift towards a mechanism-focused approach that goes beyond identifying barriers and facilitators can enhance the value of implementation research.https://doi.org/10.1186/s13012-025-01427-6ContextGeneralizabilityMechanismsImplementation strategies |
| spellingShingle | Elvin H. Geng Byron J. Powell Charles W. Goss Cara C. Lewis Anne E. Sales Bo Kim When the parts are greater than the whole: how understanding mechanisms can advance implementation research Implementation Science Context Generalizability Mechanisms Implementation strategies |
| title | When the parts are greater than the whole: how understanding mechanisms can advance implementation research |
| title_full | When the parts are greater than the whole: how understanding mechanisms can advance implementation research |
| title_fullStr | When the parts are greater than the whole: how understanding mechanisms can advance implementation research |
| title_full_unstemmed | When the parts are greater than the whole: how understanding mechanisms can advance implementation research |
| title_short | When the parts are greater than the whole: how understanding mechanisms can advance implementation research |
| title_sort | when the parts are greater than the whole how understanding mechanisms can advance implementation research |
| topic | Context Generalizability Mechanisms Implementation strategies |
| url | https://doi.org/10.1186/s13012-025-01427-6 |
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