Factors influencing implementation are things that inform, support (facilitators), or hinder (barriers) efforts to deliver effective practices and maintain them over time. They can include characteristics of the practice; the people involved; clinics, organizations, systems, and communities; and other factors. Understanding these facilitators, barriers, and other influences can be essential for deciding what practice to use for a specific mental health need, improving its fit for a setting and community, and making the practice work and last. Factors influencing implementation are sometimes referred to as barriers/facilitators or contextual determinants.
Key Components
Factors influencing implementation can be related to:
- The practice: What it is and the resources it requires; what is known about how well it works, and how well it fits or can be adapted for a specific setting and population.
- People served by the practice: This includes patients, clients, caregivers, and families. Who they are; their needs, motivations, knowledge, and perspectives; and how these interact with providers, practices, or organizations.
- Individuals who deliver the practice: Who they are; their needs, motivations, knowledge, skills, and perspectives; and their relationships with the people served by the practice and their organization.
- Organizations: How the organization as a whole works; leadership, staffing, culture, communication, values, priorities, relationships, and physical infrastructure (including technology); the organization’s approach to and readiness for making changes; the other available services and supports; and how accessible they are. These factors apply to specific clinics or sites within organizations.
- Systems and communities: Factors outside the organization; laws, policies, funding, politics, partnerships with other organizations, cultures, values, and community needs.
Importance to Implementing an Effective Program or Practice
Understanding the factors influencing implementation can be useful when preparing for a new practice, implementing the practice, and sustaining its use. While preparing for a new practice, understanding these factors can help with (1) selecting what practice to use for an identified mental health need and community (including fit between the practice and community); and (2) deciding what support is needed to implement a new practice and address barriers to practice success. Once a practice is being used, monitoring these factors can help identify and address new challenges and needs to maintain its effectiveness and sustain it into the future. Identifying these factors, prioritizing them, and addressing them can be challenging because they can be complicated, occur at multiple levels of an organization or setting, and change over time—and they can interact with each other.
Key Resources
Contextual Determinants Affecting Implementation: Qualitative Interview Guide
This practical, user-friendly, five-question, semi-structured interview guide helps identify and understand the factors that may influence the implementation and sustainment of a practice.
Inventory of Factors Affecting Successful Implementation and Sustainment (IFASIS)
This quantitative survey asks about factors influencing implementation and their importance. It can be used with people in the organization or team to help identify…
Prioritizing Implementation Barriers: Toolkit for Designing an Implementation Initiative
This toolkit helps implementation teams determine which barriers are most important to address when implementing a practice. This tool assumes that the team has already…