, 23 tweets, 13 min read Read on Twitter
Currently in a Mechanisms Network of Expertise (MNoE) workshop/session at #SIRC2019 The room is packed (standing room only) so hopefully my live-tweeting will help folks that couldn't fit.
@ImplementCollab also has a webinar on this topic. More info at …plementationresearchcollaboration.org/past-webinars/ (but no link to the webinar that I could find)
@ImplementCollab Mechanisms help us understand the causal process by which an implementation strategy functions. Ex: provider knowledge deficit is a "determinant", education is a strategy, and adoption is the outcome. A mechanism is what explains how education leads to adoption #SIRC2019
@ImplementCollab Another ex: provider low motivation (determinant), strategy is clinical champion-led team, outcome is acceptability to the practitioners. How did this work? Mechanism could be organizational climate. #SIRC2019
@ImplementCollab Mediator (Ryan Reynolds) v. Mechanism (Ryan Gosling) - Mediation analysis is a good first step in identifying mechanisms or support for mechanisms. But they don't tell us WHY we are seeing this effect. Mechanisms force us to articulate the causal processes. #SIRC2019
@ImplementCollab Why study mechanisms? Implementation studies fail to describe and explain how and why strategies produce effects. Thus, implementation studies are of little value. #SIRC2019
@ImplementCollab Policy/practice decision-makers want to know does it work and is it effective? Should I use it, approve it, fund it? But can we answer that question? What does it mean if something is "effective"? For most complex interventions, the answer is "Yes, but it depends" #SIRC2019
@ImplementCollab Most implementation studies show weak effects, high variance. (Sound familiar, #SoTL, #Pedagogy, #HigherEd research? We can use these methods from #ImplementationScience to help us study our complex contexts! See pinned tweet). #SIRC2019
@ImplementCollab Implementation outcomes are important, but a process focus (i.e., mechanisms) are important. Heterogeneity and variability in interventions, intervention sites, intervention receivers. Attempt to study the causal mechanisms! #SIRC2019
@ImplementCollab Causal models are boxes held together with rubber bands (fun analogy!). If you shake a box on the left, you're not going to get too much movement on the right. Studying mechanisms requires: de-emphasize average effect sizes, prioritize moderators, mediators, etc. #SIRC2019
@ImplementCollab Embrace, study, and guide adaptation (don't ignore it). Rethink core components, specify core functions.forms. Esmail et al. (2019) under review/PCORI Methods Standards for Complex Health Interventions. #SIRC2019
@ImplementCollab In the near future, studies without discussion of mechanisms should be viewed as poor science. (Side note: on more than one occasion, I've seen great overlap between #ImplementationScience and #OpenScience or good science practices.) #SIRC2019
@ImplementCollab This liberates those using strategies. Measure fidelity to core function, not forms. Once causal mechanisms are identified, then agents who understand them have freedom to use whatever forms they choose if core functions are retained. #SIRC2019
@ImplementCollab [break for workgroup discussions]
@ImplementCollab Report-outs from the subgroups, coming right up #SIRC2019
@ImplementCollab Measurement Group: Need diversification of measures, study designs using mixed-methods, bringing in more theory, using data sources more efficiently and creatively, thinking about tension between adaptation of measures and accumulation of knowledge... #SIRC2019
@ImplementCollab Linking theory to measurement to design, which requires longitudinal designs #SIRC2019
@ImplementCollab Context and Causal Theory Group: conceptual clarity/defining context is important, precision in articulating pathways and also measurement (what approaches do we need for levels other than individuals)? #SIRC2019
@ImplementCollab SMO Group: Provide guidance on models to specify mechanisms #SIRC2019
@ImplementCollab Design & Analysis Group: Think about the fields from which we are borrowing (and where else can we borrow from?), stakeholder engagement is important (whose perspectives do we need? What is the timing like?), leveraging data sources in meaningful ways #SIRC2019
@ImplementCollab Also need to educate funders, IRBs, and grant reviewers to understand a move away from RCTs #SIRC2019
@ImplementCollab If you have notes from this session, send them to callie.w@wsustl.edu #SIRC2019
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