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Pragmatic trials and implementation science: grounds for divorce?

Ray Pawson1

  • 1School of Sociology and Social Policy, University of Leeds, Leeds, LS2 9JT, UK. r.d.pawson@leeds.ac.uk.

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Summary

Pragmatic trials have an outdated view of knowledge transfer, limiting real-world applicability. Implementation science requires a shift towards multi-case, multi-method evidence for better problem-solving.

Keywords:
GeneralisabilityHeterogeneity of treatment effectsImplementation scienceMulti-methodsPRECIS modelsPragmatic trialsResearch usersWithin-case and cross-case analysis

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Area of Science:

  • Clinical Research
  • Health Services Research
  • Implementation Science

Background:

  • Examines the intellectual history and independent development of pragmatic trials and implementation science.
  • Investigates the compatibility and incompatibility between these two research paradigms.
  • Addresses the assumptions of pragmatic trials regarding research findings transfer and their role in evaluating implementation science.

Purpose of the Study:

  • To scrutinize the assumptions and limitations of pragmatic trials in the context of implementation science.
  • To evaluate the role of pragmatic trials in assessing implementation science strategies.
  • To propose an empirical strategy for improving knowledge transfer and generalizability in implementation science.

Main Methods:

  • Employs 'explication de texte' for close reading of paradigm expositions.
  • Analyzes the inferential logic within key literature on pragmatic trials and implementation science.
  • Interrogates conclusions from a pragmatic trial on retinal screening guidelines for family practitioners.

Main Results:

  • Identifies significant incommensurability between the two paradigms.
  • Reveals an antiquated view of knowledge transfer and over-optimism regarding applicability in pragmatic trial literature.
  • Highlights the need for a new empirical strategy to enhance knowledge transfer mechanisms and generalizability.

Conclusions:

  • Advocates for a paradigm shift in implementation science, moving beyond the limitations of pragmatic trials.
  • Proposes an explanation-building model grounded in multi-case, multi-method evidence.
  • Emphasizes pragmatism's core principles of problem-solving and perspective melding for advancing implementation science.