A stakeholder-driven method for selecting implementation strategies: a case example of pediatric hypertension...

Area of Science:

• Implementation Science
• Health Services Research
• Pediatric Health

Background:

• Pediatric hypertension clinical practice guideline (CPG) implementation faces challenges in primary care.
• Low rates of guideline-adherent diagnosis and treatment highlight the need for effective strategies.

Purpose of the Study:

• To present a generalizable method for identifying, specifying, and prioritizing implementation strategies.
• To illustrate this method with a case example of pediatric hypertension CPG implementation in community health centers.

Main Methods:

• Convened a Stakeholder Advisory Panel (SAP) including pediatricians and academic partners.
• Expanded the Expert Recommendations for Implementation Change (ERIC) protocol with modified Delphi, user-centered design, and the Implementation Research Logic Model (IRLM).
• Gathered input from patients/caregivers and clinic staff to refine strategies.

Main Results:

• Identified 17 determinants and prioritized 18 implementation strategies, focusing on intervention characteristics, inner setting, and implementer characteristics.
• Prioritized a top-tier package of 7 strategies based on effectiveness, feasibility, and priority ratings.
• Confirmed feasibility and acceptability of strategies with caregivers and clinic staff, refining their specification.

Conclusions:

• The adapted ERIC protocol offers a pragmatic structure for stakeholder-driven identification and prioritization of implementation strategies.
• Supplementing with user-centered design and the IRLM enhances efficiency and alignment with implementation contexts.
• This generalizable method increases the likelihood of strategy adoption and sustained use in practice.