What implementation strategies are relational? Using Relational Theory to explore the ERIC implementation strategies

Area of Science:

• Implementation Science
• Health Services Research
• Organizational Behavior

Background:

• Implementation research has advanced understanding of implementation processes and causal pathways.
• Current understanding needs to better integrate relational exchanges and interactions within strategies.
• Critical perspectives and theories like Relational Theory are underutilized in implementation science.

Purpose of the Study:

• To apply Relational Theory to analyze the relational components within the Expert Recommendations for Implementation Change (ERIC) implementation strategies.
• To examine how implementation strategies operationalize different types of interactions, exchanges, and alliances.

Main Methods:

• Qualitative directed content analysis of 73 ERIC implementation strategies.
• Application of the Relational and Transactional Strategy Continuum measure by three independent reviewers.
• Categorization of strategies based on relational, transactional, and operational alliance features.

Main Results:

• A majority of strategies exhibited relational alliance features (36 strategies: 17 highly relational, 19 semi-relational).
• Fewer strategies were categorized as transactional (19 strategies: 9 highly transactional, 10 semi-transactional).
• 18 strategies were coded as operational alliances, indicating a mix of relational and transactional elements.

Conclusions:

• Implementation strategies offer opportunities to further develop relational exchanges, considering actor roles and power dynamics.
• The Relational and Transactional Strategy Continuum measure can guide practitioners and researchers in selecting and combining strategies.
• This framework supports the development of strategies that foster positive alliances, communication, and power sharing for improved implementation outcomes.