Making, helping, or letting it happen: defining pragmatism in implementation trials

The hybrid effectiveness-implementation typology has become a cornerstone in implementation science, offering a way to classify studies according to their focus on effectiveness versus implementation outcomes. However, this typology reveals little about how implementation occurs in practice or the degree to which trials mirror real-world conditions. In this editorial, I argue that implementation trials should also be characterized by their level of pragmatism, defined by how much researcher control, support, or local leadership shapes implementation delivery. Drawing on my experiences with the INPREP, GLOW, and DEFENCE trials, and informed by the work of Greenhalgh and colleagues, I propose three pragmatic orientations-make-it-happen, help-it-happen, and let-it-happen-that reflect increasing contextual autonomy. Explicit reporting of a trial's pragmatic orientation using frameworks such as PRECIS-2-PS-which characterizes trials across domains, including implementation resources, flexibility of provider strategies, and delivery context-would enhance interpretation, synthesis, and scalability.