Strategies to support implementation of infectious disease decision support systems: a scoping review

Decision support systems (DSSs) are computerized tools that analyse data to guide actions and inform decision-making. Although DSSs are increasingly used in infectious disease contexts, their adoption remains inconsistent. Effective implementation is essential for integration of these tools into practice. Implementation strategies that promote sustainable uptake have not been comprehensively mapped for infectious disease DSSs. This scoping review aimed to identify and describe implementation strategies, associated outcomes, and use of theories, models, and frameworks (TMFs) in the implementation of infectious disease DSSs designed for early warning, detection, or prevention.

A scoping review was conducted following the Joanna Briggs Institute methodology and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A limited search in MEDLINE was used to develop the search strategy based on relevant publications. The final search was applied across MEDLINE, CAB Direct, AGRICOLA, and Web of Science using a time limiter (2000-2025). Studies were screened against eligibility criteria by two independent reviewers. Data were charted on implementation strategies, outcomes, and TMFs. Strategies were mapped to the Expert Recommendations for Implementing Change (ERIC) taxonomy, and outcomes were mapped to Proctor's implementation outcomes taxonomy. Data were synthesized by grouping DSSs according to their primary level of public health action: clinical/individual, population/program, or system/governance. Reported or codable strategies, outcomes, and TMFs were summarized within each level of action.

Of the 18,708 records identified, 26 studies reported in 27 publications met the inclusion criteria. In total, 20 unique implementation strategies were identified through reviewer coding of narrative descriptions, 7 implementation outcomes were inferred from descriptive indicators, and 3 TMFs were reported in the literature. Clinical/individual-level DSSs included 13 strategies, 7 outcomes, and 2 TMFs; population/program-level DSSs included 13 strategies, 7 outcomes, and 1 TMF; and system/governance-level DSSs included 7 strategies, 3 outcomes, and no TMFs.

Implementation of infectious disease DSSs most often involved activities that mapped to educational and stakeholder engagement strategies, with limited reported use of guiding theories or frameworks. Although outcome reporting was relatively common, outcome definitions and depth of outcome reporting varied widely. More deliberate use of TMFs and systematic outcome evaluation could strengthen the evidence base for DSS implementation. In policy and management contexts, better alignment between strategy selection, system design, and public health objectives may enhance sustainable DSS adoption and impact.

Not applicable.