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Mapping Theories, Models and Frameworks from implementation science for evaluating quality improvement initiatives: a
Klaudia A Arizmendi-Barrera1,2, Jafet Arrieta3,4, Tamara Nevarez Tinoco5
1Institute for Healthcare Improvement, Boston, Massachusetts, USA.
Background:
Improvement science has supported the methodological foundations for the application of quality improvement (QI) in healthcare. However, concerns persist regarding the rigour of QI evaluation. Theories, Models and Frameworks (TMFs) from implementation science support the uptake of evidence-based practices but their use to guide the evaluation of QI initiatives remains insufficiently characterised.
Objectives:
To identify which implementation science TMFs have been used to evaluate QI initiatives in healthcare, assess how these TMFs were applied in the evaluation, and compare the TMFs' intrinsic methodological attributes.
Methods:
We conducted a scoping review following Arksey and O'Malley's framework. Eligible studies were published between 2010 and 2025 and evaluated a QI initiative using at least one TMF. Peer-reviewed literature was searched in PubMed, Scopus and Web of Science. Grey literature was retrieved through targeted Google searches. TMFs were evaluated at the article level according to their application in each study and at the TMF level according to their intrinsic methodological attributes.
Results:
Out of 1824 records screened, 80 studies were included. 23 unique TMFs were identified. Of these, the most frequently used were the Reach, Effectiveness, Adoption, Implementation and Maintenance framework (27%) and the Consolidated Framework for Implementation Research (20%). Although 94% of studies used TMFs to guide data collection or analysis, only 43% explicitly tested construct relationships or causal pathways. TMFs demonstrated high conceptual clarity and structure but limited equity and sociocultural responsiveness.
Conclusions:
Application of TMFs in the evaluation of QI initiatives was heterogeneous. No single TMF captured the full range of evaluative functions. More rigorous evaluation requires an integrative approach that combines complementary TMFs to examine context, mechanisms of improvement and outcomes. Prospective operationalisation of TMF constructs, particularly equity, within study design and evaluation is essential to strengthen reproducibility and improve the transferability of findings across settings.
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