The Application and Evolution of the Practical, Robust Implementation and Sustainability Model (PRISM): History and Innovations

Implementation science theories, models, and frameworks (TMF) should help users understand complex issues in translating research into practice, guide selection of appropriate implementation strategies, and evaluate implementation outcomes. They should also be sensitive to evidence from projects that apply the framework, evolve based on those experiences, and be accessible to a range of users. This paper describes these issues as they relate to the Practical, Robust Implementation and Sustainability Model (PRISM). PRISM was created to assess key multilevel contextual factors related to the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) outcomes of health interventions. We describe key aspects of PRISM and how it has been applied, evolved, and adapted across settings, time, and content areas. Since its development in 2008 PRISM has been used in over 200 publications, with increased use in recent years. It has been used for a wide variety of purposes and more recent applications have focused on increasing its accessibility for non-researcher groups and more rapid and iterative application for use in learning heath systems. PRISM has been applied to address health equity issues including representation, representativeness, and co-creation activities in both US and non-US settings. We describe common types of adaptations made by implementation teams when applying PRISM to fit with the resources and priorities of diverse and low-resource settings. We conclude by summarizing lessons learned and providing recommendations for future research and practice using PRISM.