The co-design of a digitally supported intervention for selecting implementation tools and actions for standards (SITAS)

Background: Health and social care standards are multi-faceted interventions that promote quality and safe care in health systems. There is a need to apply evidence-based, rigorous and transparent methods when selecting strategies to support the implementation of standards. We aimed to develop an evidence- and theory-informed intervention to guide researchers in identifying appropriate implementation strategies and then selecting tailored support tools and actions for use when implementing a set of standards.

Methods: Our intervention is a digital tool entitled 'Selecting Implementation Tools and Actions for Standards (SITAS).' The Medical Research Council Framework for Developing and Evaluating Complex Interventions guided the design of SITAS. Co-design of SITAS, using a multi-stage and multi-methods approach included developing programme theory; identifying and prioritising enablers and barriers to implementing standards; identifying the best fit implementation framework using the Theory Comparison and Selection Tool; mapping enablers and barriers to the Consolidated Framework for Implementation Research (CFIR); identifying matching implementation strategies using the CFIR-ERIC (Expert Recommendations for Implementing Change) matching tool; mapping enablers and barriers to the Behaviour Change Wheel (BCW). The enablers and barriers, outputs from the CFIR-ERIC matching tool and the BCW were used to develop a prototype of the content and interactive logic within a digital tool. The prototype was refined following feedback from intended users (n = 7) at three design workshops.

Results: Programme theory was developed and refined following feedback from intended users of SITAS. Twenty-three enablers and barriers were prioritised. CFIR was identified as the best fit framework with the majority of enablers and barriers (n = 15) mapped to the 'Inner Setting' domain. 'Conduct educational meetings' was the most common strategy retrieved using the CFIR-ERIC matching tool. 'Physical opportunity' was the component of the BCW with the most enablers and barriers (n = 8). A prototype of SITAS was designed in Microsoft Excel based on the aforementioned steps. Workshops with intended users provided key insights about the content, functionality and user experience for SITAS which resulted in refinements to SITAS.

Conclusion: We developed a practical intervention enhanced by user involvement. SITAS guides users through the process of selecting and tailoring implementation strategies to specific contexts, using core concepts of implementation science. SITAS will need to undergo formal piloting before spread and scale-up.