Cochrane qualitative and implementation methods group guidance paper 4: methods for assessing evidence on intervention implementation

OBJECTIVE:

This article provides reviewers with guidance on methods for identifying and processing evidence to understand intervention implementation.

STUDY DESIGN AND SETTING:

Strategies, tools and methods are applied to the systematic review process to illustrate how process and implementation can be addressed using quantitative, qualitative and other sources of evidence (i.e., descriptive textual, non-empirical). RESULTS: Reviewers can take steps to navigate the heterogeneity and level of uncertainty present in the concepts, measures and methods used to assess implementation. Activities can be undertaken in advance of a Cochrane quantitative review to develop program theory and logic models that situate implementation in the causal chain. Four search strategies are offered to retrieve process and implementation evidence. Recommendations are made for addressing rigour or risk of bias in process evaluation or implementation evidence. Strategies are recommended for locating and extracting data from primary studies. The basic logic is presented to assist reviewers to make initial review level judgements about implementation failure and theory failure.

CONCLUSION:

Although strategies, tools and methods can assist reviewers to address process and implementation using quantitative, qualitative and other forms of evidence, few exemplar reviews exist. There is a need for further methodological development and trialling of proposed approaches.