Stakeholder Engagement as a Foundation for the Evaluation of Implementation Science Público

Abstract

Implementation science is a relatively new field that studies the methods to translate scientific research into routine practice and policy. Implementation science aims to bridge the research-policy gap and this thesis explores the proposition that achieving this aim will require a more evidence-based stakeholder engagement framework. However, there is a lack of clarity in the relationship between stakeholder engagement and the dominant frameworks of implementation science (IS). One of the most dominant implementation science evaluation frameworks, RE-AIM, has no existing strategy to evaluate stakeholder engagement (SE).

The purpose of this thesis, therefore, was to explore the feasibility and potential impact of incorporating stakeholder engagement into the RE-AIM framework for the evaluation of implementation science. The aims of this study were to: 1) analyze the RE-AIM framework to determine how it could be amended to include SE, 2) enhance the RE-AIM framework by incorporating elements from SE theory, 3) design tools for the utilization of RE-AIM(S) that allow for the evaluation of SE, and 4) apply the adapted RE-AIM(S) framework to the case of the Maldivian National TB Screening Program.

A diagnostic analysis of the RE-AIM framework was conducted, along with the creation of an adapted framework and the design of new complimentary tools. The framework and its associated tools were then retrospectively applied to a Maldivian case study. Findings showed that creative designs in IS evaluation allow for the categorization, monitoring, and tracking of changes to a program’s design or budget that are due to stakeholder engagement. The frameworks and tools resulting from this thesis should improve the evaluation of implementation science by allowing IS projects/programs to be evaluated based on how responsive they are to stakeholder input. The analysis also found that preserving interests as the unit of analysis proved difficult when attempting to design practical tools and, therefore, determined the need to use stakeholders’ inputs as a proxy for their interests. This thesis ultimately determined that not only is it feasible to incorporate stakeholder engagement into implementation science evaluation frameworks, but also that this integration could create new forms of evidence and advance the goals of implementation science.

Table of Contents

Abstract.......................................................................................................................................... IV

Acknowledgements....................................................................................................................... VI

Table of Contents.......................................................................................................................... VII

Glossary........................................................................................................................................... 1

Purpose............................................................................................................................................ 1

Specific Aims................................................................................................................................... 1

Context............................................................................................................................................ 1

The Origin of the Thesis................................................................................................................... 1

Geographical and Program Context................................................................................................. 3

Stakeholder Engagement Goals within the Program......................................................................... 5

Remaining Questions and Thesis Topic............................................................................................. 6

Background and Significance.......................................................................................................... 7

1)    What are stakeholders and what tools exist to analyze stakeholder engagement?....................... 7

2)    What is the relationship between the field of implementation science and stakeholder engagement?          8

3)    How are implementation science programs evaluated?.......................................................... 10

4)    What have been traditional stakeholder engagement strategies, and how have they been incorporated in implementation science?              12

5)    Why is it important to integrate stakeholder engagement in implementation science?............ 14

Methods......................................................................................................................................... 15

Diagnostic analysis of the RE-AIM framework................................................................................. 15

Enhancement of the RE-AIM framework through exploratory analysis............................................. 15

Design of the Stakeholder Feedback Mapping and Adaptive Learning Matrix tools............................ 16

Application of the RE-AIM(S) framework to a Maldivian Case Study.................................................. 17

Results........................................................................................................................................... 18

Aim 1 Results............................................................................................................................... 18

Aim 2 Results............................................................................................................................... 20

Aim 3 Results............................................................................................................................... 21

Stakeholder Feedback Mapping (SFM)........................................................................................ 22

The Adaptive Learning Matrix (ALM).......................................................................................... 25

Aim 4 Results............................................................................................................................... 28

The Maldivian National TB Screening Program Stakeholder Feedback Mapping (SFM)................... 28

The Maldivian National TB Screening Program Adaptive Learning Matrix (ALM)............................ 29

Discussion...................................................................................................................................... 32

Distinction Between Stakeholder Input and Interests..................................................................... 32

The Value of RE-AIM(S).................................................................................................................. 33

Stakeholder Feedback Mapping (SFM)............................................................................................ 34

The Adaptive Learning Matrix (ALM).............................................................................................. 35

The Maldivian National TB Screening Program Case........................................................................ 37

Limitations..................................................................................................................................... 38

The RE-AIM(S) Framework:............................................................................................................ 38

Stakeholder Feedback Mapping (SFM):........................................................................................... 38

The Adaptive Learning Matrix (ALM):............................................................................................. 39

Conclusion...................................................................................................................................... 40

References..................................................................................................................................... 42

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Palabra Clave	stakeholder Stakeholder engagement Program evaluation Implementation Science RE-AIM
Committee Chair / Thesis Advisor	Jim Lavery, Emory University

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