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A guide to systems-level, participatory, theory-informed implementation research in global health
  1. Nadine Seward1,
  2. Charlotte Hanlon2,3,
  3. Saba Hinrichs-Kraples4,
  4. Crick Lund5,6,
  5. Jamie Murdoch7,
  6. Tatiana Taylor Salisbury5,
  7. Ruth Verhey8,
  8. Rahul Shidhaye9,
  9. Graham Thornicroft5,
  10. Ricardo Araya5,
  11. Nick Sevdalis10
  1. 1Centre for Implementation Science, Department of Health Service and Population Research, King's College London, London, UK
  2. 2Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental Health, King's College London, London, UK
  3. 3Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
  4. 4Delft University of Technology, Delft, The Netherlands
  5. 5King's College London, London, UK
  6. 6University of Cape Town, Rondebosch, South Africa
  7. 7University of East Anglia Faculty of Medicine and Health Sciences, Norwich, UK
  8. 8Research Support Centre, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
  9. 9Pravara Institute of Medical Sciences, Loni, Maharashtra, India
  10. 10Health Service & Population Research Department, King's College London, London, UK
  1. Correspondence to Dr Nadine Seward; nadine.seward{at}


Implementation research is a multidisciplinary field that addresses the complex phenomenon of how context influences our ability to deliver evidence-informed healthcare. There is increasing realisation of the importance of applying robust implementation research to scale-up life-saving interventions that meet health-related sustainable development goals. However, the lack of high-quality implementation research is impeding our ability to meet these targets, globally. Within implementation research, theory refers to the proposed hypothesis and/or explanation of how an intervention is expected to interact with the local context and actors to bring about change. Although there is increasing interest in applying theory to understand how and why implementation programmes work in real-world settings, global health actors still tend to favour impact evaluations conducted in controlled environments. This may, in part, be due to the relative novelty as well as methodological complexity of implementation research and the need to draw on divergent disciplines, including epidemiology, implementation science and social sciences. Because of this, implementation research is faced with a particular set of challenges about how to reconcile different ways of thinking and constructing knowledge about healthcare interventions. To help translate some of the ambiguity surrounding how divergent theoretical approaches and methods contribute to implementation research, we draw on our multidisciplinary expertise in the field, particularly in global health. We offer an overview of the different theoretical approaches and describe how they are applied to continuously select, monitor and evaluate implementation strategies throughout the different phases of implementation research. In doing so, we offer a relatively brief, user-focused guide to help global health actors implement and report on evaluation of evidence-based and scalable interventions, programmes and practices.

  • health policies and all other topics
  • health systems
  • health systems evaluation
  • public health

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  • Handling editor Seye Abimbola

  • Twitter @nadineseward, @sabziehin

  • CH, SH-K, CL, JM and TTS contributed equally.

  • Contributors NSew is the guarantor and responsible for the overall content of the paper; NSew drafted the paper NSev conceptualised the idea for the paper; NSew and NSev offered insights into implementation science. JM offered details around process evaluations and context. SH-K offered details surrounding policy research TTS and NSev provided details to participatory research. CH, NSew, TTS, RS, GT, RV, RA and CL provided details of implementation research in Global Health. JM, SH-K, CH, RS, GT and NSev reviewed several drafts of the manuscript;

  • Funding NSew, CH, Prince and NSev are funded by the National Institute of Health Research (NIHR) Global Health Research Unit on Health System Strengthening in Sub-Saharan Africa, King’s College London (GHRU 16/136/54) using UK aid from the UK Government to support global health research. Sevdalis and Thornicroft’s research is further supported by the NIHR Applied Research Collaboration South London at King’s College Hospital NHS Foundation Trust, and by the ASPIRES research programme in LMICs (Antibiotic use across Surgical Pathways-Investigating, Redesigning and Evaluating Systems), funded by the Economic and Social Research Council. Sevdalis and Thornicroft are members of King’s Improvement Science, which offers cofunding to the NIHR ARC South London and is funded by King’s Health Partners (Guy’s and St Thomas’ NHS Foundation Trust, King’s College Hospital NHS Foundation Trust, King’s College London and South London and Maudsley NHS Foundation Trust) and Guy’s and St Thomas’ Foundation. Hanlon additionally receives funding support from AMARI as part of the DELTAS Africa Initiative (DEL-15-01).

  • Disclaimer The views expressed here are not necessarily those of the NIHR or the Department of Health and Social Care, the NHS, the ESRC, AMARI or the DELTAS Africa Initiative.

  • Competing interests NSew is the director of the London Safety and Training Solutions, which offers training in patient safety, implementation solutions and human factors to healthcare organisations and the pharmaceutical industry. The other authors have no conflicts of interest to declare.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.