The PR problem with implementation science

Many interventions and evidence-based practices fail to become embedded into routine use. This problem spans multiple contexts, not just limited to healthcare. Common causes include the failure to anticipate barriers to workflow integration, the creation of ‘solutions that no one asked for’ and a lack of systematic, scientifically informed approaches to demonstrate the efficacy of both a given intervention and the necessary conditions for successful integration. In the 1990s, the discipline of Implementation Science emerged as the answer to the problem of failed research translation, culminating in the creation of a dedicated journal in 2006. 

Awareness of Implementation Science’s importance has since grown and is now frequently a pre-requisite for funding applications, much like biostatistics in clinical trials. However, resistance persists in some fields, particularly in the early developmental stages of interventions. Digital health is a prime example. The rapid rise of digital tools promising to revolutionise care and reduce clinician workload has been driven largely by agile development approaches rooted in business and social marketing theory. This push to bring products to market quickly often overlooks critical design (including co-design) and Implementation Science, leading to interventions that fail to achieve sustained and scalable use. 

A key issue arises from differing priorities of designers and interpretations of the term 'implementation' across disciplines. In digital health, implementation is often understood as the final embedding of software into practice, whereas Implementation Science focuses on sustained adoption. This is achieved through structured methods and strategies that facilitate the uptake of evidence-based practice and research into regular use by practitioners and policymakers. In design science research, the design process is a sequence of expert activities that produces an innovative product. Thus, there is a disconnect that frequently places designers - eager to create new solution - at odds with implementation scientists who anticipate potential pitfalls and advocate structured developmental processes to enhance uptake and sustainability. Thought leaders, including Trisha Greenhalgh, have argued that Implementation Science has a public relations problem, suggesting a need to reframe its role to better align with the demands of a fast-moving market. 

One way forward is integrating key principles of Implementation Science, design science, business, and social marketing into a new discipline - 'Translational Design Science'. This term better reflects the true nature of Implementation Science while accommodating the need for rapid innovation, project management, and quality assurance. At every stage of the implementation lifecycle, something is being designed - whether it is a strategy to overcome barriers, an implementation plan, or a new workflow to support intervention adoption. Translation Design Science ensures that these processes are rigorous, replicable and actionable, while also making Implementation Science more accessible to stakeholders who may currently misunderstand its purpose.  By repositioning Implementation Science in this way, we can foster greater engagement across disciplines and improve the integration of evidence-based interventions into practice. 

Dr Alana Delaforce
Team Lead - Implementation Science
The Australian e-Health Research Centre (AEHRC)

Dr Rajiv Jayasena
Group Lead - Health Systems Analytics
The Australian e-Health Research Centre (AEHRC)

Prof Joy Parkinson
Associate Dean (Research and Enterprise)
Australian Catholic University