Implementation Strategies: Types, Actors and Seven Reporting Dimensions
Distinguish single-component and multifaceted implementation strategies and specify actors, actions, targets, timing, dose, outcomes and justification for reproducible research.
Editorial context
Adapted and summarized by PHC-Nepal from the uploaded WHO/TDR training slides Module3_intro_Chapter1.pdf, developed with technical support from EPFL. The upload does not establish a publication date. This is an independent educational summary, not a WHO-endorsed course or certificate. Historical infectious-disease examples illustrate research methods; they are not current Nepal statistics or clinical protocols.
Key points
- An intervention is what is delivered; an implementation strategy supports its delivery.
- Single-component and multifaceted strategies need explicit descriptions.
- Specify actor, action, target, timing, dose, outcome and justification.
- Dose here means strategy frequency or intensity—not a medicine prescription.
What is an implementation strategy?
An implementation strategy is a method used to improve the adoption, delivery or continued use of a health intervention. Training, audit and feedback, workflow changes, consultation and community engagement can be strategies when they address a defined implementation problem.
Keep the distinction clear: vaccination is a health intervention; a coordinated outreach schedule or reminder process may support its delivery. Some activities can serve different roles depending on the study, so define them within the protocol.
Single-component and multifaceted approaches
A single-component strategy may use one main activity, such as audit and feedback. A multifaceted strategy combines activities—for example, training, supervisory review and a revised reporting workflow.
More components do not automatically mean better results. Each should address a documented barrier and have a plausible mechanism. Describe which components are essential, which can be adapted and how implementation will be tracked.
Specify seven dimensions
The slides emphasize five initial dimensions and then add outcomes and justification. Proctor and colleagues' reporting recommendations bring these together so another team can understand and reproduce the strategy.
- Actor: who delivers the strategy.
- Action: the specific activity or process.
- Action target: who or what is changed.
- Temporality: when the activity starts and how it is sequenced.
- Dose: frequency, duration or intensity of the strategy.
- Implementation outcome: the delivery result it is intended to affect.
- Justification: the theory, evidence or practical reason for selecting it.
An illustrative specification
A hypothetical facility manager could hold a monthly joint stock-review meeting with dispensary staff during a pilot period. The action targets late resupply decisions, and the intended outcomes are adoption of the review process, feasibility and improved commodity availability.
The justification would come from a documented gap between stock reporting and ordering. The protocol should state attendance, duration, decision responsibilities and comparison practice rather than using a vague label such as ‘strengthen management’. This is not a measured Nepal case.
Report adaptation and resources
Document staff time, training requirements, tools and changes made during delivery. If a site modifies the frequency or target, record why and how that affects the strategy's intended function.
The training includes older malaria medicine packaging examples. These illustrate delivery design, not current drug choice or dosage. Strategy ‘dose’ should never be confused with prescribing instructions.
Sources and further reading
Use the linked institutions for current definitions, regulations, programmes and statistics.
- WHO TDR: Implementation research toolkit—Workbook (2014)
Official foundational toolkit for bottlenecks, stakeholders, questions and implementation of findings.
- Proctor et al.: Implementation strategies—recommendations for specifying and reporting (2013)
Seven dimensions for specifying implementation strategies.
- Implementation Research in Health: A Practical Guide (2013)
Peters, Tran and Adam: questions, context, methods and use of findings.
Related learning note
Implementation ResearchWhat Is Implementation Research? Concepts, Scope and Three Core PhasesUnderstand implementation research, how it differs from intervention and health systems research, and how teams define problems, design strategies and test delivery in real settings.Educational notice: This article summarizes historical and public-health material. It does not replace current national protocols, clinical judgement or care from a qualified professional.