Factors influencing implementation decisions in health care: A discrete choice experiment of intervention adoption

BACKGROUND: To overcome barriers to the implementation of effective interventions, it is important to understand the factors which may influence stakeholders' implementation decisions. We aimed to identify these factors and quantify their relative importance in the decision-making process. Stakeholders included those wishing to implement an intervention (e.g., health service researchers and providers), and those funding implementation efforts (e.g., administrators and policymakers). DESIGN: We utilized discrete choice experiment methodology to explore several factors relevant to implementation decisions. The survey instrument was developed through a systematic review and expert consultation process. Conditional and mixed logit models were used to capture observed and unobserved preference heterogeneity. We tested the robustness of our results with subgroup and sensitivity analyses. RESULTS: We received 131 survey responses. There was a strong preference for intervention factors that 1) met stakeholders' needs, 2) had excellent levels of evidence, and 3) demonstrated strong organizational readiness. Respondents showed a preference for the mid-level cost ($150,000) over the lowest cost level ($100,000) within the experimental cost attribute (relative to an annual budget of $5 million). This suggests that respondents may prioritize the other three factors over the cost of implementation. These results remained relatively consistent across professional subgroups and sensitivity analyses. CONCLUSIONS: Meeting stakeholders' needs, levels of evidence, and organizational readiness had a large influence on implementation decisions. These factors were ranked of higher importance than implementation costs, administrative processes, and the presence of local champions within an organization. Designing research programs that support these influential factors will encourage successful implementation and ensure optimal healthcare delivery.