Implementation epidemiology: The study of the frequency, distribution and determinants of effective prevention practice

Abstract

There is a growing literature demonstrating the limited extent to which quality evidence has led to injury prevention policy action. The innovation challenge now recognised throughout the world is not ‘what works’, but how to ‘make it work’ at the population level. The purpose of this paper is to introduce the concept of ‘implementation epidemiology’ as a methodology that enables the roles of injury prevention research and practice to be quantified within a single analytic process; and thus a methodology for facilitating the translation of injury research evidence to evidenced-based prevention practice. The contribution of ‘implementation epidemiology’ beyond the more traditionally defined scope of the discipline is to extend the definition of epidemiology from ‘the study of the distribution and determinants of health conditions’ to include the empirical measurement and quantification of determinants of implementation effectiveness. In order to consider injury research and practice within one methodological dimension, implementation epidemiology requires first a shift in the public health approach to injury prevention from the traditional proximal risk factor paradigm to a more ecological understanding of injury causation, and then a further shift in the notion of causation to incorporate within the eco-epidemiological models, not just the multilevel risk factors for injury, but also the determinants of widespread uptake of known countermeasures.

Keywords: models; policy; public health; implementation research