227 General discussion 8 Another major implication that hinders identifying effective or ineffective implementation strategies is insufficient specification and reporting. Often sufficient details on the action, actor, the action target, temporality, dose, implementation outcome affected, and justification [17] are lacking. This was concluded in the systematic reviews in this thesis (chapters 2 and 3), Although most of the included studies did describe who enacted the implementation strategy, details on the action target, temporality, dose and implementation outcome affected or the justification were often omitted. To illustrate this, a pharmacological study testing a new medicine that leaves out the dose, the temporality, and intended effect would be considered unacceptable. While high reporting standards are expected from researchers developing and comparing healthcare interventions, it is surprising that similar rigor is often lacking in implementation science. Researchers planning a randomized controlled trial concerning interventions for patients, clients or the public, are expected to publish a study protocol wherein the hypothesized effectiveness of the intervention is sufficiently addressed [18]. Most papers in the field of implementation science still focus on testing a particular implementation strategy in a specific context, while ideally, the effectiveness of strategies is assessed in rigorous studies comparing different implementation strategies (Chambers and Emmons [19]. Failure to conduct such rigorous studies, as Eccles, Grimshaw [20] noted in 2005, will result in implementation science remaining an expensive version of trial and error, with no a priori reason to expect success or be confident that success, if achieved, can be replicated. Of note, specifying and reporting according to available guidelines often results in extensive documentation. Moore, Arnold [21] even published a separate manuscript on this topic. Additionally, they introduced another challenge, introducing the risk of recall bias given that the trial spanned four years and strategies were not tracked in real time. Their data were collected retrospectively via self-reported use of implementation strategies by research team members in a group setting, [21]. In chapter 5 of this thesis, we included the operationalization of the implementation strategies as a supplemental file – not due to the importance of the contents itself, but due to its length. This underscores the challenge of adequately specifying and reporting, given journalimposed word limits. And the additional possible recall bias, when prospective data collection to track implementation strategies and adaptations is lacking [22].
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