Expanding the pragmatic lens in implementation science: why stakeholder perspectives matter.

Abstract

Background: Pragmatism is important in implementation science to ensure that implementation methods reflect the practical concerns of the stakeholders and services involved in change. To evaluate the usability of these methods, pragmatic measures have been developed using psychometrics. However, existing approaches have predominantly inherited a definition of pragmatism from the evidence-based healthcare movement. These metrics may not reflect concerns with pragmatism that public stakeholders (defined as those with expertise by experience of healthcare systems) may have with implementation science.

Aims: Consequently, our aim was to carry out participatory research to explore stakeholder views of pragmatic measures in implementation science theory.

Methods: We convened a working group of eight stakeholders. To facilitate discussion, we created educational materials, including a video and flyer. The working group conducted three meetings, engaging in abductive analysis to investigate the presented issues.

Results: Stakeholders expressed concerns about the restricted definition of pragmatism, the potential for biases in measurement, and the necessity for a holistic, pluralistic approach that incorporates diverse perspectives when developing and evaluating implementation theory and metrics. These findings underscore the risk of distorting the development of implementation science methods without the input and scrutiny of stakeholders. Neglecting the wider application of pragmatic philosophy in implementation science could limit stakeholder involvement in the design of implementation methods and service transformation.

Conclusions: This study, guided by experts with lived experience in healthcare services, opens doors for considering pragmatic philosophy in the evolution of pragmatic implementation measures and metrics, offering numerous promising directions for further exploration.