Implementation impact in the age of complexity: walking the tightrope between scientific rigour and real‑world pragmatism – Proceedings of the 2025 European Implementation Event

BackgroundDigital health infrastructure is ubiquitous, aiming to optimise healthcare outcomes by getting evidence-based practices to communities.Yet technology-mediated interventions can add complexity, limiting implementation and sustained use in health services.Our novel approach aims to design digital health infrastructure for realworld implementation by leveraging human-computer interaction and implementation science.To illustrate our approach, we present two distinct co-design research studies with multiple research activities.The first, a brief health promotion intervention to increase awareness of alcohol alcohol-attributable breast cancer risk, delivered in breast screening services.The second, a consumer prescription opioid safety toolkit for national dissemination in Australian pharmacies. MethodsOur approach integrates implementation science frameworks into the phases of the Double Diamond human-computer interaction process: exploration (discovery), synthesis (definition), ideation (development) and testing (delivery) to arrive at a design solution.Two implementation science frameworks are used separately to demonstrate the adaptability of the approach.In study one, the technology-focused Non-Adoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework structures the design, collection and analysis of research activities; ex-post analysis, co-design workshops, and hybrid-II implementationeffectiveness trial.In study two, behaviourally focused Theoretical Domains Framework (TDF) structures the design, collection and analysis of research activities; literature review, co-design workshops, and user-testing. ResultsThe approach scaffolded decisions around research activities; choice of stakeholder participants, evidence sources, data collection methods and analysis.In study one, 14 women and 8 staff participated in co-design workshops.Key insights related to NASSS domains, influencing the design of a behaviourally focused intervention that aimed to reduce complexity while integrating in breast screening services.In study two, 28 consumers and 14 stakeholders participated in co-design workshops and user testing.Use of the TFD elicited key behavioural factors which were mapped to the behaviour change techniques taxonomy and embedded in the design of the digital infrastructure for dissemination in pharmacies. Discussion and conclusionWe believe use of the approach reduced complexity.Clearly articulating steps within the design process made discussions between software engineers, graphic designers, researchers, and clinicians more efficient.Secondly, the scope of the design was limited to the contextual needs of the health services, staff and consumers limiting time spent designing and testing solutions that were not practical.Complexity added as specific technology based design decisions are not adequately captured in implementation science frameworks.