Opportunities to Improve the Implementation of Relational Health Interventions for Children and Families: A Secondary Analysis of a Scoping Review

Despite the availability of universally delivered evidence-based relational health interventions, their wide-scale translation into practice is slow and unsustained. Measuring implementation outcomes within intervention trials is critical to understand their effectiveness and inform future scaling. This study aimed to determine the extent to which universally delivered relational health interventions measured and reported on implementation outcomes to inform their effectiveness. A secondary analysis of a scoping review examined the extent to which 123 RCT-evaluated relational health intervention studies referred to (1) implementation related theories or frameworks; (2) implementation data collection methods; (3) implementation measures, and; (4) each of twelve implementation outcomes (acceptability, adoption, appropriateness, cost, feasibility, fidelity-adherence, fidelity-dose, fidelity-delivery, fidelity-responsiveness, fidelity-differentiation, penetration and sustainability). The type of implementation trial was also assessed. Seventeen percent of studies reported implementation outcomes as part of the intervention main effects, with the remaining studies (83%) reporting implementation outcomes as a minor sub-analysis (52%), in their discussion only (21%) or not at all (10%). The most frequently reported outcomes were fidelity measures of dose and adherence. Almost a half of the twelve implementation outcomes were not addressed. No studies described an implementation-related theory or framework, and all used non-standardised measures. Greater attention to measuring and reporting implementation outcomes within relational health intervention trials is needed to ensure that critical evidence for replicability and scalability is available to those who are considering implementation in practice. This would facilitate improvements in both intervention implementation and sustainability and importantly, relational health outcomes for children and families.