Practice-driven implementation science (PDIS): a model for treating practitioner knowledge as a primary scientific input

Implementation science has developed sophisticated frameworks for studying how evidence-based practices succeed or fail in real-world settings. However, the direction of knowledge flow has remained largely unchanged: frameworks are delivered to practitioners as tools for understanding their context, while the knowledge practitioners generate through their daily work has no systematic methods for entering the science. This paper argues that the field’s primary challenge is not accessibility but knowledge generation: not how to make implementation science more usable for practitioners, but how to treat what practitioners already know as a primary scientific input. This paper introduces Practice-Driven Implementation Science (PDIS), a complementary model for how the field generates and formalizes implementation knowledge, one that extends existing participatory and practice-based traditions rather than displacing them. PDIS is not an argument against frameworks. It is an argument about sequencing. In a practice-driven approach, frameworks arrive second, as naming tools applied to knowledge that practitioners have already generated. The starting point is not what the framework says about the context. Rather, it is what the context tells us that the framework does not yet know. PDIS is operationalized through five steps: Surface, Name, Align, Test, and Embed Equity. Equity is not a final check, but a question returned to at every step. The model also introduces the epistemic broker, a person or structured function that carries practitioner knowledge into the science and bears the labor of formalizing it, so that entering the scientific record does not depend on a practitioner’s capacity to produce research. The steps are recursive rather than linear and can be entered at any point in the implementation process. Two illustrative applications show how PDIS operates across contexts: state-funded tobacco-free initiatives training with 55 community and health systems practitioners, and a sustained community health center research partnership that is now in its sixth year. Together, they show that PDIS is not a training design philosophy but an orientation toward implementation science work across settings. The paper concludes with implications for research, training, funders, and public health departments and calls for the development of systematic methods for eliciting, naming, and formalizing practitioner-generated implementation strategies.