What question did this study set out to answer?

Identify which implementation science theories, models, and frameworks have been used to evaluate quality improvement initiatives and assess their applications.

June 26, 2026

Mapping Theories, Models and Frameworks from implementation science for evaluating quality improvement initiatives: a scoping review

Key Points

Identify which implementation science theories, models, and frameworks have been used to evaluate quality improvement initiatives and assess their applications.
Conducted a scoping review following Arksey and O’Malley’s framework.
Reviewed studies published between 2010 and 2025 that evaluated a quality improvement initiative using one or more theories, models, or frameworks.
Evaluated frameworks at the article and TMF levels for their application and methodological attributes.
80 studies included from 1824 records screened, identifying 23 unique theories, models, and frameworks.
Most frequently used were the Reach, Effectiveness, Adoption, Implementation and Maintenance framework (27%) and Consolidated Framework for Implementation Research (20%).
94% of studies used frameworks for data collection, but only 43% tested construct relationships, revealing a need for more rigorous application.

Abstract

Background Improvement science has supported the methodological foundations for the application of quality improvement (QI) in healthcare. However, concerns persist regarding the rigour of QI evaluation. Theories, Models and Frameworks (TMFs) from implementation science support the uptake of evidence-based practices but their use to guide the evaluation of QI initiatives remains insufficiently characterised. Objectives To identify which implementation science TMFs have been used to evaluate QI initiatives in healthcare, assess how these TMFs were applied in the evaluation, and compare the TMFs’ intrinsic methodological attributes. Methods We conducted a scoping review following Arksey and O’Malley’s framework. Eligible studies were published between 2010 and 2025 and evaluated a QI initiative using at least one TMF. Peer-reviewed literature was searched in PubMed, Scopus and Web of Science. Grey literature was retrieved through targeted Google searches. TMFs were evaluated at the article level according to their application in each study and at the TMF level according to their intrinsic methodological attributes. Results Out of 1824 records screened, 80 studies were included. 23 unique TMFs were identified. Of these, the most frequently used were the Reach, Effectiveness, Adoption, Implementation and Maintenance framework (27%) and the Consolidated Framework for Implementation Research (20%). Although 94% of studies used TMFs to guide data collection or analysis, only 43% explicitly tested construct relationships or causal pathways. TMFs demonstrated high conceptual clarity and structure but limited equity and sociocultural responsiveness. Conclusions Application of TMFs in the evaluation of QI initiatives was heterogeneous. No single TMF captured the full range of evaluative functions. More rigorous evaluation requires an integrative approach that combines complementary TMFs to examine context, mechanisms of improvement and outcomes. Prospective operationalisation of TMF constructs, particularly equity, within study design and evaluation is essential to strengthen reproducibility and improve the transferability of findings across settings.

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Cite This Study

Arizmendi-Barrera et al. (Wed,) studied this question.

synapsesocial.com/papers/6a3e193b030ad1a9b309205c https://doi.org/https://doi.org/10.1136/bmjqs-2025-019903

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