Tracking implementation strategies using the Iowa Implementation for Sustainability Framework (IISF) in real world settings: VA Office of Rural Health enterprise-wide initiatives

Kirsten Hanrahan; Anna Krupp; Elyse Laures; Laura Cullen; Heather Schacht Reisinger

doi:10.1186/s43058-026-01097-5

Back

Tracking implementation strategies using the Iowa Implementation for Sustainability Framework (IISF) in real world settings: VA Office of Rural Health enterprise-wide initiatives

Journal article

Open access

Peer reviewed

Tracking implementation strategies using the Iowa Implementation for Sustainability Framework (IISF) in real world settings: VA Office of Rural Health enterprise-wide initiatives

Kirsten Hanrahan, Anna Krupp, Elyse Laures, Laura Cullen and Heather Schacht Reisinger

Implementation science communications

09/09/2026

DOI: 10.1186/s43058-026-01097-5

Files and links (1)

url

https://doi.org/10.1186/s43058-026-01097-5View

Published (Version of record) Open Access

Abstract

Background The VA Office of Rural Health (ORH) funds initiatives to improve the health of rural Veterans. A practical approach to examine patterns of implementation strategies use is needed. A specified taxonomy of implementation strategies has been applied in healthcare settings, and may provide insights into strategies selected, timing, and domains. The purpose of this study was to apply this taxonomy to examine patterns of implementation strategies used in evaluation reports from 26 enterprise-wide initiatives (EWIs) in real-world settings. Methods This descriptive study used deductive content analysis to identify strategies used according to the Iowa Implementation for Sustainability Framework (IISF). Secondary analysis involved identifying strategies according to the IISF and examining patterns of utilization by phases, domains, RE-AIM (Reach, Adoption, Implementation, and Maintenance) dimensions, and rurality. Data were summarized using descriptive statistics. Results In 26 EWI reports, 1,032 strategies were catalogued. Sixty of 75 IISF strategies were reported. Across four IISF implementation phases, strategies were most frequently used in Phase 3- Promote Action & Adoption, 55.6% (f = 564) and in domains for Data (f = 390, 38.4%), Adaptation (f = 205, 20.2%), and Commitment (f = 197, 19.4%). EWIs applied an average of 39.7 (range 12–87) total strategies. Most strategies were reported in the Implementation (f = 397, 39.1%) dimension of the RE-AIM framework and in non-rural initiatives (average 45.3 vs. 33.8). Conclusions The IISF proved to be a useful and pragmatic approach to identify implementations strategies from diverse real-world reports. Results further understanding of implementation strategies used by phase, and domain, potentially bridging understanding to mechanisms of action.

Details

Title: Subtitle: Tracking implementation strategies using the Iowa Implementation for Sustainability Framework (IISF) in real world settings: VA Office of Rural Health enterprise-wide initiatives
Creators: Kirsten Hanrahan - University of Iowa
Anna Krupp - University of Iowa
Elyse Laures - University of Iowa, University of Iowa Health Care
Laura Cullen - University of Iowa
Heather Schacht Reisinger - University of Iowa
Resource Type: Journal article
Publication Details: Implementation science communications
DOI: 10.1186/s43058-026-01097-5
ISSN: 2662-2211
eISSN: 2662-2211
Publisher: Springer Nature
Language: English
Electronic publication date: 09/09/2026
Academic Unit: University of Iowa Health Care; Nursing; Center for Social Science Innovation; Internal Medicine
Record Identifier: 9985230784402771

Metrics

1 Record Views