title: Supporting successful implementation of public health interventions: protocol for a realist synthesis.
abstract: BACKGROUND
  There is a growing emphasis in public health on the importance of evidence-based interventions to improve population health and reduce health inequities. Equally important is the need for knowledge about how to implement these interventions successfully. Yet, a gap remains between the development of evidence-based public health interventions and their successful implementation. Conventional systematic reviews have been conducted on effective implementation in health care, but few in public health, so their relevance to public health is unclear. In most reviews, stringent inclusion criteria have excluded entire bodies of evidence that may be relevant for policy makers, program planners, and practitioners to understand implementation in the unique public health context. Realist synthesis is a theory-driven methodology that draws on diverse data from different study designs to explain how and why observed outcomes occur in different contexts and thus may be more appropriate for public health.
  
  
  METHODS
  This paper presents a realist review protocol to answer the research question: Why are some public health interventions successfully implemented and others not? Based on a review of implementation theories and frameworks, we developed an initial program theory, adapted for public health from the Consolidated Framework for Implementation Research, to explain the implementation outcomes of public health interventions within particular contexts. This will guide us through the review process, which comprises eight iterative steps based on established realist review guidelines and quality standards. We aim to refine this initial theory into a 'final' realist program theory that explains important context-mechanism-outcome configurations in the successful implementation of public health interventions.
  
  
  CONCLUSIONS
  Developing new public health interventions is costly and policy windows that support their implementation can be short lived. Ineffective implementation wastes scarce resources and is neither affordable nor sustainable. Public health interventions that are not implemented will not have their intended effects on improving population health and promoting health equity. This synthesis will provide evidence to support effective implementation of public health interventions taking into account the variable context of interventions. A series of knowledge translation products specific to the needs of knowledge users will be developed to provide implementation support.
  
  
  BACKGROUND
  PROSPERO CRD42015030052.
authors.affiliation: School of Nursing, University of Victoria, Room A402a, HSD Building, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada. marjorie@uvic.ca.
authors.forename: Marjorie
authors.initials: M
authors.lastname: MacDonald
authors.affiliation: School of Nursing, University of Victoria, Room A402a, HSD Building, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada.|Centre for Addictions Research of BC, Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada.
authors.forename: Bernadette
authors.initials: B
authors.lastname: Pauly
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, 2nd Floor, New Radcliffe House, Woodstock Road, Oxford, OX2 6GG, UK.
authors.forename: Geoff
authors.initials: G
authors.lastname: Wong
authors.affiliation: Faculty of Nursing, 5-276 Edmonton Clinic Health Academy, University of Alberta, 11405-87 Ave, Edmonton, AB, T6R 1C9, Canada.
authors.forename: Kara
authors.initials: K
authors.lastname: Schick-Makaroff
authors.affiliation: Faculty of Human and Social Development, University of Victoria, Victoria, BC, V8P 5C2, Canada.
authors.forename: Thea
authors.initials: T
authors.lastname: van Roode
authors.affiliation: Faculty of Human and Social Development, University of Victoria, Victoria, BC, V8P 5C2, Canada.
authors.forename: Heather Wilson
authors.initials: HW
authors.lastname: Strosher
authors.affiliation: Joint Graduate Program in Health Information Science, CIHR New Investigator, School of Health Studies, University of Western Ontario, Health Sciences Building, room 222, London, Ontario, Canada.
authors.forename: Anita
authors.initials: A
authors.lastname: Kothari
authors.affiliation: School of Nursing, 3N25E, Health Sciences Centre, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
authors.forename: Ruta
authors.initials: R
authors.lastname: Valaitis
authors.affiliation: Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario | Santé publique Ontario, Suite 300, 480 University Avenue, Toronto, ON, M5G 1V2, Canada.
authors.forename: Heather
authors.initials: H
authors.lastname: Manson
authors.affiliation: Public Health Services, British Columbia Ministry of Health, PO Box 9646, STN PROV GOVT, Victoria, BC, V8W9P1, Canada.
authors.forename: Warren
authors.initials: W
authors.lastname: O'Briain
authors.affiliation: Department of Sociology, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada.
authors.forename: Simon
authors.initials: S
authors.lastname: Carroll
authors.affiliation: Fraser Health Authority, Suite 400, Central City Tower, 13450 - 102nd Avenue, Surrey, BC, V3T 0H1, Canada.
authors.forename: Victoria
authors.initials: V
authors.lastname: Lee
authors.affiliation: Health Equity & Population Health Unit, Population and Public Health, Fraser Health Authority, 13450 - 102nd Ave, Surrey, BC, V3T 0H1, Canada.
authors.forename: Samantha
authors.initials: S
authors.lastname: Tong
authors.affiliation: Clinical Programs, Population & Public Health, Fraser Health Authority, Suite 400, Central City Tower, 13450 - 102nd Avenue, Surrey, BC, V3T 0H1, Canada.
authors.forename: Karen Dickenson
authors.initials: KD
authors.lastname: Smith
authors.affiliation: Region of Peel Public Health, 44 Peel Centre Drive, 4th flr, Brampton, ON, L6T 4B5, Canada.
authors.forename: Megan
authors.initials: M
authors.lastname: Ward
mesh_terms: D003695:Delivery of Health Care; D006801:Humans; D011634:Public Health; D012107:Research Design; D000078202:Systematic Reviews as Topic
keywords: Implementation; Knowledge translation; Population health; Public health; Public health interventions; Realist review; Realist synthesis