title: Clinical interventions, implementation interventions, and the potential greyness in between -a discussion paper.
abstract: There is increasing awareness that regardless of the proven value of clinical interventions, the use of effective strategies to implement such interventions into clinical practice is necessary to ensure that patients receive the benefits. However, there is often confusion between what is the clinical intervention and what is the implementation intervention. This may be caused by a lack of conceptual clarity between 'intervention' and 'implementation', yet at other times by ambiguity in application. We suggest that both the scientific and the clinical communities would benefit from greater clarity; therefore, in this paper, we address the concepts of intervention and implementation, primarily as in clinical interventions and implementation interventions, and explore the grey area in between.
  
  
  
  To begin, we consider the similarities, differences and potential greyness between clinical interventions and implementation interventions through an overview of concepts. This is illustrated with reference to two examples of clinical interventions and implementation intervention studies, including the potential ambiguity in between. We then discuss strategies to explore the hybridity of clinical-implementation intervention studies, including the role of theories, frameworks, models, and reporting guidelines that can be applied to help clarify the clinical and implementation intervention, respectively.
  
  
  
  Semantics provide opportunities for improved precision in depicting what is 'intervention' and what is 'implementation' in health care research. Further, attention to study design, the use of theory, and adoption of reporting guidelines can assist in distinguishing between the clinical intervention and the implementation intervention. However, certain aspects may remain unclear in analyses of hybrid studies of clinical and implementation interventions. Recognizing this potential greyness can inform further discourse.
authors.affiliation: School of Education, Health and Social Studies, Dalarna University, FALUN, Sweden. ann.catrine.eldh@liu.se.|Department of Public Health and Caring Sciences, Uppsala University, UPPSALA, Sweden. ann.catrine.eldh@liu.se.|Department of Medical and Health Sciences, Linköping University, SE-581 83, LINKÖPING, Sweden. ann.catrine.eldh@liu.se.
authors.forename: Ann Catrine
authors.initials: AC
authors.lastname: Eldh
authors.affiliation: Queens University, KINGSTON, Canada.
authors.forename: Joan
authors.initials: J
authors.lastname: Almost
authors.affiliation: Public Health Ontario, Toronto, Canada.
authors.forename: Kara
authors.initials: K
authors.lastname: DeCorby-Watson
authors.affiliation: University of Ottawa, Ottawa, Canada.
authors.forename: Wendy
authors.initials: W
authors.lastname: Gifford
authors.affiliation: University of Adelaide, Adelaide, Australia.|University of Manchester, Manchester, United Kingdom.
authors.forename: Gill
authors.initials: G
authors.lastname: Harvey
authors.affiliation: Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.|Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden.
authors.forename: Henna
authors.initials: H
authors.lastname: Hasson
authors.affiliation: University of Colorado, Colorado Springs, Colorado, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Kenny
authors.affiliation: Western University, London, Canada.
authors.forename: Sheila
authors.initials: S
authors.lastname: Moodie
authors.affiliation: School of Education, Health and Social Studies, Dalarna University, FALUN, Sweden.|Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.|Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Wallin
authors.affiliation: School of Nursing, McMaster University, Hamilton, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Yost
mesh_terms: D002986:Clinical Trials as Topic / Q000592:standards; D006302:Health Services Research; D006801:Humans; D058996:Quality Improvement; D012107:Research Design; D057170:Translational Research, Biomedical
keywords: Concept; Implementation; Implementation Science; Intervention; Knowledge Translation