Implementation capital: merging frameworks of implementation outcomes and social capital to support the use of evidence-based practices.

backgroundAlthough there is growing recognition that the implementation of evidence-based practices is a social process, the conceptualization of social capital in implementation frameworks often conflates bonding and bridging social capital. This conflation makes it difficult to concretely operationalize social capital and limits the concept's utility for explaining implementation outcomes. DISCUSSION: We propose a new framework of implementation capital that merges an existing conceptual framework of implementation outcomes with an existing operational framework of social capital. First, we review a conceptual framework of implementation outcomes, which includes the acceptability, appropriateness, adoption, feasibility, fidelity, cost, penetration, and sustainability of evidence-based practices. Second, we describe an operational framework of social capital that grounds bonding and bridging social capital in the structure of implementers' social networks. Third, we bring these two frameworks together to create a merged framework of implementation capital that shows how specific aspects of social capital can support specific implementation outcomes. Implementation outcomes of acceptability, appropriateness, and adoption are linked to bonding social capital through mechanisms of trust and norm enforcement, while outcomes of feasibility and fidelity are linked to bridging social capital through mechanisms of increased access to information and resources. Additionally, setting-level implementation outcomes of cost, penetration, and sustainability are associated with small worldliness at the setting level, which simultaneously optimizes both bonding and bridging social capital in a setting.

conclusionThe implementation capital framework is helpful because it separates two distinct forms of social capital-bonding and bridging-that are often conflated in the implementation literature, and offers concrete ways to operationalize them by examining the structure of implementers' social networks and the networks of their settings. This framework offers specific guidance about how individual and setting networks might be shifted to support implementation outcomes.