Table_1_What implementation strategies are relational? Using Relational Theory to explore the ERIC implementation strategies.DOCX

The identification and use of implementation strategies in implementation research and practice have strengthened our understanding of the implementation process as well as the causal pathways between mechanisms, strategies, and implementation outcomes. Although these contributions have advanced the application of strategies, there is still a need to learn more about how strategies might integrate relational exchanges and interactions. The inclusion of critical perspectives has been limited in implementation science, and theories such as Relational Theory can expand our understanding of the relational nature of implementation and enhance rigor through alternative theoretical applications. This study applied Relational Theory through a qualitative directed content analysis of the 73 Expert Recommendations for Implementation Change (ERIC) implementation strategies and examine relational components in strategy descriptions. Three reviewers used the structured approach to review and categorize the implementation strategies based on the Relational and Transactional Strategy Continuum measure, which operationalizes types of interactions, exchanges and alliances. Relational alliance strategies are those in which there is mutual growth and accountability, frequent interaction, shared power, and potential vulnerability. Operational alliances include forms of working exchanges between parties with balanced transactional and relational features. Operational alliances can be somewhat interactive in nature, with minor exchanges and limited accountability. Transactional alliance strategies are mostly uni-directional, influenced by power differentials, and do not require mutual growth, commitment, or exchange; thus, the power of growth is inherently one-sided. Results from the review suggest more implementation strategies with relational alliance features (highly relational, n = 17, semi-relational, n = 19) compared to transactional (highly transactional, n = 9, semi-transactional, n = 10) and 18 strategies coded as operational alliances. The qualitative review revealed opportunities to further expand how relational exchanges are considered within the implementation strategies descriptions, as well as the role of actors and power dynamics within strategy exchanges. The Relational and Transactional Strategy Continuum measure can help practitioners and researchers consider the sequencing, pairing, and impact on outcomes of different types and combinations of strategies in implementation practice and research. Additionally, the measure can support reflection on strategies that promote positive alliances, frequent connections, bi-directional communication, and power sharing.

在实施研究与实践中，对实施策略的识别与应用，深化了我们对实施过程以及机制、策略与实施结果之间因果路径的认知。尽管这些进展推动了策略的应用，但学界仍需进一步探索策略应如何整合关系性交换与互动。实施科学领域对批判性视角的吸纳较为有限，而关系理论（Relational Theory）等理论可通过替代性理论应用，拓展我们对实施过程关系属性的认知，并提升研究严谨性。本研究基于关系理论（Relational Theory），对73项《实施变革专家建议（Expert Recommendations for Implementation Change，简称ERIC）》中的实施策略开展质性定向内容分析，以检视策略描述中的关系性构成要素。3名评审员采用结构化方法，基于关系与交易策略连续量表（Relational and Transactional Strategy Continuum measure）对实施策略进行评审与分类——该量表将互动、交换与联盟的类型予以操作化定义。关系型联盟策略指具备以下特征的策略：双方实现共同成长与相互问责、互动频繁、权力共享且存在潜在脆弱性。运营型联盟则涵盖双方间兼具平衡交易性与关系性特征的工作交换形式。运营型联盟本质上具备一定互动性，但仅涉及少量交换与有限的问责机制。交易型联盟策略大多为单向性的，受权力差异影响，无需共同成长、承诺或交换；因此其成长权力本质上是单边的。评审结果显示，具备关系型联盟特征的实施策略数量（高度关系型，n = 17；半关系型，n = 19）多于交易型策略（高度交易型，n = 9；半交易型，n = 10），另有18项策略被编码为运营型联盟。本次质性评审还发现，现有实施策略描述中对关系性交换的考量，以及策略交换中行动者角色与权力动态的体现仍有进一步拓展空间。关系与交易策略连续量表可帮助实践者与研究者，在实施实践与研究中考量不同类型及组合策略的排序、搭配及其对结果的影响。此外，该量表还可辅助研究者与实践者反思那些能够促成积极联盟、高频联结、双向沟通与权力共享的策略。