The translation of new evidence and interventions into clinical practice remains a significant challenge for contemporary, evidence-based healthcare. There is a lag of 15 to 17 years for research evidence to be implemented into clinical practice (1–4). Such delays in knowledge translation may have wide-reaching impacts, both at an individual patient and broader population level, through unrealised potential for improved outcomes, and impacts on health service efficiency and resources. Addressing this knowledge translation gap is essential for the delivery of high-value care.

Implementation science seeks to bridge this gap by improving the application of evidence-based practices. Unlike clinical research, implementation science considers not only the effectiveness of innovations but also the broader clinical context that may impact their uptake. A key feature of this field is using theories, models, and frameworks to understand implementation determinants, processes and outcomes. However, practical guidance about the application of these frameworks to develop and select implementation strategies to improve implementation outcomes (for example, adoption, implementation, sustainment) remains limited (5). Several concerns have been raised in the literature regarding the design and selection of implementation strategies. Issues include limited use of theory-informed planning and strategy selection, failure to clearly define implementation goals, inadequate understanding of the determinants impacting on implementation (which informs strategy selection) and limited understanding and description of the mechanisms of change hypothesised to lead to the desired result (5–8).

Implementation Mapping is an emerging approach informed by the theories, models and frameworks of implementation science and designed to plan and tailor implementation strategies to context. It was first described by a group of American and European authors, with early examples of Implementation Mapping applied in school-based settings in the Netherlands (the “Focus on Strength” programme targeting overweight and obesity in children) (9, 10), and healthcare settings in the United States (the “Peace of Mind” programme to increase mammography screening in low income women) (11). The Implementation Mapping approach evolved from Intervention Mapping, a six-step approach developed for the design and implementation of multi-level health promotion programmes and interventions (12, 13). While Intervention Mapping includes a step focused on planning for adoption and implementation, Implementation Mapping expands on this process by introducing additional structured tasks. These tasks include [1] conducting a needs assessment and identifying adopters and implementers; [2] identifying adoption and implementation outcomes, performance objectives and determinants, and creating matrices of change; [3] choosing theoretical models, selecting or creating implementation strategies; [4] producing implementation protocols and materials; and [5] evaluating implementation outcomes (5). Implementation Mapping was developed as a systematic process to address some of the gaps in the field of implementation science, aiming to optimise implementation of evidence-based interventions through consideration of implementation context, determinants and mechanisms (5). It also provides practical guidance for creating context-specific implementation strategies which enhance implementation efforts and may improve implementation and intervention outcomes (5, 14). Additionally, Implementation Mapping can enhance the understanding of the mechanisms of change for the chosen implementation strategies (5, 14).

Since its introduction in 2019, there has been a rapid uptake of Implementation Mapping in healthcare settings (15–17). However, despite this growing field of literature, there is no systematic or scoping review about this methodology. Moreover, it is not yet clear how Implementation Mapping is being used across different applications and disciplines. A previous systematic review examined the use of Intervention Mapping to enhance health care professional practice but did not include Implementation Mapping (18). That review concluded that Intervention Mapping provides a systematic, theory and evidence-informed framework to guide context specific programme and intervention development and implementation to achieve practice change. However, whether Implementation Mapping offers similar advantages is not yet known.

Synthesising research on Implementation Mapping will provide an understanding of the existing knowledge and methods and the gaps related to the use of this approach. This could include exploring what does and does not work, when it is most useful, frequency of use across different fields or disciplines, and reported fidelity to the methodology. This will inform further research, and support more effective use of Implementation Mapping in healthcare settings. Consequently, this scoping review aims to investigate how Implementation Mapping has been used in programmes and practices in healthcare or hospital settings. Specifically, it seeks to examine the settings, participants, and process involved, and impact on implementation outcomes and patient care.

A preliminary search of MEDLINE, the Cochrane Database of Systematic Reviews and JBI Evidence Synthesis was conducted which confirmed no published systematic reviews or scoping reviews on the topic. A scoping review protocol was developed, guided by the JBI methodology (19). A scoping review was chosen as Implementation Mapping is a new process with emerging evidence that is not well characterised. Unlike systematic reviews, scoping reviews allow an exploratory approach for identification and mapping of the existing evidence, highlighting knowledge gaps and important considerations (20, 21). This supports the identification and synthesis of evidence about how Implementation Mapping can be used to inform implementation of programmes or practice changes in healthcare settings rather than evaluating the evidence itself.

Conduct and reporting of the review was guided by the JBI methodology for scoping reviews (19) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review (PRISMA-ScR) guidelines (21). The review protocol was not registered. Ethical board review was not required as all data was publicly available.

This review collates the existing literature about the use of Implementation Mapping to implement practices or programmes in healthcare settings. Implementation Mapping has been applied across a diverse range of healthcare settings and intervention types, though with notable variability in its application and reporting. It has primarily been implemented in the United States, with applications in other geographic regions limited, suggesting a concentration of expertise and uptake in North American healthcare settings. Stakeholder engagement and collaborative approaches were universally reported, reinforcing the participatory nature of Implementation Mapping. Additionally, most studies incorporated theories, models, and frameworks, particularly CFIR and ERIC, either overall or to guide determinant analysis and strategy selection, demonstrating appropriate application of Implementation Mapping as a theory-informed approach. However, inconsistent reporting of specific tasks, particularly those in later-stages such as evaluation (Task 5), highlights an area requiring further improvement. Additionally, while prioritisation of determinants (Task 2) and implementation strategies (Task 3) was inconsistently reported, several authors emphasised the importance of prioritisation in guiding effective implementation efforts.

Implementation Mapping was first formally described in 2019 in an attempt to progress the field of implementation science and close the evidence-practice gap by using a systematic process for planning and selecting implementation strategies. The need for systematic approaches to implementation strategy selection has previously been emphasised (7). Our findings suggest that Implementation Mapping meets this need by providing a structured framework applicable across different contexts and implementation stages. Several elements were described across many of the included projects and could therefore be considered the core components of Implementation Mapping. These included the importance of understanding the implementation context, use of questions to help frame specific Implementation Mapping Tasks, the use of implementation science theories, models or frameworks, and prioritisation of determinants (in Task 2) and implementation strategies (Task 3). Using these components routinely may improve the Implementation Mapping process, however it is yet to be determined whether these components impact the effectiveness of Implementation Mapping.

Despite its supportive structure, practical application of Implementation Mapping varied widely. The included projects demonstrated many different approaches to Implementation Mapping Tasks, yet most reported that adoption of the Implementation Mapping methodology helped to improve the implementation processes for their projects. Consequently, it is likely that there is no ‘right way’ or ‘best way’ to approach Implementation Mapping. A flexible approach, informed by the nature of the intervention and the implementation context, is likely best when considering application of the Implementation Mapping process, although as discussed there may be core components that should be considered. This approach also aligns with one of the important underlying concepts of Implementation Mapping, the importance of understanding and tailoring to the implementation context (5). Many authors reported the development of more nuanced implementation strategies (responding to key determinants), and implementation plans because of detailed contextual assessment. Furthermore, Domlyn et al. (40) emphasised the role of re-evaluation of the implementation context, particularly when the outer context is changing unexpectedly or rapidly. Knowledge of this can inform healthcare planners and implementers considering this approach and may help optimise future Implementation Mapping activities.

Prioritisation of both determinants (in Task 2) and implementation strategies (in Task 3) was commonly reported, although this step was not included in the original description of Implementation Mapping (5) nor subsequent editorial by Fernandez and colleagues (14). Domlyn et al. (40) argued that prioritisation of determinants (Task 2) was essential and proposed that this step should be added to the Implementation Mapping process. Almost two-thirds of the included projects reported a process for prioritising implementation strategies, with five different methods of prioritisation described. This suggests that prioritisation of implementation strategies is an important consideration for many projects and may be particularly important for projects undertaken on a larger scale, or with more complex implementation. The ‘combined’ approach described by Fakha et al. (30, 31) which considers empirical evidence of effectiveness, supported by a relevant theory of change (explaining how and why a change is expected to occur), a pragmatic rationale (feasibility, importance, practicality, applicability to context) and feedback following consultation is likely the most comprehensive approach to prioritisation of implementation strategies, yet may not be feasible or necessary in all implementation contexts.

Prioritisation is not a new concept in the field of implementation science, although evidence-based guidance about where or when this is beneficial and how to approach this is limited. In their 2017 systematic review of Intervention Mapping to enhance healthcare professional practice, Durks and colleagues suggested that determinants should be prioritised based on their relevance and changeability (18). A scoping review of prioritisation processes for programme implementation and evaluation in public health highlighted the complexity of prioritisation (53). They found that formal frameworks were seldom utilised and have rarely been used beyond a single study. The authors suggested the development of a prioritisation framework to address this evidence gap.

Prioritisation approaches from related disciplines such as quality improvement and behaviour change science may guide how this could be achieved. A 2001 report describes ranking of improvement initiatives and recommendations according to pre-specified criteria such as (i) the potential impact, (ii) the strength of evidence, (iii) issues relating to implementation; or (a) importance, (b) scientific soundness, (c) feasibility (54). A related approach described more recently in the behavioural change literature uses a matrix to visually appraise impact of the proposed technique or strategy and likelihood of adoption (effort required), with both measures ‘scored’ as high or low (55). The resulting matrix provides an easily understood summary of potential strategies or techniques, which can be considered as ‘easy and effective’ (the ‘low hanging fruit’, generally first priority), ‘hard and ineffective’ (generally low priority) and two intermediate categories, ‘easy but ineffective’ (while low impact, these can have a ‘foot-in-the-door effect which may improve uptake of or challenging techniques or strategies) and ‘hard but effective’ (potential logistical or resource requirements) (55). Methods like these prioritisation approaches were observed in many of the Implementation Mapping studies in this review, however the additional element of context was often considered. Consequently, we suggest the most important considerations for prioritisation of determinants and strategies in Implementation Mapping are selecting a prioritisation approach that is contextually appropriate, pre-specifying the criteria or parameters that will be used, and clearly reporting prioritisation processes and outcomes.

Implementation Mapping was developed to help address a highlighted lack of guidance for selection and design of implementation strategies to improve implementation outcomes. It has been applied to a diverse range of interventions in a wide variety of healthcare settings and provides a valuable ‘roadmap’ to guide implementation efforts. The use of theories, models and frameworks featured heavily in most projects, supporting Implementation Mapping as a theory-informed approach. While implementation outcomes were not robustly assessed or reported, Implementation Mapping provides a structured but flexible approach to support the development of implementation strategies and implementation plans which are tailored to context, which may improve the effectiveness of implementation efforts. Approaches for prioritising determinants and strategies in Implementation Mapping are suggested based on the findings and other literature. Finally, key considerations for the use of Implementation Mapping use in future research includes improved methodological reporting, comparative studies of different TMFs and potential core components identified in this review, application across broader geographical settings, and assessment and reporting of both implementation and intervention (clinical) outcomes.