What is PRISM?
The Practical, Robust Implementation and Sustainability Model (PRISM) is an implementation science framework that considers the multilevel and dynamic interactions between the evidence-based intervention, the perspective and characteristics of diverse recipients (e.g., patients, clinicians, decision makers), the implementation and sustainability infrastructure, and the external environment (e.g., laws and regulations, clinical practice guidelines).
PRISM connects these contextual domains with the widely used RE-AIM (Reach, Effectiveness, Adoption,
Implementation, Maintenance) outcomes, which are part of PRISM.
PRISM has been used successfully across diverse contexts (settings, populations) and topic areas.
How do PRISM and RE-AIM Fit Together?
Please find the slide the side note to the below video here along with a summary of the below video.
PRISM, the Practical Robust Implementation and Sustainability Model consists of two main parts: the PRISM contextual domains and the RE-AIM outcomes. The PRISM contextual domains include multi-level considerations for the characteristics of the intervention including perspectives of stakeholders from both individuals and settings, the characteristics of diverse recipients, the implementation and sustainability infrastructure, and the external environment. The Implementation and Sustainability Infrastructure is one of the most important domain in PRISM and is concerned with issues such as the
resources available to support initial implementation and sustained delivery of
the intervention. We expect that that the Implementation and Sustainability Infrastructure
will dynamically change and should be evaluated on an ongoing basis. The External environment includes factors such as policies and regulations, financial incentives or disincentives, clinical practice guidelines, and historical considerations.
At the most basic level, PRISM helps us identify and describe multi-level contextual predictors of the RE-AIM outcomes and make connections between context and critical outcomes of reach, effectiveness, adoption, implementation, and maintenance.
For research, we recommend:
1. The development and validation of more quantitative measures of PRISM, especially those that meet pragmatic and the PAPERS criteria. This will allow greater mixed-methods research on PRISM and understanding of various linkages.
2. The use of common and where applicable, standardized PRISM definitions, assessments, and criteria. We note examples of mixed methods research with PRISM, including survey and qualitative interview guides as well as a new interactive PRISM assessment and feedback tool that will soon be available on the re-aim.org website.
3. While preferred to advance implementation science, for pragmatic use it is not necessary to use all PRISM components or to use PRISM at all program time points (i.e., pre-implementation, implementation, sustainment). When not feasible, authors should briefly and transparently state why certain components were not used or why PRISM was only used at one time point.
4. More investigations and transparent reporting are needed that (a) compare PRISM with other TMFs and create clear cross-walks between PRISM and other TMFs; (b) combine PRISM with other models; and (c) adapt PRISM to diverse contexts and content areas.
5. Patient and community member issues involving (a) characteristics components of PRISM can be highlighted more; including especially social determinants of health and other equity-related issues; and (b) perceptions of the beneficiary of the intervention (e.g., patient-centeredness, trialability, relative advantage/etc.)
6. Consider using PRISM in more diverse settings including community, school, worksite, and other non-clinical contexts, especially including low resource settings and low- and middle-income countries.
For implementation practice, we recommend:
1. Reports on how PRISM is used with different types of implementation partners, in multi-sector research, and for team science, including the time involved and lessons learned.
2. Use of PRISM in logic models and to develop participatory implementation strategies that can help to address priority outcomes.
3. As discussed in the section on clarification, reviewing PRISM terminology to make it more user-friendly and relevant to the context of the implementation practice—for example changing some terms such as “patients” or “recipients.”
4. Development and usability evaluations of interactive tools and resources including videos that illustrate and guide PRISM use.