Letter to the Editor on “Adjunctive interventions: change methods directed at recipients that support uptake and use of health innovations.” - Letter to the editor

Sep 28, 2026

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A letter to the editor responds to Smith et al. (Implementation Science, 2024) by discussing how commonly used behavioral change methods by HIV researchers reflect both implementation strategies and interventions. The authors highlight confusion caused by the lack of consumer/patient behavior outcomes—such as acceptability, uptake, utilization, adherence, completion, and maintenance—within familiar implementation outcomes frameworks. They critique the proposed “adjunctive intervention” taxonomic overhaul and argue that the letter’s conceptual grounding rests on an inaccurate view of implementation strategies flowing from system/provider levels to recipients.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages3

Reading Time8 min

AccessFree to download

Letter to the Editor

Background: confusion and missing patient-centered outcomes

Implementation Outcomes Framework and implications

Critique of the proposed taxonomic overhaul

Lederer and Buchanan Implementation Science (2026) 21:2 [https://doi.org/10.1186/s13012-025-01451-6](https://doi.org/10.1186/s13012-025-01451-6) Implementation Science LETTER TO THE EDITOR Open Access Letter to the Editor on “Adjunctive interventions: change methods directed at recipients that support uptake and use of health innovations.”(Smith JD, Li DH, Merle, JL et al. adjunctive interventions: change methods directed at recipients that support uptake and use of health innovations. Implementation Sci 2024;19:10 . Doi:10.1186/s13012-024-01345-z) Lisa Guttentag Lederer 1* and Gretchen Buchanan2,3 In a 2024 paper, Smith et [al](al. report)[.](al. report)[ report](al. report) that the behavioral change methods commonly used by HIV researchers share prototypical features of both implementation strategies and interventions [1]. As a result, when attempting to communicate their work, these researchers often face confusion that is evident to the authors both through informal interactions (e.g., consultations) and systematic reviews of implementation-focused studies. Particularly confounding to HIV researchers conducting implementation research is the absence of outcomes related to *Correspondence: Lisa Guttentag Lederer [lisa.lederer@pitt.edu](lisa.lederer@pitt.edu) 1 Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA 2 Redleaf Center for Family Healing, Hennepin Healthcare Research Institute, Minneapolis, MN, USA 3 Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA consumer/patient behavior that are relevant to their work – including “acceptability, uptake, utilization, adherence, completion, and maintenance” of health interventions by recipients (p.3)– from familiar implementation outcomes frameworks. In fact, when Proctor et al. introduced their Implementation Outcomes Framework in 2011, they were explicit that this framework was “rudimentary,” its purpose being simply to “advance the clarity of language, provoke debate, and stimulate more systematic work toward the aims of advancing the conceptual, linguistic, and methodological clarity in the [implementation science] field” ([2], p.74). While some work has since been done to further such conceptual advancement ([3], p.3) Smith et al.’s findings could represent the fruitful beginnings of an argument for the inclusion of patient/consumer-facing constructs in implementation outcome frameworks. After all, implementation research should not be restricted to implementors and their efforts. We © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creativecommons.org/licenses/by-nc-nd/4.0/](http://creativecommons.org/licenses/by-nc-nd/4.0/.)[.](http://creativecommons.org/licenses/by-nc-nd/4.0/.) Lederer and Buchanan Implementation Science (2026) 21:2 suspect that the absence of outcomes centered on consumer/patient behavior from the Proctor et al. framework is an artifact of the foundational role of the Health Serv

FAQs

What core issue does the letter raise about implementation outcomes frameworks?

The letter argues that common frameworks inadequately capture consumer/patient behavior outcomes relevant to recipients, such as acceptability, uptake, utilization, adherence, completion, and maintenance.

How does the letter view the Implementation Outcomes Framework introduced in 2011?

It notes that Proctor et al. described the framework as rudimentary, intended to advance clarity and stimulate more systematic work in implementation science.

What is the letter’s main critique of Smith et al.’s proposed “adjunctive intervention” category?

The letter contends that the proposed taxonomic overhaul relies on an inaccurate conception of implementation strategies and incorrectly assumes a one-direction flow from system/provider level to recipient level.

Sep 28, 2026

Uploaded by awa