# Step 5

## Implementation Mapping

- See Chapter 9 of the book on Step 5.

Step 5 focuses on ensuring that the program is successfully adopted, implemented, and maintained. This step outlines: *Who has to do what to keep the program up and running*. 

_Adoption_ refers to the initial decision by key stakeholders or implementers to begin using a new program, policy, or practice. It marks the commitment to try or integrate the intervention into existing routines or systems.

_Implementation_ is the actual use of the program by those who adopted it. This involves consistently putting the program into practice with fidelity over a sufficient period to evaluate its effectiveness and determine whether it meets the needs of the target population.

_Maintenance_ ensures the program becomes part of an organization’s standard operations. It represents a long-term commitment to continue delivering the intervention consistently and effectively over time.

It is very important that potential program users, or implementers, are actually aware of the existence of the program, are motivated to use it, understand how to use it. Consequently, you will have to repeat all the IM steps, but now aimed at the program users (who are now your target group) and concentrating primarily on the outcomes of adoption, implementation, and maintenance (Fernandez et al., 2019).

Tasks of IM Step 5 involve:
- Conduct an implementation needs and assets assessment and identify program implementers
- Identify implementation performance objectives and determinants to create matrices of change objectives
- Choose change methods and design implementation strategies
- Produce implementation protocols and materials
- Evaluate implementation outcomes

Start Step 1 again, with identifying potential *adopters, implementers and maintainers*.

Then, adapt your planning group (re-evaluate who should be in there).

```{tip} Examples
Example of more exercise for young children at schools:

- Who executes your programme or intervention?
  - Our intervention for young overweight children will be adopted by parents and teachers.
- How will they know that our intervention exists?
  - Head of schools should inform them.

Example for social distancing in the Kalverstraat:

- Who executes your programme or intervention?
  - The shopkeepers will adopt our intervention.
- How will they know that our intervention exists?
  - The municipality should inform them.
```
Next, move to Step 2, where you state the desired outcomes and performance objectives specifically for adoption, implementation, and maintenance. Select the relevant determinants for each of these stages, and formulate change objectives. Then, construct matrices of change objectives tailored to implementation interventions.

Following the approach used in Step 3 of Intervention Mapping, choose change methods and practical applications to address these objectives. Finally, like in Step 4, design the scope and sequence of the implementation intervention and develop the materials needed to influence program use.