TABLE 1.

Contradictions Associated With the Planning of Embedded Implementation Science and Case Study Examples of Strategies for Resolving Contradictions

Attribute	Core Strategies of Implementation Science	Strategic Adjustments of Embedded Science	Contradictions Associated With Strategic Adjustments	Case Study Resolution of Contradictions
Goal	Problems are identified a priori and resolved through researcher controlled hypothesis testing and dissemination.	Organizational change and development requires joint researcher and host agency goal setting.	Goals are defined in terms of endpoint hypotheses to be tested rather than host agency goals for testing means of achieving system change.	Retain, but subordinate, primary health and demographic impact research to implementation research as an integrated and continuous process.⁴
Outcome evaluation	Statistical inference is based on observation of treatment and counterfactual endpoints, with units of observation conforming to power requirements.	Improved host agency functionality and impact	Protocols define project start and end dates, endpoints, and hypotheses, whereas organizational change is a continuous, open-ended, and multi-faceted process.¹⁰	Phase in research as a process that fosters continuous utilization and action.⁴⁴ Avoid ending learning processes just because a protocol has been completed.²
Leadership	Researchers in directive, independent, and autonomous roles with outreach to decision makers and managers at the end of investigation.	Collaboration of host agency and research partner leadership	Researchers assume directive, independent, and autonomous roles and episodically communicate health and demographic outcomes to host agency counterparts. Managers’ roles are defined by bureaucratic and organizational norms.	Host agency managers representing each level of the investigative process are appropriately teamed with research counterparts at each system level.
Ownership	Host agency audience through “steering committees” and end of the project dissemination.	Subordination of research leadership to host agency governance. Joint dissemination.	Leadership malaise in the host agency can permeate an embedded research system, diluting rigor and compromising research implementation.⁵⁴^,⁸⁰	Develop a partnership of research leadership with host agency institutional structures, but maintain an autonomous research operation.
Scientific rigor	Study designs conform to conventional criteria for statistical inference.	Studies embrace process research, mixed methods research designs, and multilevel analyses in concert with the norms of statistical inference.	Constructing the counterfactual is essential but inconsistent with management operations that span all organizational levels.⁹⁰ Acquiring meaningful numbers of randomized organizational units for observation and statistical inference is impossible.⁹²	Intervene with treatment and counterfactual conditions that conform to the host organizational structure. Use plausibility trials⁵⁶^,⁸⁵ with statistical methods for non-experimental designs.⁶⁰
System relevance	Systems thinking provides frameworks for data capture and analysis. Optimize costing for achieving clear and unequivocal results for hypothesis testing.	Systems thinking includes partnership arrangements and research activities that reflect units of the host agency organization. Establish researcher and host agency collaboration on operational costing and costing research.	Contexts where implementation science is needed most are settings where systems research is most challenging to conduct.⁹² Systems research requires multilevel longitudinal data that are complex to capture, manage, and analyze.⁹⁰^,⁹² Prospects for utilization are enhanced if costs are clear, but organizational change often incurs costs that are impossible to predict.	Utilize replication studies to disperse research in all relevant cultural and ecological contexts. Configure learning localities that are consistent with program organizational units at each level of the system.⁴⁴ Restrict implementation financing to affordable and replicable activities. Prioritize costing analyses for replication and scale-up phases.¹⁰⁰^,¹⁰¹