The EPIS framework provides a longitudinal backbone for understanding how new practices are adopted. It's built around four distinct, time-based phases: Exploration, Preparation, Implementation, and Sustainment. Think of these phases as the lifecycle of an implementation effort. When used for research synthesis, these phases become the primary categories for coding and analyzing data from different studies.

1. Exploration: This is the beginning. A community or organization recognizes a need and starts looking for potential solutions. For a research coder, this means looking for mentions of needs assessments, reviewing available evidence-based practices (EBPs), and initial discussions with stakeholders.
2. Preparation: A decision has been made. This phase involves detailed planning, securing resources, and building the internal capacity to adopt the new practice. Coders identify this phase when studies discuss staff training, developing workflows, or adapting the intervention to fit the local setting.
3. Implementation: The plan is put into action. This is the active rollout of the new practice. Evidence of this phase in research includes data on initial adoption rates, fidelity monitoring, and early challenges encountered by staff.
4. Sustainment: The practice becomes routine. This final phase evaluates if the new practice is integrated into standard operations long-term, often after initial funding or support ends. Coded data points might include ongoing quality assurance, policy changes, and long-term outcome data.

Across all four phases, EPIS considers the dynamic interplay between the outer and inner context. The outer context refers to systemic factors outside the organization, like government policies, funding streams, and patient advocacy groups. The inner context involves factors within the organization, such as leadership support, organizational culture, staffing, and existing infrastructure. The relationship between these two contexts is mediated by bridging factors, which connect different system levels, like inter-agency partnerships or relationships between universities and community organizations.

While the phases are presented sequentially, the process is rarely a straight line. Implementation is an iterative journey. An organization might move from the Preparation phase back to Exploration if they discover a new barrier or a better solution. Similarly, challenges during the Implementation phase might force a team to return to Preparation to retrain staff or adjust the plan.

For researchers conducting a review, operationalizing these phase boundaries is critical. This means creating clear, explicit definitions for what constitutes evidence for each phase. A coding rule might state, "Any mention of adapting materials or formal staff training will be coded as Preparation." Clear rules ensure that different coders apply the framework consistently across dozens or hundreds of studies, making the synthesis reliable.

When used in a scoping review, the four EPIS phases serve as the main buckets for organizing information. A researcher reads a study and maps its findings to the appropriate phase. Was the study about choosing an intervention? That's Exploration. Did it describe the challenges of the first six months of a program? That's Implementation.

Within each phase, the researcher then codes for inner and outer context factors. This two-level coding allows for a rich analysis. You can start to see patterns, like how outer context factors (e.g., a new state policy) influence inner context factors (e.g., leadership buy-in) during the Preparation phase across multiple studies.

Now, let's test your understanding of these core components.

By using this phased structure, researchers can synthesize findings from diverse studies into a coherent narrative about the implementation journey.