The FRESH AIR project will have impacts at four levels: 

  • Public health policy: by providing evidence, information and support for decision making and improving understanding and knowledge of the links between risk factors, interventions and health outcomes.
  • Healthcare provision for individuals and populations: by developing and adapting evidence-based prevention, diagnostic and treatment models and generating new knowledge on implementation; 
  • Professional awareness and skills: by training healthcare workers and developing new feasible and scalable training models;
  • Public perceptions and opinions: by developing and testing models that increase awareness and motivation for behaviour change and generating new knowledge on these. 

These can be divided into primary impacts, which happen as a direct result of Horizon 2020 FRESH AIR activities, and secondary impacts, which happen as a result of the increased knowledge and capacities the project generates. The impacts will be achieved over different timescales:


How Horizon 2020 FRESH AIR is using implementation science

The FRESH AIR H2020 project uses an implementation science approach. Implementation science is:

The scientific study of methods to promote the systematic uptake of clinical research findings and other evidence-based practices into routine practice, and hence to improve the quality and effectiveness of health care. It includes the study of influences on healthcare professional and organisational behaviour.  

Implementation science does not specify methods that studies should use. Instead it draws on qualitative, quantitative, and mixed-method research approaches, reflecting the fact that in this type of research, it is the question that determines the method used, rather than the method that determines the kinds of questions asked. 

This approach outlines five main interacting ‘domains’ as a framework for studying implementation and capturing learning:  

  • The intervention: the characteristics of the intervention determine whether it will be adopted or ‘fit’ for the local health system, such as complexity, observability, cost and evidence strength.
  • Outer (macro) setting: the economic, political and social contexts, including market environment (ie level of competition), sources of financing and the health status of the targeted population.
  • Inner setting (micro): the context within the implementing organisation/institution including the structure of the organisation, its culture (internal climate) and networks, leadership, staffing, ownership and payment models as well as readiness for change.  
  • Individuals involved (provider): the people who have a direct role in the implementation process. This includes health care providers, managers in various parts of the organisation/institution, policy-makers and many other stakeholders and beneficiaries. 
  • Process for implementation: this incorporates all of the methods and approaches used in facilitation, adoption, implementation and continuation of the intervention at all levels of the organisation, including the planning of strategies and activities. 

You can find out more about this approach in the Implementation Research Toolkit, prepared by the World Health Organization on behalf of the Special Programme for Research and Training in Tropical Diseases, available at

The research included in the FRESH AIR project will be reported using the Standards for reporting implementation studies of complex interventions (StaRI).  This includes a checklist of items to be included in reporting implementation studies and fits within the suite of EQUATOR reporting guidelines.