The role of evidence, context, and facilitation in an implementation trial: implications for the development of the PARIHS framework View Full Text


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Article Info

DATE

2013-03-09

AUTHORS

Jo Rycroft-Malone, Kate Seers, Jackie Chandler, Claire A Hawkes, Nicola Crichton, Claire Allen, Ian Bullock, Leo Strunin

ABSTRACT

BackgroundThe case has been made for more and better theory-informed process evaluations within trials in an effort to facilitate insightful understandings of how interventions work. In this paper, we provide an explanation of implementation processes from one of the first national implementation research randomized controlled trials with embedded process evaluation conducted within acute care, and a proposed extension to the Promoting Action on Research Implementation in Health Services (PARIHS) framework.MethodsThe PARIHS framework was prospectively applied to guide decisions about intervention design, data collection, and analysis processes in a trial focussed on reducing peri-operative fasting times. In order to capture a holistic picture of implementation processes, the same data were collected across 19 participating hospitals irrespective of allocation to intervention. This paper reports on findings from data collected from a purposive sample of 151 staff and patients pre- and post-intervention. Data were analysed using content analysis within, and then across data sets.ResultsA robust and uncontested evidence base was a necessary, but not sufficient condition for practice change, in that individual staff and patient responses such as caution influenced decision making. The implementation context was challenging, in which individuals and teams were bounded by professional issues, communication challenges, power and a lack of clarity for the authority and responsibility for practice change. Progress was made in sites where processes were aligned with existing initiatives. Additionally, facilitators reported engaging in many intervention implementation activities, some of which result in practice changes, but not significant improvements to outcomes.ConclusionsThis study provided an opportunity for reflection on the comprehensiveness of the PARIHS framework. Consistent with the underlying tenant of PARIHS, a multi-faceted and dynamic story of implementation was evident. However, the prominent role that individuals played as part of the interaction between evidence and context is not currently explicit within the framework. We propose that successful implementation of evidence into practice is a planned facilitated process involving an interplay between individuals, evidence, and context to promote evidence-informed practice. This proposal will enhance the potential of the PARIHS framework for explanation, and ensure theoretical development both informs and responds to the evidence base for implementation.Trial registrationISRCTN18046709 - Peri-operative Implementation Study Evaluation (PoISE). More... »

PAGES

28

References to SciGraph publications

  • 2011-08-30. A Guide for applying a revised version of the PARIHS framework for implementation in IMPLEMENTATION SCIENCE
  • 2008-01-07. Evaluating the successful implementation of evidence into practice using the PARiHS framework: theoretical and practical challenges in IMPLEMENTATION SCIENCE
  • 2009-05-19. What can management theories offer evidence-based practice? A comparative analysis of measurement tools for organisational context in IMPLEMENTATION SCIENCE
  • 2009-04-07. An implementation research agenda in IMPLEMENTATION SCIENCE
  • 2006-02-23. Designing theoretically-informed implementation interventions in IMPLEMENTATION SCIENCE
  • 2011-02-01. Developing the practice context to enable more effective pain management with older people: an action research approach in IMPLEMENTATION SCIENCE
  • 2010-12-14. Advancing a Conceptual Model of Evidence-Based Practice Implementation in Public Service Sectors in ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH
  • 2009-08-07. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science in IMPLEMENTATION SCIENCE
  • 2010-10-25. A critical synthesis of literature on the promoting action on research implementation in health services (PARIHS) framework in IMPLEMENTATION SCIENCE
  • 2006-02. The Role of Formative Evaluation in Implementation Research and the QUERI Experience in JOURNAL OF GENERAL INTERNAL MEDICINE
  • 2011-01-05. Individual determinants of research utilization by nurses: a systematic review update in IMPLEMENTATION SCIENCE
  • 2012-06-09. Creatures of habit: accounting for the role of habit in implementation research on clinical behaviour change in IMPLEMENTATION SCIENCE
  • 2006-02. The role of formative evaluation in implementation research and the QUERI experience in JOURNAL OF GENERAL INTERNAL MEDICINE
  • 2009-10-19. A theory of organizational readiness for change in IMPLEMENTATION SCIENCE
  • 2007-05-11. Interventions aimed at increasing research use in nursing: a systematic review in IMPLEMENTATION SCIENCE
  • 2010-11-20. Process evaluation of appreciative inquiry to translate pain management evidence into pediatric nursing practice in IMPLEMENTATION SCIENCE
  • 2012-08-30. A pragmatic cluster randomised trial evaluating three implementation interventions in IMPLEMENTATION SCIENCE
  • 2011-04-23. The behaviour change wheel: A new method for characterising and designing behaviour change interventions in IMPLEMENTATION SCIENCE
  • Identifiers

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    http://scigraph.springernature.com/pub.10.1186/1748-5908-8-28

    DOI

    http://dx.doi.org/10.1186/1748-5908-8-28

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1010869260

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/23497438


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    38 schema:description BackgroundThe case has been made for more and better theory-informed process evaluations within trials in an effort to facilitate insightful understandings of how interventions work. In this paper, we provide an explanation of implementation processes from one of the first national implementation research randomized controlled trials with embedded process evaluation conducted within acute care, and a proposed extension to the Promoting Action on Research Implementation in Health Services (PARIHS) framework.MethodsThe PARIHS framework was prospectively applied to guide decisions about intervention design, data collection, and analysis processes in a trial focussed on reducing peri-operative fasting times. In order to capture a holistic picture of implementation processes, the same data were collected across 19 participating hospitals irrespective of allocation to intervention. This paper reports on findings from data collected from a purposive sample of 151 staff and patients pre- and post-intervention. Data were analysed using content analysis within, and then across data sets.ResultsA robust and uncontested evidence base was a necessary, but not sufficient condition for practice change, in that individual staff and patient responses such as caution influenced decision making. The implementation context was challenging, in which individuals and teams were bounded by professional issues, communication challenges, power and a lack of clarity for the authority and responsibility for practice change. Progress was made in sites where processes were aligned with existing initiatives. Additionally, facilitators reported engaging in many intervention implementation activities, some of which result in practice changes, but not significant improvements to outcomes.ConclusionsThis study provided an opportunity for reflection on the comprehensiveness of the PARIHS framework. Consistent with the underlying tenant of PARIHS, a multi-faceted and dynamic story of implementation was evident. However, the prominent role that individuals played as part of the interaction between evidence and context is not currently explicit within the framework. We propose that successful implementation of evidence into practice is a planned facilitated process involving an interplay between individuals, evidence, and context to promote evidence-informed practice. This proposal will enhance the potential of the PARIHS framework for explanation, and ensure theoretical development both informs and responds to the evidence base for implementation.Trial registrationISRCTN18046709 - Peri-operative Implementation Study Evaluation (PoISE).
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