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      Making sense of complexity in context and implementation: the Context and Implementation of Complex Interventions (CICI) framework.

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          Abstract

          The effectiveness of complex interventions, as well as their success in reaching relevant populations, is critically influenced by their implementation in a given context. Current conceptual frameworks often fail to address context and implementation in an integrated way and, where addressed, they tend to focus on organisational context and are mostly concerned with specific health fields. Our objective was to develop a framework to facilitate the structured and comprehensive conceptualisation and assessment of context and implementation of complex interventions.

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          Most cited references70

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          ABSORPTIVE CAPACITY: A REVIEW, RECONCEPTUALIZATION, AND EXTENSION.

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            Evaluating the successful implementation of evidence into practice using the PARiHS framework: theoretical and practical challenges

            Background The PARiHS framework (Promoting Action on Research Implementation in Health Services) has proved to be a useful practical and conceptual heuristic for many researchers and practitioners in framing their research or knowledge translation endeavours. However, as a conceptual framework it still remains untested and therefore its contribution to the overall development and testing of theory in the field of implementation science is largely unquantified. Discussion This being the case, the paper provides an integrated summary of our conceptual and theoretical thinking so far and introduces a typology (derived from social policy analysis) used to distinguish between the terms conceptual framework, theory and model – important definitional and conceptual issues in trying to refine theoretical and methodological approaches to knowledge translation. Secondly, the paper describes the next phase of our work, in particular concentrating on the conceptual thinking and mapping that has led to the generation of the hypothesis that the PARiHS framework is best utilised as a two-stage process: as a preliminary (diagnostic and evaluative) measure of the elements and sub-elements of evidence (E) and context (C), and then using the aggregated data from these measures to determine the most appropriate facilitation method. The exact nature of the intervention is thus determined by the specific actors in the specific context at a specific time and place. In the process of refining this next phase of our work, we have had to consider the wider issues around the use of theories to inform and shape our research activity; the ongoing challenges of developing robust and sensitive measures; facilitation as an intervention for getting research into practice; and finally to note how the current debates around evidence into practice are adopting wider notions that fit innovations more generally. Summary The paper concludes by suggesting that the future direction of the work on the PARiHS framework is to develop a two-stage diagnostic and evaluative approach, where the intervention is shaped and moulded by the information gathered about the specific situation and from participating stakeholders. In order to expedite the generation of new evidence and testing of emerging theories, we suggest the formation of an international research implementation science collaborative that can systematically collect and analyse experiences of using and testing the PARiHS framework and similar conceptual and theoretical approaches. We also recommend further refinement of the definitions around conceptual framework, theory, and model, suggesting a wider discussion that embraces multiple epistemological and ontological perspectives.
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              Enabling the implementation of evidence based practice: a conceptual framework

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                Author and article information

                Journal
                Implement Sci
                Implementation science : IS
                Springer Science and Business Media LLC
                1748-5908
                1748-5908
                February 15 2017
                : 12
                : 1
                Affiliations
                [1 ] Institute for Medical Informatics, Biometry and Epidemiology, LMU Munich, Munich, Germany. pfadenh@ibe.med.uni-muenchen.de.
                [2 ] Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany.
                [3 ] Health Sciences Bremen, University of Bremen, Bremen, Germany.
                [4 ] Centre for Medical Ethics, University of Oslo, Oslo, Norway.
                [5 ] School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
                [6 ] Institute for Medical Informatics, Biometry and Epidemiology, LMU Munich, Munich, Germany.
                Article
                10.1186/s13012-017-0552-5
                10.1186/s13012-017-0552-5
                5312531
                28202031
                ac0eaea2-1cd9-417e-995f-89a87e998676
                History

                Health technology assessment,Implementation,Complex intervention,Systematic review,Concept analysis,Context,Public health,Transferability,Applicability

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