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

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          Abstract

          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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          Most cited references45

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          Diffusion of innovations

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            Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. The Cochrane Effective Practice and Organization of Care Review Group.

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              Getting evidence into practice: the role and function of facilitation.

              This paper presents the findings of a concept analysis of facilitation in relation to successful implementation of evidence into practice. In 1998, we presented a conceptual framework that represented the interplay and interdependence of the many factors influencing the uptake of evidence into practice. One of the three elements of the framework was facilitation, alongside the nature of evidence and context. It was proposed that facilitators had a key role in helping individuals and teams understand what they needed to change and how they needed to change it. As part of the on-going development and refinement of the framework, the elements within it have undergone a concept analysis in order to provide theoretical and conceptual clarity. The concept analysis approach was used as a framework to review critically the research literature and seminal texts in order to establish the conceptual clarity and maturity of facilitation in relation to its role in the implementation of evidence-based practice. The concept of facilitation is partially developed and in need of delineation and comparison. Here, the purpose, role and skills and attributes of facilitators are explored in order to try and make distinctions between this role and other change agent roles such as educational outreach workers, academic detailers and opinion leaders. We propose that facilitation can be represented as a set of continua, with the purpose of facilitation ranging from a discrete task-focused activity to a more holistic process of enabling individuals, teams and organizations to change. A number of defining characteristics of facilitation are proposed. However, further research to clarify and evaluate different models of facilitation is required.
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                Author and article information

                Journal
                Implement Sci
                Implementation science : IS
                BioMed Central
                1748-5908
                2008
                7 January 2008
                : 3
                : 1
                Affiliations
                [1 ]Green College, University of Oxford, Woodstock Road, Oxford OX2 6HG, UK
                [2 ]Centre for Health Related Research, School for Health Care Sciences, College of Health & Behavioural Sciences, University of Wales, Bangor, UK
                [3 ]Centre for Public Policy and Management, Manchester Business School, University of Manchester, Booth Street West, Manchester M15 6PB, UK
                [4 ]Institute of Nursing Research, University of Ulster, Shore Road, Newtownabbey, Co. Antrim, BT37 0QB, Northern Ireland, UK
                [5 ]RCN Institute, School of Health and Social Studies, University of Warwick, Coventry CV4 7 AL, UK
                [6 ]Fontys University of Applied Science, Eindhoven, The Netherlands
                Article
                1748-5908-3-1
                10.1186/1748-5908-3-1
                2235887
                18179688
                81e6567c-fb09-48f8-8301-9a4956a16dd3
                Copyright © 2008 Kitson et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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                Medicine
                Medicine

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