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      Systematic review of the Exploration, Preparation, Implementation, Sustainment (EPIS) framework

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          Abstract

          Background

          Effective implementation of evidence-based practices (EBPs) remains a significant challenge. Numerous existing models and frameworks identify key factors and processes to facilitate implementation. However, there is a need to better understand how individual models and frameworks are applied in research projects, how they can support the implementation process, and how they might advance implementation science. This systematic review examines and describes the research application of a widely used implementation framework, the Exploration, Preparation, Implementation, Sustainment (EPIS) framework.

          Methods

          A systematic literature review was performed to identify and evaluate the use of the EPIS framework in implementation efforts. Citation searches in PubMed, Scopus, PsycINFO, ERIC, Web of Science, Social Sciences Index, and Google Scholar databases were undertaken. Data extraction included the objective, language, country, setting, sector, EBP, study design, methodology, level(s) of data collection, unit(s) of analysis, use of EPIS (i.e., purpose), implementation factors and processes, EPIS stages, implementation strategy, implementation outcomes, and overall depth of EPIS use (rated on a 1–5 scale).

          Results

          In total, 762 full-text articles were screened by four reviewers, resulting in inclusion of 67 articles, representing 49 unique research projects. All included projects were conducted in public sector settings. The majority of projects (73%) investigated the implementation of a specific EBP. The majority of projects (90%) examined inner context factors, 57% examined outer context factors, 37% examined innovation factors, and 31% bridging factors (i.e., factors that cross or link the outer system and inner organizational context). On average, projects measured EPIS factors across two of the EPIS phases ( M = 2.02), with the most frequent phase being Implementation (73%). On average, the overall depth of EPIS inclusion was moderate (2.8 out of 5).

          Conclusion

          This systematic review enumerated multiple settings and ways the EPIS framework has been applied in implementation research projects, and summarized promising characteristics and strengths of the framework, illustrated with examples. Recommendations for future use include more precise operationalization of factors, increased depth and breadth of application, development of aligned measures, and broadening of user networks. Additional resources supporting the operationalization of EPIS are available.

          Electronic supplementary material

          The online version of this article (10.1186/s13012-018-0842-6) contains supplementary material, which is available to authorized users.

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          Most cited references45

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          The PRECIS-2 tool: designing trials that are fit for purpose.

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            Mental health provider attitudes toward adoption of evidence-based practice: the Evidence-Based Practice Attitude Scale (EBPAS).

            Mental health provider attitudes toward organizational change have not been well studied. Dissemination and implementation of evidence-based practices (EBPs) into real-world settings represent organizational change that may be limited or facilitated by provider attitudes toward adoption of new treatments, interventions, and practices. A brief measure of mental health provider attitudes toward adoption of EBPs was developed and attitudes were examined in relation to a set of provider individual difference and organizational characteristics. Participants were 322 public sector clinical service workers from 51 programs providing mental health services to children and adolescents and their families. Four dimensions of attitudes toward adoption of EBPs were identified: (1) intuitive Appeal of EBP, (2) likelihood of adopting EBP given Requirements to do so, (3) Openness to new practices, and (4) perceived Divergence of usual practice with research-based/academically developed interventions. Provider attitudes varied by education level, level of experience, and organizational context. Attitudes toward adoption of EBPs can be reliably measured and vary in relation to individual differences and service context. EBP implementation plans should include consideration of mental health service provider attitudes as a potential aid to improve the process and effectiveness of dissemination efforts.
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              Validating the organizational climate measure: links to managerial practices, productivity and innovation

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                Author and article information

                Contributors
                jcmoullin@gmail.com
                kdickson@sdsu.edu
                nstadnic@ucsd.edu
                borsika.a.rabin@gmail.com
                gaarons@ucsd.edu
                Journal
                Implement Sci
                Implement Sci
                Implementation Science : IS
                BioMed Central (London )
                1748-5908
                5 January 2019
                5 January 2019
                2019
                : 14
                : 1
                Affiliations
                [1 ]ISNI 0000 0004 0375 4078, GRID grid.1032.0, Faculty of Health Sciences, School of Pharmacy and Biomedical Sciences, , Curtin University, ; Kent Street, Bentley, Perth, 6102 Western Australia
                [2 ]Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA 92123 USA
                [3 ]ISNI 0000 0001 0790 1491, GRID grid.263081.e, Department of Child and Family Development, , San Diego State University, ; 5500 Campanile Drive, San Diego, CA 92182 USA
                [4 ]ISNI 0000 0001 2107 4242, GRID grid.266100.3, Department of Psychiatry, , University of California San Diego, ; 9500 Gilman Drive (0812), La Jolla, San Diego, CA 92093-0812 USA
                [5 ]ISNI 0000 0001 2107 4242, GRID grid.266100.3, Department of Family Medicine and Public Health, , University of California San Diego, ; 9500 Gilman Drive (0725), La Jolla, San Diego, CA 92093-0812 USA
                Author information
                http://orcid.org/0000-0001-8969-5002
                Article
                842
                10.1186/s13012-018-0842-6
                6321673
                30611302
                f6441ddc-6ae6-429a-a2c4-62cac6d742e3
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 27 July 2018
                : 26 November 2018
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100000026, National Institute on Drug Abuse;
                Award ID: R01DA038466
                Award ID: U01DA036233
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/100000025, National Institute of Mental Health;
                Award ID: R01MH072961
                Award ID: K23MH110602
                Award Recipient :
                Categories
                Systematic Review
                Custom metadata
                © The Author(s) 2019

                Medicine
                implementation,framework,model,theory,outer context,inner context,process,systematic review,diffusion of innovations

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