Background: Emerging evidence focuses on the importance of the role of leadership in successfully transferring research evidence into practice. However, little is known about the interaction between managerial leaders and clinical leaders acting as facilitators (internal facilitators [IFs]) in this implementation process.

BackgroundFacilitation is a promising implementation intervention, which requires theory-informed evaluation. This paper presents an exemplar of a multi-country realist process evaluation that was embedded in the first international randomised controlled trial evaluating two types of facilitation for implementing urinary continence care recommendations. We aimed to uncover what worked (and did not work), for whom, how, why and in what circumstances during the process of implementing the facilitation interventions in practice.MethodsThis realist process evaluation included theory formulation, theory testing and refining. Data were collected in 24 care home sites across four European countries. Data were collected over four time points using multiple qualitative methods: observation (372 h), interviews with staff (n = 357), residents (n = 152), next of kin (n = 109) and other stakeholders (n = 128), supplemented by facilitator activity logs. A combined inductive and deductive data analysis process focused on realist theory refinement and testing.ResultsThe content and approach of the two facilitation programmes prompted variable opportunities to align and realign support with the needs and expectations of facilitators and homes. This influenced their level of confidence in fulfilling the facilitator role and ability to deliver the intervention as planned. The success of intervention implementation was largely dependent on whether sites prioritised their involvement in both the study and the facilitation programme. In contexts where the study was prioritised (including release of resources) and where managers and staff support was sustained, this prompted collective engagement (as an attitude and action). Internal facilitators’ (IF) personal characteristics and abilities, including personal and formal authority, in combination with a supportive environment prompted by managers triggered the potential for learning over time. Learning over time resulted in a sense of confidence and personal growth, and enactment of the facilitation role, which resulted in practice changes.ConclusionThe scale and multi-country nature of this study provided a novel context to conduct one of the few trial embedded realist-informed process evaluations. In addition to providing an explanatory account of implementation processes, a conceptual platform for future facilitation research is presented. Finally, a realist-informed process evaluation framework is outlined, which could inform future research of this nature.Trial registrationCurrent controlled trials ISRCTN11598502.

BackgroundHealth care practice needs to be underpinned by high quality research evidence, so that the best possible care can be delivered. However, evidence from research is not always utilised in practice. This study used the Promoting Action on Research Implementation in Health Services (PARIHS) framework as its theoretical underpinning to test whether two different approaches to facilitating implementation could affect the use of research evidence in practice.MethodsA pragmatic clustered randomised controlled trial with embedded process and economic evaluation was used. The study took place in four European countries across 24 long-term nursing care sites, for people aged 60 years or more with documented urinary incontinence. In each country, sites were randomly allocated to standard dissemination, or one of two different types of facilitation. The primary outcome was the documented percentage compliance with the continence recommendations, assessed at baseline, then at 6, 12, 18, and 24 months after the intervention.Data were analysed using STATA15, multi-level mixed-effects linear regression models were fitted to scores for compliance with the continence recommendations, adjusting for clustering.ResultsQuantitative data were obtained from reviews of 2313 records. There were no significant differences in the primary outcome (documented compliance with continence recommendations) between study arms and all study arms improved over time.ConclusionsThis was the first cross European randomised controlled trial with embedded process evaluation that sought to test different methods of facilitation. There were no statistically significant differences in compliance with continence recommendations between the groups. It was not possible to identify whether different types and “doses” of facilitation were influential within very diverse contextual conditions. The process evaluation (Rycroft-Malone et al., Implementation Science. doi: 10.1186/s13012-018-0811-0) revealed the models of facilitation used were limited in their ability to overcome the influence of contextual factors.Trial registrationCurrent Controlled Trials ISRCTN11598502. Date 4/2/10.The research leading to these results has received funding from the European Union’s Seventh Framework Programme (FP7/2007–2013) under grant agreement no. 223646.Electronic supplementary materialThe online version of this article (10.1186/s13012-018-0831-9) contains supplementary material, which is available to authorized users.

International collaboration projects in academic work can be considered boundary-crossing projects with learning potential. Contrary to perceiving diversity as a barrier for understanding, we depart from dialogical arguments in perceiving ambiguity and diversity as continuous resources for meaning enrichment. Here, we report a study of an international academic project to gain more insight into how this resource is exploited. Using Bakhtin's theory, negotiation processes are analysed and explained by distinguishing voices stemming from different socio-cultural backgrounds. Project members did not explore fully the voices being expressed in their negotiation processes and therefore did not come to face their differences. We conclude that diversity should neither be seen as an obstacle for understanding, nor be presupposed as a resource for meaning generation. Rather, diversity should be actively worked on by group members in collaboration, starting by perceiving each other as real 'others' and receiving arguments initially as not understood.Key Words boundary crossing, collaboration, dialogical processes, discourse analysis, diversity, multivoiced Sanne AkkermanUtrecht University, The Netherlands Wilfried Admiraal University of Amsterdam, The Netherlands Robert Jan SimonsUtrecht University, The Netherlands Theo NiessenMaastricht University, The Netherlands Considering Diversity: Multivoicedness in International Academic CollaborationCollaboration in work settings allows professionals to come into contact with ideas and approaches of other professionals, enabling them to reflect on their own ideas and approaches and to consider alternative ideas and approaches. More generally put, being in dialogue with others entails the transcendence of private worlds (Wertsch, 1985). Advancement of new ideas, that is, conceptualCulture & Psychology

Engagement is seen as an important characteristic of action research. The term is often used to refer to the participation and involvement of the research participants. Within this article we take another angle and explore the concept of engagement in relation to the main action researcher. Using an auto-ethnographic approach, we illustrate that the involvement and 'closeness' of the researcher, although necessary within action research, can also have a darker side as people have the tendency to get trapped in their own beliefs and prejudices. If not mindful enough of their own involvement and way of being within the context, the researcher can lose him-or herself in the situation and no longer be able to encourage or facilitate the participation of others. We give suggestions for realizing productive engagement as a (participatory) researcher using concepts such as mindfulness and mindsight.