A critical synthesis of literature on the promoting action on research implementation in health services (PARIHS) framework

Abstract

BackgroundThe Promoting Action on Research Implementation in Health Services framework, or PARIHS, is a conceptual framework that posits key, interacting elements that influence successful implementation of evidence-based practices. It has been widely cited and used as the basis for empirical work; however, there has not yet been a literature review to examine how the framework has been used in implementation projects and research. The purpose of the present article was to critically review and synthesize the literature on PARIHS to understand how it has been used and operationalized, and to highlight its strengths and limitations.MethodsWe conducted a qualitative, critical synthesis of peer-reviewed PARIHS literature published through March 2009. We synthesized findings through a three-step process using semi-structured data abstraction tools and group consensus.ResultsTwenty-four articles met our inclusion criteria: six core concept articles from original PARIHS authors, and eighteen empirical articles ranging from case reports to quantitative studies. Empirical articles generally used PARIHS as an organizing framework for analyses. No studies used PARIHS prospectively to design implementation strategies, and there was generally a lack of detail about how variables were measured or mapped, or how conclusions were derived. Several studies used findings to comment on the framework in ways that could help refine or validate it. The primary issue identified with the framework was a need for greater conceptual clarity regarding the definition of sub-elements and the nature of dynamic relationships. Strengths identified included its flexibility, intuitive appeal, explicit acknowledgement of the outcome of 'successful implementation,' and a more expansive view of what can and should constitute 'evidence.'ConclusionsWhile we found studies reporting empirical support for PARIHS, the single greatest need for this and other implementation models is rigorous, prospective use of the framework to guide implementation projects. There is also need to better explain derived findings and how interventions or measures are mapped to specific PARIHS elements; greater conceptual discrimination among sub-elements may be necessary first. In general, it may be time for the implementation science community to develop consensus guidelines for reporting the use and usefulness of theoretical frameworks within implementation studies.

Access to care for vulnerable veterans with hepatitis C: a hybrid conceptual framework and a case study to guide translation

“…The ABM provides a robust evaluation guide of patient and community health variables which, when presented to clinical and administrative staff participating in healthcare intervention, would inform the design and adoption of a healthcare intervention. The original developers of the PARiHS framework envisioned its use in conjunction with other models or frameworks [37]. The PARiHS framework accepts the ABM inputs and additionally requires a pre-or early formative implementation assessment and the subsequent utilization of these findings to facilitate the intervention [37].…”

“…The original developers of the PARiHS framework envisioned its use in conjunction with other models or frameworks [37]. The PARiHS framework accepts the ABM inputs and additionally requires a pre-or early formative implementation assessment and the subsequent utilization of these findings to facilitate the intervention [37].…”

“…The PARiHS framework domains could guide survey instruments querying clinical and administrative staff on the key elements which facilitated or hindered the acceptance, modification, and eventual adoption of Project SCAN-ECHO. We have briefly summarized below potential key informant questions from each element and subelement [19,37].…”

Changing practice to support self-management and recovery in mental illness: application of an implementation model

“…One difficulty is the sheer number of models available (Damschroder et al 2009;Tabak et al 2012) with none properly tested in practice situations (Helfrich et al 2010;Chaudoir et al 2013). Another difficulty is in measuring the pre-requisites for change proposed within a particular model as few models have explicitly linked survey tools (Chaudoir et al 2013).…”

“…One difficulty is the sheer number of models available in the literature with none yet properly tested empirically (Helfrich et al 2010;Damschroder and Hagedorn 2011;Ovretveit 2011). A further difficulty is in measuring the components of the available models.…”