A Guide for applying a revised version of the PARIHS framework for implementation

Abstract

BackgroundBased on a critical synthesis of literature on use of the Promoting Action on Research Implementation in Health Services (PARIHS) framework, revisions and a companion Guide were developed by a group of researchers independent of the original PARIHS team. The purpose of the Guide is to enhance and optimize efforts of researchers using PARIHS in implementation trials and evaluations.MethodsAuthors used a planned, structured process to organize and synthesize critiques, discussions, and potential recommendations for refinements of the PARIHS framework arising from a systematic review. Using a templated form, each author independently recorded key components for each reviewed paper; that is, study definitions, perceived strengths/limitations of PARIHS, other observations regarding key issues and recommendations regarding needed refinements. After reaching consensus on these key components, the authors summarized the information and developed the Guide.ResultsA number of revisions, perceived as consistent with the PARIHS framework's general nature and intent, are proposed. The related Guide is composed of a set of reference tools, provided in Additional files. Its core content is built upon the basic elements of PARIHS and current implementation science.ConclusionsWe invite researchers using PARIHS for targeted evidence-based practice (EBP) implementations with a strong task-orientation to use this Guide as a companion and to apply the revised framework prospectively and comprehensively. Researchers also are encouraged to evaluate its use relative to perceived strengths and issues. Such evaluations and critical reflections regarding PARIHS and our Guide could thereby promote the framework's continued evolution.

Bridging the second gap in translation: a case study of barriers and facilitators to implementing Patient-initiated Clinics into secondary care

“…In the final phase of analysis we used the revised 'Promoting Action on Research Implementation in Health Services' framework (PARiHS) [19] to structure our themes and to present our findings. PARiHS considers successful implementation as 'a function of the nature and type of evidence, the qualities of the context in which the evidence is being introduced and the way the process is facilitated' [20].…”

“…The second element in the PARiHS framework concerns contextual readiness, which refers to the setting in which the intervention is to be implemented, including structures and environmental characteristics that shape practice, such as leadership support, culture, capabilities and receptivity to change [19]. This element was found to be the most significant for our implementation project.…”

“…Facilitation from the research team was both 'task' focussed and 'holistic' [19], aiming to match 'the purpose, role and skills (each of which can exist as a series of continua) to the needs of the situation' [22]. Activities included supporting the development of the implementation plans, keeping track of the necessary steps to proceed and assessing barriers and potential solutions such as facilitating communication between different departments.…”

“…Activities included supporting the development of the implementation plans, keeping track of the necessary steps to proceed and assessing barriers and potential solutions such as facilitating communication between different departments. The facilitation provided was responsive [19], as well as flexible, continuous and reflexive [20], offering support, such as re-designing paperwork (doing for) and working together with staff and patients to design educational materials (doing with) [20]. In addition, all three departments were offered financial support to facilitate overcoming specific barriers, such as some additional administration time for a limited period.…”

Implementing point of care “e-referrals” in 137 clinics to increase access to a quit smoking internet system: the Quit-Primo and National Dental PBRN HI-QUIT Studies

“…Successful implementation is most likely in cases when ORIGINAL RESEARCH evidence is high and reflects clinical experience and patient preferences, a clinical context is receptive to change and characterized by accommodating culture and appropriate evaluation mechanisms, and suitable processes and resources are available to facilitate and sustain change [27]. When used as a guiding framework, PARIHS can highlight important evidence and contextual factors that may influence an implementation effort, and can inform the development of a suitable facilitationbased implementation strategy to address those factors [28].…”