Enabling the implementation of evidence based practice: a conceptual framework

Abstract

The argument put forward in this paper is that successful implementation of research into practice is a function of the interplay of three core elements-the level and nature of the evidence, the context or environment into which the research is to be placed, and the method or way in which the process is facilitated. It also proposes that because current research is inconclusive as to which of these elements is most important in successful implementation they all should have equal standing. This is contrary to the often implicit assumptions currently being generated within the clinical eVectiveness agenda where the level and rigour of the evidence seems to be the most important factor for consideration. The paper oVers a conceptual framework that considers this imbalance, showing how it might work in clarifying some of the theoretical positions and as a checklist for staV to assess what they need to do to successfully implement research into practice.

Factors affecting implementation of an evidence-based practice in the Veterans Health Administration: Illness management and recovery.

“…This phenomenon speaks to the acceptability of the program, at least from a clinician's perspective and suggests that IMR implementation would be greatly aided by efforts to disseminate information about the program more widely. In addition, awareness of IMR at IMR sites was generally based upon first-hand experience with IMR and may be construed as "evidence" of the effectiveness of IMR (Kitson, Harvey, & McCormack, 1998). Knowledge may be essential, but not sufficient, and other themes were clearly important to implementation success.…”

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

“…The Promoting Action on Research Implementation in Health Services (PARiHS) framework is especially appealing in understanding the delivery of integrated behavioral medicine because it provides a multidimensional and interactive perspective of organizational variables, allowing for interplay between program evaluation and implementation refinement [19,20]. Since developed in the 1990s, the framework has evolved from its use in empirical case studies to its current iteration guiding implementation evaluation [21,22]. The framework considers successful implementation to be most likely when: (1) scientific evidence is viewed as sound and fitting with professional and patient beliefs; (2) the healthcare context is receptive to implementation in terms of supportive leadership, culture, and evaluative systems; and (3) there are appropriate mechanisms in place to facilitate implementation.…”

Ready to deliver maternal and newborn care? Health providers’ perceptions of their work context in rural Mozambique

“…Common to many of these frameworks is the recognition of the importance of understanding the healthcare context in which evidence is implemented [9]. The Pro-moting Action on Research Implementation in Health Services (PARIHS) framework suggests that successful implementation of evidence occurs as a function of, and the interplay between, characteristics of the evidence to be implemented, the context in which the evidence is implemented and the type of facilitation used to support the implementation [10]. Context is seen as existing on a continuum, from those supporting the use of evidence (high context) moving to those who do not support the use of evidence (low context), and comprises three sub-elements: culture, leadership, and evaluation [10].…”

“…The Pro-moting Action on Research Implementation in Health Services (PARIHS) framework suggests that successful implementation of evidence occurs as a function of, and the interplay between, characteristics of the evidence to be implemented, the context in which the evidence is implemented and the type of facilitation used to support the implementation [10]. Context is seen as existing on a continuum, from those supporting the use of evidence (high context) moving to those who do not support the use of evidence (low context), and comprises three sub-elements: culture, leadership, and evaluation [10]. Tools aimed at assessing context, and developed within the PARIHS framework, include the Alberta Context Tool (ACT) [11], the Context Assessment Index [12] and the Organizational Readiness to Change Assessment (ORCA) tool [13].…”

“…Consequently, the Context Assessment for Community Health (COACH) tool was developed in Bangladesh, Vietnam, Uganda, South Africa and Nicaragua to assess modifiable aspects of the healthcare context that may influence the implementation of interventions and the integration of EBPs into clinical routines in LMICs [14–16]. The COACH concept originated from the context element of the PARIHS framework [10,17–19] and the interconnected health system building blocks presented by the World Health Organization (WHO) [20]. The tool evaluates health providers’ perceptions of the building blocks of the local health system.…”