Implementation research design: integrating participatory action research into randomized controlled trials

Abstract

Background: A gap continues to exist between what is known to be effective and what is actually delivered in the usual course of medical care. The goal of implementation research is to reduce this gap. However, a tension exists between the need to obtain generalizeable knowledge through implementation trials, and the inherent differences between healthcare organizations that make standard interventional approaches less likely to succeed. The purpose of this paper is to explore the integration of participatory action research and randomized controlled trial (RCT) study designs to suggest a new approach for studying interventions in healthcare settings.

Computer Simulation Within Action Research: A Promising Combination for Improving Healthcare Delivery?

“…2. The ability of the simulation model to project the effects of changes before implementation creates a kind of evidence base that better fits the medical mindset (Shojania and Grimshaw 2005;Neuhauser and Diaz 2007;Leykum et al 2009). Promising projections motivate the stakeholders to take action in the real-life situation.…”

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More-2-Eat: evaluation protocol of a multi-site implementation of the Integrated Nutrition Pathway for Acute Care

“…An allied but separate component that will not be described in this protocol is an embedded feasibility randomized control trial, focused on high protein supplementation in frail elderly patients during and post hospitalization. M2E is a participatory action research study [51] with the primary objective of evaluation [52] of the implementation of INPAC in five diverse Canadian hospitals. The principal outcome of this work will be the development of a toolkit that provides strategies, tips, resources and tools for others to use when implementing INPAC.…”

“…The principal outcome of this work will be the development of a toolkit that provides strategies, tips, resources and tools for others to use when implementing INPAC. Healthcare is considered a complex adaptive system and thus participatory action research is appropriate for evaluating an implementation program that relies on change within this system [51,[53][54][55]. Process and outcome evaluation will also address the following research questions: …”