Background
PARIHS framework
Methods
Search strategy and selection of publications
Appraisal and abstraction of articles
Meta-summary and synthesis
Results
Search results
Author | Year | Journal | Method | Sample | Focus of paper |
---|---|---|---|---|---|
Kitson | 1998 | Qual Health Care | Conceptual | Not applicable | Original paper proposing the framework (later named PARIHS) in which core elements are defined. |
Harvey | 2002 | J Adv Nurs | Concept analysis | 95 articles and books published 1985 - 1998, identified from Medline, Cinahl, Pyschlit or Sociofile. | Explore maturity of the concept of facilitation as part of on-going development/refinement of PARIHS. |
McCormack | 2002 | J Adv Nurs | Concept analysis | Review of literature included 'seminal texts' and papers identified through Medline, Cinahl, Psychlit and Sociofile (search methods and details unclear). | Identify 'meaning, characteristics and consequences of practice contexts' as it relates to implementation. Part of on-going development/refinement of PARIHS. |
Rycroft-Malone | 2002 | Qual Saf Health Care | Conceptual | Not applicable | Original authors present theoretical refinements to PARIHS framework, based on the concept analyses |
Rycroft-Malone | 2004 | J Adv Nurs | Debate | Not applicable | '...aims to move on the debate...about the nature of evidence, describe the characteristics of evidence, and consider how different sources of evidence contribute to patient care.' Framed as a debate but part of on-going development/refinement of PARIHS. |
Kitson | 2008 | Implement Sci | Conceptual | Not applicable | Provides a summary of the team's 'conceptual and theoretical thinking' and future directions for PARIHS, including items to operationalize PARIHS elements in the Appendix. |
Author | Year | Journal | Method | Sample | Purpose of study/paper | Rationale for using PARIHS | How PARIHS was to be used/operationalized |
---|---|---|---|---|---|---|---|
Alkema | 2006 | Home Health Care Serv Q | Protocol | Not applicable. | Protocol for collecting qualitative data for translational study of medication management. | No explicit rationale. | Organizing framework for highlighting differences between efficacy studies and a planned translational study. |
Bahtsevani | 2008 | J Eval Clin Pract | Quantitative survey development | 2006 cross-sectional survey of 39 clinicians from 11 departments in academic hospital in Sweden. | Test-retest reliability of survey derived from PARIHS. | PARIHS implicitly presented as a validated explanatory framework. | As basis for a survey tool; items operationalized directly from Swedish translation of PARIHS sub-elements. |
Brown | 2005 | Worldviews Evid Based Nurs | Lit review | Literature search was conducted using CINAHL and MEDLINE electronic databases reviewing studies from 1980 to 2004, yielding 90 papers. In addition, hand search yielded another 10 articles. 58 papers were chosen and read. | 'Explore the factors that have a significant influence on getting evidence into practice ...and examine the relevance of these factors to postoperative pain practices' (p 131) | No explicit rationale but the authors state that PARIHS was used because translation is complex. | Organizing framework for assessing/analyzing studies that implemented pain management practices. |
Conklin | 2008 | Can J Nurs Res | Mixed methods case study | Qualitative data from documentation and four telephone interviews, and survey completed by six Webcast participants from Canadian Seniors Health Research Transfer Network (SHRTN). | Evaluate performance of Ontario's Seniors Health Research Transfer Network for smoking cessation. | No explicit rationale. | Framework to evaluate a 'practical test' of the SHRTN network at three levels: Network-wide, Network component, and Implementation Site. |
Cummings | 2007 | Nurs Res | Quantitative model | Cross-sectional survey of 6,526 nurses; 52.8% response rate, per secondary analysis of prior data (1998 Alberta Registered Nurse Study). | Develop and test theoretical model of organizational influences that predict RU by nurses and assess influence of context on RU. | PARIHS provides a framework to develop testable hypotheses about RU. | To map secondary data to components of context (culture, leadership, and evaluation) and facilitation. |
Doran | 2007 | Worldviews Evid Based Nurs | Framework | Not applicable. | Create 'an outcomes-focused knowledge translation framework ... to guide the continuous improvement of patient care through the uptake of research evidence and feedback data about patient outcomes.' | No explicit rationale but said to be 'helpful in identifying the important elements within the practice setting that need to be in place in order to foster the uptake of evidence into practice' | As guide to develop their untested framework to enhance reflective professional practice generally; not applied to a specific implementation project. |
Ellis | 2005 | Worldviews Evid Based Nurs | Case reports | Nurse managers (n = 16) from different locations in rural hospitals (n = 6) in Western Australia who participated in pre-workshop interviews; nurses who attended workshops and completed evaluation forms (n = 54); and nurses (n = 23) who participated in follow-up interviews. | Explore importance of context and facilitation in successful EBP implementation and foster EBP as a process. | PARIHS recognizes that implementing EBP relies on more than just the provision of best information. | As an organizing framework to code qualitative data and describe findings. |
Estabrooks | 2007 | Nurs Res | Quantitative model | Cross-sectional survey of 4,421 nurses, nested within 195 specialty areas, nested within 78 acute care hospitals, per secondary analysis of prior data (1998 Alberta Registered Nurse Study). | To determine independent factors that predict research utilization among nurses, taking into account influences at individual nurse, specialty, and hospital levels. | PARIHS includes contextual factors. | To map secondary data to components of context (culture, leadership, and evaluation) and facilitation. |
Meijers | 2006 | J Adv Nurs | Lit review | Articles from key word search of 5 databases (e.g., CINAHL, Medline) through March 2005. | Systematic literature review exploring relationships between contextual factors and RU by nurses. | PARIHS includes contextual factors. | To map contextual factors from the literature. |
Milner | 2005 | J Eval Clin Pract | Lit review | 12 articles and 1 dissertation from 144 articles screened from search of major databases, e.g., CINAHL, Medline, PsycINFO (through Fall 2003), plus hand search of key journals. | Systematic literature review assessing factors affecting RU by 'clinical nurse educators.' Provide insight into usefulness of PARIHS 'as a conceptual framework to guide further study in the field.' p. 641. | PARIHS reflects the complexity of research implementation process, and specifically assesses facilitation as a distinct function. | As 'backdrop' to strengthen the analysis; to map findings. |
Owen | 2001 | J Psychiatr Ment Health Nurs | Case report | Undisclosed number of sources of information, including staff from each service within a single specialist psychiatric service and female service users in the Rehabilitation and Community Care Service specialist services in United Kingdom. | Describe changes in specialist psychiatric services for women with serious, enduring mental problems. | No explicit rationale. | To 'plan, implement, monitor and evaluate the changes...' (p 226). |
Rycroft-Malone | 2004 | J Clin Nurs | Qualitative | Focus groups (n = 2) to inform the development of an interview guide. Key informant interviews (n = 17) at two case study sites in United Kingdom. | Identify factors that practitioners deem most important to implementation and whether they match up with evidence, context and facilitation concepts. | PARIHS refinement by original authors. | To map identified factors. |
Sharp | 2004 | Worldviews Evid Based Nurs | Qualitative | Clinical and non-clinical staff (n = 51) at United States Veterans Health Administration hospitals (n = 6) implementing changes in LDL-c (low-density lipoprotein cholesterol) screening and treatment. Interviews conducted between January and April 2001. | Identify barriers and facilitators to implementing strategies to improve measurement and management of LDL-c in coronary heart disease patients. | PARIHS includes contextual factors and facilitation in addition to evidence. | As an organizing framework for analysis of qualitative findings. |
Stetler | 2006 | Implement Sci | Qualitative | United States Veterans Health Administration QUERI researchers (n = 7) from quality improvement/implementation projects (n = 6). | Exploration of facilitation in QUERI implementation projects. | Facilitation highlighted as 'theoretically-promising to the change agent role of QUERI' (p 2). | Used, as applicable, to help interpret identified thematic findings in this open-ended conceptual evaluation. |
Wallin | 2005 | Int J Nurs Stud | Qualitative | Focus groups of intervention (n = 2) and control site (n = 2) teams from RCT at 4 county hospitals in central Sweden. | Explore perceptions and experiences of change teams and staff that had participated in an RCT regarding. Implementation of new neonatal guidelines. | PARIHS emphasizes interplay between evidence, context, and facilitation. | Used as an organizing framework to describe findings; also had used 'facilitation' and guidelines (evidence) as an intervention in the primary study. |
Wallin | 2006 | Nurs Res | Quantitative model | Secondary analysis of two cross-sectional survey datasets (n = 504 and n = 5,946) (1996 & 1998 Alberta Registered Nurse Study). | Derive a measure of RU and validate the measure through 4 procedures. | PARIHS purported to be multi-dimensional, non-linear and includes variables other than individual characteristics and has been used in an increasing number of studies. | Responses to 3 items from the Alberta Registered Nurse survey that were deemed to best represent sub-elements of PARIHS context (culture, leadership, and evaluation) were used to group responses as having low, moderately low, moderately high, or high context to test whether RU is positively associated with context. |
Wright McCormack* | 2006 2007 2008 | Nurs Older People Interna'l J Older People Nurs Unpublished Final Report | Quantitative case study & instrument development | Northern Ireland and Republic of Ireland. Multiple samples from multiple sites for case study and then tool development. E.g., case study focus groups (n = 26 staff); and large sample validity study in Republic of Ireland location (n = 479) from 27 different sites. | Identify influence of contextual factors on evidence-based continence care in rehabilitation settings; and develop and conduct psychometric validation of a related Context Assessment Index (CAI) to enable practitioners in such settings to assess their context. | Not explicitly indicated but authors stated that the framework illustrates and makes sense of the complex factors involved in implementing evidence into practice. | To guide structure of study, based on constructs of culture, leadership and evaluation. |
Author | Year | Journal | Strengths and issues re: PARIHS | Strengths and issues re: study/paper |
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Kitson | 1998 | Qual Health Care | Strengths: • PARIHS is described for the first time (but not yet named as such). It is an intuitively appealing framework that is succinct and yet allows for dynamic complexities of implementation. • Framework anticipates interrelationship among the three main elements. • PARIHS was an early well-articulated framework that went beyond focusing on evidence and acknowledged the non-linear nature of implementation. Issues: • Inconsistency in definitions and terms within the text of the article and terms presented in the table. • The defined continuums lacked consistency and valence (e.g., 'low regard for individuals' on the 'low' end and 'patient centered' on the 'high' end) (p. 151). • Sources considered 'high' research evidence are limited. Culture seems to include everything and lacks clarity. Does not differentiate external facilitation versus internal facilitation (e.g., through management or champions). Judges task-oriented facilitation as 'low' and 'holistic' facilitation as 'high.' Some concepts seem conflated (e.g., receptive context includes 'inclusive decision-making processes' which seems equally related to sub-element of leadership). • Proposed as a diagnostic tool to help prepare the context and select the most appropriate intervention but supportive studies were limited and retrospective. | Strengths: • Theory paper that proposes PARIHS as an inductively developed framework to help understand complex implementations. Issues: • Rationale for mapping findings from sample studies into PARIHS elements is unclear and loose. For example, in one case, physicians rejected evidence-based guidelines and the authors attribute this to inadequate facilitation without clear rationale for the attribution. |
Harvey | 2002 | J Adv Nurs | Strengths: • Authors suggested that there is some evidence that facilitators may help change clinical and organizational practice, although current data limited their ability to make conclusions. Issues: • Regardless of their suggested changes to the framework per the literature, the authors point out that further research is still needed on this inherent part of the framework, i.e., regarding different models of facilitation. • Definitional clarity in related sub-elements remains an issue; and some promising, potential sub-elements identified in the paper did not make it into their suggested refinements. | Strengths: • Literature review included 'analysis of a broad range of health care literature.' (p. 579). Provided information on the level of maturity of the facilitation concept. • Provided information for model refinement. • Pointed out the need for more research on different models of facilitation; e.g., the need to better differentiate external and/or internal facilitation. Issues: • Missing details about how the analysis was conducted, beyond authors' brief description of Morse (1995) and Morse et al.'s (1996) approach. |
McCormack | 2002 | J Adv Nurs | Strengths: • Provided some substantiation of contextual elements; especially for holistic view of implementation. • Provided some conceptual backing. • Evolved a sub-element in context from measurement to evaluation. Issues: • Concept of context lacks clarity because of the many ways it is characterized; e.g., 'what is clear from studies reviewed that have included a consideration of context is that there is inconsistency in the use of the term and that this has an impact on claims of its importance. Thus the implications of using context as a variable in research studies exploring research implementation are as yet largely unknown.' p. 101. • Muddles whether Context is an overarching element or a sub-element on equal footing with Culture, Leadership, Evaluation that needs to be subsumed under some other broader category: i.e., 'the analysis of the characteristics and consequences of context suggests that other characteristics are equally important...and that these sub-elements need to be taken into account in any articulation of the concept of context.' p. 101. | Strengths: • Draws on broader literature addressing context. Issues: • Key details of methodology missing, including parameters such as years covered by search and numbers of articles reviewed and included. • Seemed to focus more on holistic organizational change versus task-oriented implementation. |
Rycroft-Malone | 2002 | Qual Saf Health Care | Strengths: • Model now refined per concept analyses. • 'Its relative simplicity and intuitive appeal.' Issues: • Increased complexity of the framework; added sub-sub-elements; muddled the definitions in some cases, e.g., with language such as social construction acknowledged vs. perhaps consensus determined (This may reflect cultural/language/philosophical differences) • Some clearly stated attributes of a facilitator were lost. | Strengths: • Responsive to their concept analysis work to further the theoretical development of the framework. • Recognizes that this is not a 'final' framework; noting that there will be continued evolution and 'it would be premature to suggest that this represents a final version' p. 178. Issues: • Did not delve into relationships among the core elements. |
Rycroft-Malone | 2004 | J Adv Nurs | Strengths: • PARIHS' expansive acknowledgement of what can and should constitute 'evidence' in implementing EBPs Issues: • Sub-element definitions lack clarity • More understanding needed about how to integrate the multiple sources of evidence and how this melding can inform clinical decision-making | Strengths: • Tackling the issue of the nature of evidence versus traditional approaches. Issues: • Lack of clarity demonstrated when authors talk about testing their framework for 'patient-centered evidence-based care' (p. 87-8) |
Kitson | 2008 | Implement Sci | Strengths: • Asserted that PARIHS can embrace multiple theories. • Further explored potential use of the model for a 'two-stage diagnostic and evaluative approach' focused on E and C whereby 'the intervention is shaped and moulded by the information gathered' in terms of the F element (p. 1-2). Issues (Appendix): • Lack of conceptual and definitional clarity of various items. Left the reader to figure out who the actor is; e.g., 'the research evidence is of sufficiently high quality' begs the question, who is deciding and according to whose standards? (p. 1 of Additional File 1) • Phase 3's evolution lacked congruency with Phases 1 and 2, contributing to continued lack of consistency and definitional and conceptual clarity as one can't always see how a given phase builds to the next. | Strengths: • Appendix provided clearest guidance to date to define and operationalize sub-elements. Issues: • Not clear what main thesis or objective was; article appeared written with multiple objectives. |
Author | Year | Journal | Strengths and issues re: PARIHS | Strengths and issues re: study/paper |
---|---|---|---|---|
Alkema | 2006 | Home Health Care Serv Q | Strengths: • As an organizing device for highlighting differences between intervention and implementation studies. Issues: • Variable interpretation of elements/sub-elements relative to the model, which implies its lack of definitional clarity and/or need for more direction in its application. | Strengths: • Novel in using the framework to highlight differences between original and translational trials. Issues: • Just a description of a protocol; no data. |
Bahtsevani | 2008 | J Eval Clin Pract | Strengths: • Finds evidence of test-retest reliability for scale measuring PARIHS elements suggesting stability of constructs. Issues: • Item wording taken directly from Swedish translation of PARIHS, with some respondents confused about the meaning of related survey items. • Variable interpretation of PARIHS elements; e.g., 'task-oriented' role was placed on the negative/low end of their rating scale. | Strengths: • One of only two articles included in the synthesis that attempts to develop an instrument based on PARIHS. Issues: • Only test-retest, and follow-up conducted after >4 weeks, too long for test-retest; categorical ratings were dichotomized to assess reliability with Kappa, instead of using a measure appropriate to categorical ratings. |
Brown | 2005 | Worldviews Evid Based Nurs | Strengths: • Conclude that 3 PARIHS components apply very well to translation of pain management evidence into practice. Issues: • There appear to be 2 types of roles not differentiated in the model highlighted by this review: 1) Those in pre-existing roles, like clinical nurse specialists or nurse managers, which are a built-in facilitator as implementation/change may be an inherent part of what they do; 2) Someone on a project that is appointed to that interim role. | Strengths: • Systematic review. Issues: • Qualitative/observational review only, with no inclusion of interventional studies. • No data tables and lack of information re: methods for analysis and interpretation. • Focused on pain management literature which is very sparse. |
Conklin | 2008 | Can J Nurs Res | Strengths: • Demonstrated flexible use of model whereby user chooses only those elements that applied to the target at hand, i.e., levels of Networks. • Authors viewed findings as consistent with PARIHS, which emphasizes need for context-sensitive facilitation activities. • Results suggest that PARIHS has potential as a guide for evaluating other knowledge networks. Issues: • Highlighted the need to add focus on impacts or results to the framework. • Authors focused on understanding the knowledge exchange dimensions at the element level without exploring them at their sub-element level. | Strengths: • Explicitly defined outcomes as they relate to PARIHS. • The network level allowed context which can be seen as the resources or opportunities for effective communication and infrastructure opportunities like web cast. Issues: • Limited project with little data or clear logic for how results or conclusions were derived, and how the PARIHS elements were associated with the outcomes. |
Cummings | 2007 | Nurs Res | Strengths: • Indirect support for facilitation being correlated with context. Higher RU and lower rate of adverse events associated with positive context (culture, leadership, evaluation). Issues: • 'Two unanticipated findings were that the concepts of innovation and facilitation had no significant influence on nurses' research utilization' (p S35). | Strengths: • One of only 2 studies that use quantitative models to test influence of specific context and facilitation measures on research utilization. Issues: • Variables loosely mapped to PARIHS along with other non-PARIHS variables. • Complex constructs measured using single-items that were selected post-hoc. RU (dependent variable) also calculated based, in part, on contextual variables (e.g., autonomy, organizational slack). Authors note that perhaps facilitation was '... not operationalized ideally.'(p. S35) |
Doran | 2007 | Worldviews Evid Based Nurs | Strengths: • 'The model is helpful in identifying the important elements within the practice setting that need to be in place in order to foster the uptake of evidence into practice. It shows that evaluation is an important component of the context for change and indicates that multiple methods and sources of feedback should be incorporated into an organization's evaluation framework.' (p. 4) • Authors operationalized all three main components of PARIHS - apparently choosing only sub-elements that seemed to apply to their objective. Issues: • '...previous descriptions of the model do not specifically address what indicators are appropriate for evaluating nursing systems and services or how to use performance measurement and feedback to design and evaluate practice change.' | Strengths: • Provides another example of the flexible and selective use of PARIHS and additional thoughts on the evaluation component. Issues: • Model yet to be applied/tested. |
Ellis | 2005 | Worldviews Evid Based Nurs | Strengths: • Rationale for use based on: 'Embraced by academics, clinicians, and managers because it resonates with their own experience' (p. 85). • Supported PARIHS components; authors thought overall outcomes probably due to leadership, evidence, and facilitation and felt one of six hospitals did not implement due to 'clear' lack of leadership. Issues: • Noted by authors as not including underlying motivations (e.g., relative advantage or dissatisfaction as tension for change) related to protocol/intervention. • Variable definitions of elements. | Strengths: • At least to some extent, assessed the nature of the framework and needs for refinement. Issues: • Low-level qualitative case study; some details of methods unclear (e.g., what proportion of participating hospitals' nurses attended); convenience sample. • 'Many of workshop participants did not work in practice location...where the protocol was to be implemented... ' (p. 91). |
Estabrooks | 2007 | Nurs Res | Strengths: • Facilitation, context (leadership, evaluation, and culture) were significant at the specialty level in addition to other contextual measures; e.g., nurse-to-nurse collaboration (p. S7). Issues: • 'Variation in research utilization was explained mainly by differences in individual characteristics, with specialty- and organizational-level factors contributing relatively little by comparison...' (p. S7). • Results imply that PARIHS should be extended to include other contextual variables not explicitly included in the current version (e.g., nurse-to-nurse collaboration). | Strengths: • One of only two studies that use quantitative models to test influence of specific context and facilitation measures on RU. • First demonstration of multi-level modeling approaches. Issues: • Variables loosely mapped to PARIHS along with other non-PARIHS variables. • Complex constructs were measured using single-items that were selected post-hoc. • RU (the dependent variable) is calculated based, in part, on contextual variables (e.g., autonomy, organizational slack). |
McCormack et al | 2008 | CAI Documents | Strengths: • Most comprehensive attempt to operationalize context CAI appeared to be successful for practitioners to generically reflect on their practice. • Provided useful information for potentially refining the framework in terms of enhancing the meaning of context. Issues: • Findings were said to suggest that some contextual characteristics are 'less theoretically robust than thought.' • Findings included 'factors' not consistent with the current structure of the four sub-elements under Context; variable placement of sub-sub-elements. • Tool seems to be especially useful for a holistic practice focus rather than for task-specific implementation. | Strengths: • Rigorous empirical development. Issues: • Need for further research regarding validity, reliability, and usability in other settings and with different clinical topics. |
Meijers | 2006 | J Adv Nurs | Strengths: • In the literature, 'Six contextual factors were identified as having a statistically significant relationship with research utilization, namely the role of the nurse, multi-faceted access to resources, organizational climate, multifaceted support, time for research activities and provision of education' (p. 622). • 'The contextual factors could successfully be mapped to the dimensions of context in PARIHS (context, culture, leadership), with the exception of evaluation' (p. 622). • Authors 'believe that PARIHS is a fruitful starting point for better understanding of the impact of context on research utilization and more studies should explore this area of inquiry' (p. 632). Issues: • 'No single included study was assessed to be of high methodological quality' (p 626). | Strengths: • A comprehensive review of the literature. Issues: • The basis for mapping of contextual variables found in the literature onto the PARIHS framework was unclear. |
Milner | 2006 | J Eval Clin Pract | Strengths: • Authors report general match of empirical findings to PARIHS. Issues: • Empirical findings didn't map to many sub-elements. | Strengths: • Systematic review with very thorough search strategy and clear inclusion/exclusion criteria. Issues: • Lack of clarity about how independent variables were measured (i.e., how factors were to be mapped to PARIHS elements). • Focus seemed primarily on user's characteristics in general, not on role as an explicit facilitator, and not explicitly on successful implementation. |
Owen | 2001 | J Psychiatr Ment Health Nurs | Strengths: • Used 1998 version of PARIHS but content highlighted in case study confirmed later PARIHS modifications: i.e., use of evidence not just from RCTs (e.g., from program eval), use of local data, and patient 'experiences.' • Brainstorming around E, C, and F seemed to illustrate dynamic interactions among these elements, as aspects of one were reflected in another. • Were able to use the framework to analyze their current situation. • Noted the importance of patient engagement. • Used along with other models of practice and evaluation. Issues: • Needs more emphasis in the model on 'motivating multi-disciplinary groups of staff to change and accept new ideas' (p 230). • Importance of patient engagement was highlighted but unclear if is part of both evidence and/or culture. | Strengths: • With open, albeit limited case study format, able to identify important 'additional' components beyond the cited 1998 model. Issues: • Lacks sufficient details about methods to evaluate changes, e.g., re: services; source of recommendations; interviewees, data analysis or results. |
Rycroft-Malone | 2004 | J Clin Nurs | Strengths: • They added 'fit' under context; i.e., 'Initiative fits with strategic goals and is a key practice/patient issue' (p. 922). • Added 'Receptive' to sub-element of context; within that sub-element, added 'Resources - human, financial, equipment - allocated' as well as - 'Professional/social networks '(p. 922). • Adequately connected the three key variables of the PARIHS framework to the barriers and influences of getting evidence into practice. Issues: • Despite Strengths, 'the findings also suggest that further consideration is required to ensure that the PARIHS framework is appropriate, comprehensive, and accurate' (p. 921). • Criteria for inclusion and related meanings not always clear. | Strengths: • Presentation of findings was well organized and categorized by themes that emerged in the data. Issues: • Conclusions that findings confirm PARIHS did not seem adequately grounded. • No definitive a-priori measure of success and projects studied were complete yet. • Authors acknowledge study limitations as: 1) small sample sizes, 2) data credibility limited due to self-report, 3) potential bias as participants may have been 'evidence-based practice enthusiasts' (p. 920) and 4) successful implementation was 'defined largely by its absence than its presence' (p. 920) in the study. |
Sharp | 2004 | Worldviews Evid Based Nurs | Strengths: • 'Desired outcomes can be achieved when the context is less than ideal but outcomes are generally poor when attention to both context and facilitation are lacking' (p. 137). • Authors learned the utility of PARIHS whereby new strategies can be developed. • Used as a diagnostic tool for retrospective study where interventions didn't work very well. Issues: • Variable definitions of elements; and variable placement of sub-elements. | Strengths: • Reinforced the importance of needs assessment of evidence, context and facilitation factors prior to the initiation of intervention implementation. • PARIHS model utilized to organize data and link empirical data to the model to demonstrate how it can inform real life situations. Issues: • Authors linked factors to outcomes globally, but not within sites, which would have helped understanding of the data, given the variable findings noted (there seemed to be an overlap of some barriers and facilitators). |
Stetler | 2006 | Implement Sci | Strengths: • The study affirmed the importance of facilitation as a distinct role with a number of potentially crucial behaviors and activities. • Highlighted the importance of the task-oriented purpose. • Role of individual facilitator characteristics found to be important. Issues: • Categories under skills/attributes in PARIHS don't provide some of the details found in the study, nor does the framework adequately highlight the mixed facilitation approach found in primarily such task-oriented projects. |
Strengths: • Use of a stimulated recall method gave interviewees several opportunities to continue recalling and adding to the richness of the qualitative data while further commenting, affirming or challenging the analysis
Issues: • Authors noted the evaluation was 'both small scale and reliant on self-report data, thus potentially limiting its generalizability. Additionally, its purposively sampled participants represented a specific perspective and are likely EBP enthusiasts, particularly in terms of facilitation' (p. 12). • Only external facilitators were interviewed. |
Wallin | 2005 | Int J Nurs Stud | Strengths: • Results support the role of the three main components (evidence, context, facilitation) in uptake of quality improvement initiatives. • Reasonable to use PARIHS to help frame discussion of findings. • Highlighted strong role of internal leadership. Issues: • Difficult to tease out sub/elements of PARIHS because of dynamic interrelationships between elements. | Strengths: • The only study that used PARIHS to frame results from a process evaluation within a randomized control trial. Issues: • PARIHS was used loosely as an organizing framework to present results and authors did not reflect back on utility of PARIHS. |
Wallin | 2006 | Nurs Res | Strengths: • Results '...demonstrated empirical support for the validity of the context dimension of the PARIHS framework.' (p. 156) Showed a positive relationship between RU and context (culture, leadership, and evaluation) and further demonstrated a positive incremental relationship between RU and rank ordering of context from low to high. Issues: • Unclear implications for PARIHS definition of context, given how narrowly measured/defined out of unrelated dataset. • Unclear implications for definition of facilitation as it relates to inherent leader roles, such as a nurse manger. | Strengths: • Clear presentation of hypotheses and results. Issues: • RU was derived, in part, from contextual variables including autonomy and organizational slack, with rationale for doing so unclear. • Authors interpret results as validation for PARIHS but also recognize that 'only one of the PARIHS components - context - was used, and [they chose] only one variable to characterize each contextual dimension' (p. 158). • RU and context variables were selected, post hoc, from a dataset developed for another study. |