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

Independent Consultant, Amherst, Massachusetts, USA. .
Implementation Science (Impact Factor: 4.12). 08/2011; 6(1):99. DOI: 10.1186/1748-5908-6-99
Source: PubMed


Based 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.
Authors 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.
A 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.
We 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.

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Available from: Hildi J Hagedorn
    • "It is important to apprehend implementation within organisational behaviour (OB) contexts. The PARIHS formula SI ¼ ƒ(e, c, f) (Rycroft-Malone, 2004; Stetler et al., 2011) holds that successful implementation is a function, ƒ, of the quality of the evidence (e), the characteristics of the context (c), and the capacity of the facilitation (f). There is much to discuss in relation to this synthesising of the complexity of the challenges of implementation science from an OB standpoint. "
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    ABSTRACT: Purpose – The purpose of this paper is to report on a process evaluation of a randomised controlled trial (RCT) intervention study that tested the effectiveness of classroom- and simulation-based crew resource management courses, alone and in combination, and identifies organisational barriers and facilitators to implementation of team training programmes in healthcare. Design/methodology/approach – The RCT design consisted of a before and after study with a team training intervention. Quantitative data were gathered on utility and affective reactions to training, and on teamwork knowledge, attitudes, and behaviours of the learners. A sample of participants was interviewed at the conclusion of the study. Interview responses were analysed, alongside qualitative elements of the classroom course critique, to search for evidence, context, and facilitation clues to the implementation process. Findings – The RCT method provided scientifically robust data that supported the benefits of classroom training. Qualitative data identified a number of facilitators to implementation of team training, and shed light on some of the ways that learning was diffused throughout the organisation. Barriers to successful implementation were also identified, including hospital time and resource constraints and poor organisational communication. Originality/value – Quantitative randomised methods have intermittently been used to evaluate team training interventions in healthcare. Despite two decades of team training trials, however, the authors do not know as well as the authors would like what goes on inside the “black box” of such RCTs. While results are usually centred on outcomes, this study also provides insight into the context and mechanisms associated with those outcomes and identifies barriers and facilitators to successful intervention implementation.
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    • "Our work was guided by our knowledge of KMb models, notably the Promoting Action on Research Implementation in Health Sciences (PARIHS) model (Kitson, Harvey & McCormack 1998), which is a well-developed approach that we also drew on for the case studies used during the simulation. The PARIHS model has received recent attention as knowledge mobilisers search for a better understanding of the factors that drive research use (Stetler et al. 2011). The PARIHS framework stresses the interplay of three core elements: (1) the level and nature of the evidence; (2) the context or environment into which the evidence is to be placed; and (3) the way in which the process of KMb is facilitated. "
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    ABSTRACT: While there are excellent models of knowledge mobilisation (KMb) that address the opportunity for co-production and sharing of best practice knowledge among human service professionals, it remains unclear whether these models will work in less formal settings like community-based non-government organisations (NGOs) where there are fewer resources for KMb. For three days, 65 policy-makers, senior staff of NGOs, mental health professionals, KMb specialists and youth participated in a set of simulation exercises to problem solve how to mobilise knowledge in less formal settings that provide services to children and youth in challenging contexts (CYCC). Based on simulation exercises used in other settings (such as the deployment of international aid workers), participants were first provided with reports synthesising best practice knowledge relevant to their workplaces. They then engaged in an appreciative inquiry process, and were finally tasked with developing innovative strategies for KMb. Observation notes and exit interviews were used to evaluate the process and assess impact. Findings related to the process of the simulation exercises show the technique of simulation to be useful but that it requires effort to keep participants focused on the task of KMb rather than the content of best practices within a focal population. With regard to developing innovative KMb strategies, findings suggest that service providers in less formal community-based services prefer KMb activities that promote one-to-one relationships, including the participation of youth themselves, who can speak to the effectiveness of the interventions they have experienced. Unexpectedly, the use of electronic communication, including social media, was not viewed very positively by participants. These results suggest that the use of simulation to search for innovative KMb strategies and to problem solve around barriers to KMb has the potential to inform new ways of co-producing and sharing best practice knowledge among human service providers.Keywords: simulation, knowledge mobilisation, high-risk youth, community-based mental health, knowledge brokers, barriers to knowledge exchange
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    • "The focus groups started with a general question about facilitators' experience implementing SPHM in medical centers and continued with more specific questions about how they implemented the program, what things they did to implement the program, and how leadership, culture and staff influenced implementation. Subelements of facilitation including activities, skills, and characteristics, were covered as suggested in the PARIHS framework (Stetler et al., 2011). We used a three-step conclusion with each focus group— summarizing our results and confirming, reviewing the purpose and asking if anything was missed, and thanking the facilitators for participating (Krueger & Casey, 2009). "
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