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Table 2 Overview of empirical articles included in the synthesis

From: A critical synthesis of literature on the promoting action on research implementation in health services (PARIHS) framework

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
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.
  1. *We include a single entry for this project led by McCormack and McCarthy; this is the same project reported by Wright and colleagues in two articles: Wright, J. (2006). 'Developing a tool to assess person-centred continence care.' Nurs Older People 18(6): 23-8; Wright, J., B. McCormack, et al. (2007). 'Evaluating the context within which continence care is provided in rehabilitation units for older people.' International Journal of Older People Nursing 2(1): 9-19.