Skip to main content


Table 2 Limitations of and related issues with the underlying PARIHS framework [1]

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

Conceptual clarity • Ambiguity in certain terms and phrases; for example, when assessing Evidence, one criterion for "high" research evidence is that "social construction [is] acknowledged." Cross-country and philosophical differences may contribute to this perception of "obscurity" in such language.
  • Lack of specificity in element/sub-element names and definitions, making it unclear what is actually included/excluded; for example, one of the elements is titled Context, as is one of its sub-elements, Receptive Context.
  • Lack of transparency or specificity in how to operationalize various sub-elements, such as clinical experience or patient experience.
"Missing" components • Lack of a definition for Successful Implementation (SI).
  • Need to explicitly designate motivation for change/importance of a "recognized need for change" [34], as pointed out by Ellis et al.
  • Potential value of making more explicit a critical set of innovation attributes (e.g., per Rogers' diffusion of innovation theory [33]).
  • Removal of clearly stated attributes of a facilitator after earliest version of PARIHS (i.e., general credibility, authenticity, and respect).
  • Insufficient guidance or clarification under Facilitation regarding the task of developing needed "change...strategies" [5], based on suggested diagnostic analysis of E and C--and lack of inclusion of common implementation interventions that a Facilitator employs, reinforces, or proposes to enhance adoption.
Under-developed evaluation and related instrumentation/measures • Few well-developed PARIHS-related instruments or other evaluative approaches to identify related barriers/facilitators during diagnostic analysis or to evaluate successful implementation.
  • Limited evaluation or means for evaluation of the theory's use/usefulness.
  1. PARIHS = Promoting Action on Research Implementation in Health Services.