Table 3 Original and advanced conceptualizations of (i-)PARIHS elements and sub-elements
Evidence/innovation (shaded cells provide the original conceptualization of evidence in the PARIHS framework and innovation in the i-PARIHS framework) | ||
Conceptualization/sub-elements | Sources | |
Evidence in PARIHS | ||
• Research • Clinical experience | • Patient experience • Information from local context | |
Note. Each sub-element is placed on a low–high continuum | ||
Innovation in i-PARIHS | ||
• Underlying knowledge sources • Clarity • Relative advantage • Trialability | • Compatibility or contestability (degree of fit with existing practice and values) • Usability | Harvey and Kitson (2016) [11] |
Note. In i-PARIHS, innovation is introduced to represent a broader conceptualization of evidence | ||
Characteristics of evidence-based practice as a new sub-element of evidence: | ||
• Relative advantage • Observability • Compatibility • Complexity | • Trialability • Design quality and packaging • Costs | Stetler et al. (2013) [26]a |
Note. Particularly relevant in implementation programs targeting a specific evidence-based practice | ||
Context (shaded cells provide the original conceptualizations of context in the [i-]PARIHS framework) | ||
Conceptualization/sub-elements | Sources | |
Context in PARIHS | ||
• Receptive context • Culture | • Leadership • Evaluation | |
Note. Each sub-element is placed on a low–high continuum | ||
Context in i-PARIHS | ||
Local level (micro): • Formal and informal leadership support • Culture • Past experience of innovation and change • Mechanisms for embedding change • Evaluation and feedback processes • Learning environment Organizational level (meso): • Organizational priorities • Senior leadership and management support | • Culture • Structure and systems • History of innovation and change • Absorptive capacity • Learning networks External health system level (macro): • Policy drivers and priorities • Incentives and mandates • Regulatory frameworks • Environmental (in)stability • Inter-organizational networks and relationships | Harvey and Kitson (2016) [11] |
Note. Context is also categorized as inner context (local and organizational level) and outer context (external health system level) | ||
Conceptualization of external/outer context | ||
External social networks and embedded communication pathways Note. Particularly important for fragmented sectors where lines of information sharing are non-linear and multidirectional | Carlan et al. (2012) [21]a | |
External resources (resource abundance or scarcity): | ||
• Human resources • Space | • Medicine/equipment/other supplies • Communication/transport | Bergstrom et al. (2012) [22]a |
Note. Particularly relevant in low-income healthcare settings | ||
Broader organizational capacity or system-level capacity: • Socio-political (clear goals, consensus on goals among stakeholders) • Economic (dedicated funding, resources, and infrastructure) • Social (formal and informal interactions among parties, affiliated or embedded roles, diversity of engaged disciplines) Note. Particularly relevant in integrated knowledge translation activities in which researchers, clinicians, and other stakeholders purposefully convene for a particular integrated knowledge translation program | Gagliardi et al. (2014) [20]a | |
Contextual trust • Credibility of external organizations •Staff's sense of certainty about external organizations Note. External organizations include entities developing evidence-based guidelines, and entities promoting and funding implementation of evidence-based guidelines. | Sandstrom et al. (2015) [17]a Geerligs et al. (2020) [19]a | |
Societal culture, social systems, or hegemony Note. Particularly relevant in implementation of public health interventions | Niemeyer Hultstrand et al. (2020) [18]b | |
Conceptualization of leadership | ||
Leadership as a social collective process that has dynamic relationships with team culture, is characterized by diversified styles and diverse actions and operates in multiple ways and on multiple levels in the organization. | Oye et al. (2016) [23]a | |
Leadership (of nurse managers) as a facilitator of evidence implementation: • Effective teamwork ○ Communication between managers and staff nurses ○ Foster collaboration • Effective organizational structures ○ Strategic governance (leadership combining management and clinical experience, awareness of the impact of improved outcomes) • Transformational leadership ○ Influence on evidence application (culture of expectations, inspiring a shared vision, sustaining evidence-based practice) ○ Readiness for change among leaders (enabling empowering, focus on teaching and learning, recognition, using resources in management) Note. This meta-synthesis expanded conceptualizations of general elements of leadership in PARIHS (teamwork, organization structures, and transformational leadership) by elaborating on features of each element | Clavijo-Chamorro et al. (2021) [25]a | |
“Balance between leadership and management to maximize their influence on the implementation process” as a new element of leadership Note. This study highlighted the complex interplay between leadership and management and consequences for the implementation process | Granberg et al. (2021) [24] | |
Conceptualization of context in new context typologies for particular implementation context | ||
External context impacting implementation of complex interventions: | Watson et al. (2018) [14]c | |
• Professional influences • Political support • Social climate • Local infrastructure | • Policy and legal climate • Relational climate • Target population • Funding and economic climate | |
The Context and Implementation of Complex Interventions (CICI) framework (context impacting implementation of public health interventions): | Pfadenhauer et al. (2017) [15]a | |
• Geographical • Epidemiological • Socio-cultural • Socio-economic | • Ethical • Legal • Political | |
Note. According to the CICI framework, the seven domains of context act on their own and interact with interventions and implementation at macro, meso, and/or micro levels | ||
Institutional context relevant in evidence application by nursing professionals: • Institutional support (leadership) • Multidisciplinary support (teamwork and communication) • Culture of improving quality of care (nursing professionals’ attitudes toward change • Use of research (valuing research, assessment of research results, dissemination of results and experiences). | Clavijo-Chamorro et al. (2020) [16]a | |
Facilitation (shaded cells provide the original conceptualizations of facilitation in the [i-]PARIHS framework) | ||
Conceptualization/sub-elements | Sources | |
Facilitation in PARIHS | ||
• Purpose (from task-oriented to holistic-oriented) • Role • Skills and attributes Note. Roles and associated skills and attributes are described separately for the two different purposes | ||
Facilitation in i-PARIHS | Harvey and Kitson (2016) [11] | |
Facilitation is conceptualized as the active ingredient that activates implementation through assessing and responding to characteristics of the innovation and the recipients within their contextual setting. Facilitation role and process are specified for novice, experienced and expert facilitators. | ||
Conceptualization of facilitation with a focus on facilitation processes/strategies | ||
Facilitation as a deliberate implementation intervention: • Comprises deliberate methods or techniques facilitators use to facilitate evidence-based practice uptake • Is developed based on pre-implementation diagnostic assessments of the organizational context and staff's perceptions of the intervention • Promotes intervention/service fit and intervention/patient fit which is fundamental for improving sustainability. Note. Particularly applicable when implementing a specific targeted evidence-based practice or clinical intervention | Stetler et al. (2010) [26]a ; Geerligs et al. (2020) [19]a; Butow et al. (2019) [29]a | |
Facilitation as specific facilitative actions and strategies: | Steffen et al. (2021) [33]b | |
• Plan strategies • Educate strategies | • Quality management strategies • Other strategies | |
Note. The authors detail specific facilitative actions under each category of strategies | ||
Holistic-oriented facilitation: • Creating a psychologically safe space • Establishing capacity-building mentoring relationships Note. Particularly important for ‘weak context’ environments | Brown et al. (2016) [30]c; Lachance et al. (2019) [27]c | |
Conceptualization of facilitation with a focus on facilitation roles | ||
Internal & external facilitators | Connolly et al. (2020) [28]b | |
• Internal facilitators offer localized knowledge about needs, policy, and culture. Skills include project management, team and process skills, and influencing and negotiating skills. Personal characteristics include leadership and emotional intelligence. | •External facilitators serve as an expert, consultant, model, and educator, providing concrete advice and direction on intervention content and implementation processes. | |
Note. Dynamics between external and internal facilitation is an important aspect of the conceptualization, which significantly vary across projects and settings, and evolve as facilitation progresses. | ||
Active versus passive facilitation (specifically pertinent to external facilitation roles of national agencies) • Active facilitation applied by national agencies involves designated external facilitators who use project management methods to structure a site-specific implementation process for individual sites. • Passive facilitation involves raising public awareness of the existence of an innovation through web-based facilitation methods. This method could cause uncertainty and disagreement among stakeholders around the benefits of the innovation and its implementation. | Harvey et al. (2018) [34]b | |
Transferring facilitation skills from expert to novice facilitators: • Direct skill transfer ○ Active methods (teaching, modeling, coaching) ○ Participatory methods (working together, providing consultation) • Learning supports ○ Cognitive learning supports ○ Psychosocial learning supports ○ Self-learning promotion ○ Structural supports | Ritchie et al. (2021) [32]b | |
Facilitation intensity and facilitator resilience as new sub-elements of facilitation: • Facilitation intensity: the quantitative and qualitative measure of the volume of tasks and activities of facilitation • Facilitator resilience: facilitator’s ability to cope with and adapt to the complexities of facilitation Note. Facilitation intensity and facilitator resilience are conceptualized based on perceptions and experiences of facilitators themselves and reflect psychological impacts of facilitation processes on facilitator effectiveness and implementation success | Olmos-Ochoa et al. (2021) [31]b | |
Implementation success (shaded cells provide the original conceptualization of implementation success in the i-PARIHS framework) | ||
Conceptualization/sub-elements | Sources | |
Implementation success in the i-PARIHS framework • Achievement of agreed implementation/project goals • The uptake and embedding of the innovation in the practice context • Individuals, teams, and stakeholders are engaged, motivated, and own the innovation • Variation related to context is minimized across implementation settings | Harvey and Kitson (2016) [11] | |
Conceptualization of implementation success in particular implementation contexts | ||
Implementation success in the context of implementing a specific targeted evidence-based practice or clinical intervention: • Realization of the implementation plan • Evidence-based practice innovation uptake (desired changes in practice that are congruent with the evidence-based practice) • Achievement and sustainment of patient and organizational outcomes Note. Iterative theory-driven formative/process evaluations are recommended to measure implementation success, especially “realization of implementation plan” | Stetler et al. (2010) [26]a ; Rycroft-Malone et al. (2013) [35]a | |
Implementation success in the context of implementing holistic facilitation | Westergren (2012) [36]a | |
• Instrumental outcomes ○ Improved system performance (care outcomes) ○ Measurable changes in patient outcomes (health outcomes) | • Conceptual outcomes ○ Professional development ○ Enhanced organizational context | |
Conceptualization of broad knowledge translation outcomes | ||
Knowledge translation outcomes in integrated knowledge translation: • Health service outcomes (accomplish professional goals, conceptual use of research, instrumental use of research) • Social outcomes (researcher-research user interactions, diversity of disciplines, mutual learning/understanding) • Research outcomes (efficiency, quality, relevance, accelerated progress, inform new research, publications/reports) | Gagliardi et al. (2014) [20]a | |
Knowledge use outcomes as knowledge translation outcomes • Conceptual use of knowledge (research is used to gradually frame the understanding of an issue; also called enlightenment or indirect use of knowledge) • Instrumental use of knowledge (research is used to design a new policy, program, or procedure; also called structural, problem-solving, or direct use of knowledge) • Strategic use of knowledge (research is used to justify a course of action already decided upon; also called political, tactical, or symbolic use of knowledge) | Kramer et al. (2013) [37]a | |
Recipients (shaded cells provide original conceptualizations of implementation success in the i-PARIHS framework) | ||
Conceptualization/sub-elements | Sources | |
Recipients in i-PARIHS | Harvey and Kitson (2016) [11] | |
Recipients (people who are affected by and influence implementation at both the individual and collective team level) characteristics: | ||
• Motivation • Values and beliefs • Goals • Skills and knowledge • Time, resources, support | • Local opinion leaders • Collaboration and teamwork • Existing networks • Power and authority • Presence of boundaries | |
Individual factors as an explicit additional element of PARIHS | Rycroft-Malone et al. (2013) [35]a | |
• Capability • Capacity • Motivation • Resilience • Acceptability • Feelings | • Knowledge and beliefs about the innovation • Position and fit within the organization/social system • Approach to decision-making | |
Professional expectations and requirements as new sub-elements of recipients Note. Relevant because professionals are generally expected, not required, to implement evidence-based practice | Steffen et al. (2021) [33]b | |