Conceptual and relational advances of the PARIHS and i-PARIHS frameworks over the last decade: a critical interpretive synthesis

Abstract

Background The number of research publications reporting the use of the Promoting Action on Research Implementation in Health Services (PARIHS) framework and the integrated PARIHS (i-PARIHS) framework has grown steadily. We asked how the last decade of implementation research, predicated on the (i-)PARIHS framework (referring to the PARIHS or i-PARIHS framework), has contributed to our understanding of the conceptualizations of, relationships between, and dynamics among the core framework elements/sub-elements. Building on the Helfrich et al. (2010) review of research on the PARIHS framework, we undertook a critical interpretive synthesis to: (1) identify conceptual and relational advances in the (i-)PARIHS framework and (2) identify conceptual and relational aspects of the (i-)PARIHS framework that warrant further work. Methods We performed a systematic search in PubMed/PubMed Central, Ovid MEDLINE, CINAHL, JSTOR, SCOPUS, Web of Science, and PsycInfo. Articles were eligible for synthesis if they (a) were peer-reviewed articles, written in English, and published between January 2009 and December 2021, (b) applied the (i-)PARIHS framework explicitly to guide implementation research, and (c) made conceptual (expanding the conceptualization of core elements) and/or relational contributions (elaborating relationships among elements/sub-elements, or theorizing the relationships using empirical data). We used a critical interpretive synthesis approach to synthesize conceptual-relational advances of the (i-)PARIHS framework. Results Thirty-seven articles were eligible for synthesis. Twenty-four offered conceptual contributions, and 18 offered relational contributions (5 articles contributed in both ways). We found conceptual expansion of all core (i-)PARIHS elements, with most emphasis on context (particularly outer context and leadership), facilitation, and implementation success. Articles also gave insights into the complex relationships and relational dynamism among these elements, characterized as contingent, interactive, multilevel, and temporal effects. Conclusions We observed developmental advances of the (i-)PARIHS framework and proposed several directions to further advance the framework. Conceptualization of (i-)PARIHS elements (particularly evidence/innovation and recipients) need to be further developed by specifying conceptual and operational definitions of underlying sub-elements. Relationships among (i-)PARIHS elements/sub-elements need to be further elaborated through empirical studies that consider situational contingencies and causal complexities. This will require examining necessity and sufficiency of (i-)PARIHS elements/sub-elements in relation to implementation outcomes, interactions among elements, and mechanism-based explanations.

The NASSS (Non-Adoption, Abandonment, Scale-Up, Spread and Sustainability) framework use over time: A scoping review

“…Similar findings have been reported with the i-PARiHS (Integrated Promoting Action on Research Implementation in Health Services) application in research [80]. There is a need for prospective and concurrent applications of implementation TMFs to identify potential hurdles and areas of complexity ahead of time with implementation such that mitigation strategies can be put in place [81,82].…”

“…Most identified studies in this review had used the NASSS retrospectively, primarily to evaluate why an innovation was unsuccessful at becoming adopted by its intended users, got abandoned shortly thereafter, or failed at scaling to become routine within the organization, spreading to other contexts or sustaining over time. Similar findings have been reported with the i-PARiHS (Integrated Promoting Action on Research Implementation in Health Services) application in research [80]. There is a need for prospective and concurrent applications of implementation TMFs to identify potential hurdles and areas of complexity ahead of time with implementation such that mitigation strategies can be put in place [81,82].…”

“…This conceptualization resonates with the Wider Context of the NASSS. Furthermore, leadership was suggested as another key sub-construct within the Context of the i-PARiHS [89], which corresponds to the 5A Capacity subdomain within the Organization domain of the NASSS.…”

“…The inner and outer Contexts in the i-PARiHS are like the Organization and Wider Context domains of the NASSS. A review of research using the i-PARiHS [89] identified variations in how rese archers conceptualized outer Context, including specific influences from external organizations, such as guideline-producing entities, and attributions of ’contextual trust’ to broader political and economic characteristics [89]. This conceptualization resonates with the Wider Context of the NASSS.…”

Facilitators and barriers to implementing a specialized care unit for persons with cognitive impairment in an acute geriatric hospital: A process evaluation

“…For practical reasons, we decided to base our questions on the key constructs of the i-PARIHS framework. However, we do not have data concerning all i-PARIHS-sub-elements [34]. For example, in the key construct "innovation" we only found information on the sub-element "clarity".…”