Evaluating the successful implementation of evidence into practice using the PARiHS framework: theoretical and practical challenges

Abstract

Background: The PARiHS framework (Promoting Action on Research Implementation in Health Services) has proved to be a useful practical and conceptual heuristic for many researchers and practitioners in framing their research or knowledge translation endeavours. However, as a conceptual framework it still remains untested and therefore its contribution to the overall development and testing of theory in the field of implementation science is largely unquantified.

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“…The implementation scientist could potentially assume the role as the facilitator, provided they embody key characteristics of successful facilitators which include a holistic and enabling approach to team building [19]. Our model is consistent with prior literature which supports better integration of those who generate evidence, either a care disparity or quality of care measures, and those who implement healthcare innovations [22]. Facilitation could include pairing of implementation or health services researcher with clinicians implementing a healthcare intervention [61].…”

“…An assumption within the PARiHS framework is that in order for evidence-based practices to be implemented, the four components of evidence must be reviewed by an organization and a consensus reached finding the four components highly relevant and useful. The PARiHS framework conceives this data review process as involving negotiation and developing a shared understanding which is ultimately a dialectical process requiring a team approach [22]. An additional assumption of the PARiHS framework is that in order for the evidence to be gathered and used effectively, it must be reviewed in the appropriate context.…”

“…An additional assumption of the PARiHS framework is that in order for the evidence to be gathered and used effectively, it must be reviewed in the appropriate context. The context element is comprised of three components which are culture, leadership and evaluation capability [22]. To summarize these components, factors thought to contribute to context are an organization's absorptive capacity for new knowledge, strong leadership, clear strategic vision, good managerial relations, visionary staff in pivotal positions, climate conducive to experimentation and risk taking, and effective data capture systems [35].…”

“…Facilitation includes a person serving the role of facilitator whose success is correlated with being held in high regard, considered credible, empathic, flexible, and who is clear in his or her role. From the PARiHS model, we are integrating into our hybrid model a portion of the theoretical framework which is the following: if an organization believes there is evidence to support an integrated care and the organizational environment is conducive to and is comprised of personnel facilitating change, then the likelihood of integrated care to succeed increases [22].…”

“…The Promoting Action on Research Implementation in Health Services (PARiHS) framework is especially appealing in understanding the delivery of integrated behavioral medicine because it provides a multidimensional and interactive perspective of organizational variables, allowing for interplay between program evaluation and implementation refinement [19,20]. Since developed in the 1990s, the framework has evolved from its use in empirical case studies to its current iteration guiding implementation evaluation [21,22]. The framework considers successful implementation to be most likely when: (1) scientific evidence is viewed as sound and fitting with professional and patient beliefs; (2) the healthcare context is receptive to implementation in terms of supportive leadership, culture, and evaluative systems; and (3) there are appropriate mechanisms in place to facilitate implementation.…”