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Implementation science has progressed towards increased use of theoretical approaches to provide better understanding and explanation of how and why implementation succeeds or fails. The aim of this article is to propose a taxonomy that distinguishes between different categories of theories, models and frameworks in implementation science, to facilitate appropriate selection and application of relevant approaches in implementation research and practice and to foster cross-disciplinary dialogue among implementation researchers. Theoretical approaches used in implementation science have three overarching aims: describing and/or guiding the process of translating research into practice (process models); understanding and/or explaining what influences implementation outcomes (determinant frameworks, classic theories, implementation theories); and evaluating implementation (evaluation frameworks). This article proposes five categories of theoretical approaches to achieve three overarching aims. These categories are not always recognized as separate types of approaches in the literature. While there is overlap between some of the theories, models and frameworks, awareness of the differences is important to facilitate the selection of relevant approaches. Most determinant frameworks provide limited “how-to” support for carrying out implementation endeavours since the determinants usually are too generic to provide sufficient detail for guiding an implementation process. And while the relevance of addressing barriers and enablers to translating research into practice is mentioned in many process models, these models do not identify or systematically structure specific determinants associated with implementation success. Furthermore, process models recognize a temporal sequence of implementation endeavours, whereas determinant frameworks do not explicitly take a process perspective of implementation.

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Making sense of implementation theories, models and frameworks

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. This being the case, the paper provides an integrated summary of our conceptual and theoretical thinking so far and introduces a typology (derived from social policy analysis) used to distinguish between the terms conceptual framework, theory and model – important definitional and conceptual issues in trying to refine theoretical and methodological approaches to knowledge translation. Secondly, the paper describes the next phase of our work, in particular concentrating on the conceptual thinking and mapping that has led to the generation of the hypothesis that the PARiHS framework is best utilised as a two-stage process: as a preliminary (diagnostic and evaluative) measure of the elements and sub-elements of evidence (E) and context (C), and then using the aggregated data from these measures to determine the most appropriate facilitation method. The exact nature of the intervention is thus determined by the specific actors in the specific context at a specific time and place. In the process of refining this next phase of our work, we have had to consider the wider issues around the use of theories to inform and shape our research activity; the ongoing challenges of developing robust and sensitive measures; facilitation as an intervention for getting research into practice; and finally to note how the current debates around evidence into practice are adopting wider notions that fit innovations more generally. The paper concludes by suggesting that the future direction of the work on the PARiHS framework is to develop a two-stage diagnostic and evaluative approach, where the intervention is shaped and moulded by the information gathered about the specific situation and from participating stakeholders. In order to expedite the generation of new evidence and testing of emerging theories, we suggest the formation of an international research implementation science collaborative that can systematically collect and analyse experiences of using and testing the PARiHS framework and similar conceptual and theoretical approaches. We also recommend further refinement of the definitions around conceptual framework, theory, and model, suggesting a wider discussion that embraces multiple epistemological and ontological perspectives.

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

The aim of this bi-monthly column is to highlight Cochrane Systematic Reviews of relevance to pregnancy and childbirth and to stimulate discussion on the relevance and implications of the review for practice. The Cochrane Collaboration is an international organisation that prepares and maintains high quality systematic reviews to help people make well-informed decisions about healthcare and health policy. A systematic review tries to search for, appraise and bring together existing research to answer a specific research quesiton. The Cochrane Database of Systematic Reviews (CDSR) is published monthly online. Residents in countries with a national licence to the Cochrane Libray, including the U.K. and Ireland, can access the Cochrane Library online, free of charge through www.thecochranelibrary.com.

Midwife-led continuity models versus other models of care for childbearing women.

The Promoting Action on Research Implementation in Health Services, or PARIHS framework, was first published in 1998. Since this time, work has been ongoing to further develop, refine and test it. Widely used as an organising or conceptual framework to help both explain and predict why the implementation of evidence into practice is or is not successful, PARIHS was one of the first frameworks to make explicit the multi-dimensional and complex nature of implementation as well as highlighting the central importance of context. Several critiques of the framework have also pointed out its limitations and suggested areas for improvement. Building on the published critiques and a number of empirical studies, this paper introduces a revised version of the framework, called the integrated or i-PARIHS framework. The theoretical antecedents of the framework are described as well as outlining the revised and new elements, notably, the revision of how evidence is described; how the individual and teams are incorporated; and how context is further delineated. We describe how the framework can be operationalised and draw on case study data to demonstrate the preliminary testing of the face and content validity of the revised framework. This paper is presented for deliberation and discussion within the implementation science community. Responding to a series of critiques and helpful feedback on the utility of the original PARIHS framework, we seek feedback on the proposed improvements to the framework. We believe that the i-PARIHS framework creates a more integrated approach to understand the theoretical complexity from which implementation science draws its propositions and working hypotheses; that the new framework is more coherent and comprehensive and at the same time maintains it intuitive appeal; and that the models of facilitation described enable its more effective operationalisation.

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PARIHS revisited: from heuristic to integrated framework for the successful implementation of knowledge into practice

Aim
The aim of this article is to clarify the concept of spirituality for future nursing research.

Background
Previous concept analyses of spirituality have mostly reviewed the conceptual literature with little consideration of the empirical literature. The literature reviewed in prior concept analyses extends from 1972 to 2005, with no analysis conducted in the past 9 years.

Design
Rodgers' evolutionary framework was used to review both the theoretical and empirical literature pertaining to spirituality. Evolutionary concept analysis is a formal method of philosophical inquiry, in which papers are analyzed to identify attributes, antecedents, and consequences of the concept.

Data Source
Empirical and conceptual literature.

Results
Three defining attributes of spirituality were identified: connectedness, transcendence, and meaning in life. A conceptual definition of spirituality was proposed based on the findings. Also, four antecedents and five primary consequences of spirituality were identified.

Conclusions
Spirituality is a complex concept. This concept analysis adds some clarification by proposing a definition of spirituality that is underpinned by both conceptual and empirical research. Furthermore, exemplars of spirituality, based on prior qualitative research, are presented to support the findings. Hence, the findings of this analysis could guide future nursing research on spirituality.

Concept Analysis of Spirituality: An Evolutionary Approach.

https://cyberleninka.org/article/n/865223.pdf

Advance care planning: A systematic review of randomised controlled trials conducted with older adults

Aim: To test the psychometric properties of the Context Assessment Index (CAI).


 Background: We used the Promoting Action on Research Implementation in Health Services Framework (PARIHS) as the theoretical framework for the study. The framework shows the successful implementation of evidence in practice as dependent on the inter-relationship of the nature of the evidence, the quality of the context, and expert facilitation. However, a comprehensive method of assessing context has not yet been available.


Methods: A five-stage instrument development and testing methodology was used. Principal components analysis, exploratory factor analysis, and expert panel feedback were used to develop and refine the CAI model. The model was further tested for psychometric properties of internal consistency and test–retest scores. Telephone interviews were conducted with expert nurses to gauge the usability of the instrument. These stages of development and testing resulted in a final 37-item, five-factor CAI model.


Findings: This 37-item model was accepted as a reasonable explanation of the data. The measures of homogeneity were calculated for each of the five factors to measure internal reliability. The Cronbach's alpha score for the complete questionnaire was estimated at 0.93. All five factors achieved a satisfactory estimated level of internal consistency in scoring, ranging from 0.78 to 0.91. Test–retest scores indicate reliability of the findings, and the feedback from focus group participants suggests that the instrument has practical utility.


Conclusions: The CAI provides clinicians with the means to assess and understand the context in which they work and the effect this has on using evidence in practice.

Development and Testing of the Context Assessment Index (CAI)

coffey a. & mccarthy g.m. (2013) Older people’s perception of their readiness for discharge and postdischarge use of community support and services. International Journal of Older People Nursing 8, 104–115 
doi: 10.1111/j.1748-3743.2012.00316.x

Aim.  To examine older patients perception of their readiness for discharge from hospital to home and use of community supports postdischarge, including readmission.

Background.  Early discharge leaves little time for older people, families and professionals to prepare. The perspectives of patients are essential to therapeutic caring; however, few studies have examined patient’s perception of their readiness for discharge.

Design.  A quantitative, descriptive and correlational design was used. Data were collected from older patients (n = 335) at discharge and postdischarge using the Readiness for Discharge Scale (Weiss & Piacentine; Journal of Nursing Measurement, 14, 2006, 163) and a Demographic and Community Resource Questionnaire.

Findings.  At 6 weeks postdischarge, almost one-quarter had been readmitted. Family support had increased, yet a minimal increase in formal services was found. At discharge, differences in readiness existed between the younger and older old. Significant relationships existed between lower perception of readiness at discharge and increased use of informal and formal support post-discharge. Lower perception of readiness had a significant relationship with readmission in the older old.

Conclusions.  Perceptions of readiness reflect the patient’s reality and may be significant to discharge preparation and arrangements for support.

Implications for practice.  Older patients’ perspectives should be included in discharge decisions and in individualised approaches by nurses to discharge preparation.

Older people's perception of their readiness for discharge and postdischarge use of community support and services.

Aim
To report on an analysis on the concept of ‘readiness for hospital discharge’.

Background
No uniform operational definition of ‘readiness for hospital discharge’ exists in the literature, therefore a concept analysis is required to clarify the concept and identify an up to date understanding of readiness for hospital discharge. Clarity of the concept will identify all uses of the concept; provide conceptual clarity, an operational definition and direction for further research.

Design
Literature Review and Concept Analysis.

Method
A review of literature conducted in 2016 involved databases searched were: Academic Search Complete, CINAHL Plus with Full Text, PsycARTICLES, Psychology and Behavioural Sciences Collection, PsycINFO, Social Sciences Full Text (H.W. Wilson) and SocINDEX with Full Text. No date limits were applied.

Results
Identification of the attributes, antecedents and consequences of readiness for hospital discharge led to an operational definition of the concept. The following attributes belonging to ‘readiness for hospital discharge’; were extracted from the literature; physical stability, adequate support, psychological ability and adequate information and knowledge.

Conclusion
This analysis contributes to the advancement of knowledge in the area of hospital discharge, by proposing an operational definition of readiness for hospital discharge, derived from the literature. A better understanding of the phenomenon will assist health care professionals to recognise, measure and implement interventions where necessary, to ensure patients are ready for hospital discharge and assist in the advancement of knowledge for all professionals involved in patient discharge from hospital.

This article is protected by copyright. All rights reserved.

Alice Coffey

Papers

Concept Analysis of Spirituality: An Evolutionary Approach.

Advance care planning: A systematic review of randomised controlled trials conducted with older adults

Development and Testing of the Context Assessment Index (CAI)

Older people's perception of their readiness for discharge and postdischarge use of community support and services.

Readiness for hospital discharge: A concept analysis