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Cited by 303Health Policy Implementation ScienceHealth Sciences Research and EducationClinical practice guidelines implementation

The role of evidence, context, and facilitation in an implementation trial: implications for the development of the PARIHS framework

Open access
Rycroft-Malone, Jo, Seers, Kate, Chandler, Jackie, Hawkes, Claire A, Crichton, Nicola, Allen, Claire, Bullock, Ian, Strunin, Leo·2013·Implementation Science
DOI 10.1186/1748-5908-8-28PMC PMC3636004
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Abstract

BACKGROUND: The case has been made for more and better theory-informed process evaluations within trials in an effort to facilitate insightful understandings of how interventions work. In this paper, we provide an explanation of implementation processes from one of the first national implementation research randomized controlled trials with embedded process evaluation conducted within acute care, and a proposed extension to the Promoting Action on Research Implementation in Health Services (PARIHS) framework. METHODS: The PARIHS framework was prospectively applied to guide decisions about intervention design, data collection, and analysis processes in a trial focussed on reducing peri-operative fasting times. In order to capture a holistic picture of implementation processes, the same data were collected across 19 participating hospitals irrespective of allocation to intervention. This paper reports on findings from data collected from a purposive sample of 151 staff and patients pre- and post-intervention. Data were analysed using content analysis within, and then across data sets. RESULTS: A robust and uncontested evidence base was a necessary, but not sufficient condition for practice change, in that individual staff and patient responses such as caution influenced decision making. The implementation context was challenging, in which individuals and teams were bounded by professional issues, communication challenges, power and a lack of clarity for the authority and responsibility for practice change. Progress was made in sites where processes were aligned with existing initiatives. Additionally, facilitators reported engaging in many intervention implementation activities, some of which result in practice changes, but not significant improvements to outcomes. CONCLUSIONS: This study provided an opportunity for reflection on the comprehensiveness of the PARIHS framework. Consistent with the underlying tenant of PARIHS, a multi-faceted and dynamic story of implementation was evident. However, the prominent role that individuals played as part of the interaction between evidence and context is not currently explicit within the framework. We propose that successful implementation of evidence into practice is a planned facilitated process involving an interplay between individuals, evidence, and context to promote evidence-informed practice. This proposal will enhance the potential of the PARIHS framework for explanation, and ensure theoretical development both informs and responds to the evidence base for implementation.

AI snapshot

Written from the paper’s full text.

TL;DR

This embedded process evaluation of a national implementation RCT found that robust evidence was necessary but not sufficient for practice change, with context, inter-professional issues, and individual caution mediating implementation. The authors propose extending PARIHS by making individuals an explicit element alongside evidence, context, and facilitation.

Key findings

  • The trial showed no significant effect of the interventions on the primary outcome of fluid fasting time; the process evaluation drew on 151 staff and patients across 19 participating hospitals.
  • The evidence base for shortening fasting times was robust and relatively uncontested, but it was mediated by practitioner and patient caution, perceived risk, and staff fear of adverse consequences; in most sites it was unclear whether the evidence reached potential users.
  • Implementation context was challenging across micro, meso, and macro levels, including emotional responses, inter-professional issues, unclear ownership and decision-making authority, communication problems, variable organizational buy-in, and different starting points; average fluid fasting times ranged from 12.9 hours to 5.8 hours, one standard dissemination site decreased from 12.5 to 7.7 hours, and another site started at 5.8 hours and continued lower at 4.2 hours but not statistically significantly lower.
  • Facilitators reported many activities, but their relative and direct impact on policy and practice changes was difficult to judge, and there appeared to be no distinguishing features between the activities, skills, and attributes of an opinion leader and a PDSA facilitator despite the interventions being conceptually different.

Methods

  • Design: PARIHS was prospectively applied to guide intervention design, data collection, and analysis within a process evaluation embedded in a pragmatic randomized controlled trial; three interventions were randomly allocated across 19 hospitals in England, Scotland, Wales, and Northern Ireland: standard dissemination, a web-based resource championed by opinion leader(s), and a Plan-Do-Study-Act (PDSA) intervention, each over six months.
  • Data: pre- and post-intervention data were collected between November 2006 and February 2009 from a purposive sample of 151 staff and patients, including key contact interviews (28 total), change agent interviews (21 total), patient interviews (70 total), and five focus groups with 32 participants.
  • Analysis: qualitative data were transcribed and managed in N*DIST 5 and NVIVO 7; inductive and deductive content analysis was undertaken informed by Ritchie and Spencer’s approach, first within data sets and then mapped across the core PARIHS elements of evidence, context, and facilitation, with cross-checking by three researchers.

Limitations

  • The paper states that the process evaluation was designed to capture data across intervention sites rather than conduct in-depth case studies or ethnographies in a few sites, and that in-depth data collection in purposively sampled sites may have provided more illuminating evidence about intervention implementation, particularly fidelity.
  • The paper states that the study had no capacity for observational work and therefore relied on self-reported data, that some voices were missing (surgeons who did not consent and senior operational managers not included in sampling), and that although the study design and interventions were prospectively designed based on PARIHS, the evaluation of the framework was retrospective; the addition of the concept of the individual needs further consideration, elaboration, and clarification.
  • Evident from the text: because there was no significant effect on the primary outcome, the relative and direct impact of facilitator activities on policy and practice changes was difficult to judge, and no distinguishing features were found between opinion leader and PDSA facilitator activities, skills, and attributes despite the interventions being conceptually different.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/1748-5908-8-28

Cites

48 of 48 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 43 cited sources checked · 0 supported · 0 flagged

  • Findingnone given

    Progress was made in sites where implementation processes were aligned with existing initiatives.

    “Progress was made in sites where processes were aligned with existing initiatives.”
    Quote in the paperNot a substantial claim
  • Findingown data

    The implementation context was challenging, with individuals and teams bounded by professional issues, communication challenges, power, and a lack of clarity about authority and responsibility for practice change.

    “The implementation context was challenging, in which individuals and teams were bounded by professional issues, communication challenges, power and a lack of clarity for the authority and responsibility for practice change.”
    Quote in the paperSubstantial claim
  • Findingown data

    There were reports of ward-based team communication problems that had led to prolonged delays or fasting times for patients.

    “There were also reports of ward-based team communication problems, which had led to prolonged delays or fasting times for patients.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Opinion leaders and PDSA facilitators reported engaging in many activities including amendment of information, dissemination of information, awareness raising, individual review of patient fast, educational meetings, policy development, promotion of guidance, teaching/training, and using role models of good practice.

    “In interviews, opinion leaders and PDSA facilitators reported engaging in many activities including: amendment of information; dissemination of information; awareness raising; individual review of patient fast; educational meetings; policy development; promotion of guidance; teaching/training (formal and informal); and using role models of good practice.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The process evaluation's self-reported data (interviews) provide a sufficient and accurate account of the implementation activities and their impact.
  • Findingown data

    Within two of the interventions there was the potential to work with individuals and teams to overcome some challenges, but this was not translated to reductions in fasting times in most sites.

    “Within two of the interventions there was the potential to work with individuals and teams to attempt to overcome some of the challenges, but this was not translated to reductions in fasting times in most sites.”
    Quote in the paperSubstantial claim
  • May combine two claims. 39
  • Classified as probably not a substantial claim. 59
  • The quote only partly states this claim. 1

  • May combine two claims.

    Findingown data

    Facilitators reported engaging in many intervention implementation activities, some of which resulted in practice changes, but not significant improvements to outcomes.

    “Additionally, facilitators reported engaging in many intervention implementation activities, some of which result in practice changes, but not significant improvements to outcomes.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    One of the challenges encountered concerned the ownership of fasting practice.

    “One of the challenges encountered concerned the ‘ownership’ of fasting practice.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Some hospitals did not have a written fasting policy and had to develop one during the intervention phase, which left limited time to implement it.

    “Some hospitals did not have a written fasting policy and had to develop one during the intervention phase, which left limited time to implement it.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Some patients expressed a cautious attitude towards the advice they had been given because they did not want to jeopardize their treatment.

    “Some patients also expressed a cautious attitude towards the advice they had been given because they did not want to jeopardize their treatment:”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Managerial support for the project was variable, and consequently commitment and resources dedicated to it were variable.

    “While hospitals had signed up to being involved in the project, the managerial support for it was variable, and consequently so were the commitment and resources dedicated to it.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Some nurses expressed concern about getting into trouble if patients were not fasted long enough, with which some anaesthetists sympathized.

    “This was tempered by a concern expressed by some nurses about getting into trouble if patients were not fasted long enough, with which some anaesthetists sympathized:”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    At some sites existing policy was in line with the guideline evidence, and in others it was similar (e.g., three hours fluid fast).

    “At some sites existing policy was in line with the guideline evidence, and in others it was similar (e.g., three hours fluid fast).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    The enactment of facilitator roles varied and was linked to activities rather than the prescribed intervention strategy.

    “The enactment of these roles varied and was linked to activities rather than the prescribed intervention strategy.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Most respondents believed the evidence base for shortening fasting times to be robust.

    “Data from interviews with change agents and key contacts who were either senior nursing or anaesthetic staff showed that most respondents believed the evidence base for shortening fasting times to be robust:”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The hospital that started with the lowest pre-intervention fluid fast time (5.8 hours) continued to get lower (4.2 hours), but not statistically significantly lower.

    “This hospital started with the lowest pre-intervention fluid fast time (5.8 hours), which continued to get lower (4.2), but not statistically significantly lower.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Staff reported feeling overwhelmed by competing priorities, and that this project came at a bad time.

    “Staff reported feeling overwhelmed by competing priorities, and that this project came ‘at a bad time.’”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Changes to policy and practice were recorded, but they did not translate into changes to patient outcomes.

    “However, we did record changes to policy and practice, which did not translate into changes to patient outcomes.”
    Quote in the paperSubstantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    Opinion leaders and PDSA facilitators reported operationalising activities by using existing structures, real-time practice opportunities, evidence of patient discomfort, key roles, team agendas, starting small in targeted wards, and posters.

    “Opinion leaders and PDSA facilitators reported operationalising these activities in the following ways:”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The process evaluation's self-reported data (interviews) provide a sufficient and accurate account of the implementation activities and their impact.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The need for managing operating lists meant that individual staff reportedly took a cautionary approach to fasting practice.

    “The need for managing operating lists meant that individual staff reportedly took a cautionary approach to fasting practice:”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    A need was expressed for establishing clarity about roles and responsibilities and for all team members to take ownership.

    “A need was expressed for establishing clarity about roles and responsibilities and for all team members to take ownership:”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    A number of resource issues hindered implementation effort, including time for opinion leaders and PDSA facilitators, staff turnover, and lack of permanent staff.

    “A number of resource issues hindered implementation effort such as time (specifically for opinion leaders and PDSA facilitators to enact their roles, and for education sessions and team meetings), turnover of staff, and lack of permanent staff.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    For some, the fasting policy needed updating and two sites did not have a policy.

    “For some, the fasting policy needed updating and two sites did not have a policy.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    While the evidence was used locally, it did not impact on practice.

    “While this showed the evidence was used locally, it did not impact on practice [12].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [12] Rycroft-Malone J, Seers K, Crichton N, Chandler J, Hawkes C, Allen C, Bullock I, Strunin L: A pragmatic randomised controlled trial evaluating three implementation interventions. Implement Sci. 2012, 7: 80-10.1186/1748-5908-7-80. source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    In the current study, individual's risk taking behavior, emotional response, skills and experience, enthusiasm, commitment, and decision-making authority were important factors in the intervention's implementation and impact.

    “These are consistent with findings in the current study where individual's risk taking behavior, emotional response, skills and experience, enthusiasm, commitment, and decision-making authority were important factors in the intervention's implementation and impact.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The process evaluation's self-reported data (interviews) provide a sufficient and accurate account of the implementation activities and their impact.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Findingnone given

    The findings from this study re-emphasize the multiple and complex deliberative processes involved in implementation work.

    “The findings from this study re-emphasize the multiple and complex deliberative processes involved in implementation work.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    In this study, the presence of good quality evidence was a constant and proved to be a necessary but not a sufficient condition for changing current practice and routines.

    “In this study, the presence of good quality evidence was a constant, however it proved to be a necessary (for example, to guide the development of new local policy/guidance), but not a sufficient condition for changing current practice and routines.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Findingown data

    In this study, we had difficulty mapping the findings onto the high-low continua.

    “In this study, we had difficulty mapping the findings onto the high-low continua, which could be illustrative of two things.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning

    The interventions, including facilitation components, did not overcome the challenges presented by these factors to a sufficient level to affect fasting outcomes, even though facilitators reported working with individuals and teams on a variety of activities.

    “The interventions, including facilitation components, did not overcome the challenges presented by these factors to a sufficient level to affect fasting outcomes even though facilitators reported working with individuals and teams on a variety of activities.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The lack of effect on duration of fasting in the PoISE trial is a valid indicator of implementation failure rather than of the ineffectiveness of the evidence or of the outcome measure.

  • May combine two claims.

    Findingown data

    Some factors were more important than others in providing the conditions for, and influencing the effect of, implementation interventions, including inter-professional team working (including communication), decision-making authority (mediated by inter-professional tensions), and organizational buy-in.

    “Findings from this study show that some factors were more important than others in providing the conditions for, and influencing the effect of implementation interventions, which included inter-professional team working (including communication), decision-making authority (mediated by inter-professional tensions), and organizational buy-in, issues evident in others' work [e.g., [34,35].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [34] Brown D, McCormack B: Developing the practice context to enable more effective pain management with older people: an action research study. Implement Sci. 2011, 6: 9-10.1186/1748-5908-6-9. source

      Not checked in the free run.

    • cites [35] Kavanagh T, Stevens B, Seers K, Sidani S, Watt-Watson J: Process evaluation of appreciate inquiry to translate pain management evidence into pediatric nursing practice. Implement Sci. 2010, 5: 90-10.1186/1748-5908-5-90. source

      Not checked in the free run.

  • May combine two claims.

    Findingreasoning

    In this study, the evidence for shortening fasting times is scientifically robust and was generally acceptable, but these qualities were not sufficient to outweigh other factors.

    “In this study, the evidence for shortening fasting times is scientifically robust and was generally acceptable, but these qualities were not sufficient to outweigh other factors.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    A robust and uncontested evidence base was a necessary but not sufficient condition for practice change, because individual staff and patient responses such as caution influenced decision making.

    “A robust and uncontested evidence base was a necessary, but not sufficient condition for practice change, in that individual staff and patient responses such as caution influenced decision making.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Facilitation is concerned with enabling and making things easier.

    “Facilitation is concerned with enabling and making things easier [30].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [30] Harvey G, Loftus-Hills A, Rycroft-Malone J, Titchen A, Kitson A, McCormack B, Seers K: Getting evidence into practice: the role and function of facilitation. J Adv Nurs. 2002, 37 (6): 577-588. 10.1046/j.1365-2648.2002.02126.x. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    These contextual themes interact with each other, such that emotional reactions may be a function of inter-professional issues and a product of individual, team, and organizational communication.

    “These themes interact with each other such that, for example, emotional reactions may be a function of inter-professional issues, and a product of individual, team and organizational communication.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The process evaluation data provides a rich picture of implementation processes that offers an explanation for the trial findings and how implementation played out within the practice context.

    “The process evaluation data provides a rich picture of implementation processes that offers an explanation for the trial findings, and about how the implementation of interventions played out within the practice context.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Different starting points present challenges to implementation researchers, particularly within the relative confines of a trial design and the implementation of complex interventions.

    “Different starting points present challenges to implementation researchers, particularly within the relative confines of a trial design and the implementation of complex interventions.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    PARIHS represents the complexity of implementation by considering the three core elements and their sub-elements to be dynamic and interrelated.

    “PARIHS represents the complexity of implementation by considering the three core elements and their sub-elements to be dynamic and interrelated.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [13] Rycroft-Malone J, Kitson A, Harvey G, McCormack B, Seers K, Titchen A, Estabrooks CA: Ingredients for change: Revisiting a conceptual framework. Qual Saf Health Care. 2002, 11: 174-180. 10.1136/qhc.11.2.174. source

      Not checked in the free run.

    • cites [14] Rycroft-Malone J, Harvey G, Seers K, Kitson A, McCormack B, Titchen A: An exploration of the factors that influence the implementation of evidence into practice. J Clin Nurs. 2004, 13: 913-924. 10.1111/j.1365-2702.2004.01007.x. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Premisecitation

    The ability to learn from implementation studies would be improved by greater attention on theoretically driven formative and/or process evaluations to help determine how interventions work in different contexts, and to promote the transferability of findings to other settings.

    “The ability to learn from implementation studies would be improved by greater attention on theoretically driven formative and/or process evaluations to help determine how interventions work in different contexts, and to promote the transferability of findings to other settings [10,26].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [10] Stetler CB, Legro MW, Wallace CM, Bowman C, Guihan M, Hagedorn H, Kimmel B, Sharp ND, Smith JL: The role of formative evaluation in implementation research and the QUERI experience. J Gen Intern Med. 2006, 21 (Suppl 2): S1-S8. source

      Not checked in the free run.

    • cites [26] Lewin S, Glenton C, Oxman A: Use of qualitative methods alongside randomised controlled trials of complex healthcare interventions: methodological study. BMJ. 2009, 339: b3496-10.1136/bmj.b3496. http://www.bmj.com/content/339/bmj.b3496 , source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Potentially successful strategies included using existing structures or initiatives already in place to review fasting times and practice, aligning with organizational strategies, working with those in pivotal roles, and initiating awareness raising activities.

    “Potentially successful strategies included using existing structures or initiatives already in place to review fasting times and practice, aligning with organizational strategies, working with those in pivotal roles, and the initiation of awareness raising activities.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisereasoning

    Because there has been a lack of attention to implementation processes within studies, it is difficult to determine why and how interventions may have worked or not, or how to tailor interventions.

    “However, because there has been a lack of attention to implementation processes within studies such as those included in these reviews, it is difficult to determine why and how interventions may have worked or not, or how to tailor interventions.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    PARIHS is an example of a middle range explanation or theory about implementation.

    “PARIHS is an example of the development of a middle range explanation or theory about implementation [16].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [16] Merton R: On Theoretical Sociology: Five essays old and new. 1967, New York: Free Press

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    The most successful implementation will occur when evidence is robust and practitioners agree with it, the context is receptive, and implementation processes are appropriately facilitated by internal and/or external facilitators.

    “Specifically, the working proposition is that the most successful implementation will occur when evidence is robust and practitioners ‘agree’ with it, the context is receptive, and where implementation processes are appropriately facilitated by internal and/or external facilitators [13,14].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [13] Rycroft-Malone J, Kitson A, Harvey G, McCormack B, Seers K, Titchen A, Estabrooks CA: Ingredients for change: Revisiting a conceptual framework. Qual Saf Health Care. 2002, 11: 174-180. 10.1136/qhc.11.2.174. source

      Not checked in the free run.

    • cites [14] Rycroft-Malone J, Harvey G, Seers K, Kitson A, McCormack B, Titchen A: An exploration of the factors that influence the implementation of evidence into practice. J Clin Nurs. 2004, 13: 913-924. 10.1111/j.1365-2702.2004.01007.x. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    There may be more promise in the use of interventions that are theoretically based, interactive, and tailored to barriers.

    “Generally, this evidence base indicates that there may be more promise in the use of interventions that are theoretically based, interactive, and tailored to barriers [25].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [25] Baker R, Camosso-Stefinovic J, Gillies C, Shaw EJ, Cheater F, Flottorp S, Robertson N: Tailored interventions to overcome identified barriers to change: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2010, 10.1002/14651858.CD005470.pub2/abstract;jsessionid=86C5FC23066D86044C938F0C6B589926.d03t03. http://onlinelibrary.wiley.com/ [Art. No.: CD005470.], Issue 3

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Successful implementation of evidence into practice is a planned facilitated process involving an interplay between individuals, evidence, and context to promote evidence-informed practice.

    “We propose that successful implementation of evidence into practice is a planned facilitated process involving an interplay between individuals, evidence, and context to promote evidence-informed practice.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationown data

    A multi-faceted and dynamic story of implementation was evident, consistent with the underlying tenet of PARIHS.

    “Consistent with the underlying tenant of PARIHS, a multi-faceted and dynamic story of implementation was evident.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    In their review of the use of PARIHS, Helfrich et al. found that others had tended to use the framework retrospectively.

    “However, in their review of the use of PARIHS, Helfrich et al. [17] found that others had tended to use the framework retrospectively.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [17] Helfrich C, Damschroder L, Hagedorn H, Daggett G, Sahay A, Ritchie M, Damush T, Guihan M, Ullrich P, Stetler C: A critical synthesis of literature on the promoting action on research implementation in health services (PARIHS) framework. Implement Sci. 2010, 5: 82-10.1186/1748-5908-5-82. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The PDSA intervention had the potential to work with these complexities, but its delivery was compromised by the challenging environment, including lack of time and opportunity to bring people together to problem solve.

    “In theory, the PDSA intervention had the potential to work with these complexities, however, the delivery of this strategy was itself compromised by the challenging environment, including lack of time and opportunity to bring people together to problem solve.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Helfrich et al. identify three opportunities to refine the PARIHS framework: clarifying the interrelationships and dynamics between elements/sub-elements, providing a more explicit definition of successful implementation, and drawing on other conceptual frameworks and models to elaborate core PARIHS elements.

    “the three opportunities to refine the PARIHS framework they identify: being clearer about the interrelationships and dynamics between elements/sub elements would eventually help to identify more generalisable patterns; the need for a more explicit definition for successful implementation; and drawing on other conceptual frameworks and models to further elaborate on core PARIHS elements.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [17] Helfrich C, Damschroder L, Hagedorn H, Daggett G, Sahay A, Ritchie M, Damush T, Guihan M, Ullrich P, Stetler C: A critical synthesis of literature on the promoting action on research implementation in health services (PARIHS) framework. Implement Sci. 2010, 5: 82-10.1186/1748-5908-5-82. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Patients could have water up to two hours and food up to six hours before induction of anaesthesia, with resumption of fluids when fully awake.

    “The recommendations include that patients could have water up to two hours and food up to six hours before induction of anaesthesia, with resumption of fluids when fully awake [28].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] RCN/RCoA: Perioperative fasting in adults and children. Clinical Practice guidelines. 2005, London: Royal College of Nursing

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationown data

    Bringing fasting practice more in line with guideline recommendations requires a multi-disciplinary team approach and communication within and across teams and departments.

    “Bringing fasting practice more in line with the guideline recommendations requires a multi-disciplinary team approach and communication within and across teams and departments.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The analysis process was carried out by three members of the research team, which included cross-checking coding and themes, and emerging themes were shared periodically with the whole research team as an additional check on credibility.

    “The analysis process was carried out by three members of the research team, which included cross-checking coding and themes. Emerging themes were also shared periodically with the whole research team as an additional check on credibility.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisereasoning

    PARIHS appears to have good face validity because it has often been used in implementation activity and is widely cited in the international literature.

    “PARIHS appears to have good face validity in that it has been often used in implementation activity and is widely cited in the international literature.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationreasoning

    This finding is likely to be fairly typical of many clinical issues underpinned by national guidelines and a function of how organizations set their priorities.

    “This finding is likely to be fairly typical of many clinical issues underpinned by national guidelines and a function of how organizations set their priorities.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Apart from revision of information, the higher-rated activities are more active than passive.

    “Apart from revision of information, these activities are more active than passive.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The prominent role that individuals played as part of the interaction between evidence and context is not currently explicit within the PARIHS framework.

    “However, the prominent role that individuals played as part of the interaction between evidence and context is not currently explicit within the framework.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning

    The findings present a multi-faceted and dynamic story of implementation, consistent with the underlying tenant of PARIHS.

    “Consistent with the underlying tenant of PARIHS, the findings present a multi-faceted and dynamic story of implementation.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Some sites had been championing evidence-based fasting practice for some years, which could explain lower baseline times.

    “Some sites had been championing evidence-based fasting practice for some years which could explain lower baseline times.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisenone given

    To date, the role, behavior and attributes of individuals have been implicit within the PARIHS framework.

    “To date, the role, behavior and attributes of individuals have been implicit within the PARIHS framework.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

    Interpretationnone given

    The strength of the framework is in representing the elements' interconnectivity, which should be preserved in this new representation.

    “The strength of the framework is in representing the elements' interconnectivity, which should be preserved in this new representation.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationcitation

    The additional element has the potential to strengthen the framework's usefulness for planning and evaluating implementation efforts and is a reflection of current evidence and theory, particularly discussions about the social processes involved in knowledge mobilisation work.

    “The additional element has the potential to strengthen the framework's usefulness for planning and evaluating implementation efforts and is a reflection of current evidence and theory, particularly discussions about the social processes involved in knowledge mobilisation work [43].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [43] Crilly T, Jashapara A, Ferlie E: Research utilisation and knowledge mobilisation: a scoping review of the literature. 2010, NETSCC, [ http://www.netscc.ac.uk/hsdr/files/project/SDO_ES_08-1801-220_V01.pdf ]

      Not checked in the free run.

  • May combine two claims.

    Study design and conductreasoning

    The study did not have the capacity to undertake observational work and was therefore reliant on self-reported data to reach the conclusions reported in this paper.

    “We also did not have the capacity to undertake any observational work, and therefore have been reliant on self-reported data to reach the conclusions reported in this paper.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    In other theories and frameworks, the individual is acknowledged as a core component.

    “In other theories (e.g., Rogers Diffusions) and frameworks (e.g., [6,8,27], the individual is acknowledged as a core component.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [6] Damschroder LJ, Aaron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC: Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009, 4: 50-10.1186/1748-5908-4-50. source

      Not checked in the free run.

    • cites [8] Aarons GA, Hurlburt M, McCue Horwitz S: Advancing a conceptual model of evidence-based practice implementation in public service sectors. Adm Policy Ment Health. 2011, 38: 4-23. 10.1007/s10488-010-0327-7. source

      Not checked in the free run.

    • cites [27] Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O: Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q. 2004, 82 (4): 581-629. 10.1111/j.0887-378X.2004.00325.x. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Helfrich et al. encourage better elaboration of PARIHS' core elements.

    “Helfrich et al. encourage better elaboration of PARIHS' core elements.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] Helfrich C, Damschroder L, Hagedorn H, Daggett G, Sahay A, Ritchie M, Damush T, Guihan M, Ullrich P, Stetler C: A critical synthesis of literature on the promoting action on research implementation in health services (PARIHS) framework. Implement Sci. 2010, 5: 82-10.1186/1748-5908-5-82. source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    Some voices are missing from this account, including those of surgeons (who could have participated but did not consent) and senior operational managers (who were not included in the sampling strategy).

    “Additionally, there are some voices missing from this account, including those of surgeons (who could have participated, but did not consent to) and senior operational managers (who were not included in our sampling strategy).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Nilson et al. suggest that breaking 'bad' habits could be achieved by changing something in the context or by removing a person from that context.

    “These authors suggest that breaking 'bad' habits could be achieved by changing something in the context or by removing a person from that context.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [32] Nilsen P, Roback K, Broström A, Ellström P-E: Creatures of habit: accounting for the role of habit in implementation research on clinical behaviour change. Implement Sci. 2012, 7: 53-10.1186/1748-5908-7-53. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    The successful implementation of evidence into practice is a planned facilitated process involving an interplay between individuals, evidence, and context to promote evidence-informed practice.

    “The successful implementation of evidence into practice is a planned facilitated process involving an interplay between individuals, evidence, and context to promote evidence-informed practice.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning

    In-depth data collection within purposively sampled sites may have provided more illuminating evidence about intervention implementation, particularly fidelity.

    “In-depth data collection within purposively sampled sites may have provided more illuminating evidence about intervention implementation, particularly fidelity.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    The findings from this evaluation lead to proposing an extension to the PARIHS framework to enhance its usefulness as a conceptual framework that can be applied in practice.

    “The findings from this evaluation lead us to proposing an extension to the PARIHS framework to enhance its usefulness as a conceptual framework that can be applied in practice.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Making individuals more explicit within the PARIHS framework does not mean they should be separated from the other elements, particularly context.

    “It is important to state that making individuals more explicit within the PARIHS framework does not mean they should be separated from the other elements, particularly context.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationcitation

    The concept of the individual might incorporate capability, capacity, motivation (including recognising a need for change), resilience, acceptability, feelings, knowledge and beliefs (including self efficacy) about the intervention/evidence, position and fit within the organization/social system, and approach to decision-making.

    “we propose that the concept of the individual might incorporate: capability, capacity, motivation (including recognising a need for change), resilience, acceptability, feelings, knowledge and beliefs (including self efficacy) about the intervention/evidence, position and fit within the organization/social system, and approach to decision-making (e.g., experimentation, use of information).”
    Quote in the paperNot a substantial claim0 of 8 sources checked
    • cites [6] Damschroder LJ, Aaron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC: Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009, 4: 50-10.1186/1748-5908-4-50. source

      Not checked in the free run.

    • cites [7] Michie S, van Stralen MV, West R: The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implement Sci. 2011, 6: 42-10.1186/1748-5908-6-42. source

      Not checked in the free run.

    • cites [8] Aarons GA, Hurlburt M, McCue Horwitz S: Advancing a conceptual model of evidence-based practice implementation in public service sectors. Adm Policy Ment Health. 2011, 38: 4-23. 10.1007/s10488-010-0327-7. source

      Not checked in the free run.

    • cites [27] Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O: Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q. 2004, 82 (4): 581-629. 10.1111/j.0887-378X.2004.00325.x. source

      Not checked in the free run.

    • cites [37] Wenger E: Communities of Practice. 1998, Cambridge: Cambridge University Press source

      Not checked in the free run.

    • cites [40] Squires JE, Estabrooks CA, Gustavsson P, Wallin L: Individual determinants of research utilization by nurses: a systematic review update. Implement Sci. 2011, 6: 1-10.1186/1748-5908-6-1. source

      Not checked in the free run.

    • cites [41] Meijers JMM, Janssen MAP, Cummings G, Wallin L, Estabrooks CA, Halfens R: Assessing the relationships between contextual factors and research utilization in nursing: systematic literature review. J Adv Nurs. 2006, 55 (5): 622-635. 10.1111/j.1365-2648.2006.03954.x. source

      Not checked in the free run.

    • cites [42] Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A: Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf Health Care. 2005, 14 (1): 26-33. 10.1136/qshc.2004.011155. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    The PARIHS framework should be enhanced to ensure theoretical development keeps pace with the current evidence base for implementation.

    “In this paper, we propose that the PARIHS framework should be enhanced to ensure theoretical development keeps a pace with the current evidence base for implementation.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Helfrich et al. suggest that successful implementation should take a logic model approach to linking the implementation strategy to outcomes, including the realization of an implementation plan, the achievement and maintenance of the targeted evidence-based practice, and the achievement and maintenance of patient or organizational outcomes.

    “Helfrich et al. [17] suggest that successful implementation should take a logic model approach to linking the implementation strategy to outcomes, including the realization of an implementation plan, the achievement and maintenance of the targeted evidence-based practice, and the achievement and maintenance of patient or organizational outcomes.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] Helfrich C, Damschroder L, Hagedorn H, Daggett G, Sahay A, Ritchie M, Damush T, Guihan M, Ullrich P, Stetler C: A critical synthesis of literature on the promoting action on research implementation in health services (PARIHS) framework. Implement Sci. 2010, 5: 82-10.1186/1748-5908-5-82. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Although the study design and interventions were prospectively designed based on the core elements of PARIHS, the evaluation of the framework has been retrospective.

    “Although the study design and interventions were prospectively designed based on the core elements of PARIHS, our evaluation of the framework has been retrospective.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    The link between behavior and context is made explicit by habit theory, and fits well with the relationship between evidence and context in PARIHS.

    “The link between behavior and context is made explicit by habit theory, and fits well with the relationship between evidence and context in PARIHS.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    In this study, one explanation for the lack of change is that practitioners' practices were habituated towards maintaining traditional (non evidence-informed) ways of working, which then becomes their stable (and familiar) context.

    “In this study, the information in recommendations would not have been new to most practitioners; however, one explanation is that their practices were habituated towards maintaining traditional (non evidence-informed) ways of working, which then becomes their stable (and familiar) context.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The idea of creating a dissonance or awakening that current practice is not necessarily appropriate practice is a feature of other literatures including practice development.

    “This is similar to the idea of creating a dissonance or awakening that current practice is not necessarily appropriate practice, which is a feature of other literatures including practice development [33].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [33] McCormack B, Dewing J, McCance T: Developing person-centred care: addressing contextual challenges through practice development. Online J Issues Nursing. 2011, 16: 3-

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Nilson et al. suggest that those who develop habitual behaviors are less likely to act on, or may avoid, new information that challenges current practice, particularly in contexts that remain stable.

    “They suggest that those who develop habitual behaviors are less likely to act on, or may avoid new information that challenges current practice—particularly in contexts that remain stable.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [32] Nilsen P, Roback K, Broström A, Ellström P-E: Creatures of habit: accounting for the role of habit in implementation research on clinical behaviour change. Implement Sci. 2012, 7: 53-10.1186/1748-5908-7-53. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Helfrich et al. suggest that the high-low continua within PARIHS could encourage a tendency towards linear relationships between elements.

    “Helrich et al. [17] suggest that the high-low continua within PARIHS could encourage a tendency towards linear relationships between elements.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [17] Helfrich C, Damschroder L, Hagedorn H, Daggett G, Sahay A, Ritchie M, Damush T, Guihan M, Ullrich P, Stetler C: A critical synthesis of literature on the promoting action on research implementation in health services (PARIHS) framework. Implement Sci. 2010, 5: 82-10.1186/1748-5908-5-82. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning

    It could be suggested that organizations and systems become habituated, such that 12-hour fasts become so embedded and institutionalized that this standard becomes the acceptable norm.

    “Equally, it could be suggested that organizations and systems become habituated, such that in the case of fasting for example, 12-hour fasts become so embedded and institutionalized that this standard becomes the acceptable norm.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisereasoning

    Individuals are not explicitly part of the PARIHS framework but are embedded implicitly within evidence, context, and facilitation.

    “Currently individuals are not explicitly part of the PARIHS framework but are embedded implicitly within evidence (individuals interact with evidence), context (individuals are part of context), and facilitation (facilitators work with individuals and teams).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Over the last decade or so there has been a shift away from a focus on individuals to one that recognizes the role that context plays in implementation.

    “Over the last decade or so there has been a shift away from a focus on individuals (in the context of the evidence-based practice movements) to one that recognizes the role that context plays in implementation.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Using the high-low continuum may be more helpful for a visual representation at diagnosis but less useful in evaluating the process of implementation because it does not capture dynamism and patterns of interactions over time.

    “Using the high-low continuum may be more helpful in providing a visual representation at diagnosis (i.e., a snapshot), but less useful in evaluating the process of implementation because this does not capture dynamism and patterns of interactions over time.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisenone given

    Successful Implementation has not been explicitly defined in previous PARIHS publications.

    “Successful Implementation (SI) has not been explicitly defined in previous PARIHS publications.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    A logic model can encourage a linear and deductive approach to the identification of inputs, processes and outcomes, which does not fit well with the underlying premise of PARIHS, which acknowledges dynamism and the potential for inductive explanation.

    “A logic model can (although does not have to) encourage a linear and deductive approach to the identification of inputs, processes and outcomes, which does not fit well with the underlying premise of PARIHS, which acknowledges dynamism and the potential for inductive explanation [36].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [36] Kitson A, Rycroft-Malone J, Harvey G, McCormack B, Seers K, Titchen A: Evaluating the successful implementation of evidence into practice using the PARIHS framework: theoretical and practical challenges. Implement Sci. 2008, 3 (1): 1-10.1186/1748-5908-3-1. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    Individuals are currently implicitly embedded within PARIHS, but the significance of individuals within implementation is perhaps currently under-represented.

    “Individuals are currently implicitly embedded within PARIHS in that facilitators work with individuals, contexts include individuals, and individuals interact with evidence, however, the significance of individuals within implementation is perhaps currently under-represented.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning

    This definition includes the need to pay attention to planning, the process, and evaluation of implementation activity in an iterative rather than staged approach.

    “This definition includes the need to pay attention to planning, the process, and evaluation of implementation activity in an iterative rather than staged approach.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    The addition of 'individuals' to the conceptualisation of successful implementation is timely, particularly in the context of a growing emphasis in the empirical and theoretical literature on behavior and social processes.

    “The framework has been developed and refined over time, therefore the addition of 'individuals' to the conceptualisation of successful implementation is timely, particularly in the context of a growing emphasis in the empirical and theoretical literature on behavior and social processes.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationreasoning

    This shift has arguably resulted in an inattention to the study of individual factors, specifically the interplay between actors and the contexts in which they work and how that interplay influences change processes and impacts.

    “Arguably this shift has resulted in an inattention to the study of individual factors, specifically the interplay between actors and the contexts in which they work and how that interplay influences change processes and impacts.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationown data

    It could be argued that individual's behavior, intentions and actions should be part of a framework that seeks to explain successful implementation.

    “Therefore, it could be argued that individual's behavior, intentions and actions should be part of a framework that seeks to explain successful implementation.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    A more helpful definition of successful implementation is an orchestrated (active, planned) effort to make evidence-based changes by organizations, teams, and individuals that result in sustained improvements to care, patient outcomes, and service delivery, driven by and embedded in organizational strategy.

    “A more helpful definition, which acknowledges implementation as a process might be: an orchestrated (active, planned) effort to make evidence-based changes by organizations, teams, and individuals that result in sustained improvements to care, patient outcomes, and service delivery, which are driven by and embedded in organizational strategy.”
    Quote in the paperNot a substantial claim
84 of 84

  • The paper relies on this without support.

    The study was conducted during a period of major NHS changes that impacted staff turnover, workforce reviews, and reorganizations.

    “This study was conducted at a time of major NHS changes, including reconfigurations, changes to junior medical staff training grades, and a re-focus on financial deficits impacting on staff turnover, workforce reviews, and reorganizations.”

  • The paper relies on this without support.

    The PARIHS framework is a useful heuristic for guiding the development and evaluation of implementation processes.

    “PARIHS was embedded within our evaluation framework because it provided a potentially useful heuristic to guide the development of the study and evaluate the process of implementation.”

  • The paper relies on this without support.

    The process evaluation's self-reported data (interviews) provide a sufficient and accurate account of the implementation activities and their impact.

    “We also did not have the capacity to undertake any observational work, and therefore have been reliant on self-reported data to reach the conclusions reported in this paper.”

  • The paper relies on this without support.

    The lack of effect on duration of fasting in the PoISE trial is a valid indicator of implementation failure rather than of the ineffectiveness of the evidence or of the outcome measure.

    “Given the lack of effect on duration of fasting as a primary outcome, it is difficult to judge the relative impact of the activities of opinion leaders and PDSA facilitators.”
4 of 4

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Change-agent interview total does not add up

    Minor

    Table 2 lists 12 pre-intervention and 12 post-intervention change-agent interviews, which sum to 24, not the reported total of 21.

    Reported 21 · recomputed 24

  • Pre-intervention key-contact counts differ between tables

    Minor

    Table 2 reports 16 pre-intervention key-contact interviews, while Table 3 reports 19 pre-intervention key contacts.

2 of 2

Cites

Flagged first, then by citations

1 of the 49 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. Rycroft-Malone J, Bucknall T: Theory, models and frameworks. Models and Frameworks for Implementing Evidence-Based Practice. Edited by: Rycroft-Malone J, Bucknall T. 2010, Oxford: Wiley-Blackwell, 23-47.
  2. RCN/RCoA: Perioperative fasting in adults and children. Clinical Practice guidelines. 2005, London: Royal College of Nursing

Cited by

Sorted by citations

Related

Authors
Rycroft-Malone, J., Seers, K., Chandler, J., Hawkes, C. A., Crichton, N., Allen, C., Bullock, I., & Strunin, L.
Affiliations
  • University of Warwick (GB)
  • Cochrane (GB)
  • Bangor University (GB)
  • London South Bank University (GB)
  • Royal College of Physicians (GB)
  • Royal College of Anaesthetists (GB)
ORCID
Venue
Implementation Science
Publisher
Springer Science and Business Media LLC
Published
2013-03-09
Volume
8
Issue
1
Pages
28-28
ISSN
1748-5908 (ISSN-L)
DOI
10.1186/1748-5908-8-28
PMC
PMC3636004
OpenAlex
W2141566744
Semantic Scholar
1cb0304c547f34bf0151e51718de128e00ab9f4a
Cited by
303
References
49
Citations by year
2026: 3 · 2025: 10 · 2024: 13 · 2023: 18 · 2022: 25 · 2021: 35 · 2020: 26 · 2019: 27 · 2018: 30 · 2017: 29 · 2016: 31 · 2015: 31 · 2014: 20 · 2013: 5
FWCI
52.53
Type
journal article
Language
en
Open access
Licence
Locations
  • Implementation Science (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Lancaster EPrints (Lancaster University) (submittedVersion)
Topics
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
Keywords
PARIHS framework, implementation research, implementation process evaluation, evidence-informed practice, implementation context, facilitators, evidence base, practice change, acute care
MeSH terms
Attitude of Health Personnel, Data Collection, Decision Making, Diffusion of Innovation, Fasting, Health Services Research, Humans, Interprofessional Relations, Intraoperative Care, Professional Practice, Program Development, Focus Groups, Evidence-Based Practice, Translational Research, Biomedical

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-06.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-06.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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