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Cited by 1,271Health Policy Implementation ScienceHealth Sciences Research and EducationClinical practice guidelines implementation

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

Open access
Harvey, Gill, Kitson, Alison·2015·Implementation Science
DOI 10.1186/s13012-016-0398-2PMC PMC4807546
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Abstract

BACKGROUND: 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. DISCUSSION: 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.

AI snapshot

Written from the paper’s full text.

TL;DR

This paper revises the PARIHS framework into the integrated i-PARIHS framework, positioning facilitation as the active ingredient that aligns innovation, recipients, and inner/outer context. It draws on critiques, theoretical antecedents, and three implementation case studies to describe and preliminarily test the revised framework’s face and content validity.

Key findings

  • The revised i-PARIHS framework replaces the original equation SI = ƒ(E,C,F) with SI = Facn(I + R + C), where successful implementation is specified as achievement of agreed implementation/project goals, uptake and embedding of the innovation, engagement and ownership by individuals/teams/stakeholders, and minimised context-related variation across settings.
  • The CKD case reported recorded prevalence increased by 1.2% in 30 participating practices (n = 1,863 additional patients with CKD) compared with a national increase of 0.2%; blood pressure management improved from 34 to 74% (cohort 1) and 58 to 83% (cohort 2).
  • The continence case’s cluster RCT showed no difference between control and intervention wards on overall compliance to continence recommendations, but significant improvements on several secondary outcomes and 1 of the 4 specific recommendations; the nutrition stepped wedge RCT showed no difference in weight loss after 1 week, though key audit measures improved.
  • A cited systematic review found practices supported by a facilitator were 2.76 times more likely to adopt evidence-based clinical guidelines; within 23 studies, audit and feedback was used in 100% and interactive consensus building/goal setting in 91%; the NeoKIP trial reported reduced neonatal mortality of 49% in the third year.

Methods

  • Design: conceptual and theoretical revision paper introducing the i-PARIHS framework, building on published critiques and empirical studies of the original PARIHS framework.
  • Data/sample: three implementation case studies summarised in Table 1—CKD in primary care, continence care in nursing homes, and nutritional care of older adults in acute care—plus literature on PARIHS applications, critiques, and theoretical antecedents.
  • Analysis: narrative synthesis and framework development, with case study data used to demonstrate preliminary testing of the face and content validity of the revised framework.

Limitations

  • Stated: the authors note that ongoing development and evaluation of i-PARIHS are needed; prospective implementation studies remain limited; construct boundaries may overlap and attempts to distinguish them may be imperfect; the label “recipients” may imply a passive role; and future work is needed to test utility, applicability, and content and construct validity.
  • Stated: evidence from effectiveness studies of facilitation is mixed, likely because facilitation itself is a complex intervention involving one or more facilitators applying combined improvement and team-focused strategies.
  • Evident: validation reported here is preliminary face and content validity using illustrative case studies, not full psychometric or prospective outcome validation; two of the cited case study RCTs had null primary outcomes.

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

Integrity signals

Registry

Crossref · 10.1186/s13012-016-0398-2

Cites

100 of 100 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 45 cited sources checked · 0 supported · 0 flagged

  • Findingcitation

    In the CKD case, the presence of CKD indicators in the pay-for-performance system in primary care created an incentive for improvement.

    “Similarly in the case study of CKD, the presence of CKD indicators in the pay-for-performance system in primary care created an incentive for improvement [21].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21] Harvey G, Oliver K, Humphreys J, Rothwell K, Hegarty J. Improving the identification and management of chronic kidney disease in primary care: lessons from a staged improvement collaborative. Int J Qual Health Care. 2015;27(1):10–6. source

      Not checked in the free run.

  • Findingcitation

    In the continence case, in some countries, a focus on continence formed part of the external accreditation system for nursing homes, creating a driver for introducing changes to improve the management of continence at a local level.

    “For example, in the case study on promoting continence, in some of the countries studied, a focus on continence formed part of the external accreditation system for nursing homes. This created a driver for introducing changes to improve the management of continence at a local level [45].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [45] Harvey G, Kitson A, Munn Z. Promoting continence in nursing homes in four European countries: the use of PACES as a mechanism for improving the uptake of evidence-based recommendations. Int J Evid Based Healthc. 2012;10(4):388–96. source

      Not checked in the free run.

  • Findingnone given

    In all three case studies, the methods employed by facilitators typically involved improvement approaches such as Plan-Do-Study-Act cycles and audit and feedback, underpinned by project management.

    “In all three cases, the methods employed by facilitators typically involved improvement approaches such as Plan-Do-Study-Act cycles and audit and feedback, underpinned by project management.”
    Quote in the paperNot a substantial claim
  • Premisecitation

    There is increased interest and awareness of relevant theories that can and should inform implementation strategies.

    “Increased interest and awareness of relevant theories that can and should inform implementation strategies [23–25]”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [23] Eccles M, Grimshaw J, Walker A, Johnston M, Pitts N. Changing the behavior of healthcare professionals: the use of theory in promoting the uptake of research findings. J Clin Epidemiol. 2005;58(2):107–12. source

      Not checked in the free run.

    • cites [24] Estabrooks CA, Thompson DS, Lovely JJ, Hofmeyer A. A guide to knowledge translation theory. J Contin Educ Health Prof. 2006;26(1):25–36. source

      Not checked in the free run.

    • cites [25] Rycroft-Malone J. Theory and knowledge translation: setting some coordinates. Nurs Res. 2007;56(4):S78–85. source

      Not checked in the free run.

  • Interpretationcitation

    Individuals and teams have an impact in supporting or resisting an innovation.

    “This extension enables the i-PARIHS framework to consider the impact individuals and teams have in supporting or resisting an innovation.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [12] Rycroft-Malone J, Seers K, Chandler J, Hawkes C, Crichton N, Allen C, et al. The role of evidence, context, and facilitation in an implementation trial: implications for the development of the PARIHS framework. Implement Sci. 2013;8(1):28. source

      Not checked in the free run.

    • cites [37] Flodgren G, Parmelli E, Doumit G, Gattellari M, O’Brien MA, Grimshaw J et al. Local opinion leaders: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2011 Aug 10;(8):CD000125. source

      Not checked in the free run.

  • Classified as probably not a substantial claim. 33
  • May combine two claims. 16

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

    Findingcitation

    In the CKD case, some GPs and practice nurses viewed declining renal function as a natural part of ageing and believed that disclosing a diagnosis of CKD could cause unnecessary anxiety in patients, potentially missing opportunities to improve self-management and overall management of cardiovascular disease and to address increased susceptibility to acute kidney injury.

    “This was particularly the case for older patients as some General Practitioners (GPs) and practice nurses viewed declining renal function as a natural part of ageing and believed that disclosing a diagnosis of CKD could cause unnecessary anxiety in patients. By adopting this approach, opportunities to improve self-management and overall management of cardiovascular disease and to address the issue”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [41] Blakeman T, Protheroe J, Chew-Graham C, Rogers A, Kennedy A. Understanding the management of early-stage chronic kidney disease in primary care: a qualitative study. J Roy Coll Gen Pract. 2012;62:e233–42. source

      Not checked in the free run.

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

    Findingcitation

    In the continence case, collecting stories from residents about their experience of living with incontinence provided a powerful motivational tool to convince colleagues of the need to change.

    “In one nursing home, the staff responsible for facilitating implementation collected stories from residents about their experience of living with incontinence, which provided a very powerful motivational tool to convince their colleagues of the need to change.”
    Quote in the paperNot a substantial claim

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

    Findingcitation

    In the continence case, care staff held strong views about whether continence goals were achievable, particularly where residents had been managed as incontinent over prolonged periods, and changing this mindset required significant effort.

    “Focusing on goals to improve the assessment and attainment of continence amongst residents, a key area was addressing care staffs’ strongly held views as to whether such goals were achievable, particularly where residents had been managed as ‘incontinent’ over prolonged periods of time. This required a significant amount of effort to change the mindset amongst nursing home staff about achieving”
    Quote in the paperNot a substantial claim

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

    Findingown data

    In the weight loss case, making oral nutritional supplements available at the point of care required agreement of financial support and fridges to store them, and negotiations with the stocks department to address stock supply and management.

    “However, the reality of making these supplements available at the point of care delivery required the agreement of financial support to make the supplements, and the fridges to store them in, available in the ward setting. Furthermore, negotiations with the stocks department were needed to address the issue of stock supply and management.”
    Quote in the paperNot a substantial claim

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

    Interpretationreasoning

    The relationship between the innovation and the recipients is in many ways an inter-dependent one.

    “It is also apparent that the relationship between the innovation and the recipients is in many ways an inter-dependent one.”
    Quote in the paperNot a substantial claim

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

    Premisereasoning

    Evidence is one type of knowledge and (new) knowledge is the substance that needs to be introduced in order to generate change and improvement.

    “We argue that evidence is one type of knowledge and (new) knowledge is the substance that needs to be introduced in order to generate change and improvement.”
    Quote in the paperNot a substantial claim

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

    Premisenone given

    In the original PARIHS framework, context was defined in terms of resources, culture, leadership and orientation to evaluation and learning, but the framework did not delineate between the immediate local context and the wider organisational context.

    “In the PARIHS framework, we defined context in terms of resources, culture, leadership and orientation to evaluation and learning; however, we did not delineate between the immediate local context and the wider organisational context.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    In the i-PARIHS framework, successful implementation is primarily specified in terms of the achievement of implementation/project goals and results from the facilitation of an innovation with the recipients in their context.

    “In our revised, i-PARIHS framework, successful implementation is primarily specified in terms of the achievement of implementation/project goals and results from the facilitation of an innovation with the recipients in their (local, organisational and health system) context (Table 2).”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Successful implementation can be primarily specified as the achievement of implementation/project goals.

  • May combine two claims.

    Interpretationcitation

    People rarely take evidence in the original form of a systematic review or clinical guideline and directly apply it within an implementation project; rather they incorporate evidence in different ways, typically adapting the original evidence to suit their particular situation, blending explicit knowledge with tacit, practice-based knowledge.

    “people rarely take evidence in the original form of a systematic review or clinical guideline and directly apply it within an implementation project rather they incorporate evidence in a number of different ways, which typically involves adapting the original evidence in some way to suit their particular situation”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [30] Hargreaves D. Creative professionalism: the role of teachers in the knowledge society. London: Demos; 1998.

      Not checked in the free run.

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

    Interpretationreasoning

    There is not a single right way to apply facilitator roles; however, there are clear benefits in mechanisms that provide support and mentoring to new or less experienced facilitators.

    “This reinforces that there is not a single right way to apply facilitator roles; however, there are clear benefits in mechanisms that provide support and mentoring to new or less experienced facilitators.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    When facilitation is part of another role, the facilitator may feel like a lone agent, and this can result in individual feelings of isolation and being overwhelmed.

    “In some cases—and particularly where facilitation is part of another role—the facilitator may feel like a lone agent. However, given the scope and complexity of the role, this is not a desirable situation and can result in individual feelings of isolation and being overwhelmed [62].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [62] Kitson A, Harvey G. Getting started with facilitation: the facilitator’s role. In: Harvey G, Kitson A, editors. Implementing evidence-based practice in healthcare: a facilitation guide. Abingdon, Oxon: Routledge; 2015. p. 70–84. source

      Not checked in the free run.

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

    Interpretationreasoning

    The inter-play between constructs that influence implementation is generally poorly understood, not least due to problems of boundary delineation.

    “The inter-play between constructs that influence implementation is generally poorly understood, not least due to the problems of boundary delineation mentioned above; as such, there is a need for more in-depth longitudinal studies which examine the dynamics of the innovation, the actors involved, the context and the proposed model of facilitation.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The revised i-PARIHS framework explicitly integrates the conceptual framework with supporting theories and an operational model of facilitation.

    “This reflects the work that has been undertaken to explicitly integrate the conceptual framework with supporting theories and an operational model of facilitation.”
    Quote in the paperSubstantial claim

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

    Premisecitation

    PARIHS claimed an eclectic provenance of relevant theories and philosophical perspectives.

    “PARIHS claimed an eclectic provenance of relevant theories and philosophical perspectives [1].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] 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. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Another criticism of PARIHS was the lack of detail around its theoretical foundations.

    “Another criticism of PARIHS was the lack of detail around its theoretical foundations.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [1] 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. source

      Not checked in the free run.

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

    Interpretationreasoning

    Experienced facilitators learn how to manage the uncertainty of implementation and keep individuals and teams on track.

    “Experienced facilitators learn how to manage this uncertainty and keep individuals and teams on track.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The i-PARIHS framework locates the success or otherwise of implementation upon the ability of the facilitator and the facilitation process to enable recipients within their particular context to adopt and apply the innovation by tailoring their intervention appropriately.

    “The i-PARIHS framework therefore locates the success or otherwise of implementation upon the ability of the facilitator and the facilitation process to enable recipients within their particular context to adopt and apply the innovation by tailoring their intervention appropriately.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Implementation of evidence into practice is a complex, multi-dimensional process.

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

    Premisecitation

    Normalisation process theory acknowledges the interaction of actors (recipients) within their context and proposes four constructs-coherence, cognitive participation, collective action and reflexive monitoring-as the generative mechanisms required to routinely embed innovations.

    “One that has been applied in healthcare is normalisation process theory [77, 78], which acknowledges the interaction of actors (recipients) within their context and proposes four constructs titled coherence, cognitive participation, collective action and reflexive monitoring as the generative mechanisms required to routinely embed innovations.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [77] May C, Finch T. Implementation, embedding, and integration: an outline of Normalization Process Theory. Sociology. 2009;43(3):535–54. source

      Not checked in the free run.

    • cites [78] May C, Mair F, Finch T, MacFarlane A, Dowrick C, Treweek S, et al. Development of a theory of implementation and integration: normalization Process Theory. Implement Sci. 2009;4(1):29. source

      Not checked in the free run.

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

    Interpretationreasoning

    There may be overlap between the constructs of innovation, recipients and context, so any attempt to distinguish them may be imperfect and open for debate.

    “From the discussion in the paper, we have tried to delineate the boundaries between the constructs of innovation, recipients and context; yet we know that, depending on the situation, there may be overlap between them thus any attempt to distinguish them may be imperfect and open for debate.”
    Quote in the paperNot a substantial claim

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

    Interpretationnone given

    The interrelationship between the innovation, the recipients and the multiple layers of contexts is often unpredictable, fluid and iterative.

    “The reality, however, is very different; the interrelationship between the innovation, the recipients and the multiple layers of contexts is often unpredictable, fluid and iterative.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    Rogers highlighted the importance of understanding different groups within the intended audience for innovation and how they are likely to react, as well as making use of peer-to-peer conversations and credible, trusted teachers and leaders to bring people on board with the change.

    “For example, Rogers highlighted the importance of understanding different groups within the intended audience for innovation and how they are likely to react, as well as making use of peer-to-peer conversations and credible, trusted teachers and leaders to bring people on board with the change [33, 34].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [33] Rogers EM. Diffusion of innovations. 4th ed. New York: The Free Press; 1995.

      Not checked in the free run.

    • cites [34] Rogers EM. Diffusion of innovations. 5th ed. New York: Free Press; 2003.

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationcitation

    The i-PARIHS framework continues the theoretical eclecticism of PARIHS but presents it in a more coherent way.

    “In our deliberations with i-PARIHS, we have continued with the theoretical eclecticism but have tried to present it in a more coherent way [16].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [16] Harvey G, Kitson A. PARIHS re-visited: introducing i-PARIHS. In: Harvey G, Kitson A, editors. Implementing evidence-based practice in health care: a facilitation guide. Abingdon, Oxon: Routledge; 2015. p. 25–46. source

      Not checked in the free run.

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

    Interpretationreasoning

    Common themes from the theoretical overview reinforce the complex, dynamic and non-linear nature of implementation and emphasise the importance of experiential learning at the level of individuals, teams and organisations.

    “From this brief overview of theories, a number of common themes are apparent which reinforce the complex, dynamic and non-linear nature of implementation and emphasise the importance of experiential learning at the level of individuals, teams and organisations.”
    Quote in the paperSubstantial claim

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

    Premisecitation

    The humanist theoretical perspective on facilitation emphasises the importance of enabling others, as opposed to telling, teaching, persuading or coercing them to act.

    “Fundamentally, this theoretical perspective on facilitation emphasises the importance of enabling others, as opposed to telling, teaching, persuading or coercing them to act.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [82] Rogers CR. Freedom to learn—a view of What Education Might Become. Charles Merrill: Columbus, Ohio; 1969.

      Not checked in the free run.

    • cites [83] Heron J. The facilitator’s handbook. London: Kogan Page; 1989.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Within the 23 studies reviewed, facilitators employed a number of different facilitation strategies, in particular audit and feedback (used in 100 per cent of studies) and interactive consensus building and goal setting (91 per cent use), alongside reminders, tailoring to context and quality improvement tools such as Plan-Do-Study-Act (PDSA) cycles.

    “Within the 23 studies reviewed, facilitators employed a number of different facilitation strategies, in particular audit and feedback (used in 100 per cent of studies) and interactive consensus building and goal setting (91 per cent use), alongside reminders, tailoring to context and quality improvement tools such as Plan-Do-Study-Act (PDSA) cycles.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [52] Baskerville NB, Liddy C, Hogg W. Systematic review and meta-analysis of practice facilitation within primary care settings. Ann Fam Med. 2012;10:63–74. source

      Not checked in the free run.

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

    Interpretationnone given

    The labelling of the construct 'recipients' may present a rather passive role for the actors involved in implementation.

    “Likewise, we recognise that the labelling of the construct ‘recipients’ may present a rather passive role for the actors involved in implementation.”
    Quote in the paperNot a substantial claim

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

    Interpretationnone given

    Facilitation is operationalised through a network of novice, experienced and expert facilitators applying a range of enabling skills and improvement strategies to structure the implementation process, engage and manage relationships between key stakeholders and identify and negotiate barriers to implementation within the contextual setting.

    “Facilitation is operationalised through a network of novice, experienced and expert facilitators applying a range of enabling skills and improvement strategies to structure the implementation process, engage and manage relationships between key stakeholders and identify and negotiate barriers to implementation within the contextual setting.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    The PARIHS conceptual framework was developed in an attempt to represent the dynamic and multi-faceted nature of implementation in healthcare.

    “The PARIHS conceptual framework was developed in an attempt to represent the dynamic and multi-faceted nature of implementation in healthcare.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] 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. source

      Not checked in the free run.

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

    Interpretationreasoning

    The revised i-PARIHS framework positions facilitation as the active ingredient of implementation, assessing and aligning the innovation to be implemented with the intended recipients in their local, organisational and wider system context.

    “The revised i-PARIHS framework positions facilitation as the active ingredient of implementation, assessing and aligning the innovation to be implemented with the intended recipients in their local, organisational and wider system context.”
    Quote in the paperSubstantial claim

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

    Interpretationreasoning

    Facilitation is the construct that activates implementation through assessing and responding to characteristics of the innovation and the recipients (both as individuals and in teams) within their contextual setting.

    “We propose that facilitation is the construct that activates implementation through assessing and responding to characteristics of the innovation and the recipients (both as individuals and in teams) within their contextual setting.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Implementation of evidence into practice is a complex, multi-dimensional process.

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based).

    Interpretationnone given

    The further out into the spiral the facilitator moves, the greater the level of experience and skill they will need.

    “Our hypothesis is that the further out into the spiral the facilitator moves, the greater the level of experience and skill they will need.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    Weiner's theory of organisational readiness to change proposes that readiness depends on collective behaviour change linked to two key factors: change commitment (wanting to change) and change efficacy (able to change).

    “Weiner’s theory of organisational readiness to change [71] proposes that readiness depends on collective behaviour change linked to two key factors, described as change commitment (wanting to change) and change efficacy (able to change).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [71] Weiner B. A theory of organizational readiness for change. Implement Sci. 2009;4(1):67. source

      Not checked in the free run.

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

    Interpretationreasoning

    Facilitation itself is a complex intervention, involving one or more individuals in the role of facilitator, applying a combination of improvement and team-focused strategies to enable and support change.

    “This likely reflects the fact that facilitation itself is a complex intervention, involving one or more individuals in the role of facilitator, applying a combination of improvement and team-focused strategies to enable and support change.”
    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

    Novice facilitators may be able to support locally focused implementation projects but are likely to need the support of a more experienced facilitator to assess and negotiate some of the more challenging barriers or contextual factors they may encounter.

    “This in turn suggests that whilst novice facilitators may be able to support locally focused implementation projects (in terms of working with a local team to plan and undertake the project), they are likely to need the support of a more experienced facilitator to assess and negotiate some of the more challenging barriers or contextual factors they may encounter.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    There is still more work to do on clarifying the concept of facilitation.

    “As others have noted, there is still more work to do on clarifying the concept of facilitation [80, 81].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [80] Dogherty EJ, Harrison MB, Graham ID. Facilitation as a role and process in achieving evidence-based practice in nursing: a focused review of concept and meaning. Worldviews Evid Based Nurs. 2010;7(2):76–89.

      Not checked in the free run.

    • cites [81] Berta W, Cranley L, Dearing JW, Dogherty EJ, Squires JE, Estabrooks CA. Why (we think) facilitation works: insights from organizational learning theory. Implement Sci. 2015;10(1):1–13. source

      Not checked in the free run.

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

    Premisenone given

    The PARIHS framework has been widely applied, tested, reviewed and refined.

    “The framework has been widely applied, tested, reviewed and refined.”
    Quote in the paperNot a substantial claim
36 of 36

  • The authors state this as an assumption.

    Successful implementation can be primarily specified as the achievement of implementation/project goals.

    “In our revised, i-PARIHS framework, successful implementation is primarily specified in terms of the achievement of implementation/project goals and results from the facilitation of an innovation with the recipients in their (local, organisational and health system) context (Table 2).”

  • The paper relies on this without support.

    Implementation of evidence into practice is a complex, multi-dimensional process.

    “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.”
2 of 2

Cites

Flagged first, then by citations

3 of the 103 references couldn’t be matched to a known paper.

Research works printed but not linked: 3

  1. Hargreaves D. Creative professionalism: the role of teachers in the knowledge society. London: Demos; 1998.
  2. Royal College of Nursing. Quality patient care: the dynamic standard setting system. Scutari: Harrow; 1990.
  3. Heron J. The facilitator’s handbook. London: Kogan Page; 1989.

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Authors
Harvey, G., & Kitson, A.
Affiliations
  • University of Manchester (GB)
  • University of Oxford (GB)
Corresponding author
Harvey, Gill
ORCID
Venue
Implementation Science
Publisher
Springer Science and Business Media LLC
Published
2015-12
Volume
11
Issue
1
Pages
33-33
ISSN
1748-5908 (ISSN-L)
DOI
10.1186/s13012-016-0398-2
PMC
PMC4807546
OpenAlex
W2306592406
Cited by
1,271
References
103
Citations by year
2026: 115 · 2025: 130 · 2024: 203 · 2023: 166 · 2022: 187 · 2021: 170 · 2020: 115 · 2019: 86 · 2018: 61 · 2017: 33 · 2016: 3
FWCI
59.12
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Implementation Science (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Flinders Academic Commons (Flinders University) (publishedVersion)
  • Research Explorer (The University of Manchester) (submittedVersion, cc-by)
  • Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion, cc-by)
  • Flinders Academic Commons (Flinders 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, i-PARIHS framework, implementation research, implementation context, implementation facilitation, implementation teams, face and content validity
MeSH terms
Delivery of Health Care, Diffusion of Innovation, 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.

What counts as a claim ›How we measure confidence ›How we check this ›

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