Conceptual and relational advances of the PARIHS and i-PARIHS frameworks over the last decade: a critical interpretive synthesis
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Background: The number of research publications reporting the use of the Promoting Action on Research Implementation in Health Services (PARIHS) framework and the integrated PARIHS (i-PARIHS) framework has grown steadily. We asked how the last decade of implementation research, predicated on the (i-)PARIHS framework (referring to the PARIHS or i-PARIHS framework), has contributed to our understanding of the conceptualizations of, relationships between, and dynamics among the core framework elements/sub-elements. Building on the Helfrich et al. (2010) review of research on the PARIHS framework, we undertook a critical interpretive synthesis to: (1) identify conceptual and relational advances in the (i-)PARIHS framework and (2) identify conceptual and relational aspects of the (i-)PARIHS framework that warrant further work. Methods: We performed a systematic search in PubMed/PubMed Central, Ovid MEDLINE, CINAHL, JSTOR, SCOPUS, Web of Science, and PsycInfo. Articles were eligible for synthesis if they (a) were peer-reviewed articles, written in English, and published between January 2009 and December 2021, (b) applied the (i-)PARIHS framework explicitly to guide implementation research, and (c) made conceptual (expanding the conceptualization of core elements) and/or relational contributions (elaborating relationships among elements/sub-elements, or theorizing the relationships using empirical data). We used a critical interpretive synthesis approach to synthesize conceptual-relational advances of the (i-)PARIHS framework. Results: Thirty-seven articles were eligible for synthesis. Twenty-four offered conceptual contributions, and 18 offered relational contributions (5 articles contributed in both ways). We found conceptual expansion of all core (i-)PARIHS elements, with most emphasis on context (particularly outer context and leadership), facilitation, and implementation success. Articles also gave insights into the complex relationships and relational dynamism among these elements, characterized as contingent, interactive, multilevel, and temporal effects. Conclusions: We observed developmental advances of the (i-)PARIHS framework and proposed several directions to further advance the framework. Conceptualization of (i-)PARIHS elements (particularly evidence/innovation and recipients) need to be further developed by specifying conceptual and operational definitions of underlying sub-elements. Relationships among (i-)PARIHS elements/sub-elements need to be further elaborated through empirical studies that consider situational contingencies and causal complexities. This will require examining necessity and sufficiency of (i-)PARIHS elements/sub-elements in relation to implementation outcomes, interactions among elements, and mechanism-based explanations.
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“Furthermore, leadership was suggested as another key sub-construct within the Context of the i-PARiHS [89], which corresponds to the 5A Capacity subdomain within the Organization domain of the NASSS framework.”
Influential
- Authors
- Duan, Y., Iaconi, A., Wang, J., Perez, J. S., Song, Y., Chamberlain, S. A., Shrestha, S., Choroschun, K., Hoben, M., Beeber, A., Anderson, R. A., Cummings, G. G., Lanham, H. J., Norton, P. G., Estabrooks, C. A., & Berta, W.
- Affiliations
- University of Alberta (CA)
- University of North Carolina at Chapel Hill (US)
- Qingdao University (CN)
- Bielefeld University (DE)
- York University (CA)
- Johns Hopkins University (US)
- The University of Texas at San Antonio Health Science Center (US)
- University of Calgary (CA)
- University of Toronto (CA)
- Corresponding author
- Berta, Whitney
- ORCID
- Venue
- Implementation Science
- Published
- 2022-12-07
- Volume
- 17
- Issue
- 1
- Pages
- 78-78
- ISSN
- 1748-5908 (ISSN-L)
- PMC
- PMC9730581
- OpenAlex
- W4311582771
- Cited by
- 46
- References
- 56
- Citations by year
- 2026: 12 · 2025: 11 · 2024: 20 · 2023: 3
- FWCI
- 1.64
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Implementation Science (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Libraries and Cultural Resources (University of Calgary) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Libraries and Cultural Resources (University of Calgary) (submittedVersion)
- PUB – Publications at Bielefeld University (Bielefeld University) (submittedVersion)
- Funders
- Canadian Institutes of Health Research (165838)
- 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, leadership, facilitation, implementation success, recipient, framework development, health service implementation, situational contingencies, causal complexity
- MeSH terms
- Health Services, Health Services Research, Humans, Research Design
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