Abstract
BackgroundThe Promoting Action on Research Implementation in Health Services framework, or PARIHS, is a conceptual framework that posits key, interacting elements that influence successful implementation of evidence-based practices. It has been widely cited and used as the basis for empirical work; however, there has not yet been a literature review to examine how the framework has been used in implementation projects and research. The purpose of the present article was to critically review and synthesize the literature on PARIHS to understand how it has been used and operationalized, and to highlight its strengths and limitations.MethodsWe conducted a qualitative, critical synthesis of peer-reviewed PARIHS literature published through March 2009. We synthesized findings through a three-step process using semi-structured data abstraction tools and group consensus.ResultsTwenty-four articles met our inclusion criteria: six core concept articles from original PARIHS authors, and eighteen empirical articles ranging from case reports to quantitative studies. Empirical articles generally used PARIHS as an organizing framework for analyses. No studies used PARIHS prospectively to design implementation strategies, and there was generally a lack of detail about how variables were measured or mapped, or how conclusions were derived. Several studies used findings to comment on the framework in ways that could help refine or validate it. The primary issue identified with the framework was a need for greater conceptual clarity regarding the definition of sub-elements and the nature of dynamic relationships. Strengths identified included its flexibility, intuitive appeal, explicit acknowledgement of the outcome of 'successful implementation,' and a more expansive view of what can and should constitute 'evidence.'ConclusionsWhile we found studies reporting empirical support for PARIHS, the single greatest need for this and other implementation models is rigorous, prospective use of the framework to guide implementation projects. There is also need to better explain derived findings and how interventions or measures are mapped to specific PARIHS elements; greater conceptual discrimination among sub-elements may be necessary first. In general, it may be time for the implementation science community to develop consensus guidelines for reporting the use and usefulness of theoretical frameworks within implementation studies.
Highlights
The Promoting Action on Research Implementation in Health Services framework, or PARIHS, is a conceptual framework that posits key, interacting elements that influence successful implementation of evidencebased practices
Implementation researchers have widely cited PARIHS or used it as the basis for empirical work [8,9,10,11]. This body of research has occurred against the backdrop of broad calls to incorporate theoretical frameworks in quality improvement implementation activities and research [12,13,14]. It has been over a decade since Kitson and colleagues first described the PARIHS framework, and while several papers have been published that update and propose refinements [4,5,6,7,14,15], there has not yet been a literature review to examine how the framework has been used in implementation projects and research
Commentaries did not reflect planned or actual application or refinement of PARIHS (See Additional File 4, Table of commentaries excluded from the synthesis)
Summary
The Promoting Action on Research Implementation in Health Services framework, or PARIHS, is a conceptual framework that posits key, interacting elements that influence successful implementation of evidencebased practices It has been widely cited and used as the basis for empirical work; there has not yet been a literature review to examine how the framework has been used in implementation projects and research. Implementation researchers have widely cited PARIHS or used it as the basis for empirical work [8,9,10,11] This body of research has occurred against the backdrop of broad calls to incorporate theoretical frameworks in quality improvement implementation activities and research [12,13,14]. We close with a set of recommendations to increase the value of the PARIHS framework for guiding implementation activities and research
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