Experiences of using the i-PARIHS framework: a co-designed case study of four multi-site implementation projects

S C Hunter,A Mudge,A Young,P Mcrae,L Hall,A L Kitson,B Kim

doi:10.1186/s12913-020-05354-8

Abstract

BackgroundThe integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework is an implementation framework that has been developed and refined over the last 20 years. Its underlying philosophy is that implementing research into healthcare practice is complex, unpredictable and non-linear which therefore requires a flexible and responsive approach to implementation. Facilitation is recognized as the central ingredient of this approach, and i-PARIHS now provides a Facilitation Guide with associated tools. This multiple case study of four implementation projects explored how the i-PARIHS framework has been practically operationalized by diverse implementation project teams.MethodsA co-design approach was used to elicit the experiences of four implementation project teams who used the i-PARIHS framework to guide their implementation approach. We conducted the established co-design steps of (i) setting up for success, (ii) gathering the experience, and (iii) understanding the experience. In particular we explored teams’ approaches to setting up their projects; why and how they used the i-PARIHS framework and what they learnt from the experience.ResultsWe found both commonalities and differences in the use of i-PARIHS across the four implementation projects: (i) all the projects used the Facilitation Checklist that accompanies i-PARIHS as a starting point, (ii) the projects differed in how facilitation was carried out, (iii) existing tools were adapted for distinct phases: pre-implementation, during implementation, and post-implementation stages; and (iv) project-specific tools were often developed for monitoring implementation activities and fidelity.ConclusionsWe have provided a detailed overview of how current users of i-PARIHS are operationalising the framework, which existing tools they are using or adapting to use, and where they have needed to develop new tools to best utilise the framework. Importantly, this study highlights the value of existing tools from the published i-PARIHS Facilitation Guide and provides a starting point to further refine and add to these tools within a future Mobilising Implementation of i-PARIHS (or “Mi-PARIHS”) suite of resources. Specifically, Mi-PARIHS might include more explicit guidance and/or tools for developing a structured implementation plan and monitoring fidelity to the implementation plan, including recording how strategies are tailored to an evolving context.

Highlights

The integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework is an implementation framework that has been developed and refined over the last 20 years
The integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) is a conceptual framework that aims to represent the dynamic interplay of factors that influence successful implementation [4]. i-PARIHS argues that successful implementation results from the facilitation of an innovation with the intended recipients in their contextual setting; the proposition of i-PARIHS can be seen in Table 1 [4]. iPARIHS represents an evolution of the PARIHS framework [5, 6], responding to several criticisms of that framework by providing clearer theoretical underpinnings as well as practical tools and case studies to help clinicians and researchers operationalise the framework [4, 7]
This study was a collaboration between the Mi-PARIHS team and implementation project teams who had used the framework in their work and who had agreed to share their experience and tools to inform ongoing development and refinement of i-PARIHS resources

Summary

Introduction

The integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework is an implementation framework that has been developed and refined over the last 20 years. Strong evidence alone is not sufficient to change practice; the field of implementation science seeks to provide various approaches, frameworks and theories to inform systematic and successful implementation [1] These approaches assist in teasing out why particular evidence is successfully implemented in one setting and not another [2]. Various researchers from a multitude of backgrounds have developed different approaches to plan, guide and evaluate implementation efforts, with recent research suggesting more than 100 approaches being used in implementation research [3] One such framework, the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) is a conceptual framework that aims to represent the dynamic interplay of factors that influence successful implementation [4]. The integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) is a conceptual framework that aims to represent the dynamic interplay of factors that influence successful implementation [4]. i-PARIHS argues that successful implementation results from the facilitation of an innovation with the intended recipients in their contextual setting; the proposition of i-PARIHS can be seen in Table 1 [4]. iPARIHS represents an evolution of the PARIHS framework [5, 6], responding to several criticisms of that framework by providing clearer theoretical underpinnings as well as practical tools and case studies to help clinicians and researchers operationalise the framework [4, 7]

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