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Table 3 Theories meeting first assessment using analyses from Moullin et al. [22]a

From: Practice change in chronic conditions care: an appraisal of theories

Name of theory

Authors/date

Practical Robust Implementation and Sustainability Model (PRISM)

 This framework, developed by Canadian researchers, looks at how intervention design, external environment, organizational characteristics and the intended population influence intervention effectiveness when implementing evidence-based practices. It is based on the Chronic Care Model, the Model for Improvement and the RE-AIM framework and is targeted to all levels of staff across an organisation.

Feldstein & Glasgow 2008 [37]

Consolidated Framework for Implementation Research (CFIR)

 This framework, developed by US researchers focused on the health and systems of care for war veterans, was informed by Rogers’ Diffusion of Innovations Theory and the work of Greenhalgh and colleagues. The CFIR provides a menu of constructs that can be used to systematically assess potential barriers and facilitators to implementing an innovation, and provides theory-based constructs for developing context-specific logic models.

Damschroder et al. 2009 [32]

Normalisation Process Theory (NPT)

 This theory, developed in the UK, is an Action Theory concerned with explaining what people do individually and collectively, rather than their attitudes or beliefs, in order to ‘normalize’ complex interventions into routine practice. It contains four constructs (with each containing 4 sub-components), each representing a mechanism of social action, which is assessed against observation of what people do to implement complex interventions. The four constructs are:

  • Coherence - the sense-making work that people do individually and collectively when they are faced with the problem of operationalizing some set of practices.

  • Cognitive Participation - the relational work that people do to build and sustain a community of practice around a new technology or complex intervention.

  • Collective Action - the operational work that people do to enact a set of practices, whether these represent a new technology or complex healthcare intervention. Like all NPT constructs, it has four components.

  • Reflexive Monitoring - the appraisal work that people do to assess and understand the ways that a new set of practices affect them and others around them.

May et al. 2009 [33]

General Theory of Implementation

 This theory builds on NPT, informed by ideas about agency and its expression within social, social and cognitive mechanisms, and collective action. It incorporates these ideas from sociology and psychology to build a more comprehensive explanation of change.

That is, it acknowledges that change occurs within a social system involving context and emergent expressions of agency.

Context includes potential (individual and collective commitment) and capacity (material and cognitive resources, social roles, social norms). Emergent expressions of agency includes capability (workability and integration) and contribution (which include the original 4 constructs of NPT)

May et al. 2013 [34]

Promoting Action on Research Implementation in Health Services (PARiHS)

 This framework, developed by researchers in Australia and the UK, examines the interactions between three key elements for knowledge translation: evidence; context; and facilitation. It argues that successful implementation of evidence into practice had as much to do with the context or setting and how that new evidence was introduced as it had to do with the quality of the evidence. It incorporates themes from the organisation change literature such as planning, knowledge and skills. Each element consists of sub-elements that can be rated on a scale from low to high.

Kitson et al. 2008 [26]

Revised PARiHS framework for a task-oriented approach to implementation

 This framework, developed by researchers in the US independently of the original developers, is designed to enable users to more clearly and consistently define and apply relevant terms with the PARiHS. It aims to address: the lack of conceptual clarity, specificity, and transparency; the lack of inclusion of relevant elements perceived to be critical to implementation; and the lack of instrumentation and evaluation measures in the original framework.

Stetler et al. 2011 [35]

Critical Realism and the Arts Research Utilization Model (CRARUM)

 This model, developed by researchers in Canada, draws on Critical Realism to provide insight into the interrelationship between its structures and potentials, and individual action and the Arts to foster reflection on the ways in which context influences and shapes clinical practice, and how they may facilitate or impede change. It draws on The Ottawa Model of Research Use which considers a range of factors across the assessment, monitoring and evaluation continuum. In particular is stresses the importance of understanding the optimization of intervention and adoption strategies, including an assessment of the knowledge, attitudes and skills of potential adopters.

Kontos & Poland 2009 [38]

Sticky Knowledge

 This model, developed by researchers in the UK, is based on an integration of communication theory and knowledge transfer milestones in a primary care context. The researchers argue that knowledge factors play a greater role in the success or failure of a knowledge transfer than has been suspected. The model’s key knowledge factors (Predictors of stickiness at different points of knowledge transfer) include: causal ambiguity, unproven knowledge, motivation of source, credibility of source, recipient motivation, recipient absorptive capacity, recipient retentive capacity, barren organizational context, and arduous relationship between source and recipient.

Elwyn, Taubert & Kowalczuk 2007 [36]

Advancing Research and Clinical Practice Through Close Collaboration Model

 This model, developed by researchers in the US, stresses that the key strategy to sustain evidence-based care is the presence of an evidence-based practice (EBP) mentor (a clinician with advanced knowledge of EBP, mentorship, and individual as well as organizational change). In involves an assessment of organizational culture and readiness for EBP that includes an assessment of potential strengths and barriers, followed by the development of mentors as a core feature of then implementing strategies to build skills, assess and address beliefs about EBP, and evaluate EBP implementation.

Melnyk et al. 2010 [39]

  1. aOur judgment differed from that of Moullin et al. [27] in relation to three theories. We judged that “installation” was covered by General Theory of Implementation, and that “setting” was not limited to hospital and primary care for PARIHS and Sticky Knowledge respectively. We therefore included these theories above. Moullin at al [27] list a further PARIHS theory [43]. We excluded this because in our judgement the referenced publication did not provide a theory