Skip to main content
Key Specialties
Anesthesiology Cardiology Dermatology Diabetology Endocrinology Gastroenterology General Medicine Geriatrics Hematology Infectious Diseases Internal Medicine Nephrology Neurology Obstetrics and Gynecology Oncology Pediatrics Psychiatry Radiology Respiratory Medicine Rheumatology Surgery Urology
Congress Coverage
2024 ESC Congress 2024 EAN Congress 2024 ASCO Annual Meeting 2024 ACC Congress
Clinical Collections
Advances in Alzheimer’s

2024 ESC Congress

Discover the latest news and 2024 updates on managing hypertension, heart failure, coronary syndromes, atrial fibrillation and arterial disease. 
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in:

Open Access 01-12-2023 | Care | Research

Prospective application of theoretical implementation frameworks to improve health care in hospitals — a systematic review

Authors: Rebecca Barnden, David A. Snowdon, Natasha A. Lannin, Elizabeth Lynch, Velandai Srikanth, Nadine E. Andrew

Published in: BMC Health Services Research | Issue 1/2023

Login to get access

Abstract

Background

Health Service implementation projects are often guided by theoretical implementation frameworks. Little is known about the effectiveness of these frameworks to facilitate change in processes of care and patient outcomes within the inpatient setting. The aim of this review was to assess the effectiveness of the application of theoretical implementation frameworks in inpatient healthcare settings to change processes of care and associated patient outcomes.

Method

We conducted a search in CINAHL, MEDLINE, EMBASE, PsycINFO, EMCARE and Cochrane Library databases from 1st January 1995 to 15th June 2021. Two reviewers independently applied inclusion and exclusion criteria to potentially eligible studies. Eligible studies: implemented evidence-based care into an in-patient setting using a theoretical implementation framework applied prospectively; used a prospective study design; presented process of care or patient outcomes; and were published in English. We extracted theoretical implementation frameworks and study design against the Workgroup for Intervention Development and Evaluation Research (WIDER) Checklist and implementation strategies mapped to the Cochrane Effective Practice and Organisation of Care (EPOC) taxonomy. We summarised all interventions using the Template for Intervention Description and Replication (TIDieR) checklist. We appraised study quality using the Item bank on risk of bias and precision of observational studies and the revised Cochrane risk of bias tool for cluster randomised trials. We extracted process of care and patient outcomes and described descriptively. We conducted meta-analysis for process of care and patient outcomes with reference to framework category.

Results

Twenty-five studies met the inclusion criteria. Twenty-one used a pre-post (no comparison), two a pre-post with a comparison, and two a cluster randomised trial design. Eleven theoretical implementation frameworks were prospectively applied: six process models; five determinant frameworks; and one classic theory. Four studies used two theoretical implementation frameworks. No authors reported their justification for selecting a particular framework and implementation strategies were generally poorly described. No consensus was reached for a preferred framework or subset of frameworks based on meta-analysis results.

Conclusions

Rather than the ongoing development of new implementation frameworks, a more consistent approach to framework selection and strengthening of existing approaches is recommended to further develop the implementation evidence base.

Trial registration

CRD42019119429.
Appendix
Available only for authorised users
Literature
1.
Brownson RC, Fielding JE, Green LW. Building Capacity for Evidence-Based Public Health: Reconciling the Pulls of Practice and the Push of Research. Annu Rev Public Health. 2018;39:27–53.PubMedCrossRef
2.
McKenna HAS, Keeney S. Barriers to evidenced based practice in primary care. A review of the literature. Int J Nurs Stud. 2004;41:10.CrossRef
3.
Baatiema L, Otim ME, Mnatzaganian G, de-Graft Aikins A, Coombes J, Somerset S. Health professionals’ views on the barriers and enablers to evidence-based practice for acute stroke care: a systematic review. Implement Sci. 2017;12(1):74.PubMedPubMedCentralCrossRef
4.
5.
McKibbon KA, Lokker C, Wilczynski NL, Ciliska D, Dobbins M, Davis DA, et al. A cross-sectional study of the number and frequency of terms used to refer to knowledge translation in a body of health literature in 2006: a Tower of Babel? Implement Sci. 2010;5:16.PubMedPubMedCentralCrossRef
6.
Pinnock H, Barwick M, Carpenter CR, Eldridge S, Grandes G, Griffiths CJ, et al. Standards for Reporting Implementation Studies (StaRI) Statement. BMJ. 2017;356:i6795.PubMedPubMedCentralCrossRef
7.
Johnson MJ, May CR. Promoting professional behaviour change in healthcare: what interventions work, and why? A theory-led overview of systematic reviews. BMJ Open. 2015;5(9):e008592.PubMedPubMedCentralCrossRef
8.
9.
Birken SA, Powell BJ, Shea CM, Haines ER, Alexis Kirk M, Leeman J, et al. Criteria for selecting implementation science theories and frameworks: results from an international survey. Implement Sci. 2017;12(1):124.PubMedPubMedCentralCrossRef
10.
Lynch EA, Mudge A, Knowles S, Kitson AL, Hunter SC, Harvey G. “There is nothing so practical as a good theory”: a pragmatic guide for selecting theoretical approaches for implementation projects. BMC Health Serv Res. 2018;18(1):857.PubMedPubMedCentralCrossRef
11.
Strifler L, Barnsley JM, Hillmer M, Straus SE. Identifying and selecting implementation theories, models and frameworks: a qualitative study to inform the development of a decision support tool. BMC Med Inform Decis Mak. 2020;20(1):91.PubMedPubMedCentralCrossRef
12.
Tabak RG, Khoong EC, Chambers DA, Brownson RC. Bridging research and practice: models for dissemination and implementation research. Am J Prev Med. 2012;43(3):337–50.PubMedPubMedCentralCrossRef
13.
Skolarus TA, Lehmann T, Tabak RG, Harris J, Lecy J, Sales AE. Assessing citation networks for dissemination and implementation research frameworks. Implement Sci. 2017;12(1):97.PubMedPubMedCentralCrossRef
14.
15.
Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W, et al. Lost in knowledge translation: time for a map? J Contin Educ Health Prof. 2006;26(1):13–24.PubMedCrossRef
16.
Cane J, O’Connor D, Michie S. Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci. 2012;7:37.PubMedPubMedCentralCrossRef
17.
Michie SJM, Abraham C, Lawton R, Parker D, Walker A. Making psychological theory useful for implementing evidence based practice: A consensus approach. Qual Saf Health Care. 2005;14(1):8.CrossRef
18.
Rogers EM. Diffusion of Innovations. 5th ed. New York: Free Press; 2003.
19.
May CR, 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;4:29.PubMedPubMedCentralCrossRef
20.
Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 1999;89(9):1322–7.PubMedPubMedCentralCrossRef
21.
Geerligs L, Rankin NM, Shepherd HL, Butow P. Hospital-based interventions: a systematic review of staff-reported barriers and facilitators to implementation processes. Implement Sci. 2018;13(1):36.PubMedPubMedCentralCrossRef
22.
Viswanathan M, Berkman ND. Development of the RTI item bank on risk of bias and precision of observational studies. J Clin Epidemiol. 2012;65(2):163–78.PubMedCrossRef
23.
Sterne JAC, Savovic J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898.PubMedCrossRef
24.
Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health. 1998;52(6):377–84.PubMedPubMedCentralCrossRef
25.
26.
Albrecht L, Archibald M, Arseneau D, Scott SD. Development of a checklist to assess the quality of reporting of knowledge translation interventions using the Workgroup for Intervention Development and Evaluation Research (WIDER) recommendations. Implement Sci. 2013;8:52.PubMedPubMedCentralCrossRef
27.
28.
Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ. 2014;348:g1687.PubMedCrossRef
29.
Wan X, Wang W, Liu J, Tong T. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol. 2014;14:135.PubMedPubMedCentralCrossRef
30.
The Cochrane Collaboration. Review Manager (RevMan) [Computer program]. Version 5.4 ed. Copenhagen: The Cochrane Collaboration; 2020.
31.
Boustani M, Alder CA, Solid CA. Agile Implementation: A Blueprint for Implementing Evidence-Based Healthcare Solutions. J Am Geriatr Soc. 2018;66(7):1372–6.PubMedCrossRef
32.
Grol R, Wensing M. What drives change? Barriers to and incentives for achieving evidence-based practice. Med J Aust. 2004;180(6 Suppl):S57-60.PubMed
33.
34.
35.
Fixsen DL, Naoom SF, Blase FA, M FR, Walace F. Implementation research: a synthesis of the literature. Tampa: University of South Florida: The National Implemenation Research Network; 2005. p. 119.
36.
Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4(1):50.PubMedPubMedCentralCrossRef
37.
38.
Rycroft-Malone J. The PARIHS framework–a framework for guiding the implementation of evidence-based practice. J Nurs Care Qual. 2004;19(4):297–304.PubMedCrossRef
39.
Harvey G, Kitson A. PARIHS revisited: from heuristic to integrated framework for the successful implementation of knowledge into practice. Implement Sci. 2016;11:33.PubMedPubMedCentralCrossRef
40.
Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q. 2004;82(4):581–629.PubMedPubMedCentralCrossRef
41.
Azar J, Kelley K, Dunscomb J, Perkins A, Wang Y, Beeler C, et al. Using the agile implementation model to reduce central line-associated bloodstream infections. Am J Infect Control. 2019;47(1):33–7.PubMedCrossRef
42.
Byrnes A, Young A, Mudge A, Banks M, Clark D, Bauer J. Prospective application of an implementation framework to improve postoperative nutrition care processes: Evaluation of a mixed methods implementation study. Nutr Diet. 2018;75(4):353–62.PubMedCrossRef
43.
White MC, Daya L, Karel FKB, White G, Abid S, Fitzgerald A, et al. Using the Knowledge to Action Framework to Describe a Nationwide Implementation of the WHO Surgical Safety Checklist in Cameroon. Anesth Analg. 2020;130(5):1425–34.PubMedCrossRef
44.
White MC, Randall K, Capo-Chichi NFE, Sodogas F, Quenum S, Wright K, et al. Implementation and evaluation of nationwide scale-up of the Surgical Safety Checklist. Br J Surg. 2019;106(2):e91–102.PubMedPubMedCentralCrossRef
45.
Bosch M, McKenzie JE, Ponsford JL, Turner S, Chau M, Tavender EJ, et al. Evaluation of a targeted, theory-informed implementation intervention designed to increase uptake of emergency management recommendations regarding adult patients with mild traumatic brain injury: results of the NET cluster randomised trial. Implement Sci. 2019;14(1):4.PubMedPubMedCentralCrossRef
46.
Tavender EJ, Bosch M, Gruen RL, Green SE, Michie S, Brennan SE, et al. Developing a targeted, theory-informed implementation intervention using two theoretical frameworks to address health professional and organisational factors: a case study to improve the management of mild traumatic brain injury in the emergency department. Implement Sci. 2015;10:74.PubMedPubMedCentralCrossRef
47.
Garrido MA, Alvarez EA, Ponce DP, Salech F, Tobar DI, Tobar EA. Consolidated framework for advancing implementation science for the implementation process and adherence assessment of a non-pharmacological delirium prevention program. Int J Geriatr Psychiatry. 2021;36(2):302–13.PubMedCrossRef
48.
Rattray M, Desbrow B, Marshall AP, von Papen M, Roberts S. Evaluation of an intervention to improve nutrition intake in patients undergoing elective colorectal surgery: A mixed-methods pilot study. Nutrition. 2021;84:111015.PubMedCrossRef
49.
Roberts S, Williams LT, Sladdin I, Neil H, Hopper Z, Jenkins J, et al. Improving Nutrition Care, Delivery, and Intakes Among Hospitalised Patients: A Mixed Methods, Integrated Knowledge Translation Study. Nutrients. 2019;11(6):1417. https://​doi.​org/​10.​3390/​nu11061417.
50.
Savoie J, McCullum S, Wolfe DL, Slayter J, O’Connell C. Implementation of pain best practices as part of the spinal cord injury knowledge mobilization network. J Spinal Cord Med. 2019;42(sup1):226–32.PubMedPubMedCentralCrossRef
51.
Robertson TR, Eldridge NE, Ali AB, Hickman IJ, Rattray ME, Desbrow B, et al. Early oral feeding after colorectal surgery: A mixed methods study of knowledge translation. Nutr Diet. 2018;75(4):345–52.PubMedCrossRef
52.
Taylor N, Lawton R, Slater B, Foy R. The demonstration of a theory-based approach to the design of localized patient safety interventions. Implementation science : IS. 2013;8:123.PubMedPubMedCentralCrossRef
53.
Cody S, Lizarondo L, McArthur A, Barzen A, Ladera C, Levak S, et al. Improving the quality of delirium practices in a large Australian tertiary hospital: an evidence implementation initiative. Aust J Adv Nurs. 2021;38(2):3-12.
54.
Gerrish K, Laker S, Taylor C, Kennedy F, McDonnell A. Enhancing the quality of oral nutrition support for hospitalized patients: a mixed methods knowledge translation study (The EQONS study). J Adv Nurs. 2016;72(12):3182–94.PubMedCrossRef
55.
Gu Y, Hu Y, Zhang H, Fu W, Yang Y, Latour JM. Implementation of an Evidence-Based Guideline of Enteral Nutrition for Infants With Congenital Heart Disease: A Controlled Before-and-After Study. Pediatr Crit Care Med. 2020;21(6):e369–77.PubMedCrossRef
56.
Peel NM, Hornby-Turner YC, Osborne SR, Henderson A, Hubbard RE, Gray LC. Implementation and Evaluation of a Standardized Nurse-Administered Assessment of Functional and Psychosocial Issues for Patients in Acute Care. Worldviews Evid Based Nurs. 2021;18(3):161–9.PubMedCrossRef
57.
Peterson A, Carlfjord S, Schaller A, Gerdle B, Larsson B. Using education and support strategies to improve the way nurses assess regular and transient pain - A quality improvement study of three hospitals. Scand J Pain. 2017;16:15–21.PubMedCrossRef
58.
Reynolds SS, Sova C, McNalty B, Lambert S, Granger B. Implementation Strategies to Improve Evidence-Based Bathing Practices in a Neuro ICU. J Nurs Care Qual. 2019;34(2):133–8.PubMedCrossRef
59.
Salbach NM, Wood-Dauphinee S, Desrosiers J, Eng JJ, Graham ID, Jaglal SB, et al. Facilitated interprofessional implementation of a physical rehabilitation guideline for stroke in inpatient settings: process evaluation of a cluster randomized trial. Implementation Sci IS. 2017;12(1):100.PubMedCrossRef
60.
Semin-Goossens A, van de Helm JMJ, Bossuyt PMM. A failed model-based attempt to implement an evidence-based nursing guideline for fall prevention. J Nurs Care Qual. 2003;18(3):9.CrossRef
61.
Sving E, Hogman M, Mamhidir AG, Gunningberg L. Getting evidence-based pressure ulcer prevention into practice: a multi-faceted unit-tailored intervention in a hospital setting. Int Wound J. 2016;13(5):645–54.PubMedCrossRef
62.
Tian L, Yang Y, Sui W, Hu Y, Li H, Wang F, et al. Implementation of evidence into practice for cancer-related fatigue management of hospitalized adult patients using the PARIHS framework. PLoS ONE. 2017;12(10):(no pagination)(e0187257).CrossRef
63.
Romney W, Salbach N, Parrott JS, Deutsch JE. A Knowledge Translation Intervention Designed and Implemented by a Knowledge Broker Improved Documented Use of Gait Speed: A Mixed-Methods Study. J Geriatr Phys Ther. 2020;43(3):E1–10.PubMedCrossRef
64.
Thomas S, Mackintosh S. Improvement of Physical Therapist Assessment of Risk of Falls in the Hospital and Discharge Handover Through an Intervention to Modify Clinical Behavior. Phys Ther. 2016;96(6):764–73.PubMedCrossRef
65.
Scovil CY, Delparte JJ, Walia S, Flett HM, Guy SD, Wallace M, et al. Implementation of Pressure Injury Prevention Best Practices Across 6 Canadian Rehabilitation Sites: Results From the Spinal Cord Injury Knowledge Mobilization Network. Arch Phys Med Rehabil. 2019;100(2):327–35.PubMedCrossRef
66.
Stevens BJ, Yamada J, Estabrooks CA, Stinson J, Campbell F, Scott SD, et al. Pain in hospitalized children: Effect of a multidimensional knowledge translation strategy on pain process and clinical outcomes. Pain. 2014;155(1):60–8.PubMedCrossRef
67.
Romney W, Salbach N, Parrott JS, Deutsch JE. A knowledge translation intervention designed using audit and feedback and the Theoretical Domains Framework for physical therapists working in inpatient rehabilitation: A case report. Physiother Theory Pract. 2019;35(7):686–702.PubMed
68.
Sterne JAC, Hernán MA, McAleenan A, Reeves BC, Higgins JPT. Chapter 25. Assessing risk of bias in a non-randomized study. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al., editors. Cochrane Handbook for Systematic Reviews of Interventions version 63 (updated February 2022). Available from:  www.​training.​cochrane.​org/​handbook.
Metadata
Title
Prospective application of theoretical implementation frameworks to improve health care in hospitals — a systematic review
Authors
Rebecca Barnden
David A. Snowdon
Natasha A. Lannin
Elizabeth Lynch
Velandai Srikanth
Nadine E. Andrew
Publication date
01-12-2023
Publisher
BioMed Central
Keyword
Care
Published in
BMC Health Services Research / Issue 1/2023
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-023-09609-y

Other articles of this Issue 1/2023

BMC Health Services Research 1/2023 Go to the issue

Research article

Development and initial validation of the addressing client needs with social determinants of health scale (ACN: SDH)

Research

Impact of removing prescription co-payments on the use of costly health services: a pragmatic randomised controlled trial

Research

Evaluating the efficiency of primary health care institutions in China: an improved three-stage data envelopment analysis approach

Research

Challenges and strategies for conducting research in primary health care practice: an integrative review

Research

Challenges of medical commodity availability in public and private health care facilities in the Upper East Region of Ghana: a patient-centered perspective

Research

How do inpatients’ costs, length of stay, and quality of care vary across age groups after a new case-based payment reform in China? An interrupted time series analysis