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A Guide for applying a revised version of the PARIHS framework for implementation

Cheryl B Stetler12*, Laura J Damschroder3, Christian D Helfrich45 and Hildi J Hagedorn67

Author Affiliations

1 Independent Consultant, Amherst, Massachusetts, USA

2 Health Services Department, Boston University School of Public Health, Boston, Massachusetts, USA

3 HSR&D Center for Clinical Management Research and Diabetes QUERI, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA

4 Northwest HSR&D Center of Excellence, VA Puget Sound Healthcare System, Seattle, Washington, USA

5 Department of Health Services, University of Washington School of Public Health, Seattle, Washington, USA

6 VA Substance Use Disorders Quality Enhancement Research Initiative, Minneapolis VA Medical Center, Minneapolis, Minnesota, USA

7 Department of Psychiatry, School of Medicine, University of Minnesota, Minneapolis, Minnesota, USA

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Implementation Science 2011, 6:99  doi:10.1186/1748-5908-6-99

Published: 30 August 2011



Based on a critical synthesis of literature on use of the Promoting Action on Research Implementation in Health Services (PARIHS) framework, revisions and a companion Guide were developed by a group of researchers independent of the original PARIHS team. The purpose of the Guide is to enhance and optimize efforts of researchers using PARIHS in implementation trials and evaluations.


Authors used a planned, structured process to organize and synthesize critiques, discussions, and potential recommendations for refinements of the PARIHS framework arising from a systematic review. Using a templated form, each author independently recorded key components for each reviewed paper; that is, study definitions, perceived strengths/limitations of PARIHS, other observations regarding key issues and recommendations regarding needed refinements. After reaching consensus on these key components, the authors summarized the information and developed the Guide.


A number of revisions, perceived as consistent with the PARIHS framework's general nature and intent, are proposed. The related Guide is composed of a set of reference tools, provided in Additional files. Its core content is built upon the basic elements of PARIHS and current implementation science.


We invite researchers using PARIHS for targeted evidence-based practice (EBP) implementations with a strong task-orientation to use this Guide as a companion and to apply the revised framework prospectively and comprehensively. Researchers also are encouraged to evaluate its use relative to perceived strengths and issues. Such evaluations and critical reflections regarding PARIHS and our Guide could thereby promote the framework's continued evolution.