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FIRE (facilitating implementation of research evidence): a study protocol

Kate Seers1*, Karen Cox2, Nicola J Crichton3, Rhiannon Tudor Edwards4, Ann Catrine Eldh5, Carole A Estabrooks6, Gill Harvey7, Claire Hawkes8, Alison Kitson9, Pat Linck4, Geraldine McCarthy10, Brendan McCormack11, Carole Mockford1, Jo Rycroft-Malone8, Angie Titchen2 and Lars Wallin5

Author Affiliations

1 Royal College of Nursing Research Institute, School of Health and Social Studies, University of Warwick, Coventry CV4 7AL, UK

2 Fontys University of Applied Sciences School of Nursing, PO Box 347, 5600, AH Eindhoven, the Netherlands

3 Faculty of Health and Social Care, London South Bank University, 103 Borough Road, London SE1 0AA, UK

4 Bangor University, Centre for Economics and Policy in Health/Canolfan Economeg a Pholisi Iechyd, IMSCaR, College of Health and Behavioural Sciences, Dean Street Building, Bangor University, Bangor LL57 1UT, UK

5 Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet and Clinical Research Utilization (CRU), Karolinska University Hospital, Eugeniahemmet T4:02, SE-171 76 Stockholm, Sweden

6 Faculty of Nursing, University of Alberta, Edmonton, Alberta T6G 2G3, Canada

7 Health Management Group, Manchester Business School, University of Manchester, Manchester M15 6PB, UK

8 Bangor University, Centre for Health Related Research, School of Healthcare Sciences, College of Health and Behavioural Sciences, Fron Heulog, Bangor University, Bangor, Gwynedd LL57 2EF, UK

9 School of Nursing, University of Adelaide, Adelaide, 5005, Australia

10 University College Cork, College of Medicine & Health, Cork, Republic of Ireland

11 Institute of Nursing Research/School of Nursing, University of Ulster, Newtownabbey, BT37 0QB, Northern Ireland

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Implementation Science 2012, 7:25  doi:10.1186/1748-5908-7-25

Published: 27 March 2012



Research evidence underpins best practice, but is not always used in healthcare. The Promoting Action on Research Implementation in Health Services (PARIHS) framework suggests that the nature of evidence, the context in which it is used, and whether those trying to use evidence are helped (or facilitated) affect the use of evidence. Urinary incontinence has a major effect on quality of life of older people, has a high prevalence, and is a key priority within European health and social care policy. Improving continence care has the potential to improve the quality of life for older people and reduce the costs associated with providing incontinence aids.


This study aims to advance understanding about the contribution facilitation can make to implementing research findings into practice via: extending current knowledge of facilitation as a process for translating research evidence into practice; evaluating the feasibility, effectiveness, and cost-effectiveness of two different models of facilitation in promoting the uptake of research evidence on continence management; assessing the impact of contextual factors on the processes and outcomes of implementation; and implementing a pro-active knowledge transfer and dissemination strategy to diffuse study findings to a wide policy and practice community.

Setting and sample

Four European countries, each with six long-term nursing care sites (total 24 sites) for people aged 60 years and over with documented urinary incontinence

Methods and design

Pragmatic randomised controlled trial with three arms (standard dissemination and two different programmes of facilitation), with embedded process and economic evaluation. The primary outcome is compliance with the continence recommendations. Secondary outcomes include proportion of residents with incontinence, incidence of incontinence-related dermatitis, urinary tract infections, and quality of life. Outcomes are assessed at baseline, then at 6, 12, 18, and 24 months after the start of the facilitation interventions. Detailed contextual and process data are collected throughout, using interviews with staff, residents and next of kin, observations, assessment of context using the Alberta Context Tool, and documentary evidence. A realistic evaluation framework is used to develop explanatory theory about what works for whom in what circumstances.

Trial registration

Current Controlled Trials ISRCTN11598502.