This is an RSS newsfeed from BioMed Central It is intended to be used with an RSS reader. For more information about RSS newsfeeds from BioMed Central, visit http://www.biomedcentral.com/info/about/rss/ http://www.implementationscience.commostviewed/ Most viewed articles in last 30 days from Implementation Science (ISSN 1748-5908) published by BioMed Central Background: There is an important gap between the implications of clinical research evidence and the routine clinical practice of healthcare professionals. Because individual decisions are often central to adoption of a clinical-related behaviour, more information about the cognitive mechanisms underlying behaviours is needed to improve behaviour change interventions targeting healthcare professionals. The aim of this study was to systematically review the published scientific literature about factors influencing health professionals' behaviours based on social cognitive theories. These theories refer to theories where individual cognitions/thoughts are viewed as processes intervening between observable stimuli and responses in real world situations. Methods: We searched psycINFO, MEDLINE, EMBASE, CIHNAL, Index to theses, PROQUEST dissertations and theses and Current Contents for articles published in English only. We included studies that aimed to predict healthcare professionals' intentions and behaviours with a clear specification of relying on a social cognitive theory. Information on percent of explained variance (R2) was used to compute the overall frequency-weighted mean R2 to evaluate the efficacy of prediction in several contexts and according to different methodological aspects. The cognitive factors most consistently associated with prediction of healthcare professionals' intention and behaviours were documented. Results: Seventy eight studies met the inclusion criteria. Among these studies, 72 provided information on the determinants of intention and 16 prospective studies provided information on the determinants of behaviour. The theory most often used as reference was the Theory of Reasoned Action (TRA) or its extension the Theory of Planned Behaviour (TPB). An overall frequency-weighted mean R2 of 0.31 was observed for the prediction of behaviour; 0.59 for the prediction of intention. A number of moderators influenced the efficacy of prediction; frequency-weighted mean R2 varied from 0.001 to 0.58 for behaviour and 0.19 to 0.81 for intention. Conclusion: Our results suggest that the TPB appears to be an appropriate theory to predict behaviour whereas other theories better capture the dynamic underlying intention. In addition, given the variations in efficacy of prediction, special care should be given to methodological issues, especially to better define the context of behaviour performance. http://www.implementationscience.com/content/3/1/36 Gaston Godin, Ariane Bélanger-Gravel, Martin Eccles and Jeremy Grimshaw Implementation Science 2008, 3:36 Number of accesses: 736 2008-07-16 doi:10.1186/1748-5908-3-36 Implementation Science 1748-5908 3 36 2008-07-16 Background: Organizational context plays a central role in shaping the use of research by healthcare professionals. The largest group of professionals employed in healthcare organizations is nurses, putting them in a position to influence patient and system outcomes significantly. However, investigators have often limited their study on the determinants of research use to individual factors over organizational or contextual factors. Methods: The purpose of this study was to examine the determinants of research use among nurses working in acute care hospitals, with an emphasis on identifying contextual determinants of research use. A comparative ethnographic case study design was used to examine seven patient care units (two adult and five pediatric units) in four hospitals in two Canadian provinces (Ontario and Alberta). Data were collected over a six-month period by means of quantitative and qualitative approaches using an array of instruments and extensive fieldwork. The patient care unit was the unit of analysis. Drawing on the quantitative data and using correspondence analysis, relationships between various factors were mapped using the coefficient of variation. Results: Units with the highest mean research utilization scores clustered together on factors such as nurse critical thinking dispositions, unit culture (as measured by work creativity, work efficiency, questioning behavior, co-worker support, and the importance nurses place on access to continuing education), environmental complexity (as measured by changing patient acuity and re-sequencing of work), and nurses' attitudes towards research. Units with moderate research utilization clustered on organizational support, belief suspension, and intent to use research. Higher nursing workloads and lack of people support clustered more closely to units with the lowest research utilization scores. Conclusion: Modifiable characteristics of organizational context at the patient care unit level influences research utilization by nurses. These findings have implications for patient care unit structures and offer beginning direction for the development of interventions to enhance research use by nurses. http://www.implementationscience.com/content/3/1/31 Carole A Estabrooks, Shannon Scott, Janet E Squires, Bonnie Stevens, Linda O'Brien-Pallas, Judy Watt-Watson, Joanne Profetto-McGrath, Kathy McGilton, Karen Golden-Biddle, Janice Lander, Gail Donner, Geertje Boschma, Charles K Humphrey and Jack Williams Implementation Science 2008, 3:31 Number of accesses: 362 2008-06-02 doi:10.1186/1748-5908-3-31 Implementation Science 1748-5908 3 31 2008-06-02 Background: In the past two decades, scientific publications in Iran have considerably increased their medical science content, and the number of articles published in ISI journals has doubled between 1997 and 2001. The aim of the present study was to determine how frequently knowledge transfer strategies were applied in Tehran University of Medical Sciences (TUMS). We were also interested in studying the determining factors leading to the type of strategy selected. Methodology All TUMS research projects that had received grants from inside and outside the university in 2004, and were completed by the end of 2006, were included in the study. In total, 301 projects were examined, and data on each of the projects were collected by the research team using a standardized questionnaire. The projects' principle investigators filled out a second questionnaire. In all, 208 questionnaires were collected. Results: Researchers stated being more engaged in the passive strategies of knowledge transfer, especially those publishing in peer-reviewed journals. The mean score for the researchers' performance in passive and active strategies were 22% and 9% of the total score, respectively. Linear regression analysis showed that the passive strategy score decreased with the increase in the number of years working as a professional (p = 0.01) and personal interest as the only reason for choosing the research topic (p = 0.01). Regarding the active strategies of knowledge transfer, health system research studies significantly raised the score (p = 0.02) and 'executive responsibility' significantly lowered it (p = 0.03). Conclusion: As a study carried out in a Middle Eastern developing country, we see that, like many other universities in the world, many academicians still do not give priority to active strategies of knowledge transfer. Therefore, if 'linking knowledge to action' is necessary, it may also be necessary to introduce considerable changes in academic procedures and encouragement policies (e.g., employment and promotion criteria of academic members). http://www.implementationscience.com/content/3/1/39 Saharnaz Nedjat, Reza Majdzadeh, Jaleh Gholami, Sima Nedjat, Katayoun Maleki, Mostafa Qorbani, Mostafa Shokoohi and Mahnaz Ashoorkhani Implementation Science 2008, 3:39 Number of accesses: 362 2008-08-26 doi:10.1186/1748-5908-3-39 Implementation Science 1748-5908 3 39 2008-08-26 Background: Evidence shows that the standard process for obtaining informed consent in clinical trials can be inadequate, with study participants frequently not understanding even basic information fundamental to giving informed consent. Patient decision aids are effective decision support tools originally designed to help patients make difficult treatment or screening decisions. We propose that incorporating decision aids into the informed consent process will improve the extent to which participants make decisions that are informed and consistent with their preferences. A mixed methods study will test this proposal. Methods: Phase one of this project will involve assessment of a stratified random sample of 50 consent documents from recently completed investigator-initiated clinical trials, according to existing standards for supporting good decision making. Phase two will involve interviews of a purposive sample of 50 trial participants (10 participants from each of five different clinical areas) about their experience of the informed consent process, and how it could be improved. In phase three, we will convert consent forms for two completed clinical trials into decision aids and pilot test these new tools using a user-centered design approach, an iterative development process commonly employed in computer usability literature. In phase four, we will conduct a pilot observational study comparing the new tools to standard consent forms, with potential recruits to two hypothetical clinical trials. Outcomes will include knowledge of key aspects of the decision, knowledge of the probabilities of different outcomes, decisional conflict, the hypothetical participation decision, and qualitative impressions of the experience.DiscussionThis work will provide initial evidence about whether a patient decision aid can improve the informed consent process. The larger goal of this work is to examine whether study recruitment can be improved from (barely) informed consent based on disclosure-oriented documents, towards a process of high-quality participant decision-making. http://www.implementationscience.com/content/3/1/38 Jamie C Brehaut, Alison Lott, Dean A Fergusson, Kaveh G Shojania, Jonathan Kimmelman and Raphael Saginur Implementation Science 2008, 3:38 Number of accesses: 302 2008-07-23 doi:10.1186/1748-5908-3-38 Implementation Science 1748-5908 3 38 2008-07-23 The development and implementation of an evidence-based approach to health workforce planning is a necessary step to achieve access to best practice chronic disease management. In its absence, the widely reported failure in implementation of clinical best practice guidelines is almost certain to continue. This paper describes a demand model to estimate the community-based primary care health workforce consistent with the delivery of best practice chronic disease management and prevention. The model takes a geographic region as the planning frame and combines data about the health status of the regional population by disease category and stage, with best practice guidelines to estimate the clinical skill requirement or competencies for the region. The translation of the skill requirement into a service requirement can then be modelled, incorporating various assumptions about the occupation group to deliver nominated competencies. The service requirement, when compared with current service delivery, defines the gap or surplus in services. The results of the model could be used to inform service delivery as well as a workforce supply strategy. http://www.implementationscience.com/content/3/1/35 Leonie Segal, Kim Dalziel and Tom Bolton Implementation Science 2008, 3:35 Number of accesses: 258 2008-06-18 doi:10.1186/1748-5908-3-35 Implementation Science 1748-5908 3 35 2008-06-18 Background: In an effort to ensure that all physicians have access to valid and reliable evidence on drug effectiveness, the Italian Drug Agency sponsored a free-access e-learning system, based on Clinical Evidence, called ECCE. Doctors have access to an electronic version and related clinical vignettes. Correct answers to the interactive vignettes provide Continuing Medical Education credits. The aims of this trial are to establish whether the e-learning program (ECCE) increases physicians' basic knowledge about common clinical scenarios, and whether ECCE is superior to the passive diffusion of information through the printed version of Clinical Evidence.DesignAll Italian doctors naïve to ECCE will be randomised to three groups. Group one will have access to ECCE for Clinical Evidence chapters and vignettes lot A and will provide control data for Clinical Evidence chapters and vignettes lot B; group two vice versa; group three will receive the concise printed version of Clinical Evidence. There are in fact two designs: a before and after pragmatic trial utilising a two by two incomplete block design (group one versus group two) and a classical design (group one and two versus group three). The primary outcome will be the retention of Clinical Evidence contents assessed from the scores for clinical vignettes selected from ECCE at least six months after the intervention. To avoid test-retest effects, we will randomly select vignettes out of lot A and lot B, avoiding repetitions. In order to preserve the comparability of lots, we will select vignettes with similar, optimal psychometric characteristics.Trial registrationISRCTN27453314 http://www.implementationscience.com/content/3/1/37 Lorenzo Moja, Ivan Moschetti, Michela Cinquini, Valeria Sala, Anna Compagnoni, Piergiorgio Duca, Christian Deligant, Roberto Manfrini, Luca Clivio, Roberto Satolli, Antonio Addis, Jeremy M Grimshaw, Pietro Dri and Alessandro Liberati Implementation Science 2008, 3:37 Number of accesses: 210 2008-07-17 doi:10.1186/1748-5908-3-37 Implementation Science 1748-5908 3 37 2008-07-17 Background: The PARiHS framework (Promoting Action on Research Implementation in Health Services) has proved to be a useful practical and conceptual heuristic for many researchers and practitioners in framing their research or knowledge translation endeavours. However, as a conceptual framework it still remains untested and therefore its contribution to the overall development and testing of theory in the field of implementation science is largely unquantified.DiscussionThis being the case, the paper provides an integrated summary of our conceptual and theoretical thinking so far and introduces a typology (derived from social policy analysis) used to distinguish between the terms conceptual framework, theory and model – important definitional and conceptual issues in trying to refine theoretical and methodological approaches to knowledge translation.Secondly, the paper describes the next phase of our work, in particular concentrating on the conceptual thinking and mapping that has led to the generation of the hypothesis that the PARiHS framework is best utilised as a two-stage process: as a preliminary (diagnostic and evaluative) measure of the elements and sub-elements of evidence (E) and context (C), and then using the aggregated data from these measures to determine the most appropriate facilitation method. The exact nature of the intervention is thus determined by the specific actors in the specific context at a specific time and place.In the process of refining this next phase of our work, we have had to consider the wider issues around the use of theories to inform and shape our research activity; the ongoing challenges of developing robust and sensitive measures; facilitation as an intervention for getting research into practice; and finally to note how the current debates around evidence into practice are adopting wider notions that fit innovations more generally.SummaryThe paper concludes by suggesting that the future direction of the work on the PARiHS framework is to develop a two-stage diagnostic and evaluative approach, where the intervention is shaped and moulded by the information gathered about the specific situation and from participating stakeholders. In order to expedite the generation of new evidence and testing of emerging theories, we suggest the formation of an international research implementation science collaborative that can systematically collect and analyse experiences of using and testing the PARiHS framework and similar conceptual and theoretical approaches.We also recommend further refinement of the definitions around conceptual framework, theory, and model, suggesting a wider discussion that embraces multiple epistemological and ontological perspectives. http://www.implementationscience.com/content/3/1/1 Alison L Kitson, Jo Rycroft-Malone, Gill Harvey, Brendan McCormack, Kate Seers and Angie Titchen Implementation Science 2008, 3:1 Number of accesses: 209 2008-01-07 doi:10.1186/1748-5908-3-1 Implementation Science 1748-5908 3 1 2008-01-07 Background: The continuing gap between available evidence and current practice in health care reinforces the need for more effective solutions, in particular related to organizational context. Considerable advances have been made within the U.S. Veterans Health Administration (VA) in systematically implementing evidence into practice. These advances have been achieved through a system-level program focused on collaboration and partnerships among policy makers, clinicians, and researchers.The Quality Enhancement Research Initiative (QUERI) was created to generate research-driven initiatives that directly enhance health care quality within the VA and, simultaneously, contribute to the field of implementation science. This paradigm-shifting effort provided a natural laboratory for exploring organizational change processes. This article describes the underlying change framework and implementation strategy used to operationalize QUERI.Strategic approach to organizational changeQUERI used an evidence-based organizational framework focused on three contextual elements: 1) cultural norms and values, in this case related to the role of health services researchers in evidence-based quality improvement; 2) capacity, in this case among researchers and key partners to engage in implementation research; 3) and supportive infrastructures to reinforce expectations for change and to sustain new behaviors as part of the norm. As part of a QUERI Series in Implementation Science, this article describes the framework's application in an innovative integration of health services research, policy, and clinical care delivery. Conclusion: QUERI's experience and success provide a case study in organizational change. It demonstrates that progress requires a strategic, systems-based effort. QUERI's evidence-based initiative involved a deliberate cultural shift, requiring ongoing commitment in multiple forms and at multiple levels. VA's commitment to QUERI came in the form of visionary leadership, targeted allocation of resources, infrastructure refinements, innovative peer review and study methods, and direct involvement of key stakeholders. Stakeholders included both those providing and managing clinical care, as well as those producing relevant evidence within the health care system. The organizational framework and related implementation interventions used to achieve contextual change resulted in engaged investigators and enhanced uptake of research knowledge. QUERI's approach and progress provide working hypotheses for others pursuing similar system-wide efforts to routinely achieve evidence-based care. http://www.implementationscience.com/content/3/1/30 Cheryl B Stetler, Lynn McQueen, John Demakis and Brian S Mittman Implementation Science 2008, 3:30 Number of accesses: 199 2008-05-29 doi:10.1186/1748-5908-3-30 Implementation Science 1748-5908 3 30 2008-05-29 Background: Evidence-based practice (EBP) is an expected approach to improving the quality of patient care and service delivery in health care systems internationally that is yet to be realized. Given the current evidence-practice gap, numerous authors describe barriers to achieving EBP. One recurrently identified barrier is the setting or context of practice, which is likewise cited as a potential part of the solution to the gap. The purpose of this study is to identify key contextual elements and related strategic processes in organizations that find and use evidence at multiple levels, in an ongoing, integrated fashion, in contrast to those that do not. Methods: The core theoretical framework for this multi-method explanatory case study is Pettigrew and Whipp's Content, Context, and Process model of strategic change. This framework focuses data collection on three entities: the Why of strategic change, the What of strategic change, and the How of strategic change, in this case related to implementation and normalization of EBP. The data collection plan, designed to capture relevant organizational context and related outcomes, focuses on eight interrelated factors said to characterize a receptive context. Selective, purposive sampling will provide contrasting results between two cases (departments of nursing) and three embedded units in each. Data collection methods will include quantitative tools (e.g., regarding culture) and qualitative approaches including focus groups, interviews, and documents review (e.g., regarding integration and “success”) relevant to the EBP initiative.DiscussionThis study should provide information regarding contextual elements and related strategic processes key to successful implementation and sustainability of EBP, specifically in terms of a pervasive pattern in an acute care hospital-based health care setting. Additionally, this study will identify key contextual elements that differentiate successful implementation and sustainability of EBP efforts, both within varying levels of a hospital-based clinical setting and across similar hospital settings interested in EBP. http://www.implementationscience.com/content/2/1/3 Cheryl B Stetler, Judith Ritchie, Joanne Rycroft-Malone, Alyce Schultz and Martin Charns Implementation Science 2007, 2:3 Number of accesses: 198 2007-01-31 doi:10.1186/1748-5908-2-3 Implementation Science 1748-5908 2 3 2007-01-31 Background: Policies and procedures (P&Ps) have been suggested as one possible strategy for moving research evidence into practice among nursing staff in hospitals. Research in the area of P&Ps is limited, however. This paper explores: 1) nurses' use of eight specific research-based practices (RBPs) and RBP overall, 2) nurses' use and understanding of P&Ps, and 3) the role of P&Ps in promoting research utilization. Methods: Staff nurses from the eight health regions governing acute care services across the Canadian province of Newfoundland and Labrador completed an anonymous questionnaire regarding their use of eight RBPs and associated P&Ps. Data were also obtained from authorities in six of the eight regions about existing relevant P&Ps. We used descriptive statistics and multivariate regression analysis to assess the relationship between key independent variables and self-reported use of RBP. Results: Use of the eight RBPs ranged from 7.8% to 88.6%, depending on the practice. Nurses ranked P&P manuals as their number one source of practice knowledge. Most respondents (84.8%) reported that the main reason they consult the P&P manual is to confirm they are practicing according to agency rules. Multivariate regression analysis identified three significant predictors of being a user versus non-user of RBP overall: awareness, awareness by regular use, and persuasion. Six significant predictors of being a consistent versus less consistent user of RBP overall were also identified: perception of P&P existence, unit, nursing experience, personal experience as a source of practice knowledge, number of existing research-based P&Ps, and lack of time as a barrier to consulting P&P manuals. Conclusion: Findings suggest that nurses use P&Ps to guide their practice. However, the mere existence of P&Ps is not sufficient to translate research into nursing practice. Individual and organizational factors related to nurses' understanding and use of P&Ps also play key roles. Thus, moving research evidence into practice will require careful interplay between the organization and the individual. P&Ps may be the interface through which this occurs. http://www.implementationscience.com/content/2/1/17 Janet E Squires, Donna Moralejo and Sandra M LeFort Implementation Science 2007, 2:17 Number of accesses: 173 2007-06-05 doi:10.1186/1748-5908-2-17 Implementation Science 1748-5908 2 17 2007-06-05