Prospective use of theoretical frameworks to guide implementation: Systematic evaluation of PARIHS and development of a related implementation guide

Sahay A, Stetler CB. Prospective use of theoretical frameworks to guide implementation: Systematic evaluation of PARIHS and development of a related implementation guide. Poster session presented at: AcademyHealth Annual Research Meeting; 2012 Jun 23; Orlando, FL.

Objectives: The Promoting Action on Research Implementation in Health Services (PARIHS) conceptual framework is posited as useful for guiding design of implementation studies. The VA QUERI program initiated the "PARIHS Development Initiative" (PDI) to accelerate our collective learning about this framework, including its potential usefulness/ limitations, and to model exploration of implementation theories in general. PDI aimed to leverage combined experiences and knowledge available throughout QUERI regarding PARIHS to enhance our related understanding and guide its practical use. Methods: A structured qualitative process was used to explore use of PARIHS, as well as use of theory in general. The focus of this evaluative process was on rationale for selection of theories, how theories were used, and the strengths and weaknesses of the PARIHS framework. Documentation tools were developed to examine QUERI Strategic Plans, Annual Reports, project reports and publications spanning 2005-2009. Structured phone interviews were conducted using reflective exploration methods with QUERI researchers who were familiar with PARIHS and use of theory within their QUERI Centers. Interview and documentation notes were forwarded to participants for affirmation/clarifications. Based on final affirmation documents, step-wise content analysis and summaries were conducted across sources, foci and Centers to develop themes, all of which were iteratively refined and affirmed through consensus. Results: Findings demonstrate that theories have been increasingly used over time within QUERI, at both a macro and specific level; i.e., use ranged from providing general insights to directing specific aspects of individual projects, such as measurement. PARIHS was selected by QUERIs for reasons such as its logical, sensible appeal, and used to provide general guidance regarding implementation as well as directly inform assessment/measurement, intervention planning and analysis. Perceived strengths and limitations, along with challenges related to PARIHS use, were identified, reflecting and expanding upon the PDI's PARIHS synthesis. Conclusions: Implementation science theories, including PARIHS, are serving many functions for QUERI Centers, from provision of general insights for implementation programs to specific guidance on development and assessment of individual projects. Impact: This knowledge provides QUERI and other researchers' concrete information about general use of theory and specifically about PARIHS.