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The use of the PARIHS framework in implementation research and practice—a citation analysis of the literature Abstract Background The Promoting Action on Research Implementation in Health Services (PARIHS) framework was developed two decades ago and conceptualizes successful implementation (SI) as a function (f) of the evidence (E) nature and type, context (C) quality, and the facilitation (F), [SI = f (E,C,F)]. Despite a growing number of citations of theoretical frameworks including PARIHS, details of how theoretical frameworks are used remains largely unknown. This review aimed to enhance the understanding of the breadth and depth of the use of the PARIHS framework. Methods This citation analysis commenced from four core articles representing the key stages of the framework’s development. The citation search was performed in Web of Science and Scopus. After exclusion, we undertook an initial assessment aimed to identify articles using PARIHS and not only referencing any of the core articles. To assess this, all articles were read in full. Further data extraction included capturing information about where (country/countries and setting/s) PARIHS had been used, as well as categorizing how the framework was applied. Also, strengths and weaknesses, as well as efforts to validate the framework, were explored in detail. Results The citation search yielded 1613 articles. After applying exclusion criteria, 1475 articles were read in full, and the initial assessment yielded a total of 367 articles reported to have used the PARIHS framework. These articles were included for data extraction. The framework had been used in a variety of settings and in both high-, middle-, and low-income countries. With regard to types of use, 32% used PARIHS in planning and delivering an intervention, 50% in data analysis, 55% in the evaluation of study findings, and/or 37% in any other way. Further analysis showed that its actual application was frequently partial and generally not well elaborated. Conclusions In line with previous citation analysis of the use of theoretical frameworks in implementation science, we also found a rather superficial description of the use of PARIHS. Thus, we propose the development and adoption of reporting guidelines on how framework(s) are used in implementation studies, with the expectation that this will enhance the maturity of implementation science. Contributions to the literature • Describes how a well-established theoretical framework—PARIHS—has been operationalized in the scientific literature and provides examples of its use in implementation studies. • The findings underline that descriptions of the use of the framework generally were not that transparent and often partial. • Findings also point at difficulties in using the framework, such as lack of guidance on key steps to overcome barriers and support implementation • Identifies the need of common guidelines on how theories, models, and frameworks should be reported in research articles. Introduction There has been an increased use of theoretical frameworks in the field of implementation science in the last decade, with most developed in the last two decades [1, 2]. Tabak et al. identified 61 theoretical models used in dissemination and implementation science [3]. However, while theoretical frameworks are increasingly being cited, more research is needed to understand how they are chosen and applied, and how their use relates to improved implementation outcomes [1, 4]. Variously described in the form of theories, frameworks, or models, all strive to provide conceptual clarity on different aspects of implementation practice and research. For consistency, we will refer to these as theoretical frameworks, or simply “frameworks.” The Promoting Action on Research Implementation in Health Services (PARIHS) framework is a multi-dimensional framework which was developed to explicitly challenge the pipeline conceptualization of implementation [5]. The PARIHS framework is a commonly used conceptual framework [1, 4] that posits successful implementation (SI) as a function (f) of the nature and type of evidence (E) (including research, clinical experience, patient experience, and local information), the qualities of the context (C) of implementation (including culture, leadership, and evaluation), and the way the implementation process is facilitated (F) (internal and/or external person acting as a facilitator to enable the process of implementation); SI = f(E,C,F). The framework was informed by Rogers’ Diffusion of Innovations [6] and various organizational theories and theories from social science [7] and generated inductively by working with clinical staff to help them understand the practical nature of getting evidence into practice. The PARIHS framework was initially published in 1998 [5] and updated based on a conceptual analysis in 2002 [8] and further primary research [9]. A further refinement was undertaken in 2015 [10], resulting in the integrated or i-PARIHS. Articles using the revised version are not included in the citation analysis reported here. The PARIHS framework has been described as a determinant framework in that it specifies determinants that act as barriers and enablers influencing implementation outcomes [2]. Skolarus et al. [1] identified Kitson et al. [5] as one of the two primary originating sources of influence in their citation analysis of dissemination and implementation frameworks. Despite the growing number of citations of theoretical frameworks in scientific articles, the detail of how frameworks are used remains largely unknown. Systematic reviews of the application of two other commonly used frameworks [1], the Knowledge to Action framework [11] and the Consolidated Framework for Implementation Research [12], both reported that use of these frameworks, beyond simply citation, was uncommon. While PARIHS has been widely cited, it has also been scrutinized; in 2010, Helfrich et al. published a qualitative critical synthesis of studies that had used the PARIHS framework [13], finding six core concept articles and 18 empirical articles. One of the reported findings was that PARIHS was generally used as an organizing framework for analysis. At the time, no studies used PARIHS prospectively to design implementation strategies [13]. A systematic review applying citation analysis to map the use of PARIHS (similar to those undertaken for the Knowledge to Action framework (KTA) [11] and the Consolidated Framework for Implementation Research (CFIR) [12]) has not yet been performed. Systematic reviews can contribute to the development of existing theoretical frameworks by critically reviewing what authors state as their weaknesses and strengths; they can also direct future and current users of frameworks to examples of using the frameworks in different ways. To contribute to this development from the perspective of the PARIHS framework, we undertook a citation analysis of the published peer-reviewed literature that focused on the reported use of PARIHS (and its main elements), in what contexts the framework has been applied, and what scholars who have used the PARIHS framework (and its main elements) report as its strengths, limitations, and validity. Methods The method used for this study is citation analysis, i.e., the examination of the frequency and patterns of citations in scientific articles, in this case articles citing the core PARIHS framework publications. A team of researchers with engagement in the development and/or use of the PARIHS framework was constituted. Initially, the group decided on the core publications for the citation analysis. Four articles were selected as they represented the key stages of the framework’s development, namely the original paper that described PARIHS, plus three subsequent papers that informed and outlined revisions to the framework: Kitson A, Harvey G, McCormack B. Enabling the implementation of evidence-based practice: a conceptual framework. Qual Health Care. 1998;7(3):149-58. Rycroft-Malone J, Kitson A, Harvey G, McCormack B, Seers K, Titchen A, et al. Ingredients for change: revisiting a conceptual framework. BMJ Quality Saf. 2002;11(2):174-80. Rycroft-Malone J, Harvey G, Seers K, Kitson A, McCormack B, Titchen A. An exploration of the factors that influence the implementation of evidence into practice. J Clin Nurs. 2004;13(8):913-24. Kitson AL, Rycroft-Malone J, Harvey G, McCormack B, Seers K, Titchen A. Evaluating the successful implementation of evidence into practice using the PARiHS framework: theoretical and practical challenges. Implement Sci. 2008;3:1. Citation search Citation searches were performed by an information specialist (KG) to retrieve published articles citing any of the four core articles. The searches were performed in two citation databases: Web of Science and Scopus. The first searches were performed between 31 March 2016 and 1 April 2016. Later, 6 September 2019, additional searches were performed in respective databases. These searches were limited to citations that were published 1 April 2016–31 August 2019 to update the result from the first searches. All citations that were published September 1998 (i.e., when Kitson et al 1998 was published)–31 August 2019 (i.e., prior to the search date) in respective databases were collected in EndNote Library. Endnote was used for checking duplicates and retrieving full texts. To manage the scope of the citation analysis, we opted to only include articles in English published in peer-reviewed scientific journals. The searches in Web of Science were, because of the subscription, limited to Web of Science Core Collection without Book Citation Index. Data extraction The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram [14] for the data extraction is provided in Fig. 1. Initially, an assessment to identify the articles that used the PARIHS framework in any other way than merely referencing one or more of the core articles was performed (Additional file 1). For this initial assessment, all articles were read in full. After identifying articles where the PARIHS framework was used, data extraction was undertaken using a tailor-made data capture form (Additional file 1). The data capture form was developed and piloted in iterative cycles by the research team. Apart from capturing information about where (country/countries and setting/s) and with whom (professional groups and roles) PARIHS had been applied, the form included questions on whether PARIHS was used in one or more of the following ways: In planning and delivering an intervention, In data analysis, In the evaluation of study findings, and/or In any other way. Fig. 1 Adapted PRISMA flow diagram Each of these questions was followed by an open-ended item for extracting information on how this was reported [15]. To enhance reliability and data richness, each reviewer copy-pasted sections of the article corresponding to the open-ended reply into the data extraction form when appropriate and indicated page, column, and row. Two additional items captured whether the PARIHS framework had been tested or validated, as well as any reported strengths and weaknesses of the framework. Thus, we report on what the authors of the included articles claim to have done, rather than a judgment as to how and to what extent they actually used the PARIHS framework. For data extraction and validation, the research team was divided into four pairs, ensuring that each article was assessed separately by at least two research team members. The pairs received batches of 20 articles at a time. Variations in the assessments were discussed until consensus was reached within the pair(s). Further, queries detected within the pairs were raised and discussed with the whole research team, until consensus was achieved. Regular whole-team online meetings were held to consolidate findings between every new batch of articles and throughout the development and analysis process. In total, the group had > 20 online meetings and four face-to-face meetings from the initial establishment of the group in January 2015. Data analysis Categorical data were analyzed using descriptive statistics, whereas the open-ended items were analyzed qualitatively [16], including the collated extractions of data to illustrate each of the four types of use (i.e., how the PARIHS framework was depicted in terms of (1) planning and delivering an intervention, (2) analysis, (3) evaluation of study findings, and/or (4) in any other way). Applying a content analysis approach [17], members of the research team worked separately with the texts extracted from the reviewed articles. The extracts for each open-ended item were read and reread, to get a sense of the whole. Next, variations were identified and formed as categories. Findings for each question were summarized in short textual descriptions, which were shared with the whole team. In a face-to-face meeting, the data relating to each question were critically discussed and comparisons were made between the findings for each question, to identify overlaps and relationships about how PARIHS has been used. Results After duplicate control, 1613 references remained. These were sorted by language and type of publication. In this phase, 131 references categorized as books, book chapters, conference proceedings, and publications written in non-English language were excluded. Also, three of the four core articles (i.e., the three citing Kitson et al. [5] which was the starting point for development of the PARIHS framework and therefore did not appear in the citation search) were excluded from the database [8, 9, 18], as were four articles expanding and refining PARIHS [19–22]. Accordingly, 1475 articles remained, and after the assessment excluding those merely citing PARIHS, a further 1108 articles were excluded, leaving 367 articles that cited one or more of the core articles, and made explicit use of the PARIHS framework (see Fig. 1 and Table 1). Table 1 List of articles for data extraction for citation analysis of the use of the PARIHS framework. The table is sorted on type of article, type of use of the PARIHS framework, author and year of publication Authors Ref Year of publ. Full title Country(ies) Setting PARIHS used: Type of article To plan/deliver an intervention In the analysisa In the evaluation of findings In any other way Chinman, Daniels, et al. [23] 2017 Provision of peer specialist services in VA patient aligned care teams: Protocol for testing a cluster randomized implementation trial USA Primary health care setting ✓ ✓ ✓ Protocol Gordon, Lee, et al. [24] 2018 A complex culturally targeted intervention to reduce Hispanic disparities in living kidney donor transplantation: An effectiveness-implementation hybrid study protocol USA Community/Social care setting ✓ ✓ ✓ Protocol Roberge, Fournier, et al. [25] 2013 Implementing a knowledge application program for anxiety and depression in community-based primary mental health care: A multiple case study research protocol Canada Primary health care setting ✓ ✓ ✓ Protocol Blanco-Mavillard, Bennasar-Veny, et al. [26] 2018 Implementation of a knowledge mobilization model to prevent peripheral venous catheter-related adverse events: PREBACP study-a multicenter cluster-randomized trial protocol Spain Hospital setting ✓ ✓ Protocol Bucknall, Harvey, et al. [27] 2017 Prioritizing Responses Of Nurses To deteriorating patient Observations (PRONTO) protocol: Testing the effectiveness of a facilitation intervention in a pragmatic, cluster-randomized trial with an embedded process evaluation and cost analysis Australia Hospital setting ✓ ✓ Protocol Chouinard, Hudon, et al. [28] 2013 Case management and self-management support for frequent users with chronic disease in primary care: A pragmatic randomized controlled trial Canada Primary health care setting ✓ ✓ Protocol Cully, Armento, et al. [29] 2012 Brief cognitive behavioral therapy in primary care: a hybrid type 2 patient-randomized effectiveness-implementation design USA Primary health care setting ✓ ✓ Protocol Gurung, Jha, et al. [30] 2019 Scaling Up Safer Birth Bundle Through Quality Improvement in Nepal (SUSTAIN) a stepped wedge cluster randomized controlled trial in public hospitals Nepal Hospital setting ✓ ✓ Protocol Owen, Drummond, et al. [31] 2013 Monitoring and managing metabolic effects of antipsychotics: A cluster randomized trial of an intervention combining evidence-based quality improvement and external facilitation USA Multiple settings ✓ ✓ Protocol Powell, Kitson, et al. [32] 2013 A study protocol for applying the co-creating knowledge translation framework to a population health study Australia Public health ✓ ✓ Protocol Rycroft-Malone, Anderson, et al. [33] 2014 Accessibility and implementation in UK services of an effective depression relapse prevention program - mindfulness-based cognitive therapy (MBCT): ASPIRE study protocol UK Not reported ✓ ✓ Protocol Rycroft-Malone, Dopson, et al. [34] 2009 Study protocol for the translating research in elder care (TREC): Building context through case studies in long-term care project (project two) Canada Community/Social care setting ✓ ✓ Protocol Rycroft-Malone, Wilkinson, et al. [35] 2011 Implementing health research through academic and clinical partnerships: A realistic evaluation of the Collaborations for Leadership in Applied Health Research and Care (CLAHRC) UK Multiple settings ✓ ✓ Protocol Kilbourne, Almirall, et al. [36] 2014 Protocol: Adaptive Implementation of Effective Programs Trial (ADEPT): Cluster randomized SMART trial comparing a standard versus enhanced implementation strategy to improve outcomes of a mood disorders program USA Community/Social care setting ✓ ✓ Protocol McGilton, Davis, et al. [37] 2012 An inpatient rehabilitation model of care targeting patients with cognitive impairment Canada Multiple settings ✓ ✓ Protocol Botti, Kent, et al. [38] 2014 Development of a Management Algorithm for Post-operative Pain (MAPP) after total knee and total hip replacement: Study rationale and design Australia Hospital setting ✓ Protocol Cadilhac, Andrew, et al. [39] 2018 Improving quality and outcomes of stroke care in hospitals: Protocol and statistical analysis plan for the Stroke123 implementation study Australia Hospital setting ✓ Protocol Perez, Russo, et al. [40] 2013 Comparison of high and low intensity contact between secondary and primary care to detect people at ultra-high risk for psychosis: Study protocol for a theory-based, cluster randomized controlled trial UK Primary health care setting ✓ Protocol Ray-Barruel, Cooke, et al. [41] 2018 Implementing the I-DECIDED clinical decision-making tool for peripheral intravenous catheter assessment and safe removal: protocol for an interrupted time-series study Australia Hospital setting ✓ Protocol Saint, Olmsted, et al. [42] 2009 Translating health care-associated urinary tract infection prevention research into practice via the bladder bundle USA Hospital setting ✓ Protocol Sampson, Feast, et al. [43] 2019 Evidence-based intervention to reduce avoidable hospital admissions in care home residents (the Better Health in Residents in Care Homes (BHiRCH) study): Protocol for a pilot cluster randomized trial UK Community/Social care setting ✓ Protocol Seers, Cox, et al. [44] 2012 FIRE (facilitating implementation of research evidence): A study protocol UK, Ireland, Sweden, Netherlands Community/Social care setting ✓ Protocol Skene, Gerrish, et al. [45] 2016 Developing family-centered care in a neonatal intensive care unit: An action research study protocol UK Hospital setting ✓ Protocol Wallin, Målqvist, et al. [46] 2011 Implementing knowledge into practice for improved neonatal survival; A cluster-randomized, community-based trial in Quang Ninh province, Vietnam Vietnam Community/Social care setting ✓ Protocol Conklin, Kothari, et al. [47] 2011 Knowledge-to-action processes in SHRTN collaborative communities of practice: A study protocol Canada Multiple settings ✓ ✓ Protocol Estabrooks, Squires, et al. [48] 2009 Study protocol for the translating research in elder care (TREC): Building context - An organizational monitoring program in long-term care project (project one) Canada Community/Social care setting ✓ ✓ Protocol Kitson, Schultz, et al. [49] 2013 The prevention and reduction of weight loss in an acute tertiary care setting: Protocol for a pragmatic stepped wedge randomized cluster trial (the PRoWL project) Australia Hospital setting ✓ ✓ Protocol Noyes, Williams, et al. [50] 2010 Evidence into practice: Evaluating a child-centred intervention for diabetes medicine management The EPIC Project UK Multiple settings ✓ ✓ Protocol Chao, Chang, et al. [51] 2016 Adjunctive acupuncture for pain and symptom management in the inpatient setting: protocol for a pilot hybrid effectiveness-implementation study USA Hospital setting ✓ Protocol Hack, Ruether, et al. [52] 2011 Study protocol: Addressing evidence and context to facilitate transfer and uptake of consultation recording use in oncology: A knowledge translation implementation study Canada Hospital setting ✓ Protocol Stetler, Ritchie, et al. [53] 2007 Improving quality of care through routine, successful implementation of evidence-based practice at the bedside: An organizational case study protocol using the Pettigrew and Whipp model of strategic change USA Hospital setting ✓ Protocol Urquhart, Porter, et al. [54] 2012 Exploring the interpersonal-, organization-, and system-level factors that influence the implementation and use of an innovation-synoptic reporting-in cancer care Canada Hospital setting ✓ Protocol Watkins, Nagle, et al. [55] 2017 Labouring Together: Collaborative alliances in maternity care in Victoria, Australia-protocol of a mixed-methods study Australia Hospital setting ✓ Protocol De Pedro-Gómez, Morales-Asencio, et al. [56] 2012 Determining factors in evidence-based clinical practice among hospital and primary care nursing staff Spain Multiple settings ✓ Protocol Slaughter, Estabrooks, et al. [57] 2013 Sustaining Transfers through Affordable Research Translation (START): Study protocol to assess knowledge translation interventions in continuing care settings Canada Community/Social care setting ✓ Protocol Eriksson, Huy, et al. [58] 2016 Process evaluation of a knowledge translation intervention using facilitation of local stakeholder groups to improve neonatal survival in the Quang Ninh province, Vietnam Vietnam Primary health care setting ✓ ✓ ✓ ✓ Empirical study Eriksson, Nga, et al. [59] 2011 Newborn care and knowledge translation - perceptions among primary healthcare staff in northern Vietnam Vietnam Community/Social care setting ✓ ✓ ✓ ✓ Empirical study Long-Tounsel, Wilson, et al. [60] 2014 Urban and Suburban Hospital System Implementation of Multipoint Access Targeted Temperature Management in Postcardiac Arrest Patients USA Hospital setting ✓ ✓ ✓ ✓ Empirical study McWilliam, Kothari, et al. [61] 2009 Evolving the theory and praxis of knowledge translation through social interaction: A social phenomenological study Canada Community/Social care setting ✓ ✓ ✓ ✓ Empirical study Obrecht, Van Hulle Vincent, et al. [62] 2014 Implementation of evidence-based practice for a pediatric pain assessment instrument USA Hospital setting ✓ ✓ ✓ ✓ Empirical study Allen, Hall, et al. [63] 2018 Improving hospital environmental hygiene with the use of a targeted multi-modal bundle strategy Australia Hospital setting ✓ ✓ ✓ Empirical study Bahtsevani and Idvall [64] 2016 To Assess Prerequisites before an Implementation Strategy in an Orthopaedic Department in Sweden Sweden Hospital setting ✓ ✓ ✓ Empirical study Bamford, Rothwell, et al. [65] 2013 Improving care for people after stroke: How change was actively facilitated UK Multiple settings ✓ ✓ ✓ Empirical study Brenner, Breshears, et al. [66] 2011 Implementation of a Suicide Nomenclature within Two VA Healthcare Settings USA Multiple settings ✓ ✓ ✓ Empirical study Brown and McCormack [67] 2016 Exploring psychological safety as a component of facilitation within the Promoting Action on Research Implementation in Health Services framework UK Hospital setting ✓ ✓ ✓ Empirical study Diffin, Ewing, et al. [68] 2018 Facilitating successful implementation of a person-centred intervention to support family carers within palliative care: a qualitative study of the Carer Support Needs Assessment Tool (CSNAT) intervention UK Multiple settings ✓ ✓ ✓ Empirical study Diffin, Ewing, et al. [69] 2018 The Influence of Context and Practitioner Attitudes on Implementation of Person-Centered Assessment and Support for Family Carers Within Palliative Care UK Community/Social care setting ✓ ✓ ✓ Empirical study Drainoni, Koppelman, et al. [70] 2016 Why is it so hard to implement change? A qualitative examination of barriers and facilitators to distribution of naloxone for overdose prevention in a safety net environment USA Hospital setting ✓ ✓ ✓ Empirical study Ellis, Howard, et al. [71] 2005 From workshop to work practice: An exploration of context and facilitation in the development of evidence-based practice Australia Hospital setting ✓ ✓ ✓ Empirical study Gerrish, Laker, et al. [72] 2016 Enhancing the quality of oral nutrition support for hospitalized patients: a mixed methods knowledge translation study (The EQONS study) UK Hospital setting ✓ ✓ ✓ Empirical study Gesthalter, Koppelman, et al. [73] 2017 Evaluations of Implementation at Early-Adopting Lung Cancer Screening Programs: Lessons Learned USA Multiple settings ✓ ✓ ✓ Empirical study Harris, Jones, et al. [74] 2015 Changing practice to support self-management and recovery in mental illness: Application of an implementation model Australia Community/Social care setting ✓ ✓ ✓ Empirical study Harvey, McCormack, et al. [75] 2018 Designing and implementing two facilitation interventions within the "Facilitating Implementation of Research Evidence (FIRE)' study: a qualitative analysis from an external facilitators' perspective UK, Ireland, Netherlands, Sweden Community/Social care setting ✓ ✓ ✓ Empirical study Houle, Charrois, et al. [76] 2017 A randomized controlled study of practice facilitation to improve the provision of medication management services in Alberta community pharmacies Canada Community/Social care setting ✓ ✓ ✓ Empirical study Jangland and Gunningberg [77] 2017 Improving patient participation in a challenging context: a 2-year evaluation study of an implementation project Sweden Hospital setting ✓ ✓ ✓ Empirical study Lewis, Kitson, et al. [78] 2016 Improving oral health for older people in the home care setting: An exploratory implementation study Australia Home-based care ✓ ✓ ✓ Empirical study Lindsay, Kauth, et al. [79] 2015 Implementation of Video Telehealth to Improve Access to Evidence-Based Psychotherapy for Posttraumatic Stress Disorder USA Multiple settings ✓ ✓ ✓ Empirical study Mekki, Øye, et al. [80] 2017 The inter-play between facilitation and context in the promoting action on research implementation in health services framework: A qualitative exploratory implementation study embedded in a cluster randomized controlled trial to reduce restraint in nursing homes Norway Community/Social care setting ✓ ✓ ✓ Empirical study Parlour and McCormack [81] 2012 Blending critical realist and emancipatory practice development methodologies: Making critical realism work in nursing research Ireland Community/Social care setting ✓ ✓ ✓ Empirical study Persson, Nga, et al. [82] 2013 Effect of Facilitation of Local Maternal-and-Newborn Stakeholder Groups on Neonatal Mortality: Cluster-Randomized Controlled Trial Vietnam Primary health care setting ✓ ✓ ✓ Empirical study Rycroft-Malone, Fontenla, et al. [83] 2009 Protocol-based care: The standardisation of decision-making? UK Hospital setting ✓ ✓ ✓ Empirical study Rycroft-Malone, Seers, et al. [84] 2012 A pragmatic cluster randomised trial evaluating three implementation interventions UK Hospital setting ✓ ✓ ✓ Empirical study Rycroft-Malone, Seers, et al. [85] 2013 The role of evidence, context, and facilitation in an implementation trial: Implications for the development of the PARIHS framework UK Hospital setting ✓ ✓ ✓ Empirical study Rycroft-Malone, Seers, et al. [86] 2018 A realist process evaluation within the Facilitating Implementation of Research Evidence (FIRE) cluster randomised controlled international trial: An exemplar Ireland, UK, Netherlands, Sweden Community/Social care setting ✓ ✓ ✓ Empirical study Slaughter and Estabrooks [87] 2013 Optimizing the mobility of residents with dementia: A pilot study promoting healthcare aide uptake of a simple mobility innovation in diverse nursing home settings Canada Community/Social care setting ✓ ✓ ✓ Empirical study Sving, Fredriksson, et al. [88] 2017 Getting evidence-based pressure ulcer prevention into practice: a process evaluation of a multifaceted intervention in a hospital setting Sweden Hospital setting ✓ ✓ ✓ Empirical study Walsh, Ford, et al. [89] 2017 The Development and Implementation of a Participatory and Solution-Focused Framework for Clinical Research: A case example Australia Hospital setting ✓ ✓ ✓ Empirical study Mignogna, Hundt, et al. [90] 2014 Implementing brief cognitive behavioral therapy in primary care: A pilot study USA Primary health care setting ✓ ✓ ✓ Empirical study Alkema and Frey [91] 2006 Implications of translating research into practice: A medication management intervention USA Home-based care ✓ ✓ Empirical study Kilbourne, Abraham, et al. [92] 2013 Cluster randomized adaptive implementation trial comparing a standard versus enhanced implementation intervention to improve uptake of an effective re-engagement program for patients with serious mental illness USA Multiple settings ✓ ✓ Empirical study Mignogna, Martin, et al. [93] 2018 I had to somehow still be flexible: exploring adaptations during implementation of brief cognitive behavioral therapy in primary care USA Primary health care setting ✓ ✓ Empirical study Westergren [94] 2012 Action-oriented study circles facilitate efforts in nursing homes to go from feeding to serving: Conceptual perspectives on knowledge translation and workplace learning Sweden Community/Social care setting ✓ ✓ Empirical study Baloh, Zhu, et al. [95] 2018 Types of internal facilitation activities in hospitals implementing evidence-based interventions USA Hospital setting ✓ ✓ ✓ Empirical study Snelgrove-Clarke, Davies, et al. [96] 2015 Implementing a Fetal Health Surveillance Guideline in Clinical Practice: A Pragmatic Randomized Controlled Trial of Action Learning Canada Hospital setting ✓ ✓ ✓ Empirical study Wallin, Rudberg, et al. [97] 2005 Staff experiences in implementing guidelines for Kangaroo Mother Care - A qualitative study Sweden Hospital setting ✓ ✓ ✓ Empirical study Bidassie, Williams, et al. [98] 2015 Key components of external facilitation in an acute stroke quality improvement collaborative in the Veterans Health Administration USA Hospital setting ✓ ✓ Empirical study Doran, Haynes, et al. [99] 2012 The role of organizational context and individual nurse characteristics in explaining variation in use of information technologies in evidence based practice Canada Multiple settings ✓ ✓ Empirical study Fortney, Enderle, et al. [100] 2012 Implementation outcomes of evidence-based quality improvement for depression in VA community based outpatient clinics USA Multiple settings ✓ ✓ Empirical study Foss, Kvigne, et al. [101] 2014 A model (CMBP) for collaboration between university college and nursing practice to promote research utilization in students' clinical placements: A pilot study Norway Educational setting ✓ ✓ Empirical study Johnson, Ostaszkiewicz, et al. [102] 2009 Moving beyond resistance to restraint minimization: A case study of change management in aged care Australia Community/Social care setting ✓ ✓ Empirical study Kavanagh, Stevens, et al. [103] 2010 Process evaluation of appreciative inquiry to translate pain management evidence into pediatric nursing practice Canada Hospital setting ✓ ✓ Empirical study Kinley, Stone, et al. [104] 2014 The effect of using high facilitation when implementing the Gold Standards Framework in Care Homes program: A cluster randomized controlled trial UK Community/Social care setting ✓ ✓ Empirical study Lewis, Harvey, et al. [105] 2019 Can oral healthcare for older people be embedded into routine community aged care practice? A realist evaluation using normalization process theory Australia Home-based care ✓ ✓ Empirical study McGilton, Sorin-Peters, et al. [106] 2018 The effects of an interprofessional patient-centered communication intervention for patients with communication disorders Canada Hospital setting ✓ ✓ Empirical study McLean, Torkington, et al. [107] 2019 Development, Implementation, and Outcomes of Post-stroke Mood Assessment Pathways: Implications for Social Workers Australia Hospital setting ✓ ✓ Empirical study O'Halloran, Cran, et al. [108] 2007 Factors affecting adherence to use of hip protectors among residents of nursing homes - A correlation study UK Community/Social care setting ✓ ✓ Empirical study Pallangyo, Mbekenga, et al. [109] 2017 “If really we are committed things can change, starting from us”: Healthcare providers’ perceptions of postpartum care and its potential for improvement in low-income suburbs in Dar es Salaam, Tanzania Tanzania Multiple settings ✓ ✓ Empirical study Pallangyo, Mbekenga, et al. [110] 2018 Implementation of a facilitation intervention to improve postpartum care in a low-resource suburb of Dar es Salaam, Tanzania Tanzania Multiple settings ✓ ✓ Empirical study Russell-Babin and Miley [111] 2013 Implementing the best available evidence in early delirium identification in elderly hip surgery patients USA Hospital setting ✓ ✓ Empirical study Rycroft-Malone, Wilkinson, et al. [112] 2013 Collaborative action around implementation in Collaborations for Leadership in Applied Health Research and Care: toward a program theory UK Multiple settings ✓ ✓ Empirical study Seers, Rycroft-Malone, et al. [113] 2018 Facilitating Implementation of Research Evidence (FIRE): An international cluster randomized controlled trial to evaluate two models of facilitation informed by the Promoting Action on Research Implementation in Health Services (PARIHS) framework UK, Ireland, Netherlands, Sweden Community/Social care setting ✓ ✓ Empirical study Sigel, Kramer, et al. [114] 2013 Statewide dissemination of trauma-focused cognitive-behavioral therapy (TF-CBT) USA Multiple settings ✓ ✓ Empirical study Stevens, Yamada, et al. [115] 2016 Pain assessment and management after a knowledge translation booster intervention Canada Hospital setting ✓ ✓ Empirical study Sving, Högman, et al. [116] 2016 Getting evidence-based pressure ulcer prevention into practice: a multi-faceted unit-tailored intervention in a hospital setting Sweden Hospital setting ✓ ✓ Empirical study Tian, Yang, et al. [117] 2017 Implementation of evidence into practice for cancer-related fatigue management of hospitalized adult patients using the PARIHS framework China Hospital setting ✓ ✓ Empirical study Tucker, Bieber, et al. [118] 2012 Outcomes and Challenges in Implementing Hourly Rounds to Reduce Falls in Orthopedic Units USA Hospital setting ✓ ✓ Empirical study Weir, Brunker, et al. [119] 2017 Making cognitive decision support work: Facilitating adoption, knowledge and behavior change through QI USA Primary health care setting ✓ ✓ Empirical study Williams, Woodby, et al. [120] 2014 Formative Evaluation of a Multi-Component, Education-Based Intervention to Improve Processes of End-of-Life Care USA Hospital setting ✓ ✓ Empirical study Yurumezoglu and Kocaman [121] 2012 Pilot study for evidence-based nursing management: Improving the levels of job satisfaction, organizational commitment, and intent to leave among nurses in Turkey Turkey Hospital setting ✓ ✓ Empirical study Brosey and March [122] 2015 Effectiveness of Structured Hourly Nurse Rounding on Patient Satisfaction and Clinical Outcomes USA Hospital setting ✓ ✓ Empirical study Chinman, Acosta, et al. [123] 2013 Intervening with Practitioners to Improve the Quality of Prevention: One-Year Findings from a Randomized Trial of Assets-Getting To Outcomes USA Community/Social care setting ✓ ✓ Empirical study Glegg [124] 2010 Knowledge brokering as an intervention in paediatric rehabilitation practice Canada Not reported ✓ ✓ Empirical study Harvey, Oliver, et al. [125] 2015 Improving the identification and management of chronic kidney disease in primary care: Lessons from a staged improvement collaborative UK Primary health care setting ✓ ✓ Empirical study Humphreys, Harvey, et al. [126] 2012 A collaborative project to improve identification and management of patients with chronic kidney disease in a primary care setting in Greater Manchester UK Not reported ✓ ✓ Empirical study Kauth, Sullivan, et al. [127] 2010 Employing external facilitation to implement cognitive behavioral therapy in VA clinics: A pilot study USA Not reported ✓ ✓ Empirical study Almblad, Siltberg, et al. [128] 2018 Implementation of Pediatric Early Warning Score; Adherence to Guidelines and Influence of Context Sweden Hospital setting ✓ Empirical study Amaya-Jackson, Hagele, et al. [129] 2018 Pilot to policy: statewide dissemination and implementation of evidence-based treatment for traumatized youth USA Community/Social care setting ✓ Empirical study Anderson, Zlateva, et al. [130] 2016 Improving pain care through implementation of the stepped care model at a multisite community health center USA Primary health care setting ✓ Empirical study Bailey, Williams, et al. [131] 2014 Intervention to Improve Care at Life's End in Inpatient Settings: The BEACON Trial USA Hospital setting ✓ Empirical study Bunch, Leasure, et al. [132] 2016 Implementation of a rapid chest pain protocol in the emergency department: A quality improvement project USA Hospital setting ✓ Empirical study Gutmanis, Snyder, et al. [133] 2015 Health care redesign for responsive behaviours - The behavioural supports Ontario experience: Lessons learned and keys to success Canada Multiple settings ✓ Empirical study McGilton, Rochon, et al. [134] 2017 Can We Help Care Providers Communicate More Effectively With Persons Having Dementia Living in Long-Term Care Homes? Canada Community/Social care setting ✓ Empirical study Murphy, Gardner, et al. [135] 2014 A theory-informed approach to mental health care capacity building for pharmacists Canada Pharmacies ✓ Empirical study Musanti, O'Keefe, et al. [136] 2012 Partners in caring: An innovative nursing model of care delivery USA Hospital setting ✓ Empirical study O'Brien, Redley, et al. [137] 2018 STOPDVTs: Development and testing of a clinical assessment tool to guide nursing assessment of postoperative patients for Deep Vein Thrombosis Australia Hospital setting ✓ Empirical study Orsted, Rosenthal, et al. [138] 2009 Pressure ulcer awareness and prevention program: A quality improvement program through the Canadian association of wound care Canada Multiple settings ✓ Empirical study Rutledge and Skelton [139] 2011 Clinical expert facilitators of evidence-based practice: A community hospital program USA Hospital setting ✓ Empirical study Ryan, Barnett, et al. [140] 2013 Geriatrics, interprofessional practice, and interorganizational collaboration: A knowledge-to-practice intervention for primary care teams Canada Primary health care setting ✓ Empirical study Sadasivam, Hogan, et al. [141] 2013 Implementing point of care "e-referrals" in 137 clinics to increase access to a quit smoking internet system: The Quit-Primo and National Dental PBRN HI-QUIT Studies USA Primary health care setting ✓ Empirical study Smith, Almirall, et al. [142] 2019 Change in Patient Outcomes After Augmenting a Low-level Implementation Strategy in Community Practices That Are Slow to Adopt a Collaborative Chronic Care Model A Cluster Randomized Implementation Trial USA Community/Social care setting ✓ Empirical study Stevens, Yamada, et al. [143] 2014 Pain in hospitalized children: Effect of a multidimensional knowledge translation strategy on pain process and clinical outcomes Canada Hospital setting ✓ Empirical study Tilson, Mickan, et al. [144] 2016 Promoting physical therapists' use of research evidence to inform clinical practice: part 3-long term feasibility assessment of the PEAK program USA Multiple settings ✓ Empirical study Tistad, Palmcrantz, et al. [145] 2016 Developing leadership in managers to facilitate the implementation of national guideline recommendations: A process evaluation of feasibility and usefulness Sweden Multiple settings ✓ Empirical study Toole, Stichler, et al. [146] 2013 Promoting nurses' knowledge in evidence-based practice: Do educational methods matter? USA Hospital setting ✓ Empirical study Westergren, Axelsson, et al. [147] 2009 Study circles improve the precision in nutritional care in special accommodations Sweden Community/Social care setting ✓ Empirical study Young, Banks, et al. [148] 2018 Improving nutrition care and intake for older hospital patients through system-level dietary and mealtime interventions Australia Hospital setting ✓ Empirical study Balbale, Hill, et al. [149] 2015 Evaluating implementation of methicillin-resistant Staphylococcus aureus (MRSA) prevention guidelines in spinal cord injury centers using the PARIHS framework: A mixed methods study USA Hospital setting ✓ ✓ ✓ Empirical study Bergström, Peterson, et al. [150] 2012 Knowledge translation in Uganda: A qualitative study of Ugandan midwives' and managers' perceived relevance of the sub-elements of the context cornerstone in the PARIHS framework Uganda Multiple settings ✓ ✓ ✓ Empirical study Boblin, Ireland, et al. [151] 2013 Using Stake's Qualitative Case Study Approach to Explore Implementation of Evidence-Based Practice Canada Hospital setting ✓ ✓ ✓ Empirical study Cammer, Morgan, et al. [152] 2014 The hidden complexity of long-term care: How context mediates knowledge translation and use of best practices Canada Community/Social care setting ✓ ✓ ✓ Empirical study Cummings, Estabrooks, et al. [153] 2007 Influence of organizational characteristics and context on research utilization Canada Hospital setting ✓ ✓ ✓ Empirical study Estabrooks, Midodzi, et al. [154] 2007 Predicting research use in nursing organizations: A multilevel analysis Canada Hospital setting ✓ ✓ ✓ Empirical study Estabrooks, Squires, et al. [155] 2009 Development and assessment of the Alberta Context Tool Canada Hospital setting ✓ ✓ ✓ Empirical study Estabrooks, Squires, et al. [156] 2011 Advancing the argument for validity of the Alberta Context Tool with healthcare aides in residential long-term care Canada Community/Social care setting ✓ ✓ ✓ Empirical study Gagliardi, Webster, et al. [157] 2014 How does context influence collaborative decision-making for health services planning, delivery and evaluation? Canada Hospital setting ✓ ✓ ✓ Empirical study Gibb [158] 2013 An environmental scan of an aged care workplace using the PARiHS model: Assessing preparedness for change Australia Community/Social care setting ✓ ✓ ✓ Empirical study Helfrich, Li, et al. [159] 2009 Organizational readiness to change assessment (ORCA): Development of an instrument based on the promoting action on research in health services (PARIHS) framework USA Multiple settings ✓ ✓ ✓ Empirical study Kristensen and Hounsgaard [160] 2013 Implementation of coherent, evidence-based pathways in Danish rehabilitation practice Denmark Multiple settings ✓ ✓ ✓ Empirical study Malte, McFall, et al. [161] 2013 Survey of providers' attitudes toward integrating smoking cessation treatment into posttraumatic stress disorder care USA Hospital setting ✓ ✓ ✓ Empirical study McCormack, McCarthy, et al. [162] 2009 Development and testing of the Context Assessment Index (CAI) Ireland, Northern Ireland, UK Multiple settings ✓ ✓ ✓ Empirical study McCullough, Chou, et al. [163] 2015 The interplay of contextual elements in implementation: An ethnographic case study USA Multiple settings ✓ ✓ ✓ Empirical study Palmcrantz, Tistad, et al. [164] 2015 Assessing feasibility and acceptability of study procedures: getting ready for implementation of national stroke guidelines in out-patient health care Sweden Primary health care setting ✓ ✓ ✓ Empirical study Schultz and Kitson [165] 2010 Measuring the context of care in an Australian acute care hospital: A nurse survey Australia Hospital setting ✓ ✓ ✓ Empirical study Stolee, Steeves, et al. [166] 2010 Health information use in home care: Brainstorming barriers, facilitators, and recommendations Canada Home-based care ✓ ✓ ✓ Empirical study Urquhart, Sargeant, et al. [167] 2011 Factors related to the implementation and use of an innovation in cancer surgery Canada Hospital setting ✓ ✓ ✓ Empirical study Watts, Shiner, et al. [168] 2014 Implementation of evidence-based psychotherapies for posttraumatic stress disorder in VA specialty clinics USA Hospital setting ✓ ✓ ✓ Empirical study Wente and Kleiber [169] 2013 An Exploration of Context and the Use of Evidence-Based Nonpharmacological Practices in Emergency Departments USA Hospital setting ✓ ✓ ✓ Empirical study Zubkoff, Carpenter-Song, et al. [170] 2016 Clinicians’ Perception of Patient Readiness for Treatment: An Emerging Theme in Implementation Science? USA Primary health care setting ✓ ✓ ✓ Empirical study Arling, Doebbeling, et al. [171] 2011 Improving the implementation of evidence-based practice and information systems in healthcare: A social network approach Canada Multiple settings ✓ ✓ Empirical study Bahtsevani, Willman, et al. [172] 2008 Developing an instrument for evaluating implementation of clinical practice guidelines: A test-retest study Sweden Hospital setting ✓ ✓ Empirical study Boaz, Baeza, et al. [173] 2016 Does the "diffusion of innovations' model enrich understanding of research use? Case studies of the implementation of thrombolysis services for stroke UK and Sweden Hospital setting ✓ ✓ Empirical study Boström, Wallin, et al. [174] 2007 Evidence-based practice and determinants of research use in elderly care in Sweden Sweden Community/Social care setting ✓ ✓ Empirical study Butow, Williams, et al. [175] 2019 A psychological intervention (ConquerFear) for treating fear of cancer recurrence: Views of study therapists regarding sustainability Australia Hospital setting ✓ ✓ Empirical study Carlan, Kramer, et al. [176] 2012 Digging into construction: Social networks and their potential impact on knowledge transfer Canada Construction setting ✓ ✓ Empirical study Chou, Graber, et al. [177] 2018 Specifying an implementation framework for Veterans Affairs antimicrobial stewardship programmes: using a factor analysis approach USA Multiple settings ✓ ✓ Empirical study Conklin and Stolee [178] 2008 A model for evaluating knowledge exchange in a network context Canada Community/Social care setting ✓ ✓ Empirical study Conklin, Lusk, et al. [179] 2013 Knowledge brokers in a knowledge network: The case of Seniors Health Research Transfer Network knowledge brokers Canada Not reported ✓ ✓ Empirical study Cummings, Hutchinson, et al. [180] 2010 The relationship between characteristics of context and research utilization in a pediatric setting Canada Hospital setting ✓ ✓ Empirical study Eldh, Fredriksson, et al. [181] 2014 Facilitators and barriers to applying a national quality registry for quality improvement in stroke care Sweden Hospital setting ✓ ✓ Empirical study Elnitsky, Powell-Cope, et al. [182] 2015 Implementation of Safe Patient Handling in the US Veterans Health System: A Qualitative Study of Internal Facilitators' Perceptions USA Hospital setting ✓ ✓ Empirical study Eriksson, Eriksson, et al. [183] 2019 Occupational therapists’ perceptions of implementing a client-centered intervention in close collaboration with researchers: A mixed methods study Sweden multiple settings ✓ ✓ Empirical study Forberg, Unbeck, et al. [184] 2016 Effects of computer reminders on complications of peripheral venous catheters and nurses' adherence to a guideline in paediatric care-a cluster randomised study Sweden Hospital setting ✓ ✓ Empirical study Gifford, Tavakoli, et al. [185] 2015 Implementation of Smoking Cessation Treatment in VHA Substance Use Disorder Residential Treatment Programs USA Community/Social care setting ✓ ✓ Empirical study Hack, Ruether, et al. [186] 2013 Promoting consultation recording practice in oncology: Identification of critical implementation factors and determination of patient benefit Canada Hospital setting ✓ ✓ Empirical study Hill, Guihan, et al. [187] 2017 Use of the PARIHS Framework for Retrospective and Prospective Implementation Evaluations USA Multiple settings ✓ ✓ Empirical study Holt, Pankow, et al. [188] 2018 Factors associated with using research evidence in national sport organisations Canada Not reported ✓ ✓ Empirical study Hurtubise, Rivard, et al. [189] 2016 Virtual Knowledge Brokering: Describing the Roles and Strategies Used by Knowledge Brokers in a Pediatric Physiotherapy Virtual Community of Practice Canada Not reported ✓ ✓ Empirical study Hølge-Hazelton, Bruun, et al. [190] 2019 Danish Translation and Adaptation of the Context Assessment Index With Implications for Evidence-Based Practice Danmark Hospital setting ✓ ✓ Empirical study Ismail, Squires, et al. [191] 2018 The Influence of Context on Utilizing Research Evidence for Pain Management in Jordanian Pediatric Intensive Care Units (PICU) Jordania Hospital setting ✓ ✓ Empirical study Jansson and Forsberg [192] 2016 How do nurses and ward managers perceive that evidence-based sources are obtained to inform relevant nursing interventions? - An exploratory study Sweden Hospital setting ✓ ✓ Empirical study Jansson, Pilhamar, et al. [193] 2011 Factors and conditions that have an impact in relation to the successful implementation and maintenance of individual care plans Sweden Hospital setting ✓ ✓ Empirical study Kramer, Wells, et al. [194] 2013 Did you have an impact? A theory-based method for planning and evaluating knowledge-transfer and exchange activities in occupational health and safety Canada Multiple settings ✓ ✓ Empirical study Lo, Hoben, et al. [195] 2018 Importance of clinical educators to research use and suggestions for better efficiency and effectiveness: results of a cross-sectional survey of care aides in Canadian long-term care facilities Canada Community/Social care setting ✓ ✓ Empirical study Lundell, Tistad, et al. [196] 2017 Building COPD care on shaky ground: A mixed methods study from Swedish primary care professional perspective Sweden Primary health care setting ✓ ✓ Empirical study McCalman, Tsey, et al. [197] 2014 The characteristics, implementation and effects of Aboriginal and Torres Strait Islander health promotion tools: A systematic literature search Not reported Multiple settings ✓ ✓ Empirical study McKillop, Crisp, et al. [198] 2012 Barriers and Enablers to Implementation of a New Zealand-Wide Guideline for Assessment and Management of Cardiovascular Risk in Primary Health Care: A Template Analysis New Zealand Primary health care setting ✓ ✓ Empirical study Meherali, Paul, et al. [199] 2017 Use of Research by Undergraduate Nursing Students: A Qualitative Descriptive Study Canada Not reported ✓ ✓ Empirical study Naik, Lawrence, et al. [200] 2015 Building a primary care/research partnership: Lessons learned from a telehealth intervention for diabetes and depression USA Primary health care setting ✓ ✓ Empirical study Nygårdh, Ahlström, et al. [201] 2016 Handling a challenging context: Experiences of facilitating evidence-based elderly care Sweden Community/Social care setting ✓ ✓ Empirical study Peirson, Ciliska, et al. [202] 2012 Building capacity for evidence informed decision making in public health: A case study of organizational change Canada Primary health care setting ✓ ✓ Empirical study Perry, Bellchambers, et al. [203] 2011 Examination of the utility of the Promoting Action on Research Implementation in Health Services framework for implementation of evidence based practice in residential aged care settings Australia Community/Social care setting ✓ ✓ Empirical study Sandström, Willman, et al. [204] 2015 Perceptions of national guidelines and their (non) implementation in mental healthcare: A deductive and inductive content analysis Sweden Multiple settings ✓ ✓ Empirical study Sharp, Pineros, et al. [205] 2004 A qualitative study to identify barriers and facilitators to implementation of pilot interventions in the Veterans Health Administration (VHA) Northwest network USA Hospital setting ✓ ✓ Empirical study Stetler, Legro, et al. [206] 2006 Role of "external facilitation" in implementation of research findings: A qualitative evaluation of facilitation experiences in the Veterans Health Administration USA Not reported ✓ ✓ Empirical study Stevens, Riahi, et al. [207] 2011 The Influence of Context on Pain Practices in the NICU: Perceptions of Health Care Professionals Canada Hospital setting ✓ ✓ Empirical study Ullrich, Lavela, et al. [208] 2014 Associations between perceptions of evidence and adoption of H1N1 influenza infection prevention strategies among healthcare workers providing care to persons with spinal cord injury USA Multiple settings ✓ ✓ Empirical study Ullrich, Sahay, et al. [209] 2014 Use of implementation theory: A focus on PARIHS USA Multiple settings ✓ ✓ Empirical study Vabo, Slettebø, et al. [210] 2017 Participants' perceptions of an intervention implemented in an Action Research Nursing Documentation Project Norway Multiple settings ✓ ✓ Empirical study Wallin, Estabrooks, et al. [211] 2006 Development and validation of a derived measure of research utilization by nurses Canada Not reported ✓ ✓ Empirical study Ward, Baloh, et al. [212] 2017 Promoting Action on Research Implementation in Health Services framework applied to TeamSTEPPS implementation in small rural hospitals USA Hospital setting ✓ ✓ Empirical study Wilde, Sonley, et al. [213] 2019 Mindfulness Training in UK Secondary Schools: a Multiple Case Study Approach to Identification of Cornerstones of Implementation UK Not reported ✓ ✓ Empirical study Øye, Mekki, et al. [214] 2015 Evidence Molded by Contact with Staff Culture and Patient Milieu: an Analysis of the Social Process of Knowledge Utilization in Nursing Homes Norway Community/Social care setting ✓ ✓ Empirical study Benoit and Semenic [215] 2014 Barriers and Facilitators to Implementing the Baby-Friendly Hospital Initiative in Neonatal Intensive Care Units Canada Hospital setting ✓ ✓ Empirical study Campbell and Profetto-McGrath [216] 2013 Skills and Attributes Required by Clinical Nurse Specialists to Promote Evidence-Based Practice Canada Multiple settings ✓ ✓ Empirical study Douglas, Hinckley, et al. [217] 2014 Perceptions of speech-language pathologists linked to evidence-based practice use in skilled nursing facilities USA Community/Social care setting ✓ ✓ Empirical study Gunningberg, Brudin, et al. [218] 2010 Nurse Managers' prerequisite for nursing development: A survey on pressure ulcers and contextual factors in hospital organizations Sweden Multiple settings ✓ ✓ Empirical study Hagedorn and Heideman [219] 2010 The relationship between baseline Organizational Readiness to Change Assessment subscale scores and implementation of hepatitis prevention services in substance use disorders treatment clinics: A case study USA Multiple settings ✓ ✓ Empirical study Henry Dr, Hagedorn, et al. [220] 2010 A formative evaluation of organizational readiness to implement nurse-initiated HIV rapid testing in two veterans health administration substance use disorder clinics USA Not reported ✓ ✓ Empirical study Hälleberg Nyman, Forsman, et al. [221] 2019 Promoting evidence-based urinary incontinence management in acute nursing and rehabilitation care—A process evaluation of an implementation intervention in the orthopaedic context Sweden Hospital setting ✓ ✓ Empirical study Jacobsen, Mekki, et al. [222] 2017 A mixed method study of an education intervention to reduce use of restraint and implement person-centered dementia care in nursing homes Norway Community/Social care setting ✓ ✓ Empirical study Kirkpatrick, Boblin, et al. [223] 2014 The nurse as bricoleur in falls prevention: Learning from a case study of the implementation of fall prevention best practices Canada Hospital setting ✓ ✓ Empirical study Stryczek, Lea, et al. [224] 2019 De-implementing Inhaled Corticosteroids to Improve Care and Safety in COPD Treatment: Primary Care Providers’ Perspectives USA Primary health care setting ✓ ✓ Empirical study Bokhour, Saifu, et al. [225] 2015 The role of evidence and context for implementing a multimodal intervention to increase HIV testing USA Primary health care setting ✓ Empirical study Garvin, Kim, et al. [226] 2018 Automating Quality Measures for Heart Failure Using Natural Language Processing: A Descriptive Study in the Department of Veterans Affairs USA Multiple settings ✓ Empirical study Harrison, Reddy, et al. [227] 2019 Implementing an Inpatient Acupuncture Service for Pain and Symptom Management: Identifying Opportunities and Challenges USA Hospital setting ✓ Empirical study Hawkins, Malte, et al. [228] 2017 Survey of Primary Care and Mental Health Prescribers' Perspectives on Reducing Opioid and Benzodiazepine Co-Prescribing Among Veterans USA Multiple settings ✓ Empirical study Hoben, Estabrooks, et al. [229] 2016 Factor Structure, Reliability and Measurement Invariance of the Alberta Context Tool and the Conceptual Research Utilization Scale, for German Residential Long Term Care Germany Community/Social care setting ✓ Empirical study Hofler, Cordes, et al. [230] 2017 Implementing Immediate Postpartum Long-Acting Reversible Contraception Programs USA Hospital setting ✓ Empirical study Hommel, Gunningberg, et al. [231] 2017 Successful factors to prevent pressure ulcers – an interview study Sweden Hospital setting ✓ Empirical study Kothari, Boyko, et al. [232] 2015 Communities of practice for supporting health systems change: A missed opportunity Canada Community/Social care setting ✓ Empirical study Kristensen, Borg, et al. [233] 2012 Aspects affecting occupational therapists' reasoning when implementing research-based evidence in stroke rehabilitation Denmark Multiple settings ✓ Empirical study McCullough, Gillespie, et al. [234] 2017 Forming and activating an internal facilitation group for successful implementation: A qualitative study USA Not reported ✓ Empirical study Mocumbi, McKee, et al. [235] 2018 Ready to deliver maternal and newborn care? Health providers’ perceptions of their work context in rural Mozambique Mozambique Primary health care setting ✓ Empirical study Murphy, Washington, et al. [236] 2019 Identifying and Addressing Language Needs in Primary Care: a Pilot Implementation Study USA Primary health care setting ✓ Empirical study Rycroft-Malone, Fontenla, et al. [237] 2010 A realistic evaluation: The case of protocol-based care UK Not reported ✓ Empirical study Shimada, Hogan, et al. [238] 2013 Patient-provider secure messaging in VA: Variations in adoption and association with urgent care utilization USA Multiple settings ✓ Empirical study Stolee, Hiller, et al. [239] 2012 Flying by the Seat of Our Pants: Current Processes to Share Best Practices to Deal With Elder Abuse Canada Not reported ✓ Empirical study Tukey, Clark, et al. [240] 2016 Readiness for Implementation of Lung Cancer Screening A National Survey of Veterans Affairs Pulmonologists USA Hospital setting ✓ Empirical study Xiang, Robinson-Lane, et al. [241] 2018 Implementing and sustaining evidence-based practice in health care: The Bridge Model experience USA Community/Social care setting ✓ Empirical study Zubkoff, Shiner, et al. [242] 2016 Staff Perceptions of Substance Use Disorder Treatment in VA Primary Care–Mental Health Integrated Clinics USA Primary health care setting ✓ Empirical study Estabrooks, Kenny, et al. [243] 2007 A comparison of research utilization among nurses working in Canadian civilian and United States Army healthcare settings Canada, USA Hospital setting ✓ ✓ Empirical study Ireland, Kirkpatrick, et al. [244] 2013 The real world journey of implementing fall prevention best practices in three acute care hospitals: A case study Canada Hospital setting ✓ ✓ Empirical study Kristensen, Borg, et al. [245] 2011 Facilitation of research-based evidence within occupational therapy in stroke rehabilitation Denmark Multiple settings ✓ ✓ Empirical study Lavoie-Tremblay, Richer, et al. [246] 2012 Implementation of Evidence-Based Practices in the Context of a Redevelopment Project in a Canadian Healthcare Organization Canada Hospital setting ✓ ✓ Empirical study Leclair, Ripat, et al. [247] 2013 Advancing the use of theory in occupational therapy: A collaborative process Canada Not reported ✓ ✓ Empirical study Matthew-Maich, Ploeg, et al. [248] 2013 Supporting the uptake of nursing guidelines: What you really need to know to move nursing guidelines into practice Canada Hospital setting ✓ ✓ Empirical study Ranse, Yates, et al. [249] 2015 Factors influencing the provision of end-of-life care in critical care settings: Development and testing of a survey instrument Australia Hospital setting ✓ ✓ Empirical study Squires, Estabrooks, et al. [250] 2013 The influence of organizational context on the use of research by nurses in Canadian pediatric hospitals Canada Hospital setting ✓ ✓ Empirical study Svensson, Ohlsson, et al. [251] 2012 Development and implementation of a standardized care plan for carotid endarterectomy Sweden Hospital setting ✓ ✓ Empirical study Tierney, Kislov, et al. [252] 2014 A qualitative study of a primary-care based intervention to improve the management of patients with heart failure: The dynamic relationship between facilitation and context UK Primary health care setting ✓ ✓ Empirical study Urquhart, Porter, et al. [253] 2014 Multi-level factors influence the implementation and use of complex innovations in cancer care: A multiple case study of synoptic reporting Canada Multiple settings ✓ ✓ Empirical study Warner [254] 2013 Synthesizing research evidence for therapists providing home-based rehabilitative care Canada Home-based care ✓ ✓ Empirical study Warner and Stadnyk [255] 2014 What is the evidence and context for implementing family-centered care for older adults Canada Home-based care ✓ ✓ Empirical study Wilson, Sleutel, et al. [256] 2015 Empowering nurses with evidence-based practice environments: Surveying magnet®, pathway to excellence®, and non-magnet facilities in one healthcare system USA Hospital setting ✓ ✓ Empirical study Abrahamson, Miech, et al. [257] 2015 Pay-for-performance policy and data-driven decision making within nursing homes: A qualitative study USA Community/Social care setting ✓ Empirical study Backman, Hebert, et al. [258] 2018 Implementation of a multimodal patient safety improvement program "SafetyLEAP" in intensive care units: A cross-case study analysis Canada Hospital setting ✓ Empirical study Brobeck, Odencrants, et al. [259] 2013 Health promotion practice and its implementation in Swedish health care Sweden Primary health care setting ✓ Empirical study Brown and McCormack [260] 2011 Developing the practice context to enable more effective pain management with older people: An action research approach UK Hospital setting ✓ Empirical study Carlfjord, Andersson, et al. [261] 2012 Applying the RE-AIM framework to evaluate two implementation strategies used to introduce a tool for lifestyle intervention in Swedish primary health care Sweden Primary health care setting ✓ Empirical study Carlfjord, Kristenson, et al. [262] 2011 Experiences of Working with the Tobacco Issue in the Context of Health Promoting Hospitals and Health Services: A Qualitative Study Sweden Multiple settings ✓ Empirical study Cranley, Birdsell, et al. [263] 2012 Insights into the impact and use of research results in a residential long-term care facility: a case study Canada Community/Social care setting ✓ Empirical study Dogherty, Harrison, et al. [264] 2013 Turning Knowledge Into Action at the Point-of-Care: The Collective Experience of Nurses Facilitating the Implementation of Evidence-Based Practice Canada Multiple settings ✓ Empirical study Espirito Santo and Choquette [265] 2013 Experience of adapting and implementing an evidence-based nursing guideline for prevention of diaper dermatitis in a paediatric oncology setting Canada Hospital setting ✓ Empirical study Harvey, Kitson, et al. [266] 2012 Promoting continence in nursing homes in four European countries: The use of PACES as a mechanism for improving the uptake of evidence-based recommendations Republic Ireland, Sweden, UK, Netherlands Community/Social care setting ✓ Empirical study Hermansyah, Sainsbury, et al. [267] 2017 The operation of a Research and Development (R&D) program and its significance for practice change in community pharmacy Australia Not reported ✓ Empirical study Johnston, Gagnon, et al. [268] 2007 One-on-One Coaching to Improve Pain Assessment and Management Practices of Pediatric Nurses Canada Hospital setting ✓ Empirical study Kinley, Denton, et al. [269] 2018 Development and implementation of the Steps to Successful Palliative Care programme in residential care homes for people with a learning disability UK Community/Social care setting ✓ Empirical study Kinley, Denton, et al. [270] 2018 Improving the approach to future care planning in care homes UK Community/Social care setting ✓ Empirical study Marfurt-Russenberger, Axelin, et al. [271] 2016 The Experiences of Professionals Regarding Involvement of Parents in Neonatal Pain Management Switzerland Hospital setting ✓ Empirical study Meagher-Stewart, Solberg, et al. [272] 2012 Understanding the role of communities of practice in evidence-informed decision making in public health Canada Primary health care setting ✓ Empirical study Meyer-Zehnder, Albisser Schleger, et al. [273] 2017 How to introduce medical ethics at the bedside - Factors influencing the implementation of an ethical decision-making model Switzerland Hospital setting ✓ Empirical study Nguyen and Wilson [274] 2016 Hospital readiness for undertaking evidence-based practice: A survey Vietnam Hospital setting ✓ Empirical study Painter, Clark, et al. [275] 2014 Physical function and physical activity assessment and promotion in the hemodialysis clinic: A qualitative study USA Hospital setting ✓ Empirical study Powell-Cope, Moore, et al. [276] 2015 Perceptions of Practice Guidelines for People with Spinal Cord Injury USA Multiple settings ✓ Empirical study Powrie, Danly, et al. [277] 2014 Using implementation science to facilitate evidence-based practice changes to promote optimal outcomes for orthopaedic patients USA Hospital setting ✓ Empirical study Scott, Estabrooks, et al. [278] 2008 A context of uncertainty: How context shapes nurses' research utilization behaviors Canada Hospital setting ✓ Empirical study Skene, Gerrish, et al. [279] 2019 Developing family-centred care in a neonatal intensive care unit: An action research study UK Hospital setting ✓ Empirical study Squires, Aloisio, et al. [280] 2019 Attributes of context relevant to healthcare professionals' use of research evidence in clinical practice: a multi-study analysis Canada, Australia Multiple settings ✓ Empirical study Stenberg and Wann-Hansson [281] 2011 Health care professionals' attitudes and compliance to clinical practice guidelines to prevent falls and fall injuries Sweden Hospital setting ✓ Empirical study Thunberg, Ferm, et al. [282] 2019 Implementation of pictorial support for communication with people who have been forced to flee: Experiences from neonatal care Sweden Hospital setting ✓ Empirical study Tishelman, Bergenmar, et al. [283] 2008 Using undergraduate nursing students as mediators in a knowledge transfer programme for care for patients with advanced cancer Sweden Multiple settings ✓ Empirical study Wedge and Gosney [284] 2005 Pressure-relieving equipment: Promoting its correct use amongst nurses via differing modes of educational delivery UK Hospital setting ✓ Empirical study Anderson, Wang, et al. [285] 2012 Comprehensive assessment of chronic pain management in primary care: A first phase of a quality improvement initiative at a multisite community health center USA Primary health care setting ✓ Empirical study Arce, De Ormijana, et al. [286] 2014 A qualitative study on clinicians' perceptions about the implementation of a population risk stratification tool in primary care practice of the Basque Health Service Spain Primary health care setting ✓ Empirical study Bergström, Skeen, et al. [287] 2015 Health system context and implementation of evidence-based practices-development and validation of the Context Assessment for Community Health (COACH) tool for low- and middle-income settings South Africa, Vietnam, Uganda, Nicaragua, Bangladesh Multiple settings ✓ Empirical study Bramley, Manning, et al. [288] 2018 Engaging and developing front-line clinical nurses to drive care excellence: Evaluating the Chief Nurse Excellence in Care Junior Fellowship initiative UK Hospital setting ✓ Empirical study Capasso, Collins, et al. [289] 2009 Outcomes of a clinical nurse specialist-initiated wound care education program: Using the promoting action on research implementation in health services framework USA Hospital setting ✓ Empirical study Conklin, Cohen-Schneider, et al. [290] 2012 Enacting change through action learning: Mobilizing and managing power and emotion Canada Hospital setting ✓ Empirical study Curran, Woo, et al. [291] 2015 Training Substance Use Disorder Counselors in Cognitive Behavioral Therapy for Depression: Development and Initial Exploration of an Online Training Program USA Primary health care setting ✓ Empirical study Damschroder, Moin, et al. [292] 2015 Implementation and evaluation of the VA DPP clinical demonstration: protocol for a multi-site non-randomized hybrid effectiveness-implementation type III trial USA Multiple settings ✓ Empirical study Doran, Haynes, et al. [293] 2010 Supporting Evidence-Based Practice for Nurses through Information Technologies Canada Multiple settings ✓ Empirical study Estrada [294] 2009 Exploring Perceptions of a Learning Organization by RNs and Relationship to EBP Beliefs and Implementation in the Acute Care Setting USA Hospital setting ✓ Empirical study Fitzgerald and Harvey [295] 2015 Translational networks in healthcare? Evidence on the design and initiation of organizational networks for knowledge mobilization UK Multiple settings ✓ Empirical study Forgeron, Jongudomkarn, et al. [296] 2009 Children's pain assessment in Northeastern Thailand: Perspectives of health professionals Thailand Hospital setting ✓ Empirical study Friberger and Falkman [297] 2013 Collaboration processes, outcomes, challenges and enablers of distributed clinical communities of practice Sweden Not reported ✓ Empirical study Graham, Maddox, et al. [298] 2013 Coronary Stents and Subsequent Surgery: Reported Provider Attitudes and Practice Patterns USA Hospital setting ✓ Empirical study Hefter and Gerson [299] 2010 Increasing Adherence to Scheduled Outpatient Dobutamine Stress Echocardiograms USA Hospital setting ✓ Empirical study Hunter, Chinman, et al. [300] 2009 Technical assistance as a prevention capacity-building tool: A demonstration using the getting to outcomes® framework USA Community/Social care setting ✓ Empirical study Mallidou, Cummings, et al. [301] 2011 Staff, space, and time as dimensions of organizational slack: A psychometric assessment Canada Hospital setting ✓ Empirical study Nilsson Kajermo, Böe, et al. [302] 2013 Swedish Translation, Adaptation and Psychometric Evaluation of the Context Assessment Index (CAI) Sweden Multiple settings ✓ Empirical study Powers, Preshong, et al. [303] 2016 A Model of Regulatory Alignment to Enhance the Long-Term Care Survey Process in a Veterans Health Care Network USA Not reported ✓ Empirical study Ryan, Franklin, et al. [304] 2018 Ranking and prioritizing strategies for reducing mortality and morbidity from noncommunicable diseases post disaster: An Australian perspective Australia Community/Social care setting ✓ Empirical study Shuman, Ploutz-Snyder, et al. [305] 2018 Development and Testing of the Nurse Manager EBP Competency Scale USA Hospital setting ✓ Empirical study Shuman, Powers, et al. [306] 2019 Unit Leadership and Climates for Evidence-Based Practice Implementation in Acute Care: A Cross-Sectional Descriptive Study USA Hospital setting ✓ Empirical study Siraj-Blatchford, Taggart, et al. [307] 2008 Towards the transformation of practice in early childhood education: The effective provision of pre-school education (EPPE) project UK Multiple settings ✓ Empirical study Squires, Hayduk, et al. [308] 2015 Reliability and validity of the Alberta context tool (ACT) with professional nurses: Findings from a multi-study analysis Canada, Australia Multiple settings ✓ Empirical study Tucker, Olson, et al. [309] 2009 Evidence-Based Practice Self-efficacy Scale: Preliminary Reliability and Validity USA Multiple settings ✓ Empirical study Urquhart, Jackson, et al. [310] 2015 Health system-level factors influence the implementation of complex innovations in cancer care Canada Multiple settings ✓ Empirical study Vetter [311] 2015 The Influence of Clinical Decision Support on Diagnostic Accuracy in Nurse Practitioners USA Home-based care ✓ Empirical study Weaver, Smith, et al. [312] 2007 Interventions to increase influenza vaccination rates in veterans with spinal cord injuries and disorders USA Hospital setting ✓ Empirical study Liedgren, Elvhage, et al. [313] 2016 The Use of Decision Support Systems in Social Work: A Scoping Study Literature Review Sweden Multiple settings ✓ ✓ ✓ Empirical review study Brown and McCormack [314] 2005 Developing postoperative pain management: Utilising the promoting action on research implementation in health services (PARIHS) framework Not reported Hospital setting ✓ ✓ Empirical review study Helfrich, Damschroder, et al. [13] 2010 A critical synthesis of literature on the promoting action on research implementation in health services (PARIHS) framework Not reported Not reported ✓ ✓ Empirical review study McCalman, Bainbridge, et al. [315] 2016 The effectiveness of implementation in Indigenous Australian healthcare: An overview of literature reviews Not reported Multiple settings ✓ ✓ Empirical review study Meijers, Janssen, et al. [316] 2006 Assessing the relationships between contextual factors and research utilization in nursing: systematic literature review Not reported Not reported ✓ ✓ Empirical review study Milner, Estabrooks, et al. [317] 2006 Research utilization and clinical nurse educators: A systematic review Not reported Not reported ✓ ✓ Empirical review study Pfadenhauer, Gerhardus, et al. [318] 2017 Making sense of complexity in context and implementation: The Context and Implementation of Complex Interventions (CICI) framework Not reported Not reported ✓ ✓ Empirical review study Toms, Williams, et al. [319] 2019 The development and theoretical application of an implementation framework for dialectical behaviour therapy: a critical literature review Sweden, USA, UK, Australia, Ireland, New Zealand, Canada, Netherlands, Germany Not reported ✓ ✓ Empirical review study Wood, Migliore, et al. [320] 2019 Confronting Challenges in Reducing Heart Failure 30-Day Readmissions: Lessons Learned With Implications for Evidence-Based Practice USA Hospital setting ✓ ✓ Empirical review study Franx, Dixon, et al. [321] 2013 Implementation strategies for collaborative primary care-mental health models Netherlands, USA, and UK Multiple settings ✓ Empirical review study Hudon, Gervais, et al. [322] 2015 The contribution of conceptual frameworks to knowledge translation interventions in physical therapy Canada Not reported ✓ Empirical review study Dogherty, Harrison, et al. [323] 2010 Facilitation as a role and process in achieving evidence-based practice in nursing: A focused review of concept and meaning Not reported Multiple settings ✓ ✓ Empirical review study Flottorp, Oxman, et al. [324] 2013 A checklist for identifying determinants of practice: A systematic review and synthesis of frameworks and taxonomies of factors that prevent or enable improvements in healthcare professional practice Not reported Not reported ✓ ✓ Empirical review study Aas, Tuntland, et al. [325] 2011 Workplace interventions for neck pain in workers Netherlands, Norway, Finland, Sweden, USA Not reported ✓ Empirical review study Geerligs, Rankin, et al. [326] 2018 Hospital-based interventions: A systematic review of staff-reported barriers and facilitators to implementation processes USA, UK, Canada, Australia/ New Zealand, Denmark, Sweden, Finland, Italy, the Netherlands, Uganda, South Africa, Tanzania, Ghana, Mexico Multiple settings ✓ Empirical review study McConnell, O'Halloran, et al. [327] 2013 Systematic Realist Review of Key Factors Affecting the Successful Implementation and Sustainability of the Liverpool Care Pathway for the Dying Patient UK Multiple settings ✓ Empirical review study Rogers [328] 2009 Transferring research into practice: An integrative review Not reported Not reported ✓ Empirical review study Salter and Kothari [329] 2014 Using realist evaluation to open the black box of knowledge translation: A state-of-the-art review UK Multiple settings ✓ Empirical review study Sandström, Borglin, et al. [330] 2011 Promoting the Implementation of Evidence-Based Practice: A Literature Review Focusing on the Role of Nursing Leadership Not reported Multiple settings ✓ Empirical review study Wahr, Abernathy, et al. [331] 2017 Medication safety in the operating room: literature and expert-based recommendations USA Not reported ✓ Empirical review study Baskerville, Liddy, et al. [332] 2012 Systematic Review and Meta-Analysis of Practice Facilitation Within Primary Care Settings 23 studies from various countries, not described in the paper. Primary health care setting ✓ Empirical review study Colquhoun, Letts, et al. [333] 2010 A scoping review of the use of theory in studies of knowledge translation Several countries were represented in this review study but not clearly stated. Multiple settings ✓ Empirical review study Leeman, Calancie, et al. [334] 2017 Developing Theory to Guide Building Practitioners' Capacity to Implement Evidence-Based Interventions USA, UK, Canada Not reported ✓ Empirical review study Nilsen and Bernhardsson [335] 2019 Context matters in implementation science: A scoping review of determinant frameworks that describe contextual determinants for implementation outcomes N/A Not reported ✓ Empirical review study O'Keefe-McCarthy, Santiago, et al. [336] 2008 Ventilator-associated pneumonia bundled strategies: An evidence-based practice Canada Hospital setting ✓ Empirical review study Prihodova, Guerin, et al. [337] 2019 Key components of knowledge transfer and exchange in health services research: Findings from a systematic scoping review N/A Multiple settings ✓ Empirical review study Tabak, Khoong, et al. [3] 2012 Bridging research and practice: Models for dissemination and implementation research Not reported Not reported ✓ Empirical review study Ward, House, et al. [338] 2009 Developing a framework for transferring knowledge into action: a thematic analysis of the literature Not reported Multiple settings ✓ Empirical review study Doran and Sidani [339] 2007 Outcomes-focused knowledge translation: A framework for knowledge translation and patient outcomes improvement N/A Not reported ✓ ✓ ✓ Opinion/ theoretical paper Ritchie, Dollar, et al. [340] 2014 Responding to needs of clinical operations partners: Transferring implementation facilitation knowledge and skills N/A Primary health care setting ✓ Opinion/ theoretical paper Damschroder, Aron, et al. [341] 2009 Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science N/A Not reported ✓ ✓ Opinion/ theoretical paper Florczak [342] 2016 Evidence-Based Practice: What’s New Is Old N/A Not reported ✓ ✓ Opinion/ theoretical paper Kavanagh, Stevens, et al. [343] 2008 Examining appreciative inquiry as a knowledge translation intervention in pain management N/A Not reported ✓ ✓ Opinion/ theoretical paper Kavanagh, Watt-Watson, et al. [344] 2007 An examination of the factors enabling the successful implementation of evidence-based acute pain practices into pediatric nursing N/A Multiple settings ✓ ✓ Opinion/ theoretical paper Rongey, Asch, et al. [345] 2011 Access to care for vulnerable veterans with hepatitis C: A hybrid conceptual framework and a case study to guide translation N/A Multiple settings ✓ ✓ Opinion/ theoretical paper Rycroft-Malone [346] 2007 Theory and knowledge translation: Setting some coordinates N/A Not reported ✓ ✓ Opinion/ theoretical paper Stetler, Damschroder, et al. [347] 2011 A Guide for applying a revised version of the PARIHS framework for implementation N/A Not reported ✓ ✓ Opinion/ theoretical paper Tucker, Klotzbach, et al. [348] 2006 Lessons learned in translating research evidence on early intervention programs into clinical care N/A Not reported ✓ ✓ Opinion/ theoretical paper Urquhart, Sargeant, et al. [349] 2013 Exploring the usefulness of two conceptual frameworks for understanding how organizational factors influence innovation implementation in cancer care N/A Not reported ✓ ✓ Opinion/ theoretical paper Wallin, Profetto-McGrath, et al. [350] 2005 Implementing nursing practice guidelines. A complex undertaking N/A Not reported ✓ ✓ Opinion/ theoretical paper Owen and Milburn [351] 2001 Implementing research findings into practice: Improving and developing services for women with serious and enduring mental health problems N/A Community/Social care setting ✓ ✓ Opinion/ theoretical paper Blackwood [352] 2003 Can protocolised-weaning developed in the United States transfer to the United Kingdom context: A discussion N/A Hospital setting ✓ Opinion/ theoretical paper Gawlinski and Rutledge [353] 2008 Selecting a model for evidence-based practice changes: A practical approach N/A Hospital setting ✓ Opinion/ theoretical paper Genuis [354] 2007 Evolving information in an evidence-Based world: Theoretical considerations N/A Not reported ✓ Opinion/ theoretical paper Hunt, Curran, et al. [355] 2012 Partnership for implementation of evidence-based mental health practices in rural federally qualified health centers: Theory and methods N/A Community/Social care setting ✓ Opinion/ theoretical paper Nilsen [2] 2015 Making sense of implementation theories, models and frameworks N/A Not reported ✓ Opinion/ theoretical paper Pfadenhauer, Mozygemba, et al. [356] 2015 Context and implementation: A concept analysis towards conceptual maturity N/A Not reported ✓ Opinion/ theoretical paper Ruth and Matusitz [357] 2013 Comparative Standards of Evidence in Social Work N/A Community/Social care setting ✓ Opinion/ theoretical paper Squires, Reay, et al. [358] 2012 Designing strategies to implement research-based policies and procedures: A set of recommendations for nurse leaders based on the PARiHS framework N/A Not reported ✓ Opinion/ theoretical paper Harvey and Kitson [359] 2016 PARIHS revisited: From heuristic to integrated framework for the successful implementation of knowledge into practice N/A Not reported ✓ ✓ Opinion/ theoretical paper Larkin, Griffith, et al. [360] 2007 Promoting research utilization using a conceptual framework N/A Hospital setting ✓ ✓ Opinion/ theoretical paper Spassiani, Parker Harris, et al. [361] 2016 Exploring How Knowledge Translation Can Improve Sustainability of Community-based Health Initiatives for People with Intellectual/Developmental Disabilities N/A Not reported ✓ ✓ Opinion/ theoretical paper Andrews and Moon [362] 2005 Space, place, and the evidence base: Part II - Rereading nursing environment through geographical research N/A Hospital setting ✓ Opinion/ theoretical paper Andrews, Holmes, et al. [363] 2005 'Airplanes are flying nursing homes': geographies in the concepts and locales of gerontological nursing practice N/A Community/Social care setting ✓ Opinion/ theoretical paper Bucknall [364] 2007 A gaze through the lens of decision theory toward knowledge translation science N/A Not reported ✓ Opinion/ theoretical paper Gibson [365] 2005 Evidence in action: Fostering growth of research-based practice in children's cancer nursing N/A Multiple settings ✓ Opinion/ theoretical paper Bandeira, Witt, et al. [366] 2017 The use of a methodological framework in the implementation of evidence as part of nursing research N/A Not reported ✓ Opinion/ theoretical paper Boucher, Roper, et al. [367] 2013 Science and Practice Aligned Within Nursing Structure and Process for Evidence-Based Practice N/A Multiple settings ✓ Opinion/ theoretical paper Chambers, Luesby, et al. [368] 2010 The Seniors Health Research Transfer Network knowledge network model: System-wide implementation for health and healthcare of seniors N/A Multiple settings ✓ Opinion/ theoretical paper Doane, Reimer-Kirkham, et al. [369] 2015 (Re)theorizing integrated knowledge translation a heuristic for knowledge-as-action N/A Not reported ✓ Opinion/ theoretical paper Ellen, Panisset, et al. [370] 2017 A Knowledge Translation framework on ageing and health N/A Not reported ✓ Opinion/ theoretical paper Harvey, Fitzgerald, et al. [371] 2011 The NIHR collaboration for leadership in applied health research and care (CLAHRC) for Greater Manchester: Combining empirical, theoretical and experiential evidence to design and evaluate a large-scale implementation strategy N/A Multiple settings ✓ Opinion/ theoretical paper Hutchinson, Wilkinson, et al. [372] 2012 Using the Promoting Action on Research Implementation in Health Services Framework to Guide Research Use in the Practice Setting N/A Not reported ✓ Opinion/ theoretical paper Hysong, Woodard, et al. [373] 2014 Publishing Protocols for Partnered Research N/A Multiple settings ✓ Opinion/ theoretical paper Jeffs, Sidani, et al. [374] 2013 Using theory and evidence to drive measurement of patient, nurse and organizational outcomes of professional nursing practice N/A Not reported ✓ Opinion/ theoretical paper Jukes and Aspinall [375] 2015 Leadership and learning disability nursing N/A Not reported ✓ Opinion/ theoretical paper Lynch, Mudge, et al. [376] 2018 There is nothing so practical as a good theory: a pragmatic guide for selecting theoretical approaches for implementation projects N/A Multiple settings ✓ Opinion/ theoretical paper Matthew-Maich, Ploeg, et al. [377] 2010 Transformative learning and research utilization in nursing practice: A missing link? N/A Not reported ✓ Opinion/ theoretical paper Mitchell, Fisher, et al. [378] 2010 A thematic analysis of theoretical models for translational science in nursing: Mapping the field N/A Not reported ✓ Opinion/ theoretical paper O’Meara, Furness, et al. [379] 2017 Educating paramedics for the future: A holistic approach N/A Not reported ✓ Opinion/ theoretical paper Persaud [380] 2014 Enhancing learning, innovation, adaptation, and sustainability in health care organizations: The ELIAS performance management framework N/A Not reported ✓ Opinion/ theoretical paper Schoville and Titler [381] 2015 Guiding Healthcare Technology Implementation: A New Integrated Technology Implementation Model N/A Not reported ✓ Opinion/ theoretical paper Shah, Warre, et al. [382] 2013 Quality improvement initiatives in neonatal intensive care unit networks: Achievements and challenges N/A Hospital setting ✓ Opinion/ theoretical paper Smith [383] 2018 Revisiting implementation theory: An interdisciplinary comparison between urban planning and healthcare implementation research N/A Not reported ✓ Opinion/ theoretical paper Tilson and Mickan [144] 2014 Promoting physical therapists' of research evidence to inform clinical practice: Part 1 - Theoretical foundation, evidence, and description of the PEAK program N/A Multiple settings ✓ Opinion/ theoretical paper Warner and Townsend [384] 2012 Applying knowledge translation theories to occupation N/A Not reported ✓ Opinion/ theoretical paper Young [385] 2015 Solving the wicked problem of hospital malnutrition N/A Not reported ✓ Opinion/ theoretical paper aProtocols planned to use PARIHS in the analysis Of these 367 articles, 235 cited Kitson et al. [5], 208 cited Kitson et al. [18], 136 cited Rycroft-Malone et al. [8], and 92 cited Rycroft-Malone et al. [9]. In total, the 367 articles consisted of 35 protocols [25, 28, 29, 31–38, 40, 42, 44–50, 52–54, 56, 57]. A further 255 articles reported empirical studies: ▪ 91 where PARIHS guided the development of the intervention [58–82, 84–143, 145, 146, 386–388], ▪ 92 intervention studies where PARIHS did not guide the development of an intervention [149, 152, 153, 155, 156, 158, 160, 162, 167, 168, 171, 176, 178, 179, 182–185, 194, 201–203, 205–209, 211, 212, 214, 217, 219–223, 225, 234–236, 243–245, 249–252, 254, 255, 258–261, 263, 265, 266, 268–270, 273, 274, 276–285, 287–292, 296, 297, 299–301, 303–312], ▪ 72 non-intervention studies [150, 151, 154, 157, 159, 161, 163–166, 169, 170, 172–175, 177, 180, 181, 186–193, 195–200, 204, 210, 213, 215, 216, 218, 224, 226–233, 237–242, 246–248, 253, 256, 257, 262, 264, 267, 271, 272, 275, 286, 293–295, 298, 302] In addition, the database included 28 empirical review studies [3, 13, 313, 314, 316–338, 389] and 49 opinion/theoretical articles [2, 144, 339–385]. In terms of professional focus, about 65% of the included articles involved nursing. In the following sections, references have been added to the categorical items in the data extraction while we have opted only to provide examples of references to the findings from the qualitative exploration of how the PARIHS framework was operationalized in detail. Settings Of the articles reporting type of setting where the implementation project/research took place, a majority were undertaken in hospitals (n = 126) [26, 27, 30, 38, 39, 41, 42, 45, 49, 51–55, 60, 62–64, 67, 70–72, 77, 84, 85, 88, 89, 95–98, 103, 106, 107, 111, 115–118, 120–122, 128, 131, 132, 136, 137, 139, 143, 146, 149, 151, 153–155, 157, 161, 165, 167–169, 172, 173, 175, 180–182, 184, 186, 190–193, 205, 207, 212, 215, 221, 223, 227, 230, 231, 240, 243, 244, 246, 248–251, 256, 258, 260, 265, 268, 271, 273–275, 277–279, 281, 282, 284, 288–290, 294, 296, 298, 299, 301, 305, 306, 312, 314, 320, 336, 352, 353, 360, 362, 382, 386, 388], followed by a combination of multiple healthcare settings (n = 80) [31, 35, 37, 47, 50, 56, 65, 66, 68, 73, 79, 92, 99, 100, 109, 110, 112, 114, 133, 138, 144, 145, 150, 159, 160, 162, 163, 171, 177, 183, 187, 194, 197, 204, 208–210, 216, 218, 219, 226, 228, 233, 238, 245, 253, 262, 264, 276, 280, 283, 287, 292, 293, 295, 302, 307–310, 313, 321, 323, 326, 327, 329, 330, 333, 337, 338, 344, 345, 365, 367, 368, 371, 373, 376, 387, 389], community/social care settings (n = 54) [24, 34, 36, 43, 44, 46, 48, 57, 59, 61, 69, 74–76, 80, 81, 86, 87, 94, 102, 104, 108, 113, 123, 129, 134, 142, 152, 156, 158, 174, 178, 185, 195, 201, 203, 214, 217, 222, 229, 232, 241, 257, 263, 266, 269, 270, 300, 304, 351, 355, 357, 363], primary health care (n = 34) [23, 25, 28, 29, 40, 58, 82, 90, 93, 119, 125, 130, 140, 141, 164, 170, 196, 198, 200, 202, 224, 225, 235, 236, 242, 252, 259, 261, 272, 285, 286, 291, 332, 340], and home-based care (n = 7) [78, 91, 105, 166, 254, 255, 311]. Five articles were derived from special settings such as construction [176], education [101], pharmacies [135], urban planning [383], and public health institutions [32]. In 44 articles [2, 3, 13, 33, 124, 126, 127, 179, 206, 211, 220, 237, 239, 247, 297, 316, 317, 322, 324, 325, 328, 339, 341–343, 346–350, 354, 356, 358, 364, 369, 372, 374, 375, 377, 378, 380, 381, 384, 385], the setting was not reported or not applicable (e.g., opinion/theoretical articles). For empirical studies and published protocols, about 28% were derived from research in the USA, 22% from Canada, 10% from Sweden, and 10% from the UK. The remaining articles mainly originated from other high-income countries in Europe; in addition, there were a few articles reporting studies in low- and middle-income countries, including Vietnam, Tanzania, Mozambique, and Uganda [46, 82, 110, 150, 235, 287]. Timing of different types of articles The types of articles published using the PARIHS framework changed over time, with an increase in the number of empirical studies from 2004 onwards, as illustrated in Fig. 2. As the search for articles for this review only included the first eight months of 2019, the graph is limited to full years (i.e., 1998 through 2018). Fig. 2 Types of articles published before December 31 using the PARIHS framework Use of PARIHS Figure 3 depicts how PARIHS was used by type of article. Although authors frequently claimed that PARIHS was used in one or more ways, details as to how the framework was used were often lacking. Fig. 3 Use of the PARIHS framework by type of article The application of PARIHS to plan and deliver an intervention In total, 117 (32%) articles claimed to use the PARIHS framework to plan and deliver an intervention [23–46, 58–82, 84–143, 145, 146, 339, 340, 386–388]. Predominantly, these were empirical studies (n = 91) [58–82, 84–143, 145, 146, 386–388] but also two opinion/theoretical articles [339, 340] and 24 protocols [23–46]. Of the 117 articles, about half stated that the framework was used for theoretically informing, framing, or guiding an intervention (e.g., [82, 103, 105, 134, 386]). However, in these studies, PARIHS was referred to only in a general sense, in that the core elements of the framework were said to have informed the planning of the study. There was a lack of detail provided about what elements of the framework were used and how they were operationalized to plan and deliver an intervention. In the other half of the 117 articles, it was described more specifically that one or more elements of the framework had been used. Most commonly the facilitation element (e.g., [58, 80, 92, 98, 110]) was referred to as guiding an implementation strategy. The articles that provided explicit descriptions of interventions using facilitation employed strategies such as education, reminders, audit-and-feedback, action learning, and evidence-based quality improvement, and roles including internal and external facilitators and improvement teams to enable the uptake of evidence (e.g., [23, 79, 125, 142]). Some articles drew on the PARIHS framework more specifically, to understand the role of organizational context in implementation (e.g., [34, 63, 145, 340]). The application of PARIHS in data analysis There were 184 (50%) articles where the PARIHS framework was reported to be used in the analysis [2, 13, 23–35, 47–55, 58–82, 84–94, 149–242, 313, 314, 316–322, 339, 341–358, 386, 389]. Most of these involved empirical studies (n = 131) [58–82, 84–94, 149–242, 386] where PARIHS often was described as guiding or framing the data collection, e.g., developing an interview guide, and/or analysis, but with no further details. In articles that provided more detailed information, PARIHS was used to guide or frame qualitative analyses in about 50 studies (e.g., [67, 94, 173, 178, 207]). Of these, around 20 used a deductive approach in that they used the elements and sub-elements to structure the analytic process (e.g., [150, 170, 188, 215, 242]). About 35 studies applied PARIHS for quantitative analysis, (e.g., [69, 168, 174, 190, 211]). In half of these, the Alberta Context Tool (e.g., [155, 165, 180, 195, 229]) and the Organizational Readiness to Change Assessment Tool (e.g., [74, 159, 219, 240]) were used; both these tools being derived from PARIHS. Empirical studies using the PARIHS framework in the analysis encompassed primarily all three main elements of PARIHS (e.g., [166, 181, 193, 221]) and the context domain (e.g., [78, 152, 153, 207]), and in lesser extent the evidence (e.g., [185, 208, 214]) and the facilitation domain (e.g., [58, 67, 79, 182]). Eleven review studies [13, 313, 314, 316–322, 389] used the framework for the analysis; findings were mapped to PARIHS elements in a few studies [316, 317, 389]; one described that their data had been “analysed through the lens of PARIHS” (p1) [389]. A couple of the review studies had PARIHS as the object for analysis, comparing it with other frameworks [318, 322]. This approach was also common in the 20 opinion/theoretical articles [2, 339, 341–348, 350–358], where the PARIHS framework itself was the focus of the analysis (e.g., [341, 349, 354]). In these articles, the analysis was performed in different ways, primarily through mapping and comparing PARIHS to other frameworks or models or even policies, but also for general discussions on implementation and evidence-based practice. Among the 185 articles that reported using the PARIHS framework in the analysis, there were also 22 protocols where authors reported that the intention was to use the framework in the analysis [23–35, 47–55]. The application of PARIHS in the evaluation of study findings A total of 203 (55%) included articles provided information on how the PARIHS framework was used in the evaluation of study findings, in terms of contributing to the discussion and interpretation of results [13, 52, 58–82, 84–89, 95–121, 149–214, 243–259, 261–284, 313, 314, 316–320, 323–331, 339, 341–350, 359–365, 386, 389]. The majority (n = 167) of these were empirical studies [52, 58–82, 84–89, 95–121, 149–214, 243–259, 261–284, 386]. We found two main approaches to how the PARIHS framework was used in the evaluation of study findings. First, PARIHS was used to organize the discussion of the findings (e.g., [73, 87, 109, 166, 214]), where the framework and/or its elements were used to provide a structure for reporting or generally discussing the findings, or both, for example in stating that the key elements of PARIHS were reflected in the study findings. Second, the framework was used to consider the implications of the study’s findings (e.g., [81, 84, 170, 207, 361]), where the framework or its elements (varying between one (e.g., [75, 195, 211]), two (e.g., [71, 86, 105]), and all the three main elements (e.g., [80, 261, 269])) enabled authors to elaborate on findings, or reflect on the implications of their study to evaluate the PARIHS framework itself. Specifically, we found some empirical articles reported evaluating the PARIHS element “context” by means of context tools (e.g., [155]). In addition, an evaluation of the study findings using the framework was identified in 18 opinion/theoretical articles [339, 341–350, 359–365] and 18 empirical review studies [13, 313, 314, 316–320, 323–331, 389]. Among the opinion/theoretical articles, there were papers evaluating other theoretical constructions in relation to the PARIHS framework (e.g., [364]). The application of PARIHS in any other way A total of 136 (37%) reported using PARIHS in some other way than directly informing the planning and delivery of an intervention or analyzing and evaluating findings [3, 23–25, 36, 37, 47–50, 56–62, 90, 95–97, 122–127, 144, 149–170, 215–224, 243–256, 285–313, 323, 324, 332–338, 351, 359–361, 366–385]. A majority of these articles (n = 89) were empirical studies [58–62, 90, 95–97, 122–127, 149–170, 215–224, 243–256, 285–312], and about half of these described the use of PARIHS as an overall guide to frame the study (e.g., [58, 60, 168, 222, 285, 303]). A similar finding was apparent in the 11 protocols [23–25, 36, 37, 47–50, 56, 57]; about half of these also referred to the use of PARIHS to guide and frame the study design (e.g., [47, 48, 50, 57]). An alternative use of PARIHS in empirical studies involved focusing on one of the three PARIHS elements (n = 17) and investigating them in greater depth, most notably context (n = 10) (e.g., [155, 232]) and facilitation (n = 7) (e.g., [307, 312]). A total of 25 opinion/theoretical articles [144, 351, 359–361, 366–385] reported using the PARIHS framework in some other way, including a discussion about PARIHS as part of presenting a general overview of theories and frameworks to inform implementation (e.g., [369, 376, 378, 384]), using PARIHS to augment, develop, or evaluate other implementation models and frameworks (e.g., [318, 359, 367, 374, 382]), and informing education and learning and teaching initiatives [144, 372]. Empirical review articles (n = 11) included reviews of implementation frameworks [3, 313, 323, 324, 332–338], including PARIHS, a review of the facilitation dimension of PARIHS and a discussion of the potential to combine implementation and improvement methodologies. Testing and providing views on the validity of the framework A total of 102 (28%) articles described testing or validating PARIHS, or provided comments on the validity of the framework [3, 13, 23, 24, 35, 44, 46, 58, 60, 62, 64, 67, 71, 74, 76, 78–81, 84, 85, 89, 98, 105, 107, 110, 113, 115, 120, 121, 143, 149, 150, 153, 155, 157–159, 166, 168, 170, 172, 180–182, 187, 188, 190, 191, 195, 198, 201, 203, 204, 206–209, 211, 212, 214, 229, 246, 249, 250, 252, 253, 255, 264, 267, 268, 277, 278, 280, 281, 287, 303, 308, 314, 316–319, 322, 323, 326, 330, 332, 333, 335, 336, 341, 342, 345–347, 349, 359, 364, 369, 381, 386]. Of these, 72 were empirical studies [4, 58, 60, 62, 64, 67, 71, 74, 76, 78–81, 84, 85, 89, 98, 105, 107, 110, 113, 115, 120, 121, 143, 149, 150, 153, 155, 157–159, 166, 168, 170, 172, 180–182, 187, 188, 190, 191, 195, 198, 201, 203, 204, 206–209, 211, 212, 214, 229, 246, 249, 250, 252, 253, 255, 264, 267, 268, 277, 278, 280, 281, 287, 303, 308, 386], five were study protocols [23, 24, 35, 44, 46], 10 opinion/theoretical articles [341, 342, 345–347, 349, 359, 364, 369, 381], and 15 empirical reviews [3, 13, 314, 316–319, 322, 323, 326, 330, 332, 333, 335, 336]. Empirical studies either tested the whole or parts of the framework with a focus on: ▪ The validity of the whole framework (e.g., [24, 74, 157, 195, 209]) ▪ The validity of context (e.g., [155, 190, 280, 287, 308]) ▪ The validity of facilitation (e.g., [23, 58, 182, 206]) ▪ The validity of evidence (e.g., [255]) ▪ Identifying gaps in the framework (e.g., [64, 170, 326]) Over the review study period (1998 to 2019), among empirical studies, there was a shift from primarily studying the context element of the framework to more articles evaluating the whole framework. This was also evident in the pattern found in the protocols, which mostly focused on testing facilitation (e.g., [58, 182, 206]). Opinion/theoretical articles tended to critique the whole framework (e.g., [319, 326, 342, 349, 369]). Of the 15 empirical reviews, the majority focused on the whole framework (e.g., [13, 322, 333]), then on context (e.g., [316, 318, 335]) and then on facilitation (e.g., [323]). Of note is the lack of attention in the literature to the element of “evidence” in the PARIHS framework (examples of articles paying attention to evidence include [208, 255]). The articles varied in detail, depth, and quality in terms of descriptions of how they went about testing the validity of the PARIHS framework. Approaches ranged from general observations of whether the research teams/users found the elements and sub-elements easy to use (e.g., [62, 188, 203]), to studies that used elements of context described in the PARIHS framework to validate new context measures across settings and groups (e.g., [150, 155, 207]). As one example, the Alberta Context Tool started from the PARIHS conceptualization of context to include dimensions of culture, leadership, and evaluation. Regarding the strength and limitations of the PARIHS framework, about one third of the included articles reported on its strengths and about 10% commented on perceived limitations. The identified strengths included: ▪ Holistic implementation framework (e.g., [141, 164, 209, 258]) that is perceived as intuitive and accessible. ▪ Both practical and theoretical and therefore feasible to use by both clinicians and researchers; also seen as intuitive to use and accessible (e.g., [117, 209, 255]). ▪ Can be used as a tool: diagnostic/process/evaluative tool; predictive/explanatory tool or as a way to explain the interplay of factors (e.g., [93, 205, 255, 285, 379]). ▪ Can accommodate a range of other theoretical perspectives (including approaches such as social network theory, participatory action research, coaching, change management and other knowledge translation frameworks) (e.g., [93, 105, 245, 246]). ▪ Can be used successfully in a range of different contexts (low- and middle-income countries) [150] and services and for various groups of patients (disability, aged care) (e.g., [80, 113, 248, 312]). Limitations of the PARIHS framework included: ▪ Poor operationalization of key terms leading to difficulties in understanding and an overlap of elements and sub-elements (e.g., [165, 285, 376]). ▪ Lack of practical guidance on steps to operationalize the framework (e.g., [209, 254]) with a subsequent lack of tools. ▪ Lack of information on the individual and their characteristics (e.g., [209, 361]) and their lack of understanding of evidence (e.g., [204, 390]). ▪ Too structured and does not acknowledge the multidimensionality and uncertainty of implementation (e.g., [143, 214]). ▪ Lack of acknowledgement of wider contextual issues such as the impact of professional, socio-political, and policy issues on implementation (e.g., [115, 143, 285, 354]). ▪ Not providing support in how to overcome barriers to successful implementation (e.g., [88]). Discussion In a recent survey among implementation scientists, the PARIHS framework was found to be one of the sixth most commonly used theoretical frameworks [4]. Yet, in our review, about 23% (n = 367) of the identified 1614 articles citing any of the four selected core PARIHS articles used the framework in any substantial way. Similarly, a review of the CFIR found that 26/429 (6%) of articles citing the framework were judged to use the framework in a meaningful way (i.e., used the CFIR to guide data collection, measurement, coding, analysis, and/or reporting) [12]. A citation analysis of the KTA framework found that about 14% (146/1057) of screened abstracts described using the KTA to varying degrees, although only 10 articles were judged to have applied the framework in a fully integrated way to inform the design, delivery, and evaluation of implementation activities [11]. PARIHS has been used in a diverse range of settings but, similarly to other commonly used implementation frameworks, most often superficially or partially. The whole framework has seldom been used holistically to guide all aspects of implementation studies. Implementation science scholars have repeatedly argued that the underuse, superficial use, and misuse of implementation frameworks might reduce the potential scientific advancements in the field, but also the capacity for changing healthcare practice and outcomes [4]. The rationale for not using the whole PARIHS framework could be many, including the justified reason of only being interested in a particular element. As such, partial use cannot always be considered as inappropriate. Simultaneously, many researchers entering the field might be overwhelmed with the many frameworks available and the lack of guidance about how to select and operationalize them and using their elements [2, 4, 391]. The current citation analysis can thus help remedy a gap in the literature by revealing how the PARIHS framework has been used to date, in full or partially, and thus provides input to users of its potential use. The use of theoretical frameworks in implementation science serves the purpose of guiding researchers’ and practitioners’ implementation plans and informing their approaches to implementation and evaluation. This includes decisions about what data to gather to describe and explain implementation, their hypotheses about action steps needed, how to account for the critical role of context, and providing a foundation for analysis and discussion [7]. The advancement of theoretically informed implementation science will, however, depend on much improved descriptions as to why and how a certain framework was used, and an enhanced and better-informed critical reflection of the functionality of that framework. This review shows that the PARIHS framework has rarely been used as a whole; rather, certain elements tend to be applied, often retrospectively as indicated in Fig. 3 underlining the use of PARIHS in the evaluation of study findings, which resonates with the findings of reviews about the use of the KTA [2] and CFIR [11] frameworks. This could be as a result of a lack of theoretical coherence of some frameworks making them difficult to apply holistically, and/or a function of a general challenge that researchers face in operationalizing theory. However, this could also be a result of publishing constraints. While the PARIHS framework may have guided implementation or been implicitly used in the study design, it was rarely the focus of the publications. Further, the aims and scopes of scientific health care journals have historically prioritized clinical outcomes over implementation outcomes where one could expect a more detailed description of the use of theoretical frameworks. This may have resulted in authors not fully reporting their use of, e.g., the PARIHS framework. The number of empirical studies using the PARIHS framework has steadily increased over the review period. There is also evidence to show that more research teams have contributed to critiquing the framework in terms of reporting on its strengths and limitations and its validity. The pattern of investigation is moving from studies on context, to more systematic explorations of facilitation, thus contributing to a more detailed understanding of the elements and sub-elements of the framework. The lack of focus on “evidence” identified in this review highlights the need for researchers and clinicians to focus on the multi-dimensionality of what is being implemented. Common patterns emerging in this review support the changes made to the most recent refinement of the PARIHS framework [359]. Consistent with other reviews of the use of theoretical frameworks in implementation science, we found that PARIHS was often not used as intended. Further, it was not always clear why the particular framework was chosen. Frequently, authors merely cite a framework without providing any further information about how the framework was used. The lack of clear guidance on how to operationalize frameworks might be one of the underlying reasons for this. Lastly, to enable a critical review of frameworks and further build collective understanding of implementation, we urge authors to be more explicit about how theory informs studies. Development and adoption of reporting guidelines on how framework(s) are used in implementation studies might assist in sharpening the link between the used framework(s) and the individual study, but could potentially also enhance the opportunities for advancing the scientific understanding of implementation. Limitations To increase study reliability during the review process, more than one person identified, assessed, and interpreted the data. We had regular meetings to discuss potential difficulties in assessing included articles, and subsequently, all decisions were resolved by consensus to enhance rigor. We used a rigorous search strategy, which was undertaken by an information specialist. The standardization of our processes across the team was also enhanced by the creation of an online data extraction form via Google. However, as the form was not linked to other software (e.g., Endnote), this added time-consuming processes. As we did not include articles that were not written in English, we may have limited the insights about the application of the PARIHS framework, particularly with relevance to different country contexts. Additionally, we did not search the grey literature for practical reasons concerning the size of the literature, which may also have provided some additional insights not reflected in this publication. We also limited our search to two databases, which may mean we missed some relevant articles. However, we are confident that we found the majority of relevant published evidence to address the review questions because of a rigorous approach to retrieval. Thus, we think the findings of our citation analysis on the use of PARIHS are generalizable for studies in English published in peer-reviewed journals. Conclusions The importance of theoretically underpinned implementation science has been consistently highlighted. Theory is important for maximizing the chances of study transferability, providing an explanation of implementation processes, developing and tailoring implementation interventions, evaluating implementation, and explaining outcomes. This review of the use of the PARIHS framework, one of the most cited implementation frameworks, shows that its actual use and application has been frequently partial and generally not well described. Our ability to advance the science of implementation and ultimately affect outcomes will, in part, be dependent on better use of theory. Therefore, it is incumbent on theory developers to generate accessible and applicable theories, frameworks, and models, and for theory users to operationalize these in a considered and transparent way. We propose that the development and adoption of reporting guidelines on how framework(s) are used in implementation studies might enhance the maturity of implementation science. Supplementary information Additional file 1: Form for initial assessment and form for data extraction Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Supplementary information Supplementary information accompanies this paper at 10.1186/s13012-020-01003-0. Acknowledgements The authors wish to acknowledge Sayna Bahraini, Heledd Owen Griffiths, and Veronica Costea for partaking in the initial assessment of retrieved articles. Authors’ contributions All authors made substantial contributions to the manuscript. KG and AB conducted the citation searches. AB led the initial assessment. AB, AE, ACE, IDG, GH, AK, JRM, and LW developed the data extraction form and undertook data extraction in pairs of two. AB coordinated the data extraction. AB analyzed the descriptive data and AE, ACE, GH, SH, AK, and LW analyzed the qualitative data. AB prepared figures and tables and drafted the manuscript together with LW, AE, ACE, IDG, KG, GH, SH, AK, and JRM revised the manuscript. All authors have read and gave final approval of the version of the manuscript submitted for publication. Funding IDG is a recipient of a CIHR Foundation Grant (FDN #143237) and AB the recipient of a FORTE grant (COFAS-2, 2014-2733). The funders had no role in designing the study, retrieving, or analyzing included articles, decision to publish, or preparation of the manuscript. Open access funding provided by Uppsala University. Availability of data and materials The datasets generated and analyzed during the current study can be obtained through contacting the first author. Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Competing interests We acknowledge that GH, AK, and JRM were all involved in the development of the PARIHS framework. Further, IDG, JRM, and LW are all members of the BMC Implementation Science Editorial Board.

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