These categories are not always recognized as separate types of approaches in the literature. At the individual level, the ability to appraise research evidence is required. Models are closely related to theory and the difference between a theory and a model is not always clear. The Stetler model provides a way to think about the relationship between research use and evidence-informed practice. Read about for some powerful new tools.
The E-mail message field is required. Furthermore, there is the issue of whether the barriers and enablers are the actual determinants i. Barriers identified in the literature review are addressed in the case study. For instance, are people driven primarily by their individual beliefs and motivation or does a pervasive organizational culture impose norms and values that regulate how people behave and make individual characteristics relatively unimportant? A detailed case study based on the model is included. Theories applied in implementation science can be characterized as middle level. For instance, Estabrooks et al. Several organization-level theories might have relevance for implementation science.
File Attachment None Web-link Reference Stetler, C. The Stetler model of evidence-based practice outlines criteria to determine the desirability and feasibility of applying a study or studies to address an issue. Although evaluation frameworks may be considered in a category of their own, theories, models and frameworks from the other four categories can also be applied for evaluation purposes because they specify concepts and constructs that may be operationalized and measured. Still, it seems unlikely that there will ever be a grand implementation theory since implementation is too multifaceted and complex a phenomenon to allow for universal explanations. The book concludes with an analysis and synthesis of the included models and frameworks. The determinant frameworks do not address how change takes place or any causal mechanisms, underscoring that they should not be considered theories.
The role afforded the context varies, from studies e. Still, context is generally understood as the conditions or surroundings in which something exists or occurs, typically referring to an analytical unit that is higher than the phenomena directly under investigation. The context is an integral part of all the determinant frameworks. Many frameworks are multilevel, identifying determinants at different levels, from the individual user or adopter e. Theories are more consistent with existing facts than common sense, which typically means that a hypothesis based on an established theory is a more educated guess than one based on common sense. A few papers presenting overviews of theories, models and frameworks used in implementation science were also used: Estabrooks et al. Models and Frameworks for Implementing Evidence- Based Practice: Linking Evidence to Action looks at ways of implementing evidence gained through research and factors that influence successful implementation.
While there is overlap between some of the theories, models and frameworks, awareness of the differences is important to facilitate the selection of relevant approaches. Two figures illustrate the model and the implementation process. Conceptual use occurs when using research changes the understanding or the way one thinks about an issue. This user driven revision differs from other frameworks in that it links practice changes within the system. Action models elucidate important aspects that need to be considered in implementation practice and usually prescribe a number of stages or steps that should be followed in the process of translating research into practice.
Is a particular behaviour primarily influenced by reflective thought processes or is it an automatically enacted habit? Contents: Title Page; Contents; Notes on Contributors; Foreword; Preface; 1 Evidence-based practice; Introduction; What is evidence-based practice? The relevance of the end users e. Description The Stetler model of research utilization helps practitioners assess how research findings and other relevent evidence can be applied in practice. For instance, this model is a useful guide to using research evidence in developing health messages for breastfeeding. Poor theoretical underpinning makes it difficult to understand and explain how and why implementation succeeds or fails, thus restraining opportunities to identify factors that predict the likelihood of implementation success and develop better strategies to achieve more successful implementation. The frameworks are superficially quite disparate, with a broad range of terms, concepts and constructs as well as different outcomes, yet they are quite similar with regard to the general types of determinants they account for.
These two concepts are not the same. Phase V: Evaluation - Clarify expected outcomes relative to purpose of seeking evidence and whether the evaluation is related to a direct use or consider use decision. While the use of theory does not necessarily yield more effective implementation than using common sense, there are certain advantages to applying formal theory over common sense i. These categories are not always recognized as separate types of approaches in the literature. The aim is to describe and analyse how theories, models and frameworks have been applied in implementation science and propose a taxonomy that distinguishes between different approaches to advance clarity and achieve a common terminology. A theory in this field usually implies some predictive capacity e. A review of guideline implementation strategies by Davies et al.
The use of a single theory that focuses only on a particular aspect of implementation will not tell the whole story. Changes in health care e. The adaptation allows researchers to prioritize aspects considered to be most critical to analyse issues related to the how and why of implementation, thus improving the relevance and appropriateness to the particular circumstances at hand. A framework usually denotes a structure, overview, outline, system or plan consisting of various descriptive categories, e. Classic theories Implementation researchers are also wont to apply theories from other fields such as psychology, sociology and organizational theory. The book concludes with an analysis and synthesis of the included models and frameworks. A model typically involves a deliberate simplification of a phenomenon or a specific aspect of a phenomenon.