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1.
BMC Health Serv Res ; 20(1): 81, 2020 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-32013977

RESUMO

BACKGROUND: This review of scholarly work in health care knowledge translation advances understanding of implementation components that support the complete and timely integration of new knowledge. We adopt a realist approach to investigate what is known from the current literature about the impact of, and the potential relationships between, context, complexity and implementation process. METHODS: Informed by two distinct pathways, knowledge utilization and knowledge translation, we utilize Rogers' Diffusion of Innovations theory (DOI) and Harvey and Kitson's integrated- Promoting Action on Research Implementation in Health Service framework (PARIHS) to ground this review. Articles from 5 databases; Medline, Scopus, PsycInfo, Web of Science, and Google Scholar and a search of authors were retrieved. Themes and patterns related to these implementation components were extracted. Literature was selected for inclusion by consensus. Data extraction was iterative and was moderated by the authors. RESULTS: A total of 67 articles were included in the review. Context was a central component to implementation. It was not clear how and to what extent context impacted implementation. Complexity was found to be a characteristic of context, implementation process, innovations and a product of the relationship between these three elements. Social processes in particular were reported as influential however; descriptions of how these social process impact were limited. Multiple theoretical and operational models were found to ground implementation processes. We offer an emerging conceptual model to illustrate the key discoveries. CONCLUSIONS: The review findings indicate there are dynamic relationship between context, complexity and implementation process for enhancing uptake of evidence-based knowledge in hospital settings. These are represented in a conceptual model. Limited empiric evidence was found to explain the nature of the relationships.


Assuntos
Assistência à Saúde/organização & administração , Difusão de Inovações , Prática Clínica Baseada em Evidências/organização & administração , Pesquisa Médica Translacional , Pesquisa sobre Serviços de Saúde , Humanos
4.
Health Res Policy Syst ; 17(1): 79, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31399114

RESUMO

BACKGROUND: Interest in value-based healthcare, generally defined as providing better care at lower cost, has grown worldwide, and learning health systems (LHSs) have been proposed as a key strategy for improving value in healthcare. LHSs are emerging around the world and aim to leverage advancements in science, technology and practice to improve health system performance at lower cost. However, there remains much uncertainty around the implementation of LHSs and the distinctive features of these systems. This paper presents a conceptual framework that has been developed in Canada to support the implementation of value-creating LHSs. METHODS: The framework was developed by an interdisciplinary team at the Institut national d'excellence en santé et en services sociaux (INESSS). It was informed by a scoping review of the scientific and grey literature on LHSs, regular team discussions over a 14-month period, and consultations with Canadian and international experts. RESULTS: The framework describes four elements that characterise LHSs, namely (1) core values, (2) pillars and accelerators, (3) processes and (4) outcomes. LHSs embody certain core values, including an emphasis on participatory leadership, inclusiveness, scientific rigour and person-centredness. In addition, values such as equity and solidarity should also guide LHSs and are particularly relevant in countries like Canada. LHS pillars are the infrastructure and resources supporting the LHS, whereas accelerators are those specific structures that enable more rapid learning and improvement. For LHSs to create value, such infrastructures must not only exist within the ecosystem but also be connected and aligned with the LHSs' strategic goals. These pillars support the execution, routinisation and acceleration of learning cycles, which are the fundamental processes of LHSs. The main outcome sought by executing learning cycles is the creation of value, which we define as the striking of a more optimal balance of impacts on patient and provider experience, population health and health system costs. CONCLUSIONS: Our framework illustrates how the distinctive structures, processes and outcomes of LHSs tie together with the aim of optimising health system performance and delivering greater value in health systems.


Assuntos
/organização & administração , Canadá , Prática Clínica Baseada em Evidências/organização & administração , Gastos em Saúde , Humanos , Sistemas de Informação/organização & administração , Liderança , Objetivos Organizacionais , Satisfação do Paciente , Políticas
5.
Int J Evid Based Healthc ; 17 Suppl 1: S22-S23, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31283573

RESUMO

The notion of context, while underpinning everything that we do in health care, remains something that is difficult to define; however, it determines the success or failure of everything that we do, particularly in the global healthcare arena. Whether we consider context as an objective or subjective construct, it should influence every evidence-based decision we make as healthcare professionals. Methods developed as part of the implementation science movement, including realist synthesis and 'mindlines', emphasize the important of addressing social, cultural and environmental context-specific influences when considering the implementation of complex interventions, particularly in diverse populations. The Joanna Briggs Institute evidence-based clinical fellowship program empowers practitioners, through education, to implement evidence into their own practice areas, taking into account the key variables that impact on successful adoption.


Assuntos
Prática Clínica Baseada em Evidências/organização & administração , Pessoal de Saúde/psicologia , Atitude do Pessoal de Saúde , Tomada de Decisões , Prática Clínica Baseada em Evidências/métodos , Pessoal de Saúde/educação , Humanos , Ciência da Implementação
6.
Int J Evid Based Healthc ; 17 Suppl 1: S24-S25, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31283574

RESUMO

The article discusses the methodological and socioadaptive issues that impact on the development and implementation of evidence-based guidelines for the prevention and control of healthcare-associated infections.


Assuntos
Infecção Hospitalar/prevenção & controle , Prática Clínica Baseada em Evidências/métodos , Prática Clínica Baseada em Evidências/organização & administração , Guias como Assunto , Humanos , Ciência da Implementação
7.
Int J Evid Based Healthc ; 17 Suppl 1: S68-S71, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31283587

RESUMO

In 2016, the Belgian Minister for Social Affairs and Public Health decided to set up a central governance structure for evidence-based practice (EBP). The underlying model, consisting of six EBP life cycle cells (prioritization, development, validation, dissemination, implementation and evaluation) and a bipolar governance layer was developed in 2017. Based on the characteristics of the Belgian EBP landscape, a network administrative organization was chosen to coordinate and facilitate the operational processes in the EBP life cycle and act as intermediate between the two forces: stakeholders and funders/policy makers. Scientific processes remain the responsibility of the EBP experts in the cells. As organizational change can result in resistance, building trust and consensus is a very important success factor for the setup of the network. The process is now in an advanced stage and in 2019 the EBP governance structure will be operationalized.


Assuntos
Prática Clínica Baseada em Evidências/organização & administração , Bélgica , Guias como Assunto/normas , Humanos , Inovação Organizacional , Desenvolvimento de Programas/métodos
8.
J Community Health Nurs ; 36(3): 147-154, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31291769

RESUMO

The purpose of this manuscript is to describe a mutually beneficial collaboration with a Public Health Department and a University to implement an evidence-based program to teach nutrition and physical activity to improve adult and child outcomes. We first assessed the needs of the Public Health Department to build sustainable capacity. Next, all collaborators were invited to work together to focus on success. We invested in the leadership structure and strategically planned together. Finally, all of the collaborators worked together to practice cultural awareness. The process of implementing evidence-based programs allows all collaborators to emerge from the interaction stronger as a result of respectful dialogue and team building.


Assuntos
Prática Clínica Baseada em Evidências/métodos , Exercício Físico , Comportamentos Relacionados com a Saúde , Promoção da Saúde/métodos , Estado Nutricional , Prática de Saúde Pública , Adulto , Criança , Competência Cultural , Prática Clínica Baseada em Evidências/organização & administração , Promoção da Saúde/organização & administração , Humanos , Obesidade Pediátrica/prevenção & controle , Desenvolvimento de Programas , Planejamento Estratégico
9.
Int J Technol Assess Health Care ; 35(4): 266-272, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31337453

RESUMO

OBJECTIVES: As more health technology assessment (HTA) bodies seek to implement patient involvement, there is a desire to learn from other HTA bodies about their experiences and understand what approaches can be used and which ones make a real difference to HTA. This is difficult, as the impact of patient involvement in HTA is not well documented. This study aims to promote further discussion about the ways in which patient involvement can impact HTAs by studying stories of impact. METHODS: In a multi-stakeholder workshop, experts leading patient involvement in four HTA bodies shared examples of HTAs where they believed patient involvement made a difference, then they reflected on these impact stories within the wider context of impact evaluation. RESULTS: The HTA bodies drew on patient input and patient-based evidence to inform their HTAs. The patient involvement was observed to elucidate patients' experiences, needs and preferences which, in turn, was observed to influence the HTA recommendations about optimal use of technologies, including taking account of issues for sub-groups, outcomes that matter to patients and educational needs. CONCLUSIONS: Personal stories of patient involvement may enable a wider understanding of different approaches to and impact of patient involvement. The examples relate to both patient input and patient-based evidence and highlight the role that patient involvement can play in reducing uncertainties and complementing the clinical and economic evidence in HTA. They suggest that impact can be seen in recommendations about how and when a technology is used.


Assuntos
Prática Clínica Baseada em Evidências/organização & administração , Participação do Paciente/métodos , Avaliação da Tecnologia Biomédica/organização & administração , Bandagens/normas , Humanos , Apneia Obstrutiva do Sono/terapia , Avaliação da Tecnologia Biomédica/normas , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Fator de Necrose Tumoral alfa/uso terapêutico
10.
Implement Sci ; 14(1): 63, 2019 06 14.
Artigo em Inglês | MEDLINE | ID: mdl-31200730

RESUMO

BACKGROUND: In healthcare settings, system and organization leaders often control the selection and design of implementation strategies even though frontline workers may have the most intimate understanding of the care delivery process, and factors that optimize and constrain evidence-based practice implementation within the local system. Innovation tournaments, a structured participatory design strategy to crowdsource ideas, are a promising approach to participatory design that may increase the effectiveness of implementation strategies by involving end users (i.e., clinicians). We utilized a system-wide innovation tournament to garner ideas from clinicians about how to enhance the use of evidence-based practices (EBPs) within a large public behavioral health system. METHODS: Our innovation tournament occurred in three phases. First, we invited over 500 clinicians to share, through a web-based platform, their ideas regarding how their organizations could best support use of EBPs. Clinicians could rate and comment on ideas submitted by others. Second, submissions were judged by an expert panel (including behavioral scientists, system leaders, and payers) based on their rated enthusiasm for the idea. Third, we held a community-facing event during which the six clinicians who submitted winning ideas presented their strategies to 85 attendees representing a cross-section of clinicians and system and organizational leaders. RESULTS: We had a high rate of participation (12.3%), more than double the average rate of previous tournaments conducted in other settings (5%). A total of 65 ideas were submitted by 55 participants representing 38 organizations. The most common categories of ideas pertained to training (42%), financing and compensation (26%), clinician support and preparation tools (22%), and EBP-focused supervision (17%). The expert panel and clinicians differed on their ratings of the ideas, highlighting value of seeking input from multiple stakeholder groups when developing implementation strategies. CONCLUSIONS: Innovation tournaments are a useful and feasible methodology for engaging end users, system leaders, and behavioral scientists through a structured approach to developing implementation strategies. The process and resultant strategies engendered significant enthusiasm and engagement from participants at all levels of a healthcare system. Research is needed to compare the effectiveness of strategies developed through innovation tournaments to strategies developed through design approaches.


Assuntos
Medicina do Comportamento/organização & administração , Crowdsourcing , Prática Clínica Baseada em Evidências/organização & administração , Inovação Organizacional , Humanos , Projetos de Pesquisa
11.
Implement Sci ; 14(1): 66, 2019 06 20.
Artigo em Inglês | MEDLINE | ID: mdl-31221201

RESUMO

BACKGROUND: Effective leadership for organizational change is critical to the implementation of evidence-based practices (EBPs). As organizational leaders in behavioral health organizations often are promoted from within the agency for their long-standing, effective work as counselors, they may lack formal training in leadership, management, or practice change. This study assesses a novel implementation leadership training designed to promote leadership skills and successful organizational change specific to EBP implementation. METHODS: We conducted a pre-post outcome evaluation of the Training in Implementation Practice Leadership (TRIPLE), delivered via three in-person, half-day training sessions, with interim coaching and technical support. Sixteen mid-level leaders (75% female, 94% Caucasian, mean age 37 years) from 8 substance abuse treatment agencies participated. Professional roles included clinical managers, quality improvement coordinators, and program directors. Participants completed surveys prior to the first and following the final session. At both time points, measures included the Implementation Leadership Scale, Implementation Climate Scale, and Organizational Readiness for Implementing Change Scale. At post-test, we added the Training Acceptability and Appropriateness Scale (TAAS), assessing participant satisfaction with the training. Qualitative interviews were conducted 6 to 8 months after the training. RESULTS: Most participants (86% and 79%, respectively) reported increased implementation leadership skills and implementation climate; paired samples t tests indicated these pre-post increases were statistically significant. Implementation leadership scores improved most markedly on the Proactive and Knowledgeable subscales. For implementation climate, participants reported the greatest increases in educational support and recognition for using EBP. Post-test scores on the TAAS also indicated that participants found the training program to be highly acceptable and appropriate for their needs. Qualitative results supported positive outcomes of training that resulted in both increased organizational implementation as well as leadership skills of participants. CONCLUSIONS: This training program represents an innovative, effective, and well-received implementation strategy for emerging behavioral healthcare leaders seeking to adopt or improve the delivery of EBPs. Reported implementation leadership skills and implementation climate improved following the training program, suggesting that TRIPLE may have helped fulfill a critical need for emerging behavioral healthcare leaders.


Assuntos
Prática Clínica Baseada em Evidências/organização & administração , Pessoal de Saúde/educação , Capacitação em Serviço , Liderança , Inovação Organizacional , Competência Profissional , Centros de Tratamento de Abuso de Substâncias , Adulto , Feminino , Humanos , Masculino
12.
J Allied Health ; 48(2): 119-126, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31167014

RESUMO

BACKGROUND: The significance of evidence-based practice (EBP) cannot be overstated. However, literature on the perception of occupational and physical therapists toward EBP is scarce. METHODS: This survey study was intended to examine occupational and physical therapists' perceptions of EBP. A total of 47 of 261 practicing therapists in a health care system in the Midwest U.S. responded to the questionnaire previously developed by Rubin et al. RESULTS: The results of the study showed that therapists reported familiarity with the EBP process and maintained an overall positive attitude toward EBP. Of the five subscale measures of EBP, familiarity with EBP process had the greatest average score (3.82±0.48) followed by attitude about EBP process (3.73±0.37). The smallest mean subscale score was found on the measure of current engagement in EBP process (2.93±0.55). Therapists reported intent to engage in the EBP process but were less favorable to engage in EBP and only reported engagement in EBP a little less than "some of the time." Barriers to engaging in EBP included time, access, and the constraints of the responders' practice setting. Implications of this study resulted in recommendations for clinical practice and educational programs.


Assuntos
Atitude do Pessoal de Saúde , Prática Clínica Baseada em Evidências/organização & administração , Terapeutas Ocupacionais/psicologia , Fisioterapeutas/psicologia , Adulto , Prática Clínica Baseada em Evidências/normas , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Meio-Oeste dos Estados Unidos , Percepção
13.
Am J Nurs ; 119(6): 62-66, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31135435

RESUMO

This is the second article in a new series about evidence-based practice (EBP) that builds on AJN's award-winning previous series-Evidence-Based Practice, Step by Step-published between 2009 and 2011 (to access the series, go to http://links.lww.com/AJN/A133). This follow-up series will feature exemplars illustrating the various strategies that can be used to implement EBP changes-one of the most challenging steps in the EBP process.


Assuntos
Prática Clínica Baseada em Evidências/educação , Prática Clínica Baseada em Evidências/organização & administração , Recursos Humanos de Enfermagem no Hospital/educação , Recursos Humanos de Enfermagem no Hospital/organização & administração , Admissão e Escalonamento de Pessoal/organização & administração , Desenvolvimento de Pessoal/organização & administração , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
14.
Int J Technol Assess Health Care ; 35(3): 204-211, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31017075

RESUMO

OBJECTIVES: Very few practical frameworks exist to guide the formulation of recommendations at hospital-based health technology assessment (HTA) units. The objectives of our study were: (i) to identify decision criteria specific to the context of hospital-based health technologies and interventions, (ii) to estimate the extent to which the expert community agrees on the importance of the identified criteria, (iii) to incorporate the identified criteria into a decision-aid tool, and (iv) to illustrate the application of a prototype decision-aid tool. METHODS: Relevant decision criteria were identified using existing frameworks for HTA recommendations, our past experience, a literature search, and feedback from a survey of diverse stakeholders. RESULTS: Based on the survey results, twenty-three decision criteria were incorporated into the final framework. We defined an approach that eschewed a scoring system, but instead relied on a visual means for arriving at a final recommendation, by juxtaposing the importance rating for each criterion against the results of the health technology assessment. For a technology to be approved, a majority of criteria considered important should also have received favorable findings. CONCLUSIONS: We created a simple and practical decision-aid tool that incorporates all decision criteria relevant to a hospital-based HTA unit. With its ease of use and accessibility, our tool renders the subjective decision-making process more structured and transparent.


Assuntos
Tomada de Decisões Gerenciais , Técnicas de Apoio para a Decisão , Prática Clínica Baseada em Evidências/organização & administração , Administração Hospitalar , Avaliação da Tecnologia Biomédica/organização & administração , Comportamento Cooperativo , Análise Custo-Benefício , Eficiência Organizacional , Humanos , Políticas
15.
J Clin Nurs ; 28(13-14): 2681-2687, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30938867

RESUMO

AIMS AND OBJECTIVES: To determine the clinical and professional impacts of nurses' and other clinicians' involvement in a research training programme. BACKGROUND: Evidence-based practice (EBP) can be supported by nurses' involvement in research. Registered nurses report common barriers to EBP and research, but training programmes have been shown to overcome some of those barriers and lead to successful research engagement and EBP enhancement. DESIGN: This mixed-methods evaluation study used a survey and interviews to explore the clinical and professional impacts of research training programme participation on nurses' and other clinicians' clinical practice, appreciation for EBP, interest in advanced education, future research involvement and dissemination activities. METHODS: The study adhered to the SQUIRE guidelines for quality improvement studies as part of the EQUATOR network (Enhancing the Quality and Transparency of Health Research). Survey invitations were sent to 126 clinicians who had participated in a research training programme. All were invited to complete the questionnaire and participate in an interview. RESULTS: Survey results and interview responses showed a positive impact. Participants reported examples of sustained practice changes, enhanced EBP, heightened interest in graduate studies, strong interest in future research engagement and a large number of dissemination activities, including publications and conference presentations. CONCLUSIONS: The evaluation found that participation in a research training programme can have a positive clinical and professional impact on participants, including enhancing their appreciation for EBP and research, their interest in advanced education and meaningful dissemination of findings to improve patient care. RELEVANCE TO CLINICAL PRACTICE: As healthcare leaders seek to increase EBP to improve patient care, successful models for nurses' engagement in research and EBP are critically important. This research training programme is one promising model for supporting nurses' and other clinicians' engagement in EBP and research.


Assuntos
Atitude do Pessoal de Saúde , Prática Clínica Baseada em Evidências/organização & administração , Pesquisa em Enfermagem/educação , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
16.
J Pediatric Infect Dis Soc ; 8(3): 276-278, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31006812

RESUMO

The pediatric infectious disease community has struggled to identify metrics that demonstrate the value that we add to the care of our patients. This challenge is largely a function of our typical role as a consultant in most healthcare settings. Most current quality metrics, however, are designed to measure patient outcomes that are directly affected by the primary clinical team, not the consultants they seek to involve. Novel measurement strategies are needed to capture the value that pediatric infectious disease consultation adds to the health of individual patients and the well-being of populations.


Assuntos
Doenças Transmissíveis , Consultores , Prática Clínica Baseada em Evidências/normas , Médicos , Assistência à Saúde/organização & administração , Assistência à Saúde/normas , Prática Clínica Baseada em Evidências/organização & administração , Humanos , Guias de Prática Clínica como Assunto , Padrões de Prática Médica , Encaminhamento e Consulta , Especialização
19.
BMC Public Health ; 19(1): 270, 2019 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-30841888

RESUMO

BACKGROUND: Mis-implementation (i.e., the premature termination or inappropriate continuation of public health programs) contributes to the misallocation of limited public health resources and the sub-optimal response to the growing global burden of chronic disease. This study seeks to describe the occurrence of mis-implementation in four countries of differing sizes, wealth, and experience with evidence-based chronic disease prevention (EBCDP). METHODS: A cross-sectional study of 400 local public health practitioners in Australia, Brazil, China, and the United States was conducted from November 2015 to April 2016. Online survey questions focused on how often mis-termination and mis-continuation occur and the most common reasons programs end and continue. RESULTS: We found significant differences in knowledge of EBCDP across countries with upwards of 75% of participants from Australia (n = 91/121) and the United States (n = 83/101) reporting being moderately to extremely knowledgeable compared with roughly 60% (n = 47/76) from Brazil and 20% (n = 21/102) from China (p < 0.05). Far greater proportions of participants from China thought effective programs were never mis-terminated (12.2% (n = 12/102) vs. 1% (n = 2/121) in Australia, 2.6% (n = 2/76) in Brazil, and 1.0% (n = 1/101) in the United States; p < 0.05) or were unable to estimate how frequently this happened (45.9% (n = 47/102) vs. 7.1% (n = 7/101) in the United States, 10.5% (n = 8/76) in Brazil, and 1.7% (n = 2/121) in Australia; p < 0.05). The plurality of participants from Australia (58.0%, n = 70/121) and the United States (36.8%, n = 37/101) reported that programs often mis-continued whereas most participants from Brazil (60.5%, n = 46/76) and one third (n = 37/102) of participants from China believed this happened only sometimes (p < 0.05). The availability of funding and support from political authorities, agency leadership, and the general public were common reasons programs continued and ended across all countries. A program's effectiveness or evidence-base-or lack thereof-were rarely reasons for program continuation and termination. CONCLUSIONS: Decisions about continuing or ending a program were often seen as a function of program popularity and funding availability as opposed to effectiveness. Policies and practices pertaining to programmatic decision-making should be improved in light of these findings. Future studies are needed to understand and minimize the individual, organizational, and political-level drivers of mis-implementation.


Assuntos
Doença Crônica/prevenção & controle , Prática Clínica Baseada em Evidências/organização & administração , Administração em Saúde Pública/métodos , Prática de Saúde Pública/normas , Austrália , Brasil , China , Estudos Transversais , Tomada de Decisões , Prática Clínica Baseada em Evidências/normas , Humanos , Avaliação de Programas e Projetos de Saúde , Administração em Saúde Pública/economia , Estados Unidos
20.
BMC Health Serv Res ; 19(1): 189, 2019 Mar 25.
Artigo em Inglês | MEDLINE | ID: mdl-30909897

RESUMO

BACKGROUND: The relevance of context in implementation science is reflected in the numerous theories, frameworks, models and taxonomies that have been proposed to analyse determinants of implementation (in this paper referred to as determinant frameworks). This scoping review aimed to investigate and map how determinant frameworks used in implementation science were developed, what terms are used for contextual determinants for implementation, how the context is conceptualized, and which context dimensions that can be discerned. METHODS: A scoping review was conducted. MEDLINE and EMBASE were searched from inception to October 2017, and supplemented with implementation science text books and known published overviews. Publications in English that described a determinant framework (theory, model, taxonomy or checklist), of which context was one determinant, were eligible. Screening and inclusion were done in duplicate. Extracted data were analysed to address the study aims. A qualitative content analysis with an inductive approach was carried out concerning the development and core context dimensions of the frameworks. The review is reported according to the PRISMA guidelines. RESULTS: The database searches yielded a total of 1113 publications, of which 67 were considered potentially relevant based on the predetermined eligibility criteria, and retrieved in full text. Seventeen unique determinant frameworks were identified and included. Most were developed based on the literature and/or the developers' implementation experiences. Six of the frameworks explicitly referred to "context", but only four frameworks provided a specific definition of the concept. Instead, context was defined indirectly by description of various categories and sub-categories that together made up the context. Twelve context dimensions were identified, pertaining to different aggregation levels. The most widely addressed context dimensions were organizational support, financial resources, social relations and support, and leadership. CONCLUSIONS: The findings suggest variation with regard to how the frameworks were developed and considerable inconsistency in terms used for contextual determinants, how context is conceptualized, and which contextual determinants are accounted for in frameworks used in implementation science. Common context dimensions were identified, which can facilitate research that incorporates a theory of context, i.e. assumptions about how different dimensions may influence each other and affect implementation outcomes. A thoughtful application of the concept and a more consistent terminology would enhance transparency, simplify communication among researchers, and facilitate comparison across studies.


Assuntos
Prática Clínica Baseada em Evidências/organização & administração , Ciência da Implementação , Liderança
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