scholarly journals Understanding the implementation of evidence-informed policies and practices from a policy perspective: a critical interpretive synthesis

2021 ◽  
Author(s):  
Heather L Bullock ◽  
John N Lavis ◽  
Michael G Wilson ◽  
Gillian Mulvale ◽  
Ashleigh Miatello
Keyword(s):  
Grey Literature ◽  
Synthesis Method ◽  
Empirical Work ◽  
Implementation Process ◽  
Empirical Literature ◽  
Implementation Theory ◽  
Policy Perspective ◽  
Implementation Processes ◽  
Critical Interpretive Synthesis ◽  
New Perspective

Abstract Background: The fields of implementation science and knowledge translation have evolved somewhat independently from the field of policy implementation research, despite calls for better integration. As a result, implementation theory and empirical work do not often reflect the implementation experience from a policy lens nor benefit from the scholarship in all three fields. This means policymakers, researchers and practitioners may find it challenging to draw from theory that adequately reflects their implementation efforts.Methods: We developed an integrated theoretical framework of the implementation process from a policy perspective by combining findings from these fields using the critical interpretive synthesis method. We began with the compass question: how is policy currently described in implementation theory and processes and what aspects of policy are important for implementation success? We then searched 12 databases as well as grey literature and supplemented these documents with other sources to fill conceptual gaps. Using a grounded and interpretive approach to analysis, we built the framework constructs, drawing largely from the theoretical literature and then tested and refined the framework using empirical literature.Results: A total of 11,434 documents were retrieved and assessed for eligibility and 35 additional documents were identified through other sources. Eighty-six unique documents were ultimately included in the analysis. Our findings indicate that policy is described as: 1) the context; 2) a focusing lens; 3) the innovation itself; 4) a lever of influence; 5) an enabler/facilitator or barrier; or 6) an outcome. Policy actors were also identified as important participants or leaders of implementation. Our analysis led to the development of a two-part conceptual framework, including process and determinant components. Conclusions: This framework begins to bridge the divide between disciplines and provides a new perspective about implementation processes at the systems level. It offers researchers, policymakers and implementers a new way of thinking about implementation that better integrates policy considerations and can be used for planning or evaluating implementation efforts.

scholarly journals Understanding the implementation of evidence-informed policies and practices from a policy perspective: a critical interpretive synthesis

2020 ◽  
Author(s):  
Heather L Bullock ◽  
John N Lavis ◽  
Michael G Wilson ◽  
Gillian Mulvale ◽  
Ashleigh Miatello
Keyword(s):  
Grey Literature ◽  
Synthesis Method ◽  
Empirical Work ◽  
Implementation Process ◽  
Empirical Literature ◽  
Implementation Theory ◽  
Policy Perspective ◽  
Implementation Processes ◽  
Critical Interpretive Synthesis ◽  
Way Of Thinking

Abstract Background: The fields of implementation science and knowledge translation have evolved somewhat independently from the field of policy implementation research, despite calls for better integration. As a result, implementation theory and empirical work do not often reflect the implementation experience from a policy lens nor benefit from the scholarship in all three fields. This means policymakers, researchers and practitioners may find it challenging to draw from theory that adequately reflects their implementation efforts.Methods: We developed an integrated theoretical framework of the implementation process from a policy perspective by combining findings from these fields using the critical interpretive synthesis method. We began with the compass question: how is policy currently described in implementation theory and processes and what aspects of policy are important for implementation success? We then searched 12 databases as well as grey literature and supplemented these documents with other sources to fill conceptual gaps. Using a grounded and interpretive approach to analysis, we built the framework constructs, drawing largely from the theoretical literature and then tested and refined the framework using empirical literature.Results: A total of 11,434 documents were retrieved and assessed for eligibility and 35 additional documents were identified through other sources. Eighty-six unique documents were ultimately included in the analysis. Our findings indicate that policy is described as: 1) the context; 2) a focusing lens; 3) the innovation itself; 4) a lever of influence; 5) an enabler/facilitator or barrier; or 6) an outcome. Policy actors were also identified as important participants or leaders of implementation. Our analysis led to the development of a two-part conceptual framework, including process and determinant components. Conclusions: This framework begins to bridge the divide between disciplines and offers a new way of thinking about implementation processes at the systems level. It offers researchers, policymakers and implementers with a new way of thinking about implementation and can be used for planning or evaluating implementation efforts.

scholarly journals Understanding the implementation of evidence-informed policies and practices from a policy perspective: a critical interpretive synthesis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Heather L. Bullock ◽  
John N. Lavis ◽  
Michael G. Wilson ◽  
Gillian Mulvale ◽  
Ashleigh Miatello
Keyword(s):  
Synthesis Method ◽  
Empirical Work ◽  
Implementation Process ◽  
Empirical Literature ◽  
Implementation Theory ◽  
Policy Perspective ◽  
Implementation Processes ◽  
Critical Interpretive Synthesis ◽  
New Perspective ◽  
Focusing Lens

Abstract Background The fields of implementation science and knowledge translation have evolved somewhat independently from the field of policy implementation research, despite calls for better integration. As a result, implementation theory and empirical work do not often reflect the implementation experience from a policy lens nor benefit from the scholarship in all three fields. This means policymakers, researchers, and practitioners may find it challenging to draw from theory that adequately reflects their implementation efforts. Methods We developed an integrated theoretical framework of the implementation process from a policy perspective by combining findings from these fields using the critical interpretive synthesis method. We began with the compass question: How is policy currently described in implementation theory and processes and what aspects of policy are important for implementation success? We then searched 12 databases as well as gray literature and supplemented these documents with other sources to fill conceptual gaps. Using a grounded and interpretive approach to analysis, we built the framework constructs, drawing largely from the theoretical literature and then tested and refined the framework using empirical literature. Results A total of 11,434 documents were retrieved and assessed for eligibility and 35 additional documents were identified through other sources. Eighty-six unique documents were ultimately included in the analysis. Our findings indicate that policy is described as (1) the context, (2) a focusing lens, (3) the innovation itself, (4) a lever of influence, (5) an enabler/facilitator or barrier, or (6) an outcome. Policy actors were also identified as important participants or leaders of implementation. Our analysis led to the development of a two-part conceptual framework, including process and determinant components. Conclusions This framework begins to bridge the divide between disciplines and provides a new perspective about implementation processes at the systems level. It offers researchers, policymakers, and implementers a new way of thinking about implementation that better integrates policy considerations and can be used for planning or evaluating implementation efforts.

scholarly journals Understanding the implementation of evidence-informed policies and practices from a policy perspective: a critical interpretive synthesis

2020 ◽  
Author(s):  
Heather L Bullock ◽  
John N Lavis ◽  
Michael G Wilson ◽  
Gillian Mulvale ◽  
Ashleigh Miatello
Keyword(s):  
Grey Literature ◽  
Synthesis Method ◽  
Empirical Work ◽  
Implementation Process ◽  
Empirical Literature ◽  
Implementation Theory ◽  
Policy Makers ◽  
Policy Perspective ◽  
Critical Interpretive Synthesis ◽  
Way Of Thinking

Abstract Background: The fields of implementation science and knowledge translation have evolved somewhat independently from the field of policy implementation research, despite calls for better integration. As a result, implementation theory and empirical work do not often reflect the implementation experience from a policy lens nor benefit from the scholarship in all three fields. This means policy-makers, researchers and practitioners may find it challenging to draw from theory that adequately reflects their implementation efforts.Methods: We developed an integrated theoretical framework of the implementation process from a policy perspective by combining findings from these fields using the critical interpretive synthesis method. We began with the compass question: how is policy currently described in implementation theory and processes and what aspects of policy are important for implementation success? We then searched 12 databases as well as grey literature and supplemented these documents with other sources to fill conceptual gaps. Using a grounded and interpretive approach to analysis, we built the framework constructs, drawing largely from the theoretical literature and then tested and refined the framework using empirical literature.Results: A total of 7850 documents were retrieved and assessed for eligibility and 34 additional documents were identified through other sources. Eighty-two unique documents were ultimately included in the analysis. Our findings indicate that policy is described as: 1) the context; 2) a focusing lens; 3) the innovation itself; 4) a lever of influence; 5) an enabler/facilitator or barrier; or 6) an outcome. Policy actors were also identified as important participants or leaders of implementation. Our analysis led to the development of a two-part conceptual framework, including process and determinant components. Conclusions: This framework begins to bridge the divide between disciplines and offers a new way of thinking about implementation processes at the systems level. It offers researchers, policy-makers and implementers with a new way of thinking about implementation and can be used for planning or evaluating implementation efforts.

scholarly journals Towards a multilevel governance framework on the implementation of patient rights in health facilities: a protocol for a systematic scoping review

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e038927
Author(s):  
Meena Putturaj ◽  
Sara Van Belle ◽  
Bart Criel ◽  
Nora Engel ◽  
Anja Krumeich ◽  
...  
Keyword(s):  
Scoping Review ◽  
Grey Literature ◽  
Quality Of Healthcare ◽  
Patient Rights ◽  
Health Facilities ◽  
Multilevel Governance ◽  
Empirical Literature ◽  
Governance Framework ◽  
Critical Interpretive Synthesis ◽  
Synthesis Approach

IntroductionPatient rights are “those rights that are attributed to a person seeking healthcare”. Patient rights have implications for quality of healthcare and acts as a key accountability tool. It can galvanise structural improvements in the health system and reinforces ethical healthcare. States are duty bound to respect, protect and promote patient rights. The rhetoric on patient rights is burgeoning across the globe. With changing modes of governance arrangements, a number of state and non-state actors and institutions at various levels play a role in the design and implementation of (patient rights) policies. However, there is limited understanding on the multilevel institutional mechanisms for patient rights implementation in health facilities. We attempt to fill this gap by analysing the available scholarship on patient rights through a critical interpretive synthesis approach in a systematic scoping review.MethodsThe review question is ‘how do the multilevel actors, institutional structures, processes interact and influence the patient rights implementation in healthcare facilities? How do they work at what level and in which contexts?” Three databases PubMed, LexisNexis and Web of Science will be systematically searched until 30th April 2020, for empirical and non-empirical literature in English from both lower middle-income countries and high-income countries. Targeted search will be performed in grey literature and through citation and reference tracking of key records. Using the critical interpretive synthesis approach, a multilevel governance framework on the implementation of patient rights in health facilities which is grounded in the data will be developed.Ethics and disseminationThe review uses published literature hence ethics approval is not required. The findings of the review will be published in a peer-reviewed journal.Registration numberPROSPERO 2020 CRD42020176939

scholarly journals Navigating change – managers’ experience of implementation processes in disability health care: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anette Granberg ◽  
Marie Matérne ◽  
Lars-Olov Lundqvist ◽  
Anna Duberg
Keyword(s):  
Health Care ◽  
Health Care Organizations ◽  
Contextual Factors ◽  
Implementation Process ◽  
Public And Private ◽  
Implementation Processes ◽  
Telephone Interviews ◽  
External Conditions ◽  
The Many ◽  
Dance Intervention

Abstract Background Effective implementation processes play a central role in health care organizations and affect the care of patients. Managers are pivotal in facilitating the use of new practices, but their experience and how it affects the implementation outcome are still largely unknown. In the field of disability health care in particular, managers experiences have scarcely been investigated. Therefore, the aim of this study is to explore managers’ experiences of the implementation process when transferring new practices into disability health care settings. Methods Semi-structured individual telephone interviews were conducted with managers at disability health care organizations in four administrative regions in central Sweden. A total of 23 managers with formal managerial responsibility from both public and private health care were strategically selected to be interviewed. The interviews were analysed using reflexive thematic analysis with an inductive approach. Results The analysis resulted in two themes about factors influencing the implementation process: firstly, Contextual factors set the agenda for what can be achieved, which highlighted aspects that hinder or enable the implementation process, such as internal and external conditions, the workplace culture, the employees and managers’ attitudes and openness to change: secondly, Leadership in the winds of change, which described the challenges of balancing managerial tasks with leading the change, and the importance of a leadership that involves the participation of the employees. Conclusions This study explored how and to what extent managers address and manage the implementation process and the many associated challenges. The findings highlight the importance of leadership support and organizational structure in order to transfer new practices into the work setting, and to encourage an organizational culture for leading change that promotes positive outcomes. We suggest that identifying strategies by focusing on contextual factors and on aspects of leadership will facilitate implementation processes. Trial registration The SWAN (Structured Water Dance Intervention) study was retrospectively registered on April 9, 2019 and is available online at ClinicalTrials.gov (ID: NCT03908801).

scholarly journals Leadership assumptions on implementation of patient involvement methods

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kathrine Håland Jeppesen ◽  
Kirsten Frederiksen ◽  
Marianne Johansson Joergensen ◽  
Kirsten Beedholm
Keyword(s):  
Health Care ◽  
Organizational Learning ◽  
Health Care Professionals ◽  
Large Scale ◽  
Patient Involvement ◽  
Hospital Setting ◽  
Implementation Process ◽  
University Hospital ◽  
Structured Interviews ◽  
Implementation Processes

Abstract Background From 2014 to 17, a large-scale project, ‘The User-involving Hospital’, was implemented at a Danish university hospital. Research highlights leadership as crucial for the outcome of change processes in general and for implementation processes in particular. According to the theory on organizational learning by Agyris and Schön, successful change requires organizational learning. Argyris and Schön consider that the assumptions of involved participants play an important role in organizational learning and processes. The purpose was to explore leaders’ assumptions concerning implementation of patient involvement methods in a hospital setting. Methods Qualitative explorative interview study with the six top leaders in the implementation project. The semi-structured interviews were conducted and analyzed in accordance with Kvale and Brinkmanns’ seven stages of interview research. Result The main leadership assumptions on what is needed in the implementation process are in line with the perceived elements in organizational learning according to the theory of Argyris and Schön. Hence, they argued that implementation of patient involvement requires a culture change among health care professionals. Two aspects on how to obtain success in the implementation process were identified based on leadership assumptions: “The health care professionals’ roles in the implementation process” and “The leaders’ own roles in the implementation process”. Conclusion The top leaders considered implementation of patient involvement a change process that necessitates a change in culture with health care professionals as crucial actors. Furthermore, the top leaders considered themselves important facilitators of this implementation process.

Does Insulin Use Worsen the Prognosis of COVID-19 Patients with Type 2 Diabetes Mellitus? A Current Update

2021 ◽  
Vol 18 ◽  
Author(s):  
Elvan Wiyarta ◽  
Wismandari Wisnu
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Disease Progression ◽  
Grey Literature ◽  
Final Analysis ◽  
Eligibility Criteria ◽  
New Perspective ◽  
Insulin Use

Background: Insulin has recently received special attention concerning its use in COVID-19 patients. Although controversial, insulin can be able to worsen the prognosis of COVID-19 patients with Type 2 Diabetes Mellitus (T2DM) through an inflammatory pathway. This uncertain aspect brings a new perspective related to insulin use in this pandemic era. Objective: We tried to collect and analyze various studies related to this issue to provide a complete picture of the prognosis of insulin use in COVID-19 patients with T2DM. Methods: We comprehensively searched PubMed, Cochrane CENTRAL, Embase, EBSCO CINAHL, MEDLINE, and grey literature databases for studies investigating the effect of insulin on COVID-19 outcomes, including mortality, hospitalization, disease progression, other prognostic surrogates. Records were screened against the eligibility criteria. Result: 2556 articles were retrieved and were screened. A total of 8 studies were included in the final analysis. There are no studies with solid evidence supporting the effect of insulin treatment on the worsening of the prognosis of COVID-19 patients with T2DM. Although several studies have shown that insulin is associated with a poor prognosis, most studies have not considered confounders. This certainly makes it challenging to analyze the effects of insulin independently. Conclusion: We propose that COVID-19 patients with T2DM continue to receive insulin, but with careful observation of the risk of disease progression.

scholarly journals What drives political commitment for nutrition? A review and framework synthesis to inform the United Nations Decade of Action on Nutrition

2018 ◽  
Vol 3 (1) ◽  
pp. e000485 ◽  
Author(s):  
Phillip Baker ◽  
Corinna Hawkes ◽  
Kate Wingrove ◽  
Alessandro Rhyl Demaio ◽  
Justin Parkhurst ◽  
...  
Keyword(s):  
United Nations ◽  
Low Income ◽  
Synthesis Method ◽  
Income Country ◽  
Empirical Literature ◽  
Political Commitment ◽  
Middle Income ◽  
Strategic Commitment ◽  
The United Nations ◽  
Actor Networks

IntroductionGenerating country-level political commitment will be critical to driving forward action throughout the United Nations Decade of Action on Nutrition (2016–2025). In this review of the empirical nutrition policy literature, we ask: what factors generate, sustain and constrain political commitment for nutrition, how and under what circumstances? Our aim is to inform strategic ‘commitment-building’ actions.MethodWe adopted a framework synthesis method and realist review protocol. An initial framework was derived from relevant theory and then populated with empirical evidence to test and modify it. Five steps were undertaken: initial theoretical framework development; search for relevant empirical literature; study selection and quality appraisal; data extraction, analysis and synthesis and framework modification.Results75 studies were included. We identified 18 factors that drive commitment, organised into five categories: actors; institutions; political and societal contexts; knowledge, evidence and framing; and, capacities and resources. Irrespective of country-context, effective nutrition actor networks, strong leadership, civil society mobilisation, supportive political administrations, societal change and focusing events, cohesive and resonant framing, and robust data systems and available evidence were commitment drivers. Low-income and middle-income country studies also frequently reported international actors, empowered institutions, vertical coordination and capacities and resources. In upper-middle-income and high-income country studies, private sector interference frequently undermined commitment.ConclusionPolitical commitment is not something that simply exists or emerges accidentally; it can be created and strengthened over time through strategic action. Successfully generating commitment will likely require a core set of actions with some context-dependent adaptations. Ultimately, it will necessitate strategic actions by cohesive, resourced and strongly led nutrition actor networks that are responsive to the multifactorial, multilevel and dynamic political systems in which they operate and attempt to influence. Accelerating the formation and effectiveness of such networks over the Nutrition Decade should be a core task for all actors involved.

scholarly journals Prevalence of Sexual Violence in Migrants, Applicants for International Protection, and Refugees in Europe: A Critical Interpretive Synthesis of the Evidence

2018 ◽  
Vol 15 (9) ◽  
pp. 1979 ◽  
Author(s):  
Lotte De Schrijver ◽  
Tom Vander Beken ◽  
Barbara Krahé ◽  
Ines Keygnaert
Keyword(s):  
Sexual Violence ◽  
Sexual And Reproductive Health ◽  
Ecological Model ◽  
Grey Literature ◽  
Public Health Problem ◽  
Future Research ◽  
Major Public Health Problem ◽  
International Protection ◽  
Critical Interpretive Synthesis ◽  
Definition Of

(1) Background: Sexual violence (SV) is a major public health problem, with negative socio-economic, physical, mental, sexual, and reproductive health consequences. Migrants, applicants for international protection, and refugees (MARs) are vulnerable to SV. Since many European countries are seeing high migratory pressure, the development of prevention strategies and care paths focusing on victimised MARs is highly needed. To this end, this study reviews evidence on the prevalence of SV among MAR groups in Europe and the challenges encountered in research on this topic. (2) Methods: A critical interpretive synthesis of 25 peer-reviewed academic studies and 22 relevant grey literature documents was conducted based on a socio-ecological model. (3) Results: Evidence shows that SV is highly frequent in MARs in Europe, yet comparison with other groups is still difficult. Methodologically and ethically sound representative studies comparing between populations are still lacking. Challenges in researching SV in MARs are located at the intrapersonal, interpersonal, community, societal, and policy levels. (4) Conclusions: Future research should start with a clear definition of the concerned population and acts of SV to generate comparable data. Participatory qualitative research approaches could be applied to better grasp the complexity of interplaying determinants of SV in MARs.

scholarly journals Understanding Low-value Care and Associated De-implementation Processes: A Qualitative Study of Choosing Wisely Interventions Across Canadian Hospitals

2021 ◽  
Author(s):  
Gillian Parker ◽  
Monika Kastner ◽  
Karen Born ◽  
Nida Shahid ◽  
Whitney Berta
Keyword(s):  
Process Model ◽  
Healthcare Providers ◽  
Implementation Process ◽  
Choosing Wisely ◽  
Structured Interviews ◽  
Team Members ◽  
Implementation Processes ◽  
Healthcare Settings ◽  
National Campaigns ◽  
The Impact

Abstract Background:Choosing Wisely (CW) is an international movement comprised of national campaigns in more than 20 countries to reduce low-value care (LVC). Hospitals and healthcare providers are examining existing practices and putting interventions in place to reduce practices that offer little to no benefit to patients or may cause them harm. De-implementation, the reduction or removal of a healthcare practice is an emerging field of research. Little is known about the factors which (i) sustain LVC; and (ii) the magnitude of the problem of LVC. In addition, little is known about the processes of de-implementation, and if and how these processes differ from implementation endeavours. The objective of this study was to explicate the myriad factors which impact the processes and outcomes of de-implementation initiatives that are designed to address national Choosing Wisely campaign recommendations.Methods:Semi-structured interviews were conducted with individuals implementing Choosing Wisely Canada recommendations in healthcare settings in four provinces. The interview guide was developed using concepts from the literature and the Implementation Process Model (IPM) as a framework. All interviews were conducted virtually, recorded, and transcribed verbatim. Data were analysed using thematic analysis.Results:Seventeen Choosing Wisely team members were interviewed. Participants identified numerous provider factors, most notably habit, which sustain LVC. Contrary to reporting in recent studies, the majority of LVC in the sample was not ‘patient facing’; therefore, patients were not a significant driver for the LVC, nor a barrier to reducing it. Participants detailed aspects of the magnitude of the problems of LVC, specifically the impact of harm and resources. Unique factors influencing the processes of de-implementation reported were: influence of Choosing Wisely campaigns, availability of data, lack of targets and hard-coded interventions.Conclusions: This study explicates factors ranging from those which impact the maintenance of LVC to factors that impact the success of de-implementation interventions intended to reduce them. The findings draw attention to the significance of unintentional factors, highlight the importance of understanding the impact of harm and resources to reduce LVC and illuminate the overstated impact of patients in de-implementation literature. These findings illustrate the complexities of de-implementation.

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