A realist review of interventions and strategies to promote evidence-informed healthcare: a focus on change agency

Implementation Science

Valerie Wilson³  Lars Wallin¹  Marita Titler⁹  Cheyl Stetler⁸  Erna Snelgrove-Clarke⁵  Alyce Schultz⁴  Bridie Kent^1,10  Tracey Bucknall⁶  Alison M Hutchinson^1,11  Kara DeCorby²  Joanne Rycroft-Malone⁷  Brendan McCormack^1,12 

[1] Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Sweden;School of Nursing, McMaster University, 1280 Main St W, Ontario, Hamilton, Canada;Faculty of Nursing, Midwifery and Health, University of Technology Sydney, Building 10, 235-253 Jones Street, Ultimo, Australia;Alyce A Schultz, Independent Consultant, 3172 Hillcrest Drive 59715, Bozeman, MT, USA;School of Nursing, Dalhousie University, Nova Scotia B3H 4R2, Halifax, Canada;Alfred-Deakin Centre for Nursing Research, The Alfred Hospital, 55 Commercial Rd, Victoria 3004, Melbourne, Australia;School of Healthcare Sciences, Bangor University, Fron Heulog, Ffriddoedd Road, Bangor, UK;EBP/Evaluation Consultant, 321 Middle Street Amherst, Massachusetts, & Health Services Department, Boston University School of Public Health, Boston, Massachusetts, USA;School of Nursing, University of Michigan, 400 North Ingalls Building, Michigan 48109–5482, Ann Arbor, MI, USA;School of Nursing and Midwifery, University of Plymouth, Drake Circus, PL4 8AA, Plymouth, UK;Deakin-Southern Health Nursing Research Centre, I Block 246 Clayton Road, Victoria 3168, Clayton, Australia;Institute of Nursing and Health Research/School of Nursing, University of Ulster, Shore Road, Newtownabbey, BT37 0QB, Antrim, Co, Northern Ireland

关键词: Knowledge brokers’ knowledge utilization;    Opinion leaders;    Facilitators;    Change agency;    Evidence-informed health care;    Realist synthesis;   

Others  :  813342
DOI  :  10.1186/1748-5908-8-107

 received in 2013-01-13, accepted in 2013-08-29,  发布年份 2013

【 摘 要 】

Background

Change agency in its various forms is one intervention aimed at improving the effectiveness of the uptake of evidence. Facilitators, knowledge brokers and opinion leaders are examples of change agency strategies used to promote knowledge utilization. This review adopts a realist approach and addresses the following question: What change agency characteristics work, for whom do they work, in what circumstancesand why?

Methods

The literature reviewed spanned the period 1997-2007. Change agency was operationalized as roles that are aimed at effecting successful change in individuals and organizations. A theoretical framework, developed through stakeholder consultation formed the basis for a search for relevant literature. Team members, working in sub groups, independently themed the data and developed chains of inference to form a series of hypotheses regarding change agency and the role of change agency in knowledge use.

Results

24, 478 electronic references were initially returned from search strategies. Preliminary screening of the article titles reduced the list of potentially relevant papers to 196. A review of full document versions of potentially relevant papers resulted in a final list of 52 papers. The findings add to the knowledge of change agency as they raise issues pertaining to how change agents’ function, how individual change agent characteristics effect evidence-informed health care, the influence of interaction between the change agent and the setting and the overall effect of change agency on knowledge utilization. Particular issues are raised such as how accessibility of the change agent, their cultural compatibility and their attitude mediate overall effectiveness. Findings also indicate the importance of promoting reflection on practice and role modeling. The findings of this study are limited by the complexity and diversity of the change agency literature, poor indexing of literature and a lack of theory-driven approaches.

Conclusion

This is the first realist review of change agency. Though effectiveness evidence is weak, change agent roles are evolving, as is the literature, which requires more detailed description of interventions, outcomes measures, the context, intensity, and levels at which interventions are implemented in order to understand how change agent interventions effect evidence-informed health care.

【 授权许可】

   
2013 mccormack et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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