A realist process evaluation within the Facilitating Implementation of Research Evidence (FIRE) cluster randomised controlled international trial: an exemplar

Implementation Science

卷:13

Gill Harvey¹  Jo Rycroft-Malone²  Alison Kitson³  Brendan McCormack⁴  Ann Catrine Eldh⁵  Lars Wallin⁵  Theo Niessen⁶  Karen Cox⁶  Teatske van der Zijpp⁶  Christel McMullan⁷  Angie Titchen⁸  Paul Slater⁸  Nicola Crichton⁹  Claire Hawkes¹⁰  Kate Seers¹⁰  Carole Mockford¹⁰ 

[1] Adelaide Nursing School, University of Adelaide;

[2] Bangor Institute for Health and Medical Research, School of Healthcare Sciences, Bangor University;

[3] College of Nursing and Health Sciences, Flinders University;

[4] Division of Nursing, Queen Margaret University Edinburgh;

[5] Faculty of Medicine and Health Science, Department of Nursing, Linkoping, and Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Linkopings University;

[6] Fontys School of People and Health Studies, Fontys University of Applied Sciences;

[7] Institute of Applied Health Research, University of Birmingham;

[8] Institute of Nursing and Health Research, Ulster University;

[9] School of Health and Social Care, London South Bank University;

[10] Warwick Medical School, University of Warwick;

关键词: Facilitation;    Realist process evaluation;    Implementation;    PARIHS;    Urinary incontinence;    Context;   

DOI  :  10.1186/s13012-018-0811-0

来源: DOAJ

【 摘 要 】

Abstract Background Facilitation is a promising implementation intervention, which requires theory-informed evaluation. This paper presents an exemplar of a multi-country realist process evaluation that was embedded in the first international randomised controlled trial evaluating two types of facilitation for implementing urinary continence care recommendations. We aimed to uncover what worked (and did not work), for whom, how, why and in what circumstances during the process of implementing the facilitation interventions in practice. Methods This realist process evaluation included theory formulation, theory testing and refining. Data were collected in 24 care home sites across four European countries. Data were collected over four time points using multiple qualitative methods: observation (372 h), interviews with staff (n = 357), residents (n = 152), next of kin (n = 109) and other stakeholders (n = 128), supplemented by facilitator activity logs. A combined inductive and deductive data analysis process focused on realist theory refinement and testing. Results The content and approach of the two facilitation programmes prompted variable opportunities to align and realign support with the needs and expectations of facilitators and homes. This influenced their level of confidence in fulfilling the facilitator role and ability to deliver the intervention as planned. The success of intervention implementation was largely dependent on whether sites prioritised their involvement in both the study and the facilitation programme. In contexts where the study was prioritised (including release of resources) and where managers and staff support was sustained, this prompted collective engagement (as an attitude and action). Internal facilitators’ (IF) personal characteristics and abilities, including personal and formal authority, in combination with a supportive environment prompted by managers triggered the potential for learning over time. Learning over time resulted in a sense of confidence and personal growth, and enactment of the facilitation role, which resulted in practice changes. Conclusion The scale and multi-country nature of this study provided a novel context to conduct one of the few trial embedded realist-informed process evaluations. In addition to providing an explanatory account of implementation processes, a conceptual platform for future facilitation research is presented. Finally, a realist-informed process evaluation framework is outlined, which could inform future research of this nature. Trial registration Current controlled trials ISRCTN11598502.

【 授权许可】

Unknown