title: Use of the PARIHS Framework for Retrospective and Prospective Implementation Evaluations.
abstract: BACKGROUND
  The Promoting Action on Research Implementation in Health Services (PARIHS) framework has been used by implementation researchers to assess factors impacting implementation and to use that information to identify optimal interventions and implementation strategies. In this paper, two studies are presented demonstrating the utility of PARIHS as a tool for retrospective and prospective evaluation of implementation in the health care setting.
  
  
  METHODS
  Descriptive case study.
  
  
  METHODS
  A qualitative consensus process was used to evaluate provider perceptions of PARIHS constructs of evidence, context, and facilitation and their subelements which were scored on a continuum of low to high.
  
  
  RESULTS
  The first example demonstrates retrospective use of PARIHS which provided insight into the factors contributing to variations in implementation across sites in an ongoing program. Evidence was strong (high), whereas context noted some challenges in culture and measurement (mixed), and the presence of dedicated program facilitators was positive but dual roles limited their ability to fully support implementation (mixed). The second example demonstrates prospective use of PARIHS for evaluation which gathered information about intervention sites for the purposes of selecting implementation strategies responsive to site needs. Evidence supporting the intervention was limited (low), context noted that limited awareness of the intervention was a challenge (low), and that a strong internal facilitator supported implementation (high).
  
  
  CONCLUSIONS
  The descriptive case study presented here underscores the value of a theory-guided approach to implementation and highlights that PARIHS can help implementers understand factors impacting implementation, identify areas for future intervention, and inform selection of strategies to support or enhance implementation efforts.
authors.affiliation: Associate Implementation Research Coordinator, Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL, USA.
authors.forename: Jennifer N
authors.initials: JN
authors.lastname: Hill
authors.affiliation: Research Health Scientist, Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL, USA.
authors.forename: Marylou
authors.initials: M
authors.lastname: Guihan
authors.affiliation: Research Health Scientist, Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Hogan
authors.affiliation: Research Scientist, Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL, USA.
authors.forename: Bridget M
authors.initials: BM
authors.lastname: Smith
authors.affiliation: Research Health Scientist, Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL, USA.
authors.forename: Sherri L
authors.initials: SL
authors.lastname: LaVela
authors.affiliation: Director, Center of Innovation for Complex Chronic Care, Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL, USA.
authors.forename: Frances M
authors.initials: FM
authors.lastname: Weaver
authors.affiliation: Research Scientist, Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL, USA.
authors.forename: Henry D
authors.initials: HD
authors.lastname: Anaya
authors.affiliation: Research Health Scientist, Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL, USA.
authors.forename: Charlesnika T
authors.initials: CT
authors.lastname: Evans
mesh_terms: D006801:Humans; D016730:Program Development / Q000379:methods; D015397:Program Evaluation / Q000379:methods*; D036301:Qualitative Research; D058996:Quality Improvement; D012107:Research Design / Q000592:standards*
keywords: PARIHS; evaluation; implementation science; theoretical framework; translation