Innovation Evidence-Base

Sources of evidence may be internal or external and include published literature, guidelines, anecdotal stories from colleagues, information from a competitor, previous experiences with recipients, results from a local pilot, and other sources (Harvey & Kitson, 2015; Rycroft-Malone, Harvey, et al., 2002; Stetler, 2001).

The original CFIR elaborated further on this construct, stating that though there is no agreed upon measure of “strong evidence,” there is empirical support for a positive association with dissemination, though evidence is mixed (Dopson et al., 2010). Though strong evidence is important, it is not always dominant in individual decisions to adopt nor is it ever sufficient (L. Fitzgerald & Dopson, 2006). The PARiHS model lists three sources of evidence as being key for uptake: research studies, clinical experience, and previous patient experience (Rycroft-Malone, Harvey, et al., 2002), and Stetler adds the possibility of other sources that appear to be credible (Stetler, 2001). Externally and internally generated evidence, including experience through piloting (see Implementation Process: Doing), may be combined to build a case for implementing an innovation (Stetler, 2001). The more sources of evidence used, the more likely innovations will be taken up (A. Kitson et al., 1998; Rycroft-Malone, Kitson, et al., 2002).

Regarding quantitative measurement of this construct: In a systematic review of quantitative measures related to implementation, Lewis et al. identified one measure (Lewis, Mettert, & Lyon, 2021). Using PAPERS measurement quality criteria with an aggregate scale ranging from -9 to +36 (Lewis, Mettert, Stanick, et al., 2021), the single measure had a score of 2, indicating the need for continued development of high-quality measures.

Qualitative coding guidelines that are aligned with the Updated CFIR will be added in the near future.

Regarding quantitative measurement of this construct: In a systematic review of quantitative measures related to implementation, Lewis et al. identified one measure (Lewis, Mettert, & Lyon, 2021). Using PAPERS measurement quality criteria with an aggregate scale ranging from -9 to +36 (Lewis, Mettert, Stanick, et al., 2021), the single measure had a score of 2, indicating the need for continued development of high-quality measures.

As we become aware of measures, we will post them here. Please contact us with updates.

Dopson, S., FitzGerald, L., Ferlie, E., Gabbay, J., & Locock, L. (2010). No magic targets! Changing clinical practice to become more evidence based. Health Care Management Review, 35(1), 2–12. https://doi.org/10.1097/HMR.0b013e3181c88e79

Fitzgerald, L., & Dopson, S. (2006). Knowledge, credible evidence, and utilization. In Knowledge to action? Evidence-based health care in context (p. 223). Oxford University Press.

Harvey, G., & Kitson, A. (2015). PARIHS revisited: From heuristic to integrated framework for the successful implementation of knowledge into practice. Implementation Science, 11(1), 33. https://doi.org/10.1186/s13012-016-0398-2.

Kitson, A. L., Rycroft-Malone, J., Harvey, G., McCormack, B., Seers, K., & Titchen, A. (2008). Evaluating the successful implementation of evidence into practice using the PARIHS framework: Theoretical and practical challenges. Implement Sci, 3(1), 1.

Lewis, C. C., Mettert, K., & Lyon, A. R. (2021). Determining the influence of intervention characteristics on implementation success requires reliable and valid measures: Results from a systematic review. Implementation Research and Practice, 2, 263348952199419. https://doi.org/10.1177/2633489521994197

Lewis, C. C., Mettert, K. D., Stanick, C. F., Halko, H. M., Nolen, E. A., Powell, B. J., & Weiner, B. J. (2021). The psychometric and pragmatic evidence rating scale (PAPERS) for measure development and evaluation. Implementation Research and Practice, 2, 263348952110373.

Rycroft-Malone, J., Kitson, G., Harvey, B., McCormack, K., Seers, A. T., & C. Estabrooks. (2002). Ingredients for change: Revisiting a conceptual framework. (Viewpoint). Quality and Safety in Health Care, 11(2), 174–180.

Rycroft-Malone, J., Harvey, G., Kitson, A., McCormack, B., Seers, K., & Titchen, A. (2002). Getting evidence into practice: Ingredients for change. Nurs Stand, 16(37), 38–43.

Stetler, C. B. (2001). Updating the Stetler Model of research utilization to facilitate evidence-based practice. Nursing Outlook, 49(6), 272–279.