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Combined use of the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework with other implementation frameworks: a systematic review

Implementation Science Communications volume 6, Article number: 25 (2025) Cite this article

Abstract

Background

Appropriately and comprehensive applying implementation frameworks is one of the key challenges in implementation science resulting in increased use of multiple implementation frameworks within projects. This is particularly true for frameworks such as PARIHS/i-PARIHS. Therefore, this systematic review aimed to examine if and why the PARIHS/i-PARIHS framework has been applied in research with other implementation frameworks.

Methods

We searched six databases from 2016 (the year following i-PARIHS’ publication) to April 2024 and supplemented this with a citation search of the seminal i-PARIHS paper. We included studies that 1) were peer-reviewed with a protocol or empirical study design, 2) have applied the PARIHS or i-PARIHS framework for implementation planning, delivery, analysis, or evaluation and 3) also used at least one other implementation framework. Descriptive statistics were conducted to report on study characteristics and frequency for each implementation framework used with PARIHS/i-PARIHS. A qualitative, content analysis was used to analyse the answers to open-ended extraction questions.

Results

Thirty-six articles met criteria for inclusion and included 16 protocols and 20 empirical articles (twelve intervention and eight cross-sectional studies). Thirty-four of the studies used one additional implementation framework and two studies used two additional implementation frameworks. In total, nine implementation frameworks were applied with PARIHS/i-PARIHS, including: 1) RE-AIM, 2) CFIR, 3) NPT, 4) REP, 5) TDF, 6), DSF, 7) KTA, 8) Stetler’s Model, and 9) SIF. Thirty-four reported a rationale for using PARIHS/i-PARIHS and 34 reported a rationale for using the other implementation framework. Only eleven reported a rationale for using more than one implementation framework. Only three reported strengths of combining implementation frameworks.

Conclusions

Overall, this review identified that implementation researchers are using PARIHS/i-PARIHS in combination with other implementation frameworks and providing little to no rationale for why. Use of multiple implementation frameworks without detailed rationales compromises our ability to evaluate mechanisms of effectiveness. Implementation researchers and practitioners need to be more explicit about their framework selection, detailing the complementary strengths of the frameworks that are being used in combination, including why using one is not sufficient.

Trial registration

This systematic review was registered with PROSPERO: ID: 392147.

Peer Review reports

Background

Implementation science aims to offer evidence-informed approaches in the form of frameworks, models, and theories (from here on termed ‘implementation frameworks’) to support the adoption of research into policy and practice. There are more than 100 published implementation frameworks [1] that can differ in their purpose due to their underpinning theories and the conceptual level on which they focus. Implementation frameworks offer support to 1) predict or guide the implementation process, 2) organise, understand, or explain factors that influence implementation, and 3) evaluate the implementation success (or failure) [1,2,3].

Implementation frameworks can be further classified into five categories: process models, determinant frameworks, classic theories, implementation theories, and evaluation frameworks [1]. Examples of commonly used implementation frameworks, as described in the Implementation Science Handbook [4], include Consolidated Framework for Implementation Research (CFIR) [5], Knowledge to Action (KTA) [6], Normalisation Process Theory (NPT) [7], Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) [8], Stetler’s Model [9], Theoretical Domains Framework (TDF) [10, 11], and Promoting Action on Research Implementation in Health Services (PARIHS) [12].

PARIHS is a determinant framework signifying that successful implementation of evidence into practice is a function of the quality and type of evidence, the characteristics of the setting or context, and how the evidence was introduced or facilitated into practice [12]. Through iterative work where PARIHS was applied and tested, it was subsequently refined in 2015 and the integrated-PARIHS (i-PARIHS) framework was introduced [13]. The i-PARIHS framework positions facilitation as the active ingredient, conceptualised as both a role (‘being’ a facilitator) and actions (‘doing’ facilitation) [13, 14]. i-PARIHS posits that facilitating a new way of working (i.e., uptake of the innovation) with the different target groups (i.e., recipients who need to adopt the innovation and those impacted by its uptake) within their context leads to successful implementation [13].

i-PARIHS’ emphasis of facilitation reflects its view of implementation as a complex and non-linear process. Facilitation thus functions as a meta-strategy to guide teams through the implementation process and facilitators can draw on additional implementation strategies to navigate barriers and embrace enablers [14]. With this characterisation of facilitation, the framework becomes flexible in its application and allows for context-responsive actions and iterative tailoring to dynamic contexts with multiple and varying recipients.

However, this context-responsive and iterative approach to implementation can make the framework complex to apply in practice, particularly for first-time or novice users. Successfully harnessing the flexibility of i-PARIHS requires an understanding of the framework. A recent citation analysis of the original PARIHS framework identified, from a total of 367 published articles, that only a few used the framework to comprehensively guide multiple aspects of their implementation effort [15]. This parallels reviews of other implementation frameworks, such as CFIR [16] and KTA [17], which have identified that they have seldom been used as intended.

Appropriately selecting and applying implementation frameworks is not a new issue and is one of the key challenges researchers and clinicians face when planning and conducting implementation efforts [1, 2, 18]. This is largely due to not knowing which implementation framework to select or how to select from the increasing number being published [1, 2, 18]. This uncertainty can contribute to or exacerbate difficulties in applying an implementation framework. Additionally, doubt on the appropriateness of a single implementation framework is leading to an increasing number of teams selecting more than one implementation framework. There seems to be limited understanding in the field of implementation science on when and how to apply more than one implementation framework to an implementation effort, and whether combined use enhances implementation success.

For many implementation efforts, one implementation framework may be sufficient to address all the aims and scope of the effort [19]. However, given the complexities of implementation, multiple implementation frameworks may support answering different research questions—for example, using the determinant framework i-PARIHS to plan, guide, and deliver an implementation project, while supplementing with the RE-AIM framework [8], an evaluation framework. In this example, the two implementation frameworks vary in their purpose and theoretical underpinning and therefore applying them in different stages of the implementation effort ensures the theoretical integrity of each framework. This serves as an example of how applying more than one implementation framework may be useful and has the potential to strengthen implementation efforts. However, there are potential risks and complexities of applying multiple implementation efforts—for example, applying i-PARIHS with CFIR [5] to plan, guide, deliver, and/or evaluate an implementation project. In this example, these implementation frameworks have similarities in their purpose and theoretical underpinning. While each framework independently has been shown to lead to successful implementation, combining them may introduce unforeseen complexities and risks, as well as undermine their implementation effectiveness. Additionally, applying both may also create unnecessary duplication and redundant effort.

To date, no literature has systematically assessed how the PARIHS/i-PARIHS framework has been applied with other implementation frameworks in research and practice. It is currently not known what implementation frameworks are being applied with PARIHS/i-PARIHS and why. This presents a risk to the integrity of the field of implementation science as we do not know if combined use is theoretically justified. Therefore, this systematic review aims to examine if and why the PARIHS/i-PARIHS framework has been applied in research with other implementation frameworks (inclusive of all implementation theories, models, and/or frameworks).

Research questions

  1. 1.

    What implementation frameworks have been applied with the PARIHS/i-PARIHS framework?

  2. 2.

    How has PARIHS/i-PARIHS been applied with other implementation frameworks?

  3. 3.

    What are the reported rationales for applying PARIHS/i-PARIHS and other implementation frameworks?

  4. 4.

    What are the reported strengths and limitations of applying other implementation frameworks with PARIHS/i-PARIHS?

Methods

This study used systematic review methodology and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for conducting and reporting on the review’s steps. The review team consisted of multidisciplinary researchers closely acquainted with the PARIHS/i-PARIHS framework who were invited for collaboration in the design and execution of this study. The protocol for this study is registered on Prospero (ID: 392147).

Search strategy

This study used a systematic search that consisted of a primary search in multiple databases and a supplementary search to capture all relevant scientific articles utilising the PARIHS/i-PARIHS framework. The supplementary search was conducted in support of reducing bias and increasing confidence of capturing all relevant articles [20].

Primary search

The primary search method used a systematic search in databases of multiple disciplines, including Scopus, Web of Science, PsycInfo, PubMed, CINAHL, and JSTOR. The search strategy used key terms that reflected the use of the i-PARIHS framework as well as terms for the original PARIHS framework, including “iparihs”, “i-parihs”, “parihs” and "promoting action on research implementation in health services". Preliminary searches were run to pilot the search terms and ensure their fit for purpose. (The search term “PARIHS” was to ensure inclusion of peer-reviewed articles that may interchangeably use the terms PARIHS and i-PARIHS, consistent with a published review looking at how the i-PARIHS framework has been used [21]. In addition, the inclusion of the original framework term enabled us to determine if there is continued use of the original PARIHS framework, following the publication of the revised i-PARIHS.)

The search was restricted to publications from January 1st 2016 (the year following i-PARIHS’ publication) to April 3rd 2024.

Two independent reviewers (SH and SM) double screened all retrieved titles and abstracts, followed by full-text screening. Screening adhered to the inclusion and exclusion criteria (see below Study selection, and Supplementary File 1) and was completed in Covidence [22]. Conflicts were discussed by the reviewers to reach consensus.

Supplementary search

Citation searching was done as a supplementary search method using a seminal i-PARIHS article [13] that introduced the integrated version of the framework. This method of supplementary searching was chosen over other search strategies due to the nature of the review (that is, looking for studies that have applied this framework). The citations were searched using two databases (Web of Science and Scopus). Articles were screened by two independent reviewers (SH and SM) in EndNote [23], following the same inclusion and exclusion criteria (see Supplementary File 1). Relevant articles were imported into Covidence for extraction.

Study selection

Studies were included if they: 1) were peer-reviewed articles with a protocol or empirical study design 2) have applied the PARIHS or i-PARIHS framework for implementation planning, delivery, analysis, or evaluation and 3) also used at least one other implementation framework. Studies were excluded if 1) they were non-English, 2) their full text was unavailable, 3) or the frameworks were mentioned or referenced only in the study without any description of application. Detailed inclusion and exclusion criteria can be found in Supplementary File 1.

Data extraction

Articles meeting the study selection criteria were double-extracted by seven independent reviewers (SH, SM, BK, AB, AE, ACE, and LW) using Covidence [22] – i.e., extraction for each included article was conducted by a pair of reviewers from among the seven independent reviewers. The data extraction form was adapted from Bergström et al. [15] to reflect the objectives of this study (i.e., allowing extraction for PARIHS/i-PARIHS and other implementation frameworks). The data extraction form was developed and piloted by all members of the research team and revised based on feedback prior to starting the data extraction.

The data extraction form collected information about the study characteristics, including authors, year of publication, country, setting and article type. Further, the form included questions on how PARIHS/i-PARIHS was applied, including one or more of the following ways: 1) in planning or designing the implementation approach, 2) in conducting implementation or delivering the intervention, 3) in analysing any of the data collected, and 4) in evaluating intervention or implementation effectiveness. Each question was followed by an open-ended response field for extracting the relevant information where reviewers could copy and paste sections of the article that were relevant to the review query. The form also collected the same information for each implementation framework used with PARIHS/i-PARIHS, including any reported rationale for choosing the frameworks, and information on the context for how they were applied as above. The form collected any reported strengths and limitations of the implementation frameworks.

A data extraction guide containing examples of extractions from an included article that were conducted through the piloting process, and a decision-making matrix, were developed to aid in extraction, provide transparency, and reduce errors.

Any conflicts in the extraction were discussed among the reviewer pairs completing extraction to reach a consensus. Regular meetings occurred among the research team members to consolidate findings and review the data extraction process.

Quality appraisal

All studies that satisfied the inclusion criteria were included in this review. As this is a systematic review focused on the application of theoretical implementation science approaches (but not on the results or outcomes of the included studies), a formal critical appraisal tool was not used. This is consistent with a previous systematic review (a critical interpretive synthesis of the PARIHS and i-PARIHS frameworks) [21]. Also, consistent with the systematic review on CFIR [16], this review assessed the quality and depth of application of the PARIHS/i-PARIHS framework and other theoretical implementation science approaches by:

  1. (1)

    the inclusion criteria of our systematic review (i.e., applied PARIHS/i-PARIHS and at least one other implementation framework, not just mention the frameworks without application), and;

  2. (2)

    the research questions, focusing on the rationale and context for applying other implementation frameworks, and the strengths and limitations of doing so.

This quality assessment was intended exclusively to evaluate the quality of the application of i-PARIHS with other theoretical implementation science approaches (and not the quality of any other aspects of the studies described in the included articles).

Data analysis

The extracted data were exported from Covidence [22] and downloaded as an Excel spreadsheet. Descriptive statistics was used to analyse the categorical data for the study characteristics. The frequency for each implementation framework used with PARIHS/i-PARIHS was determined. The answers to open-ended extraction questions for how PARIHS/i-PARIHS and other frameworks were used were analysed qualitatively, applying a content analysis approach [24]. For each question, the qualitative extracts were read and re-read for familiarisation and then openly coded [24]. Following coding, categories were developed to provide an overall summary of the rationales and strengths for each implementation framework and their combined application.

Results

Study selection

The primary search of the databases identified 1,057 articles, and after removing duplicates (n = 554), 503 underwent title and abstract screening. Of these, 316 articles underwent full-text screening, and 26 remained for inclusion from the primary search. From the supplementary search, 834 articles were identified. After removing duplicates (n = 372), 462 articles were screened, resulting in 10 articles remaining for inclusion. Thus, in total, 36 articles were included in the review. The flow of articles included in the study are shown in Fig. 1.

Fig. 1
figure 1

Flow diagram of included studies

Full size image

Study characteristics

In total, the 36 articles consisted of 16 protocols [25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40]. A further 20 articles reported empirical studies; twelve were intervention studies [41,42,43,44,45,46,47,48,49,50,51,52] and eight were cross sectional studies [53,54,55,56,57,58,59,60].

All 36 articles conducted research within the health system. Two spanned both the health and education system [37, 60] and one spanned both the health and social care system [41].

Ten of the articles conducted research within primary care [25, 32, 35, 36, 38, 40, 48, 49, 55, 58], eight within the community [29, 37, 41, 43, 54, 56, 57, 60], nine within hospital settings [33, 39, 44,45,46,47, 50, 52, 59], seven spanning hospital and primary care [26,27,28, 30, 34, 42, 53], one spanning community and primary care [31], and one spanning community and hospital [51].

Of the 36 articles, 19 were derived from research in the USA [25,26,27,28,29,30,31, 34, 35, 37,38,39, 42, 48, 49, 52, 53, 58, 60], eight from Australia [32, 33, 44, 45, 47, 50, 51, 54], three from Sweden [36, 46, 56], two from the UK [41, 55], one from Canada [57], one from China [59], one from Eswatini [43], and one from Nigeria [40].

Table 1 provides a summary of the study characteristics.

Table 1 Study characteristics
Full size table

Application of i-PARIHS and other implementation frameworks

In total, 31 studies applied the i-PARIHS framework [25,26,27,28, 30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53, 55, 58] and five of the studies applied the original PARIHS framework [29, 54, 57, 59, 60].

Thirty-four of the studies used one additional implementation framework. However, two studies used two additional implementation frameworks [35, 36]. In total, nine implementation frameworks were applied with PARIHS/i-PARIHS. These included:

  • Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) [8]: n = 16 [25,26,27, 29,30,31,32, 34, 35, 37, 38, 40, 47, 48, 52, 60]

  • The Consolidated Framework for Implementation Research (CFIR) [5]: n = 9 [28, 36, 39, 41, 42, 45, 57,58,59]

  • Normalisation Process Theory (NPT) [7]: n = 5 [33, 36, 43, 44, 54]

  • Replicating Effective Programs (REP) [61]: n = 2 [49, 53]

  • Theoretical Domains Framework (TDF) [10, 11]: n = 2 [51, 55]

  • Dynamic Sustainability Framework (DSF) [62]: n = 1 [35]

  • Knowledge to Action (KTA) [6]: n = 1 [46]

  • Stetler’s Model [9]: n = 1 [56]

  • Strategic Implementation Framework (SIF) [63]: n = 1 [50]

The way in which PARIHS/i-PARIHS and other implementation frameworks were used varied significantly. Table 2 summarises how each included study applied i-PARIHS and other implementation frameworks across the different phases of an implementation project (planning, delivery, analysis, and evaluation). Meanwhile, Fig. 2 provides an overall quantitative summary of which frameworks were used within the phases.

Table 2 Summary of how PARIHS/i-PARIHS and other implementation frameworks have been applied (n = 36)
Full size table
Fig. 2
figure 2

Use of i-PARIHS and other implementation frameworks by phases of study design

Full size image

Of the 36 articles, PARIHS/i-PARIHS was used in 31 to plan or design the implementation approach [25,26,27,28,29,30,31, 33,34,35,36,37,38,39,40,41,42, 44,45,46,47,48,49,50, 52,53,54,55,56,57,58, 60], in 19 to conduct implementation or deliver an intervention [26, 33, 34, 36,37,38,39,40,41,42, 44, 46, 48,49,50, 53,54,55,56, 60], in 22 to analyse data collected [25, 28,29,30,31,32, 34, 35, 37,38,39, 41, 43, 45, 48, 50,51,52,53, 57,58,59] and in 15 to evaluate intervention or implementation effectiveness [25, 27,28,29,30,31,32,33, 39, 43, 44, 48, 53, 57, 59].

Overall, only three articles used i-PARIHS in all four phases of the study design [39, 48, 53] and only one of the articles used another implementation framework (CFIR) in all four phases of the study design [42]. The majority of the articles combined their use of PARIHS/i-PARIHS and other implementation framework within one (or more) of the study design phases [25,26,27,28,29,30,31,32,33, 35, 36, 38, 39, 41,42,43,44,45,46,47,48,49,50,51,52,53, 55,56,57,58, 60]. Whereas five of the articles used PARIHS/i-PARIHS and another implementation framework in separate study design phases [34, 37, 40, 54, 59].

Rationale for i-PARIHS and other implementation frameworks

The articles varied in detail, depth, and quality in terms of descriptions of why they selected more than one implementation framework. Of the 36 articles, 34 reported a rationale for using PARIHS/i-PARIHS [25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53, 56,57,58,59,60] and 34 reported a rationale for using the other implementation framework [25, 27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42, 45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60]. Supplementary File 2 provides a summary.

Rationale for i-PARIHS

Of the 34 articles that reported a rationale for using PARIHS/i-PARIHS, 22 reported using PARIHS/i-PARIHS to guide the implementation process and to use facilitation [26, 28, 33,34,35,36,37,38,39, 41, 42, 44, 46,47,48,49,50, 56,57,58,59,60] and 13 reported using PARIHS/i-PARIHS to identify barriers and enablers to implementation and evaluation of implementation outcomes [25, 27, 29,30,31,32, 38, 40, 43,44,45, 51,52,53, 58].

Rationale for other implementation framework

Of the 16 articles that used RE-AIM, all consistently reported using RE-AIM to evaluate implementation outcomes [25,26,27, 29,30,31,32, 34, 35, 37, 38, 40, 47, 48, 52, 60]. Six of the nine articles that used CFIR reported using CFIR to evaluate the implementation process [28, 36, 39, 41, 45, 58] and four reported using CFIR to guide or inform the implementation process [28, 42, 57, 59]. Two of the four articles that used NPT reported a rationale. One reported using NPT to guide a realist evaluation and [54] and the other reported using NPT to survey participants [33]. One of the two articles that used REP reported using it to structure the implementation stages and guide the facilitation process [53] and the other reported using REP to structure the implementation process and guide analysis [49]. Of the two articles that used TDF, both reported a rationale. One reported to use TDF to develop a behaviour change intervention [55] and one reported using TDF to inform interview questions to evaluate pilot implementation for future scale-up [51]. Stetler’s Model was reported to be used to support the facilitation process [56], and SIF was reported to be used for a mixed methods evaluation [50].

Rationale for multiple implementation frameworks

Whilst many of the studies reported a rationale for each individual implementation framework, only eleven reported an explicit rationale for using multiple [25, 28, 35, 37, 40, 47, 48, 51, 57,58,59].

The following rationales were provided for combining approaches:

  • i-PARIHS and RE-AIM:

    • ◦ Allowed for testing of efficacy and feasibility of delivering the intervention at scale [25]

    • ◦ Provided a more systematic approach to evaluation [47]

    • ◦ Allowed for a focus on longitudinal facilitation [35]

    • ◦ A conceptual framework was developed outlining how the two approaches worked together to design and evaluate implementation [38, 40]

  • PARIHS/i-PARIHS and CFIR:

    • ◦ Allowed for a more comprehensive approach to implementation supported by facilitation [28]

    • ◦ To complement one another and identify all characteristics of relevant contextual factors [57]

    • ◦ Allowed for documentation of effectiveness and how facilitation was used to navigate barriers and enablers [38, 58]

    • ◦ Existing frameworks were not sufficient as a single approach [59]

  • i-PARIHS and REP:

    • ◦ To test the combined use of approaches [49]

  • i-PARIHS and TDF:

    • ◦ As i-PARIHS builds on the other implementation framework [51]

Strengths and limitations of i-PARIHS and other implementation frameworks

Only three of the 36 articles reported strengths of combining implementation frameworks [38, 46, 59]. One of the articles combined i-PARIHS and RE-AIM and reported that use of both allowed for clear documentation of effectiveness as well as how facilitation was used to overcome barriers and harness enablers [38]. One of the articles combined PARIHS and CFIR and reported that using both allowed for sufficient guidance to support the implementation process [59]. The third article combined PARIHS and KTA and reported that using facilitation to engage clinicians in the knowledge creation and action cycles to tailor and adapt the intervention content was key to implementation success [46]. None of the articles explicitly reported limitations of combining implementation frameworks.

There was also a limited description of strengths and limitations regarding the individual use of PARIHS/i-PARIHS and other implementation frameworks. Of the 36 articles, only nine reported strengths of using PARIHS/i-PARIHS [26, 28, 33, 38, 43, 44, 46, 51, 60]. Four of the eight articles reported facilitation as a strength of using PARIHS/i-PARIHS [26, 28, 33, 46], and three reported its strength in the planning phase to assess factors that may influence implementation [38, 44, 51]. Further, one reported its strength in supporting structured reporting of implementation processes [43], and one reported its strength in organising the overall project and supporting communication with stakeholders [60].

Of the 36 articles, only four reported strengths of using the other implementation frameworks [28, 38, 39, 59]. Two reported strengths for CFIR, specifically, as being more comprehensive than other frameworks [28] and for providing practical tools [59]. Two reported strengths for RE-AIM, specifically, as being able to evaluate implementation in a real-world setting [38] and for offering a systematic guide for collecting and analysing data [40]. None of the articles explicitly reported limitations regarding the individual use of PARIHS/i-PARIHS or other implementation frameworks.

Discussion

This is the first review to systematically examine what implementation frameworks have been applied with PARIHS/i-PARIHS in the literature. Thirty-six studies were included in the review and nine different implementation frameworks were identified as being applied with PARIHS/i-PARIHS. This provides evidence that combined use of implementation frameworks is an emerging trend within the field of implementation science and one that warrants examination. This is especially true given that this review identified how varied the articles are in the detail, depth, and quality in terms of descriptions of why they used more than one implementation framework.

Despite identifying nine frameworks used alongside PARIHS/i-PARIHS, two are clearly the most commonly used: Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) [8] and the Consolidated Framework for Implementation Research (CFIR) [5]. An interesting finding was that five of the 36 included articles used the original PARIHS framework, despite the revised i-PARIHS framework being published and available. Only one article [59] provided a rationale stating that the PARIHS was a better fit due to its clearly defined constructs, sub elements, and rating criteria. However, this may suggest a lack of recognition of the revised i-PARIHS framework, as it was specifically developed to provide clearer theoretical underpinnings and support for operationalising the framework [4, 13].

Despite PARIHS/i-PARIHS being a determinant framework that can be used across all phases of implementation research [4], we identified that many researchers are not using it in this way. Only three studies reported use of PARIHS/i-PARIHS in all four phases [39, 48, 53]. This indicates that implementation researchers see a need to supplement PARIHS/i-PARIHS with another implementation framework. The most common phase in which PARIHS/i-PARIHS was used was planning or delivery, which may reflect the utility of the flexible and context-tailorable facilitation (both the role and the actions) represented by i-PARIHS. This is supported by the most common reported rationale for using PARIHS/i-PARIHS being due to the framework’s facilitation construct.

The most common way in which RE-AIM was used in combination with PARIHS/i-PARIHS was in evaluation. This combination makes sense given the differences in purpose and theoretical underpinning of each framework. This is supported by the most common reported rationale for using RE-AIM being to evaluate implementation outcomes, which is to be expected as it is an evaluation framework [4]. Similarly, of the few articles that reported strengths of combined use, those that did confirm that combining PARIHS/i-PARIHS with RE-AIM provides a strong implementation (facilitation) and evaluation approach. This combination indicates that implementation researchers may see shortcomings in PARIHS/i-PARIHS to evaluate implementation efforts and this can be supplemented with the RE-AIM framework.

However, it gets interesting when interpreting the use of PARIHS/i-PARIHS with CFIR. The use of CFIR does not appear to support other phases; rather, it appears to supplement PARIHS/i-PARIHS within one (or more) of the phases. The conceptual similarities between PARIHS/i-PARIHS and CFIR, and the reported rationales for each, leave an unanswered question of why users are combining similar implementation frameworks. The similarities and no reported relative advantage beg the question of whether we are seeing unnecessary duplication with the risk of theoretical conflict. The most commonly reported rationale for using CFIR was to guide and evaluate the implementation process. However, i-PARIHS and CFIR were equally used within the evaluation phase, undermining the reported additional utility of CFIR for evaluation. One possibility may be that given the similarities, the two frameworks are viewed as theoretically compatible, and the distinct benefit of each may be facilitation for PARIHS/i-PARIHS and the available tools and resources for CFIR.

Despite all included studies combining use of implementation frameworks, unfortunately, we have learnt very little about why multiple frameworks have been used, with only a very few studies reporting an explicit rationale for selecting more than one framework. Most reported a rationale for using PARIHS/i-PARIHS as well as the other implementation framework, however the detail, depth, and quality of descriptions varied significantly. Overall, this supports previous research proposing that implementation frameworks are not used to their full capacity [15]. The citation analysis on PARIHS by Bergström et al. [15] found that only 23% of included studies used the framework in a substantial way. These findings are similar to reviews conducted on other implementation frameworks. Specifically, a review on CFIR found that less than 10% of included studies used the framework in a meaningful way [19]. The field of implementation science has repeatedly made clear that underuse, superficial use, or misuse of implementation frameworks can undermine methodological rigour and can impact health and clinical outcomes [15, 18]. If the field of implementation science was already in a situation where individual frameworks are not being comprehensively applied, we are now facing combined use of frameworks without clear justification. This presents a critical issue for the science of implementation science. If implementation frameworks are combined within research studies without clear rationale and explanation, this can obscure our ability to understand mechanisms of effect and may undermine scientific integrity. Ultimately, it muddies the water.

In the context of this review, the lack of consideration for the theoretical underpinnings and lack of clear rationales for combining frameworks of the same or different theoretical underpinnings, makes it difficult to conclude what combinations may be effective or useful for various purposes. This finding builds on a recent review that explored the selection and application of implementation frameworks from the five categories: process models, determinant frameworks, classic theories, implementation theories, and evaluation frameworks [1]. The review found that studies did not discuss or justify why they selected implementation frameworks from a particular category, indicating no consideration for theoretical underpinnings [64]. Like our investigation, the review identified four studies that used more than one implementation framework, which often belonged to different categories. The review concluded however, that despite it making sense intuitively to combine frameworks from different categories (e.g. combining a determinant framework with a process model) the lack of reported detail makes it difficult to draw conclusions around the merit and effectiveness of combined uses [64].

As outlined, this review presents significant implications for the field of implementation science, primarily for its researchers and practitioners. Firstly, when planning and designing an implementation project, researchers and practitioners need to consider the purpose and theoretical underpinnings of implementation frameworks, as this will not only support comprehensive use of one framework but will aid in deciding if it theoretically and practically makes sense to use more than one. Secondly, if a decision is made to use more than one implementation framework, there needs to be an explicit rationale that is articulated and reported. It is not sufficient to simply report what frameworks were used nor is it sufficient to replicate the study design of a prior publication. We propose that good reporting should include 1) a clear rationale for multiple implementation framework selection, including risks of not combining, 2) how the decision was made to use multiple frameworks, 3) ways in which all the elements of each implementation framework were used or not used, and 4) acknowledgement of the strengths and limitations of using multiple implementation frameworks. Reporting this detail will be critical to ensuring that combined use of frameworks can be evaluated for effectiveness.

Limitations

This study was a systematic review specifically on the use of PARIHS/i-PARIHS in combination with other implementation frameworks thus further exploration is warranted to understand the combined use of implementation frameworks more broadly. In addition, we cannot say with certainty that the included studies did not have rationales for why they selected the implementation frameworks they did, and why they decided to use more than one. It is worth acknowledging that the exclusion of this methodological detail may be influenced by publishing biases as health journals have historically prioritised trial methodology and clinical outcomes over implementation methodology and implementation outcomes [15]. This may have resulted in many of the authors not fully detailing or reporting their selection and application of implementation frameworks. Additionally, as we did not include articles that were not written in English, we may have limited insights into the selection and application of implementation frameworks published in other languages.

Conclusion

Implementation science is a field that aims to offer evidence-informed approaches in the form of implementation frameworks, to support the adoption of research into policy and practice. Utilising these implementation frameworks is intended to maximise the chances of successful implementation and also provides critical insights into, and explanations of, implementation processes and outcomes. This systematic review on the use of the i-PARIHS framework in combination with other implementation frameworks shows that, as a field, we are potentially moving away from being able to offer evidence-informed approaches to support the adoption of research into policy and practice. The findings highlight that implementation researchers are using more than one implementation framework within an implementation effort and are providing very little to no rationale for why. This makes it difficult, if not impossible, to determine what is the impact of the frameworks on implementation success or failure. There are significant risks that combining implementation frameworks may undermine the theoretical integrity of each individual framework if such rationale is missing. The advancement of the field of implementation science is reliant on framework users to be more explicit about their framework selection, detailing the complementary strengths of the frameworks that are being used in combination, including why one is not sufficient. Further, we support prior calls for the development and adoption of reporting guidelines on how frameworks are used in implementation studies. This will ultimately strengthen the ability to assess whether combining implementation frameworks leads to better, or hinders, implementation and clinical outcomes.

Data availability

All data generated or analysed during this study are included in this published article [and its supplementary information files].

Abbreviations

CFIR:

Consolidated Framework for Implementation Research

DSF:

Dynamic Sustainability Framework

i-PARIHS:

Integrated-Promoting Action on Research Implementation in Health Services

KTA:

Knowledge to Action

NPT:

Normalisation Process Theory

PARIHS:

Promoting Action on Research Implementation in Health Services

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

RE-AIM:

Reach, Effectiveness, Adoption, Implementation and Maintenance

REP:

Replicating Effective Programs

SIF:

Strategic Implementation Framework

TDF:

Theoretical Domains Framework

References

  1. Nilsen P. Overview of theories, models and frameworks in implementation science. In: Nilsen P, Birken SA, editors. Handbook on implementation science. Cheltenham: Edward Elgar Publishing Limited; 2020. p. 8–31.

    Chapter  Google Scholar 

  2. Lynch EA, Mudge A, Knowles S, Kitson AL, Hunter SC, Harvey G. “There is nothing so practical as a good theory”: a pragmatic guide for selecting theoretical approaches for implementation projects. BMC Health Serv Res. 2018;18(1):857.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Presseau J, Kasperavicius D, Rodrigues IB, Braimoh J, Chambers A, Etherington C, et al. Selecting implementation models, theories, and frameworks in which to integrate intersectional approaches. BMC Med Res Methodol. 2022;22(1):212.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Nilsen P, Birken SA. Handbook on implementation science. Chltenham: Edward Elgar Publishing; 2020.

    Book  Google Scholar 

  5. Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4(1):50.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W, et al. Lost in knowledge translation: time for a map? J Contin Educ Heal Prof. 2006;26(1):13–24.

    Article  Google Scholar 

  7. May C, Finch T. Implementing, embedding, and integrating practices: an outline of normalization process theory. Sociology. 2009;43(3):535–54.

    Article  Google Scholar 

  8. Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 1999;89(9):1322–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Stetler CB. Stetler Model. In: Rycroft-Malone J, Bucknall T, editors. Models and frameworks for implementing evidence-based practices: linking evidence to actrion. Chichester: Wiley-Blackwell; 2010. p. 51–82.

    Google Scholar 

  10. Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A. Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf Health Care. 2005;14(1):26.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Michie S, Atkins L, West R. The behaviour change wheel: a guide to designing interventions. London: Silverback; 2014.

    Google Scholar 

  12. Kitson A, Harvey G, McCormack B. Enabling the implementation of evidence based practice: a conceptual framework. Qual Health Care. 1998;7(3):149.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Harvey G, Kitson A. PARIHS revisited: from heuristic to integrated framework for the successful implementation of knowledge into practice. Implement Sci. 2016;11(1):33.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Harvey G, Kitson A. Implementing evidence-based practice in healthcare: a facilitation guide. Abingdon: Routledge, Taylor and Francis; 2015.

    Book  Google Scholar 

  15. Bergström A, Ehrenberg A, Eldh AC, Graham ID, Gustafsson K, Harvey G, et al. The use of the PARIHS framework in implementation research and practice—a citation analysis of the literature. Implement Sci. 2020;15(1):68.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Kirk MA, Kelley C, Yankey N, Birken SA, Abadie B, Damschroder L. A systematic review of the use of the consolidated framework for implementation research. Implement Sci. 2016;11(1):72.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Field B, Booth A, Ilott I, Gerrish K. Using the Knowledge to Action Framework in practice: a citation analysis and systematic review. Implement Sci. 2014;9(1):172.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Birken SA, Powell BJ, Shea CM, Haines ER, Alexis Kirk M, Leeman J, et al. Criteria for selecting implementation science theories and frameworks: results from an international survey. Implement Sci. 2017;12(1):124.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Birken SA, Powell BJ, Presseau J, Kirk MA, Lorencatto F, Gould NJ, et al. Combined use of the Consolidated Framework for Implementation Research (CFIR) and the Theoretical Domains Framework (TDF): a systematic review. Implement Sci. 2017;12(1):2.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Cooper C, Lovell R, Husk K, Booth A, Garside R. Supplementary search methods were more effective and offered better value than bibliographic database searching: a case study from public health and environmental enhancement. Res Synth Methods. 2018;9(2):195–223.

    Article  PubMed  Google Scholar 

  21. Duan Y, Iaconi A, Wang J, Perez JS, Song Y, Chamberlain SA, et al. Conceptual and relational advances of the PARIHS and i-PARIHS frameworks over the last decade: a critical interpretive synthesis. Implement Sci. 2022;17(1):78.

    Article  PubMed  PubMed Central  Google Scholar 

  22. The Covidence Team. Covidence systematic review software. Melbourne: Veritar Health Innovation; 2023.

  23. The Endnote Team. Endnote. Philadelphia: Clarivate Analytics; 2013.

    Google Scholar 

  24. Elo S, Kyngäs H. The qualitative content analysis process. J Adv Nurs. 2008;62(1):107–15.

    Article  PubMed  Google Scholar 

  25. Almeida FA, Michaud TL, Wilson KE, Schwab RJ, Goessl C, Porter GC, et al. Preventing diabetes with digital health and coaching for translation and scalability (PREDICTS): a type 1 hybrid effectiveness-implementation trial protocol. Contemp Clin Trials. 2020;88:105877.

    Article  PubMed  Google Scholar 

  26. Bahraini NH, Matarazzo BB, Barry CN, Post EP, Forster JE, Dollar KM, et al. Protocol: examining the effectiveness of an adaptive implementation intervention to improve uptake of the VA suicide risk identification strategy: a sequential multiple assignment randomized trial. Implement Sci. 2020;15(1):58.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Edelman EJ, Dziura J, Deng Y, Bold KW, Murphy SM, Porter E, et al. A SMARTTT approach to Treating Tobacco use disorder in persons with HIV (SMARTTT): rationale and design for a hybrid type 1 effectiveness-implementation study. Contemp Clin Trials. 2021;110:106379.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Gordon EJ, Lee J, Kang RH, Caicedo JC, Holl JL, Ladner DP, et al. A complex culturally targeted intervention to reduce Hispanic disparities in living kidney donor transplantation: an effectiveness-implementation hybrid study protocol. BMC Health Serv Res. 2018;18(1):368.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Hill JL, Heelan KA, Bartee RT, Wichman C, Michaud T, Abbey BM, et al. A type III hybrid effectiveness-implementation pilot trial testing dissemination and implementation strategies for a pediatric weight management intervention: the Nebraska childhood obesity research demonstration project. Child Obes. 2021;17(S1):S-70-S−8.

    Article  Google Scholar 

  30. Iverson KM, Dichter ME, Stolzmann K, Adjognon OL, Lew RA, Bruce LE, et al. Assessing the Veterans Health Administration’s response to intimate partner violence among women: protocol for a randomized hybrid type 2 implementation-effectiveness trial. Implement Sci. 2020;15(1):29.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Levin JB, Briggs F, Blixen C, Bauer M, Einstadter D, Albert JM, et al. A randomized controlled trial of customized adherence enhancement (CAE-E): study protocol for a hybrid effectiveness-implementation project. Trials. 2022;23(1):634.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Michaud TL, Estabrooks PA, You W, McGuire TJ, Almeida F, Karls K, et al. Sustaining the reach of a scalable weight loss intervention through financial incentives- a pragmatic, feasibility, online randomized trial protocol. Contemp Clin Trials. 2020;98:106142.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Mudge AM, Banks MD, Barnett AG, Blackberry I, Graves N, Green T, et al. CHERISH (collaboration for hospitalised elders reducing the impact of stays in hospital): protocol for a multi-site improvement program to reduce geriatric syndromes in older inpatients. BMC Geriatr. 2017;17(1):11.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Owen RR, Woodward EN, Drummond KL, Deen TL, Oliver KA, Petersen NJ, et al. Using implementation facilitation to implement primary care mental health integration via clinical video telehealth in rural clinics: protocol for a hybrid type 2 cluster randomized stepped-wedge design. Implement Sci. 2019;14(1):33.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Singh AN, Sanchez V, Kenzie ES, Sullivan E, McCormack JL, Hiebert Larson J, et al. Improving screening, treatment, and intervention for unhealthy alcohol use in primary care through clinic, practice-based research network, and health plan partnerships: protocol of the ANTECEDENT study. PLoS ONE. 2022;17(6):e0269635.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Strid EN, Wallin L, Nilsagård Y. Implementation of a health promotion practice using individually targeted lifestyle interventions in primary health care: protocol for the “Act in Time” mixed methods process evaluation study. JMIR Res Protoc. 2022;11(8):e37634.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Swindle T, Johnson SL, Whiteside-Mansell L, Curran GM. A mixed methods protocol for developing and testing implementation strategies for evidence-based obesity prevention in childcare: a cluster randomized hybrid type III trial. Implement Sci. 2017;12(1):90.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Wray LO, Ritchie MJ, Oslin DW, Beehler GP. Enhancing implementation of measurement-based mental health care in primary care: a mixed-methods randomized effectiveness evaluation of implementation facilitation. BMC Health Serv Res. 2018;18(1):753.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Szymczak JE, Petty LA, Gandhi TN, Neetz RA, Hersh A, Presson AP, et al. Protocol for a parallel cluster randomized trial of a participatory tailored approach to reduce overuse of antibiotics at hospital discharge: the ROAD home trial. Implement Sci. 2024;19(1):23.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Aifah AA, Hade EM, Colvin C, Henry D, Mishra S, Rakhra A, et al. Study design and protocol of a stepped wedge cluster randomized trial using a practical implementation strategy as a model for hypertension-HIV integration — the MAP-IT trial. Implement Sci. 2023;18(1):14.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Amador S, Rapaport P, Lang I, Sommerlad A, Mukadam N, Stringer A, et al. Implementation of START (STrAtegies for RelaTives) for dementia carers in the third sector: widening access to evidence-based interventions. PLoS One. 2021;16(6):e0250410.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Damush TM, Miech EJ, Rattray NA, Homoya B, Penney LS, Cheatham A, et al. Implementation evaluation of a complex intervention to improve timeliness of care for veterans with transient ischemic attack. J Gen Intern Med. 2021;36(2):322–32.

    Article  CAS  PubMed  Google Scholar 

  43. Niemeyer Hultstrand J, Engström E, Målqvist M, Tydén T, Maseko N, Jonsson M. Evaluating the implementation of the reproductive life plan in disadvantaged communities: a mixed-methods study using the i-PARIHS framework. PLoS One. 2020;15(9):e0236712.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Meloncelli N, Barnett A, de Jersey S. An implementation science approach for developing and implementing a dietitian-led model of care for gestational diabetes: a pre-post study. BMC Pregnancy Childbirth. 2020;20(1):661.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Merlo G, Suna JM, McIntosh A, Jardine K, Kenny L, Orchard J, et al. Implementation of a novel vocal cord dysfunction management pathway using the consolidated framework for implementation research. Cardiol Young. 2022;32(5):775–81.

    Article  PubMed  Google Scholar 

  46. Alt Murphy M, Björkdahl A, Forsberg-Wärleby G, Persson CU. Implementation of evidence-based assessment of upper extremity in stroke rehabilitation: from evidence to clinical practice. J Rehabil Med. 2021;53(1):jrm00148.

    Article  PubMed  Google Scholar 

  47. Peel NM, Hornby-Turner YC, Osborne SR, Henderson A, Hubbard RE, Gray LC. Implementation and evaluation of a standardized nurse-administered assessment of functional and psychosocial issues for patients in acute care. Worldviews Evid Based Nurs. 2021;18(3):161–9.

    Article  PubMed  Google Scholar 

  48. Smith TL, Kim B, Benzer JK, Yusuf Z, Fletcher TL, Walder AM. FLOW: Early results from a clinical demonstration project to improve the transition of patients with mental health disorders back to primary care. Psychol Serv. 2021;18(1):23–32.

    Article  PubMed  Google Scholar 

  49. Smith SN, Almirall D, Prenovost K, Goodrich DE, Abraham KM, Liebrecht C, et al. Organizational culture and climate as moderators of enhanced outreach for persons with serious mental illness: results from a cluster-randomized trial of adaptive implementation strategies. Implement Sci. 2018;13(1):93.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Sabesan S, Malica M, Gebbie C, Scott C, Thomas D, Zalcberg J. Implementation of the Australasian Teletrial Model: translating ideas into action using implementation science frameworks. J Telemed Telecare. 2021;29(8):641–7.

    Article  PubMed  Google Scholar 

  51. Pang RK, Andrew NE, Srikanth V, Weller CD, Snowdon DA. Perceptions of barriers and facilitators to a pilot implementation of an algorithm-supported care navigation model of care: a qualitative study. Healthcare. 2023;11(23):3011.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Sideris K, Weir CR, Schmalfuss C, Hanson H, Pipke M, Tseng P-H, et al. Artificial intelligence predictive analytics in heart failure: results of the pilot phase of a pragmatic randomized clinical trial. J Am Med Inform Assoc. 2024;31(4):919–28.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Connolly SL, Sullivan JL, Ritchie MJ, Kim B, Miller CJ, Bauer MS. External facilitators’ perceptions of internal facilitation skills during implementation of collaborative care for mental health teams: a qualitative analysis informed by the i-PARIHS framework. BMC Health Serv Res. 2020;20(1):165.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Lewis A, Harvey G, Hogan M, Kitson A. Can oral healthcare for older people be embedded into routine community aged care practice? A realist evaluation using normalisation process theory. Int J Nurs Stud. 2019;94:32–41.

    Article  PubMed  Google Scholar 

  55. McClatchey K, Marsh V, Steed L, Holmes S, Taylor SJC, Wiener-Ogilvie S, et al. Developing a theoretically informed education programme within the context of a complex implementation strategy in UK primary care: an exemplar from the IMP2ART trial. Trials. 2022;23(1):350.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Nygårdh A, Ahlström G, Wann-Hansson C. Handling a challenging context: experiences of facilitating evidence-based elderly care. J Nurs Manag. 2016;24(2):201–10.

    Article  PubMed  Google Scholar 

  57. Ruest M, Léonard G, Thomas A, Desrosiers J, Guay M. Algo’s integrated knowledge translation process in homecare services: a cross-sectional correlational study for identifying its level of utilization and its associated characteristics. Can J Occup Ther. 2021;89(1):13–25.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Tuepker A, Elnitsky C, Newell S, Zaugg T, Henry JA. A qualitative study of implementation and adaptations to Progressive Tinnitus Management (PTM) delivery. PLoS ONE. 2018;13(5):e0196105.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Yue J, Liu J, Zhao Y, Williams S, Zhang B, Zhang L, et al. Evaluating factors that influenced the successful implementation of an evidence-based neonatal care intervention in Chinese hospitals using the PARIHS framework. BMC Health Serv Res. 2022;22(1):104.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Felker BL, Towle CB, Wick IK, McKee M. Designing and implementing TeleBehavioral health training to support rapid and enduring transition to virtual care in the COVID era. J Technol Behav Sci. 2023;8(3):225–33.

    Article  Google Scholar 

  61. Centers for Disease Control and Prevention. Replicating effective programs plus. 2006. Available from: http://www.cdc.gov/hiv/projects/rep/default.htm.

  62. Chambers DA, Glasgow RE, Stange KC. The dynamic sustainability framework: addressing the paradox of sustainment amid ongoing change. Implement Sci. 2013;8(1):117.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Tawse A, Tabesh P. Strategy implementation: a review and an introductory framework. Eur Manag J. 2021;39(1):22–33.

    Article  Google Scholar 

  64. Barnden R, Snowdon DA, Lannin NA, Lynch E, Srikanth V, Andrew NE. Prospective application of theoretical implementation frameworks to improve health care in hospitals — a systematic review. BMC Health Serv Res. 2023;23(1):607.

    Article  PubMed  PubMed Central  Google Scholar 

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The authors declare that there was no funding that supported this research.

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Authors and Affiliations

  1. Flinders University, College of Nursing and Health Sciences, Caring Futures Institute, Sturt Road, Bedford Park, Adelaide, South Australia, 5042, Australia

    Sarah C. Hunter, Samantha Morgillo & Alison L. Kitson

  2. Center for Health Optimization and Implementation Research, VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA, 02130, USA

    Bo Kim

  3. Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA

    Bo Kim

  4. Department of Women’s and Children’s Health, SWEDESD - Sustainability Learning and Research Center, Uppsala University, Uppsala, Sweden

    Anna Bergström

  5. Department of Learning, Informatics, Management and Ethics, Medical Management Center, Karolinska Institutet, PROCOME, Stockholm, Sweden

    Anna Bergström

  6. Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine (CES), Region Stockholm, Stockholm, Sweden

    Anna Bergström

  7. School of Health and Welfare, Dalarna University, Falun, 791 88, Sweden

    Anna Ehrenberg & Lars Wallin

  8. Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, 581 83, Sweden

    Ann Catrine Eldh

  9. Department of Public Health and Caring Sciences, Uppsala University, Box 564, Uppsala, 751 22, Sweden

    Ann Catrine Eldh

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Contributions

All authors made substantial contributions to the concept and design of the work. SCH and SM conducted title and abstract screening and authors SCH, SM, BK, AB, AE, ACE, and LW conducted data extraction. SCH and SM conducted the preliminary synthesis and analysis of the results, and all authors contributed to interpretation of the results and final analysis and presentation. ALK provided strategic and intellectual oversight. All authors contributed to writing and approved the submitted version of the manuscript.

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Correspondence to Sarah C. Hunter.

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ALK is one of the developers of the PARIHS and i-PARIHS frameworks. AB is part of the Editorial Board for Implementation Science Communications. All other authors declare that they have no competing interests.

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Hunter, S.C., Morgillo, S., Kim, B. et al. Combined use of the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework with other implementation frameworks: a systematic review. Implement Sci Commun 6, 25 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s43058-025-00704-1

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Implementation Science Communications

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