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

Jo Rycroft-Malone, Kate Seers, Ann Catrine Eldh, Karen Cox, Nicola Crichton, Gill Harvey, Claire Hawkes, Alison Kitson, B McCormack, Christel McMullan, Carole Mockford, Theo Niessen, Paul F Slater, Angie Titchen, Teatske van der Zijpp, Lars Wallin

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background
Facilitation is a promising implementation intervention, which required theory informed evaluation. This paper presents an exemplar of a multi-country realist process evaluation that was embedded in a 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. Process evaluation data were collected over four time-points using multiple qualitative methods: observation (372 hours), interviews with staff (n=357), residents (n=152), next of kin (n=109) 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.
LanguageEnglish
JournalImplementation Science
DOIs
Publication statusPublished - 16 Nov 2018

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Randomized Controlled Trials
Research
Aptitude
Learning
Home Care Services
Observation
Interviews
Growth

Keywords

  • Facilitation
  • older people
  • urinary incontinence
  • PARIHS
  • realist process evaluation
  • implementation
  • context

Cite this

Rycroft-Malone, Jo ; Seers, Kate ; Eldh, Ann Catrine ; Cox, Karen ; Crichton, Nicola ; Harvey, Gill ; Hawkes, Claire ; Kitson, Alison ; McCormack, B ; McMullan, Christel ; Mockford, Carole ; Niessen, Theo ; Slater, Paul F ; Titchen, Angie ; van der Zijpp, Teatske ; Wallin, Lars. / A realist process evaluation within the Facilitating Implementation of Research Evidence (FIRE) cluster randomised controlled international trial: an exemplar. In: Implementation Science. 2018.
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title = "A realist process evaluation within the Facilitating Implementation of Research Evidence (FIRE) cluster randomised controlled international trial: an exemplar",
abstract = "BackgroundFacilitation is a promising implementation intervention, which required theory informed evaluation. This paper presents an exemplar of a multi-country realist process evaluation that was embedded in a 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.MethodsThis realist process evaluation included theory formulation, theory testing and refining. Data were collected in 24 care home sites across four European countries. Process evaluation data were collected over four time-points using multiple qualitative methods: observation (372 hours), interviews with staff (n=357), residents (n=152), next of kin (n=109) other stakeholders (n=128), supplemented by facilitator activity logs. A combined inductive and deductive data analysis process focused on realist theory refinement and testing. ResultsThe 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.ConclusionThe 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.",
keywords = "Facilitation, older people, urinary incontinence, PARIHS, realist process evaluation, implementation, context",
author = "Jo Rycroft-Malone and Kate Seers and Eldh, {Ann Catrine} and Karen Cox and Nicola Crichton and Gill Harvey and Claire Hawkes and Alison Kitson and B McCormack and Christel McMullan and Carole Mockford and Theo Niessen and Slater, {Paul F} and Angie Titchen and {van der Zijpp}, Teatske and Lars Wallin",
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language = "English",
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Rycroft-Malone, J, Seers, K, Eldh, AC, Cox, K, Crichton, N, Harvey, G, Hawkes, C, Kitson, A, McCormack, B, McMullan, C, Mockford, C, Niessen, T, Slater, PF, Titchen, A, van der Zijpp, T & Wallin, L 2018, 'A realist process evaluation within the Facilitating Implementation of Research Evidence (FIRE) cluster randomised controlled international trial: an exemplar', Implementation Science. https://doi.org/10.1186/s13012-018-0811-0

A realist process evaluation within the Facilitating Implementation of Research Evidence (FIRE) cluster randomised controlled international trial: an exemplar. / Rycroft-Malone, Jo; Seers, Kate; Eldh, Ann Catrine; Cox, Karen; Crichton, Nicola ; Harvey, Gill; Hawkes, Claire; Kitson, Alison; McCormack, B; McMullan, Christel; Mockford, Carole; Niessen, Theo; Slater, Paul F; Titchen, Angie; van der Zijpp, Teatske; Wallin, Lars.

In: Implementation Science, 16.11.2018.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A realist process evaluation within the Facilitating Implementation of Research Evidence (FIRE) cluster randomised controlled international trial: an exemplar

AU - Rycroft-Malone, Jo

AU - Seers, Kate

AU - Eldh, Ann Catrine

AU - Cox, Karen

AU - Crichton, Nicola

AU - Harvey, Gill

AU - Hawkes, Claire

AU - Kitson, Alison

AU - McCormack, B

AU - McMullan, Christel

AU - Mockford, Carole

AU - Niessen, Theo

AU - Slater, Paul F

AU - Titchen, Angie

AU - van der Zijpp, Teatske

AU - Wallin, Lars

PY - 2018/11/16

Y1 - 2018/11/16

N2 - BackgroundFacilitation is a promising implementation intervention, which required theory informed evaluation. This paper presents an exemplar of a multi-country realist process evaluation that was embedded in a 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.MethodsThis realist process evaluation included theory formulation, theory testing and refining. Data were collected in 24 care home sites across four European countries. Process evaluation data were collected over four time-points using multiple qualitative methods: observation (372 hours), interviews with staff (n=357), residents (n=152), next of kin (n=109) other stakeholders (n=128), supplemented by facilitator activity logs. A combined inductive and deductive data analysis process focused on realist theory refinement and testing. ResultsThe 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.ConclusionThe 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.

AB - BackgroundFacilitation is a promising implementation intervention, which required theory informed evaluation. This paper presents an exemplar of a multi-country realist process evaluation that was embedded in a 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.MethodsThis realist process evaluation included theory formulation, theory testing and refining. Data were collected in 24 care home sites across four European countries. Process evaluation data were collected over four time-points using multiple qualitative methods: observation (372 hours), interviews with staff (n=357), residents (n=152), next of kin (n=109) other stakeholders (n=128), supplemented by facilitator activity logs. A combined inductive and deductive data analysis process focused on realist theory refinement and testing. ResultsThe 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.ConclusionThe 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.

KW - Facilitation

KW - older people

KW - urinary incontinence

KW - PARIHS

KW - realist process evaluation

KW - implementation

KW - context

U2 - 10.1186/s13012-018-0811-0

DO - 10.1186/s13012-018-0811-0

M3 - Article

JO - Implementation Science

T2 - Implementation Science

JF - Implementation Science

SN - 1748-5908

ER -