A Guide for applying a revised version of the PARIHS framework for implementation

<p>Abstract</p> <p>Background</p> <p>Based on a critical synthesis of literature on use of the Promoting Action on Research Implementation in Health Services (PARIHS) framework, revisions and a companion <it>Guide </it>were developed by a group of researchers independent of the original PARIHS team. The purpose of the <it>Guide </it>is to enhance and optimize efforts of researchers using PARIHS in implementation trials and evaluations.</p> <p>Methods</p> <p>Authors used a planned, structured process to organize and synthesize critiques, discussions, and potential recommendations for refinements of the PARIHS framework arising from a systematic review. Using a templated form, each author independently recorded key components for each reviewed paper; that is, study definitions, perceived strengths/limitations of PARIHS, other observations regarding key issues and recommendations regarding needed refinements. After reaching consensus on these key components, the authors summarized the information and developed the <it>Guide</it>.</p> <p>Results</p> <p>A number of revisions, perceived as consistent with the PARIHS framework's general nature and intent, are proposed. The related <it>Guide </it>is composed of a set of reference tools, provided in Additional files. Its core content is built upon the basic elements of PARIHS and current implementation science.</p> <p>Conclusions</p> <p>We invite researchers using PARIHS for targeted evidence-based practice (EBP) implementations with a strong task-orientation to use this <it>Guide </it>as a companion and to apply the revised framework prospectively and comprehensively. Researchers also are encouraged to evaluate its use relative to perceived strengths and issues. Such evaluations and critical reflections regarding PARIHS and our <it>Guide </it>could thereby promote the framework's continued evolution.</p

Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science

Abstract Background Many interventions found to be effective in health services research studies fail to translate into meaningful patient care outcomes across multiple contexts. Health services researchers recognize the need to evaluate not only summative outcomes but also formative outcomes to assess the extent to which implementation is effective in a specific setting, prolongs sustainability, and promotes dissemination into other settings. Many implementation theories have been published to help promote effective implementation. However, they overlap considerably in the constructs included in individual theories, and a comparison of theories reveals that each is missing important constructs included in other theories. In addition, terminology and definitions are not consistent across theories. We describe the Consolidated Framework For Implementation Research (CFIR) that offers an overarching typology to promote implementation theory development and verification about what works where and why across multiple contexts. Methods We used a snowball sampling approach to identify published theories that were evaluated to identify constructs based on strength of conceptual or empirical support for influence on implementation, consistency in definitions, alignment with our own findings, and potential for measurement. We combined constructs across published theories that had different labels but were redundant or overlapping in definition, and we parsed apart constructs that conflated underlying concepts. Results The CFIR is composed of five major domains: intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation. Eight constructs were identified related to the intervention (e.g., evidence strength and quality), four constructs were identified related to outer setting (e.g., patient needs and resources), 12 constructs were identified related to inner setting (e.g., culture, leadership engagement), five constructs were identified related to individual characteristics, and eight constructs were identified related to process (e.g., plan, evaluate, and reflect). We present explicit definitions for each construct. Conclusion The CFIR provides a pragmatic structure for approaching complex, interacting, multi-level, and transient states of constructs in the real world by embracing, consolidating, and unifying key constructs from published implementation theories. It can be used to guide formative evaluations and build the implementation knowledge base across multiple studies and settings.http://deepblue.lib.umich.edu/bitstream/2027.42/78272/1/1748-5908-4-50.xmlhttp://deepblue.lib.umich.edu/bitstream/2027.42/78272/2/1748-5908-4-50-S1.PDFhttp://deepblue.lib.umich.edu/bitstream/2027.42/78272/3/1748-5908-4-50-S3.PDFhttp://deepblue.lib.umich.edu/bitstream/2027.42/78272/4/1748-5908-4-50-S4.PDFhttp://deepblue.lib.umich.edu/bitstream/2027.42/78272/5/1748-5908-4-50.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/78272/6/1748-5908-4-50-S2.PDFPeer Reviewe

Bidirectional Relations Between Parenting and Behavior Problems From Age 8 to 13 in Nine Countries

This study used data from 12 cultural groups in nine countries (China, Colombia, Italy, Jordan, Kenya, Philippines, Sweden, Thailand, and the United States; N = 1,298) to understand the cross‐cultural generalizability of how parental warmth and control are bidirectionally related to externalizing and internalizing behaviors from childhood to early adolescence. Mothers, fathers, and children completed measures when children were ages 8–13. Multiple‐group autoregressive, cross‐lagged structural equation models revealed that child effects rather than parent effects may better characterize how warmth and control are related to child externalizing and internalizing behaviors over time, and that parent effects may be more characteristic of relations between parental warmth and control and child externalizing and internalizing behavior during childhood than early adolescence

Parenting, culture, and the development of externalizing behaviors from age 7 to 14 in nine countries

Using multilevel models, we examined mother-, father-, and child-reported (N = 1,336 families) externalizing behavior problem trajectories from age 7 to 14 in nine countries (China, Colombia, Italy, Jordan, Kenya, the Philippines, Sweden, Thailand, and the United States). The intercept and slope of children\u27s externalizing behavior trajectories varied both across individuals within culture and across cultures, and the variance was larger at the individual level than at the culture level. Mothers’ and children\u27s endorsement of aggression as well as mothers’ authoritarian attitudes predicted higher age 8 intercepts of child externalizing behaviors. Furthermore, prediction from individual-level endorsement of aggression and authoritarian attitudes to more child externalizing behaviors was augmented by prediction from cultural-level endorsement of aggression and authoritarian attitudes, respectively. Cultures in which father-reported endorsement of aggression was higher and both mother- and father-reported authoritarian attitudes were higher also reported more child externalizing behavior problems at age 8. Among fathers, greater attributions regarding uncontrollable success in caregiving situations were associated with steeper declines in externalizing over time. Understanding cultural-level as well as individual-level correlates of children\u27s externalizing behavior offers potential insights into prevention and intervention efforts that can be more effectively targeted at individual children and parents as well as targeted at changing cultural norms that increase the risk of children\u27s and adolescents’ externalizing behavior

Boys’ and Girls’ Relational and Physical Aggression in Nine Countries

Distinguishing between relational and physical aggression has become a key feature of many developmental studies in North America and Western Europe, but very little information is available on relational aggression in more diverse cultural contexts. This study examined the factor structure of, gender differences in, and associations between relational and physical aggression in China, Colombia, Italy, Jordan, Kenya, the Philippines, Sweden, Thailand, and the United States. Children ages 7 to 10 years (N = 1410) reported on their relationally and physically aggressive behavior. Relational and physical aggression shared a common factor structure across countries. Unsurprisingly, boys reported being more physically aggressive than girls across all nine countries; surprisingly, there were no significant gender differences in relational aggression. In all nine countries, relational and physical aggression were significantly correlated (average r = .49). The countries differed significantly in the mean levels of both relational and physical aggression that children reported using and with respect to whether children reported using more physical than relational aggression or more relational than physical aggression. Despite mean level differences in relational and physical aggression across countries, the findings provided support for cross-country similarities in associations between relational and physical aggression, as well as links between gender and aggression

Puberty Predicts Approach But Not Avoidance on the Iowa Gambling Task in a Multinational Sample

According to the dual systems model of adolescent risk taking, sensation seeking and impulse control follow different developmental trajectories across adolescence and are governed by two different brain systems. The authors tested whether different underlying processes also drive age differences in reward approach and cost avoidance. Using a modified Iowa Gambling Task in a multinational, cross‐sectional sample of 3,234 adolescents (ages 9–17; M = 12.87, SD = 2.36), pubertal maturation, but not age, predicted reward approach, mediated through higher sensation seeking. In contrast, age, but not pubertal maturation, predicted increased cost avoidance, mediated through greater impulse control. These findings add to evidence that adolescent behavior is best understood as the product of two interacting, but independently developing, brain systems

Mothers\u27, fathers\u27 and children\u27s perceptions of parents\u27 expectations about children\u27s family obligations in nine countries

Children\u27s family obligations involve assistance and respect that children are expected to provide to immediate and extended family members and reflect beliefs related to family life that may differ across cultural groups. Mothers, fathers and children (N = 1432 families) in 13 cultural groups in 9 countries (China, Colombia, Italy, Jordan, Kenya, Philippines, Sweden, Thailand and United States) reported on their expectations regarding children\u27s family obligations and parenting attitudes and behaviours. Within families, mothers and fathers had more concordant expectations regarding children\u27s family obligations than did parents and children. Parenting behaviours that were warmer, less neglectful and more controlling as well as parenting attitudes that were more authoritarian were related to higher expectations regarding children\u27s family obligations between families within cultures as well as between cultures. These international findings advance understanding of children\u27s family obligations by contextualising them both within families and across a number of diverse cultural groups in 9 countries

How International Research on Parenting Advances Understanding of Child Development

International research on parenting and child development can advance our understanding of similarities and differences in how parenting is related to children\u27s development across countries. Challenges to conducting international research include operationalizing culture, disentangling effects within and between countries, and balancing emic and etic perspectives. Benefits of international research include testing whether findings regarding parenting and child development replicate across diverse samples, incorporating cultural and contextual diversity to foster more inclusive and representative research samples and investigators than has typically occurred, and understanding how children develop in proximal parenting and family and distal international contexts

Neighborhood Danger, Parental Monitoring, Harsh Parenting, and Child Aggression in Nine Countries

Exposure to neighborhood danger during childhood has negative effects that permeate multiple dimensions of childhood. The current study examined whether mothers’, fathers’, and children’s perceptions of neighborhood danger are related to child aggression, whether parental monitoring moderates this relation, and whether harsh parenting mediates this relation. Interviews were conducted with a sample of 1293 children (age M = 10.68, SD = 0.66; 51% girls) and their mothers (n = 1282) and fathers (n = 1075) in nine countries (China, Colombia, Italy, Jordan, Kenya, the Philippines, Sweden, Thailand, and the United States). Perceptions of greater neighborhood danger were associated with more child aggression in all nine countries according to mothers’ and fathers’ reports and in five of the nine countries according to children’s reports. Parental monitoring did not moderate the relation between perception of neighborhood danger and child aggression. The mediating role of harsh parenting was inconsistent across countries and reporters. Implications for further research are discussed, and include examination of more specific aspects of parental monitoring as well as more objective measures of neighborhood danger