Designing and implementing two facilitation interventions within the ‘Facilitating Implementation of Research Evidence (FIRE)’ study: a qualitative analysis from an external facilitators’ perspective

dc.contributor.authorHarvey, Gill
dc.contributor.authorMcCormack, Brendan
dc.contributor.authorKitson, Alison L
dc.contributor.authorLynch, Elizabeth A
dc.contributor.authorTitchen, Angie
dc.date.accessioned2018-11-23T01:48:15Z
dc.date.available2018-11-23T01:48:15Z
dc.date.issued2018-11-16
dc.date.updated2018-11-20T05:35:03Z
dc.descriptionOpen Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.en_US
dc.description.abstractBackground: The "Facilitating Implementation of Research Evidence" study found no significant differences between sites that received two types of facilitation support and those that did not on the primary outcome of documented compliance with guideline recommendations. Process evaluation highlighted factors that influenced local, internal facilitators' ability to enact the roles as envisaged. In this paper, the external facilitators responsible for designing and delivering the two types of facilitation intervention analyse why the interventions proved difficult to implement as expected, including the challenge of balancing fidelity and adaptation. Methods: Qualitative data sources included notes from monthly internal-external facilitator teleconference meetings, from closing events for the two facilitation interventions and summary data analyses from repeated interviews with 16 internal facilitators. Deductive and inductive data analysis was led by an independent researcher to evaluate how facilitation in practice compared to the logic pathways designed to guide fidelity in the delivery of the interventions. Results: The planned facilitation interventions did not work as predicted. Difficulties were encountered in each of the five elements of the logic pathway: recruitment and selection of appropriate internal facilitators, preparation for the role, ability to apply facilitation knowledge and skills at a local level, support and mentorship from external facilitators via monthly teleconferences, working collaboratively and enabling colleagues to implement guideline recommendations. Moreover, problems were cumulative and created tensions for the external facilitators in terms of balancing the logic pathway with a more real-world, flexible and iterative approach to facilitation. Conclusion: Evaluating an intervention that is fluid and dynamic within the methodology of a randomised controlled trial is complex and challenging. At a practical level, relational aspects of facilitation are critically important. It is essential to recruit and retain individuals with the appropriate set of skills and characteristics, explicit support from managerial leaders and accessible mentorship from more experienced facilitators. At a methodological level, there is a need for attention to the balance between fidelity and adaptation of interventions. For future studies, we suggest a theoretical approach to fidelity, with a focus on mechanisms, informed by prospective use of process evaluation data and more detailed investigation of the context-facilitation dynamic.en_US
dc.description.sponsorshipThe research leading to these results has received funding from the European Union’s Seventh Framework Programme (FP7/2007-2013) under grant agreement no. 223646.en_US
dc.identifier.citationHarvey, G., McCormack, B., Kitson, A., Lynch, E. and Titchen, A., (2018). Designing and implementing two facilitation interventions within the ‘Facilitating Implementation of Research Evidence (FIRE)’ study: a qualitative analysis from an external facilitators’ perspectiveImplementation Science, 13(1):141.en_US
dc.identifier.doihttps://doi.org/10.1186/s13012-018-0812-zen_US
dc.identifier.issn1748-5908
dc.identifier.urihttp://hdl.handle.net/2328/38598
dc.language.isoenen_US
dc.language.rfc3066en
dc.oaire.license.condition.licenseCC-BY
dc.publisherBMCen_US
dc.rights© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.en_US
dc.rights.holder© The Author(s). 2018en_US
dc.subjectFacilitationen_US
dc.subjectInternal-external facilitatorsen_US
dc.subjectPARIHSen_US
dc.subjectFidelityen_US
dc.subjectAdaptationen_US
dc.titleDesigning and implementing two facilitation interventions within the ‘Facilitating Implementation of Research Evidence (FIRE)’ study: a qualitative analysis from an external facilitators’ perspectiveen_US
dc.typeArticleen_US
local.contributor.authorOrcidLookupHarvey, Gill: https://orcid.org/0000-0003-0937-7819en_US
local.contributor.authorOrcidLookupLynch, Elizabeth A: https://orcid.org/0000-0001-8756-1051en_US
local.contributor.authorOrcidLookupKitson, Alison L: https://orcid.org/0000-0002-7690-6226
local.contributor.authorOrcidLookupHarvey, Gill: https://orcid.org/0000-0003-0937-7819
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