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In their paper Leeman et al. present a theory-based taxonomy of methods used to implement change in practice. They compiled a provisional taxonomy of implementation methods based on theory and existing taxonomies within the literature. This was used to guide the content analysis of a convenience sample of 43 empirical studies of the implementation of research-based practice changes, all involving nurses, and published between 1995 and 2005. The taxonomy was revised iteratively during the course of the analysis to comprehensively capture information from each report. This work was undertaken against a backdrop of their awareness that implementation research was characterized by the use of inconsistent terminology, particularly regarding the methods used in studies and a lack of attention to differences in the relevance of methods across different disciplines. They state that studies of effectiveness of implementation studies have generated mixed results and with positive effects being small. They argue the justification for their study is based on the fact that limited success of implementation for change in practice may in part be due to lack of use of a framework.

The initial taxonomy devised by Leeman et al. included contingency theory, diffusion of innovations theory and behavioural change theories across five methods. These were: increasing coordination to manage interdependence, raising awareness of the practice of change, persuading interpersonal channels and norms, persuading by reinforcing belief that the behaviour will lead to desirable results and, finally increasing behavioural control. The convenience sample of studies was identified from a search of Medline and the Nursing and Allied Health Database (CINAHL) undertaken as part of a broader review of the determinants of implementation effectiveness. The sample in this case was identified using the search terms ‘quality assurance’, ‘diffusion of innovation’, ‘evidence-based medicine’, ‘nursing practice’, ‘evidence based’‘research utilization and ‘research transfer’ (Leeman et al. 2007, p. 195).

Leeman et al.’s JAN paper makes a significant contribution within the dissemination and implementation field: it advances knowledge and will influence future work by providing a theoretical framework that can be usefully used in future research. It continues the groundbreaking traditions of the ‘Chapel Hill’ stable where the CURN project looked at barriers and facilitators to implementing research in practice (see Funk et al. 1995). I am intrigued, however, as the title of the paper and the aim and provisional theoretical framework included the word ‘implementation’ but this was not used as a search term, nor that of ‘dissemination’, within their study. If these search terms had been used then the convenience sample and content analysis may have included the research studies by Williams et al. (1997) and Button et al. (1998). Hand searching references and contacting lead investigators are recommendations within systematic review methods to locate studies and avoid bias, and it is also appreciated that re-running a search again with the same search terms can locate or generate different ‘hits’ (Egger et al. 2005). So, despite using systematic search methods – and replicating them – it is not yet a precise science. In order to avoid missed studies it is worth spending time developing, piloting and refining the search strategy to ensure specificity and sensitivity for the location of relevant studies.

Despite this observation which has intrigued me since reading the paper, I congratulate these eminent scholars for a valuable and important study which provides a framework that can be used to good effect in future research to advance theory, knowledge and practice. In particular, as the authors state their taxonomy offers a new system that can be used to categorize implementation methods, also by linking methods and theory the taxonomy can usefully be used to guide the selection of the implementation methods to best fit the characteristics of practice change, users’ stage of adoption, their perception of change and their ability to implement change in their practice setting. The challenge remains to disseminate and implement research findings into practice so that the organization and delivery of services and care is based on effective evidence.

References

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  2. References
  • Button D., Roe B., Webb C., Frith T., Colin Thome D. & Gardner L. (1998) Consensus guidelines for the promotion and management of continence by primary health care teams: development, implementation and evaluation. Journal of Advanced Nursing 27, 9199.
  • Egger M., Dickersin K. & Davey Smith G. (2005) Problems and limitations in conducting systematic reviews. In Systematic Reviews in Health Care: Meta-analysis in Context, Chapter 3 (EggerM., Davey-SmithG. & AltmanD.G., Eds), BMJ Publishing, London, pp. 4368.
  • Funk S.G., Tornquist E.M. & Champagne M.T. (1995) Barriers and facilitators of research utilization. An integrative review. Nursing Clinics of North America 30, 395407.
  • Leeman J., Baernholdt M. & Sandelowski M. (2007) Developing a theory-based taxonomy of methods for implementing change in practice. Journal of Advanced Nursing 58, 191200.
  • Williams K., Crichton N.J. & Roe B. (1997) Disseminating research evidence: a controlled trial in continence care. Journal of Advanced Nursing 25, 691698.