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Use of Implementation Theory: A Focus on PARIHS


  • Philip M. Ullrich PhD,

    Corresponding author
    1. Research Scientist, Spinal Cord Injury QUERI, VA Puget Sound Health Care System, Seattle, WA
    • Address correspondence to Philip M. Ullrich, Spinal Cord Injury QUERI, VA Puget Sound Health Care System, 1600 S Columbian Way, Seattle, WA 98108;

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  • Anju Sahay PhD,

    1. Research Scientist, Chronic Heart Failure QUERI Center, VA Palo Alto Health Care System, Palo Alto, CA
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  • Cheryl B. Stetler PhD

    1. Independent Consultant, Amherst, MA
    2. Health Services Department, Boston University School of Public Health, Boston, MA
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Limited understanding and application of theory in implementation research contributes to variable effectiveness of implementation studies. Better understanding of direct experiences with theory could improve implementation research and the potency of interventions.


This study was a conceptual exercise aimed at characterizing experiences with and applications of the Promoting Action on Research Implementation in Health Services (PARIHS) framework.


This was a structured, qualitative study involving document reviews and interviews used to answer the following overarching questions about nine implementation research centers: Why and how was PARIHS used? What strengths and weaknesses were identified for PARIHS?


PARIHS was being used for varied purposes, at varied levels, in varied ways, and to a varying extent within and across centers. Lack of implementation theory use in investigators’ early years was common. Variability in the nature of theory use was attributable to characteristics of the centers, individual investigators, and features of PARIHS. Strengths and weaknesses of the PARIHS framework were identified.

Linking Evidence to Action

The study provides information to researchers and theorists about the use of one well-known implementation framework. The information suggests areas for improvements in PARIHS as well as theory use in general, and should assist in the development of theory-based programs of research.