Table 1 i-PARIHS constructs and how ESP constructs were defined for analysis
i-PARIHS constructs and definitions | Comparable ESP constructs and definitions |
|---|---|
Facn = Facilitation | ESP implementation processes |
• The active element that assesses, aligns and integrates the innovation, recipients and context • Uses action-learning techniques to enable adoption of new knowledge into practice • Enables and encourages teams and individuals to reflect and think in a systematic way and to embrace continuous improvement of their practice based on best available evidence • Commonly involves improvement approaches underpinned by project management [11] | • Used networks, built on relationships and used snowballing recruitment to engage stakeholders in data interpretation • Distributed aggregated CQI data and cumulative findings among stakeholders using phased reports • Encouraged teams and individuals to engage with the data, reflect on their practice, systems and context, and think about how to use this evidence to improve care • Gathered group and individual input through phase online surveys culminating in final reports • Used iterative processes based on a CQI approach • Used concurrent developmental evaluation to gather evaluative feedback and put learning into practice, adapt reports and processes to support engagement and use of collaboratively produced evidence |
I = Innovation | The ESP Innovation |
The focus or content of the implementation effort | Used aggregated CQI data from 175 Indigenous PHC centres in 5 jurisdictions to: • Identify priority evidence-practice gaps, barriers/enablers operating at different health system levels and strategies for improvement in key areas of clinical care • Develop accessible, useful and usable reports Used interactive dissemination processes to: • Share explicit evidence and capture stakeholder knowledge to co-produce evidence for improving care • Distribute reports and administer surveys online • Collect and analyse survey responses and prepare reports of ESP findings • Repeat the process using aggregated CQI data in different areas of clinical care |
R = Recipients (individual, collective) | ESP stakeholders |
Staff, support services and patients involved in and affected by implementation and how they respond to the changes required to implement the innovation | Individuals and teams involved in Indigenous PHC and how they responded to the requirements of participating in the ESP project. Stakeholders included: • Indigenous health practitioners, nurses, midwives, doctors, including medical specialists, allied health professionals • CQI practitioners • Middle and senior managers • Policy officers, health board members • Researchers/academics and others |
C = Context (inner, outer) | ESP Context (inner, outer) |
Contextual factors, their potential impact on implementation and how best to handle them | Inner context: Local Indigenous PHC centres with diverse: • Range of services, population size • Settings (urban, rural, remote) • Governance arrangements • Infrastructure, resources, staffing • CQI approaches and continuity, ABCD history and policy support [6] Inner context: organisational PHC services and centres, support organisations, research institutions, universities, government departments Outer context Government policy commitment and funding initiatives addressing health inequity for Indigenous people, CQI research networks, national policy environment for CQI |