Original citation:
Seers, Kate (2013) Final report summary - FIRE (Facilitating Implementation of Research
Evidence). European Commission : Community Research and Development Information
Services.
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FIRE Report Summary
Proje ct re fe re nce : 223646
Funde d unde r: FP7-HEALTH
Final Report Summary - FIRE (Facilitating Implementation of Research Evidence)
Exe cutive Summary:
Facilitating Imple me ntation of Re s e arch Evide nce (FIRE)
Background: Re s e arch e vide nce is not always us e d to e ns ure be s t practice in he althcare . This s tudy us e d the Promoting Action of Re s e arch Imple me ntation in He alth Se rvice s (PARIHS) frame work which argue s that the nature of the e vide nce , the conte xt in which it is us e d, and the e xte nt of facilitation (or he lp) that pe ople have to us e the e vide nce all e ffe ct whe the r it is us e d in practice .
Aims : The s tudy aime d to e xte nd knowle dge of facilitation as a proce s s for ge tting re s e arch e vide nce into practice by e valuating the contribution two diffe re nt mode ls of facilitation can make to imple me nting e vide nce bas e d urinary contine nce re comme ndations into practice .
Me thods : The s tudy took place in four Europe an countrie s , aiming for s ix long te rm nurs ing care s ite s in e ach country (total 24 s ite s ) involving pe ople age d 60 ye ars or more with docume nte d urinary incontine nce . An inte rnal facilitator was nominate d in e ach inte rve ntion s ite to work with e xte rnal facilitators to imple me nt the urinary incontine nce (UI) re comme ndations . The de s ign of the s tudy was a pragmatic clus te re d randomis e d controlle d trial with e mbe dde d proce s s and e conomic e valuation. Long te rm care s e ttings we re randomly allocate d to one of thre e arms (s tandard dis s e mination, and two diffe re nt facilitation inte rve ntions ), us ing a ce ntralis e d randomis ation point to e ns ure allocation conce alme nt. The primary outcome was docume nte d compliance s core (or pe rce ntage compliance ) with the contine nce re comme ndations . Se condary outcome s include d proportion of re s ide nts with incontine nce , incide nce of incontine nce re late d de rmatitis , urinary tract infe ctions and quality of life . The s e outcome s we re as s e s s e d at bas e line , the n at 6, 12, 18 and 24 months afte r the inte rve ntion. Data about the conte xt we re colle cte d throughout, us ing inte rvie ws with s taff, re s ide nts , ne xt of kin and ke y s take holde rs . Obs e rvations of care , obs e rvations of facilitation, as s e s s me nt of conte xt (us ing the Albe rta Conte xt Tool) and docume ntary e vide nce we re colle cte d.
Findings : Quantitative data was available for n=430 re s ide nts at bas e line , n=462 at +6 months , n=497 at +12 months , n=479 at +18 months and n= 445 at +24 months afte r the inte rve ntion. Total numbe r of re cords re vie we d acros s all time points n=2313. Qualitative data include d 332 hours 25 minute s of obs e rvations of care ; 39 hours of obs e rvation of facilitation activity; 471 s taff inte rvie ws ; 174 re s ide nt inte rvie ws ; 120 ne xt of kin/care r inte rvie ws ; and 125 s take holde r inte rvie ws acros s all four countrie s .
The re was no s ignificant diffe re nce be twe e n s tudy arms and all s tudy arms improve d on the primary outcome
(docume nte d compliance with contine nce re comme ndations ) ove r time in all countrie s . Whe n comparing bas e line to 24 months afte r the inte rve ntion, for re comme ndation thre e (having an individualis e d tre atme nt plan in place ), the two facilitation arms , but not the control arm, both improve d s ignificantly on including individualis e d goals of care and docume nting progre s s agains t thos e goals . With s e condary outcome s , both facilitation arms , but not the control group, had s ignificantly be tte r docume ntation of i) the le ve l of cognitive impairme nt, ii) de pre s s ion and iii) incontine nce as s ociate d de rmatitis be twe e n bas e line and 24 months . The qualitative findings s how that the role of e vide nce was unconte s te d, but that the facilitation inte rve ntions ’ pote ntial to ove rcome conte xtual is s ue s was partial. Data s how the e ffe ct of facilitation was me diate d by conte xtual characte ris tics and inte rnal facilitator characte ris tics . The conte xt characte ris tics include d re s ource s , knowle dge and unde rs tanding of urinary incontine nce , availability of s taff, s tability of practice e nvironme nt, value s and be lie fs , s tarting point of the long te rm care s e tting, phys ical e nvironme nt, le ade rs hip s tyle and s upport. The inte rnal facilitator characte ris tics include d re s ilie nce , knowle dge and unde rs tanding, value s and be lie fs , s tarting point and pe rs onal and formal authority.
inte rve ntion is e s s e ntial; 4) the re is a ne e d to pay particular atte ntion to facilitator s e le ction, pre paration and s upport, ne gotiating the balance be twe e n virtual and face to face s upport.
Proje ct Conte xt and Obje ctive s :
Background: Re s e arch e vide nce is not always us e d to e ns ure be s t practice in he althcare . This s tudy us e d the Promoting Action of Re s e arch Imple me ntation in He alth Se rvice s (PARIHS) frame work which argue s that the nature of the e vide nce , the conte xt in which it is us e d, and the e xte nt of facilitation (or he lp) that pe ople have to us e the e vide nce all e ffe ct whe the r it is us e d in practice .
Aims : The s tudy aime d to e xte nd knowle dge of facilitation as a proce s s for ge tting re s e arch e vide nce into practice by e valuating the contribution two diffe re nt mode ls of facilitation can make to imple me nting e vide nce bas e d urinary contine nce re comme ndations into practice . The protocol for this s tudy has be e n publis he d (Se e rs e t al 2012). Me thods : The s tudy took place in four Europe an countrie s (England, Swe de n, Ne the rlands , Re public of Ire land), and planne d to re cruit s ix long te rm nurs ing care s ite s in e ach country (total 24 s ite s ) involving pe ople age d 60 ye ars or more with docume nte d urinary incontine nce . An inte rnal facilitator was nominate d in e ach inte rve ntion s ite to work with e xte rnal facilitators to imple me nt the urinary incontine nce (UI) re comme ndations . The s e re comme ndations we re take n from the algorithm de ve lope d by Committe e 11 [Incontine nce in the frail e lde rly] of the Fourth Inte rnational Cons ultation on Incontine nce (DuBe au e t al 2009). The s e re comme ndations include d 1) the re s ide nt s hould be active ly s cre e ne d for incontine nce , 2) a de taile d as s e s s me nt s hould be carrie d out, 3) an individualis e d tre atme nt plan s hould be in place and 4) a s pe cialis t re fe rral s hould be made if ne e de d.
The de s ign of the s tudy was a pragmatic clus te re d randomis e d controlle d trial with e mbe dde d proce s s and e conomic e valuation. Long te rm care s e ttings we re randomly allocate d to one of thre e arms (s tandard dis s e mination, and two diffe re nt facilitation inte rve ntions ), us ing a ce ntralis e d randomis ation point to e ns ure allocation conce alme nt. The
primary outcome was docume nte d compliance s core (or pe rce ntage compliance ) with the contine nce re comme ndations . Se condary outcome s include d proportion of re s ide nts with incontine nce , incide nce of incontine nce re late d de rmatitis , urinary tract infe ctions and quality of life . The s e outcome s we re as s e s s e d at bas e line , the n at 6, 12, 18 and 24 months afte r the inte rve ntion. Data about the conte xt we re colle cte d throughout, us ing inte rvie ws with s taff, re s ide nts , ne xt of kin and ke y s take holde rs . Obs e rvations of care , obs e rvations of facilitation, as s e s s me nt of conte xt (us ing the Albe rta Conte xt Tool) and docume ntary e vide nce we re colle cte d throughout.
Arm one , the s tandard dis s e mination control group, re ce ive d the urinary incontine nce re comme ndations and a Powe rPoint pre s e ntation on imple me ntation. Both facilitation inte rve ntion groups re ce ive d the s ame mate rials as the control group plus a s pe cific inte rve ntion as follows : arm two, Type A - te chnical facilitation, was a 12 month
de ve lopme nt programme bas e d on manage me nt s cie nce , organis ational le arning, quality improve me nt and humanis tic ps ychology. Inte rnal facilitators (a s taff me mbe r from e ach s e tting) took part in a thre e day re s ide ntial programme run by two e xte rnal facilitators , followe d by 10 days to work on the imple me ntation and e valuation of re comme ndations , s upporte d by 12 half days for monthly te le confe re nce s and s e lf-dire cte d s tudy. Arm thre e , Type B - e nabling facilitation, was a 24 month de ve lopme nt programme bas e d on critical s ocial s cie nce conce pts to focus on de ve lopme nt of
individual practitione rs and conte xts . Inte rnal facilitators took part in a five day re s ide ntial programme run by two e xte rnal facilitators followe d by 20 days to work on the imple me ntation and e valuation of the re comme ndations , s upporte d by 24 half day le arning groups via te le confe re ncing, and 12 half days for s e lf-dire cte d s tudy.
A mode l of co-facilitation was us e d in both of the facilitation arms whe re a s e cond s taff me mbe r or “buddy” worke d with the inte rnal facilitator, us ing this as a de ve lopme nt opportunity, including taking the le ad if the initial facilitator was unable to continue . In arm 3, inte rnal facilitators we re als o offe re d the opportunity of a critical companion (who could he lp practitione rs analys e all type s of knowle dge /e vide nce , ble nd and apply this knowle dge in particular patie nt s ituations , ove rcome barrie rs to practis ing in a pe rs on-ce ntre d and e vide nce -informe d way and le arn in and from practice . Titche n 2003).
Our Knowle dge Trans lation Strate gy was de ve lope d us ing a mode l of s take holde r involve me nt throughout the s tudy, and de ve loping a portfolio of ne tworking and dis s e mination activitie s . Stake holde r involve me nt informe d the
de ve lopme nt and re fine me nt of the ore tical propos itions both as the s tudy progre s s e d and as the findings e me rge d. A range of ne tworking and dis s e mination me thods we re us e d to promote the input and involve me nt of countrie s from throughout Europe and be yond.
The obje ctive s of the s tudy are to:
1. Exte nd curre nt knowle dge of facilitation as a proce s s for trans lating re s e arch e vide nce into practice .
Bas e d on the PARiHS frame work, two diffe re nt mode ls of facilitation we re de ve lope d (de s cribe d as te chnical and e nabling facilitation), re quiring diffe re nt le ve ls of facilitator s kills and knowle dge and with corre s ponding diffe re nt le ve ls of re s ource re quire me nts in te rms of pre paration and s upport of facilitators and the ways in which the y work with individuals and te ams who are atte mpting to imple me nt re s e arch into practice .
2. Evaluate the fe as ibility and e ffe ctive ne s s of two diffe re nt mode ls of facilitation in promoting the uptake of re s e arch e vide nce on contine nce promotion
An inte rve ntion s tudy in four countrie s was s e t up to te s t the two diffe re nt mode ls of facilitation agains t a s tandard me thod of dis s e minating e vide nce of be s t practice on contine nce promotion. Six units pe r country participate d in the s tudy (two units for e ach of the thre e inte rve ntion arms ). The re s e arch e vide nce to be imple me nte d was agre e d by a cons e ns us , drawing on e xis ting e vide nce in the form of s ys te matic re vie ws and clinical guide line s on contine nce promotion. The contine nce re comme ndations us e d we re thos e for incontine nce in the Frail Elde rly from the 4th
Inte rnational Cons ultation on Incontine nce (2009). The s e e vide nce bas e d contine nce re comme ndations we re dis cus s e d with contine nce care e xpe rts on the FIRE Advis ory Committe e . Country contine nce e xpe rts als o che cke d that
3. To advance curre nt knowle dge of guide line imple me ntation in he althcare , with a particular focus on unde rs tanding the impact of conte xtual factors on the proce s s e s and outcome s of imple me ntation
The re s e arch was unde rpinne d by a the ory-drive n me thodology, with a particular focus on e xplaining what works , for whom, how and in what way. A de taile d s e t of conte xtual, proce s s and outcome data we re colle cte d in all the s tudy s ite s to track the de taile d proce s s e s of imple me nting re s e arch e vide nce , to account for and e xplain conte xtual diffe re nce s be twe e n and within countrie s , and to monitor the s us tainability of change s ove r time .
4. Imple me nt a pro-active dis s e mination s trate gy that comple me nts the de s ign of the s tudy and facilitate s the diffus ion of the s tudy findings to a wide policy and practice community throughout Europe and be yond.
Dis s e mination was planne d in paralle l to the de s ign and imple me ntation of the s tudy, re fle cting the the ory-drive n nature of the re s e arch and the importance of s take holde r involve me nt at all s tage s of the re s e arch proce s s .
The proje ct e xplore d and e valuate d facilitation as a proce s s for promoting the uptake of re s e arch e vide nce on contine nce promotion in clinical practice . It built on pre vious re s e arch from the PARIHS (Promoting Action on Re s e arch Imple me ntation in He alth Se rvice s ) frame work. The s tudy has advance d unde rs tanding about the contribution that facilitation and facilitators can make to trans lating the findings of re s e arch into practice . It looke d at diffe re nt mode ls of facilitation to ide ntify whe the r it is pos s ible to de te rmine a ‘good e nough’ mode l of facilitation that could addre s s the comple x range of factors that influe nce the uptake of re s e arch e vide nce within the time and re s ource cons trains of day to day s e rvice de live ry.
Urinary incontine nce has a major e ffe ct on quality of life of olde r pe ople and the ir care rs . Guide line s e xis t for managing urinary contine nce , but incontine nce is fre que ntly s e e n as an ine vitable part of aging. Imple me nting re s e arch e vide nce that promote s contine nce has the pote ntial to improve the quality of life for olde r pe ople and the ir care rs , and we ll as re ducing cos ts of incontine nce aids .
Proje ct Re s ults :
Se e MS Word docume nt attache d - FIRE 223646 final rpt v53 re s ults
Pote ntial Impact:
This s tudy e xplore d and e valuate d facilitation as a proce s s for promoting the uptake of re s e arch e vide nce on contine nce promotion in clinical practice . It built on pre vious re s e arch from the PARIHS (Promoting Action on Re s e arch Imple me ntation in He alth Se rvice s ) frame work. The propos ition unde rlying the PARIHS frame work is that s ucce s s ful imple me ntation is a function of the nature and quality of the e vide nce be ing imple me nte d, the characte ris tics and re ce ptive ne s s of the conte xt in which it is to be imple me nte d, and the appropriate ne s s of the facilitation approach us e d to e nable imple me ntation. The re s e arch was unde rpinne d by a the ory-drive n me thodology, with a particular focus on e xplaining what works , for whom, how and in what way. A de taile d s e t of conte xtual, proce s s and outcome data we re colle cte d in all the s tudy s ite s to track the de taile d proce s s e s of imple me nting re s e arch e vide nce , to account for and e xplain conte xtual diffe re nce s be twe e n and within countrie s , and to monitor the s us tainability of change s ove r time . This s tudy’s firs t aim was to e xte nd curre nt knowle dge of facilitation as a proce s s for trans lating re s e arch e vide nce into practice . Two diffe re nt mode ls of facilitation we re de ve lope d. Each mode l had diffe re nt the ore tical unde rpinnings , diffe re nt le ve ls of facilitator s kills and knowle dge , with corre s ponding diffe re nt le ve ls of re s ource re quire me nts in te rms of pre paration and s upport of facilitators and the ways in which the y work with individuals and te ams who are atte mpting to imple me nt re s e arch into practice . The s tudy’s s e cond aim was to e valuate the fe as ibility and
e ffe ctive ne s s of two diffe re nt mode ls of facilitation in promoting the uptake of re s e arch e vide nce on contine nce promotion.
In re s pe ct of the s e two aims , the findings s howe d that whils t both facilitation programme s we re broadly fe as ible , ne ithe r of the facilitation programme s (Type A te chnical and Type B e nabling) made a s tatis tically s ignificant diffe re nce to the primary outcome – docume nte d compliance with contine nce re comme ndations . Howe ve r, the y did re s ult in a s mall improve me nt in the docume ntation of le ve l of cognition, de pre s s ion and incontine nce as s ociate d de rmatitis , and s ome individual and home le ve l change s we re made . In addition the data re ve ale d a s trong country e ffe ct.
The s tudy provide d many ins ights that e xte nde d knowle dge of facilitation as a proce s s for trans lating re s e arch into practice and illuminate d why docume nte d compliance with contine nce re comme ndations did not s ignificantly improve . Linke d to this , the findings have als o improve d unde rs tanding of the impact of conte xtual factors on the proce s s e s and outcome s of imple me ntation, which me t the s tudy’s third aim.
(organis ational) le ve l would s e e m to be important, as it was barrie rs at all the s e le ve ls that impe de d the
imple me ntation of contine nce re comme ndations , and the facilitation programme as de s igne d in this s tudy, working via inte rnal facilitators , and primarily focus e d at the micro and the me s o le ve ls , was only able to partially ove rcome the s e barrie rs .
Individual characte ris tics that s e e me d to influe nce an inte rnal facilitators ’ capacity to e nact the ir role include d the ir e nthus ias m, cre dibility, ability to e ngage othe rs ’ ‘he arts and minds ,’ fe ar of failure , and le ve l of knowle dge . Howe ve r, the ir ability to function within the ir role s was influe nce d by more or le s s s upportive conte xts .
Ove rall, it s e e me d that the e ffe ct of facilitation was me diate d by conte xtual characte ris tics and inte rnal facilitator characte ris tics . The conte xt characte ris tics include d re s ource s , knowle dge and unde rs tanding of urinary incontine nce , availability of s taff, s tability of practice e nvironme nt, value s and be lie fs , s tarting point of the long te rm care s e tting, phys ical e nvironme nt, le ade rs hip s tyle and s upport. The inte rnal facilitator characte ris tics include d re s ilie nce , knowle dge and unde rs tanding, value s and be lie fs , s tarting point and pe rs onal and formal authority.
The re we re s ome as pe cts that appe are d important in re lation to the facilitation programme and how we ll its approach “fitte d” with both the inte rnal facilitator and the s tyle of the home . The e xte rnal facilitators trie d to tailor s upport as much as pos s ible to the individual IFs . Howe ve r, Type B facilitation in particular e nge nde re d for s ome a re action of e ithe r re ally “ge tting” the approach and running with it, or fe e ling “this is n’t for me ”. This s ort of re s pons e was not ide ntifie d in Type A facilitation. The us e of a randomis e d controlle d trial de s ign me ant that s e ttings we re randomly allocate d to e ithe r one of the two facilitation inte rve ntions or the control arm. The re was thus no pos s ibility of matching the conte xtual characte ris tics of s e ttings to a type of facilitation, although our unde rs tanding of how this might be unde rtake n would ne e d furthe r e xploration and te s ting.
Anothe r factor linke d to the facilitation programme was the mode of de live ry of the ongoing s upport. Although the initial re s ide ntial programme for the inte rnal facilitators was face to face , the ongoing s upport programme (12 months in Type A and 24 months in Type B) was provide d virtually, us ing te le confe re nce s and e mail. All four e xte rnal facilitators (two for Type A and two for Type B) we re ve ry e xpe rie nce d. Howe ve r, the virtual nature of the ongoing s upport was more challe nging than originally anticipate d, particularly for thos e inte rnal facilitators with Englis h as a s e cond language . One le s s on from this is that it is ve ry difficult to take part in a te le confe re nce in a s e cond language whe n you ne e d not only to unde rs tand, but to think and formulate your re s pons e in light of othe r contributions , and re s pond to challe nge from e xte rnal facilitators . For e xample , s ome IFs re porte d that by the time the y had formulate d a que s tion, the dis cus s ion had ofte n move d on. Thos e s ite s that utilis e d a critical companion, who could provide face to face he lp with language is s ue s , amongs t othe r things , re porte d this as ve ry pos itive . The e xte rnal facilitators als o re porte d the difficultie s of us ing virtual s upport.
Providing only face to face s upport from e xte rnal facilitators is cle arly much more labour inte ns ive , and is not like ly to be pos s ible whe n rolling out an imple me ntation of e vide nce bas e d re comme ndations acros s s e ttings . Howe ve r, this s tudy found local e xpe rt s upport can play a ke y role , and e xploring and te s ting how on-going s upport might be be s t ble nde d be twe e n local face to face s upport and more virtual s upport from e xte rnal e xpe rtis e is important. The s tudy als o highlighte d the limitations of us ing a virtual mode l of ongoing s upport.
This s tudy re ve ale d that a comple x inte rplay of conte xtual factors was crucial in de te rmining whe the r re comme ndations for urinary incontine nce we re imple me nte d in long te rm care s e ttings for olde r pe ople . It s e e me d conte xtual is s ue s we re particularly dominant and we re not always ove rcome by facilitation activitie s . The imple me ntation of the facilitation approache s appe are d to be me diate d by characte ris tics of both the s e tting and the inte rnal facilitator, by the le ve l of e ngage me nt of both the s ite and the inte rnal facilitator, and by prioritis ation of the FIRE s tudy by the long te rm care s e ttings participating in this s tudy.
This s tudy incre as e d our unde rs tanding of the e le me nts of the PARIHS mode l (e vide nce , facilitation and conte xt). In this s tudy, the role of e vide nce was unconte s te d. Staff acce pte d the e vide nce bas e d contine nce re comme ndations ,
s ugge s ting the y we re s e e n as high quality. Us ing a facilitation programme to e nable imple me ntation of contine nce re comme ndations re s ulte d in s ome change s , but not in the primary outcome . We could que s tion whe the r the primary outcome was the right one (the docume nte d compliance with the contine nce re comme ndation), howe ve r, it appe ars to be appropriate to look at compliance with re comme ndations if this is what is be ing imple me nte d. For Type B facilitation, s ome individuals and s ome s e ttings s e e me d to fe e l it was not the right approach for the m or the ir s e tting, while othe rs re ally took off with this approach. Since this was not appare nt in the Type A facilitation group, it may be that the
individual and s e tting ne e d to be more care fully matche d whe n us ing Type B facilitation, and Type A facilitation may have a wide r applicability acros s s e ttings . The re was no robus t e vide nce in the primary or s e condary outcome s which s ugge s te d that Type A or Type B facilitation re s ulte d in be tte r outcome s . The ans we r to “what is good e nough
facilitation?” is thus that e ithe r Type A or Type B could re s ult in s ome change s , but ne ithe r affe cte d the primary outcome of the s tudy.
Since the data s hows that both Type A and Type B groups did improve compare d to bas e line , one of the main e xplanations for the lack of a s ignificant diffe re nce in the primary outcome appe ars to be that the control groups als o improve d ove r time . It could be argue d that for the control s ite s , providing writte n e vide nce and an imple me ntation guide , and/or be ing part of a s tudy for two ye ars with s ix monthly data colle ction had an e ffe ct. Howe ve r, the qualitative data s ugge s te d that for mos t control groups , the y did not us e the writte n e vide nce and imple me ntation guide . Only one of the s ix control s ite s re porte d be ing prompte d to re vie w the ir practice and its docume ntation knowing the re s e arche r would be vis iting
So Type A and Type B inte rve ntions did have a s tatis tically s ignificant e ffe ct on docume ntation of s ome s e condary outcome s , a change not s e e n in the control group, although clinically this change was not large , and a s ubs tantial proportion of re s ide nts s till had no docume nte d as s e s s me nt of le ve l of cognitive impairme nt, de pre s s ion and incontine nce as s ociate d de rmatitis be twe e n bas e line and 24 months afte r the s tart of the facilitation inte rve ntion programme .
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Result In Brief
Contact
Pre we tt, Jane (De puty Dire ctor, Re s e arch Support Se rvice s ) Te l.: +44 24 76 522746
but the e le me nt with the mos t we ight appe are d to be conte xt. This is thus whe re gre ate r e ffort in te rms of e nabling change ne e ds to be focus e d. High quality e vide nce and high quality facilitation at a dis tance could not always ove rcome a challe nging conte xt. The role of the individual, re ce ntly adde d as an e le me nt of the PARIHS frame work (Rycroft-Malone e t al 2013) was s upporte d by this s tudy, be caus e imple me ntation of the facilitation approache s appe are d to be
me diate d by characte ris tics of the inte rnal facilitator.
Main dis s e mination s trate gy
The fourth aim of this s tudy was to imple me nt a pro-active dis s e mination s trate gy that comple me nts the de s ign of the s tudy and facilitate s the diffus ion of the s tudy findings to a wide policy and practice community throughout Europe and be yond.
Dis s e mination was planne d in paralle l to the de s ign and imple me ntation of the s tudy, re fle cting the the ory-drive n nature of the re s e arch and the importance of s take holde r involve me nt at all s tage s of the re s e arch proce s s .
The re are thre e main s trands to out dis s e mination activitie s : Firs t, dis s e mination at a range of national and inte rnational confe re nce s ; s e cond, publication and third, e ngage me nt of a varie ty of s take holde rs throughout the cours e of the s tudy. A s ummary of the s tudy, which has be e n trans late d into 8 language s , will e nable wide s pre ad inte rnational
dis s e mination.
1) Confe re nce dis s e mination – s e e te mplate A2 2) Publication lis t – s e e te mplate A1
3) Engage me nt of Stake holde rs
In line with the the ory drive n me thodology unde rpinning the s tudy, s take holde r e ngage me nt was unde rtake n to inform the de ve lopme nt and re fine me nt of the the ore tical propos itions that we re us e d to guide the proce s s e valuation. Thre e ke y s tage s of s take holde r e ngage me nt took place , at the s tart of the proje ct and at months 22 and 46. In the initial s tage of e ngage me nt, me mbe rs of the proje ct advis ory we re cons ulte d to s hape the high le ve l propos itions that unde rpinne d the s tudy de s ign. The re afte r, the two s ubs e que nt s take holde r e ngage me nt activitie s involve d inte ractive works hops with a wide r group of acade mics and practitione rs working in the fie ld of knowle dge mobilis ation in he alth care . The s e took place at an annual me e ting, the Knowle dge Utilis ation (KU) Colloquium, which is an inte rnational, invitational e ve nt. At month 22, a works hop on the FIRE proje ct was he ld at the KU11 me e ting in Be lfas t. This works hop was facilitate d by me mbe rs of the FIRE proje ct te am and was atte nde d by ove r 30 participants from countrie s including Swe de n, De nmark, UK, Canada and the US. A s ubs e que nt works hop at month 46 was he ld at the KU12 me e ting in Me lbourne , Aus tralia and was atte nde d by around 20 participants .
The re s e arch le ading to the s e re s ults has re ce ive d funding from the Europe an Union's Se ve nth Frame work Programme (FP7/2007-2013) unde r grant agre e me nt 223646
Re fe re nce s
Se e rs , K., Cox, K., Crichton, NJ., Tudor-Edwards , R., Eldh, A., Es tabrooks , CA., Harve y, G., re Hawke s , C., Kits on, A., Linck, P., McCarthy, G., McCormack, B., Mockford, C., Rycroft-Malone , J., Titche n, A., & Wallin, L., (2012) FIRE (Facilitating
Imple me ntation of Re s e arch Evide nce ): a s tudy protocol. Imple me ntation Scie nce 7: 25 doi:10.1186/1748-5908-7-25
http://www.imple me ntations cie nce .com/conte nt/7/1/25
DuBe au CE, Kuche l GA Johns on T Palme r MH Wagg A Committe e 11. Incontine nce in the frail e lde rly. In: Abrams P, Cardozo L, Khoury S & We in A (e ds ) . Incontine nce . 4th Inte rnational Cons ultation on Incontine nce . He alth Publications Limite d. 2009:961-1024 and1796-1789
http://www.ics office .org/Publications /ICI_4/book.pdf Acce s s e d 31/08/11
Titche n A (2003) Critical Companions hip: Part 1, Nurs ing Standard, 18 (9): 33-40
Lis t of We bs ite s :
Proje ct's co-ordinator : Profe s s or Kate Se e rs
Title and Organis ation: Profe s s or of He alth Re s e arch and Dire ctor, Royal Colle ge of Nurs ing Ins titute , Warwick Me dical School, Unive rs ity of Warwick, UK.
Te l: 00 44 (0)24 7615 0614, Fax: 00 44 (0)24 7615 0643 E-mail: kate .s e e rs @warwick.ac.uk
Proje ct we bs ite addre s s : http://www2.warwick.ac.uk/fac/me d/re s e arch/hs cie nce /rcn/re s e arch/the me c/fire proje ct/
Information s ource : SESAM
Last updat ed o n 2014-11-04
Fax: +44 24 76 574458
Subjects
He althcare de live ry/s e rvice s
Ret rieved o n 2016-09-29
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