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Implement Sci. 2018 Nov 16;13(1):137. doi: 10.1186/s13012-018-0831-9.

Facilitating Implementation of Research Evidence (FIRE): an international cluster randomised controlled trial to evaluate two models of facilitation informed by the Promoting Action on Research Implementation in Health Services (PARIHS) framework.

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Warwick Research in Nursing, Warwick Medical School, University of Warwick, Coventry, UK.
School of Health Care Sciences, Bangor University, Bangor, UK.
Fontys School of People and Health Studies, Fontys University of Applied Sciences, Eindhoven, The Netherlands.
School of Health and Social Care, London South Bank University, 103 Borough Road, London, SE1 0AA, UK.
Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, Bangor, UK.
Faculty of Medicine and Health Science, Department of Nursing, Linkoping University, Linkoping, Sweden.
Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.
Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
Adelaide Nursing School, University of Adelaide, Adelaide, Australia.
Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK.
College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.
Division of Nursing, Queen Margaret University, Edinburgh, UK.
Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
Warwick Medical School, University of Warwick, Coventry, UK.
Institute of Nursing and Health Research, Ulster University, Shore Rd, Belfast, Northern Ireland.
School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.



Health care practice needs to be underpinned by high quality research evidence, so that the best possible care can be delivered. However, evidence from research is not always utilised in practice. This study used the Promoting Action on Research Implementation in Health Services (PARIHS) framework as its theoretical underpinning to test whether two different approaches to facilitating implementation could affect the use of research evidence in practice.


A pragmatic clustered randomised controlled trial with embedded process and economic evaluation was used. The study took place in four European countries across 24 long-term nursing care sites, for people aged 60 years or more with documented urinary incontinence. In each country, sites were randomly allocated to standard dissemination, or one of two different types of facilitation. The primary outcome was the documented percentage compliance with the continence recommendations, assessed at baseline, then at 6, 12, 18, and 24 months after the intervention. Data were analysed using STATA15, multi-level mixed-effects linear regression models were fitted to scores for compliance with the continence recommendations, adjusting for clustering.


Quantitative data were obtained from reviews of 2313 records. There were no significant differences in the primary outcome (documented compliance with continence recommendations) between study arms and all study arms improved over time.


This was the first cross European randomised controlled trial with embedded process evaluation that sought to test different methods of facilitation. There were no statistically significant differences in compliance with continence recommendations between the groups. It was not possible to identify whether different types and "doses" of facilitation were influential within very diverse contextual conditions. The process evaluation (Rycroft-Malone et al., Implementation Science. doi: 10.1186/s13012-018-0811-0) revealed the models of facilitation used were limited in their ability to overcome the influence of contextual factors.


Current Controlled Trials ISRCTN11598502 . Date 4/2/10. The research leading to these results has received funding from the European Union's Seventh Framework Programme (FP7/2007-2013) under grant agreement no. 223646.


Context; Facilitation; Implementation; Older people; PARIHS; RCT; Urinary incontinence

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