Table 4.

Overview of Key Features of Metanarratives.

Metanarrative	Disciplinary and Philosophical roots	Definition and Scope of Implementation	General Format of Review Questions	Implementation Conceptualised as…	End-users/Beneficiaries Conceptualised as	Implementation Context conceptualised as…
1. Implementation should be Informed by Theoretical Constructs	Cognitive, ecological, socio-cultural, communication, change, adult learning and improvement theories. Social diffusion theory, organizational theory. Interpretivist, critical and recursive roots.	Necessitates the exploration of theoretical constructs embedded in healthcare to uncover the multiple factors that influence professional practice.	What theory base or constructs underpin implementation and how can they be used to guide all of its phases?	Seeks an understanding of evidence use through theory-based reasoning and decisions.	Researchers, health system decision-makers, and health care providers. Scarce mention of consumers.	Is complex and is a potent influence on how a theory may operate within a particular project or programme.
2. The Relationships Between Theoretical Constructs and the Ways in Which they Impact Implementation	Social diffusion theory and organizational theory. Quality and safety. Based on positivist, interpretive, critical and recursive research.	Consists of multiple layers, intersections, and interdependent elements that create complex adaptive system that typifies healthcare.	What are the influences, measures, and outcome aspirations that may predict success (or failure)?	Captures the factors impacting on achievement, accomplishment and execution of translating research findings effectively and rapidly into policy and practice.	Researchers, health system decision-makers, and health care providers. Scarce mention of consumers.	The context, the nature of innovation/s, and the capacity to sustain are interacting dynamics of a complex and unstable phenomenon.
3. Developing New frameworks from Theories, Constructs and Key Factors	Psychology, sociology, biomedical science, public health, sociology, business and management studies. Primarily positivist roots with pragmatist and interpretivist influences.	Implementation is to be understandable and usable for a broad audience aided by simplifying complexity, specifying relationships, for use in various contexts.	What are the key factors influencing implementation processes and outcomes, and how do they relate to one another?	A collection of activities designed to alter the behaviour of health care providers, under the influence of a variety of contextual factors.	Researchers, health system decision-makers, and health care providers.	Context exists within and outside an organization and fundamentally influences implementation.
4. Applying Existing Frameworks in Many Ways	Primarily positivist approaches, some interpretivist influence.	Implementation is a process through which knowledge/evidence is disseminated and adopted into practice.	How are implementation frameworks being used and to what effect?	A process which occurs within a particular context involving barriers and facilitators.	Researchers and individuals seeking to disseminate knowledge.	Related to the type of evidence/intervention being implemented, and micro, meso and macro level factors that can support or hinder implementation.
5. Evaluating Effectiveness of Interventions within Frameworks/Models	Psychology, sociology, biomedical science, public health, sociology, business and management studies. Positivist research base.	Implementation involves what works. Efficacy and safety are paramount. Change is more likely if strategies address contextual barriers and enablers.	What are the most effective ways to improve health care practice and health outcomes?	Use of research evidence involves employing strategies to implement improvements in patient care.	Researchers, health system decision-makers, and health care providers and ultimately patients when health outcomes are improved.	Context determines important factors and directs the approaches used to select interventions.