Table 2.
Characteristics of included studies
| Authors, date, country, setting | Study aim | Sample (N) | Guiding framework | Design, data collection method | Main findings | MMAT Quality score (0–100) |
|---|---|---|---|---|---|---|
| Abdekoda et al. (2015) Iran University-affiliated hospitals |
To determine organizational contextual factors that may affect physicians’ acceptance of electronic medical record’s (EMR) adoption | Physicians (general practitioners, specialists, clinical fellows) (330) | Technology acceptance model | Quantitative; cross-sectional surveys | Organizational contextual factors are main determinants in leading physicians’ attitude toward EMRs adoption | 100 |
| Barnett et al. (2011) UK Primary and secondary healthcare organizations |
To explore how healthcare innovators of process-based initiatives perceived factors that promoted or hindered innovation implementation and diffusion | Representatives of organizations who were winners of innovation in healthcare award (15) | None | Qualitative; semi-structured interviews | Inter-organizational partnerships human resources (champions) were integral in developing, establishing and diffusing the innovations | 75 |
| Bergstrom et al. (2012) Uganda Health centers that provide obstetric services |
To examine relevance of organizational context from PARiHS, and whether other factors organizational context was perceived to influence implementation strategies for low-incoming settings from the perspectives of midwives and managers | Nurses, midwives, physicians (23) | PARiHS | Qualitative; semi-structured interviews and focus groups | Receptive context, culture, leadership, access to resources, community and evaluation—are relevant to influencing implementation efforts | 75 |
| Berta et al. (2010) Canada Long-term care settings |
To enhance understanding of what enables or impedes a health care organization when applying new knowledge intended to improve care in long-term care (LTC) | Administrative staff, clinical staff (63) | Organizational learning theory | Qualitative; semi-structured interviews and focus groups | Organizational contextual elements essential for successful knowledge application. Leaders vital in the success of knowledge application processes | 75 |
| Carljford et al. (2010) Sweden Primary healthcare units |
To identify key factors influencing the adoption of an innovation being introduced in primary healthcare units in Sweden | General practitioners, nurses, nursing assistants, dietitians, welfare officers, occupational therapists (67) | Rogers’ diffusion of innovations | Qualitative; focus groups | Adoption positively influenced by perceptions of the innovation being compatible with existing routines and norms. Organizational changes and staff shortages can be obstacles for adoption process | 75 |
| Chuang et al. (2011) USA Various healthcare organizations |
To better understand the organizational and relational factors that influence middle managers’ support for the innovation implementation process | Middle managers across various healthcare organizations (92) | Organizational framework of innovation implementation | Qualitative; semi-structured interviews and focus groups | There is interplay between middle managers’ control and discretion, and the dedication of staff and other resources for empowering managers to implement the complex innovation | 75 |
| Cummings et al. (2010) Canada Hospitals |
To elicit pediatric and neonatal healthcare professionals’ perceptions of the organizational context in which they work and their use of research to inform practice | Registered nurses (RN), nurse practitioners (NP), graduate nurses (GN) (248) | PARiHS | Quantitative; cross-sectional surveys | Nurses in contexts with more positive culture, leadership, and evaluation reported more research utilization than nurses in less positive contexts | 100 |
| Doran et al. (2012) Canada Hospitals, long-term care (LTC) facilities, and community organizations |
To investigate the role of organizational context and nurse characteristics in explaining variation in nurses’ use of personal digital assistants (PDAs) and mobile Tablet PCs for accessing evidence-based information | RN, NP in long-term care (469) | PARiHS | Quantitative; cross-sectional surveys | Frequency of best practice guideline use was explained by resources, organizational time, staffing. Frequency of Nursing Plus database use explained by culture, resources, breadth of device functions | 100 |
| Estabrooks et al. (2007) Canada and USA US army hospitals, Canadian hospital healthcare settings |
To compare research utilization in two different healthcare contexts—Canadian civilian and US Army settings. | RN, NP, nurse managers (1750) | None | Mixed methods; self-report surveys, interviews, observational study | Predictors in the US Army setting for research use: trust and years of experience; and Canadian civilian setting: in-service attendance, time (organizational), champion, library access | 75 |
| Estabrooks et al. (2008) Canada Acute care hospitals |
To examine the determinants of research use among nurses working in acute care hospitals, with an emphasis on identifying contextual determinants of research use | RN, NP (235) | Rogers’ diffusion of innovations | Quantitative; cross-sectional surveys | Units with highest mean research utilization scores clustered on unit culture, importance of continuing education, environmental complexity. Lowest research use scores clustered on high workload and lack of people support | 75 |
| Estabrooks et al. (2015) Canada Nursing homes |
To investigate the influence of individual and organization context factors on use of best practices by care aides in nursing homes in the Canadian prairie provinces | Nursing home facilitators, home care aides, managers (1282) | None | Quantitative; cross-sectional surveys | Significant predictors were evaluation (feedback mechanisms), structural resources, and organizational slack (time) for best practice use by care aides | 100 |
| Green et al. (2017) England Acute medical units |
To investigate the implementation of two distinct care bundles in the acute medical setting and identify the factors that supported successful implementation | CFIR | Qualitative; review of recorded meeting minutes and audio recordings of meetings | Resources to support initiatives (incl. training), perceived sustainability of changes, senior leadership support was seen as critical | 75 | |
| Harris et al. (2013) USA Outpatient medical clinics |
To explore the organization contextual factors that were important for implementation of a short message system (SMS)-based intervention for persons living with Human Immunodeficiency Virus (HIV) | Providers, study coordinator, patients (14) | Weiner et al.’s [81] conceptual model of process evaluation | Qualitative; in-depth interviews | Leadership and resources important in implementing SMS based intervention | 75 |
| Harvey et al. (2015) UK Health service organizations |
To extend and develop an understanding of how organizational context affects the implementation and effectiveness of improvement in healthcare organizations | Middle-level and senior-level managers in hospitals (22) | Absorptive Capacity Framework | Qualitative; semi-structured interviews | Strategic priorities, communication resources on learning, collaboration with external stakeholders and make use of available knowledge important for implementation success. | 50 |
| Hofstede et al. (2013) Netherlands General hospitals, medical centers, private clinics |
To explore and categorize all barriers and facilitators associated with the implementation of shared decision making in sciatica care from the perspectives of healthcare providers and patients | Physical therapists, surgeons, general practitioners, neurologists (62) | Grol and Wensing’s [82] model | Qualitative; semi-structured interviews and focus groups | Lack of time, high workload, lack of trust, and communication issues were barriers to implementation | 50 |
| Koehn et al. (2008) USA Large, urban medical center |
To investigate registered nurses’ perceptions, attitudes and knowledge/skills associated with evidence-based practice | RN, NP (422) | None | Quantitative; cross-sectional surveys | Lack of time, leadership buy-in, and resources as main barriers. Implementing culture of EBP important to moderate staff attitudes on EBP uptake | 75 |
| Krein et al. (2010) USA Hospitals |
To examine quality improvement efforts and the implementation of recommended practices to prevent central line-associated bloodstream infections (CLABSI) in US hospitals | Epidemiologists, nurses, physician directors, front-line clinicians (86) | Rogers’ diffusion of innovations | Qualitative; semi-structured interviews | Type of cultural, emotional and political context greatly affect implementation. Collaboration, leadership and resources play key role in uptake | 75 |
| Livet et al. (2008) USA Mental health centers |
To examine the organizational-level mechanisms that are part of the Prevention Delivery System and their influence on implementation of comprehensive programming frameworks aimed to help practitioners plan, implement, evaluate and sustain their interventions | Board and provider agency representatives (32) | None | Quantitative; cross-sectional surveys and interviews (coded and quantified) | Leadership, shared vision, champions, technical assistance (resources) were common correlates of use across programming processes | 100 |
| Lodge et al. (2016) USA State hospitals, community centers |
To identify barriers to implementing a person-centered recovery planning system for mental health patients. | Leadership, case managers, rehabilitation specialists, social workers, psychologists, coordinators (71) | CFIR | Qualitative; focus groups | Lack of time and resources (incl. training), lack of staff buy-in, non-collaborative planning, leadership barriers, dissemination barriers related to implementation failure | 50 |
| Marchionni et al. (2008) Canada Inpatient units in a large healthcare center |
To examine what contextual factors support the implementation of best practice guidelines (BPG) in nursing care | RN, NP (20) | None | Quantitative; pre and post design surveys | Supportive organizational culture and key people leading change important for implementing BPG | 75 |
| McCullough et al. (2015) USA Anticoagulation clinics |
To identify the interconnected patterns among contextual elements that influence uptake of an anticoagulation clinic improvement initiative | Pharmacy administrators, pharmacists, nurses, support staff (51) | PARiHS | Qualitative; semi-structured interviews, ethnographic observations | Leadership, teamwork and communication interacted with each other, often yielding results that could not be predicted by looking at just one factor alone | 75 |
| Olstad et al. (2011) Canada Recreational facilities |
To investigate the awareness, adoption and implementation of a nutritional guideline for children among recreational facilities | Mayors, councilors, middle-level managers (151) | Greenhalgh’s multi-tiered model of diffusion of complex innovations, Prochaska and Velicer’s transtheoretical model of change | Mixed methods; cross-sectional survey with open- and close-ended questions | Inner context, negative feedback received during the implementation process, managers’ belief that implementing nutrition guidelines would limit profit were key barriers to uptake | 50 |
| Omer et al. (2012) Saudi Arabia Large hospitals |
To explore barriers to and facilitators of research finding utilization in nursing practice | Nurses, nursing managers (413) | None | Quantitative; cross-sectional surveys | Communication, adopter, and innovation factors; lack of time, lack of authority, lack of physician cooperation, lack of EBP-related education are barriers to research use | 100 |
| Ozdemir and Akdemir (2009) Turkey Inpatient clinics in hospitals |
To identify the factors that the nurses believe are essential for evidence to become the basis of their practice and the obstacles to research utilization | RN, NP (219) | None | Quantitative; cross-sectional surveys | Older and highly experienced nurses likely to implement evidence into practice; research use related to organizational support | 75 |
| Powell et al. (2009) UK Acute care hospitals |
To explore organizational difficulties during the implementation of national policy recommendations in local contexts. | Anesthetists, surgeons, nurses, managers (71) | None | Qualitative; case-study; semi-structured interviews | Networks, financial resources, time and training affected local uptake of national policy recommendations | 75 |
| Riekerk et al. (2009) Netherlands Intensive care unit in a teaching hospital |
To implement a delirium screening instrument into daily critical care, to assess the obstacles to its implementation. | Physicians, nurses (53) | None | Quantitative; pre-post surveys | Communication, staffing and training emerged as important elements for implementation | 50 |
| Sommerbakk et al. (2016) Norway Local medical centers (primary care services that offer short-term in-patient care) |
To determine the barriers and facilitators for implementing improvements in PC have been experienced by health care providers | Physicians, nurses, managers (20) | Grol and Wensing’s (2004) model | Qualitative; semi-structured interviews and focus groups | Barriers and facilitators were connected to: credibility, advantage, accessibility of innovation; individual motivation, PC expertise, confidence; patient compliance; leadership, culture, communication, resources, expertise, policy, finance, training, reminders | 75 |
| Squires et al. (2013) Canada Medical, surgical, critical care units in pediatric hospitals |
To identify dimensions of organizational context and individual (nurse) characteristics that influence pediatric nurses’ self-reported use of research | RN, NP (735) | None | Mixed methods; semi-structured interviews, non-participant observation, document analysis, cross-sectional survey | Predictors of conceptual research use: belief suspension-implement, problem solving ability, use of research in the past, leadership, culture, evaluation, formal interactions, informal interactions, organizational slack-space, and unit specialty | 100 |
| Stevens et al. (2014) Canada Pediatric hospitals |
To determine the effectiveness of the KT strategies implemented in relation to unit aims; describe KT strategies implemented and their influence on pain assessment and management practices across unit types; identify facilitators and barriers to the implementation of KT strategies | Pediatric hospital units (16) | None | Mixed methods; chart review; process evaluation checklist (analyzed with qualitative content analysis) | Unit leadership, staff engagement, dedicated time and resources facilitated effective implementation of KT strategies. | 75 |
| Thomas et al. (2011) UK National health service organizations |
To identify organizational factors facilitating research-based practice in allied health profession departments. | Clinicians and operational managers (58) | None | Qualitative; semi-structured interviews | Staff development, communication, resources and infrastructure, evaluation and feedback facilitated research use | |
| Urquhart et al. (2014) Canada Women’s and children’s hospital |
To examine the key interpersonal, organizational, and system level factors that influenced the implementation and use of synoptic reporting tools in three specific areas of cancer care | Radiologists, endoscopists, surgeons (53) | PARiHS, organizational framework of innovation implementation (Helfrich et al. [83]) | Qualitative; semi-structured interviews, document analysis, non-participant observation | Stakeholder involvement, communication, training and support, champions and respected colleagues, administrative and managerial support, and innovation attributes influential to implementation initiative | 75 |
| Vamos et al. (2017) USA Hospitals |
To explore the multilevel contextual factors that influenced the implementation of the Obstetric Hemorrhage Initiative (OHI) among hospitals | Multidisciplinary hospital staff (50) | CFIR | Qualitative; individual in-depth interviews | Leadership engagement; engaging people; planning; reflecting, inner staff knowledge/beliefs; resources; communication; culture. Leadership and staff buy-in emerged as important components influencing OHI implementation across disciplines | 75 |
| Whitley et al. (2009) USA Mental health centers |
To examine which factors promote or hinder successful implementation of illness management and recovery in these settings | Mental health centers (12) | None | Mixed methods; semi-structured interviews, field notes, cross-sectional surveys | Leadership, culture, training, staff and supervision meaningfully determined implementation success/failure. These themes worked synergistically to effect implementation | 75 |
| Wright et al. (2007) UK Rehabilitation units |
To identify the contextual indictors that enable or hinder effective evidence based continence care in rehabilitation settings for older people | Medical staff, nursing leaders, nursing staff (123) | PARiHS | Mixed methods; self-reported surveys, semi-structured observation of practice | Leadership, evaluation and culture barriers led to poor uptake | 75 |
| Yamada et al. (2017) Canada Pediatric hospitals |
To assess how organizational context moderates the effect of research use and pain outcomes in hospitalized children. | RN, NP (779) | None | Quantitative; cross-sectional surveys | Culture, social capital, informal interactions, resources, organizational slack significantly moderated the effect of instrumental research use on pain assessment; culture, social capital, resources and organizational slack time moderated the effect of conceptual research use and pain assessment | 100 |
| Zazzali et al. (2008) USA Mental health service organizations |
To explain the adoption and implementation of FFT in a small sample of family and child mental health services organizations | Administrators (15) | None | Qualitative; semi-structured interviews | Resource, organizational structure and culture influenced the ease with which treatment program was implemented | 75 |
Note: MMAT scores vary from 25% (one criterion met) to 100% (all criteria met). For qualitative and quantitative studies, this score is the number of criteria met divided by four. For mixed methods studies, the overall quality score is the lowest score of the quantitative and qualitative study component