Table 1.

Framework components

Evidence—what is included in the evidence base of practice, and in the evidence base of the continence care recommendations, which has the potential to influence how care is delivered
Practice recommendations, including their sharing and dissemination (through standard dissemination intervention)
Practitioner experience
Resident experience of continence care
Local data/information about continence care/practice (including supplies)
Context—factors that may interact to mediate intervention implementation and the response of recipients
Organisation and infrastructure of homes	How care and service delivery is organised
	Type of home ownership
Culture and philosophy of the home	How leaders and managers create particular environments
	Orientation to learning
	How staff are valued
	Attitudes and approach to residents
	Relationships and connections between people
Macro context	Political factors—health policy, legislation
	Economic factors
	Societal, e.g. attitudes to older people
	Education systems
	Relationships with industry (continence products)
	Difference in systems across countries
Facilitation	Underpinning theories of action
Type A	• Quality improvement, organisational learning, and humanistic psychology—how individuals learn and apply that knowledge to improvement activities. • Within the PARIHS framework type A represents an approach to facilitation towards the left of the facilitation continuum [21].
Type B	• Critical social sciences, focussed on enlightenment, empowerment and emancipation—that enable individuals to develop new understandings about what needs to be changed and how to change it, including (1) understanding, (2) choosing and development appropriate strategies, (3) doing and (4) evaluation. • Within the PARIHS framework, type B represents an approach to facilitation towards the right of the facilitation continuum [21].
Internal–external facilitation	The chain of action between internal (IF) and external facilitators (EF)
Buddy	Relationship and dynamic between internal facilitator and buddy
Facilitator characteristics	Experience, knowledge and engagement of individual facilitators
Potential impacts	• Including anticipated and unanticipated, and reach and potential spread • Changes to continence practice - Improved assessment - Appropriate use of products - Revised continence local policy - Introduction of new practices and activities • Positive impact on residents’ and next of kin experiences • Positive impact on practitioners’ experiences, attitudes and learning • Positive impact on internal facilitators’ skills, confidence, experience, knowledge (and values with respect to type B) • Potentially positive impact on care home context (type B)