“Horses for Courses”; Comment on “Translating Evidence Into Healthcare Policy and Practice: Single Versus Multi-Faceted Implementation Strategies – Is There a Simple Answer to a Complex Question?”

Document Type : Commentary


1 School of Health Sciences, University of Stirling, Stirling Scotland, UK

2 Nursing, Midwifery and Allied Health Professionals Research Unit, School of Health Sciences, University of Stirling, Stirling Scotland, UK


This commentary considers the vexed question of whether or not we should be spending time and resources on using multifaceted interventions to undertake implementation of evidence in healthcare. A review of systematic reviews has suggested that simple interventions may be just as effective as those taking a multifaceted approach. Taking cognisance of the Promoting Action on Research Implementation in Health Services (PARIHS) framework this commentary takes account of the evidence, context and facilitation factors in undertaking implementation. It concludes that a ‘horses for courses’ approach is necessary meaning that the specific implementation approach should be selected to fit the implementation task in hand whether it be a single or multifaceted approach and reviewed on an individual basis.


Main Subjects

  1. Pettigrew AM. The Awakening Giant: Continuity and Change in Imperial Chemical Industries. Chichester: Wiley Blackwell; 1985.
  2. Harvey G, Kitson A. Translating evidence into healthcare policy and practice: Single versus multi-faceted implementation strategies – is there a simple answer to a complex question? Int J Health Policy Manag. 2015;4:123-126. doi:10.15171/ijhpm.2015.54
  3. Squires J, Sullivan K, Eccles M, Worswick J, Grimshaw J. Are multifaceted  interventions more effective than single- component interventions in changing health-care professionals’ behaviours? Implement Sci. 2014; 9:152. doi:10.1186/s13012-014-0152-6
  4. Hoffmann TC, Glasziou PP, Boutron I, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ. 2014;348:g1687. doi:10.1136/bmj.g1687
  5. Petticrew M. Time to rethink the systematic review catechism? Moving from 'what works' to 'what happens'. Syst Rev. 2015;4:36. doi:10.1186/s13643-015-0027-1
  6. Nilsen P. Making sense of implementation theories, models and frameworks. Implement Sci. 2015;10:53. doi:10.1186/s13012-015-0242-0
  7. Davidoff F, Dixon-Woods M, Leviton L, et al. Demystifying theory and its use in improvement. BMJ Qual Saf. 2015;24(3):228-238. doi:10.1136/bmjqs-2014-003627
  8. Kitson A, Harvey G, McCormack B. Enabling the implementation of evidence based practice: a conceptual framework. Qual Health Care. 1998;7:149-159.
  9. Rycroft-Malone J, Kitson A, Harvey G, et al. Ingredients for change: revisiting a conceptual framework. Qual  Saf Healthcare. 2002;11:174-180.
  10. Kitson A, Rycroft-Malone J, Harvey G, McCormack B, Seers K, Titchen A. Evaluating the successful implementation of evidence into practice using the PARIHS framework: theoretical and practical challenges. Implement Sci. 2008;3:1. doi:10.1186/1748-5908-3-1
  11. Harvey G, Loftus-Hills A, Rycroft-Malone J, et al. Getting evidence into practice: the role and function of facilitation. J Adv Nurs. 2002;37:577-588.
  12. Bate P. Perspectives on Context: Context Is Everything. London: The Health Foundation; 2014
  13. Carlile PR. A pragmatic view of knowledge and boundaries: boundary objects in new product development. Organ Sci 2002;13:442-455. doi:10.1287/orsc.13.4.442.2953
  14. Ward V, Smith S, House A, Hamer S. Exploring knowledge exchange: A useful framework for policy and practice. Soc Sci Med. 2012;74(3):297-304.