Table 2 Characteristics of included studies

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

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

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

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

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

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

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