Dagens FSV-oversigt: A realist review of interventions and strategies to promote evidence-informed healthcare: a focus on change agency.

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Date: Sat, 27 Sep 2014 10:31:41 -0000
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Dagens #fsvoversigt:

A realist review of interventions and strategies to promote evidence-informed 
healthcare: a focus on change agency.

Implement Sci. 2013;8:107

Authors: McCormack B, Rycroft-Malone J, Decorby K, Hutchinson AM, Bucknall T, 
Kent B, Schultz A, Snelgrove-Clarke E, Stetler C, Titler M, Wallin L, Wilson V

Abstract

BACKGROUND: Change agency in its various forms is one intervention aimed at 
improving the effectiveness of the uptake of evidence. Facilitators, knowledge 
brokers and opinion leaders are examples of change agency strategies used to 
promote knowledge utilization. This review adopts a realist approach and 
addresses the following question: What change agency characteristics work, for 
whom do they work, in what circumstances and why?

METHODS: The literature reviewed spanned the period 1997-2007. Change agency 
was operationalized as roles that are aimed at effecting successful change in 
individuals and organizations. A theoretical framework, developed through 
stakeholder consultation formed the basis for a search for relevant literature. 
Team members, working in sub groups, independently themed the data and 
developed chains of inference to form a series of hypotheses regarding change 
agency and the role of change agency in knowledge use.

RESULTS: 24, 478 electronic references were initially returned from search 
strategies. Preliminary screening of the article titles reduced the list of 
potentially relevant papers to 196. A review of full document versions of 
potentially relevant papers resulted in a final list of 52 papers. The findings 
add to the knowledge of change agency as they raise issues pertaining to how 
change agents' function, how individual change agent characteristics effect 
evidence-informed health care, the influence of interaction between the change 
agent and the setting and the overall effect of change agency on knowledge 
utilization. Particular issues are raised such as how accessibility of the 
change agent, their cultural compatibility and their attitude mediate overall 
effectiveness. Findings also indicate the importance of promoting reflection on 
practice and role modeling. The findings of this study are limited by the 
complexity and diversity of the change agency literature, poor indexing
  of literature and a lack of theory-driven approaches.

CONCLUSION: This is the first realist review of change agency. Though 
effectiveness evidence is weak, change agent roles are evolving, as is the 
literature, which requires more detailed description of interventions, outcomes 
measures, the context, intensity, and levels at which interventions are 
implemented in order to understand how change agent interventions effect 
evidence-informed health care.

PMID: 24010732 [PubMed - indexed for MEDLINE]

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Dette abstract er hentet via PubMed fra National Library of Medicine, USA 
(http://www.ncbi.nlm.nih.gov/About/disclaimer.html).
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Dagens FSV-oversigt: A realist review of interventions and strategies to promote evidence-informed healthcare: a focus on change agency.

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