School of Nursing, University of Northern British Columbia, Prince George, British Columbia, Canada.
Health Research Institute, University of Northern British Columbia, Prince George, British Columbia, Canada.
Syst Rev. 2023 Mar 2;12(1):30. doi: 10.1186/s13643-023-02176-7.
An enduring challenge remains about how to effectively implement programs, services, or practices. Too often, implementation does not achieve its intended effectiveness, fidelity, and sustainability, even when frameworks or theories determine implementation strategies and actions. A different approach is needed. This scoping review joined two markedly different bodies of literature: implementation and hermeneutics. Implementation is usually depicted as focused, direct, and somewhat linear, while hermeneutics attends to the messiness of everyday experience and human interaction. Both, however, are concerned with practical solutions to real-life problems. The purpose of the scoping review was to summarize existing knowledge on how a hermeneutic approach has informed the process of implementing health programs, services, or practices.
We completed a scoping review by taking a Gadamerian hermeneutic approach to the JBI scoping review method. Following a pilot search, we searched eight health-related electronic databases using broadly stated terms such as implementation and hermeneutics. A diverse research team that included a patient and healthcare leader, working in pairs, independently screened titles/abstracts and full-text articles. Through the use of inclusion criteria and full-team dialogue, we selected the final articles and identified their characteristics, hermeneutic features, and implementation components.
Electronic searches resulted in 2871 unique studies. After full-text screening, we retained six articles that addressed both hermeneutics and implementing a program, service, or practice. The studies varied widely in location, topic, implementation strategies, and hermeneutic approach. All addressed assumptions underpinning implementation, the human dimensions of implementing, power differentials, and knowledge creation during implementation. All studies addressed issues foundational to implementing such as cross-cultural communication and surfacing and addressing tensions during processes of change. The studies showed how creating conceptual knowledge was a precursor to concrete, instrumental knowledge for action and behavioral change. Finally, each study demonstrated how the hermeneutic process of the fusion of horizons created new understandings needed for implementation.
Hermeneutics and implementation have rarely been combined. The studies reveal important features that can contribute to implementation success. Implementers and implementation research may benefit from understanding, articulating, and communicating hermeneutic approaches that foster the relational and contextual foundations necessary for successful implementation.
The protocol was registered at the Centre for Open Science on September 10, 2019. MacLeod M, Snadden D, McCaffrey G, Zimmer L, Wilson E, Graham I, et al. A hermeneutic approach to advancing implementation science: a scoping review protocol 2019. Accessed at osf.io/eac37.
如何有效地实施项目、服务或实践仍然是一个持久的挑战。即使框架或理论确定了实施策略和行动，实施也常常无法达到预期的有效性、保真度和可持续性。需要采取一种不同的方法。本次范围界定综述将两种截然不同的文献结合在一起：实施和解释学。实施通常被描绘为专注、直接且有些线性的，而解释学则关注日常经验和人际互动的复杂性。然而，两者都关注解决现实生活问题的实际解决方案。本次范围界定综述的目的是总结有关解释学方法如何为健康项目、服务或实践的实施过程提供信息的现有知识。
我们采用伽达默尔解释学方法对 JBI 范围界定综述方法进行了范围界定综述。在进行试点搜索后，我们使用了广泛的术语，如实施和解释学，在八个与健康相关的电子数据库中进行了搜索。一个包括患者和医疗保健领导者的多元化研究团队，以两人一组的形式独立筛选标题/摘要和全文文章。通过使用纳入标准和全团队对话，我们选择了最终的文章，并确定了它们的特征、解释学特征和实施组成部分。
电子搜索产生了 2871 个独特的研究。经过全文筛选，我们保留了六篇既涉及解释学又涉及实施项目、服务或实践的文章。这些研究在地点、主题、实施策略和解释学方法上差异很大。所有研究都涉及到实施背后的假设、实施中的人类维度、权力差异以及实施过程中的知识创造。所有研究都解决了实施的基础问题，例如跨文化交流以及在变革过程中发现和解决紧张关系。这些研究表明，如何创建概念性知识是为行动和行为改变创建具体、工具性知识的前提。最后，每项研究都表明，融合视野的解释学过程如何为实施创造新的理解。
解释学和实施很少结合在一起。这些研究揭示了有助于实施成功的重要特征。实施者和实施研究可能受益于理解、阐明和沟通促进成功实施所需的关系和背景基础的解释学方法。
该方案于 2019 年 9 月 10 日在开放科学中心注册。MacLeod M, Snadden D, McCaffrey G, Zimmer L, Wilson E, Graham I, et al. A hermeneutic approach to advancing implementation science: a scoping review protocol 2019. Accessed at osf.io/eac37.
