What is Known About the Role of External Facilitators During the Implementation of Complex Interventions in Healthcare Settings? A Scoping Review

Overview

Journal BMJ Open

Specialty General Medicine

Date 2024 Jul 1

PMID 38951001

Authors

Ariane Girard

Amelie Doucet

Mireille Lambert

Sarah Ouadfel

Geneve Caron

Catherine Hudon

Affiliations

Soon will be listed here.

Abstract

Objective: To synthesise current knowledge about the role of external facilitators as an individual role during the implementation of complex interventions in healthcare settings.

Design: A scoping review was conducted. We reviewed original studies (between 2000 and 2023) about implementing an evidence-based complex intervention in a healthcare setting using external facilitators to support the implementation process. An information specialist used the following databases for the search strategy: MEDLINE, CINAHL, APA PsycINFO, Academic Search Complete, EMBASE (Scopus), Business Source Complete and SocINDEX.

Results: 36 reports were included for analysis, including 34 different complex interventions. We performed a mixed thematic analysis to synthesise the data. We identified two primary external facilitator roles: lead facilitator and process expert facilitator. Process expert external facilitators have specific responsibilities according to their role and expertise in supporting three main processes: clinical, change management and knowledge/research management.

Conclusions: Future research should study processes supported by external facilitators and their relationship with facilitation strategies and implementation outcomes. Future systematic or realist reviews may also focus on outcomes and the effectiveness of external facilitation.

Citing Articles

Barriers and Facilitators-Lessons Learned From a Randomised Trial to Implement Clinical Practice Guidelines for the Prevention of Coercion in Psychiatry.

Jaeger S, Kampmann M, Baumgardt J, Bechdolf A, Buhling-Schindowski F, Cole C Int J Ment Health Nurs. 2025; 34(1):e70011.

PMID: 39952793 PMC: 11828726. DOI: 10.1111/inm.70011.

References

Diffin J, Ewing G, Harvey G, Grande G . Facilitating successful implementation of a person-centred intervention to support family carers within palliative care: a qualitative study of the Carer Support Needs Assessment Tool (CSNAT) intervention. BMC Palliat Care. 2018; 17(1):129. PMC: 6302509. DOI: 10.1186/s12904-018-0382-5. View

Craven K, Holmes J, Powers K, Clarke S, Cripps R, Lindley R . Embedding mentoring to support trial processes and implementation fidelity in a randomised controlled trial of vocational rehabilitation for stroke survivors. BMC Med Res Methodol. 2021; 21(1):203. PMC: 8487447. DOI: 10.1186/s12874-021-01382-y. View

Kelley R, Griffiths A, Shoesmith E, McDermid J, Couch E, Robinson O . The influence of care home managers on the implementation of a complex intervention: findings from the process evaluation of a randomised controlled trial of dementia care mapping. BMC Geriatr. 2020; 20(1):303. PMC: 7446218. DOI: 10.1186/s12877-020-01706-5. View

Clarke D, Godfrey M, Hawkins R, Sadler E, Harding G, Forster A . Implementing a training intervention to support caregivers after stroke: a process evaluation examining the initiation and embedding of programme change. Implement Sci. 2013; 8:96. PMC: 3765868. DOI: 10.1186/1748-5908-8-96. View

Bird M, Mortenson W, Eng J . Evaluation and facilitation of intervention fidelity in community exercise programs through an adaptation of the TIDier framework. BMC Health Serv Res. 2020; 20(1):68. PMC: 6993417. DOI: 10.1186/s12913-020-4919-y. View

Chlan L, Ridgeway J, Tofthagen C, Hamann B, Mele K, Dozois D . Iterative development and pilot testing of an intervention fidelity monitoring plan for the enhanced, electronic health record-facilitated pragmatic clinical trial: Implications for training and protocol integrity. Contemp Clin Trials Commun. 2021; 24:100868. PMC: 8617340. DOI: 10.1016/j.conctc.2021.100868. View

Porcheret M, Main C, Croft P, McKinley R, Hassell A, Dziedzic K . Development of a behaviour change intervention: a case study on the practical application of theory. Implement Sci. 2014; 9(1):42. PMC: 3983864. DOI: 10.1186/1748-5908-9-42. View

Hunt A, Allen K, Dittmann K, Linkewich E, Donald M, Hutter J . Clinician perspectives on implementing a team-based metacognitive strategy training approach to stroke rehabilitation. J Eval Clin Pract. 2021; 28(2):201-207. DOI: 10.1111/jep.13610. View

Campbell M, Fitzpatrick R, Haines A, Kinmonth A, Sandercock P, Spiegelhalter D . Framework for design and evaluation of complex interventions to improve health. BMJ. 2000; 321(7262):694-6. PMC: 1118564. DOI: 10.1136/bmj.321.7262.694. View

10.

Hockley J, Froggatt K, Van den Block L, Onwuteaka-Philipsen B, Kylanen M, Szczerbinska K . A framework for cross-cultural development and implementation of complex interventions to improve palliative care in nursing homes: the PACE steps to success programme. BMC Health Serv Res. 2019; 19(1):745. PMC: 6814133. DOI: 10.1186/s12913-019-4587-y. View

11.

Siantz E, Redline B, Henwood B . Practice Facilitation in Integrated Behavioral Health and Primary Care Settings: a Scoping Review. J Behav Health Serv Res. 2020; 48(1):133-155. DOI: 10.1007/s11414-020-09709-1. View

12.

Damush T, Miech E, Rattray N, Homoya B, Penney L, Cheatham A . Implementation Evaluation of a Complex Intervention to Improve Timeliness of Care for Veterans with Transient Ischemic Attack. J Gen Intern Med. 2020; 36(2):322-332. PMC: 7878645. DOI: 10.1007/s11606-020-06100-w. View

13.

Novick G, Womack J, Lewis J, Stasko E, Rising S, Sadler L . Perceptions of Barriers and Facilitators During Implementation of a Complex Model of Group Prenatal Care in Six Urban Sites. Res Nurs Health. 2015; 38(6):462-74. PMC: 4772136. DOI: 10.1002/nur.21681. View

14.

Olmos-Ochoa T, Ganz D, Barnard J, Penney L, Finley E, Hamilton A . Sustaining implementation facilitation: a model for facilitator resilience. Implement Sci Commun. 2021; 2(1):65. PMC: 8218441. DOI: 10.1186/s43058-021-00171-4. View

15.

Ludden T, Shade L, Reeves K, Welch M, Taylor Y, Mohanan S . Asthma dissemination around patient-centered treatments in North Carolina (ADAPT-NC): a cluster randomized control trial evaluating dissemination of an evidence-based shared decision-making intervention for asthma management. J Asthma. 2018; 56(10):1087-1098. PMC: 6456434. DOI: 10.1080/02770903.2018.1514630. View

16.

Berry K, Wright J, Sprange K, Cooper C, Courtney-Walker R, Mountain G . The implementation of Journeying through Dementia: Strategies to run a successful pragmatic multicenter trial of a complex intervention. Brain Behav. 2021; 11(12):e2436. PMC: 8671795. DOI: 10.1002/brb3.2436. View

17.

Mathias K, Nayak P, Singh P, Pillai P, Goicolea I . Is the Parwarish parenting intervention feasible and relevant for young people and parents in diverse settings in India? A mixed methods process evaluation. BMJ Open. 2022; 12(2):e054553. PMC: 8860057. DOI: 10.1136/bmjopen-2021-054553. View

18.

Cannon J, Gilbert M, Ebener P, Malone P, Reardon C, Acosta J . Influence of an Implementation Support Intervention on Barriers and Facilitators to Delivery of a Substance Use Prevention Program. Prev Sci. 2019; 20(8):1200-1210. PMC: 6883157. DOI: 10.1007/s11121-019-01037-x. View

19.

Page M, McKenzie J, Bossuyt P, Boutron I, Hoffmann T, Mulrow C . The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372:n71. PMC: 8005924. DOI: 10.1136/bmj.n71. View

20.

Svenningsson I, Petersson E, Udo C, Westman J, Bjorkelund C, Wallin L . Process evaluation of a cluster randomised intervention in Swedish primary care: using care managers in collaborative care to improve care quality for patients with depression. BMC Fam Pract. 2019; 20(1):108. PMC: 6660943. DOI: 10.1186/s12875-019-0998-4. View