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

McCormack, Brendan, Rycroft-Malone, Joanne, DeCorby, Kara, Hutchinson, Alison M, Bucknall, Tracey, Kent, Bridie, Schultz, Alyce, Snelgrove-Clarke, Erna, Stetler, Cheyl, Titler, Marita, Wallin, Lars and Wilson, Valerie 2013, A realist review of interventions and strategies to promote evidence-informed healthcare: a focus on change agency, Implementation Science, vol. 8, no. 1, Article 107, pp. 1-12.

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Title A realist review of interventions and strategies to promote evidence-informed healthcare: a focus on change agency
Author(s) McCormack, Brendan
Rycroft-Malone, Joanne
DeCorby, Kara
Hutchinson, Alison M
Bucknall, Tracey
Kent, Bridie
Schultz, Alyce
Snelgrove-Clarke, Erna
Stetler, Cheyl
Titler, Marita
Wallin, Lars
Wilson, Valerie
Journal name Implementation Science
Volume number 8
Issue number 1, Article 107
Start page 1
End page 12
Total pages 12
Publisher BioMed Central
Place of publication London, UK
Publication date 2013-09-08
ISSN 1748-5908
Keyword(s) Realist synthesis
Evidence-informed health care
Change agency
Facilitators
Opinion leaders
Knowledge brokers’ knowledge utilization
Summary 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.
Language eng
Field of Research 111099 Nursing not elsewhere classified
Socio Economic Objective 970111 Expanding Knowledge in the Medical and Health Sciences
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2013, BioMed Central
Persistent URL http://hdl.handle.net/10536/DRO/DU:30061165

Document type: Journal Article
Collections: School of Nursing and Midwifery
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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.