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      The impacts of implementing recovery innovations: a conceptual framework grounded in qualitative research

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          Abstract

          Background

          Implementing mental health recovery into services is a policy priority in Canada and globally. To that end, a 5 year study was undertaken with seven organisations providing mental health and housing services to people living with a mental health challenge to implement guidelines for the transformation of services and systems towards a recovery-orientation. Multi-stakeholder implementation teams were established and a facilitated process guided teams to choosing and planning for the implementation of one recovery innovation. The recovery innovations chosen were hiring peer support workers, Wellness Recovery Action Planning (WRAP), a family support group, and staff recovery training.

          Methods

          This study reports on data collected at the post-implementation stage. 90 service users, service providers, family members, managers, other actors and knowledge users participated in 41 group, individual or dyad semi-structured interviews. The interview guides included open-ended questions eliciting participants’ impressions regarding the impact of implementing the innovation on service users, service providers and organisations. We applied a collaborative qualitative content analysis approach in NVivo12 to coding and interpreting the data generated from these questions.

          Results

          Eighteen impacts of implementing recovery innovations from the perspectives of diverse stakeholder groups were identified. Three impacts of working as an implementation team member and as part of a research project were also identified. Impacts were developed into a conceptual framework organised around four overall categories of impact: Ways of being, Ways of interacting, Ways of thinking, and Ways of operating and doing business.

          Conclusions

          The IMpacts of Recovery Innovations (IMRI) framework version 1 can assist researchers, evaluators and decision-makers identify, explore and understand impact in the context of recovery innovations. The framework helps fill a gap in conceptualising service and organisation-level impacts. Future research is needed to validate the framework and map it to existing methods for studying impact.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s13033-022-00559-2.

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          Most cited references50

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          Using thematic analysis in psychology

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            Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science

            Background Many interventions found to be effective in health services research studies fail to translate into meaningful patient care outcomes across multiple contexts. Health services researchers recognize the need to evaluate not only summative outcomes but also formative outcomes to assess the extent to which implementation is effective in a specific setting, prolongs sustainability, and promotes dissemination into other settings. Many implementation theories have been published to help promote effective implementation. However, they overlap considerably in the constructs included in individual theories, and a comparison of theories reveals that each is missing important constructs included in other theories. In addition, terminology and definitions are not consistent across theories. We describe the Consolidated Framework For Implementation Research (CFIR) that offers an overarching typology to promote implementation theory development and verification about what works where and why across multiple contexts. Methods We used a snowball sampling approach to identify published theories that were evaluated to identify constructs based on strength of conceptual or empirical support for influence on implementation, consistency in definitions, alignment with our own findings, and potential for measurement. We combined constructs across published theories that had different labels but were redundant or overlapping in definition, and we parsed apart constructs that conflated underlying concepts. Results The CFIR is composed of five major domains: intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation. Eight constructs were identified related to the intervention (e.g., evidence strength and quality), four constructs were identified related to outer setting (e.g., patient needs and resources), 12 constructs were identified related to inner setting (e.g., culture, leadership engagement), five constructs were identified related to individual characteristics, and eight constructs were identified related to process (e.g., plan, evaluate, and reflect). We present explicit definitions for each construct. Conclusion The CFIR provides a pragmatic structure for approaching complex, interacting, multi-level, and transient states of constructs in the real world by embracing, consolidating, and unifying key constructs from published implementation theories. It can be used to guide formative evaluations and build the implementation knowledge base across multiple studies and settings.
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              Conceptual framework for personal recovery in mental health: systematic review and narrative synthesis.

              No systematic review and narrative synthesis on personal recovery in mental illness has been undertaken. To synthesise published descriptions and models of personal recovery into an empirically based conceptual framework. Systematic review and modified narrative synthesis. Out of 5208 papers that were identified and 366 that were reviewed, a total of 97 papers were included in this review. The emergent conceptual framework consists of: (a) 13 characteristics of the recovery journey; (b) five recovery processes comprising: connectedness; hope and optimism about the future; identity; meaning in life; and empowerment (giving the acronym CHIME); and (c) recovery stage descriptions which mapped onto the transtheoretical model of change. Studies that focused on recovery for individuals of Black and minority ethnic (BME) origin showed a greater emphasis on spirituality and stigma and also identified two additional themes: culturally specific facilitating factors and collectivist notions of recovery. The conceptual framework is a theoretically defensible and robust synthesis of people's experiences of recovery in mental illness. This provides an empirical basis for future recovery-oriented research and practice.
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                Author and article information

                Contributors
                myra.piat@mcgill.ca
                Journal
                Int J Ment Health Syst
                Int J Ment Health Syst
                International Journal of Mental Health Systems
                BioMed Central (London )
                1752-4458
                9 October 2022
                9 October 2022
                2022
                : 16
                : 49
                Affiliations
                [1 ]GRID grid.412078.8, ISNI 0000 0001 2353 5268, Department of Psychiatry, , McGill University and Douglas Mental Health University Institute, ; 6875, Boul. LaSalle, Montréal, Québec H4H 1R3 Canada
                [2 ]GRID grid.8250.f, ISNI 0000 0000 8700 0572, Department of Anthropology, , Durham University, ; Dawson Building, South Road, Durham, DH1 3LE UK
                [3 ]GRID grid.265686.9, ISNI 0000 0001 2175 1792, École de Travail Social, , Université de Moncton, ; Local 386, 18, avenue Antonine-Maillet, Moncton, Nouveau-Brunswick E1A 3E9 Canada
                [4 ]GRID grid.14709.3b, ISNI 0000 0004 1936 8649, Department of Psychiatry, , McGill University, ; Ludmer Research and Training Building, 1033 Avenue des Pins, Montréal, QC H3A 1A1 Canada
                [5 ]GRID grid.412078.8, ISNI 0000 0001 2353 5268, Douglas Mental Health University Institute, ; 6875, Boul. LaSalle, Montréal, Québec H4H 1R3 Canada
                [6 ]GRID grid.265686.9, ISNI 0000 0001 2175 1792, Ecole de Travail Social, Université de Moncton, ; Local 378, 18, avenue Antonine-Maillet, Moncton, Nouveau-Brunswick E1A 3E9 Canada
                [7 ]GRID grid.17091.3e, ISNI 0000 0001 2288 9830, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, , The University of British Columbia, ; 2211 Westbrook Mall T325, Vancouver, BC V6T 2B5 Canada
                Article
                559
                10.1186/s13033-022-00559-2
                9548307
                36210449
                3ef6a398-9e10-4f43-a092-a92879a173e7
                © The Author(s) 2022

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 30 May 2022
                : 14 September 2022
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000024, Canadian Institutes of Health Research;
                Award ID: 148172
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/501100000156, Fonds de Recherche du Québec - Santé;
                Funded by: FundRef http://dx.doi.org/10.13039/100008794, Research Manitoba;
                Funded by: FundRef http://dx.doi.org/10.13039/501100000245, Michael Smith Foundation for Health Research;
                Funded by: FundRef http://dx.doi.org/10.13039/100013123, Fondation de la recherche en santé du Nouveau-Brunswick;
                Categories
                Research
                Custom metadata
                © The Author(s) 2022

                Neurology
                conceptual framework,guidelines,impact,implementation science,mental health recovery,qualitative research,system transformation

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