Identifying knowledge gaps between practice and research for implementation components of sustainable interventions to improve the working environment – A rapid review

Applied Ergonomics 67 (2018) 178e192

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Applied Ergonomics journal homepage: www.elsevier.com/locate/apergo

Review article

Identifying knowledge gaps between practice and research for implementation components of sustainable interventions to improve the working environment e A rapid review Charlotte Diana Nørregaard Rasmussen*, Helene Højberg, Elizabeth Bengtsen, Marie Birk Jørgensen National Research Centre for the Working Environment, Lersø Parkall
e 105, 2100 Copenhagen Ø, Denmark

a r t i c l e i n f o

a b s t r a c t

Article history: Received 3 January 2017 Received in revised form 9 June 2017 Accepted 24 September 2017

In a recent study, we involved all relevant stakeholders to identify practice-based implementation components for successful implementation and sustainability in work environment interventions. To understand possible knowledge gaps between evidence and practice, the aim of this paper is to investigate if effectiveness studies of the 11 practice-based implementation components can be identified in existing scientific literature. PubMed/MEDLINE, PsycINFO, and Web of Science were searched for relevant studies. After screening, 38 articles met the inclusion criteria. Since some of the studies describe more than one practice-based implementation concept a total of 125 quality criteria assessments were made. The overall result is that 10 of the 11 practice-based implementation components can be found in the scientific literature, but the evaluation of them is poor. From this review it is clear that there are knowledge gaps between evidence and practice with respect to the effectiveness of implementation concepts. © 2017 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Keywords: Workplace Occupational health Nursing assistants

Contents 1. 2.

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Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179 Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179 2.1. Search strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179 2.2. Selection process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180 2.3. Appraisal of study type and content . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181 Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181 3.1. Engaged and active management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181 3.2. Available and ready to use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181 3.3. Connected with daily work tasks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181 3.4. General structures and resources in place to make it happen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182 3.5. Process steering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186 3.6. Relevant to current workplace needs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186 3.7. Easy transfer to action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188 3.8. Engaged employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188 3.9. Awareness, mutual goals and co-production . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188 3.10. Support from internal and external stakeholders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188 3.11. Delivered in an attractive form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189 Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190 4.1. More research is needed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190

* Corresponding author. E-mail address: [email protected] (C.D.N. Rasmussen). https://doi.org/10.1016/j.apergo.2017.09.014 0003-6870/© 2017 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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4.2. Traditional scientific designs aren't the way to address this . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190 Limitations and implications for practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190 5.1. Practice-based research may move us forward . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191 Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191 Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191 Competing interests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191 Authors' contributions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191 Funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191

1. Introduction “There is no public health without good workplace health” (European Network for Workplace Health Promotion, 2002). The workplace is increasingly being viewed upon as a setting not only to prevent occupational injury, but also to improve overall health and well-being (World Health Organization, 1986). However, despite many efforts by introducing various strategies such as programs, policies and interventions, improvements in work environment and health remains a challenge. Insignificant or modest findings in these strategies may be attributable to them being poorly designed or theorised, poorly implemented, or having inadequate evaluation methods (Glasgow et al., 1999; Oakley et al., 2006). Evidence-based practice has been increasingly popular in the recent years within the work environment (Kuijer et al., 2014; Nayback-Beebe et al., 2013; Slaughter et al., 2015), whereas only few studies have focused on practice-based evidence (Dunet et al., 2008; Reavley et al., 2010). Evidence-based practice provides evidence that often comes from artificially controlled research that does not fit the realities of practice (Green, 2006), since research studies require strict adherence to protocols to control threats to study validity (Treweek and Zwarenstein, 2009). However, practice-based evidence provides knowledge of what is needed in practice. Workplaces, practitioners or other end users that are involved in programs, policies or interventions to improve the work environment are an important source of information about strategies that may be effective. Strategies already being implemented are obviously feasible, in contrast to research-based interventions that may not necessarily be adaptable to multiple workplace settings. Closer engagement with practitioners or other end users could contribute to closing the gap between research and practice (Green, 2008) and provide information about effective strategies for improving the work environment and health. In a recent study, we involved all relevant stakeholders in a comprehensive concept mapping process to identify the prerequisites for effective interventions for improving the working environment among nursing assistants. This resulted in 11 practicebased implementation components (PBIC's), which are structures and processes that need to be present for successful implementation and effect of work environment interventions: “Engaged and Active Management”, “Available and Ready to Use”, “Connected with Daily Work Tasks”, “General Structures and Resources in Place to make it happen”, “Process Steering”, “Relevant to Current Workplace Needs”, “Easy Transfer to Action”, “Engaged Employees”, “Awareness, Mutual Goals and Co-production”, “Support from Internal and External Stakeholders”, “Delivered in an Attractive Form” (Højberg et al., 2017) (Fig. 1). In order to fully understand possible knowledge gaps between evidence and practice for sustainability in work environment, the aim of this paper is to investigate if effectiveness studies that include the 11 PBIC's can be identified in existing scientific

literature through a rapid review. Therefore, the overall research question is: Is there scientific research to support practice-based knowledge regarding implementation components for effective work environment interventions for nursing assistants? 2. Methods We used a rapid review (RR). RR's are often described as “reviews that use methods to accelerate or streamline traditional systematic review processes” (Ganann et al., 2010). RR's do not appear in the literature with one single definition (Watt et al., 2008b), and there are no clear published guidelines on how to conduct RR's, but it is stated that an RR can be carried out when there is a need for a time- and resource sensitive review process, and that it can provide a way to generate similar types of knowledge synthesis as more comprehensive systematic reviews do, but in a much shorter time period (Ganann et al., 2010; Khangura et al., 2012; Watt et al., 2008a). The benefit of such reviews is that they meet policy and practice needs by providing an overview of the field in a short time frame; hence they do not aim to assess each piece of evidence systematically. Limitations include the short time frames and need to review materials. This increases the possibility that some literature might be overlooked. To make the review process transparent we used the PRISMA statement to guide us (Moher et al., 2009). Due to the short time frame, no protocol is published and nor has it been registered. 2.1. Search strategy Our search strategy included searching in the following scientific databases by an information scientist: PubMed/MEDLINE, PsycINFO, and Web of Science. The searches were carried out between September 25th and November 19th, 2015. We did not include grey literature, references list of relevant papers were not inspected to identify further relevant articles and we did not do any additional citation search or contact study authors to identify additional studies. The search was not limited to years. Only articles published in English were included in the search. A basic search strategy with three clusters of keywords was used. The first cluster referred to the target population, i.e., “eldercare workers”, “nursing assistants”, “nurses' aides” and “care workers” etc. The second cluster referred to the setting, i.e. “Employee”, “Job”, “Work”, “Occupation” etc. The third cluster referred to the intervention to search for implementation of changes, i.e. “intervention”, “program”, “change”, “implement” etc. The keywords for the second and third cluster were inspired by the search strategy used in the review by Van Eerd and colleagues (van Eerd et al., 2010) and by the article on search strategy by Verbeek and colleagues (Verbeek et al., 2005). All clusters included variations of the keywords. This basic search was then combined with an individual search for each of the 11 PBIC's (all in all 11 separate literature searches (reviews) in all three databases). We used the

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Fig. 1. Description of the 11 practice-based implementation components identified by a stakeholder group in a concept mapping workshop, which are structures and processes that need to be present for successful implementation and effect of work environment interventions.

underlying statements that had generated the components in the previous practice-based concept mapping procedure to identify keywords for the 11 PBIC's (Højberg et al., 2017). To optimize the search, we also asked a scientific reference group and other researchers within the field to provide some keywords for the components. See Table 1 for search strategy and terms. References identified from our search were downloaded into Reference

Manager, version 11, to be screened for inclusion in the review. 2.2. Selection process One reviewer examined all potential titles and if necessary abstracts for inclusion. Any titles or abstracts that did not meet the inclusion criteria were excluded. For any references where possible

Table 1 Example of search strategy. The basic search included three clusters: population, setting and intervention, and these were combined by using the Boolean operator “AND”, while terms within each cluster were combined by the Boolean operator “OR”. Further we excluded hospital as an intervention setting, by using the Boolean operator “NOT” in the search strategy. The basic search was combined with the individual search for each of the eleven components by using the Boolean operator “AND”. Basic Search

Individual Component Searches

Population

Setting

Intervention

Component

eldercare workers, nursing assistants; nurses' aides; care workers; homecare workers; care aides; healthcare workers

Employee; Employees; Job site; Team; Work Location; Work place; Workers; Workplace; Worksite; Work-Site; Occupation

intervention(s/studies); program(s); change(s); modif(ication/iers); implement(s/ations); process; method(s); approach(es); safety management; program evaluation; prevention; intervention stud(y/ies); facilitator(s); barrier(s); accommodation(s); change management; employee assistance program(s); EAP program(s/mes); Human resources management; Professional management; Policy intervention programs; programs; Occupational health and safety; OHS, Compressed working week; Flexible working conditions; Job design; Leadership development; Management training; Multicomponent; Organizational Innovation; Physical exercise; Qualification; Redesign; Relaxation; Reorganisation; Reorganizing; Skills training; Systems approach; Training; Multidisciplinary; Participative; Behavioural; Behavioral; Prevention; Protection; Physical training; Multi-faceted; Multifaceted; Participatory Ergonomics

“Engaged and Active Management” “Available and Ready to Use” “Connected with Daily Work Tasks” “General Structures and Resources in Place to Make it Happen” “Process Steering” “Relevant to Current Workplace Needs” “Easy Transfer to Action” “Engaged Employees” “Awareness, Mutual Goals and Coproduction” “Support from Internal and External Stakeholders” “Delivered in an Attractive Form”

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inclusion was unclear, a second reviewer independently examined the corresponding titles and abstracts. To check for consistency undertaken during this process, a second reviewer checked a random sample of titles and abstracts. We used the PICOS (participants, interventions, comparators, outcomes, and study design) to guide us in the inclusion criteria. Therefore studies were included if: 1) participants were nursing assistants (home care workers, nurses' aides etc.), 2) the study described implementation of a workplace, work environment or occupational intervention/change with respect to the concept of interest, 3) the study had some kind of comparison, either being a control group or a follow-up measurement, so a change could be evaluated, 4) the outcome was either work environment or workers' health related and 5) the study design included trials (RCT's, non-randomised trials, trials with before and after measurements), and process evaluations of the trial including qualitative studies as well and reviews describing findings from trials. Studies were excluded if: 1) they only focused on nurses or other healthcare personnel (not nursing assistants) or 2) studies were conducted at the hospital, since our main population of interest was nursing assistants working in homecare or nursing homes. 2.3. Appraisal of study type and content The articles included on title and abstract level underwent a full article screen by 2 reviewers. Articles were excluded if the PBIC was not part of the intervention. In case of disagreement between the two reviewers a third reviewer read the paper and consensus between the three reviewers was reached. Articles co-authored by the members were primarily assessed by the independent researcher. Additionally, when reading the full text, if other components were found in the articles, they were included in the appraisal of study type and content for the respective concept. Since we had a fairly open inclusion criteria regarding study design, a content and appraisal instrument had to be applicable for all literature types. Therefore, to consider the quality and content of the paper, a simple indication of country of origin, publication year, study population and study size, and study design was extracted. The study design (SD) of each article was scored from 1 to 5 according to the following criteria: 1) if the study included the PBIC in the intervention but did not specifically evaluate the concept 2) if the study included the PBIC in the intervention and evaluated the concept (this was further divided into a) if the evaluation was qualitative, b) if the evaluation was quantitative or c) if the evaluation used mixed-methods) 3) if the study had included the PBIC in a controlled design (that is; if the concept was present in the intervention group, but not in the comparison group, and this was the main difference between the groups) 4) if the study examined the PBIC in an RCT design 5) if the study was a review of the PBIC. For studies that had a SD of 2 or higher we reported the main effects of the study on work environment and/or health. However, for the studies with a SD of 1 we report the overall characteristics.

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possibly inclusion in the review, additionally 13 articles were included, since they described others of the 11 PBIC's. Thus, a total number of 38 articles were included in the final review (Table 3). However, since more PBIC's were identified in the studies, the appraisal for SD was done 125 times (Fig. 3). 3.1. Engaged and active management For the PBIC “Engaged and Active Management”, a total of 8357 articles were found, but only eight articles were included in the final review. The interventions described in the studies included education of supervisors/management (Beck et al., 2014; Jeon et al., 2012, 2015; Morgan and Konrad, 2008; Petterson et al., 2006; Yeatts and Cready, 2007) and supervisors serving as champion for the project (Baumann et al., 2012). Two of the studies used an RCT design (Jeon et al., 2012, 2015), whereas most studies used quasi experimental designs (Beck et al., 2014; Morgan and Konrad, 2008; Petterson et al., 2006; Yeatts and Cready, 2007) and a few studies used qualitative methods (Baumann et al., 2012; Marziali et al., 2014). We rated one study with SD 4 (Jeon et al., 2015) which evaluated the effect of an engaged and active management in an RCT design. This study found an effect on the process outcomes (e.g. management support, leadership actions and behaviours and effort) but no effect in reducing staff turnover (Jeon et al., 2015). Two studies evaluated an engaged and active management by qualitative or mixed methods (Baumann et al., 2012; Morgan and Konrad, 2008) and were rated a SD 2. In one of the two studies, strong leadership commitment was vital for the effect of the program (Baumann et al., 2012), and the other study found that support from management increased due to the intervention (Morgan and Konrad, 2008). The remaining five studies did merely describe an engaged and active management as part of the intervention (SD 1). An additional 13 articles were identified as relevant to this PBIC (Amuwo et al., 2011, Amuwo et al., 2013; Dill et al., 2009; Figueiredo €rde, 2000; Hartvigsen et al., et al., 2013; Flannery et al., 2012; Forsga 2005; Kurowski et al., 2012; Leff et al., 2000; MacDonald and Walton, 2007; Mccarthy, 1992, Nabe-Nielsen et al., 2011; Rasmussen et al., 2015). Most of these studies did not evaluate the effect of an engaged and active management, but did only describe this as being part of the intervention (SD 1). However one study evaluated an engaged and active management by quantitative measures (SD 2b). The study evaluated a safe resident handling program including an information meeting with the department heads. However, they did not specifically evaluate on the effect of high or low supervisor support with respect to improvement of the work environment (Kurowski et al., 2012). 3.2. Available and ready to use For the PBIC “Available and Ready to Use”, a total of 1848 articles were found. After assessing titles and abstracts, zero articles were included for full reading of text. However, one article was included from reviewing the 10 other PBIC's. Marziali and colleagues described that the intervention consisted of an e-learning program as Power Point formatted on a DVD with voice-over that was available and ready to use, but did not evaluate on this specifically (SD 1) (Marziali et al., 2014).

3. Results 3.3. Connected with daily work tasks A total of 33.355 articles were identified in our initial search. After exclusion of duplicates the total number of identified articles was 29.815. The identified articles for each of the 11 PBIC's ranged from 153 to 8357 (Fig. 2). From the original search 25 articles were included for the review (Table 2). When reading full text for

For the PBIC “Connected with Daily Work Tasks”, a total of 580 articles were found and four articles were included in the final review. The interventions described included education in specific care (Figueiredo et al., 2013), and training of care skills (Proctor

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Fig. 2. Flow diagram: A total of 33.355 articles were identified in the three databases (PubMed, PsycNET, Web of Science). For the 11 separate searches, the flow diagram shows a range in number of identified articles from a maximum of 186e9053 articles. After exclusion of duplicates a total of 29.815 articles were identified for all 11 components. The PICOS screening was carried out on title and abstract level for all the 11 searches resulting in 95 articles for full text reading. After full text reading we ended up with a number between 0 and 8 articles that matched the inclusion criteria. In the additional search when reading the included articles for the other implementation components, we identified a further 0e19 studies. The two searches combined resulted in a total number of 0e25 included articles for the final review for each practice-based implementation components.

et al., 1998), a competence program (Petterson et al., 2006), and ethical discussion groups including topics regarding caring phi€rde, 2000). Only one study evaluated the interlosophy (Forsga vention in an RCT design (Proctor et al., 1998), whereas the other €rde, 2000) and studies used quasi experimental designs (Forsga before and after measurements (Figueiredo et al., 2013; Petterson et al., 2006). None of the included studies evaluated on the effect of the intervention being connected with daily work tasks (SD >1), but did only describe this as being part of the intervention (SD 1). An additional six articles were identified as relevant to this PBIC (Barbosa et al., 2014; Beck et al., 2014; Coogle et al., 2006; MacDonald and Walton, 2007; Morgan and Konrad, 2008; Yeatts and Cready, 2007). Four of these studies only described the concept as being part of the intervention (SD 1). However, a study by Morgan and Konrad that involved a curriculum covering clinical and interpersonal skills found an increased job performance and better quality of care, but no effect on turnover which was the main outcome of the study (SD 2c) (Morgan and Konrad, 2008). In the study by Yeatts and colleagues the intervention partly consisted of weekly 30-min meetings with focus on for instance review of resident health conditions or review of new residents and their

specific needs. They found improved resident care, but did not relate this finding to the primary outcomes turnover and absenteeism (SD 2c) (Yeatts and Cready, 2007). 3.4. General structures and resources in place to make it happen For the PBIC “General Structures and Resources in Place to Make it Happen”, a total of 4000 articles were found and seven articles were included in the review. The interventions described in the studies included use of consultants (Amuwo et al., 2011; Baumann et al., 2012; Kurowski et al., 2012; Petterson et al., 2006), allocation of time (Pillemer et al., 2008) and resources (e.g. equipment) (Ho et al., 2012; Kurowski et al., 2012) and the use of a very structured process (Leff et al., 2000). Two studies were RCTs (Ho et al., 2012; Pillemer et al., 2008), whereas the other studies used before and after measurements (Kurowski et al., 2012; Leff et al., 2000; Petterson et al., 2006) or process evaluations (Amuwo et al., 2011; Baumann et al., 2012). Only one study evaluated the effect of having general structures and resources in place (Baumann et al., 2012) (SD 2a). From a qualitative evaluation they found that the use of consultants was vital to the success of the project

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Table 2 The design of each article for the practice-based implementation concept (PBIC) was scored on a scale from 1 to 5 according to the following criteria: 1) if the study included the concept in the intervention but not specifically evaluated the concept; 2) if the study included the concept in the intervention and evaluated the concept (this was further divided into a) if the evaluation was qualitative, b) if the evaluation was quantitative or c) if the evaluation used mixed-method); 3) if the study had included the concept in a controlled design; 4) if the study examined the concept in an RCT design; 5) if the study was a review of the concept. The presence of the PBIC in each intervention is highlighted (bold). N

Study design

Study population & Study size

Intervention description and description of the PBIC

Study Design for the PBIC

ENGAGED AND ACTIVE MANAGEMENT (Jeon et al., 2015) Australia 2015

Double blind RCT

Approximately 500 care staff and 50 managers from 12 residential and community-aged care sites

Structured education and support program designed to promote safe, high-quality person-centred and evidencebased care by assisting middle managers to develop effective team relationships and person/client-centred leadership strategies that enable them to deal with the day-to-day realities of care services. Health and safety intervention (participatory ergonomic Process 6 organisations (acute care hospitals, long-term care home, (Baumann evaluation retirement residence, community service center, rehabilitation intervention). et al., Creation of a multidisciplinary steering committee (senior and complex continuing care/long-term care organisation) 2012) management/leadership, risk management, union Canada representatives, health and safety human resources, joint 2012 health and safety committee members, specialists within the organisation (e.g., ergonomists, physiotherapists and occupational therapists)), and an external consultant and a change team. 390 nursing assistants from 18 nursing homes A workforce development program for nursing assistants in (Morgan and Quasinursing homes involving continuing education by onsite experimental Konrad, trainers, compensation for education modules, supervisory design 2008) skills training of frontline supervisors, and short-term supplemented USA/ retention contracts for bonuses and/or wage increases upon England by qualitative completion. assessments 2008 194 managers, nurses, therapists and nurse assistants Training and support in either person centred care or dementia (Jeon et al., RCT care mapping. The researchers arranged meetings with 2012) managers. Managers selected workers to specific roles. Australia 2012 Implementation of empowered work teams. (Yeatts and Multi-method Certified nursing assistants, nurses, and nurse management from 10 nursing homes Nurse management members involved the teams in pretestCready, management decisions related to certified nursing assistants posttest 2007) work. USA 2007 (Petterson 493 auxiliary nurses and nursing assistants Intervention in three steps: 1) a competence program educating Before and et al., “innovation leaders”, 2) worksite competence circles, and 3) after local worksite projects. (questionnaire) 2006) The intervention was strongly supported by the top Sweden management and the unions. 2006 185 nurse assistants and Study circles and interactive workshops increasing knowledge (Beck et al., Quasiexperimental 9 leaders for nurse assistants. 2014) For the leaders the content followed the nursing assistants' Sweden study-circle sessions but was focused on how to support and 2014 guide the nursing assistants. Qualitative 147 nursing assistants and 17 nursing supervisors from 17 E-learning program focusing on managing relationship conflicts (Marziali study nursing homes with residents, families and co-workers, and self-care and et al., management of lifestyle behaviours. Supervisors received a 2014) separate DVD focusing on supervisory strategies for Canada supporting nursing assistant's management of emotional 2015 stress.

4

2a

2c

1

1

1

1

1

AVAILABLE AND READY TO USE e

e

e

e

e

CONNECTED WITH DAILY WORK TASKS (Figueiredo et al., 2013) Portugal 2013 (Proctor et al., 1998) England 1998

Pilot study, qualitative/ quantitative

6 caregivers at a long-term care home for older people

RCT

98 care staff from 12 nursing and residential homes for the elderly

The program combined eight psychoeducational group sessions 1 aiming to provide staff with specialized knowledge regarding the condition of dementia and its care and to help staff to manage the emotional demands of working in dementia care. 1 Seminars were provided by a multi-disciplinary old age psychiatry team of nursing staff, medical staff and occupational therapists. The topics covered in the program were based on the results of a pilot study where care staff was asked to identify areas in which they felt they needed to develop their knowledge and skills. The second part of the training schedule was devised to aid staff in becoming skilled in behavioural management of residents by developing individual care programs. (continued on next page)

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Table 2 (continued ) Study population & Study size

N

Study design

(Petterson et al., 2006) Sweden 2006 €rde, (Forsga 2000) Sweden 2000

493 auxiliary nurses and nursing assistants Before and after (questionnaire)

Quasiexperimental

Intervention description and description of the PBIC

Study Design for the PBIC

Intervention in three steps: 1) a competence program educating 1 “innovation leaders”, 2) worksite competence circles, and 3) local worksite projects. The competence program included learning sessions on quality of care and ethics. Systematic ethical discussion groups. A discussion manual was 1 8 special types of housing (registered nurses and enrolled nurses, managers and caregivers employed in care of the elderly produced where thecore quotations' were linked to theory. This manual was structured thematically. and disabled) Example of content included: to be conscious about one's caring-philosophy.

GENERAL STRUCTURES AND RESOURCES IN PLACE TO MAKE IT HAPPEN (Baumann et al., 2012) Canada 2012 (Pillemer et al., 2008) USA 2008

(Petterson et al., 2006) Sweden 2006 (Kurowski et al., 2012) USA 2012 (Ho et al., 2012) Hongkong 2012 (Amuwo et al., 2011) USA 2011 (Leff et al., 2000) USA 2000

Health and safety intervention (participatory ergonomic 6 organisations (acute care hospitals, long-term care home, retirement residence, community service center, rehabilitation intervention). Public Health and Safety Association expert consultants were and complex continuing care/long-term care organisation) used as educators and coaches. The consultants provided an implementation framework and a series of targeted workshops. 762 certified nursing A staff person from each facility was designated as a retention Pretest assistants in 32 nursing homes specialist serving as the key internal consultant regarding eposttest retention programs. randomised As a condition of participating in the program, the nursing trial home agreed to allow this individual to devote at least 20% of Design his or her time to retention activities over the course of one year. 493 auxiliary nurses and nursing assistants Intervention in three steps: 1) a competence program educating Before and “innovation leaders”, 2) worksite competence circles, and 3) after local worksite projects. (questionnaire) The competence program was led by professional teachers. Project plans were elaborated jointly by the participating employees. Prospective Nursing assistants from 5 nursing homes A Safe Resident Handling Program. study Equipment, based on nurses' assessments, was purchased by each facility, and a third-party firm provided training to all clinical staff on the use of and maintenance procedures for mechanical handling devices. The WHO multimodal strategy was employed. RCT Healthcare workers (doctors, registered/enrolled nurses, All intervention homes were supplied with alcohol-based physiotherapists/occupational therapists, personal care hand rub, alcohol-based hand rub racks, pull reels, hand workers/assistants and health workers) from 18 homes for hygiene posters and reminders, a health talk, video clips, elderly training materials, and performance feedback. Process 1027 home care aides The intervention program consisted of a participatory employee evaluation training program delivered by researchers and two intervention tools designed to help prevent occupational exposure to blood and body fluids. Process evaluation

Post-test/ screening

2a

1

1

1

1

1

Licensed nursing assistants

Performance improvement team on injury prevention including 1 management, therapists, team leader, and nursing assistants. Performance improvement plan in a seven-step improvement process involving determining the current situation, team objective, analysis, potential solutions, results, standardizations, and future plans.

6 organisations (acute care hospitals, long-term care home, retirement residence, community service center, rehabilitation and complex continuing care/long-term care organisation)

1 Health and safety intervention (participatory ergonomic intervention). Public Health and Safety Association expert consultants were used as educators and coaches. The consultants provided an implementation framework and a series of targeted workshops. Up to two days per month for the initial year of the program, the consultant provides guidance. 1 4-h team-building workshop followed by six monthly 2-h meetings. The teams would complete one lesson and then work on their goals for a month, whereas investigators produced the planned topic for upcoming meeting. Each topic was segmented into participatory learning activities such as games, guided tool demonstrations, and role-play. Participants alternated serving as the team leader, using the scripted team leader manual, whereas other team members used a corresponding workbook. 1

PROCESS STEERING (Baumann et al., 2012) Canada 2012

Process evaluation

16 home care workers (Olson et al., Process evaluation pre/ 2015) post-test USA 2015

RCT

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185

Table 2 (continued ) N

Study design

(Pillemer et al., 2008) USA 2008

Study population & Study size

Intervention description and description of the PBIC

762 certified nursing assistants in 32 nursing homes.

A staff person from each facility was designated as a retention specialist serving as the key internal consultant regarding retention programs. This individual received tools and ongoing support to conduct a needs assessment, to institute retention programs, and to evaluate the programs' success and modify them as needed. 1 Structured education and support program to promote safe, high-quality person-centred and evidence-based care by assisting middle managers to develop effective team relationships and person/client-centred leadership strategies that enable them to deal with the day-to-day realities of care services. Utilizing action learning techniques, 360-degree feedback, case-scenarios, one-on-one interactions with a program facilitator, and individual practice improvements projects, all of which is facilitated in the program participants' workplace. The intervention program consisted of a participatory employee 1 training program delivered by researchers and two intervention tools designed to help prevent occupational exposure to blood and body fluids. Delivered as a structured program of 28 h of training per year.

(Jeon et al., 2015) Australia 2015

Double blind RCT

Approximately 500 care staff and 50 managers from 12 residential and community-aged care sites

(Amuwo et al., 2011) USA 2011

Process evaluation

1027 home care aides

Study Design for the PBIC

RELEVANT TO CURRENT WORKPLACE NEEDS (Figueiredo et al., 2013) Portugal 2013

Pilot study, qualitative/ quantitative

(Mccarthy, 1992) USA 1992

Qualitative

(Barbosa et al., 2014) Portugal 2015

Pre/post-test control group design

The program combined eight psychoeducational group sessions 1 aiming to provide staff with specialized knowledge regarding the condition of dementia and its care and to help staff to manage the emotional demands of working in dementia care. A focus-group interview with staff was conducted at the facility prior to the intervention aiming to get a deep understanding about their perceived needs, competencies, and expectations towards the program. 8 workers (certified nurse's assistants, registered nurse, activity The intervention consisted of various relaxation techniques and 1 director, and the unit program coordinator) from one unit for strategies for managing stress (music therapy, low impact exercise, didactic material on attitude shaping, handout on persons with Alzheimer's disease nutrition and physical well-being). The program was begun in response to what nursing home administrators perceived to be problematic stress levels among the staff. 58 direct care workers from 4 aged care residential facilities A person-centred care-based psychoeducational intervention 1 on direct care workers aiming at developing care competencies and tools for stress management. The intervention design was informed by relevant literature on psychoeducational approaches, person-centred care, and dementia, findings from a pilot study conducted by authors' team, and interviews with direct care workers and managers about training and emotional needs. 6 caregivers at a long-term care home for older people

EASY TRANSFER TO ACTION e

e

e

e

e

Pre/post-test

21 home health aides

Participatory workshops including the home health aides to 1 generate and discuss ideas for interventions to reduce physical stress associated with the aides' work.

RCT

1 A multifaceted implementation strategy on behaviour, 1649 healthcare workers (3 university hospitals, 1 academic center for dentistry, 2 general hospitals, 2 nursing homes) from behavioural determinants, knowledge and awareness of healthcare workers regarding the use of recommendations to 48 departments prevent hand eczema. Participatory working groups were set up to enhance the implementation of the recommendations for hand eczema. 693 home care aides A 1-day educational session utilizing peer educators and active 1 learning methods to increase awareness about the risks for occupational exposure to blood and body fluids among home care aides. Participatory peer education techniques and small group interactive trainings.

ENGAGED EMPLOYEES (Czuba et al., 2012) USA 2012 (van der Meer et al., 2014) Holland 2014 (Amuwo et al., 2013) USA 2013

Quasiexperimental

(continued on next page)

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Table 2 (continued ) N

Study design

Study population & Study size

Controlled trial 70 home care workers (Pohjonen et al., 1998) Finland 1998 (Rasmussen RCT 594 nurses' aides, kitchen workers and janitors et al., 2015) Denmark 2015 (Amuwo et al., 2011) USA 2011

Process evaluation

1027 home care aides

Intervention description and description of the PBIC

Study Design for the PBIC

Various ergonomic measures utilizing the developmental participatory approach based on teamwork and training within the work units.

1

1 A multi-faceted intervention integrating participatory ergonomics, physical training, and cognitive behavioural training. An ergonomic work group consisting of 5 to 7 workers and a trained local therapist was responsible for the participatory ergonomics process. 1 The intervention program consisted of a participatory employee training program delivered by researchers and two intervention tools designed to help prevent occupational exposure to blood and body fluids.

AWARENESS, MUTUAL GOALS AND CO-PRODUCTION e

e

e

e

e

SUPPORT FROM INTERNAL AND EXTERNAL STAKEHOLDERS (Petterson et al., 2006) Sweden 2006

493 auxiliary nurses and nursing assistants Before and after (questionnaire)

Intervention in three steps: 1) a competence program educating 1 “innovation leaders”, 2) worksite competence circles, and 3) local worksite projects. The intervention was strongly supported by the top management and the unions. After the program, the qualified innovation leaders and the middle managers started an organisation-wide supporting network

DELIVERED IN AN ATTRACTIVE FORM (MacDonald Pre-post tests and Walton, 2007) Canada 2007

881 staff in long-term care facilities (certified nursing assistants) An E-learning program including educational pedagogies and 1 innovative ways to conceptualise and deliver healthcare education, was developed and distributed to caregivers.

(Baumann et al., 2012). The rest of the included studies did only describe having general structures and resources in place as being part of the intervention (SD 1). An additional 18 articles were identified as relevant to this PBIC (Barbosa et al., 2014; Coogle et al., 2006; Dill et al., 2009; Figueiredo et al., 2013; Flannery et al., 2012; Forsg€ arde, 2000; Garde et al., 2011; Hartvigsen et al., 2005; Jeon et al., 2012, 2015; Marziali et al., 2014; Mccarthy, 1992, Morgan and Konrad, 2008; Olson et al., 2015; Proctor et al., 1998; Rasmussen et al., 2015; Tveito and Eriksen, 2009; Zwijsen et al., 2015). Most of these studies only described an engaged and active management as being part of the intervention (SD 1). In the study by Jeon and colleagues, both a facilitator and a consultant were involved in delivering the program (Jeon et al., 2015). An economic evaluation was performed to evaluate the cost of the use of the facilitator and the consultant as the mean-based incremental cost-effectiveness ratio (ICER) for a 1point increase in the mean score for leadership (Jeon et al., 2015) (SD 2b) The mean-based ICER of 1-point increase in the mean score for leadership was AUS$ 1343 (Jeon et al., 2015). In another study with psychoeducational group sessions aiming to provide staff with specialized knowledge regarding the condition of dementia and its care delivered by facilitators, the importance of the facilitators' role was emphasized by the participants (SD 2a) (Figueiredo et al., 2013). 3.5. Process steering For the PBIC “Process Steering”, a total of 3542 articles were

found and five articles were included in the review. The interventions described in the studies included a structured process and follow up (Amuwo et al., 2011; Baumann et al., 2012; Jeon et al., 2015; Olson et al., 2015; Pillemer et al., 2008) or use of a scripted manual (Olson et al., 2015). Two studies were RCTs (Jeon et al., 2015; Pillemer et al., 2008), whereas the other studies were process evaluations (Amuwo et al., 2011; Baumann et al., 2012; Olson et al., 2015). None of the included studies evaluated on the effect of process steering specifically (SD 1). An additional 4 articles were identified as relevant to this PBIC (Andersen and Westgaard, 2013; Hartvigsen et al., 2005; Leff et al., 2000; Rasmussen et al., 2015). None of these studies evaluated on the effect of process steering (SD 1). 3.6. Relevant to current workplace needs For the PBIC “Relevant to Current Workplace Needs”, a total of 3550 articles were found and three articles were included in the final review. The concept was represented as a needs assessment in all three studies (Barbosa et al., 2014; Figueiredo et al., 2013; Mccarthy, 1992), and one of the studies used information from a pilot study to develop the intervention (Barbosa et al., 2014). Two of the studies were classified as pilot studies (Figueiredo et al., 2013; Mccarthy, 1992), and the third study used before and after measurements (Barbosa et al., 2014). None of the included studies evaluated on the effect of the intervention being relevant to current workplace needs (SD 1). An additional 10 articles were identified as relevant to this PBIC

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187

Table 3 Overview of all 38 studies included in the review. They are ranged according to total number of practice-based implementation components (ranging from 1 to 7 components). Engaged and Practice-based implementation Active Management components (PBIC) (Figueiredo et al., 2013) (Baumann et al., 2012) (Amuwo et al., 2011) (Leff et al., 2000) (Petterson et al., 2006) (Mccarthy, 1992) (Rasmussen et al., 2015) (Jeon et al., 2015) (Morgan and Konrad, 2008) (Yeatts and Cready, 2007) (Beck et al., 2014) (Marziali et al., 2014) (Pillemer et al., 2008) (Barbosa et al., 2014) (Olson et al., 2015) (MacDonald and Walton, 2007) (Dill et al., 2009) (Flannery et al., 2012) (Proctor et al., 1998) €rde, (Forsga 2000) (Kurowski et al., 2012) (Amuwo et al., 2013) (Hartvigsen et al., 2005) (Ho et al., 2012) (Jeon et al., 2012) (Pohjonen et al., 1998) (Nabe-Nielsen et al., 2011) (Nabe-Nielsen et al., 2012) (Nelson et al., 2006) (Coogle et al., 2006) (Tveito and Eriksen, 2009) (Garde et al., 2011) (Zwijsen et al., 2015) (Andersen and Westgaard, 2013) (Czuba et al., 2012)

Available Connected with Daily and Ready to Work Tasks Use

O

X

General Structures and Resources in Place to Make it Happen

Engaged Easy Transfer Employees to Action

X

O

O

O

O

X

O

O

X

X

X

O

X

X

X X

O

O X

X

O

O

O

O

O

X

O

X

O

X

O O

Awareness, Mutual Goals and Coproduction O

O X

O O

O

O

O

O

X

O

O

O

O

O X

O O

O

O

X

O

X

O

O O

O

O

O X

O

O

O

O O

O O

X

O

O

X

O

O

X

X

O O

O

O

X

O

O

X

X O

O

O

X

O

O

X

O

O

Delivered in an Attractive Form

O

X

X

Support from Internal and External Stakeholders

Process Relevant to Steering Current Workplace Needs

O

O O

X O

O

O

O

O

O

O

O

O O

O

O

O

O

O O

O

X (continued on next page)

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Table 3 (continued ) Engaged and Practice-based implementation Active Management components (PBIC)

Available Connected with Daily and Ready to Work Tasks Use

General Structures and Resources in Place to Make it Happen

Process Relevant to Steering Current Workplace Needs

(van der Meer et al., 2014) (Peterson et al., 2008) (Stevens et al., 1998)

Engaged Easy Transfer Employees to Action

Awareness, Mutual Goals and Coproduction

Support from Internal and External Stakeholders

Delivered in an Attractive Form

X O O

X ¼ Included from original component searches. O ¼ Included from other component searches.

(Baumann et al., 2012; Dill et al., 2009; Flannery et al., 2012; Kurowski et al., 2012; Leff et al., 2000; MacDonald and Walton, 2007; Nabe-Nielsen et al., 2012; Nelson et al., 2006; Pillemer et al., 2008; Proctor et al., 1998). Most of the included studies didn't evaluate on the effect of the intervention being relevant to current workplace needs (SD 1). One study evaluated a health and safety intervention (participatory ergonomic intervention) including a hazard specific assessment (assessment tools included among others an organizational profile, consultant logs and safety checklists). The assessment was used to refine the program on an ongoing basis and the tools for assessment was found useful by the participants (SD 2a) (Baumann et al., 2012). 3.7. Easy transfer to action For the PBIC “Easy Transfer to Action”, a total of 855 articles were found and nine articles were included for full reading of text. After full text reading we excluded all nine articles. When assessing articles included for the 10 other components, none of the articles matched the concept. Therefore, there are no studies evaluating this concept. 3.8. Engaged employees For the PBIC “Engaged Employees”, a total of 153 articles were found and six articles were included in the review. The concept was mostly represented as involving the employees through a participatory approach (Amuwo et al., 2011; Czuba et al., 2012; Pohjonen et al., 1998; Rasmussen et al., 2015; van der Meer et al., 2014). One study used small group interactive training (Amuwo et al., 2013). Two of the studies were RCTs (Rasmussen et al., 2015; van der Meer et al., 2014) and one was a controlled trial (Pohjonen et al., 1998). The remaining studies used before and after measurements (Amuwo et al., 2013; Czuba et al., 2012) and a process evaluation (Amuwo et al., 2011). None of the included studies evaluated on the concept specifically (SD 1). An additional 19 articles were identified as relevant to this PBIC (Andersen and Westgaard, 2013; Barbosa et al., 2014; Baumann et al., 2012; Beck et al., 2014; Figueiredo et al., 2013; Flannery et al., 2012; Garde et al., 2011; Leff et al., 2000; Mccarthy, 1992, Nabe-Nielsen et al., 2011; Nabe-Nielsen et al., 2012; Nelson et al., 2006; Olson et al., 2015; Peterson et al., 2008; Petterson et al., 2006; Pillemer et al., 2008; Tveito and Eriksen, 2009; Yeatts and Cready, 2007; Zwijsen et al., 2015). A prospective, quasi experimental study aimed at investigating if increased influence on working hours among shift workers led to better sleep quality. The employees were categorized into groups based on the performed activities: High (self-rostering), moderate (education and/or policy for working hours), and low intensity intervention (meetings and discussions) and reference. Influence on one's own working hours

increased only in the high intensity group and no effects on sleep quality were observed for any of the groups (SD 3) (Garde et al., 2011). Barbosa and colleagues had a supportive component in their program where the employees among others were asked to interact with each other (Barbosa et al., 2014). After the intervention participants reported qualitatively that their interaction had become better, but did not relate this finding to the effect on stress, burnout, and job satisfaction (SD 2a) (Barbosa et al., 2014). A study investigating implementation of empowered work teams found an increase in empowerment, but did not evaluate the effect of this on turnover (SD 2b) (Yeatts and Cready, 2007). In the study by Bauman and colleagues investigating the effect of a health and safety intervention (participatory ergonomic intervention) for improving culture of safety, the process evaluation of the study revealed that team dynamics were heightened and there was an increase in communication among staff. However, these findings were not related to the effect on culture of safety (SD 2a) (Baumann et al., 2012). The remaining included studies didn't evaluate on the effect of engaged employees (SD 1). 3.9. Awareness, mutual goals and co-production For the PBIC “Awareness, Mutual Goals and Co-production”, a total of 3282 articles were found and two articles were included for full reading of text. After full text reading we had to exclude both. An additional 7 articles were identified as relevant to this PBIC (Baumann et al., 2012; Beck et al., 2014; Dill et al., 2009; Figueiredo et al., 2013; Leff et al., 2000; Morgan and Konrad, 2008; Pohjonen et al., 1998). A study investigating implementation of empowered work teams that included orienting and training of both certified nursing assistants, nurses and nurse management found mixed effects on cooperation between the groups (SD 2c) (Yeatts and Cready, 2007). In another study with psychoeducational group sessions aiming to provide staff with specialized knowledge regarding the condition of dementia and its care, the participants reported that the program was perceived as an opportunity to increase the group cohesion (SD 2a) (Figueiredo et al., 2013). However, both of the above mentioned studies did not evaluate on the effect of awareness, mutual goals and co-production on the working environment. 3.10. Support from internal and external stakeholders For the PBIC “Support from Internal and External Stakeholders”, a total of 1859 articles were found. In the final review one article was included. The intervention described in the study was strongly supported by the top management and the unions. The study was evaluated with before and after measurements (Petterson et al., 2006). However the study didn't evaluate on the effect of Support from Internal and External Stakeholders in the intervention, but

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189

Engaged and AcƟve Management

Available and Ready to Use Connected with Daily Work Tasks

General Structures and Resources in Place to Make it Happen

Process Steering Relevant to Current Workplace Needs Easy Transfer to AcƟon

Engaged Employees

Awareness, Mutual Goals and Co-producƟon Support from Internal and External Stakeholders Delivered in an AƩracƟve Form 0

1

2

3

4

5

Fig. 3. Overview of the study design on a scale from 1 to 5 of the 125 study design assessments in the review; 1) if the study included the practice-based implementation concept in the intervention but did not specifically evaluate the concept, 2) if the study included the practice-based implementation concept in the intervention and evaluated the concept, 3) if the study had included the practice-based implementation concept in a controlled design, 4) if the study examined the practice-based implementation concept in an RCT design, 5) if the study was a review of the practice-based implementation concept.

only described this as being part of the intervention (SD 1). An additional six articles were identified as relevant to this PBIC (Amuwo et al., 2011, Amuwo et al., 2013; Baumann et al., 2012; Jeon et al., 2015; Rasmussen et al., 2015; Stevens et al., 1998). None of these studies evaluated on the effect of support from internal and external stakeholders, but only described this as being part of the intervention (SD 1).

3.11. Delivered in an attractive form For the PBIC “Delivered in an Attractive Form”, a total of 1789 articles were found. In the final review only one article was included. The intervention described in the study encompassed educational pedagogies and innovative ways to conceptualise and deliver a healthcare education (MacDonald and Walton, 2007). The study used before and after measurements, but didn't specifically

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evaluate the concept of delivered in an attractive form (SD 1). An additional six articles were identified as relevant to this PBIC (Amuwo et al., 2011; Figueiredo et al., 2013; Ho et al., 2012; Marziali et al., 2014; Mccarthy, 1992, Olson et al., 2015). In a study by Amuwo and colleagues, two training tools were developed: an information card for home care aides and a sharps safety magnet for their clients. A process evaluation found that most (72%) of the home care aides preferred the training tools to lecture-style trainings typically offered (SD 2b) (Amuwo et al., 2011). In the study by Figueiredo and colleagues, a psychoeducational program for staff in care homes was introduced to increase knowledge regarding dementia care, promote skills to integrate motor and multisensory stimulation in daily care, and develop coping strategies to manage emotional work related demands. Various didactic methods, such as case examples based on staff past experiences, group discussions, homework exercises, role-playing, and brainstorming were used during the psychoeducational sessions. The qualitative evaluation following implementation of the intervention showed that participants found the materials and didactic methods, such as discussions, group exercises, role-playing or brainstorming very useful (SD 2a) (Figueiredo et al., 2013). However, the remaining four of the studies only described the form of the delivery as part of the intervention (SD 1). 4. Discussion With this study we aimed to investigate the quality and extent of scientific research of practice-based knowledge regarding implementation of effective and sustainable work environment interventions. The overall result of this review is that 10 of the 11 PBIC's are described in the scientific literature, but the overall SD of the studies is mostly poor in terms of traditional evidence-based evaluation. Only two of the included 38 studies specifically evaluated the effect of including the implementation component in the intervention (SD 3 and 4) (Garde et al., 2011; Jeon et al., 2015) and only one of those studies evaluated the implementation concept in an RCT design (Jeon et al., 2015). Our findings suggest the following: 1) more research is needed, and 2) traditional scientific methods aren't suitable methods to study these PBIC's. Our discussion will address these possibilities one at a time. 4.1. More research is needed Our study may indicate that implementation components that are recognised by practitioners to be feasible are not scientifically documented. If they are studied they are only vaguely presented in the intervention description, and the evaluation of the contribution of the implementation components for the effectiveness of an intervention is not prioritized in the design. This challenges implementation science, since important implementation components may not be recognised as important or scientifically founded (Durlak and DuPre, 2008). But it also challenges our interpretation of the evaluation of the effective components in interventions, since these are seldom detached from the implementation components in effectiveness studies (Durlak and DuPre, 2008; Peters et al., 2014), and thus outcomes of such studies cannot be ascribed to the effective components themselves, but is battered in the implementation. This is as such not a problem if the implementation components are clearly described, since the intervention then is a combination of implementation and effective components. However, often the effective components are included only because thorough research has been conducted on the efficiency of the effective component, while the implementation components are included based on less strict criteria. While scientific evidence is

not the only criteria for inclusion of implementation components (good stakeholder involvement and local ownership is essential), more well-founded scientific attention to feasible implementation components would contribute to a more broad recognition of the importance of good implementation and the soundness of including it as a main component in interventions. 4.2. Traditional scientific designs aren't the way to address this While effective components of interventions are often intended to be evaluated in high quality designs like RCTs, our study indicates that the inclusion and evaluation of implementation components don't receive much attention. Overall this leads us to the question whether it is even possible to evaluate implementation components? As long as there is no consistent reporting of implementation components, we cannot know if these implementation components have been considered, and the failure or success of the implementation components therefore remains a black box (Saunders et al., 2005). Most intervention studies consisted of several implementation components. Only four of the 38 included studies only described one of the implementation components (Czuba et al., 2012; Peterson et al., 2008; Stevens et al., 1998; van der Meer et al., 2014). This suggests that there often is a need for several components at a time to achieve effective implementation. For instance, it may not be important that there is an engaged management if the workers are not involved as well. And thus it is perhaps pointless to examine management as an independent component in an RCT design. Future studies should explicitly describe what the efficient intervention components are and what the implementation components are. Furthermore, it could be interesting to evaluate the implementation components more explicitly in an appropriate evaluation design. An additional number of articles were identified as relevant to the PBIC's even though the studies weren't identified in our original search. If we only relied on our original search, there wouldn't have been identified any studies evaluating the components in three of the PBIC's (Table 2). Interestingly four of the implementation components had more than 10 additional studies added from this procedure. This reflects that our original search wasn't able to identify these articles. This could be due to that the implementation components are so specific that they cannot be found by the keywords. Only two studies had a SD of 3 or more (Garde et al., 2011; Jeon et al., 2015). In order to get a SD of 3 or more the concept has to be present in the intervention group, but not in the comparison group. However, since most of the studies were multi-factorial and consisted of several implementation components, it was difficult to distinguish the effects of each component. 5. Limitations and implications for practice The methodological approaches used in our rapid review differ from the traditional systematic review in that we used a less comprehensive search strategy (i.e. no grey-literature search, no attempt to contact leading authors in the field, inclusion of Englishonly articles), did not assess for possible publication bias and made no plan to pool the data and perform a meta-analysis. Furthermore, only three databases where included in our searches. Searching more databases would possibly have increased the number of identified articles. While some have questioned the validity of rapid reviews (Ganann et al., 2010; Watt et al., 2008b) there remains a need to achieve a balance between comprehensiveness and timeliness in order to disseminate the findings of research rather quickly to respond the needs of practice. This study sought to investigate the knowledge-gaps between practice and research of

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11 PBIC's. This means, that we were only interested in mapping the existing literature and not provide actual advice on what to do based on the evidence. Although we used a rapid review, two researchers did the quality assessment. Another strength of this study is that it derived from practice and that the research is grounded in the needs of practice. 5.1. Practice-based research may move us forward This review is the first seeking to identify the scientific literature about practice-based implementation components. From this review it is clear that there are knowledge gaps between evidence and practice with respect to the effectiveness of PBIC's for sustainable work environment interventions. If we move away from scientific evidence criteria and instead ask the practitioners and thereby producing the research closer to the actual circumstances of practice we may produce research that is made more relevant, more actionable and more tailored to practice and the context where it is supposed to be applied. Furthermore, we may thereby succeed in narrowing the knowledge gaps between evidence and practice. Acknowledgements The authors would like to acknowledge the Danish Government for their financial support. Abbreviations SD PBIC RR RCT

Study Design Practice based implementation concept Rapid Review Randomised controlled trial

Competing interests The authors declare that they have no competing interests. Authors' contributions CNR and MBJ created the study concept and design. CNR, HH and EB constructed and refined the search strategy. CNR and HH acquired the data. Analysis and interpretation of the data was completed by CNR, HHJ and MBJ. CNR was responsible for drafting the paper. All authors have read and commented on the draft version as well as approved the final version of the manuscript. Funding The study was financed by the Danish Government through a grant to the FOR-SOSU program (SATS 2004) at the National Research Centre for the Working Environment. The funding source did not take part in the study design, data collection, interpretation of the results, writing of the manuscript, or decisions regarding publication of the manuscript. References Amuwo, S., Sokas, R.K., Nickels, L., Zanoni, J., Lipscomb, J., 2011. Implementation and evaluation of interventions for home care aides on blood and body fluid exposure in large-group settings. New Solut. 21, 235e250. Amuwo, S., Lipscomb, J., McPhaul, K., Sokas, R.K., 2013. Reducing occupational risk for blood and body fluid exposure among home care aides: an intervention effectiveness study. Home Health Care Serv. Q. 32, 234e248. Andersen, G.R., Westgaard, R.H., 2013. Understanding significant processes during work environment interventions to alleviate time pressure and associated sick leave of home care workers  a case study. BMC Health Serv. Res. 13, 477.

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