research article framework

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Organizing Your Social Sciences Research Paper

• Theoretical Framework
• Purpose of Guide
• Design Flaws to Avoid
• Independent and Dependent Variables
• Glossary of Research Terms
• Reading Research Effectively
• Narrowing a Topic Idea
• Broadening a Topic Idea
• Extending the Timeliness of a Topic Idea
• Academic Writing Style
• Applying Critical Thinking
• Choosing a Title
• Making an Outline
• Paragraph Development
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• Executive Summary
• The C.A.R.S. Model
• Background Information
• The Research Problem/Question
• Citation Tracking
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• Evaluating Sources
• Primary Sources
• Secondary Sources
• Tiertiary Sources
• Scholarly vs. Popular Publications
• Qualitative Methods
• Quantitative Methods
• Insiderness
• Using Non-Textual Elements
• Limitations of the Study
• Common Grammar Mistakes
• Writing Concisely
• Avoiding Plagiarism
• Footnotes or Endnotes?
• Further Readings
• Generative AI and Writing
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Theories are formulated to explain, predict, and understand phenomena and, in many cases, to challenge and extend existing knowledge within the limits of critical bounded assumptions or predictions of behavior. The theoretical framework is the structure that can hold or support a theory of a research study. The theoretical framework encompasses not just the theory, but the narrative explanation about how the researcher engages in using the theory and its underlying assumptions to investigate the research problem. It is the structure of your paper that summarizes concepts, ideas, and theories derived from prior research studies and which was synthesized in order to form a conceptual basis for your analysis and interpretation of meaning found within your research.

Abend, Gabriel. "The Meaning of Theory." Sociological Theory 26 (June 2008): 173–199; Kivunja, Charles. "Distinguishing between Theory, Theoretical Framework, and Conceptual Framework: A Systematic Review of Lessons from the Field." International Journal of Higher Education 7 (December 2018): 44-53; Swanson, Richard A. Theory Building in Applied Disciplines . San Francisco, CA: Berrett-Koehler Publishers 2013; Varpio, Lara, Elise Paradis, Sebastian Uijtdehaage, and Meredith Young. "The Distinctions between Theory, Theoretical Framework, and Conceptual Framework." Academic Medicine 95 (July 2020): 989-994.

Importance of Theory and a Theoretical Framework

Theories can be unfamiliar to the beginning researcher because they are rarely applied in high school social studies curriculum and, as a result, can come across as unfamiliar and imprecise when first introduced as part of a writing assignment. However, in their most simplified form, a theory is simply a set of assumptions or predictions about something you think will happen based on existing evidence and that can be tested to see if those outcomes turn out to be true. Of course, it is slightly more deliberate than that, therefore, summarized from Kivunja (2018, p. 46), here are the essential characteristics of a theory.

• It is logical and coherent
• It has clear definitions of terms or variables, and has boundary conditions [i.e., it is not an open-ended statement]
• It has a domain where it applies
• It has clearly described relationships among variables
• It describes, explains, and makes specific predictions
• It comprises of concepts, themes, principles, and constructs
• It must have been based on empirical data [i.e., it is not a guess]
• It must have made claims that are subject to testing, been tested and verified
• It must be clear and concise
• Its assertions or predictions must be different and better than those in existing theories
• Its predictions must be general enough to be applicable to and understood within multiple contexts
• Its assertions or predictions are relevant, and if applied as predicted, will result in the predicted outcome
• The assertions and predictions are not immutable, but subject to revision and improvement as researchers use the theory to make sense of phenomena
• Its concepts and principles explain what is going on and why
• Its concepts and principles are substantive enough to enable us to predict a future

Given these characteristics, a theory can best be understood as the foundation from which you investigate assumptions or predictions derived from previous studies about the research problem, but in a way that leads to new knowledge and understanding as well as, in some cases, discovering how to improve the relevance of the theory itself or to argue that the theory is outdated and a new theory needs to be formulated based on new evidence.

A theoretical framework consists of concepts and, together with their definitions and reference to relevant scholarly literature, existing theory that is used for your particular study. The theoretical framework must demonstrate an understanding of theories and concepts that are relevant to the topic of your research paper and that relate to the broader areas of knowledge being considered.

The theoretical framework is most often not something readily found within the literature . You must review course readings and pertinent research studies for theories and analytic models that are relevant to the research problem you are investigating. The selection of a theory should depend on its appropriateness, ease of application, and explanatory power.

The theoretical framework strengthens the study in the following ways :

• An explicit statement of  theoretical assumptions permits the reader to evaluate them critically.
• The theoretical framework connects the researcher to existing knowledge. Guided by a relevant theory, you are given a basis for your hypotheses and choice of research methods.
• Articulating the theoretical assumptions of a research study forces you to address questions of why and how. It permits you to intellectually transition from simply describing a phenomenon you have observed to generalizing about various aspects of that phenomenon.
• Having a theory helps you identify the limits to those generalizations. A theoretical framework specifies which key variables influence a phenomenon of interest and highlights the need to examine how those key variables might differ and under what circumstances.
• The theoretical framework adds context around the theory itself based on how scholars had previously tested the theory in relation their overall research design [i.e., purpose of the study, methods of collecting data or information, methods of analysis, the time frame in which information is collected, study setting, and the methodological strategy used to conduct the research].

By virtue of its applicative nature, good theory in the social sciences is of value precisely because it fulfills one primary purpose: to explain the meaning, nature, and challenges associated with a phenomenon, often experienced but unexplained in the world in which we live, so that we may use that knowledge and understanding to act in more informed and effective ways.

The Conceptual Framework. College of Education. Alabama State University; Corvellec, Hervé, ed. What is Theory?: Answers from the Social and Cultural Sciences . Stockholm: Copenhagen Business School Press, 2013; Asher, Herbert B. Theory-Building and Data Analysis in the Social Sciences . Knoxville, TN: University of Tennessee Press, 1984; Drafting an Argument. Writing@CSU. Colorado State University; Kivunja, Charles. "Distinguishing between Theory, Theoretical Framework, and Conceptual Framework: A Systematic Review of Lessons from the Field." International Journal of Higher Education 7 (2018): 44-53; Omodan, Bunmi Isaiah. "A Model for Selecting Theoretical Framework through Epistemology of Research Paradigms." African Journal of Inter/Multidisciplinary Studies 4 (2022): 275-285; Ravitch, Sharon M. and Matthew Riggan. Reason and Rigor: How Conceptual Frameworks Guide Research . Second edition. Los Angeles, CA: SAGE, 2017; Trochim, William M.K. Philosophy of Research. Research Methods Knowledge Base. 2006; Jarvis, Peter. The Practitioner-Researcher. Developing Theory from Practice . San Francisco, CA: Jossey-Bass, 1999.

Strategies for Developing the Theoretical Framework

I.  Developing the Framework

Here are some strategies to develop of an effective theoretical framework:

• Examine your thesis title and research problem . The research problem anchors your entire study and forms the basis from which you construct your theoretical framework.
• Brainstorm about what you consider to be the key variables in your research . Answer the question, "What factors contribute to the presumed effect?"
• Review related literature to find how scholars have addressed your research problem. Identify the assumptions from which the author(s) addressed the problem.
• List  the constructs and variables that might be relevant to your study. Group these variables into independent and dependent categories.
• Review key social science theories that are introduced to you in your course readings and choose the theory that can best explain the relationships between the key variables in your study [note the Writing Tip on this page].
• Discuss the assumptions or propositions of this theory and point out their relevance to your research.

A theoretical framework is used to limit the scope of the relevant data by focusing on specific variables and defining the specific viewpoint [framework] that the researcher will take in analyzing and interpreting the data to be gathered. It also facilitates the understanding of concepts and variables according to given definitions and builds new knowledge by validating or challenging theoretical assumptions.

II.  Purpose

Think of theories as the conceptual basis for understanding, analyzing, and designing ways to investigate relationships within social systems. To that end, the following roles served by a theory can help guide the development of your framework.

• Means by which new research data can be interpreted and coded for future use,
• Response to new problems that have no previously identified solutions strategy,
• Means for identifying and defining research problems,
• Means for prescribing or evaluating solutions to research problems,
• Ways of discerning certain facts among the accumulated knowledge that are important and which facts are not,
• Means of giving old data new interpretations and new meaning,
• Means by which to identify important new issues and prescribe the most critical research questions that need to be answered to maximize understanding of the issue,
• Means of providing members of a professional discipline with a common language and a frame of reference for defining the boundaries of their profession, and
• Means to guide and inform research so that it can, in turn, guide research efforts and improve professional practice.

Adapted from: Torraco, R. J. “Theory-Building Research Methods.” In Swanson R. A. and E. F. Holton III , editors. Human Resource Development Handbook: Linking Research and Practice . (San Francisco, CA: Berrett-Koehler, 1997): pp. 114-137; Jacard, James and Jacob Jacoby. Theory Construction and Model-Building Skills: A Practical Guide for Social Scientists . New York: Guilford, 2010; Ravitch, Sharon M. and Matthew Riggan. Reason and Rigor: How Conceptual Frameworks Guide Research . Second edition. Los Angeles, CA: SAGE, 2017; Sutton, Robert I. and Barry M. Staw. “What Theory is Not.” Administrative Science Quarterly 40 (September 1995): 371-384.

Structure and Writing Style

The theoretical framework may be rooted in a specific theory , in which case, your work is expected to test the validity of that existing theory in relation to specific events, issues, or phenomena. Many social science research papers fit into this rubric. For example, Peripheral Realism Theory, which categorizes perceived differences among nation-states as those that give orders, those that obey, and those that rebel, could be used as a means for understanding conflicted relationships among countries in Africa. A test of this theory could be the following: Does Peripheral Realism Theory help explain intra-state actions, such as, the disputed split between southern and northern Sudan that led to the creation of two nations?

However, you may not always be asked by your professor to test a specific theory in your paper, but to develop your own framework from which your analysis of the research problem is derived . Based upon the above example, it is perhaps easiest to understand the nature and function of a theoretical framework if it is viewed as an answer to two basic questions:

• What is the research problem/question? [e.g., "How should the individual and the state relate during periods of conflict?"]
• Why is your approach a feasible solution? [i.e., justify the application of your choice of a particular theory and explain why alternative constructs were rejected. I could choose instead to test Instrumentalist or Circumstantialists models developed among ethnic conflict theorists that rely upon socio-economic-political factors to explain individual-state relations and to apply this theoretical model to periods of war between nations].

The answers to these questions come from a thorough review of the literature and your course readings [summarized and analyzed in the next section of your paper] and the gaps in the research that emerge from the review process. With this in mind, a complete theoretical framework will likely not emerge until after you have completed a thorough review of the literature .

Just as a research problem in your paper requires contextualization and background information, a theory requires a framework for understanding its application to the topic being investigated. When writing and revising this part of your research paper, keep in mind the following:

• Clearly describe the framework, concepts, models, or specific theories that underpin your study . This includes noting who the key theorists are in the field who have conducted research on the problem you are investigating and, when necessary, the historical context that supports the formulation of that theory. This latter element is particularly important if the theory is relatively unknown or it is borrowed from another discipline.
• Position your theoretical framework within a broader context of related frameworks, concepts, models, or theories . As noted in the example above, there will likely be several concepts, theories, or models that can be used to help develop a framework for understanding the research problem. Therefore, note why the theory you've chosen is the appropriate one.
• The present tense is used when writing about theory. Although the past tense can be used to describe the history of a theory or the role of key theorists, the construction of your theoretical framework is happening now.
• You should make your theoretical assumptions as explicit as possible . Later, your discussion of methodology should be linked back to this theoretical framework.
• Don’t just take what the theory says as a given! Reality is never accurately represented in such a simplistic way; if you imply that it can be, you fundamentally distort a reader's ability to understand the findings that emerge. Given this, always note the limitations of the theoretical framework you've chosen [i.e., what parts of the research problem require further investigation because the theory inadequately explains a certain phenomena].

The Conceptual Framework. College of Education. Alabama State University; Conceptual Framework: What Do You Think is Going On? College of Engineering. University of Michigan; Drafting an Argument. Writing@CSU. Colorado State University; Lynham, Susan A. “The General Method of Theory-Building Research in Applied Disciplines.” Advances in Developing Human Resources 4 (August 2002): 221-241; Tavallaei, Mehdi and Mansor Abu Talib. "A General Perspective on the Role of Theory in Qualitative Research." Journal of International Social Research 3 (Spring 2010); Ravitch, Sharon M. and Matthew Riggan. Reason and Rigor: How Conceptual Frameworks Guide Research . Second edition. Los Angeles, CA: SAGE, 2017; Reyes, Victoria. Demystifying the Journal Article. Inside Higher Education; Trochim, William M.K. Philosophy of Research. Research Methods Knowledge Base. 2006; Weick, Karl E. “The Work of Theorizing.” In Theorizing in Social Science: The Context of Discovery . Richard Swedberg, editor. (Stanford, CA: Stanford University Press, 2014), pp. 177-194.

Writing Tip

Borrowing Theoretical Constructs from Other Disciplines

An increasingly important trend in the social and behavioral sciences is to think about and attempt to understand research problems from an interdisciplinary perspective. One way to do this is to not rely exclusively on the theories developed within your particular discipline, but to think about how an issue might be informed by theories developed in other disciplines. For example, if you are a political science student studying the rhetorical strategies used by female incumbents in state legislature campaigns, theories about the use of language could be derived, not only from political science, but linguistics, communication studies, philosophy, psychology, and, in this particular case, feminist studies. Building theoretical frameworks based on the postulates and hypotheses developed in other disciplinary contexts can be both enlightening and an effective way to be more engaged in the research topic.

CohenMiller, A. S. and P. Elizabeth Pate. "A Model for Developing Interdisciplinary Research Theoretical Frameworks." The Qualitative Researcher 24 (2019): 1211-1226; Frodeman, Robert. The Oxford Handbook of Interdisciplinarity . New York: Oxford University Press, 2010.

Another Writing Tip

Don't Undertheorize!

Do not leave the theory hanging out there in the introduction never to be mentioned again. Undertheorizing weakens your paper. The theoretical framework you describe should guide your study throughout the paper. Be sure to always connect theory to the review of pertinent literature and to explain in the discussion part of your paper how the theoretical framework you chose supports analysis of the research problem or, if appropriate, how the theoretical framework was found to be inadequate in explaining the phenomenon you were investigating. In that case, don't be afraid to propose your own theory based on your findings.

Yet Another Writing Tip

What's a Theory? What's a Hypothesis?

The terms theory and hypothesis are often used interchangeably in newspapers and popular magazines and in non-academic settings. However, the difference between theory and hypothesis in scholarly research is important, particularly when using an experimental design. A theory is a well-established principle that has been developed to explain some aspect of the natural world. Theories arise from repeated observation and testing and incorporates facts, laws, predictions, and tested assumptions that are widely accepted [e.g., rational choice theory; grounded theory; critical race theory].

A hypothesis is a specific, testable prediction about what you expect to happen in your study. For example, an experiment designed to look at the relationship between study habits and test anxiety might have a hypothesis that states, "We predict that students with better study habits will suffer less test anxiety." Unless your study is exploratory in nature, your hypothesis should always explain what you expect to happen during the course of your research.

The key distinctions are:

• A theory predicts events in a broad, general context;  a hypothesis makes a specific prediction about a specified set of circumstances.
• A theory has been extensively tested and is generally accepted among a set of scholars; a hypothesis is a speculative guess that has yet to be tested.

Cherry, Kendra. Introduction to Research Methods: Theory and Hypothesis. About.com Psychology; Gezae, Michael et al. Welcome Presentation on Hypothesis. Slideshare presentation.

Still Yet Another Writing Tip

Be Prepared to Challenge the Validity of an Existing Theory

Theories are meant to be tested and their underlying assumptions challenged; they are not rigid or intransigent, but are meant to set forth general principles for explaining phenomena or predicting outcomes. Given this, testing theoretical assumptions is an important way that knowledge in any discipline develops and grows. If you're asked to apply an existing theory to a research problem, the analysis will likely include the expectation by your professor that you should offer modifications to the theory based on your research findings.

Indications that theoretical assumptions may need to be modified can include the following:

• Your findings suggest that the theory does not explain or account for current conditions or circumstances or the passage of time,
• The study reveals a finding that is incompatible with what the theory attempts to explain or predict, or
• Your analysis reveals that the theory overly generalizes behaviors or actions without taking into consideration specific factors revealed from your analysis [e.g., factors related to culture, nationality, history, gender, ethnicity, age, geographic location, legal norms or customs , religion, social class, socioeconomic status, etc.].

Philipsen, Kristian. "Theory Building: Using Abductive Search Strategies." In Collaborative Research Design: Working with Business for Meaningful Findings . Per Vagn Freytag and Louise Young, editors. (Singapore: Springer Nature, 2018), pp. 45-71; Shepherd, Dean A. and Roy Suddaby. "Theory Building: A Review and Integration." Journal of Management 43 (2017): 59-86.

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Theoretical Framework Example for a Thesis or Dissertation

Published on October 14, 2015 by Sarah Vinz . Revised on July 18, 2023 by Tegan George.

Your theoretical framework defines the key concepts in your research, suggests relationships between them, and discusses relevant theories based on your literature review .

A strong theoretical framework gives your research direction. It allows you to convincingly interpret, explain, and generalize from your findings and show the relevance of your thesis or dissertation topic in your field.

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Table of contents

Sample problem statement and research questions, sample theoretical framework, your theoretical framework, other interesting articles.

Your theoretical framework is based on:

• Your problem statement
• Your research questions
• Your literature review

A new boutique downtown is struggling with the fact that many of their online customers do not return to make subsequent purchases. This is a big issue for the otherwise fast-growing store.Management wants to increase customer loyalty. They believe that improved customer satisfaction will play a major role in achieving their goal of increased return customers.

To investigate this problem, you have zeroed in on the following problem statement, objective, and research questions:

• Problem : Many online customers do not return to make subsequent purchases.
• Objective : To increase the quantity of return customers.
• Research question : How can the satisfaction of the boutique’s online customers be improved in order to increase the quantity of return customers?

The concepts of “customer loyalty” and “customer satisfaction” are clearly central to this study, along with their relationship to the likelihood that a customer will return. Your theoretical framework should define these concepts and discuss theories about the relationship between these variables.

Some sub-questions could include:

• What is the relationship between customer loyalty and customer satisfaction?
• How satisfied and loyal are the boutique’s online customers currently?
• What factors affect the satisfaction and loyalty of the boutique’s online customers?

As the concepts of “loyalty” and “customer satisfaction” play a major role in the investigation and will later be measured, they are essential concepts to define within your theoretical framework .

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Below is a simplified example showing how you can describe and compare theories in your thesis or dissertation . In this example, we focus on the concept of customer satisfaction introduced above.

Customer satisfaction

Thomassen (2003, p. 69) defines customer satisfaction as “the perception of the customer as a result of consciously or unconsciously comparing their experiences with their expectations.” Kotler & Keller (2008, p. 80) build on this definition, stating that customer satisfaction is determined by “the degree to which someone is happy or disappointed with the observed performance of a product in relation to his or her expectations.”

Performance that is below expectations leads to a dissatisfied customer, while performance that satisfies expectations produces satisfied customers (Kotler & Keller, 2003, p. 80).

The definition of Zeithaml and Bitner (2003, p. 86) is slightly different from that of Thomassen. They posit that “satisfaction is the consumer fulfillment response. It is a judgement that a product or service feature, or the product of service itself, provides a pleasurable level of consumption-related fulfillment.” Zeithaml and Bitner’s emphasis is thus on obtaining a certain satisfaction in relation to purchasing.

Thomassen’s definition is the most relevant to the aims of this study, given the emphasis it places on unconscious perception. Although Zeithaml and Bitner, like Thomassen, say that customer satisfaction is a reaction to the experience gained, there is no distinction between conscious and unconscious comparisons in their definition.

The boutique claims in its mission statement that it wants to sell not only a product, but also a feeling. As a result, unconscious comparison will play an important role in the satisfaction of its customers. Thomassen’s definition is therefore more relevant.

Thomassen’s Customer Satisfaction Model

According to Thomassen, both the so-called “value proposition” and other influences have an impact on final customer satisfaction. In his satisfaction model (Fig. 1), Thomassen shows that word-of-mouth, personal needs, past experiences, and marketing and public relations determine customers’ needs and expectations.

These factors are compared to their experiences, with the interplay between expectations and experiences determining a customer’s satisfaction level. Thomassen’s model is important for this study as it allows us to determine both the extent to which the boutique’s customers are satisfied, as well as where improvements can be made.

Figure 1 Customer satisfaction creation 

Of course, you could analyze the concepts more thoroughly and compare additional definitions to each other. You could also discuss the theories and ideas of key authors in greater detail and provide several models to illustrate different concepts.

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What Is A Theoretical Framework? A Practical Answer

• Published: 30 November 2015
• Volume 26 , pages 593–597, ( 2015 )

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• Norman G. Lederman 1 &
• Judith S. Lederman 1  

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Avoid common mistakes on your manuscript.

Other than the poor or non-existent validity and/or reliability of data collection measures, the lack of a theoretical framework is the most frequently cited reason for our editorial decision not to publish a manuscript in the Journal of Science Teacher Education . A poor or missing theoretical framework is similarly a critical problem for manuscripts submitted to other journals for which Norman or Judith have either served as Editor or been on the Editorial Board. Often the problem is that an author fails to justify his/her research effort with a theoretical framework. However, there is another level to the problem. Many individuals have a rather narrow conception of what constitutes a theoretical framework or that it is somehow distinct from a conceptual framework. The distinction on lack thereof is a story for another day. The following story may remind you of an experience you or one of your classmates have had.

Doctoral students live in fear of hearing these now famous words from their thesis advisor: “This sounds like a promising study, but what is your theoretical framework?” These words instantly send the harried doctoral student to the library (giving away our ages) in search of a theory to support the proposed research and to satisfy his/her advisor. The search is often unsuccessful because of the student’s misconception of what constitutes a “theoretical framework.” The framework may actually be a theory, but not necessarily. This is especially true for theory driven research (typically quantitative) that is attempting to test the validity of existing theory. However, this narrow definition of a theoretical framework is commonly not aligned with qualitative research paradigms that are attempting to develop theory, for example, grounded theory, or research falling into the categories of description and interpretation research (Peshkin, 1993 ). Additionally, a large proportion of doctoral theses do not fit the narrow definition described. The argument here is not that various research paradigms have no overarching philosophies or theories about knowing. Clearly quantitative research paradigms are couched in a realist perspective and qualitative research paradigms are couched in an idealist perspective (Bogdan & Biklen, 1982 ). The discussion here is focused on theoretical frameworks at a much more specific and localized perspective with respect to the justification and conceptualization of a single research investigation. So, what is a theoretical framework?

It is, perhaps, easier to understand the nature and function of a theoretical framework if it is viewed as the answer to two basic questions:

What is the problem or question?

Why is your approach to solving the problem or answering the question feasible?

Indeed, the answers to these questions are the substance and culmination of Chapters I and II of the proposal and completed dissertation, or the initial sections preceding the Methods section of a research article. The answers to these questions can come from only one source, a thorough review of the literature (i.e., a review that includes both the theoretical and empirical literature as well as apparent gaps in the literature). Perhaps, a hypothetical situation can best illustrate the development and role of the theoretical framework in the formalization of a dissertation topic or research investigation. Let us continue with the doctoral student example, keeping in mind that a parallel situation also presents itself to any researcher planning research that he/she intends to publish.

As an interested reader of educational literature, a doctoral student becomes intrigued by the importance of questioning in the secondary classroom. The student immediately begins a manual and computer search of the literature on questioning in the classroom. The student notices that the research findings on the effectiveness of questioning strategies are rather equivocal. In particular, much of the research focuses on the cognitive levels of the questions asked by the teacher and how these questions influence student achievement. It appears that the research findings exhibit no clear pattern. That is, in some studies, frequent questioning at higher cognitive levels has led to more achievement than frequent questioning at the lower cognitive levels. However, an equal number of investigations have shown no differences between the achievement of students who are exposed to questions at distinctly different cognitive levels, but rather the simple frequency of questions.

The doctoral student becomes intrigued by these equivocal findings and begins to speculate about some possible explanations. In a blinding flash of insight, the student remembers hearing somewhere that an eccentric Frenchman named Piaget said something about students being categorized into levels of cognitive development. Could it be that a student’s cognitive level has something to do with how much and what he/she learns? The student heads back to the library and methodically searches through the literature on cognitive development and its relationship to achievement.

At this point, the doctoral student has become quite familiar with two distinct lines of educational research. The research on the effectiveness of questioning has established that there is a problem. That is, does the cognitive level of questioning have any effect on student achievement? In effect, this answers the first question identified previously with respect to identification of a theoretical framework. The research on the cognitive development of students has provided an intriguing perspective. That is, could it be possible that students of different cognitive levels are affected differently by questions at different cognitive levels? If so, an answer to the problem concerning the effectiveness questioning may be at hand. This latter question, in effect, has addressed the second question previously posed about the identification of a theoretical framework. At this point, the student has narrowed his/her interests as a result of reviewing the literature. Note that the doctoral student is now ready to write down a specific research question and that this is only possible after having conducted a thorough review of the literature.

The student writes down the following research hypotheses:

Both high and low cognitive level pupils will benefit from both high and low cognitive levels of questions as opposed to no questions at all.

Pupils categorized at high cognitive levels will benefit more from high cognitive level questions than from low level questions.

Pupils categorized at lower cognitive levels will benefit more from low cognitive level questions than from high level questions.

These research questions still need to be transformed into testable statistical hypotheses, but they are ready to be presented to the dissertation advisor. The advisor looks at the questions and says: “This looks like a promising study, but what is your theoretical framework?” There is no need, however for a sprint to the library. The doctoral student has a theoretical framework. The literature on questioning has established that there is a problem and the literature on cognitive development has provided the rationale for performing the specific investigation that is being proposed. ALL IS WELL!

If some of the initial research completed by Norman concerning what classroom variables contributed to students’ understandings of nature of science (Lederman, 1986a , 1986b ; Lederman & Druger, 1985 ) had to align with the overly restricted definition of a theoretical framework, which necessitates the presence of theory, it never would have been published. In these initial studies, various classroom variables were identified that were related to students’ improved understandings of nature of science. The studies were descriptive and correlational and were not driven by any theory about how students learn nature of science. Indeed, the design of the studies was derived from the fact that there were no existing theories, general or specific, to explain how students might learn nature of science more effectively. Similarly, the seminal study of effective teaching, the Beginning Teacher Evaluation Study (Tikunoff, Berliner, & Rist, 1975 ), was an ethnographic study that was not guided by the findings of previous research on effective teaching. Rather, their inductive study simply compared 40 teachers “known” to be effective and ineffective of mathematics and reading to derive differences in classroom practice. Their study had no theoretical framework if one were to use the restrictive conception that a theory needed to provide a guiding framework for the investigation. There are plenty of other examples that have guided lines of research that could be provided, but there is no need to beat a dead horse by detailing more examples. The simple, but important, point is that research following qualitative research paradigms or traditions (Jacob, 1987 ; Smith, 1987 ) are particularly vulnerable to how ‘theoretical framework’ is defined. Indeed, it could be argued that the necessity of a theory is a remnant from the times in which qualitative research was not as well accepted as it is today. In general, any research design that is inductive in nature and attempts to develop theory would be at a loss. We certainly would not want to eliminate multiple traditions of research from the Journal of Science Teacher Education .

Harry Wolcott’s discussion about validity in qualitative research (Wolcott, 1990 ) is quite explicit about the lack of theory or necessity of theory in driving qualitative ethnography. Interestingly, he even rejects the idea of validity as being a necessary criterion in qualitative research. Additionally, Bogdan and Biklen ( 1982 ) emphasize the importance of qualitative researchers “bracketing” (i.e., masking or trying to forget) their a priori theories so that it does not influence the collection of data or any meanings assigned to data during an investigation. Similar discussions about how qualitative research differs from quantitative research with respect to the necessity of theory guiding the research have been advanced by many others (e.g., Becker, 1970 ; Bogdan & Biklen, 1982 ; Erickson, 1986 ; Krathwohl, 2009 ; Rist, 1977 ; among others). Perhaps, Peshkin ( 1993 , p. 23) put it best when he expressed his concern that “Research that is not theory driven, hypothesis testing, or generalization producing may be dismissed as deficient or worse.” Again, the key point is that qualitative research is as valuable and can contribute as much to our knowledge of teaching and learning as quantitative research.

There is little doubt that qualitative researchers often invoke theory when analyzing the data they have collected or try to place their findings within the context of the existing literature. And, as stated at the beginning of this editorial, different research paradigms have large overarching theories about how one comes to know about the world. However, this is not the same thing has using a theory as a framework for the design of an investigation from the stating of research questions to developing a design to answer the research questions.

It is quite possible that you may be thinking that this editorial about the meaning of a theoretical framework is too theoretical. Trust us in believing that there is a very practical reason for us addressing this issue. At the beginning of the editorial we talked about the lack of a theoretical framework being the second most common reason for manuscripts being rejected for publication in the Journal of Science Teacher Education . Additionally, we mentioned that this is a common reason for manuscripts being rejected by other prominent journals in science education, and education in general. Consequently, it is of critical importance that we, as a community, are clear about the meaning of a theoretical framework and its use. It is especially important that our authors, reviewers, associate editors, and we as Editors of the journal are clear on this matter. Let us not fail to mention that most of us are advising Ph.D. students in the conceptualization of their dissertations. This issue is not new. In 1992, the editorial board of the Journal of Research in Science Teaching was considering the claim, by some, that qualitative research was not being evaluated fairly for publication relative to quantitative research. In their analysis of the relative success of publication for quantitative and qualitative research, Wandersee and Demastes ( 1992 , p. 1005) noted that reviewers often noted, “The manuscript had a weak theoretical basis” when reviewing qualitative research.

Theoretical frameworks are critically important to all of our work, quantitative, qualitative, or mixed methods. All research articles should have a valid theoretical framework to justify the importance and significance of the work. However, we should not live in fear, as the doctoral student, of not having a theoretical framework, when we actually have such, because an Editor, reviewer, or Major Professor is using any unduly restrictive and outdated meaning for what constitutes a theoretical framework.

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Lederman, N.G., Lederman, J.S. What Is A Theoretical Framework? A Practical Answer. J Sci Teacher Educ 26 , 593–597 (2015). https://doi.org/10.1007/s10972-015-9443-2

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What is a Conceptual Framework and How to Make It (with Examples)

A strong conceptual framework underpins good research. A conceptual framework in research is used to understand a research problem and guide the development and analysis of the research. It serves as a roadmap to conceptualize and structure the work by providing an outline that connects different ideas, concepts, and theories within the field of study. A conceptual framework pictorially or verbally depicts presumed relationships among the study variables.

The purpose of a conceptual framework is to serve as a scheme for organizing and categorizing knowledge and thereby help researchers in developing theories and hypotheses and conducting empirical studies.

In this post, we explain what is a conceptual framework, and provide expert advice on how to make a conceptual framework, along with conceptual framework examples.

Table of Contents

What is a Conceptual Framework in Research

Definition of a conceptual framework.

A conceptual framework includes key concepts, variables, relationships, and assumptions that guide the academic inquiry. It establishes the theoretical underpinnings and provides a lens through which researchers can analyze and interpret data. A conceptual framework draws upon existing theories, models, or established bodies of knowledge to provide a structure for understanding the research problem. It defines the scope of research, identifying relevant variables, establishing research questions, and guiding the selection of appropriate methodologies and data analysis techniques.

Conceptual frameworks can be written or visual. Other types of conceptual framework representations might be taxonomic (verbal description categorizing phenomena into classes without showing relationships between classes) or mathematical descriptions (expression of phenomena in the form of mathematical equations).

Figure 1: Definition of a conceptual framework explained diagrammatically

Conceptual Framework Origin

The term conceptual framework appears to have originated in philosophy and systems theory, being used for the first time in the 1930s by the philosopher Alfred North Whitehead. He bridged the theological, social, and physical sciences by providing a common conceptual framework. The use of the conceptual framework began early in accountancy and can be traced back to publications by William A. Paton and John B. Canning in the first quarter of the 20 th century. Thus, in the original framework, financial issues were addressed, such as useful features, basic elements, and variables needed to prepare financial statements. Nevertheless, a conceptual framework approach should be considered when starting your research journey in any field, from finance to social sciences to applied sciences.

Purpose and Importance of a Conceptual Framework in Research

The importance of a conceptual framework in research cannot be understated, irrespective of the field of study. It is important for the following reasons:

• It clarifies the context of the study.
• It justifies the study to the reader.
• It helps you check your own understanding of the problem and the need for the study.
• It illustrates the expected relationship between the variables and defines the objectives for the research.
• It helps further refine the study objectives and choose the methods appropriate to meet them.

What to Include in a Conceptual Framework

Essential elements that a conceptual framework should include are as follows:

• Overarching research question(s)
• Study parameters
• Study variables
• Potential relationships between those variables.

The sources for these elements of a conceptual framework are literature, theory, and experience or prior knowledge.

How to Make a Conceptual Framework

Now that you know the essential elements, your next question will be how to make a conceptual framework.

For this, start by identifying the most suitable set of questions that your research aims to answer. Next, categorize the various variables. Finally, perform a rigorous analysis of the collected data and compile the final results to establish connections between the variables.

In short, the steps are as follows:

• Choose appropriate research questions.
• Define the different types of variables involved.
• Determine the cause-and-effect relationships.

Be sure to make use of arrows and lines to depict the presence or absence of correlational linkages among the variables.

Developing a Conceptual Framework

Researchers should be adept at developing a conceptual framework. Here are the steps for developing a conceptual framework:

1. Identify a research question

Your research question guides your entire study, making it imperative to invest time and effort in formulating a question that aligns with your research goals and contributes to the existing body of knowledge. This step involves the following:

• Choose a broad topic of interest
• Conduct background research
• Narrow down the focus
• Define your goals
• Make it specific and answerable
• Consider significance and novelty
• Seek feedback.

 2. Choose independent and dependent variables

The dependent variable is the main outcome you want to measure, explain, or predict in your study. It should be a variable that can be observed, measured, or assessed quantitatively or qualitatively. Independent variables are the factors or variables that may influence, explain, or predict changes in the dependent variable.

Choose independent and dependent variables for your study according to the research objectives, the nature of the phenomenon being studied, and the specific research design. The identification of variables is rooted in existing literature, theories, or your own observations.

3. Consider cause-and-effect relationships

To better understand and communicate the relationships between variables in your study, cause-and-effect relationships need to be visualized. This can be done by using path diagrams, cause-and-effect matrices, time series plots, scatter plots, bar charts, or heatmaps.

4. Identify other influencing variables

Besides the independent and dependent variables, researchers must understand and consider the following types of variables:

• Moderating variable: A variable that influences the strength or direction of the relationship between an independent variable and a dependent variable.
• Mediating variable: A variable that explains the relationship between an independent variable and a dependent variable and clarifies how the independent variable affects the dependent variable.
• Control variable: A variable that is kept constant or controlled to avoid the influence of other factors that may affect the relationship between the independent and dependent variables.
• Confounding variable: A type of unmeasured variable that is related to both the independent and dependent variables.

Example of a Conceptual Framework

Let us examine the following conceptual framework example. Let’s say your research topic is “ The Impact of Social Media Usage on Academic Performance among College Students .” Here, you want to investigate how social media usage affects academic performance in college students. Social media usage (encompassing frequency of social media use, time spent on social media platforms, and types of social media platforms used) is the independent variable, and academic performance (covering grades, exam scores, and class attendance) is the dependent variable.

This conceptual framework example also includes a mediating variable, study habits, which may explain how social media usage affects academic performance. Study habits (time spent studying, study environment, and use of study aids or resources) can act as a mechanism through which social media usage influences academic outcomes. Additionally, a moderating variable, self-discipline (level of self-control and self-regulation, ability to manage distractions, and prioritization skills), is included to examine how individual differences in self-control and discipline may influence the relationship between social media usage and academic performance.

Confounding variables are also identified (socioeconomic status, prior academic achievement), which are potential factors that may influence both social media usage and academic performance. These variables need to be considered and controlled in the study to ensure that any observed effects are specifically attributed to social media usage. A visual representation of this conceptual framework example is seen in Figure 2.

Figure 2: Visual representation of a conceptual framework for the topic “The Impact of Social Media Usage on Academic Performance among College Students”

Key Takeaways

Here is a snapshot of the basics of a conceptual framework in research:

• A conceptual framework is an idea or model representing the subject or phenomena you intend to study.
• It is primarily a researcher’s perception of the research problem. It can be used to develop hypotheses or testable research questions.
• It provides a preliminary understanding of the factors at play, their interrelationships, and the underlying reasons.
• It guides your research by aiding in the formulation of meaningful research questions, selection of appropriate methods, and identification of potential challenges to the validity of your findings.
• It provides a structure for organizing and understanding data.
• It allows you to chalk out the relationships between concepts and variables to understand them.
• Variables besides dependent and independent variables (moderating, mediating, control, and confounding variables) must be considered when developing a conceptual framework.

Frequently Asked Questions

What is the difference between a moderating variable and a mediating variable.

Moderating and mediating variables are easily confused. A moderating variable affects the direction and strength of this relationship, whereas a mediating explains how two variables relate.

What is the difference between independent variables, dependent variables, and confounding variables?

Independent variables are the variables manipulated to affect the outcome of an experiment (e.g., the dose of a fat-loss drug administered to rats). Dependent variables are variables being measured or observed in an experiment (e.g., changes in rat body weight as a result of the drug). A confounding variable distorts or masks the effects of the variables being studied because it is associated both with dependent variable and with the independent variable. For instance, in this example, pre-existing metabolic dysfunction in some rats could interact differently with the drug being studied and also affect rat body weight.

Should I have more than one dependent or independent variable in a study?

The need for more than one dependent or independent variable in a study depends on the research question, study design, and relationships being investigated. Note the following when making this decision for your research:

• If your research question involves exploring the relationships between multiple variables or factors, it may be appropriate to have more than one dependent or independent variable.
• If you have specific hypotheses about the relationships between several variables, it may be necessary to include multiple dependent or independent variables.
• Adequate resources, sample size, and data collection methods should be considered when determining the number of dependent and independent variables to include.

What is a confounding variable?

A confounding variable is not the main focus of the study but can unintentionally influence the relationship between the independent and dependent variables. Confounding variables can introduce bias and give rise to misleading conclusions. These variables must be controlled to ensure that any observed relationship is genuinely due to the independent variable.

What is a control variable?

A control variable is something not of interest to the study’s objectives but is kept constant because it could influence the outcomes. Control variables can help prevent research biases and allow for a more accurate assessment of the relationship between the independent and dependent variables. Examples are (i) testing all participants at the same time (e.g., in the morning) to minimize the potential effects of circadian rhythms, (ii) ensuring that instruments are calibrated consistently before each measurement to minimize the influence of measurement errors, and (iii) randomization of participants across study groups.

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Theoretical Framework – Types, Examples and Writing Guide

Table of Contents

Theoretical Framework

Definition:

Theoretical framework refers to a set of concepts, theories, ideas , and assumptions that serve as a foundation for understanding a particular phenomenon or problem. It provides a conceptual framework that helps researchers to design and conduct their research, as well as to analyze and interpret their findings.

In research, a theoretical framework explains the relationship between various variables, identifies gaps in existing knowledge, and guides the development of research questions, hypotheses, and methodologies. It also helps to contextualize the research within a broader theoretical perspective, and can be used to guide the interpretation of results and the formulation of recommendations.

Types of Theoretical Framework

Types of Types of Theoretical Framework are as follows:

Conceptual Framework

This type of framework defines the key concepts and relationships between them. It helps to provide a theoretical foundation for a study or research project .

Deductive Framework

This type of framework starts with a general theory or hypothesis and then uses data to test and refine it. It is often used in quantitative research .

Inductive Framework

This type of framework starts with data and then develops a theory or hypothesis based on the patterns and themes that emerge from the data. It is often used in qualitative research .

Empirical Framework

This type of framework focuses on the collection and analysis of empirical data, such as surveys or experiments. It is often used in scientific research .

Normative Framework

This type of framework defines a set of norms or values that guide behavior or decision-making. It is often used in ethics and social sciences.

Explanatory Framework

This type of framework seeks to explain the underlying mechanisms or causes of a particular phenomenon or behavior. It is often used in psychology and social sciences.

Components of Theoretical Framework

The components of a theoretical framework include:

• Concepts : The basic building blocks of a theoretical framework. Concepts are abstract ideas or generalizations that represent objects, events, or phenomena.
• Variables : These are measurable and observable aspects of a concept. In a research context, variables can be manipulated or measured to test hypotheses.
• Assumptions : These are beliefs or statements that are taken for granted and are not tested in a study. They provide a starting point for developing hypotheses.
• Propositions : These are statements that explain the relationships between concepts and variables in a theoretical framework.
• Hypotheses : These are testable predictions that are derived from the theoretical framework. Hypotheses are used to guide data collection and analysis.
• Constructs : These are abstract concepts that cannot be directly measured but are inferred from observable variables. Constructs provide a way to understand complex phenomena.
• Models : These are simplified representations of reality that are used to explain, predict, or control a phenomenon.

How to Write Theoretical Framework

A theoretical framework is an essential part of any research study or paper, as it helps to provide a theoretical basis for the research and guide the analysis and interpretation of the data. Here are some steps to help you write a theoretical framework:

• Identify the key concepts and variables : Start by identifying the main concepts and variables that your research is exploring. These could include things like motivation, behavior, attitudes, or any other relevant concepts.
• Review relevant literature: Conduct a thorough review of the existing literature in your field to identify key theories and ideas that relate to your research. This will help you to understand the existing knowledge and theories that are relevant to your research and provide a basis for your theoretical framework.
• Develop a conceptual framework : Based on your literature review, develop a conceptual framework that outlines the key concepts and their relationships. This framework should provide a clear and concise overview of the theoretical perspective that underpins your research.
• Identify hypotheses and research questions: Based on your conceptual framework, identify the hypotheses and research questions that you want to test or explore in your research.
• Test your theoretical framework: Once you have developed your theoretical framework, test it by applying it to your research data. This will help you to identify any gaps or weaknesses in your framework and refine it as necessary.
• Write up your theoretical framework: Finally, write up your theoretical framework in a clear and concise manner, using appropriate terminology and referencing the relevant literature to support your arguments.

Theoretical Framework Examples

Here are some examples of theoretical frameworks:

• Social Learning Theory : This framework, developed by Albert Bandura, suggests that people learn from their environment, including the behaviors of others, and that behavior is influenced by both external and internal factors.
• Maslow’s Hierarchy of Needs : Abraham Maslow proposed that human needs are arranged in a hierarchy, with basic physiological needs at the bottom, followed by safety, love and belonging, esteem, and self-actualization at the top. This framework has been used in various fields, including psychology and education.
• Ecological Systems Theory : This framework, developed by Urie Bronfenbrenner, suggests that a person’s development is influenced by the interaction between the individual and the various environments in which they live, such as family, school, and community.
• Feminist Theory: This framework examines how gender and power intersect to influence social, cultural, and political issues. It emphasizes the importance of understanding and challenging systems of oppression.
• Cognitive Behavioral Theory: This framework suggests that our thoughts, beliefs, and attitudes influence our behavior, and that changing our thought patterns can lead to changes in behavior and emotional responses.
• Attachment Theory: This framework examines the ways in which early relationships with caregivers shape our later relationships and attachment styles.
• Critical Race Theory : This framework examines how race intersects with other forms of social stratification and oppression to perpetuate inequality and discrimination.

When to Have A Theoretical Framework

Following are some situations When to Have A Theoretical Framework:

• A theoretical framework should be developed when conducting research in any discipline, as it provides a foundation for understanding the research problem and guiding the research process.
• A theoretical framework is essential when conducting research on complex phenomena, as it helps to organize and structure the research questions, hypotheses, and findings.
• A theoretical framework should be developed when the research problem requires a deeper understanding of the underlying concepts and principles that govern the phenomenon being studied.
• A theoretical framework is particularly important when conducting research in social sciences, as it helps to explain the relationships between variables and provides a framework for testing hypotheses.
• A theoretical framework should be developed when conducting research in applied fields, such as engineering or medicine, as it helps to provide a theoretical basis for the development of new technologies or treatments.
• A theoretical framework should be developed when conducting research that seeks to address a specific gap in knowledge, as it helps to define the problem and identify potential solutions.
• A theoretical framework is also important when conducting research that involves the analysis of existing theories or concepts, as it helps to provide a framework for comparing and contrasting different theories and concepts.
• A theoretical framework should be developed when conducting research that seeks to make predictions or develop generalizations about a particular phenomenon, as it helps to provide a basis for evaluating the accuracy of these predictions or generalizations.
• Finally, a theoretical framework should be developed when conducting research that seeks to make a contribution to the field, as it helps to situate the research within the broader context of the discipline and identify its significance.

Purpose of Theoretical Framework

The purposes of a theoretical framework include:

• Providing a conceptual framework for the study: A theoretical framework helps researchers to define and clarify the concepts and variables of interest in their research. It enables researchers to develop a clear and concise definition of the problem, which in turn helps to guide the research process.
• Guiding the research design: A theoretical framework can guide the selection of research methods, data collection techniques, and data analysis procedures. By outlining the key concepts and assumptions underlying the research questions, the theoretical framework can help researchers to identify the most appropriate research design for their study.
• Supporting the interpretation of research findings: A theoretical framework provides a framework for interpreting the research findings by helping researchers to make connections between their findings and existing theory. It enables researchers to identify the implications of their findings for theory development and to assess the generalizability of their findings.
• Enhancing the credibility of the research: A well-developed theoretical framework can enhance the credibility of the research by providing a strong theoretical foundation for the study. It demonstrates that the research is based on a solid understanding of the relevant theory and that the research questions are grounded in a clear conceptual framework.
• Facilitating communication and collaboration: A theoretical framework provides a common language and conceptual framework for researchers, enabling them to communicate and collaborate more effectively. It helps to ensure that everyone involved in the research is working towards the same goals and is using the same concepts and definitions.

Characteristics of Theoretical Framework

Some of the characteristics of a theoretical framework include:

• Conceptual clarity: The concepts used in the theoretical framework should be clearly defined and understood by all stakeholders.
• Logical coherence : The framework should be internally consistent, with each concept and assumption logically connected to the others.
• Empirical relevance: The framework should be based on empirical evidence and research findings.
• Parsimony : The framework should be as simple as possible, without sacrificing its ability to explain the phenomenon in question.
• Flexibility : The framework should be adaptable to new findings and insights.
• Testability : The framework should be testable through research, with clear hypotheses that can be falsified or supported by data.
• Applicability : The framework should be useful for practical applications, such as designing interventions or policies.

Advantages of Theoretical Framework

Here are some of the advantages of having a theoretical framework:

• Provides a clear direction : A theoretical framework helps researchers to identify the key concepts and variables they need to study and the relationships between them. This provides a clear direction for the research and helps researchers to focus their efforts and resources.
• Increases the validity of the research: A theoretical framework helps to ensure that the research is based on sound theoretical principles and concepts. This increases the validity of the research by ensuring that it is grounded in established knowledge and is not based on arbitrary assumptions.
• Enables comparisons between studies : A theoretical framework provides a common language and set of concepts that researchers can use to compare and contrast their findings. This helps to build a cumulative body of knowledge and allows researchers to identify patterns and trends across different studies.
• Helps to generate hypotheses: A theoretical framework provides a basis for generating hypotheses about the relationships between different concepts and variables. This can help to guide the research process and identify areas that require further investigation.
• Facilitates communication: A theoretical framework provides a common language and set of concepts that researchers can use to communicate their findings to other researchers and to the wider community. This makes it easier for others to understand the research and its implications.

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• Roberta Heale 1 ,
• Helen Noble 2
• 1 Laurentian University , School of Nursing , Sudbury , Ontario , Canada
• 2 Queens University Belfast , School of Nursing and Midwifery , Belfast , UK
• Correspondence to Dr Roberta Heale, School of Nursing, Laurentian University, Ramsey Lake Road, Sudbury, P3E2C6, Canada; rheale{at}laurentian.ca

https://doi.org/10.1136/ebnurs-2019-103077

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Often the most difficult part of a research study is preparing the proposal based around a theoretical or philosophical framework. Graduate students ‘…express confusion, a lack of knowledge, and frustration with the challenge of choosing a theoretical framework and understanding how to apply it’. 1 However, the importance in understanding and applying a theoretical framework in research cannot be overestimated.

The choice of a theoretical framework for a research study is often a reflection of the researcher’s ontological (nature of being) and epistemological (theory of knowledge) perspective. We will not delve into these concepts, or personal philosophy in this article. Rather we will focus on how a theoretical framework can be integrated into research.

The theoretical framework is a blueprint for your research project 1 and serves several purposes. It informs the problem you have identified, the purpose and significance of your research demonstrating how your research fits with what is already known (relationship to existing theory and research). This provides a basis for your research questions, the literature review and the methodology and analysis that you choose. 1 Evidence of your chosen theoretical framework should be visible in every aspect of your research and should demonstrate the contribution of this research to knowledge. 2

What is a theory?

A theory is an explanation of a concept or an abstract idea of a phenomenon. An example of a theory is Bandura’s middle range theory of self-efficacy, 3 or the level of confidence one has in achieving a goal. Self-efficacy determines the coping behaviours that a person will exhibit when facing obstacles. Those who have high self-efficacy are likely to apply adequate effort leading to successful outcomes, while those with low self-efficacy are more likely to give up earlier and ultimately fail. Any research that is exploring concepts related to self-efficacy or the ability to manage difficult life situations might apply Bandura’s theoretical framework to their study.

Using a theoretical framework in a research study

Example 1: the big five theoretical framework.

The first example includes research which integrates the ‘Big Five’, a theoretical framework that includes concepts related to teamwork. These include team leadership, mutual performance monitoring, backup behaviour, adaptability and team orientation. 4 In order to conduct research incorporating a theoretical framework, the concepts need to be defined according to a frame of reference. This provides a means to understand the theoretical framework as it relates to a specific context and provides a mechanism for measurement of the concepts.

In this example, the concepts of the Big Five were given a conceptual definition, that provided a broad meaning and then an operational definition, which was more concrete. 4 From here, a survey was developed that reflected the operational definitions related to teamwork in nursing: the Nursing Teamwork Survey (NTS). 5 In this case, the concepts used in the theoretical framework, the Big Five, were the used to develop a survey specific to teamwork in nursing.

The NTS was used in research of nurses at one hospital in northeastern Ontario. Survey questions were grouped into subscales for analysis, that reflected the concepts of the Big Five. 6 For example, one finding of this study was that the nurses from the surgical unit rated the items in the subscale of ’team leadership' (one of the concepts in the Big Five) significantly lower than in the other units. The researchers looked back to the definition of this concept in the Big Five in their interpretation of the findings. Since the definition included a person(s) who has the leadership skills to facilitate teamwork among the nurses on the unit, the conclusion in this study was that the surgical unit lacked a mentor, or facilitator for teamwork. In this way, the theory of teamwork was presented through a set of concepts in a theoretical framework. The Theoretical Framework (TF)was the foundation for development of a survey related to a specific context, used to measure each of the concepts within the TF. Then, the analysis and results circled back to the concepts within the TF and provided a guide for the discussion and conclusions arising from the research.

Example 2: the Health Decisions Model

In another study which explored adherence to intravenous chemotherapy in African-American and Caucasian Women with early stage breast cancer, an adapted version of the Health Decisions Model (HDM) was used as the theoretical basis for the study. 7 The HDM, a revised version of the Health Belief Model, incorporates some aspects of the Health Belief Model and factors relating to patient preferences. 8 The HDM consists of six interrelated constituents that might predict how well a person adheres to a health decision. These include sociodemographic, social interaction, experience, knowledge, general and specific health beliefs and patient preferences, and are clearly defined. The HDM model was used to explore factors which might influence adherence to chemotherapy in women with breast cancer. Sociodemographic, social interaction, knowledge, personal experience and specific health beliefs were used as predictors of adherence to chemotherapy.

The findings were reported using the theoretical framework to discuss results. The study found that delay to treatment, health insurance, depression and symptom severity were predictors to starting chemotherapy which could potentially be adapted with clinical interventions. The findings from the study contribute to the existing body of literature related to cancer nursing.

Example 3: the nursing role effectiveness model

In this final example, research was conducted to determine the nursing processes that were associated with unexpected intensive care unit admissions. 9 The framework was the Nursing Role Effectiveness Model. In this theoretical framework, the concepts within Donabedian’s Quality Framework of Structure, Process and Outcome were each defined according to nursing practice. 10 11  Processes defined in the Nursing Role Effectiveness Model were used to identify the nursing process variables that were measured in the study.

A theoretical framework should be logically presented and represent the concepts, variables and relationships related to your research study, in order to clearly identify what will be examined, described or measured. It involves reading the literature and identifying a research question(s) while clearly defining and identifying the existing relationship between concepts and theories (related to your research questions[s] in the literature). You must then identify what you will examine or explore in relation to the concepts of the theoretical framework. Once you present your findings using the theoretical framework you will be able to articulate how your study relates to and may potentially advance your chosen theory and add to knowledge.

• Kalisch BJ ,
• Parent M , et al
• Strickland OL ,
• Dalton JA , et al
• Eraker SA ,
• Kirscht JP ,
• Lightfoot N , et al
• Harrison MB ,
• Laschinger H , et al

Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests None declared.

Provenance and peer review Not commissioned; internally peer reviewed.

Patient and public involvement Not required.

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Original research

Evidence-based practice models and frameworks in the healthcare setting: a scoping review, jarrod dusin.

1 Department of Evidence Based Practice, Children’s Mercy Hospitals and Clinics, Kansas City, Missouri, USA

2 Therapeutic Science, The University of Kansas Medical Center, Kansas City, Kansas, USA

Andrea Melanson

Lisa mische-lawson, associated data.

bmjopen-2022-071188supp001.pdf

bmjopen-2022-071188supp002.pdf

No data are available.

The aim of this scoping review was to identify and review current evidence-based practice (EBP) models and frameworks. Specifically, how EBP models and frameworks used in healthcare settings align with the original model of (1) asking the question, (2) acquiring the best evidence, (3) appraising the evidence, (4) applying the findings to clinical practice and (5) evaluating the outcomes of change, along with patient values and preferences and clinical skills.

A Scoping review.

Included sources and articles

Published articles were identified through searches within electronic databases (MEDLINE, EMBASE, Scopus) from January 1990 to April 2022. The English language EBP models and frameworks included in the review all included the five main steps of EBP. Excluded were models and frameworks focused on one domain or strategy (eg, frameworks focused on applying findings).

Of the 20 097 articles found by our search, 19 models and frameworks met our inclusion criteria. The results showed a diverse collection of models and frameworks. Many models and frameworks were well developed and widely used, with supporting validation and updates. Some models and frameworks provided many tools and contextual instruction, while others provided only general process instruction. The models and frameworks reviewed demonstrated that the user must possess EBP expertise and knowledge for the step of assessing evidence. The models and frameworks varied greatly in the level of instruction to assess the evidence. Only seven models and frameworks integrated patient values and preferences into their processes.

Many EBP models and frameworks currently exist that provide diverse instructions on the best way to use EBP. However, the inclusion of patient values and preferences needs to be better integrated into EBP models and frameworks. Also, the issues of EBP expertise and knowledge to assess evidence must be considered when choosing a model or framework.

STRENGTHS AND LIMITATIONS OF THIS STUDY

• Currently, no comprehensive review exists of evidence-based practice (EBP) models and frameworks.
• Well-developed models and frameworks may have been excluded for not including all five steps of original model for EBP.
• This review did not measure the quality of the models and frameworks based on validated studies.

Introduction

Evidence-based practice (EBP) grew from evidence-based medicine (EBM) to provide a process to review, translate and implement research with practice to improve patient care, treatment and outcomes. Guyatt 1 coined the term EBM in the early 1990s. Over the last 25 years, the field of EBM has continued to evolve and is now a cornerstone of healthcare and a core competency for all medical professionals. 2 3 At first, the term EBM was used only in medicine. However, the term EBP now applies to the principles of other health professions. This expansion of the concept of EBM increases its complexity. 4 The term EBP is used for this paper because it is universal across professions.

Early in the development of EBP, Sackett 5 created an innovative five-step model. This foundational medical model provided a concise overview of the process of EBP. The five steps are (1) asking the question, (2) acquiring the best evidence, (3) appraising the evidence, (4) applying the findings to clinical practice and (5) evaluating the outcomes of change. Other critical components of Sackett’s model are considering patient value and preferences and clinical skills with the best available evidence. 5 The influence of this model has led to its integration and adaption into every field of healthcare. Historically, the foundation of EBP has focused on asking the question, acquiring the literature and appraising the evidence but has had difficulty integrating evidence into practice. 6 Although the five steps appear simple, each area includes a vast number of ways to review the literature (eg, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), Newcastle-Ottawa Scale) and entire fields of study, such as implementation science, a field dedicated to implementing EBP. 7 8 Implementation science can be traced to the 1960s with Everett Rogers’ Diffusion of Innovation Theory and has grown alongside EBP over the last 25 years. 7 9

One way to manage the complexity of EBP in healthcare is by developing EBP models and frameworks that establish strategies to determine resource needs, identify barriers and facilitators, and guide processes. 10 EBP models and frameworks provide insight into the complexity of transforming evidence into clinical practice. 11 They also allow organisations to determine readiness, willingness and potential outcomes for a hospital system. 12 EBP can differ from implementation science, as EBP models include all five of Sackett’s steps of EBP, while the non-process models of implementation science typically focus on the final two steps. 5 10 There are published scoping reviews of implementation science, 13 however, no comprehensive review of EBP models and frameworks currently exists. Although there is overlap of EBP, implementation science and knowledge translation models and frameworks 10 14 the purpose of the scoping review was to explore how EBP models and frameworks used in healthcare settings align with the original EBP five-step model.

A scoping review synthesises findings across various study types and provides a broad overview of the selected topic. 15 The Arksey and O’Malley method and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-ScR) procedures guided this review (see online supplemental PRISMA-ScR checklist ). 15 16 The primary author established the research question and inclusion and exclusion criteria before conducting the review. An a priori protocol was not pre-registered. One research question guided the review: Which EBP models and frameworks align with Sackett’s original model?

Supplementary data

Eligibility criteria.

To be included in the review, English language published EBP models and frameworks needed to include the five main steps of EBP (asking the question, acquiring the best evidence, appraising the evidence, applying the findings to clinical practice and assessing the outcomes of change) based on Sackett’s model. 5 If the models or frameworks involved identifying problems or measured readiness for change, the criteria of ‘asking the question’ was met. Exclusions included models or frameworks focused on one domain or strategy (eg, frameworks focused on applying findings). Also, non-peer-reviewed abstracts, letters, editorials, opinion articles, and dissertations were excluded.

Search and selection

To identify potential studies, a medical librarian searched the databases from January 1990 to April 2022 in MEDLINE, EMBASE and Scopus in collaboration with the primary author. The search was limited to 1990 because the term EBP was coined in the early 90s. The search strategy employed the following keywords: ‘Evidence-Based Practice’ OR ‘evidence based medicine’ OR ‘evidence-based medicine’ OR ‘evidence based nursing’ OR ‘evidence-based nursing’ OR ‘evidence based practice’ OR ‘evidence-based practice’ OR ‘evidence based medicine’ OR ‘evidence-based medicine’ OR ‘evidence based nursing’ OR ‘evidence-based nursing’ OR ‘evidence based practice’ OR ‘evidence-based practice’ AND ‘Hospitals’ OR ‘Hospital Medicine’ OR ‘Nursing’ OR ‘Advanced Practice Nursing’ OR ‘Academic Medical Centers’ OR ‘healthcare’ OR ‘hospital’ OR ‘healthcare’ OR ‘hospital’ AND ‘Models, Organizational’ OR ‘Models, Nursing’ OR ‘framework’ OR ‘theory’ OR ‘theories’ OR ‘model’ OR ‘framework’ OR ‘theory’ OR ‘theories’ OR ‘model’. Additionally, reference lists in publications included for full-text review were screened to identify eligible models and frameworks (see online supplemental appendix A for searches).

Selection of sources of evidence

Two authors (JD and AM) independently screened titles and abstracts and selected studies for potential inclusion in the study, applying the predefined inclusion and exclusion criteria. Both authors then read the full texts of these articles to assess eligibility for final inclusion. Disagreement between the authors regarding eligibility was resolved by consensus between the three authors (JD, AM and LM-L). During the selection process, many models and frameworks were found more than once. Once a model or framework article was identified, the seminal article was reviewed for inclusion. If models or frameworks had been changed or updated since the publication of their seminal article, the most current iteration published was reviewed for inclusion. Once a model or framework was identified and verified for inclusion, all other articles listing the model or framework were excluded. This scoping review intended to identify model or framework aligned with Sackett’s model; therefore, analysing every article that used the included model or framework was unnecessary (see online supplemental appendix B for tracking form).

Data extraction and analysis

Data were collected on the following study characteristics: (1) authors, (2) publication year, (3) model or framework and (4) area(s) of focus in reference to Sackett’s five-step model. After initial selection, models and frameworks were analysed for key features and alignment to the five-step EBP process. A data analysis form was developed to map detailed information (see online supplemental appendix C for full data capture form). Data analysis focused on identifying (1) the general themes of the model or frameworks, and (2) any knowledge gaps. Data extraction and analysis were done by the primary author (JD) and verified by one other author (AM). 15

Patient and public involvement

Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

The search identified 6523 potentially relevant references (see figure 1 ). Following a review of the titles and abstracts, the primary author completed a more detailed screening of 37 full papers. From these, 19 models and frameworks were included. Table 1 summarises the 19 models and frameworks. Of the 19 models and frameworks assessed and mapped, 15 had broad target audiences, including healthcare or public health organisations or health systems. Only five models and frameworks included a target audience of individual clinicians (eg, physicians and nurses). 17–22

Retrieval and selection process.

Models and frameworks organised by integration of patient preferences and values

EBP, evidence-based practice.

Asking the question

All 19 models and frameworks included a process for asking questions. Most focused on identifying problems that needed to be addressed on an organisational or hospital level. Five used the PICO (population, intervention, comparator, outcome) format to ask specific questions related to patient care. 19–25

Acquiring the evidence

The models and frameworks gave basic instructions on acquiring literature, such as ‘conduct systematic search’ or ‘acquire resource’. 20 Four recommended sources from previously generated evidence, such as guidelines and systematic reviews. 6 21 22 26 Although most models and frameworks did not provide specifics, others suggested this work be done through EBP mentors/experts. 20 21 25 27 Seven models included qualitative evidence in the use of evidence, 6 19 21 24 27–29 while only four models considered the use of patient preference and values as evidence. 21 22 24 27 Six models recommended internal data be used in acquiring information. 17 20–22 24 27

Assessing the evidence

The models and frameworks varied greatly in the level of instruction provided in assessing the best evidence. All provided a general overview in assessing and grading the evidence. Four recommended this work be done by EBP mentors and experts. 20 25 27 30 Seven models developed specific tools to be used to assess the levels of evidence. 6 17 21 22 24 25 27

Applying the evidence

The application of evidence also varied greatly for the different models and frameworks. Seven models recommended pilot programmes to implement change. 6 21–25 31 Five recommended the use of EBP mentors and experts to assist in the implementation of evidence and quality improvement as a strategy of the models and frameworks. 20 24 25 27 Thirteen models and frameworks discussed patient values and preferences, 6 17–19 21–27 31 32 but only seven incorporated this topic into the model or framework, 21–27 and only five included tools and instructions. 21–25 Twelve of the 20 models discussed using clinical skill, but specifics of how this was incorporated was lacking in models and frameworks. 6 17–19 21–27 31

Evaluating the outcomes of change

Evaluation varied among the models and frameworks, but most involved using implementation outcome measures to determine the project’s success. Five models and frameworks provide tools and in-depth instruction for evaluation. 21 22 24–26 Monash Partners Learning Health Systems provided detailed instruction on using internal institutional data to determine success of application. 26 This framework uses internal and external data along with evidence in decision making as a benchmark for successful implementation.

EBP models and frameworks provide a process for transforming evidence into clinical practice and allow organisations to determine readiness and willingness for change in a complex hospital system. 12 The large number of models and frameworks complicates the process by confusing what the best tool is for healthcare organisations. This review examined many models and frameworks and assessed the characteristics and gaps that can better assist healthcare organisations to determine the right tool for themselves. This review identified 19 EBP models and frameworks that included the five main steps of EBP as described by Sackett. 5 The results showed that the themes of the models and frameworks are as diverse as the models and frameworks themselves. Some are well developed and widely used, with supporting validation and updates. 21 22 24 27 One such model, the Iowa EBP model, has received over 3900 requests for permission to use it and has been updated from its initial development and publication. 24 Other models provided tools and contextual instruction such as the Johns Hopkin’s model which includes a large number of supporting tools for developing PICOs, instructions for grading literature and project implementation. 17 21 22 24 27 By contrast, the ACE Star model and the An Evidence Implementation Model for Public Health Systems only provide high level overview and general instructions compared with other models and frameworks. 19 29 33

Gaps in the evidence

A consistent finding in research of clinician experience with EBP is the lack of expertise that is needed to assess the literature. 24 34 35 The models and frameworks reviewed demonstrated that the user must possess the knowledge and related skills for this step in the process. The models and frameworks varied greatly in the level of instruction to assess the evidence. Most provided a general overview in assessing and grading the evidence, though a few recommended that this work be done by EBP mentors and experts. 20 25 27 ARCC, JBI and Johns Hopkins provided robust tools and resources that would require administrative time and financial support. 21 22 27 Some models and frameworks offered vital resources or pointed to other resources for assessing evidence, 24 but most did not. While a few used mentors and experts to assist with assessing the literature, a majority did not address this persistent issue.

Sackett’s five-step model included another important consideration when implementing EBP: patient values and preferences. One criticism of EBP is that it ignores patient values and preferences. 36 Over half of the models and frameworks reported the need to include patient values and preferences, but the tools, instruction or resources for including them were limited. The ARCC model integrates patient preferences and values into the model, but it is up to the EBP mentor to accomplish this task. 37 There are many tools for assessing evidence, but few models and frameworks provide this level of guidance for incorporating patient preference and values. The inclusion of patient and family values and preferences can be misunderstood, insincere, and even tokenistic but without it there is reduced chance of success of implementation of EBP. 38 39

Strengths and limitations

Similar to other well-designed scoping reviews, the strengths of this review include a rigorous search conducted by a skilled librarian, literature evaluation by more than one person, and the utilisation of an established methodological framework (PRISMA-ScR). 14 15 Additionally, utilising the EBP five-step models as a point of alignment allows for a more comprehensive breakdown and established reference points for the reviewed models and frameworks. While scoping reviews have been completed on implementation science and knowledge translation models and framework, to our knowledge, this is the first scoping review of EBP models and frameworks. 13 14 Limitations of the study include that well-developed models and frameworks may have been excluded for not including all five steps. 40 For example, the Promoting Action on Research Implementation in Health Services (PARIHS) framework is a well-developed and validated implementation framework but did not include all five steps of an EBP model. 40 Also, some models and frameworks have been studied and validated over many years. It was beyond the scope of the review to measure the quality of the models and frameworks based on these other validated studies.

Implications and future research

Healthcare organisations can support EBP by choosing a model or framework that best suits their environment and providing clear guidance for implementing the best evidence. Some organisations may find the best fit with the ARCC and the Clinical Scholars Model because of the emphasis on mentors or the Johns Hopkins model for its tools for grading the level of evidence. 21 25 27 In contrast, other organisations may find the Iowa model useful with its feedback loops throughout its process. 24

Another implication of this study is the opportunity to better define and develop robust tools for patient and family values and preferences within EBP models and frameworks. Patient experiences are complex and require thorough exploration, so it is not overlooked, which is often the case. 39 41 The utilisation of EBP models and frameworks provide an opportunity to explore this area and provide the resources and understanding that are often lacking. 38 Though varying, models such as the Iowa Model, JBI and Johns Hopkins developed tools to incorporate patient and family values and preferences, but a majority of the models and frameworks did not. 21 22 24 An opportunity exists to create broad tools that can incorporate patient and family values and preferences into EBP to a similar extent as many of the models and frameworks used for developing tools for literature assessment and implementation. 21–25

Future research should consider appraising the quality and use of the different EBP models and frameworks to determine success. Additionally, greater clarification on what is considered patient and family values and preferences and how they can be integrated into the different models and frameworks is needed.

This scoping review of 19 models and frameworks shows considerable variation regarding how the EBP models and frameworks integrate the five steps of EBP. Most of the included models and frameworks provided a narrow description of the steps needed to assess and implement EBP, while a few provided robust instruction and tools. The reviewed models and frameworks provided diverse instructions on the best way to use EBP. However, the inclusion of patient values and preferences needs to be better integrated into EBP models. Also, the issues of EBP expertise to assess evidence must be considered when selecting a model or framework.

Supplementary Material

Acknowledgments.

We thank Keri Swaggart for completing the database searches and the Medical Writing Center at Children's Mercy Kansas City for editing this manuscript.

Contributors: All authors have read and approved the final manuscript. JD conceptualised the study design, screened the articles for eligibility, extracted data from included studies and contributed to the writing and revision of the manuscript. LM-L conceptualised the study design, provided critical feedback on the manuscript and revised the manuscript. AM screened the articles for eligibility, extracted data from the studies, provided critical feedback on the manuscript and revised the manuscript. JD is the guarantor of this work.

Funding: The article processing charges related to the publication of this article were supported by The University of Kansas (KU) One University Open Access Author Fund sponsored jointly by the KU Provost, KU Vice Chancellor for Research, and KUMC Vice Chancellor for Research and managed jointly by the Libraries at the Medical Center and KU - Lawrence

Disclaimer: No funding agencies had input into the content of this manuscript.

Competing interests: None declared.

Patient and public involvement: Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

Provenance and peer review: Not commissioned; externally peer reviewed.

Supplemental material: This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Data availability statement

Ethics statements, patient consent for publication.

Not applicable.

• Systematic review
• Open access
• Published: 07 August 2024

Models and frameworks for assessing the implementation of clinical practice guidelines: a systematic review

• Nicole Freitas de Mello   ORCID: orcid.org/0000-0002-5228-6691 1 , 2 ,
• Sarah Nascimento Silva   ORCID: orcid.org/0000-0002-1087-9819 3 ,
• Dalila Fernandes Gomes   ORCID: orcid.org/0000-0002-2864-0806 1 , 2 ,
• Juliana da Motta Girardi   ORCID: orcid.org/0000-0002-7547-7722 4 &
• Jorge Otávio Maia Barreto   ORCID: orcid.org/0000-0002-7648-0472 2 , 4  

Implementation Science volume  19 , Article number:  59 ( 2024 ) Cite this article

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The implementation of clinical practice guidelines (CPGs) is a cyclical process in which the evaluation stage can facilitate continuous improvement. Implementation science has utilized theoretical approaches, such as models and frameworks, to understand and address this process. This article aims to provide a comprehensive overview of the models and frameworks used to assess the implementation of CPGs.

A systematic review was conducted following the Cochrane methodology, with adaptations to the "selection process" due to the unique nature of this review. The findings were reported following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines. Electronic databases were searched from their inception until May 15, 2023. A predetermined strategy and manual searches were conducted to identify relevant documents from health institutions worldwide. Eligible studies presented models and frameworks for assessing the implementation of CPGs. Information on the characteristics of the documents, the context in which the models were used (specific objectives, level of use, type of health service, target group), and the characteristics of each model or framework (name, domain evaluated, and model limitations) were extracted. The domains of the models were analyzed according to the key constructs: strategies, context, outcomes, fidelity, adaptation, sustainability, process, and intervention. A subgroup analysis was performed grouping models and frameworks according to their levels of use (clinical, organizational, and policy) and type of health service (community, ambulatorial, hospital, institutional). The JBI’s critical appraisal tools were utilized by two independent researchers to assess the trustworthiness, relevance, and results of the included studies.

Database searches yielded 14,395 studies, of which 80 full texts were reviewed. Eight studies were included in the data analysis and four methodological guidelines were additionally included from the manual search. The risk of bias in the studies was considered non-critical for the results of this systematic review. A total of ten models/frameworks for assessing the implementation of CPGs were found. The level of use was mainly policy, the most common type of health service was institutional, and the major target group was professionals directly involved in clinical practice. The evaluated domains differed between the models and there were also differences in their conceptualization. All the models addressed the domain "Context", especially at the micro level (8/12), followed by the multilevel (7/12). The domains "Outcome" (9/12), "Intervention" (8/12), "Strategies" (7/12), and "Process" (5/12) were frequently addressed, while "Sustainability" was found only in one study, and "Fidelity/Adaptation" was not observed.

Conclusions

The use of models and frameworks for assessing the implementation of CPGs is still incipient. This systematic review may help stakeholders choose or adapt the most appropriate model or framework to assess CPGs implementation based on their specific health context.

Trial registration

PROSPERO (International Prospective Register of Systematic Reviews) registration number: CRD42022335884. Registered on June 7, 2022.

Peer Review reports

Contributions to the literature

Although the number of theoretical approaches has grown in recent years, there are still important gaps to be explored in the use of models and frameworks to assess the implementation of clinical practice guidelines (CPGs). This systematic review aims to contribute knowledge to overcome these gaps.

Despite the great advances in implementation science, evaluating the implementation of CPGs remains a challenge, and models and frameworks could support improvements in this field.

This study demonstrates that the available models and frameworks do not cover all characteristics and domains necessary for a complete evaluation of CPGs implementation.

The presented findings contribute to the field of implementation science, encouraging debate on choices and adaptations of models and frameworks for implementation research and evaluation.

Substantial investments have been made in clinical research and development in recent decades, increasing the medical knowledge base and the availability of health technologies [ 1 ]. The use of clinical practice guidelines (CPGs) has increased worldwide to guide best health practices and to maximize healthcare investments. A CPG can be defined as "any formal statements systematically developed to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances" [ 2 ] and has the potential to improve patient care by promoting interventions of proven benefit and discouraging ineffective interventions. Furthermore, they can promote efficiency in resource allocation and provide support for managers and health professionals in decision-making [ 3 , 4 ].

However, having a quality CPG does not guarantee that the expected health benefits will be obtained. In fact, putting these devices to use still presents a challenge for most health services across distinct levels of government. In addition to the development of guidelines with high methodological rigor, those recommendations need to be available to their users; these recommendations involve the diffusion and dissemination stages, and they need to be used in clinical practice (implemented), which usually requires behavioral changes and appropriate resources and infrastructure. All these stages involve an iterative and complex process called implementation, which is defined as the process of putting new practices within a setting into use [ 5 , 6 ].

Implementation is a cyclical process, and the evaluation is one of its key stages, which allows continuous improvement of CPGs development and implementation strategies. It consists of verifying whether clinical practice is being performed as recommended (process evaluation or formative evaluation) and whether the expected results and impact are being reached (summative evaluation) [ 7 , 8 , 9 ]. Although the importance of the implementation evaluation stage has been recognized, research on how these guidelines are implemented is scarce [ 10 ]. This paper focused on the process of assessing CPGs implementation.

To understand and improve this complex process, implementation science provides a systematic set of principles and methods to integrate research findings and other evidence-based practices into routine practice and improve the quality and effectiveness of health services and care [ 11 ]. The field of implementation science uses theoretical approaches that have varying degrees of specificity based on the current state of knowledge and are structured based on theories, models, and frameworks [ 5 , 12 , 13 ]. A "Model" is defined as "a simplified depiction of a more complex world with relatively precise assumptions about cause and effect", and a "framework" is defined as "a broad set of constructs that organize concepts and data descriptively without specifying causal relationships" [ 9 ]. Although these concepts are distinct, in this paper, their use will be interchangeable, as they are typically like checklists of factors relevant to various aspects of implementation.

There are a variety of theoretical approaches available in implementation science [ 5 , 14 ], which can make choosing the most appropriate challenging [ 5 ]. Some models and frameworks have been categorized as "evaluation models" by providing a structure for evaluating implementation endeavors [ 15 ], even though theoretical approaches from other categories can also be applied for evaluation purposes because they specify concepts and constructs that may be operationalized and measured [ 13 ]. Two frameworks that can specify implementation aspects that should be evaluated as part of intervention studies are RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) [ 16 ] and PRECEDE-PROCEED (Predisposing, Reinforcing and Enabling Constructs in Educational Diagnosis and Evaluation-Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development) [ 17 ]. Although the number of theoretical approaches has grown in recent years, the use of models and frameworks to evaluate the implementation of guidelines still seems to be a challenge.

This article aims to provide a complete map of the models and frameworks applied to assess the implementation of CPGs. The aim is also to subside debate and choices on models and frameworks for the research and evaluation of the implementation processes of CPGs and thus to facilitate the continued development of the field of implementation as well as to contribute to healthcare policy and practice.

A systematic review was conducted following the Cochrane methodology [ 18 ], with adaptations to the "selection process" due to the unique nature of this review (details can be found in the respective section). The review protocol was registered in PROSPERO (registration number: CRD42022335884) on June 7, 2022. This report adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [ 19 ] and a completed checklist is provided in Additional File 1.

Eligibility criteria

The SDMO approach (Types of Studies, Types of Data, Types of Methods, Outcomes) [ 20 ] was utilized in this systematic review, outlined as follows:

Types of studies

All types of studies were considered for inclusion, as the assessment of CPG implementation can benefit from a diverse range of study designs, including randomized clinical trials/experimental studies, scale/tool development, systematic reviews, opinion pieces, qualitative studies, peer-reviewed articles, books, reports, and unpublished theses.

Studies were categorized based on their methodological designs, which guided the synthesis, risk of bias assessment, and presentation of results.

Study protocols and conference abstracts were excluded due to insufficient information for this review.

Types of data

Studies that evaluated the implementation of CPGs either independently or as part of a multifaceted intervention.

Guidelines for evaluating CPG implementation.

Inclusion of CPGs related to any context, clinical area, intervention, and patient characteristics.

No restrictions were placed on publication date or language.

Exclusion criteria

General guidelines were excluded, as this review focused on 'models for evaluating clinical practice guidelines implementation' rather than the guidelines themselves.

Studies that focused solely on implementation determinants as barriers and enablers were excluded, as this review aimed to explore comprehensive models/frameworks.

Studies evaluating programs and policies were excluded.

Studies that only assessed implementation strategies (isolated actions) rather than the implementation process itself were excluded.

Studies that focused solely on the impact or results of implementation (summative evaluation) were excluded.

Types of methods

Not applicable.

All potential models or frameworks for assessing the implementation of CPG (evaluation models/frameworks), as well as their characteristics: name; specific objectives; levels of use (clinical, organizational, and policy); health system (public, private, or both); type of health service (community, ambulatorial, hospital, institutional, homecare); domains or outcomes evaluated; type of recommendation evaluated; context; limitations of the model.

Model was defined as "a deliberated simplification of a phenomenon on a specific aspect" [ 21 ].

Framework was defined as "structure, overview outline, system, or plan consisting of various descriptive categories" [ 21 ].

Models or frameworks used solely for the CPG development, dissemination, or implementation phase.

Models/frameworks used solely for assessment processes other than implementation, such as for the development or dissemination phase.

Data sources and literature search

The systematic search was conducted on July 31, 2022 (and updated on May 15, 2023) in the following electronic databases: MEDLINE/PubMed, Centre for Reviews and Dissemination (CRD), the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Epistemonikos, Global Health, Health Systems Evidence, PDQ-Evidence, PsycINFO, Rx for Change (Canadian Agency for Drugs and Technologies in Health, CADTH), Scopus, Web of Science and Virtual Health Library (VHL). The Google Scholar database was used for the manual selection of studies (first 10 pages).

Additionally, hand searches were performed on the lists of references included in the systematic reviews and citations of the included studies, as well as on the websites of institutions working on CPGs development and implementation: Guidelines International Networks (GIN), National Institute for Health and Care Excellence (NICE; United Kingdom), World Health Organization (WHO), Centers for Disease Control and Prevention (CDC; USA), Institute of Medicine (IOM; USA), Australian Department of Health and Aged Care (ADH), Healthcare Improvement Scotland (SIGN), National Health and Medical Research Council (NHMRC; Australia), Queensland Health, The Joanna Briggs Institute (JBI), Ministry of Health and Social Policy of Spain, Ministry of Health of Brazil and Capes Theses and Dissertations Catalog.

The search strategy combined terms related to "clinical practice guidelines" (practice guidelines, practice guidelines as topic, clinical protocols), "implementation", "assessment" (assessment, evaluation), and "models, framework". The free term "monitoring" was not used because it was regularly related to clinical monitoring and not to implementation monitoring. The search strategies adapted for the electronic databases are presented in an additional file (see Additional file 2).

Study selection process

The results of the literature search from scientific databases, excluding the CRD database, were imported into Mendeley Reference Management software to remove duplicates. They were then transferred to the Rayyan platform ( https://rayyan.qcri.org ) [ 22 ] for the screening process. Initially, studies related to the "assessment of implementation of the CPG" were selected. The titles were first screened independently by two pairs of reviewers (first selection: four reviewers, NM, JB, SS, and JG; update: a pair of reviewers, NM and DG). The title screening was broad, including all potentially relevant studies on CPG and the implementation process. Following that, the abstracts were independently screened by the same group of reviewers. The abstract screening was more focused, specifically selecting studies that addressed CPG and the evaluation of the implementation process. In the next step, full-text articles were reviewed independently by a pair of reviewers (NM, DG) to identify those that explicitly presented "models" or "frameworks" for assessing the implementation of the CPG. Disagreements regarding the eligibility of studies were resolved through discussion and consensus, and by a third reviewer (JB) when necessary. One reviewer (NM) conducted manual searches, and the inclusion of documents was discussed with the other reviewers.

Risk of bias assessment of studies

The selected studies were independently classified and evaluated according to their methodological designs by two investigators (NM and JG). This review employed JBI’s critical appraisal tools to assess the trustworthiness, relevance and results of the included studies [ 23 ] and these tools are presented in additional files (see Additional file 3 and Additional file 4). Disagreements were resolved by consensus or consultation with the other reviewers. Methodological guidelines and noncomparative and before–after studies were not evaluated because JBI does not have specific tools for assessing these types of documents. Although the studies were assessed for quality, they were not excluded on this basis.

Data extraction

The data was independently extracted by two reviewers (NM, DG) using a Microsoft Excel spreadsheet. Discrepancies were discussed and resolved by consensus. The following information was extracted:

Document characteristics : author; year of publication; title; study design; instrument of evaluation; country; guideline context;

Usage context of the models : specific objectives; level of use (clinical, organizational, and policy); type of health service (community, ambulatorial, hospital, institutional); target group (guideline developers, clinicians; health professionals; health-policy decision-makers; health-care organizations; service managers);

Model and framework characteristics : name, domain evaluated, and model limitations.

The set of information to be extracted, shown in the systematic review protocol, was adjusted to improve the organization of the analysis.

The "level of use" refers to the scope of the model used. "Clinical" was considered when the evaluation focused on individual practices, "organizational" when practices were within a health service institution, and "policy" when the evaluation was more systemic and covered different health services or institutions.

The "type of health service" indicated the category of health service where the model/framework was used (or can be used) to assess the implementation of the CPG, related to the complexity of healthcare. "Community" is related to primary health care; "ambulatorial" is related to secondary health care; "hospital" is related to tertiary health care; and "institutional" represented models/frameworks not specific to a particular type of health service.

The "target group" included stakeholders related to the use of the model/framework for evaluating the implementation of the CPG, such as clinicians, health professionals, guideline developers, health policy-makers, health organizations, and service managers.

The category "health system" (public, private, or both) mentioned in the systematic review protocol was not found in the literature obtained and was removed as an extraction variable. Similarly, the variables "type of recommendation evaluated" and "context" were grouped because the same information was included in the "guideline context" section of the study.

Some selected documents presented models or frameworks recognized by the scientific field, including some that were validated. However, some studies adapted the model to this context. Therefore, the domain analysis covered all models or frameworks domains evaluated by (or suggested for evaluation by) the document analyzed.

Data analysis and synthesis

The results were tabulated using narrative synthesis with an aggregative approach, without meta-analysis, aiming to summarize the documents descriptively for the organization, description, interpretation and explanation of the study findings [ 24 , 25 ].

The model/framework domains evaluated in each document were studied according to Nilsen et al.’s constructs: "strategies", "context", "outcomes", "fidelity", "adaptation" and "sustainability". For this study, "strategies" were described as structured and planned initiatives used to enhance the implementation of clinical practice [ 26 ].

The definition of "context" varies in the literature. Despite that, this review considered it as the set of circumstances or factors surrounding a particular implementation effort, such as organizational support, financial resources, social relations and support, leadership, and organizational culture [ 26 , 27 ]. The domain "context" was subdivided according to the level of health care into "micro" (individual perspective), "meso" (organizational perspective), "macro" (systemic perspective), and "multiple" (when there is an issue involving more than one level of health care).

The "outcomes" domain was related to the results of the implementation process (unlike clinical outcomes) and was stratified according to the following constructs: acceptability, appropriateness, feasibility, adoption, cost, and penetration. All these concepts align with the definitions of Proctor et al. (2011), although we decided to separate "fidelity" and "sustainability" as independent domains similar to Nilsen [ 26 , 28 ].

"Fidelity" and "adaptation" were considered the same domain, as they are complementary pieces of the same issue. In this study, implementation fidelity refers to how closely guidelines are followed as intended by their developers or designers. On the other hand, adaptation involves making changes to the content or delivery of a guideline to better fit the needs of a specific context. The "sustainability" domain was defined as evaluations about the continuation or permanence over time of the CPG implementation.

Additionally, the domain "process" was utilized to address issues related to the implementation process itself, rather than focusing solely on the outcomes of the implementation process, as done by Wang et al. [ 14 ]. Furthermore, the "intervention" domain was introduced to distinguish aspects related to the CPG characteristics that can impact its implementation, such as the complexity of the recommendation.

A subgroup analysis was performed with models and frameworks categorized based on their levels of use (clinical, organizational, and policy) and the type of health service (community, ambulatorial, hospital, institutional) associated with the CPG. The goal is to assist stakeholders (politicians, clinicians, researchers, or others) in selecting the most suitable model for evaluating CPG implementation based on their specific health context.

Search results

Database searches yielded 26,011 studies, of which 107 full texts were reviewed. During the full-text review, 99 articles were excluded: 41 studies did not mention a model or framework for assessing the implementation of the CPG, 31 studies evaluated only implementation strategies (isolated actions) rather than the implementation process itself, and 27 articles were not related to the implementation assessment. Therefore, eight studies were included in the data analysis. The updated search did not reveal additional relevant studies. The main reason for study exclusion was that they did not use models or frameworks to assess CPG implementation. Additionally, four methodological guidelines were included from the manual search (Fig.  1 ).

PRISMA diagram. Acronyms: ADH—Australian Department of Health, CINAHL—Cumulative Index to Nursing and Allied Health Literature, CDC—Centers for Disease Control and Prevention, CRD—Centre for Reviews and Dissemination, GIN—Guidelines International Networks, HSE—Health Systems Evidence, IOM—Institute of Medicine, JBI—The Joanna Briggs Institute, MHB—Ministry of Health of Brazil, NICE—National Institute for Health and Care Excellence, NHMRC—National Health and Medical Research Council, MSPS – Ministerio de Sanidad Y Política Social (Spain), SIGN—Scottish Intercollegiate Guidelines Network, VHL – Virtual Health Library, WHO—World Health Organization. Legend: Reason A –The study evaluated only implementation strategies (isolated actions) rather than the implementation process itself. Reason B – The study did not mention a model or framework for assessing the implementation of the intervention. Reason C – The study was not related to the implementation assessment. Adapted from Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. https://doi.org/10.1136/bmj.n71 . For more information, visit:

According to the JBI’s critical appraisal tools, the overall assessment of the studies indicates their acceptance for the systematic review.

The cross-sectional studies lacked clear information regarding "confounding factors" or "strategies to address confounding factors". This was understandable given the nature of the study, where such details are not typically included. However, the reviewers did not find this lack of information to be critical, allowing the studies to be included in the review. The results of this methodological quality assessment can be found in an additional file (see Additional file 5).

In the qualitative studies, there was some ambiguity regarding the questions: "Is there a statement locating the researcher culturally or theoretically?" and "Is the influence of the researcher on the research, and vice versa, addressed?". However, the reviewers decided to include the studies and deemed the methodological quality sufficient for the analysis in this article, based on the other information analyzed. The results of this methodological quality assessment can be found in an additional file (see Additional file 6).

Documents characteristics (Table  1 )

The documents were directed to several continents: Australia/Oceania (4/12) [ 31 , 33 , 36 , 37 ], North America (4/12 [ 30 , 32 , 38 , 39 ], Europe (2/12 [ 29 , 35 ] and Asia (2/12) [ 34 , 40 ]. The types of documents were classified as cross-sectional studies (4/12) [ 29 , 32 , 34 , 38 ], methodological guidelines (4/12) [ 33 , 35 , 36 , 37 ], mixed methods studies (3/12) [ 30 , 31 , 39 ] or noncomparative studies (1/12) [ 40 ]. In terms of the instrument of evaluation, most of the documents used a survey/questionnaire (6/12) [ 29 , 30 , 31 , 32 , 34 , 38 ], while three (3/12) used qualitative instruments (interviews, group discussions) [ 30 , 31 , 39 ], one used a checklist [ 37 ], one used an audit [ 33 ] and three (3/12) did not define a specific instrument to measure [ 35 , 36 , 40 ].

Considering the clinical areas covered, most studies evaluated the implementation of nonspecific (general) clinical areas [ 29 , 33 , 35 , 36 , 37 , 40 ]. However, some studies focused on specific clinical contexts, such as mental health [ 32 , 38 ], oncology [ 39 ], fall prevention [ 31 ], spinal cord injury [ 30 ], and sexually transmitted infections [ 34 ].

Usage context of the models (Table  1 )

Specific objectives.

All the studies highlighted the purpose of guiding the process of evaluating the implementation of CPGs, even if they evaluated CPGs from generic or different clinical areas.

Levels of use

The most common level of use of the models/frameworks identified to assess the implementation of CPGs was policy (6/12) [ 33 , 35 , 36 , 37 , 39 , 40 ]. In this level, the model is used in a systematic way to evaluate all the processes involved in CPGs implementation and is primarily related to methodological guidelines. This was followed by the organizational level of use (5/12) [ 30 , 31 , 32 , 38 , 39 ], where the model is used to evaluate the implementation of CPGs in a specific institution, considering its specific environment. Finally, the clinical level of use (2/12) [ 29 , 34 ] focuses on individual practice and the factors that can influence the implementation of CPGs by professionals.

Type of health service

Institutional services were predominant (5/12) [ 33 , 35 , 36 , 37 , 40 ] and included methodological guidelines and a study of model development and validation. Hospitals were the second most common type of health service (4/12) [ 29 , 30 , 31 , 34 ], followed by ambulatorial (2/12) [ 32 , 34 ] and community health services (1/12) [ 32 ]. Two studies did not specify which type of health service the assessment addressed [ 38 , 39 ].

Target group

The focus of the target group was professionals directly involved in clinical practice (6/12) [ 29 , 31 , 32 , 34 , 38 , 40 ], namely, health professionals and clinicians. Other less related stakeholders included guideline developers (2/12) [ 39 , 40 ], health policy decision makers (1/12) [ 39 ], and healthcare organizations (1/12) [ 39 ]. The target group was not defined in the methodological guidelines, although all the mentioned stakeholders could be related to these documents.

Model and framework characteristics

Models and frameworks for assessing the implementation of cpgs.

The Consolidated Framework for Implementation Research (CFIR) [ 31 , 38 ] and the Promoting Action on Research Implementation in Health Systems (PARiHS) framework [ 29 , 30 ] were the most commonly employed frameworks within the selected documents. The other models mentioned were: Goal commitment and implementation of practice guidelines framework [ 32 ]; Guideline to identify key indicators [ 35 ]; Guideline implementation checklist [ 37 ]; Guideline implementation evaluation tool [ 40 ]; JBI Implementation Framework [ 33 ]; Reach, effectiveness, adoption, implementation and maintenance (RE-AIM) framework [ 34 ]; The Guideline Implementability Framework [ 39 ] and an unnamed model [ 36 ].

Domains evaluated

The number of domains evaluated (or suggested for evaluation) by the documents varied between three and five, with the majority focusing on three domains. All the models addressed the domain "context", with a particular emphasis on the micro level of the health care context (8/12) [ 29 , 31 , 34 , 35 , 36 , 37 , 38 , 39 ], followed by the multilevel (7/12) [ 29 , 31 , 32 , 33 , 38 , 39 , 40 ], meso level (4/12) [ 30 , 35 , 39 , 40 ] and macro level (2/12) [ 37 , 39 ]. The "Outcome" domain was evaluated in nine models. Within this domain, the most frequently evaluated subdomain was "adoption" (6/12) [ 29 , 32 , 34 , 35 , 36 , 37 ], followed by "acceptability" (4/12) [ 30 , 32 , 35 , 39 ], "appropriateness" (3/12) [ 32 , 34 , 36 ], "feasibility" (3/12) [ 29 , 32 , 36 ], "cost" (1/12) [ 35 ] and "penetration" (1/12) [ 34 ]. Regarding the other domains, "Intervention" (8/12) [ 29 , 31 , 34 , 35 , 36 , 38 , 39 , 40 ], "Strategies" (7/12) [ 29 , 30 , 33 , 35 , 36 , 37 , 40 ] and "Process" (5/12) [ 29 , 31 , 32 , 33 , 38 ] were frequently addressed in the models, while "Sustainability" (1/12) [ 34 ] was only found in one model, and "Fidelity/Adaptation" was not observed. The domains presented by the models and frameworks and evaluated in the documents are shown in Table  2 .

Limitations of the models

Only two documents mentioned limitations in the use of the model or frameworks. These two studies reported limitations in the use of CFIR: "is complex and cumbersome and requires tailoring of the key variables to the specific context", and "this framework should be supplemented with other important factors and local features to achieve a sound basis for the planning and realization of an ongoing project" [ 31 , 38 ]. Limitations in the use of other models or frameworks are not reported.

Subgroup analysis

Following the subgroup analysis (Table  3 ), five different models/frameworks were utilized at the policy level by institutional health services. These included the Guideline Implementation Evaluation Tool [ 40 ], the NHMRC tool (model name not defined) [ 36 ], the JBI Implementation Framework + GRiP [ 33 ], Guideline to identify key indicators [ 35 ], and the Guideline implementation checklist [ 37 ]. Additionally, the "Guideline Implementability Framework" [ 39 ] was implemented at the policy level without restrictions based on the type of health service. Regarding the organizational level, the models used varied depending on the type of service. The "Goal commitment and implementation of practice guidelines framework" [ 32 ] was applied in community and ambulatory health services, while "PARiHS" [ 29 , 30 ] and "CFIR" [ 31 , 38 ] were utilized in hospitals. In contexts where the type of health service was not defined, "CFIR" [ 31 , 38 ] and "The Guideline Implementability Framework" [ 39 ] were employed. Lastly, at the clinical level, "RE-AIM" [ 34 ] was utilized in ambulatory and hospital services, and PARiHS [ 29 , 30 ] was specifically used in hospital services.

Key findings

This systematic review identified 10 models/ frameworks used to assess the implementation of CPGs in various health system contexts. These documents shared similar objectives in utilizing models and frameworks for assessment. The primary level of use was policy, the most common type of health service was institutional, and the main target group of the documents was professionals directly involved in clinical practice. The models and frameworks presented varied analytical domains, with sometimes divergent concepts used in these domains. This study is innovative in its emphasis on the evaluation stage of CPG implementation and in summarizing aspects and domains aimed at the practical application of these models.

The small number of documents contrasts with studies that present an extensive range of models and frameworks available in implementation science. The findings suggest that the use of models and frameworks to evaluate the implementation of CPGs is still in its early stages. Among the selected documents, there was a predominance of cross-sectional studies and methodological guidelines, which strongly influenced how the implementation evaluation was conducted. This was primarily done through surveys/questionnaires, qualitative methods (interviews, group discussions), and non-specific measurement instruments. Regarding the subject areas evaluated, most studies focused on a general clinical area, while others explored different clinical areas. This suggests that the evaluation of CPG implementation has been carried out in various contexts.

The models were chosen independently of the categories proposed in the literature, with their usage categorized for purposes other than implementation evaluation, as is the case with CFIR and PARiHS. This practice was described by Nilsen et al. who suggested that models and frameworks from other categories can also be applied for evaluation purposes because they specify concepts and constructs that may be operationalized and measured [ 14 , 15 , 42 , 43 ].

The results highlight the increased use of models and frameworks in evaluation processes at the policy level and institutional environments, followed by the organizational level in hospital settings. This finding contradicts a review that reported the policy level as an area that was not as well studied [ 44 ]. The use of different models at the institutional level is also emphasized in the subgroup analysis. This may suggest that the greater the impact (social, financial/economic, and organizational) of implementing CPGs, the greater the interest and need to establish well-defined and robust processes. In this context, the evaluation stage stands out as crucial, and the investment of resources and efforts to structure this stage becomes even more advantageous [ 10 , 45 ]. Two studies (16,7%) evaluated the implementation of CPGs at the individual level (clinical level). These studies stand out for their potential to analyze variations in clinical practice in greater depth.

In contrast to the level of use and type of health service most strongly indicated in the documents, with systemic approaches, the target group most observed was professionals directly involved in clinical practice. This suggests an emphasis on evaluating individual behaviors. This same emphasis is observed in the analysis of the models, in which there is a predominance of evaluating the micro level of the health context and the "adoption" subdomain, in contrast with the sub-use of domains such as "cost" and "process". Cassetti et al. observed the same phenomenon in their review, in which studies evaluating the implementation of CPGs mainly adopted a behavioral change approach to tackle those issues, without considering the influence of wider social determinants of health [ 10 ]. However, the literature widely reiterates that multiple factors impact the implementation of CPGs, and different actions are required to make them effective [ 6 , 46 , 47 ]. As a result, there is enormous potential for the development and adaptation of models and frameworks aimed at more systemic evaluation processes that consider institutional and organizational aspects.

In analyzing the model domains, most models focused on evaluating only some aspects of implementation (three domains). All models evaluated the "context", highlighting its significant influence on implementation [ 9 , 26 ]. Context is an essential effect modifier for providing research evidence to guide decisions on implementation strategies [ 48 ]. Contextualizing a guideline involves integrating research or other evidence into a specific circumstance [ 49 ]. The analysis of this domain was adjusted to include all possible contextual aspects, even if they were initially allocated to other domains. Some contextual aspects presented by the models vary in comprehensiveness, such as the assessment of the "timing and nature of stakeholder engagement" [ 39 ], which includes individual engagement by healthcare professionals and organizational involvement in CPG implementation. While the importance of context is universally recognized, its conceptualization and interpretation differ across studies and models. This divergence is also evident in other domains, consistent with existing literature [ 14 ]. Efforts to address this conceptual divergence in implementation science are ongoing, but further research and development are needed in this field [ 26 ].

The main subdomain evaluated was "adoption" within the outcome domain. This may be attributed to the ease of accessing information on the adoption of the CPG, whether through computerized system records, patient records, or self-reports from healthcare professionals or patients themselves. The "acceptability" subdomain pertains to the perception among implementation stakeholders that a particular CPG is agreeable, palatable or satisfactory. On the other hand, "appropriateness" encompasses the perceived fit, relevance or compatibility of the CPG for a specific practice setting, provider, or consumer, or its perceived fit to address a particular issue or problem [ 26 ]. Both subdomains are subjective and rely on stakeholders' interpretations and perceptions of the issue being analyzed, making them susceptible to reporting biases. Moreover, obtaining this information requires direct consultation with stakeholders, which can be challenging for some evaluation processes, particularly in institutional contexts.

The evaluation of the subdomains "feasibility" (the extent to which a CPG can be successfully used or carried out within a given agency or setting), "cost" (the cost impact of an implementation effort), and "penetration" (the extent to which an intervention or treatment is integrated within a service setting and its subsystems) [ 26 ] was rarely observed in the documents. This may be related to the greater complexity of obtaining information on these aspects, as they involve cross-cutting and multifactorial issues. In other words, it would be difficult to gather this information during evaluations with health practitioners as the target group. This highlights the need for evaluation processes of CPGs implementation involving multiple stakeholders, even if the evaluation is adjusted for each of these groups.

Although the models do not establish the "intervention" domain, we thought it pertinent in this study to delimit the issues that are intrinsic to CPGs, such as methodological quality or clarity in establishing recommendations. These issues were quite common in the models evaluated but were considered in other domains (e.g., in "context"). Studies have reported the importance of evaluating these issues intrinsic to CPGs [ 47 , 50 ] and their influence on the implementation process [ 51 ].

The models explicitly present the "strategies" domain, and its evaluation was usually included in the assessments. This is likely due to the expansion of scientific and practical studies in implementation science that involve theoretical approaches to the development and application of interventions to improve the implementation of evidence-based practices. However, these interventions themselves are not guaranteed to be effective, as reported in a previous review that showed unclear results indicating that the strategies had affected successful implementation [ 52 ]. Furthermore, model domains end up not covering all the complexity surrounding the strategies and their development and implementation process. For example, the ‘Guideline implementation evaluation tool’ evaluates whether guideline developers have designed and provided auxiliary tools to promote the implementation of guidelines [ 40 ], but this does not mean that these tools would work as expected.

The "process" domain was identified in the CFIR [ 31 , 38 ], JBI/GRiP [ 33 ], and PARiHS [ 29 ] frameworks. While it may be included in other domains of analysis, its distinct separation is crucial for defining operational issues when assessing the implementation process, such as determining if and how the use of the mentioned CPG was evaluated [ 3 ]. Despite its presence in multiple models, there is still limited detail in the evaluation guidelines, which makes it difficult to operationalize the concept. Further research is needed to better define the "process" domain and its connections and boundaries with other domains.

The domain of "sustainability" was only observed in the RE-AIM framework, which is categorized as an evaluation framework [ 34 ]. In its acronym, the letter M stands for "maintenance" and corresponds to the assessment of whether the user maintains use, typically longer than 6 months. The presence of this domain highlights the need for continuous evaluation of CPGs implementation in the short, medium, and long term. Although the RE-AIM framework includes this domain, it was not used in the questionnaire developed in the study. One probable reason is that the evaluation of CPGs implementation is still conducted on a one-off basis and not as a continuous improvement process. Considering that changes in clinical practices are inherent over time, evaluating and monitoring changes throughout the duration of the CPG could be an important strategy for ensuring its implementation. This is an emerging field that requires additional investment and research.

The "Fidelity/Adaptation" domain was not observed in the models. These emerging concepts involve the extent to which a CPG is being conducted exactly as planned or whether it is undergoing adjustments and adaptations. Whether or not there is fidelity or adaptation in the implementation of CPGs does not presuppose greater or lesser effectiveness; after all, some adaptations may be necessary to implement general CPGs in specific contexts. The absence of this domain in all the models and frameworks may suggest that they are not relevant aspects for evaluating implementation or that there is a lack of knowledge of these complex concepts. This may suggest difficulty in expressing concepts in specific evaluative questions. However, further studies are warranted to determine the comprehensiveness of these concepts.

It is important to note the customization of the domains of analysis, with some domains presented in the models not being evaluated in the studies, while others were complementarily included. This can be seen in Jeong et al. [ 34 ], where the "intervention" domain in the evaluation with the RE-AIM framework reinforced the aim of theoretical approaches such as guiding the process and not determining norms. Despite this, few limitations were reported for the models, suggesting that the use of models in these studies reflects the application of these models to defined contexts without a deep critical analysis of their domains.

Limitations

This review has several limitations. First, only a few studies and methodological guidelines that explicitly present models and frameworks for assessing the implementation of CPGs have been found. This means that few alternative models could be analyzed and presented in this review. Second, this review adopted multiple analytical categories (e.g., level of use, health service, target group, and domains evaluated), whose terminology has varied enormously in the studies and documents selected, especially for the "domains evaluated" category. This difficulty in harmonizing the taxonomy used in the area has already been reported [ 26 ] and has significant potential to confuse. For this reason, studies and initiatives are needed to align understandings between concepts and, as far as possible, standardize them. Third, in some studies/documents, the information extracted was not clear about the analytical category. This required an in-depth interpretative process of the studies, which was conducted in pairs to avoid inappropriate interpretations.

Implications

This study contributes to the literature and clinical practice management by describing models and frameworks specifically used to assess the implementation of CPGs based on their level of use, type of health service, target group related to the CPG, and the evaluated domains. While there are existing reviews on the theories, frameworks, and models used in implementation science, this review addresses aspects not previously covered in the literature. This valuable information can assist stakeholders (such as politicians, clinicians, researchers, etc.) in selecting or adapting the most appropriate model to assess CPG implementation based on their health context. Furthermore, this study is expected to guide future research on developing or adapting models to assess the implementation of CPGs in various contexts.

The use of models and frameworks to evaluate the implementation remains a challenge. Studies should clearly state the level of model use, the type of health service evaluated, and the target group. The domains evaluated in these models may need adaptation to specific contexts. Nevertheless, utilizing models to assess CPGs implementation is crucial as they can guide a more thorough and systematic evaluation process, aiding in the continuous improvement of CPGs implementation. The findings of this systematic review offer valuable insights for stakeholders in selecting or adjusting models and frameworks for CPGs evaluation, supporting future theoretical advancements and research.

Availability of data and materials

Abbreviations.

Australian Department of Health and Aged Care

Canadian Agency for Drugs and Technologies in Health

Centers for Disease Control and

Consolidated Framework for Implementation Research

Cumulative Index to Nursing and Allied Health Literature

Clinical practice guideline

Centre for Reviews and Dissemination

Guidelines International Networks

Getting Research into Practice

Health Systems Evidence

Institute of Medicine

The Joanna Briggs Institute

Ministry of Health of Brazil

Ministerio de Sanidad y Política Social

National Health and Medical Research Council

National Institute for Health and Care Excellence

Promoting action on research implementation in health systems framework

Predisposing, Reinforcing and Enabling Constructs in Educational Diagnosis and Evaluation-Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

International Prospective Register of Systematic Reviews

Reach, effectiveness, adoption, implementation, and maintenance framework

Healthcare Improvement Scotland

United States of America

Virtual Health Library

World Health Organization

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This study is supported by the Fundação de Apoio à Pesquisa do Distrito Federal (FAPDF). FAPDF Award Term (TOA) nº 44/2024—FAPDF/SUCTI/COOBE (SEI/GDF – Process 00193–00000404/2024–22). The content in this article is solely the responsibility of the authors and does not necessarily represent the official views of the FAPDF.

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NFM and JOMB conceived the idea and the protocol for this study. NFM conducted the literature search. NFM, SNS, JMG and JOMB conducted the data collection with advice and consensus gathering from JOMB. The NFM and JMG assessed the quality of the studies. NFM and DFG conducted the data extraction. NFM performed the analysis and synthesis of the results with advice and consensus gathering from JOMB. NFM drafted the manuscript. JOMB critically revised the first version of the manuscript. All the authors revised and approved the submitted version.

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Supplementary Information

13012_2024_1389_moesm1_esm.docx.

Additional file 1: PRISMA checklist. Description of data: Completed PRISMA checklist used for reporting the results of this systematic review.

Additional file 2: Literature search. Description of data: The search strategies adapted for the electronic databases.

13012_2024_1389_moesm3_esm.doc.

Additional file 3: JBI’s critical appraisal tools for cross-sectional studies. Description of data: JBI’s critical appraisal tools to assess the trustworthiness, relevance, and results of the included studies. This is specific for cross-sectional studies.

13012_2024_1389_MOESM4_ESM.doc

Additional file 4: JBI’s critical appraisal tools for qualitative studies. Description of data: JBI’s critical appraisal tools to assess the trustworthiness, relevance, and results of the included studies. This is specific for qualitative studies.

13012_2024_1389_MOESM5_ESM.doc

Additional file 5: Methodological quality assessment results for cross-sectional studies. Description of data: Methodological quality assessment results for cross-sectional studies using JBI’s critical appraisal tools.

13012_2024_1389_MOESM6_ESM.doc

Additional file 6: Methodological quality assessment results for the qualitative studies. Description of data: Methodological quality assessment results for qualitative studies using JBI’s critical appraisal tools.

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Freitas de Mello, N., Nascimento Silva, S., Gomes, D.F. et al. Models and frameworks for assessing the implementation of clinical practice guidelines: a systematic review. Implementation Sci 19 , 59 (2024). https://doi.org/10.1186/s13012-024-01389-1

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Deprescribing Equity—A Research Framework for Older Adults

• 1 Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles
• 2 Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
• 3 Leonard Davis School of Gerontology, University of Southern California, Los Angeles
• Research Letter Antiplatelet and Anticoagulant Use in Nursing Home Residents With Atrial Fibrillation Darae Ko, MD, MSc; Yoojin Lee, MPH; Dae Hyun Kim, MD, ScD; Sachin J. Shah, MD, MPH; Kaleen N. Hayes, PharmD, PhD; Andrew R. Zullo, PharmD, PhD; Sarah D. Berry, MD, MPH JAMA Internal Medicine

Atrial fibrillation (AF) is the most common heart rhythm disorder and is associated with considerable morbidity from ischemic stroke, particularly among older adults. 1 Oral anticoagulant (OAC) therapy greatly reduces stroke risk. Despite the evidence against antiplatelet use for stroke prevention, these therapies are often prescribed for AF. However, few have characterized this potentially inappropriate use in older adults.

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Essien UR , Keller MS. Deprescribing Equity—A Research Framework for Older Adults. JAMA Intern Med. Published online August 12, 2024. doi:10.1001/jamainternmed.2024.3824

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Why Dropping the E in DEI Is a Mistake

• Enrica N. Ruggs
• Oscar Holmes IV

The Society for Human Resource Management’s decision to remove “equity” from its DEI framework sets a dangerous precedent that flies in the face of decades of research.

The Society for Human Resource Management (SHRM) has decided to remove “equity” from its inclusion, equity, and diversity (IE&D) framework, now promoting “inclusion and diversity” (I&D) instead. This decision sets a dangerous precedent that flies in the face of decades of research about DEI in the workplace. It undermines efforts to create equitable workplaces and ignores the vital role of equity in fostering fairness and addressing systemic barriers faced by marginalized groups. Instead of scaling back their focus on equity, companies should: 1) Commit to achievable equity goals; 2) Implement and track evidence-based DEI policies and practices; and 3) Establish accountability and transparency.

Recently, the Society for Human Resource Management (SHRM), a leading voice of HR professionals, announced that it was abandoning the acronym “IE&D” — inclusion, equity, and diversity — in favor of “I&D.”

• Enrica N. Ruggs , PhD is an associate professor of management in the C. T. Bauer College of Business at the University of Houston. She is a workplace diversity scholar who conducts research on reducing discrimination and bias in organizations and improving workplace experiences for individuals with marginalized identities.
• Oscar Holmes IV , PhD, SHRM-SCP is an associate professor of management at Rutgers University-Camden and the creator and host of the podcast Diversity Matters . In his research he examines how leaders can maximize productivity and well-being by fostering more inclusive workplaces.

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