ArticleJournal of evaluation in clinical practice2026
Addressing the How of Implementation: A Hermeneutic Exploration of Implementing Virtual Kidney Care in a Remote, Rural Health Region.
Article in Journal of evaluation in clinical practice, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
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Authors and funding
10 authors.
Funding
Abstract
rationaleImplementing evidence-informed healthcare services is typically approached as a structured, time-limited project, focused largely on what to do. Less well understood is how implementation actually unfolds in practice: the ways in which those involved navigate change and generate solutions in diverse community settings. Without understanding how implementation happens in unique contexts, implementation failure may remain poorly understood.
aimThe aim was to understand what it means for kidney care team providers, information technology staff, and patients to engage in implementing an evolving virtual kidney care service in a large, sparsely populated rural and remote region.
methodWe interviewed eight kidney care service providers, two information technology specialists, and 17 patients in northern British Columbia, Canada, for their experiences in implementing, delivering, and receiving virtual kidney care and how their practices changed with COVID-19. Through an inductive, reflexive process of analysis and hermeneutic interpretation, we identified patterns in how virtual kidney care was implemented.
resultsThe analysis showed six hermeneutic principles of implementation at work in the everyday practices of the kidney care and information technology teams: acknowledging central concerns, creating new common understandings, collectively acting, surfacing tensions, being responsive to context, and engaging in ongoing dialogue. Rather than discrete, technical, and time-limited, we found implementation to be an ongoing, evolving, relational, generative, and iterative process that is inextricably connected to its context, and that never fully ends.
conclusionAttending to the how revealed dimensions of implementation practice that are seldom visible in conventional implementation research. A hermeneutic sensibility, marked by openness, humility, and dialogue, with a commitment to understanding, responsiveness, and relationship-building, is key to implementation, especially in the ever-changing contexts of rural and remote areas. The findings point to the value of a hermeneutic approach in implementing, sustaining, and researching innovations in dynamic healthcare systems and rural settings.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.