Definition of Genre

Genre originates from the French word meaning kind or type. As a literary device, genre refers to a form, class, or type of literary work. The primary genres in literature are poetry, drama / play , essay , short story , and novel . The term genre is used quite often to denote literary sub-classifications or specific types of literature such as comedy , tragedy , epic poetry, thriller , science fiction , romance , etc.

It’s important to note that, as a literary device, the genre is closely tied to the expectations of readers. This is especially true for literary sub-classifications. For example, Jane Austen ’s work is classified by most as part of the romance fiction genre, as demonstrated by this quote from her novel Sense and Sensibility :

When I fall in love, it will be forever.

Though Austen’s work is more complex than most formulaic romance novels, readers of Austen’s work have a set of expectations that it will feature a love story of some kind. If a reader found space aliens or graphic violence in a Jane Austen novel, this would undoubtedly violate their expectations of the romantic fiction genre.

Difference Between Style and Genre

Although both seem similar, the style is different from the genre. In simple terms, style means the characters or features of the work of a single person or individual. However, the genre is the classification of those words into broader categories such as modernist, postmodernist or short fiction and novels, and so on. Genres also have sub-genre, but the style does not have sub-styles. Style usually have further features and characteristics.

Common Examples of Genre

Genres could be divided into four major categories which also have further sub-categories. The four major categories are given below.

  • Poetry: It could be categorized into further sub-categories such as epic, lyrical poetry, odes , sonnets , quatrains , free verse poems, etc.
  • Fiction : It could be categorized into further sub-categories such as short stories, novels, skits, postmodern fiction, modern fiction, formal fiction, and so on.
  • Prose : It could be further categorized into sub-genres or sub-categories such as essays, narrative essays, descriptive essays, autobiography , biographical writings, and so on.
  • Drama: It could be categorized into tragedy, comedy, romantic comedy, absurd theatre, modern play, and so on.

Common Examples of Fiction Genre

In terms of literature, fiction refers to the prose of short stories, novellas , and novels in which the story originates from the writer’s imagination. These fictional literary forms are often categorized by genre, each of which features a particular style, tone , and storytelling devices and elements.

Here are some common examples of genre fiction and their characteristics:

  • Literary Fiction : a work with artistic value and literary merit.
  • Thriller : features dark, mysterious, and suspenseful plots.
  • Horror : intended to scare and shock the reader while eliciting a sense of terror or dread; may feature scary entities such as ghosts, zombies, evil spirits, etc.
  • Mystery : generally features a detective solving a case with a suspenseful plot and slowly revealing information for the reader to piece together.
  • Romance : features a love story or romantic relationship; generally lighthearted, optimistic, and emotionally satisfying.
  • Historical : plot takes place in the past with balanced realism and creativity; can feature actual historical figures, events, and settings.
  • Western : generally features cowboys, settlers, or outlaws of the American Old West with themes of the frontier.
  • Bildungsroman : story of a character passing from youth to adulthood with psychological and/or moral growth; the character becomes “educated” through loss, a journey, conflict , and maturation.
  • Science Fiction : speculative stories derived and/or inspired by natural and social sciences; generally features futuristic civilizations, time travel, or space exploration.
  • Dystopian : sub-genre of science fiction in which the story portrays a setting that may appear utopian but has a darker, underlying presence that is problematic.
  • Fantasy : speculative stories with imaginary characters in imaginary settings; can be inspired by mythology or folklore and generally include magical elements.
  • Magical Realism : realistic depiction of a story with magical elements that are accepted as “normal” in the universe of the story.
  • Realism : depiction of real settings, people, and plots as a means of approaching the truth of everyday life and laws of nature.

Examples of Writers Associated with Specific Genre Fiction

Writers are often associated with a specific genre of fictional literature when they achieve critical acclaim, public notoriety, and/or commercial success with readers for a particular work or series of works. Of course, this association doesn’t limit the writer to that particular genre of fiction. However, being paired with a certain type of literature can last for an author’s entire career and beyond.

Here are some examples of writers that have become associated with specific fiction genre:

  • Stephen King: horror
  • Ray Bradbury : science fiction
  • Jackie Collins: romance
  • Toni Morrison: black feminism
  • John le Carré: espionage
  • Philippa Gregory: historical fiction
  • Jacqueline Woodson: racial identity fiction
  • Philip Pullman: fantasy
  • Flannery O’Connor: Southern Gothic
  • Shel Silverstein: children’s poetry
  • Jonathan Swift : satire
  • Larry McMurtry: western
  • Virginia Woolf: feminism
  • Raymond Chandler: detective fiction
  • Colson Whitehead: Afrofuturism
  • Gabriel García Márquez : magical realism
  • Madeleine L’Engle: children’s fantasy fiction
  • Agatha Christie : mystery
  • John Green : young adult fiction
  • Margaret Atwood: dystopian

Famous Examples of Genre in Other Art Forms

Most art forms feature genre as a means of identifying, differentiating, and categorizing the many forms and styles within a particular type of art. Though there are many crossovers when it comes to genre and no finite boundaries, most artistic works within a particular genre feature shared patterns , characteristics, and conventions.

Here are some famous examples of genres in other art forms:

  • Music : rock, country, hip hop, folk, classical, heavy metal, jazz, blues
  • Visual Art : portrait, landscape, still life, classical, modern, impressionism, expressionism
  • Drama : comedy, tragedy, tragicomedy , melodrama , performance, musical theater, illusion
  • Cinema : action, horror, drama, romantic comedy, western, adventure , musical, documentary, short, biopic, fantasy, superhero, sports

Examples of Genre in Literature

As a literary device, the genre is like an implied social contract between writers and their readers. This does not mean that writers must abide by all conventions associated with a specific genre. However, there are organizational patterns within a genre that readers tend to expect. Genre expectations allow readers to feel familiar with the literary work and help them to organize the information presented by the writer. In addition, keeping with genre conventions can establish a writer’s relationship with their readers and a framework for their literature.

Here are some examples of genres in literature and the conventions they represent:

Example 1: Macbeth by William Shakespeare

Tomorrow, and tomorrow, and tomorrow , Creeps in this petty pace from day to day To the last syllable of recorded time, And all our yesterdays have lighted fools The way to dusty death. Out, out , brief candle! Life’s but a walking shadow, a poor player That struts and frets his hour upon the stage And then is heard no more: it is a tale Told by an idiot, full of sound and fury, Signifying nothing.

The formal genre of this well-known literary work is Shakespearean drama or play. Macbeth can be sub-categorized as a literary tragedy in that the play features the elements of a classical tragic work. For example, Macbeth’s character aligns with the traits and path of a tragic hero –a protagonist whose tragic flaw brings about his downfall from power to ruin. This tragic arc of the protagonist often results in catharsis (emotional release) and potential empathy among readers and members of the audience .

In addition to featuring classical characteristics and conventions of the tragic genre, Shakespeare’s play also resonates with modern readers and audiences as a tragedy. In this passage, one of Macbeth’s soliloquies , his disillusionment, and suffering is made clear in that, for all his attempts and reprehensible actions at gaining power, his life has come to nothing. Macbeth realizes that death is inevitable, and no amount of power can change that truth. As Macbeth’s character confronts his mortality and the virtual meaninglessness of his life, readers and audiences are called to do the same. Without affirmation or positive resolution , Macbeth’s words are as tragic for readers and audiences as they are for his own character.

Like  M a cbeth , Shakespeare’s tragedies are as currently relevant as they were when they were written. The themes of power, ambition, death, love, and fate incorporated in his tragic literary works are universal and timeless. This allows tragedy as a genre to remain relatable to modern and future readers and audiences.

Example 2: The Color Purple by Alice Walker

All my life I had to fight. I had to fight my daddy . I had to fight my brothers. I had to fight my cousins and my uncles. A girl child ain’t safe in a family of men. But I never thought I’d have to fight in my own house. She let out her breath. I loves Harpo, she say. God knows I do. But I’ll kill him dead before I let him beat me.

The formal genre of this literary work is novel. Walker’s novel can be sub-categorized within many fictional genres. This passage represents and validates its sub-classification within the genre of feminist fiction. Sofia’s character, at the outset, is assertive as a black woman who has been systematically marginalized in her community and family, and she expresses her independence from the dominance and control of men. Sofia is a foil character for Celie, the protagonist, who often submits to the power, control, and brutality of her husband. The juxtaposition of these characters indicates the limited options and harsh consequences faced by women with feminist ideals in the novel.

Unfortunately, Sofia’s determination to fight for herself leads her to be beaten close to death and sent to prison when she asserts herself in front of the white mayor’s wife. However, Sofia’s strong feminist traits have a significant impact on the other characters in the novel, and though she is not able to alter the systemic racism and subjugation she faces as a black woman, she does maintain her dignity as a feminist character in the novel.

Example 3: A Word to Husbands by Ogden Nash

To keep your marriage brimming With love in the loving cup, Whenever you’re wrong, admit it; Whenever you’re right, shut up.

The formal genre of this literary work is poetry. Nash’s poem would be sub-categorized within the genre of humor . The poet’s message to what is presumably his fellow husbands is witty, clear, and direct–through the wording and message of the last poetic line may be unexpected for many readers. In addition, the structure of the poem sets up the “punchline” at the end. The piece begins with poetic wording that appears to romanticize love and marriage, which makes the contrasting “base” language of the final line a satisfying surprise and ironic twist for the reader. The poet’s tone is humorous and light-hearted which also appeals to the characteristics and conventions of this genre.

Synonyms of Genre

Genre doesn’t have direct synonyms . A few close meanings are category, class, group, classification, grouping, head, heading, list, set, listing, and categorization. Some other words such as species, variety, family, school, and division also fall in the category of its synonyms.

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Different Types of Literature

What is literature.

Literature generally can be any written work, but it especially is an artistic or intellectual work of writing. The usage of language in literature differs sometimes from the way it is ordinarily used. The difference is the use of artistic tools to create aesthetic beauty in a text. Literature is the depiction of the society. It is a great tool to teach the morality to a society. 

Here is the detailed study about types of literature.

Types of Literature

Below are the main types of literature: Drama, Fable, Autobiography , Biography , Poetry, Prose, Science Fiction, and Journalistic Literature.

Drama is a play in literature, and a playwright composes it. It portrays fictional or non-fictional stories. To explain away certain events, characters, or stories, a drama is produced, using dialogues or actions. It can be performed on stage, radio or on big screens as in films. Conflicts, emotions and impressive characters are required to produce a high-quality drama. There are many forms of drama but some of the most common are:  comedy, tragedy, musical drama  and  melodrama . Let us have a brief explanation of these types of drama.

1. Comedy :  

Comedy is a type of drama, which is lighter in tone. Its purpose is to make the audience laugh and amuse them. It has a happy ending. Very unusual circumstances are there coupled with quick and witty remarks. People consider it as the most entertaining and fun form of drama and literature. An example of a comedy drama is  ’The Comedy of Errors’  by William Shakespeare.

2. Tragedy :  

Tragedy is the type of drama that has a dark theme. It portrays suffering, pain, longing, and often death. An example of a tragedy drama is ‘ Othello ’  by William Shakespeare.

3. Musical Drama :  

A musical drama tells a story with dialogues, songs, music, and dance. These things convey the emotions in the drama. An example of a musical drama is  ‘A Star is Born’ , which starred Lady Gaga.

4. Melodrama :  

Melodrama is a kind of drama that portrays exaggerated emotions like tension or excitement. It arouses the same emotions in the audience and makes them indulged in it. The situation and the dialogues are more important in a melodrama than action. An example of a melodrama is  ‘Still   Life, Brief Encounter’  by Noel Coward.

Writers write a fable when the intention is to provide the audience with a moral story. A fable usually uses animals as characters to convey the story. In Fables, animals act like humans and can speak and understand reasoning. They are a personification of human characteristics and their nature. An example of a fable is the famous story of ‘The Tortoise and the Hare’ , which almost every child has heard in his childhood. The Animal Farm by George Orwell is also a famous fable. 

Autobiography

  Autobiography is an interesting thing to read because of its teller of the story is the one, about who the story is. The character himself is the writer and describes his life from his own original perspective and experiences. It gives you an insight on the person that is writing it, because they share their true-life events and thoughts. Mostly, famous people write autobiographies to tell their story to their fans and the world. A famous and spectacular example of autobiography is  ‘The Diary of a Young Girl’ , a book by Anne Frank.

Biography in literature tells the story of a person from another person’s perspective. Someone else writes it rather than the subject himself. Biography differs from a resume because it enlightens the audience with different aspects of a person’s life. A great example of biography is ‘Unbroken:   A World War II Story of Survival, Resilience, and Redemption’,  by Laura Hillenbrand.

Poetry in literature is a composition of rhythm, sound, and lyrics. The definition of poetry by one of the greatest poets in history, William Wordsworth, is  “the spontaneous overflow of powerful feelings” . The poet composes poetry in a sort of song to develop emotions and imaginations in the listeners’ hearts and minds. Poetry is aesthetic. The poet chooses words carefully, so the listeners can relate themselves to it. The four main types of poetry are haiku, free verse, sonnets ,  and  acrostic   poems . An example of one of the most beautiful books of poetry is  ‘Ariel’ , by Sylvia Plath.

Prose in literature is that form of literature, which is somewhat plain and simple. It has no special grammar structure or a writing pattern to follow. It is written in a usual tone, forming into a natural speech or a conversational tone. Nothing is specific in prose. Paragraphs or sentences can be long or short. Examples of prose include novels, newspapers, textbooks, etc.

Science Fiction

Science fiction, also called “sci-fi,” is a genre of literature where most of the things are imaginary. The stories are about the future technology. These fiction stories also have a relationship to real science laws, because science considers those things possible in the future, according to the scientific laws. Science fictions are sometimes true and sometimes they are just imaginations based on assumptions. Some examples of science fiction are, ‘The Time Machine’  by H. G. Wells,  ‘Spies in Disguise’  by Blue Sky Studios,  ‘A Wrinkle in Time’  by Madeleine L’Engle, etc.

Journalistic Literature

Journalistic Literature is a sort of nonfiction. In literary journalism, the journalist gathers information and then creates and publishes. It combines the facts and reporting with some clever strategies and narrative techniques. These techniques make the reports more engaging and interesting. People call literary journalism also Narrative or New Journalism. Some of the most prominent literary journalists of past and present are Mark Singer, Richard Rhodes, Jack London, Stephen Crane, Tom Wolfe, Henry Mayhew, etc.

Related Articles

What is literature?

History of English literature

What is literary English?

Figurative language in English literature

What is a sonnet?

What is metaphysical poetry?

Definition and types of irony

Literary terms used in English drama

How to answer a literary question?

Shakespearean Tragedy

Greek tragedy versus Shakespearean tragedy

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What are the 5 Main Literature Genres?

What are the 5 Main Literature Genres?

Categorizing Literature Genres

Popular literature genres

This is often considered the oldest form of literature. Before writing was invented, oral stories were commonly put into some sort of poetic form to make them easier to remember and recite. Poetry today is usually written down but is still sometimes performed. A lot of people think of rhymes and counting syllables and lines when they think of poetry, and some poems certainly follow strict forms. But other types of poetry are so free-form that they lack any rhymes or common patterns. There are even kinds of poetry that cross genre lines, such as prose poetry. In general, though, a text is a poem when it has some sort of meter or rhythm , and when it focuses on the way the syllables, words, and phrases sound when put together. Poems are heavy in imagery and metaphor and are often made up of fragments and phrases rather than complete, grammatically correct sentences. And poetry is nearly always written in stanzas and lines, creating a unique look on the page. Poetry, as experienced in the classroom, is usually one of three types. There are the shorter, more modern poems, spanning anything from a few lines to a few pages. Often these are collected in books of poems by a single author or by a variety of writers. Edgar Allen Poe’s “ The Raven ,” is one of the most commonly taught poems of this type. Then there are the classical, formulaic poems of Shakespeare’s time, such as the blank verse and the sonnet. And finally, there are the ancient, epic poems transcribed from oral stories. These long, complex poems resemble novels, such as Homer’s The Iliad and The Odyssey .

Once you know what poetry is, it’s easy to define prose. Prose can be defined as any kind of written text that isn’t poetry (which means drama, discussed below, is technically a type of prose). The most typical varieties of prose are novels and short stories, while other types include letters, diaries, journals, and non-fiction (also discussed below). Prose is written in complete sentences and organized in paragraphs. Instead of focusing on sound, which is what poetry does, prose tends to focus on plot and characters. Prose is the type of literature read most often taught in English classrooms. Any novel or short story falls into this category, from Jane Eyre to Twilight and from “ A Sound of Thunder ” to “ The Crucible .” Like poetry, prose is broken down into a large number of other sub-genres. Some of these genres revolve around the structure of the text, such as novellas, biographies, and memoirs, and others are based on the subject matter, like romances, fantasies, and mysteries.

Any text meant to be performed rather than read can be considered drama (unless it’s a poem meant to be performed, of course). In layman’s terms, dramas are usually called plays. When written down the bulk of a drama is dialogue, with periodic stage directions such as “he looks away angrily.” Of all the genres of literature discussed in this article, drama is the one given the least time in most classrooms. And often when drama is taught , it’s only read the same way you might read a novel. Since dramas are meant to be acted out in front of an audience, it’s hard to fully appreciate them when looking only at pages of text. Students respond best to dramas, and grasp their mechanics more fully when exposed to film or theater versions or encouraged to read aloud or act out scenes during class. The dramas most commonly taught in classrooms are definitely those written by the bard. Shakespeare’s plays are challenging, but rewarding when approached with a little effort and a critical mindset. Popular choices from his repertoire include Hamlet , Taming of the Shrew , and Romeo and Juliet , among others. Older Greek plays are also taught fairly often, especially Sophocles’ Antigone . And any good drama unit should include more modern plays for comparison, such as Arthur Miller’s Death of a Salesman .

Non-Fiction

Poetry and drama both belong to the broader category of fiction —texts that feature events and characters that have been made up. Then there is non-fiction, a vast category that is a type of prose and includes many different sub-genres. Non-fiction can be creative, such as the personal essay, or factual, such as the scientific paper. Sometimes the purpose of non-fiction is to tell a story (hence the autobiography), but most of the time the purpose is to pass on information and educate the reader about certain facts, ideas, and/or issues. Some genres of non-fiction include histories, textbooks, travel books, newspapers, self-help books, and literary criticism. A full list of non-fiction types would be at least as long as this entire article. But the varieties most often used in the classroom are textbooks, literary criticism, and essays of various sorts. Most of what students practice writing in the classroom is the non-fiction essay, from factual to personal to persuasive. And non-fiction is often used to support and expand students’ understanding of fiction texts—after reading Hamlet students might read critical articles about the play and historical information about the time period and/or the life of Shakespeare.

The newest type of literature that has been defined as a distinct genre is media. This categorization was created to encompass the many new and important kinds of texts in our society today, such as movies and films, websites, commercials, billboards, and radio programs. Any work that doesn’t exist primarily as a written text can probably be considered media, particularly if it relies on recently developed technologies. Media literature can serve a wide variety of purposes—among other things it can educate, entertain, advertise, and/or persuade. More and more educators are coming to recognize the importance of teaching media in the classroom . Students are likely to be exposed to far more of this type of literature than anything else throughout their lives, so it makes sense to teach them how to be critical and active consumers of media. Internet literacy is a growing field, for example, since the skills required to understand and use online information differ in important ways from the skills required to analyze printed information. Teaching media literacy is also a great way for educators to help students become participants in their own culture, through lessons on creating their own websites or home movies or commercials.

Other Types of Literature

These are far from the only important genres of literature. Here are a few more that are sometimes used in classrooms: Oral Literature: The oldest type of literature, and the foundation on which culture was built. Now, most oral texts have been written down, of course, and are usually taught in the form of epic poems or plays or folk tales. Folklore/Folk Tales/Fables: A distinction is often made between regular prose and folklore. Most folk tales were originally oral literature, and are short stories meant to pass on a particular lesson or moral. They often have a timeless quality, dealing with common human concerns that are just as relevant to us today, while still being products of a very specific culture and time period. Graphic Novels and Comic Books: It used to be that most educators saw comic books as the lowest form of literature, not suitable or valuable for children. But times have changed, and many teachers have come to realize that comic books and the more modern graphic novels are both appealing to kids and are a valid form of literature in their own right.

Some Resources

“ Literary Genres ” by the California Board of Education “ Helping Children Understand Literary Genres ” by Carl B. Smith

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The Five Main Genres of Literature

Five Main Genres of Literature

Understanding the differences between various types of literature can be difficult. Today, Vista Higher Learning is breaking down the differences to give you a crash course on the five main genres of literature.

One of the most popular genres of literature, fiction, features imaginary characters and events.

This genre is often broken up into five subgenres: fantasy, historical fiction, contemporary fiction, mystery, and science fiction.

Nonetheless, there are more than just five types of fiction, ranging from romance to graphic novels.

In fantasy, the characters or settings could not exist in the world as we know it because they require a sort of “magical” element.

The Harry Potter and Twilight series are popular examples.

Historical fiction, however, features made-up stories that accurately portray life during a particular period in history.

Examples include books such as The Da Vinci Code or The Boy in the Striped Pajamas .

Similar to historical fiction is the subgenre of contemporary fiction.

In this category, stories take place in the present day and characters encounter modern day difficulties and issues.

T he Hate U Give and Sisterhood of the Traveling Pants are popular contemporary fiction novels.

Another popular subgenre of fiction is mystery. In these suspense-filled stories, characters use various clues to solve crimes or uncover a culprit.

The Nancy Drew and Sherlock Holmes novels are prime examples of the mystery genre.

The last subgenre of fiction is science fiction.

In these types of stories, authors and readers explore new and exciting realities made possible by imagined technologies or social changes.

Star Wars is one of the most famous examples.

#2 Nonfiction

Unlike fiction, nonfiction tells the story of real people and events. Examples include biographies, autobiographies, or memoirs.

Another popular category of literature, known as drama or play, is a story created specifically for a stage performance.

The most renowned author of drama was William Shakespeare—the writer of Macbeth , Hamlet , and Romeo and Juliet .

More modern plays include A Streetcar Named Desire and A Raisin in the Sun .

The fourth genre of literature is poetry. In this style of writing, words are arranged in a metrical pattern and often (though not always) in rhymed verse.

Renowned poets include e.e. cummings, Robert Frost, and Maya Angelou.

#5 Folktale 

Another beloved genre of literature is folktale. Folktale, which is also referred to as mythology, tells stories of originally oral literature and are meant to pass on particular moral lessons.

These tales often have a timeless quality, dealing with common concerns that are relevant despite the time period.

Did this help you differentiate between the various types of literature? Tune into our blog for similar content in the upcoming weeks.

Read also: How to Help Students with Language Learning Anxiety

By Erika Semprun

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  • Systematic review
  • Open access
  • Published: 19 February 2024

‘It depends’: what 86 systematic reviews tell us about what strategies to use to support the use of research in clinical practice

  • Annette Boaz   ORCID: orcid.org/0000-0003-0557-1294 1 ,
  • Juan Baeza 2 ,
  • Alec Fraser   ORCID: orcid.org/0000-0003-1121-1551 2 &
  • Erik Persson 3  

Implementation Science volume  19 , Article number:  15 ( 2024 ) Cite this article

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Metrics details

The gap between research findings and clinical practice is well documented and a range of strategies have been developed to support the implementation of research into clinical practice. The objective of this study was to update and extend two previous reviews of systematic reviews of strategies designed to implement research evidence into clinical practice.

We developed a comprehensive systematic literature search strategy based on the terms used in the previous reviews to identify studies that looked explicitly at interventions designed to turn research evidence into practice. The search was performed in June 2022 in four electronic databases: Medline, Embase, Cochrane and Epistemonikos. We searched from January 2010 up to June 2022 and applied no language restrictions. Two independent reviewers appraised the quality of included studies using a quality assessment checklist. To reduce the risk of bias, papers were excluded following discussion between all members of the team. Data were synthesised using descriptive and narrative techniques to identify themes and patterns linked to intervention strategies, targeted behaviours, study settings and study outcomes.

We identified 32 reviews conducted between 2010 and 2022. The reviews are mainly of multi-faceted interventions ( n  = 20) although there are reviews focusing on single strategies (ICT, educational, reminders, local opinion leaders, audit and feedback, social media and toolkits). The majority of reviews report strategies achieving small impacts (normally on processes of care). There is much less evidence that these strategies have shifted patient outcomes. Furthermore, a lot of nuance lies behind these headline findings, and this is increasingly commented upon in the reviews themselves.

Combined with the two previous reviews, 86 systematic reviews of strategies to increase the implementation of research into clinical practice have been identified. We need to shift the emphasis away from isolating individual and multi-faceted interventions to better understanding and building more situated, relational and organisational capability to support the use of research in clinical practice. This will involve drawing on a wider range of research perspectives (including social science) in primary studies and diversifying the types of synthesis undertaken to include approaches such as realist synthesis which facilitate exploration of the context in which strategies are employed.

Peer Review reports

Contribution to the literature

Considerable time and money is invested in implementing and evaluating strategies to increase the implementation of research into clinical practice.

The growing body of evidence is not providing the anticipated clear lessons to support improved implementation.

Instead what is needed is better understanding and building more situated, relational and organisational capability to support the use of research in clinical practice.

This would involve a more central role in implementation science for a wider range of perspectives, especially from the social, economic, political and behavioural sciences and for greater use of different types of synthesis, such as realist synthesis.

Introduction

The gap between research findings and clinical practice is well documented and a range of interventions has been developed to increase the implementation of research into clinical practice [ 1 , 2 ]. In recent years researchers have worked to improve the consistency in the ways in which these interventions (often called strategies) are described to support their evaluation. One notable development has been the emergence of Implementation Science as a field focusing explicitly on “the scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice” ([ 3 ] p. 1). The work of implementation science focuses on closing, or at least narrowing, the gap between research and practice. One contribution has been to map existing interventions, identifying 73 discreet strategies to support research implementation [ 4 ] which have been grouped into 9 clusters [ 5 ]. The authors note that they have not considered the evidence of effectiveness of the individual strategies and that a next step is to understand better which strategies perform best in which combinations and for what purposes [ 4 ]. Other authors have noted that there is also scope to learn more from other related fields of study such as policy implementation [ 6 ] and to draw on methods designed to support the evaluation of complex interventions [ 7 ].

The increase in activity designed to support the implementation of research into practice and improvements in reporting provided the impetus for an update of a review of systematic reviews of the effectiveness of interventions designed to support the use of research in clinical practice [ 8 ] which was itself an update of the review conducted by Grimshaw and colleagues in 2001. The 2001 review [ 9 ] identified 41 reviews considering a range of strategies including educational interventions, audit and feedback, computerised decision support to financial incentives and combined interventions. The authors concluded that all the interventions had the potential to promote the uptake of evidence in practice, although no one intervention seemed to be more effective than the others in all settings. They concluded that combined interventions were more likely to be effective than single interventions. The 2011 review identified a further 13 systematic reviews containing 313 discrete primary studies. Consistent with the previous review, four main strategy types were identified: audit and feedback; computerised decision support; opinion leaders; and multi-faceted interventions (MFIs). Nine of the reviews reported on MFIs. The review highlighted the small effects of single interventions such as audit and feedback, computerised decision support and opinion leaders. MFIs claimed an improvement in effectiveness over single interventions, although effect sizes remained small to moderate and this improvement in effectiveness relating to MFIs has been questioned in a subsequent review [ 10 ]. In updating the review, we anticipated a larger pool of reviews and an opportunity to consolidate learning from more recent systematic reviews of interventions.

This review updates and extends our previous review of systematic reviews of interventions designed to implement research evidence into clinical practice. To identify potentially relevant peer-reviewed research papers, we developed a comprehensive systematic literature search strategy based on the terms used in the Grimshaw et al. [ 9 ] and Boaz, Baeza and Fraser [ 8 ] overview articles. To ensure optimal retrieval, our search strategy was refined with support from an expert university librarian, considering the ongoing improvements in the development of search filters for systematic reviews since our first review [ 11 ]. We also wanted to include technology-related terms (e.g. apps, algorithms, machine learning, artificial intelligence) to find studies that explored interventions based on the use of technological innovations as mechanistic tools for increasing the use of evidence into practice (see Additional file 1 : Appendix A for full search strategy).

The search was performed in June 2022 in the following electronic databases: Medline, Embase, Cochrane and Epistemonikos. We searched for articles published since the 2011 review. We searched from January 2010 up to June 2022 and applied no language restrictions. Reference lists of relevant papers were also examined.

We uploaded the results using EPPI-Reviewer, a web-based tool that facilitated semi-automation of the screening process and removal of duplicate studies. We made particular use of a priority screening function to reduce screening workload and avoid ‘data deluge’ [ 12 ]. Through machine learning, one reviewer screened a smaller number of records ( n  = 1200) to train the software to predict whether a given record was more likely to be relevant or irrelevant, thus pulling the relevant studies towards the beginning of the screening process. This automation did not replace manual work but helped the reviewer to identify eligible studies more quickly. During the selection process, we included studies that looked explicitly at interventions designed to turn research evidence into practice. Studies were included if they met the following pre-determined inclusion criteria:

The study was a systematic review

Search terms were included

Focused on the implementation of research evidence into practice

The methodological quality of the included studies was assessed as part of the review

Study populations included healthcare providers and patients. The EPOC taxonomy [ 13 ] was used to categorise the strategies. The EPOC taxonomy has four domains: delivery arrangements, financial arrangements, governance arrangements and implementation strategies. The implementation strategies domain includes 20 strategies targeted at healthcare workers. Numerous EPOC strategies were assessed in the review including educational strategies, local opinion leaders, reminders, ICT-focused approaches and audit and feedback. Some strategies that did not fit easily within the EPOC categories were also included. These were social media strategies and toolkits, and multi-faceted interventions (MFIs) (see Table  2 ). Some systematic reviews included comparisons of different interventions while other reviews compared one type of intervention against a control group. Outcomes related to improvements in health care processes or patient well-being. Numerous individual study types (RCT, CCT, BA, ITS) were included within the systematic reviews.

We excluded papers that:

Focused on changing patient rather than provider behaviour

Had no demonstrable outcomes

Made unclear or no reference to research evidence

The last of these criteria was sometimes difficult to judge, and there was considerable discussion amongst the research team as to whether the link between research evidence and practice was sufficiently explicit in the interventions analysed. As we discussed in the previous review [ 8 ] in the field of healthcare, the principle of evidence-based practice is widely acknowledged and tools to change behaviour such as guidelines are often seen to be an implicit codification of evidence, despite the fact that this is not always the case.

Reviewers employed a two-stage process to select papers for inclusion. First, all titles and abstracts were screened by one reviewer to determine whether the study met the inclusion criteria. Two papers [ 14 , 15 ] were identified that fell just before the 2010 cut-off. As they were not identified in the searches for the first review [ 8 ] they were included and progressed to assessment. Each paper was rated as include, exclude or maybe. The full texts of 111 relevant papers were assessed independently by at least two authors. To reduce the risk of bias, papers were excluded following discussion between all members of the team. 32 papers met the inclusion criteria and proceeded to data extraction. The study selection procedure is documented in a PRISMA literature flow diagram (see Fig.  1 ). We were able to include French, Spanish and Portuguese papers in the selection reflecting the language skills in the study team, but none of the papers identified met the inclusion criteria. Other non- English language papers were excluded.

figure 1

PRISMA flow diagram. Source: authors

One reviewer extracted data on strategy type, number of included studies, local, target population, effectiveness and scope of impact from the included studies. Two reviewers then independently read each paper and noted key findings and broad themes of interest which were then discussed amongst the wider authorial team. Two independent reviewers appraised the quality of included studies using a Quality Assessment Checklist based on Oxman and Guyatt [ 16 ] and Francke et al. [ 17 ]. Each study was rated a quality score ranging from 1 (extensive flaws) to 7 (minimal flaws) (see Additional file 2 : Appendix B). All disagreements were resolved through discussion. Studies were not excluded in this updated overview based on methodological quality as we aimed to reflect the full extent of current research into this topic.

The extracted data were synthesised using descriptive and narrative techniques to identify themes and patterns in the data linked to intervention strategies, targeted behaviours, study settings and study outcomes.

Thirty-two studies were included in the systematic review. Table 1. provides a detailed overview of the included systematic reviews comprising reference, strategy type, quality score, number of included studies, local, target population, effectiveness and scope of impact (see Table  1. at the end of the manuscript). Overall, the quality of the studies was high. Twenty-three studies scored 7, six studies scored 6, one study scored 5, one study scored 4 and one study scored 3. The primary focus of the review was on reviews of effectiveness studies, but a small number of reviews did include data from a wider range of methods including qualitative studies which added to the analysis in the papers [ 18 , 19 , 20 , 21 ]. The majority of reviews report strategies achieving small impacts (normally on processes of care). There is much less evidence that these strategies have shifted patient outcomes. In this section, we discuss the different EPOC-defined implementation strategies in turn. Interestingly, we found only two ‘new’ approaches in this review that did not fit into the existing EPOC approaches. These are a review focused on the use of social media and a review considering toolkits. In addition to single interventions, we also discuss multi-faceted interventions. These were the most common intervention approach overall. A summary is provided in Table  2 .

Educational strategies

The overview identified three systematic reviews focusing on educational strategies. Grudniewicz et al. [ 22 ] explored the effectiveness of printed educational materials on primary care physician knowledge, behaviour and patient outcomes and concluded they were not effective in any of these aspects. Koota, Kääriäinen and Melender [ 23 ] focused on educational interventions promoting evidence-based practice among emergency room/accident and emergency nurses and found that interventions involving face-to-face contact led to significant or highly significant effects on patient benefits and emergency nurses’ knowledge, skills and behaviour. Interventions using written self-directed learning materials also led to significant improvements in nurses’ knowledge of evidence-based practice. Although the quality of the studies was high, the review primarily included small studies with low response rates, and many of them relied on self-assessed outcomes; consequently, the strength of the evidence for these outcomes is modest. Wu et al. [ 20 ] questioned if educational interventions aimed at nurses to support the implementation of evidence-based practice improve patient outcomes. Although based on evaluation projects and qualitative data, their results also suggest that positive changes on patient outcomes can be made following the implementation of specific evidence-based approaches (or projects). The differing positive outcomes for educational strategies aimed at nurses might indicate that the target audience is important.

Local opinion leaders

Flodgren et al. [ 24 ] was the only systemic review focusing solely on opinion leaders. The review found that local opinion leaders alone, or in combination with other interventions, can be effective in promoting evidence‐based practice, but this varies both within and between studies and the effect on patient outcomes is uncertain. The review found that, overall, any intervention involving opinion leaders probably improves healthcare professionals’ compliance with evidence-based practice but varies within and across studies. However, how opinion leaders had an impact could not be determined because of insufficient details were provided, illustrating that reporting specific details in published studies is important if diffusion of effective methods of increasing evidence-based practice is to be spread across a system. The usefulness of this review is questionable because it cannot provide evidence of what is an effective opinion leader, whether teams of opinion leaders or a single opinion leader are most effective, or the most effective methods used by opinion leaders.

Pantoja et al. [ 26 ] was the only systemic review focusing solely on manually generated reminders delivered on paper included in the overview. The review explored how these affected professional practice and patient outcomes. The review concluded that manually generated reminders delivered on paper as a single intervention probably led to small to moderate increases in adherence to clinical recommendations, and they could be used as a single quality improvement intervention. However, the authors indicated that this intervention would make little or no difference to patient outcomes. The authors state that such a low-tech intervention may be useful in low- and middle-income countries where paper records are more likely to be the norm.

ICT-focused approaches

The three ICT-focused reviews [ 14 , 27 , 28 ] showed mixed results. Jamal, McKenzie and Clark [ 14 ] explored the impact of health information technology on the quality of medical and health care. They examined the impact of electronic health record, computerised provider order-entry, or decision support system. This showed a positive improvement in adherence to evidence-based guidelines but not to patient outcomes. The number of studies included in the review was low and so a conclusive recommendation could not be reached based on this review. Similarly, Brown et al. [ 28 ] found that technology-enabled knowledge translation interventions may improve knowledge of health professionals, but all eight studies raised concerns of bias. The De Angelis et al. [ 27 ] review was more promising, reporting that ICT can be a good way of disseminating clinical practice guidelines but conclude that it is unclear which type of ICT method is the most effective.

Audit and feedback

Sykes, McAnuff and Kolehmainen [ 29 ] examined whether audit and feedback were effective in dementia care and concluded that it remains unclear which ingredients of audit and feedback are successful as the reviewed papers illustrated large variations in the effectiveness of interventions using audit and feedback.

Non-EPOC listed strategies: social media, toolkits

There were two new (non-EPOC listed) intervention types identified in this review compared to the 2011 review — fewer than anticipated. We categorised a third — ‘care bundles’ [ 36 ] as a multi-faceted intervention due to its description in practice and a fourth — ‘Technology Enhanced Knowledge Transfer’ [ 28 ] was classified as an ICT-focused approach. The first new strategy was identified in Bhatt et al.’s [ 30 ] systematic review of the use of social media for the dissemination of clinical practice guidelines. They reported that the use of social media resulted in a significant improvement in knowledge and compliance with evidence-based guidelines compared with more traditional methods. They noted that a wide selection of different healthcare professionals and patients engaged with this type of social media and its global reach may be significant for low- and middle-income countries. This review was also noteworthy for developing a simple stepwise method for using social media for the dissemination of clinical practice guidelines. However, it is debatable whether social media can be classified as an intervention or just a different way of delivering an intervention. For example, the review discussed involving opinion leaders and patient advocates through social media. However, this was a small review that included only five studies, so further research in this new area is needed. Yamada et al. [ 31 ] draw on 39 studies to explore the application of toolkits, 18 of which had toolkits embedded within larger KT interventions, and 21 of which evaluated toolkits as standalone interventions. The individual component strategies of the toolkits were highly variable though the authors suggest that they align most closely with educational strategies. The authors conclude that toolkits as either standalone strategies or as part of MFIs hold some promise for facilitating evidence use in practice but caution that the quality of many of the primary studies included is considered weak limiting these findings.

Multi-faceted interventions

The majority of the systematic reviews ( n  = 20) reported on more than one intervention type. Some of these systematic reviews focus exclusively on multi-faceted interventions, whilst others compare different single or combined interventions aimed at achieving similar outcomes in particular settings. While these two approaches are often described in a similar way, they are actually quite distinct from each other as the former report how multiple strategies may be strategically combined in pursuance of an agreed goal, whilst the latter report how different strategies may be incidentally used in sometimes contrasting settings in the pursuance of similar goals. Ariyo et al. [ 35 ] helpfully summarise five key elements often found in effective MFI strategies in LMICs — but which may also be transferrable to HICs. First, effective MFIs encourage a multi-disciplinary approach acknowledging the roles played by different professional groups to collectively incorporate evidence-informed practice. Second, they utilise leadership drawing on a wide set of clinical and non-clinical actors including managers and even government officials. Third, multiple types of educational practices are utilised — including input from patients as stakeholders in some cases. Fourth, protocols, checklists and bundles are used — most effectively when local ownership is encouraged. Finally, most MFIs included an emphasis on monitoring and evaluation [ 35 ]. In contrast, other studies offer little information about the nature of the different MFI components of included studies which makes it difficult to extrapolate much learning from them in relation to why or how MFIs might affect practice (e.g. [ 28 , 38 ]). Ultimately, context matters, which some review authors argue makes it difficult to say with real certainty whether single or MFI strategies are superior (e.g. [ 21 , 27 ]). Taking all the systematic reviews together we may conclude that MFIs appear to be more likely to generate positive results than single interventions (e.g. [ 34 , 45 ]) though other reviews should make us cautious (e.g. [ 32 , 43 ]).

While multi-faceted interventions still seem to be more effective than single-strategy interventions, there were important distinctions between how the results of reviews of MFIs are interpreted in this review as compared to the previous reviews [ 8 , 9 ], reflecting greater nuance and debate in the literature. This was particularly noticeable where the effectiveness of MFIs was compared to single strategies, reflecting developments widely discussed in previous studies [ 10 ]. We found that most systematic reviews are bounded by their clinical, professional, spatial, system, or setting criteria and often seek to draw out implications for the implementation of evidence in their areas of specific interest (such as nursing or acute care). Frequently this means combining all relevant studies to explore the respective foci of each systematic review. Therefore, most reviews we categorised as MFIs actually include highly variable numbers and combinations of intervention strategies and highly heterogeneous original study designs. This makes statistical analyses of the type used by Squires et al. [ 10 ] on the three reviews in their paper not possible. Further, it also makes extrapolating findings and commenting on broad themes complex and difficult. This may suggest that future research should shift its focus from merely examining ‘what works’ to ‘what works where and what works for whom’ — perhaps pointing to the value of realist approaches to these complex review topics [ 48 , 49 ] and other more theory-informed approaches [ 50 ].

Some reviews have a relatively small number of studies (i.e. fewer than 10) and the authors are often understandably reluctant to engage with wider debates about the implications of their findings. Other larger studies do engage in deeper discussions about internal comparisons of findings across included studies and also contextualise these in wider debates. Some of the most informative studies (e.g. [ 35 , 40 ]) move beyond EPOC categories and contextualise MFIs within wider systems thinking and implementation theory. This distinction between MFIs and single interventions can actually be very useful as it offers lessons about the contexts in which individual interventions might have bounded effectiveness (i.e. educational interventions for individual change). Taken as a whole, this may also then help in terms of how and when to conjoin single interventions into effective MFIs.

In the two previous reviews, a consistent finding was that MFIs were more effective than single interventions [ 8 , 9 ]. However, like Squires et al. [ 10 ] this overview is more equivocal on this important issue. There are four points which may help account for the differences in findings in this regard. Firstly, the diversity of the systematic reviews in terms of clinical topic or setting is an important factor. Secondly, there is heterogeneity of the studies within the included systematic reviews themselves. Thirdly, there is a lack of consistency with regards to the definition and strategies included within of MFIs. Finally, there are epistemological differences across the papers and the reviews. This means that the results that are presented depend on the methods used to measure, report, and synthesise them. For instance, some reviews highlight that education strategies can be useful to improve provider understanding — but without wider organisational or system-level change, they may struggle to deliver sustained transformation [ 19 , 44 ].

It is also worth highlighting the importance of the theory of change underlying the different interventions. Where authors of the systematic reviews draw on theory, there is space to discuss/explain findings. We note a distinction between theoretical and atheoretical systematic review discussion sections. Atheoretical reviews tend to present acontextual findings (for instance, one study found very positive results for one intervention, and this gets highlighted in the abstract) whilst theoretically informed reviews attempt to contextualise and explain patterns within the included studies. Theory-informed systematic reviews seem more likely to offer more profound and useful insights (see [ 19 , 35 , 40 , 43 , 45 ]). We find that the most insightful systematic reviews of MFIs engage in theoretical generalisation — they attempt to go beyond the data of individual studies and discuss the wider implications of the findings of the studies within their reviews drawing on implementation theory. At the same time, they highlight the active role of context and the wider relational and system-wide issues linked to implementation. It is these types of investigations that can help providers further develop evidence-based practice.

This overview has identified a small, but insightful set of papers that interrogate and help theorise why, how, for whom, and in which circumstances it might be the case that MFIs are superior (see [ 19 , 35 , 40 ] once more). At the level of this overview — and in most of the systematic reviews included — it appears to be the case that MFIs struggle with the question of attribution. In addition, there are other important elements that are often unmeasured, or unreported (e.g. costs of the intervention — see [ 40 ]). Finally, the stronger systematic reviews [ 19 , 35 , 40 , 43 , 45 ] engage with systems issues, human agency and context [ 18 ] in a way that was not evident in the systematic reviews identified in the previous reviews [ 8 , 9 ]. The earlier reviews lacked any theory of change that might explain why MFIs might be more effective than single ones — whereas now some systematic reviews do this, which enables them to conclude that sometimes single interventions can still be more effective.

As Nilsen et al. ([ 6 ] p. 7) note ‘Study findings concerning the effectiveness of various approaches are continuously synthesized and assembled in systematic reviews’. We may have gone as far as we can in understanding the implementation of evidence through systematic reviews of single and multi-faceted interventions and the next step would be to conduct more research exploring the complex and situated nature of evidence used in clinical practice and by particular professional groups. This would further build on the nuanced discussion and conclusion sections in a subset of the papers we reviewed. This might also support the field to move away from isolating individual implementation strategies [ 6 ] to explore the complex processes involving a range of actors with differing capacities [ 51 ] working in diverse organisational cultures. Taxonomies of implementation strategies do not fully account for the complex process of implementation, which involves a range of different actors with different capacities and skills across multiple system levels. There is plenty of work to build on, particularly in the social sciences, which currently sits at the margins of debates about evidence implementation (see for example, Normalisation Process Theory [ 52 ]).

There are several changes that we have identified in this overview of systematic reviews in comparison to the review we published in 2011 [ 8 ]. A consistent and welcome finding is that the overall quality of the systematic reviews themselves appears to have improved between the two reviews, although this is not reflected upon in the papers. This is exhibited through better, clearer reporting mechanisms in relation to the mechanics of the reviews, alongside a greater attention to, and deeper description of, how potential biases in included papers are discussed. Additionally, there is an increased, but still limited, inclusion of original studies conducted in low- and middle-income countries as opposed to just high-income countries. Importantly, we found that many of these systematic reviews are attuned to, and comment upon the contextual distinctions of pursuing evidence-informed interventions in health care settings in different economic settings. Furthermore, systematic reviews included in this updated article cover a wider set of clinical specialities (both within and beyond hospital settings) and have a focus on a wider set of healthcare professions — discussing both similarities, differences and inter-professional challenges faced therein, compared to the earlier reviews. These wider ranges of studies highlight that a particular intervention or group of interventions may work well for one professional group but be ineffective for another. This diversity of study settings allows us to consider the important role context (in its many forms) plays on implementing evidence into practice. Examining the complex and varied context of health care will help us address what Nilsen et al. ([ 6 ] p. 1) described as, ‘society’s health problems [that] require research-based knowledge acted on by healthcare practitioners together with implementation of political measures from governmental agencies’. This will help us shift implementation science to move, ‘beyond a success or failure perspective towards improved analysis of variables that could explain the impact of the implementation process’ ([ 6 ] p. 2).

This review brings together 32 papers considering individual and multi-faceted interventions designed to support the use of evidence in clinical practice. The majority of reviews report strategies achieving small impacts (normally on processes of care). There is much less evidence that these strategies have shifted patient outcomes. Combined with the two previous reviews, 86 systematic reviews of strategies to increase the implementation of research into clinical practice have been conducted. As a whole, this substantial body of knowledge struggles to tell us more about the use of individual and MFIs than: ‘it depends’. To really move forwards in addressing the gap between research evidence and practice, we may need to shift the emphasis away from isolating individual and multi-faceted interventions to better understanding and building more situated, relational and organisational capability to support the use of research in clinical practice. This will involve drawing on a wider range of perspectives, especially from the social, economic, political and behavioural sciences in primary studies and diversifying the types of synthesis undertaken to include approaches such as realist synthesis which facilitate exploration of the context in which strategies are employed. Harvey et al. [ 53 ] suggest that when context is likely to be critical to implementation success there are a range of primary research approaches (participatory research, realist evaluation, developmental evaluation, ethnography, quality/ rapid cycle improvement) that are likely to be appropriate and insightful. While these approaches often form part of implementation studies in the form of process evaluations, they are usually relatively small scale in relation to implementation research as a whole. As a result, the findings often do not make it into the subsequent systematic reviews. This review provides further evidence that we need to bring qualitative approaches in from the periphery to play a central role in many implementation studies and subsequent evidence syntheses. It would be helpful for systematic reviews, at the very least, to include more detail about the interventions and their implementation in terms of how and why they worked.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Before and after study

Controlled clinical trial

Effective Practice and Organisation of Care

High-income countries

Information and Communications Technology

Interrupted time series

Knowledge translation

Low- and middle-income countries

Randomised controlled trial

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Acknowledgements

The authors would like to thank Professor Kathryn Oliver for her support in the planning the review, Professor Steve Hanney for reading and commenting on the final manuscript and the staff at LSHTM library for their support in planning and conducting the literature search.

This study was supported by LSHTM’s Research England QR strategic priorities funding allocation and the National Institute for Health and Care Research (NIHR) Applied Research Collaboration South London (NIHR ARC South London) at King’s College Hospital NHS Foundation Trust. Grant number NIHR200152. The views expressed are those of the author(s) and not necessarily those of the NIHR, the Department of Health and Social Care or Research England.

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AB led the conceptual development and structure of the manuscript. EP conducted the searches and data extraction. All authors contributed to screening and quality appraisal. EP and AF wrote the first draft of the methods section. AB, JB and AF performed result synthesis and contributed to the analyses. AB wrote the first draft of the manuscript and incorporated feedback and revisions from all other authors. All authors revised and approved the final manuscript.

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Boaz, A., Baeza, J., Fraser, A. et al. ‘It depends’: what 86 systematic reviews tell us about what strategies to use to support the use of research in clinical practice. Implementation Sci 19 , 15 (2024). https://doi.org/10.1186/s13012-024-01337-z

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DOI : https://doi.org/10.1186/s13012-024-01337-z

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