Background
Implementation science (IS) aims to research and promote evidence-based healthcare. Practice ‘context’ is known to directly impact research uptake. There is a paucity of evidence demonstrating how IS and related theories are contributing to evidence adoption in medical radiography practice.

Study Aim
This study investigated the state of implementation in UK radiography practice by researching practice context (as described by the PARIHS (IS) framework); revealing factors which might enable or hinder evidence adoption in clinical practice; and promoting effective policy.

Method
A standalone mixed method systematic review was undertaken to investigate the state of IS and related theory use in radiography. A convergent mixed methods design was used for the main study. The quantitative arm employed a modified ‘Context Assessment Index’ (CAI) instrument in a national survey of radiographers (n=152 valid responses). Data were then used to calculate a national Context Index (CI) for radiography, and practice related information. The qualitative arm used semi-structured interviews (n=20) and Thematic Analysis to elicit views about current practice and factors which might impact evidence-based interventions in radiography. Data were then combined to gain additional insight, and significant issues were interpreted with Systems Theory lenses. A dissemination event with key stakeholders was also undertaken.

Findings
There was little evidence in the systematic review indicating that IS and related theories were making an impact on evidence-based radiography. Research was mainly of low quality, however data was gathered highlighting implementation interventions that had been tried in practice, together with key barriers and enablers.

The national CI for radiography was relatively high (a positive indicator for practice related evidence adoption) and specific factors with high and low scores enabled context mediators to be identified. Statistical testing showed the modified instrument was robust and applicable to professions outside nursing.

Three themes were identified in the qualitative data, highlighting the impact that context has at all levels of influence such as government policy, organizational behaviour, and workplace context. The powerful roles that individuals have on radiographer practice showed issues of professional dominance, apathy, and emergence. Combining data from both arms highlighted a disparity between a relatively strong quantified CI, and the enduring implementation and contextual challenges, found in the qualitative data. This study also highlighted the potential insensitivity of the CAI to individual actor traits. The dissemination and engagement event with a key national body showed promise in embedding implementation as a core component of future policy for evidence use in the profession.

Conclusions
Policy makers, organizations and radiographers should be aware that implementation efforts within other health and care domains might not easily or directly translate to the radiography context. There is potential for strong implementation in radiography with a need to facilitate and empower radiographer leaders at all levels in the health system. The reported radiography contextual barriers and enablers should inform future research in this regard. This study is unique in that PARIHS, and Systems Theory lenses, were used to guide the research and interpret qualitative data, and the first study to calculate the CI for radiography in the UK. This study adds to the body of knowledge on implementation in the radiography setting.