{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T07:18:21Z","timestamp":1787815101624,"version":"build-2784847793"},"reference-count":42,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["FDN 143237"],"award-info":[{"award-number":["FDN 143237"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Evaluation Clinical Practice"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>\n                      Implementing evidence\u2010informed healthcare services is typically approached as a structured, time\u2010limited project, focused largely on\n                      <jats:italic>what<\/jats:italic>\n                      to do. Less well understood is\n                      <jats:italic>how<\/jats:italic>\n                      implementation actually unfolds in practice: the ways in which those involved navigate change and generate solutions in diverse community settings. Without understanding\n                      <jats:italic>how<\/jats:italic>\n                      implementation happens in unique contexts, implementation failure may remain poorly understood.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>The 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>We 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\u201019. Through an inductive, reflexive process of analysis and hermeneutic interpretation, we identified patterns in how virtual kidney care was implemented.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The 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\u2010limited, 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Attending to the\n                      <jats:italic>how<\/jats:italic>\n                      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\u2010building, is key to implementation, especially in the ever\u2010changing 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.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jep.70524","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T19:52:46Z","timestamp":1783540366000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Addressing the How of Implementation: A Hermeneutic Exploration of Implementing Virtual Kidney Care in a Remote, Rural Health Region"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4174-6381","authenticated-orcid":false,"given":"Martha L. P.","family":"Macleod","sequence":"first","affiliation":[{"name":"School of Nursing University of Northern British Columbia Prince George British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-0497-5771","authenticated-orcid":false,"given":"Anurag","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Medicine Faculty of Medicine\u2013Northern Medical Program Prince George British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"Barker","sequence":"additional","affiliation":[{"name":"School of Nursing University of Northern British Columbia Prince George British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steinunn","family":"J\u00f3natansd\u00f3ttir","sequence":"additional","affiliation":[{"name":"School of Health, Business and Natural Sciences University of Akureyri Nor\u00f0ursl\u00f3\u00f0 Akureyri Iceland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Snadden","sequence":"additional","affiliation":[{"name":"Division of Medical Sciences, Northern Medical Program University of Northern British Columbia Prince George British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5702-4818","authenticated-orcid":false,"given":"Graham","family":"McCaffrey","sequence":"additional","affiliation":[{"name":"Faculty of Nursing University of Calgary Calgary Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lela V.","family":"Zimmer","sequence":"additional","affiliation":[{"name":"School of Nursing University of Northern British Columbia Prince George British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Zimmer","sequence":"additional","affiliation":[{"name":"Patient Partner Prince George British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cathy","family":"Ulrich","sequence":"additional","affiliation":[{"name":"School of Nursing University of Northern British Columbia Prince George British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian D.","family":"Graham","sequence":"additional","affiliation":[{"name":"School of Epidemiology and Public Health, Canada and Clinical Epidemiology Program, Ottawa Hospital Research Institute University of Ottawa Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,8]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-024-01399-z"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.3389\/frhs.2023.1343058"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.3389\/frhs.2023.1162762"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12874-021-01418-3"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/0038038509103208"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2005.11.001"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.34172\/ijhpm.2024.8461"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-017-0696-3"},{"key":"e_1_2_11_10_1","volume-title":"The Improvement Guide. 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