Background: The implementation of evidence-based knowledge into practice, is an area of research and practice that has been evolving over the past few decades as the production of evidence-based innovations and the need for effective implementation increases. Knowledge implementation is a complex process, with many frameworks, models and theories to guide it. Yet there is a gap looking at the cross cultural utility of such frameworks.

Objectives: To explore the appropriateness and utility of the PARIHS framework in the cultural translation and adaptation of an evidence-based clinical practice guideline into clinical practice in the healthcare system in Malta. To identify the challenges and barriers to successful cultural translation and implementation to inform future cross-cultural knowledge translation programmes.

Methods: Embedded single case, case study. Data collection was facilitated using focus groups with multidisciplinary healthcare professionals, semi structured interviews, non-participant observation of two guideline development groups. Data were analysed both inductively and deductively using Framework Analysis. Guideline development was based on NICE methodology.

Results: Findings indicate that the components of the PARIHS framework of evidence, context and facilitation are useful to guide the cultural translation and adaptation of an evidence-based clinical practice guideline. Challenges and barriers to successful translation and potential implementation were identified; the influence of politics, culture and context, resources; human and financial and stakeholder involvement.

Conclusion : The PARIHS framework is a useful tool to guide the cultural translation and adaptation of an evidence-based clinical practice guideline. The study added important expansion of categories to the PARIHS framework; need for further inclusion of culture; definition of what context means within the framework; the role of the patient; inclusion of politics as a sub element of context; importance of resources.