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      Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science

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          Abstract

          Background

          Many interventions found to be effective in health services research studies fail to translate into meaningful patient care outcomes across multiple contexts. Health services researchers recognize the need to evaluate not only summative outcomes but also formative outcomes to assess the extent to which implementation is effective in a specific setting, prolongs sustainability, and promotes dissemination into other settings. Many implementation theories have been published to help promote effective implementation. However, they overlap considerably in the constructs included in individual theories, and a comparison of theories reveals that each is missing important constructs included in other theories. In addition, terminology and definitions are not consistent across theories. We describe the Consolidated Framework For Implementation Research (CFIR) that offers an overarching typology to promote implementation theory development and verification about what works where and why across multiple contexts.

          Methods

          We used a snowball sampling approach to identify published theories that were evaluated to identify constructs based on strength of conceptual or empirical support for influence on implementation, consistency in definitions, alignment with our own findings, and potential for measurement. We combined constructs across published theories that had different labels but were redundant or overlapping in definition, and we parsed apart constructs that conflated underlying concepts.

          Results

          The CFIR is composed of five major domains: intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation. Eight constructs were identified related to the intervention ( e.g., evidence strength and quality), four constructs were identified related to outer setting ( e.g., patient needs and resources), 12 constructs were identified related to inner setting ( e.g., culture, leadership engagement), five constructs were identified related to individual characteristics, and eight constructs were identified related to process ( e.g., plan, evaluate, and reflect). We present explicit definitions for each construct.

          Conclusion

          The CFIR provides a pragmatic structure for approaching complex, interacting, multi-level, and transient states of constructs in the real world by embracing, consolidating, and unifying key constructs from published implementation theories. It can be used to guide formative evaluations and build the implementation knowledge base across multiple studies and settings.

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          Most cited references 103

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          The theory of planned behavior

           Icek Ajzen (1991)
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            Self-efficacy: Toward a unifying theory of behavioral change.

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              Diffusion of innovations in service organizations: systematic review and recommendations.

              This article summarizes an extensive literature review addressing the question, How can we spread and sustain innovations in health service delivery and organization? It considers both content (defining and measuring the diffusion of innovation in organizations) and process (reviewing the literature in a systematic and reproducible way). This article discusses (1) a parsimonious and evidence-based model for considering the diffusion of innovations in health service organizations, (2) clear knowledge gaps where further research should be focused, and (3) a robust and transferable methodology for systematically reviewing health service policy and management. Both the model and the method should be tested more widely in a range of contexts.
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                Author and article information

                Journal
                Implement Sci
                Implementation Science : IS
                BioMed Central
                1748-5908
                2009
                7 August 2009
                : 4
                : 50
                Affiliations
                [1 ]HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System (11H), 2215 Fuller Rd, Ann Arbor, MI 48105, USA
                [2 ]VA HSR&D Center for Quality Improvement Research (14W), Louis Stokes Cleveland DVAMC, 10701 East Blvd, Cleveland, OH 44106, USA
                [3 ]Health Management and Policy, School of Public Health, University of Michigan,109 S. Observatory (M3507 SPH II), Ann Arbor, Michigan 48109-2029, USA
                Article
                1748-5908-4-50
                10.1186/1748-5908-4-50
                2736161
                19664226
                Copyright © 2009 Damschroder et al., licensee BioMed Central Ltd.

                This is an open access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Categories
                Research Article

                Medicine

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