A systematic review of the use of the Consolidated Framework for Implementation Research

Abstract

BackgroundIn 2009, Damschroder et al. developed the Consolidated Framework for Implementation Research (CFIR), which provides a comprehensive listing of constructs thought to influence implementation. This systematic review assesses the extent to which the CFIR’s use in implementation research fulfills goals set forth by Damschroder et al. in terms of breadth of use, depth of application, and contribution to implementation research.MethodsWe searched Scopus and Web of Science for publications that cited the original CFIR publication by Damschroder et al. (Implement Sci 4:50, 2009) and downloaded each unique result for review. After applying exclusion criteria, the final articles were empirical studies published in peer-review journals that used the CFIR in a meaningful way (i.e., used the CFIR to guide data collection, measurement, coding, analysis, and/or reporting). A framework analysis approach was used to guide abstraction and synthesis of the included articles.ResultsTwenty-six of 429 unique articles (6 %) met inclusion criteria. We found great breadth in CFIR application; the CFIR was applied across a wide variety of study objectives, settings, and units of analysis. There was also variation in the method of included studies (mixed methods (n = 13); qualitative (n = 10); quantitative (n = 3)). Depth of CFIR application revealed some areas for improvement. Few studies (n = 3) reported justification for selection of CFIR constructs used; the majority of studies (n = 14) used the CFIR to guide data analysis only; and few studies investigated any outcomes (n = 11). Finally, reflections on the contribution of the CFIR to implementation research were scarce.ConclusionsOur results indicate that the CFIR has been used across a wide range of studies, though more in-depth use of the CFIR may help advance implementation science. To harness its potential, researchers should consider how to most meaningfully use the CFIR. Specific recommendations for applying the CFIR include explicitly justifying selection of CFIR constructs; integrating the CFIR throughout the research process (in study design, data collection, and analysis); and appropriately using the CFIR given the phase of implementation of the research (e.g., if the research is post-implementation, using the CFIR to link determinants of implementation to outcomes).Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0437-z) contains supplementary material, which is available to authorized users.

Implementing Implementation: Practical Lessons Learned From Supporting Evidence- Informed Service Delivery in Community-Based Child and Youth Mental Health Agencies

“…While the CFIR team found no significant alterations to their framework were required (Kirk, Kelley, Yankey, Birken, Abadie, & Damschroder, 2016), we identified a number of important areas for enhancing the CFIR constructs, particularly for community-based agencies interested in a planned and sustainable approach to implementing the best available evidence. These areas include attention to a broad range of stakeholders, including youth and families who are directly impacted by the EIP, several distinct areas that need to be monitored and evaluated (e.g., fidelity to the practice, implementation capacity, process of implementing, client outcomes), and the processes relating to sustaining and spreading the EIP.…”

A Survey to Evaluate Facilitators and Barriers to Quality Measurement and Improvement: Adapting Tools for Implementation Research in Palliative Care Programs

“…19 The CFIR synthesized relevant theories into an integrated framework for implementation research and has been widely applied for implementation science. 20 We selected four domains from the adapted CFIR as most relevant to the survey: (1) intervention characteristics (e.g., of the quality measurement program), (2) organizational characteristics; (3) characteristics and roles of providers, and (4) process of implementation. Each domain includes multiple constructs.…”

Implementing eHealth Technology to Address Gaps in Early Infant Diagnosis Services: Qualitative Assessment of Kenyan Provider Experiences (Preprint)

“…Similar to many previous studies, our reporting on selected salient constructs demonstrates CFIR's flexibility and versatility, yet also its limitation in allowing cross-study comparisons where different constructs are reported. Furthermore, we used the CFIR at the post-implementation phase to guide analysis only [34], like most published studies applying the model. Integration and assessment of CFIR throughout the implementation process -from intervention design to outcome analysis -may have produced a more representative picture of implementation characteristics, particularly if specific constructs were more relevant or easily measured at earlier stages.…”