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

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.

Psychiatric service staff perceptions of implementing a shared decision-making tool: a process evaluation study

“…Systematic reviews report that there is no clear picture of what implementation strategies are most effective. In order to increase opportunities for successful implementation, the importance of tailoring implementation to contextual conditions is regularly emphasized (Damschroder et al, 2009). From a clinical perspective, as well as from a wider implementation research horizon, the need for enhancing knowledge on how to translate evidence on SDM into psychiatric practice is therefore an urgent issue.…”

Exploring experiences among adopters during the diffusion of a novel dance intervention in Sweden

“…Some of the results in our study can be understood with reference to Rogers’ diffusion of innovations theory (Rogers, 2003) and subsequent implementation frameworks such as the ecological framework constructed by Durlak and DuPre (2008) and the Consolidated Framework for Advancing Implementation Research (CFIR) developed by Damschroder et al (2009). The perceived relative advantage, i.e., the degree to which an innovation is perceived as better than what it supersedes, is one of the key elements in Rogers’ theory.…”

“…This fits well with what is labelled tension for change in the CFIR. Tension for change is part of the implementation climate; if the current situation is perceived as intolerable by stakeholders and there is a need for change, this contributes to a positive implementation climate (Damschroder et al, 2009). Further, the results in the present study show that the scope of the intervention was in concordance with individual and personal beliefs.…”

“…Numerous so-called determinant frameworks have been developed to describe barriers and facilitators that influence the implementation and use of new practices (Nilsen, 2015). Most of these frameworks describe three types of determinants that influence implementation: perceived attributes of the practice (e.g., complexity and relative advantage in relation to the current practice); individual characteristics of the users of the new practice (e.g., attitudes, beliefs and motivation concerning the new practice); and contextual factors (e.g., organizational support and support from colleagues and time constraints) (Cochrane, Olson, Murray, Dupuis, Tooman, Hayes., 2007; Damschroder et al, 2009; Grol, Wensing, & Eccles, 2005; Rycroft-Malone & Bucknall., 2010). The frameworks also address various strategies that support implementation, ideally accounting for as many determinants as possible to achieve successful implementation of a new practice (Bauer et al, 2015).…”

“…The theory posits that diffusion of new practices in a social context, e.g., health care, is influenced by a number of factors, including the setting, the users, the perceived need for the intervention and external influences. Several implementation frameworks are influenced by the work of Rogers and have identified similar factors as being important (Damschroder et al, 2009; Greenhalgh, Robert, Bate, Macfarlane, & Kyriakidou, 2005; Gurses et al, 2010). However, more research is needed to understand how public health interventions are perceived and spread within politically controlled organizations outside the health-care sector.…”