The Updated Consolidated Framework for Implementation Research: CFIR 2.0

Abstract

BackgroundMany implementation efforts fail, even with highly developed plans for execution, because contextual factors can be powerful forces working against implementation in the real-world. The Consolidated Framework for Implementation Research (CFIR) is one of the most commonly used determinant frameworks to assess these contextual factors, however, it has been 10 years since publication and there is a need for updates. The purpose of this manuscript is to describe the updated CFIR 2.0, which addresses important user critiques of the framework.MethodsUser feedback was obtained from two sources: 1) a literature review with a systematic search; and 2) a survey of authors who used the CFIR 2009 in a published study. Data were combined across both sources and reviewed to identify themes; a consensus approach was used to finalize all CFIR 2.0 updates. The VA Ann Arbor Healthcare System IRB declared this study exempt from the requirements of 38 CFR 16 based on category 2. ResultsThe systematic search yielded 376 articles and 334 unique authors with contact information; 59 articles included feedback on the CFIR. Forty percent (n=134/334) of authors responded to the survey. The CFIR received positive ratings on most framework sensibility items, e.g., applicability, usability, but respondents also provided recommendations for changes. Overall, updates to the CFIR 2.0 include revisions to existing constructs as well as the addition, removal, or relocation of constructs. These changes serve to facilitate use of the CFIR, address gaps in themes, and better center recipients. ConclusionThe updates in the CFIR 2.0 reflect feedback from the growing community of CFIR users; although there are many updates, constructs can be mapped back to the CFIR 2009 to ensure longitudinal consistency. We invite users to continuing critiquing the framework in order it continue to evolve.

Optimization of Care Pathways Through Technological, Clinical, Organizational and Social Innovations: A Qualitative Study

“…The conceptual model was generated from empirical findings but resonates well with existing implementation frameworks. For example, some points are in line with the CFIR framework proposed and improved by Damschroder et al [37][38][39] In particular, it strengthens the recent adjustments, emphasizing the need to pay attention to the needs of the actors receiving the innovations and to ensure their commitment. 39 However, certain key points of our model stand out.…”

Development and Evaluation of the Fuld Institute Evidence-based Implementation and Sustainability Toolkit for Health Care Settings

“…Specifically, within the field of implementation science, a number of TMFs have been refined on the basis of end-user evaluations of feasibility, complexity, appropriateness, and acceptability. 13,51,52 Because implementation science seeks to identify optimal methods for increasing uptake of EBPs within practice settings, it is important that tools to support implementation are useful and meaningful to those leading and participating in implementation efforts. Continued use of this toolkit by nurse leaders will contribute valuable information on usefulness for guiding implementation efforts, as well as degree of implementation success among clinical teams.…”

Facilitators of palliative care quality improvement team cohesion

“…We believe that our findings contribute to the evidence pointing toward the utility of integrating organizational theory with implementation frameworks in team-based implementation evaluation. It is important to note that CFIR is currently undergoing revision, with Version 2.0 clarifying the use of theory within the implementation framework (Damschroder, 2020; Damschroder et al, 2021). Our use of theory helped us elucidate the “mechanisms of action” of the CFIR framework (Damschroder et al, 2021), with our facilitators of team cohesion pointing toward team processes that could be encouraged at the outset of future implementation efforts.…”

“…It is important to note that CFIR is currently undergoing revision, with Version 2.0 clarifying the use of theory within the implementation framework (Damschroder, 2020; Damschroder et al, 2021). Our use of theory helped us elucidate the “mechanisms of action” of the CFIR framework (Damschroder et al, 2021), with our facilitators of team cohesion pointing toward team processes that could be encouraged at the outset of future implementation efforts. Furthermore, the updated CFIR framework includes the need for “teaming” in implementation, pointing to the utility of using team theory in the planning stages of implementation, intentionally fostering team processes to improve innovation outcomes.…”