A framework for identifying implementation factors across contexts: The Consolidated Framework for Implementation Research (CFIR)

Damschroder, L.J., Aron, D.C., Keith, R.E., Kirsh, S.R., Alexander, J.A. et Lowery, J.C. (2009). Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implementation Science, 4: 50. doi: 10.1186/1748-5908-4-50.


How do you know that an intervention that has been shown to be effective in one setting will prove to be as effective in another setting? When considering the transferability of findings, implementation factors can play an important role in determining implementation success. However, factors can have more or less influence in different settings and under different circumstances.

The Consolidated Framework for Implementation Research (CFIR) includes taxonomy, terminology and definitions that create a knowledge base of implementation factors across multiple contexts. This 'meta-theoretical' framework identifies constructs across five domains: intervention (e.g., evidence strength and quality); outer setting (e.g., patient needs and resources); inner setting (e.g., culture, leadership engagement); individual characteristics; and process (e.g., plan, evaluate and reflect).

Individuals can assess whether the constructs will influence (positively or negatively) the success of the implementation.

Website: http://cfirguide.org/

Steps for Using Method/Tool

The CFIR consists of a list of constructs for individuals involved with the implementation process to consider. The five major domains include:

Intervention Characteristics - includes eight constructs related to characteristics of the intervention being implemented into a particular organization

Outer Setting - includes four constructs related to factors such as the economic, political and social context within which an organization resides

Inner Setting - includes 12 constructs related to features such as the structural, political and cultural contexts through which the implementation process will proceed

Characteristics of Individuals - includes five constructs related to the individuals involved with the intervention and/or implementation process

Process - includes eight constructs related to essential activities of the implementation process that are common across organizational change models

In terms of research and evaluation, the CFIR can be used to identify barriers and facilitators to implementation (formative evaluation), monitor progress toward implementation goals (process evaluation) and assess how implementation may have influenced performance of an intervention (outcome or impact evaluation). Those interested in using the CFIR to guide a formative, process or outcome evaluation should incorporate the following steps into their evaluation plan.

1. Assess each construct for importance and direction of influence.

2. Carefully adapt and operationalize definitions.

3. Discern the levels(s) at which each should be evaluated and defined.

4. Decide how to measure and access.

5. Be aware of the time points at which measurement and evaluation occur, while acknowledging the transient nature of the state of each of these contextual factors.

6. Document each decision and rationale, along with findings related to each construct.


These summaries are written by the NCCMT to condense and to provide an overview of the resources listed in the Registry of Methods and Tools and to give suggestions for their use in a public health context. For more information on individual methods and tools included in the review, please consult the authors/developers of the original resources.

We have provided the resources and links as a convenience and for informational purposes only; they do not constitute an endorsement or an approval by McMaster University of any of the products, services or opinions of the external organizations, nor have the external organizations endorsed their resources and links as provided by McMaster University. McMaster University bears no responsibility for the accuracy, legality or content of the external sites.

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