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

A Summary of

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.

Relevance for Public Health

This method is informed by theories related to the healthcare sector, however it is broad enough to inform public health implementation activities.

This resource can be used to guide the adaptation of public health interventions and to develop implementation plans by considering factors that are likely to influence implementation success in a specific setting.

Description

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/

Accessing the Method/Tool


Language(s)

English

Format(s)

On-line Access

Cost

None

Implementing the Method/Tool


Time for Participation/Completion

Information not available

Additional Resources and/or Skills Needed for Implementation

Not Specified

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.

Who is involved

Individuals (e.g., program evaluators, managers, researchers) involved with the planning, organizing and evaluation of an implementation process would be involved in this method.

Conditions for Use

Not specified

Evaluation and Measurement Characteristics


Evaluation

Has not been evaluated

Validity

Information not available

Reliability

Information not available

Methodological Rating

Unknown/No evidence

Method/Tool Development


Developer(s)

Laura Damschroder
David C. Aron
Rosalind E. Keith
Susan R. Kirsh
Jeffery A. Alexander
Julie C. Lowery

Method of Development

This framework is built upon a previous synthesis of implementation factors conducted by Greenhalgh et al (2004) using snowball sampling to identify new theories. Specifically, the theories included in this framework are related to dissemination, innovation, organizational change, implementation, knowledge translation and research uptake.

To develop the list of constructs within the domains, developers combined certain constructs across existing implementation theories while separating and delineating others to develop definitions that can be readily operationalized. Constructs were selected for inclusion based on strength of conceptual and evidential support in the literature for influencing implementation, a high consistency in definition, alignment with the authors' own experiences and potential for operationalization as measures.

Notably, the Society for Implementation Research Collaboration’s (SIRC) Instrument Review Project (IRP) developed a methodology for searching and synthesizing quantitative instruments used to assess implementation in mental health, health care and school settings (Lewis et al, 2015). The 48 dissemination and implementation science constructs contained in the SIRC’s methodology were adapted from two highly cited implementation frameworks (1) Damschroder et al’s (2009) CFIR and (2) Proctor et al’s (2009) Implementation Outcomes Framework. The CFIR was chosen by SIRC because it is a comprehensive, meta-theoretical framework that addresses existing overlap in the implementation science evidence base and provides a common taxonomy of constructs and domains. As such, the CFIR has been used to identify and evaluate the reliability and validity of common constructs and domains within existing implementation science instruments.

Release Date

2009

Contact Person/Source

Laura Damschroder
Ann Arbor VA Center for Clinical Management Research
2215 Fuller Road, Mailstop 152
Ann Arbor, USA 48105-2399

Phone: (734) 845-3603
​Email: Laura.Damschroder@va.gov

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.

Resources

Title of Primary Resource Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science
File Attachment None
Web-link
Reference

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.

Type of Material Journal article
Format Periodical
Cost to Access None.
Language English
Conditions for Use

© 2004 Milbank Memorial Fund

Title of Supplementary Resource The Society for Implementation Research Collaboration Instrument Review Project: A methodology to promote evaluation
File Attachment None
Web-link
Reference

Lewis, C.C., Stanick, C.F., Martinez, R.G., Weiner, B.J., Kim, M., Barwick, M., et al. (2015). The Society for Implementation Research Collaboration Instrument Review Project: A methodology to promote rigorous evaluation. Implementation Science, 10, 2.

Type of Material Journal Article
Format Periodical
Cost to Access None.
Language English
Conditions for Use

© 2015 Lewis et al.; licensee BioMed Central

Title of Supplementary Resource Implementation research in mental health services: An emerging science with conceptual, methodological, and training challenges
File Attachment None
Web-link
Reference

Proctor, E.K., Landsverk, J., Aarons, G., Chambers, D., Glisson, C., Mittman, B. (2009). Implementation research in mental health services: An emerging science with conceptual, methodological, and training challenges. Administration and Policy in Mental Health, 36, 24-34.

Type of Material Journal article
Format Periodical
Cost to Access None.
Language English
Conditions for Use

© Springer Science+Business Media

Title of Supplementary Resource Diffusion of innovations in service organizations: Systematic review and recommendations
File Attachment None
Web-link
Reference

Greenhalgh, T., Robert, G., Macfarlane, F., Bate, P., Kyriakidou, O. (2004). Diffusion of innovations in service organizations: Systematic review and recommendations. Millbank Quarterly, 82, 581-629.

Type of Material Journal article
Format Periodical
Cost to Access None.
Language English
Conditions for Use
© 2004 Milbank Memorial Fund

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