Fostering implementation of health services research findings into practice

A consolidated framework for advancing implementation science

Dados Bibliográficos

ID23313555
AutoresLaura J Damschroder (0000-0002-3657-8459, VA Ann Arbor Healthcare System), David C Aron (0000-0002-2837-0797, Louis Stokes Cleveland VA Medical Center), Rosalind E Keith (0000-0001-9910-5766, VA Ann Arbor Healthcare System), Susan Kirsh (Louis Stokes Cleveland VA Medical Center), Susan R Kirsh, J Alexander (0000-0002-4627-6665, University of Michigan), Jeffery A Alexander, Julie C Lowery (0000-0003-3973-7459, VA Ann Arbor Healthcare System)
Ano2009
Volume4
Fascículo1
Páginas50-50
Data de publicação2009-12-01
Peer ReviewedSim
Open AccessSim
TipoARTICLE
PeriódicoImplementation Science (JOURNAL)
Identificadores do periódicoISSN: 1748-5908 • E-ISSN: 1748-5908
EditoraSpringer Science and Business Media LLC (PUBLISHER)
DOI10.1186/1748-5908-4-50
PMID19664226
PMCIDPMC2736161
OpenAlexW2020155291
IdiomaEN
Citações recebidas1.451
Referências citadas68

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. METHODS: We used a snowball sampling approach to identify published theories that were evaluated to identify constructs based on strength of conceptual or empirical support for influence on implementation, consistency in definitions, alignment with our own findings, and potential for measurement. We combined constructs across published theories that had different labels but were redundant or overlapping in definition, and we parsed apart constructs that conflated underlying concepts. RESULTS: The CFIR is composed of five major domains: intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation. Eight constructs were identified related to the intervention (e.g., evidence strength and quality), four constructs were identified related to outer setting (e.g., patient needs and resources), 12 constructs were identified related to inner setting (e.g., culture, leadership engagement), five constructs were identified related to individual characteristics, and eight constructs were identified related to process (e.g., plan, evaluate, and reflect). We present explicit definitions for each construct. CONCLUSION: The CFIR provides a pragmatic structure for approaching complex, interacting, multi-level, and transient states of constructs in the real world by embracing, consolidating, and unifying key constructs from published implementation theories. It can be used to guide formative evaluations and build the implementation knowledge base across multiple studies and settings.

Conceptual framework · Epistemology · Formative assessment · Health administration · Health care · Health services research · Implementation research · Management science · Mathematics education · Nursing research · Psychological intervention · Public health · Qualitative research · Rigour · Snowball sampling · Sociology · Terminology · Computer Science · Health Informatics · Health Policy Implementation Science · Medicine · Mental Health and Patient Involvement · Nursing · Participatory Visual Research Methods · Psychology