Domain | Existing CFIR construct19 | Definition within CFIR19 | Emergent issues |
---|---|---|---|
I. Intervention characteristics | Evidence strength and quality | The stakeholder’s belief in the quality and validity of the evidence of the intervention having the desired outcome | Evidence for the benefits of PROMs use in primary care |
Relative advantage | The perceived advantage of using a particular intervention versus an alternative or existing solution | PROMs may be used to frame discussions of shared-decision making, justify treatment decisions, support nursing staff | |
Adaptability | The degree to which an intervention can be refined to meet the specific needs of the local environment | Ability to be digitalised | |
Complexity | The potential disruptiveness and intricacy involved in its implementation | PROMs can take time to complete and to interpret and utilise results | |
Design quality | How well the intervention is assembled and presented | PROMs are poorly presented to stakeholders | |
II. Outer setting | Patient needs and resources | The requirements of patients and the factors that influence how they are met by an organisation | Variation in patient reliability, health literacy, comorbidities |
External policy and incentives | The strategies that policymakers and commissioners employ to spread the implementation of the intervention, include mandates, guidelines, and financial incentives | Adverse influence of financial incentives, CCG | |
III. Inner setting | Implementation climate | The capacity for change of an organisation through its attitude to the intervention, their relative priority, and how their use will be supported and rewarded | No pressure for change, compatibility, relative priority |
Readiness for implementation | The tangible indicators of the decision to implement a particular intervention this includes factors such as access to knowledge, information, and training | GPs lack of awareness of PROMs, no systematic training | |
IV. Characteristics of individuals | Knowledge and beliefs about the intervention | The attitudes of individual GPs towards any intervention as shaped by their understanding of its use and the value they place on it | Considered a research tool |
V. Process | Planning | The engagement of organisations and individuals in the process of change and ensuring an appropriate plan is in place | Lack of coherent approach |
Engagement | The degree to which relevant individuals are engaged in the process of implementation | Absence of consultation or staff engagement |
CCG = clinical commissioning group. CFIR = Consolidated Framework of Implementation Research PROMs = Patient Reported Outcome Measures.