Table 2 Conceptual model of levels in implementation research illustrated in CFIR and EPIS frameworks
From: Eight characteristics of rigorous multilevel implementation research: a step-by-step guide
CFIR / EPIS | Level name | Definition | Examples |
|---|---|---|---|
Outer setting / Outer Context | Countrya | A nation with its own government, occupying a specific territory (Oxford languages dictionary) | Denmark, USA, Honduras |
Health systemb | An organization that includes at least one hospital and at least one group of physicians that provide comprehensive care (including primary and specialty care) who are connected with each other and with the hospital through common ownership or joint management (U.S. Agency for Healthcare Research and Quality’s Compendium of US Health Systems, 2016) | National Health System (UK), Kaiser Permanente (USA) | |
Regionc | An area, administrative district, or division of a country with definable characteristics or boundaries | District, county, parish, province, state | |
Locality | An area or neighborhood that constitutes a subdivision of a larger social or political entity | Neighborhood, city, town, census tract | |
Inner setting / Inner context | Organization/agency | A group of people arranged within a formal legal structure (e.g., for-profit or not-for-profit) for the specific purpose of delivering healthcare. Exercises authority over departments/wards, clinics/practice sites, program/units, clinical teams, and/or providers | Hospital network; multistate organization delivering mental health services |
Department/ward | A subdivision of an organization with a specialized purpose, capacity, or workgroup(s) | Oncology unit within a hospital | |
Clinic/practice/site | A single, specific, geographically distinct location in which, or from which, providers deliver health-related or behavior change interventions to a target population or populations. Serves as the operational center of programs/units, clinical teams, and/or providers | Primary care practice, outpatient mental health clinic, school | |
Program/unit | A group of providers or clinical teams that deliver a specific, clearly defined health-related or behavior change intervention to a target patient population; programs are sub-units of higher-level entities such as clinics or organizations | Pediatric oncology ward in a children’s hospital | |
Individuals involved / Individual characteristics | Clinical team | One or more providers (including dyads) who directly co-deliver, or coordinate or share responsibility for delivery of, a health-related or behavior change intervention to a patient or patient population | Assertive Community Treatment team, Multisystemic Therapy team |
Provider | A single individual who delivers a health-related or behavior change intervention to the target patient | Clinician, prescriber, home visitor, peer-to-peer specialist, volunteer | |
Patientd | The individual, or smallest group of individuals, targeted by the clinical intervention or policy to be implemented | Child with depression, adult experiencing HIV, family group | |
Process / timing within EPIS Phases | Observation/time | A single, specific point in time at which an implementation-relevant measurement is taken for either research or clinical purposes | Baseline status, posttreatment status, 3-month follow-up status |