Volume 10 Supplement 1

7th Annual Conference on the Science of Dissemination and Implementation in Health

Open Access

Measuring constructs from the Consolidated Framework for Implementation Research in the context of increasing colorectal cancer screening at community health centers

  • Shuting Liang1,
  • Michelle Kegler1,
  • Michelle Carvalho1,
  • Maria Fernandez2,
  • Bryan Weiner3,
  • Sara Jacobs4,
  • Rebecca Williams5,
  • Betsy Risendal6, 7,
  • Letoynia Coombs6,
  • Daniela Friedman8, 9,
  • Beth Glenn10, 11, 12 and
  • Shin-Ping Tu13
Implementation Science201510(Suppl 1):A10


Published: 14 August 2015


The Consolidated Framework for Implementation Research (CFIR) is a comprehensive meta-framework widely applied to implementation related studies. Yet, few have used validated measures to operationalize constructs in CFIR in real-life settings. In this study, we operationalized selected CFIR constructs in an assessment to identify factors influencing implementation of evidence-based practices for increasing colorectal cancer screening in Community Health Centers (CHC).


We selected 16 constructs from all five domains of CFIR. Measures were developed and tested in a cross-sectional survey with CHCs' clinical staff and leaders respectively. We performed a separate confirmatory factor analysis (CFA) for measures with three or more items, computed inter-item consistency (Cronbach's alpha), inter-rater reliability (ICC) and agreement (rWG(J)) statistics, and assessed construct validity via inter-correlations among constructs at individual and organizational levels.


A total of 277 individuals and 59 CHC clinics were included in the analysis. CFA showed satisfactory structural validity (CFI>0.90, TLI>0.90, SRMR<0.08, RMSEA<0.08); all measures showed reasonable reliability (alpha>0.70). The ICCs (>0.1) and rWG(J) (>0.75) suggest it appropriate to aggregate individual responses by computing clinic means. Results also suggest good construct validity at both individual and clinic levels. Inner setting and process-related constructs are correlated with most variables across domains; correlations between outer setting and intervention characteristics and other domains vary more noticeably by construct.


Our study is one of the first to quantitatively measure constructs from all five domains of CFIR and demonstrate their psychometric properties. We depicted their inter-correlations at multiple levels, which set the foundation for establishing predictive models, causal pathways and developing interventions that target these factors. These findings could contribute to further development of the CFIR.

Authors’ Affiliations

Emory Prevention Research Center, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University
School of Public Health, University of Texas Health Science Center at Houston
Department of Health Policy and Management, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill
Public Health Research Division, RTI International, Research Triangle Park
Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill
University of Colorado Comprehensive Cancer Center
Department of Community and Behavioral Health, Colorado School of Public Health
Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina
Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina
UCLA Kaiser Permanente Center for Health Equity, University of California Los Angeles
Fielding School of Public Health, University of California Los Angeles
Jonsson Comprehensive Cancer Center, University of California Los Angeles
Department of Medicine, Virginia Commonwealth University


© Liang et al. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.