Table 4 Recommendations for applying the CIFR in implementation research

Consider how to most meaningfully use the CFIR across different phases of implementation (pre-, during, or post-implementation).

Explicit use and reporting of CFIR constructs at various phases of implementation would allow comparisons across phases.

Meaningful pre-implementation assessment would help to identify barriers to address and facilitators to leverage, which in turn, would inform choice of strategies that will increase likelihood of implementation success. In addition, this information can be used to adapt the intervention to fit local context.

Meaningful during or post-implementation studies would continue identification of barriers and facilitators to implementation to:

 ▪ Inform scale-up efforts

 ▪ Inform implementation of an innovation in other settings/contexts

 ▪ Associate CFIR constructs with implementation outcomes (if using mixed-methods or quantitative studies)

Report how CFIR constructs were selected for assessment.

Help to ensure rigor of implementation studies (i.e., that the most salient implementation-related factors were investigated) and promotes the ability to compare research over time and across contexts.

Researchers using the CFIR should clearly report: (1) justification/rationale for selecting CFIR constructs and (2) the CFIR constructs used in the research study.

Increase use of CFIR to investigate outcomes.

Investigation of outcomes allows for more robust comparisons across studies to identify which constructs influence outcomes and under what conditions.

Researchers should include measurement of implementation outcomes to assess association of CFIR constructs with implementation outcomes.

Within the context of investigating outcomes, researchers should: (1) include implementation outcome measures (such as those mentioned by Proctor et al. [25]), (2) provide clearer linkage of CFIR constructs with outcomes, and (3) provide clearer specification of which CFIR constructs were used to investigate outcomes.

Integrate the CFIR more holistically into the research process.

Integrating the CFIR into research question development and data collection efforts early-on will strengthen research and applicability of findings.

The CFIR should be used throughout the research process. Researchers can use the CFIR Technical Assistance wiki (www.cfirguide.org) to develop research questions, interview and coding guides, as well as to refine CFIR constructs, definitions, and theoretical developments.