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Table 2 Number of level 1 and level 2 strategies by CFIR barrier

From: Choosing implementation strategies to address contextual barriers: diversity in recommendations and future directions

CFIR construct Barrier description No. ERIC strategies
Level 1 Level 2
Intervention source Stakeholders have a negative perception of the innovation because of the entity that developed it and/or where it was developed. 0 9
Evidence strength and quality Stakeholders have a negative perception of the quality and validity of evidence supporting the intervention. 0 10
Relative advantage Stakeholders do not see the advantage of implementing the innovation compared to an alternative solution or keeping things the same. 0 11
Adaptability Stakeholders do not believe that the innovation can be sufficiently adapted, tailored, or re-invented to meet local needs. 1 10
Trialability Stakeholders believe they cannot test the innovation on a smaller scale within the organization or undo implementation if needed. 0 10
Complexity Stakeholders believe that the innovation is complex based on their perception of duration, scope, radicalness, disruptiveness, centrality, and/or intricacy and number of steps needed to implement. 0 15
Design quality and packaging Stakeholders believe the innovation is poor quality based on the way it is bundled, presented, and/or assembled. 0 7
Cost Stakeholders believe the innovation costs and/or the costs to implement (including investment, supply, and opportunity costs) are too high. 1 9
Patient needs and resources Patient needs, including barriers and facilitators to meet those needs, are not accurately known and/or this information is not a high priority for the organization. 3 5
Cosmopolitanism The organization is not well networked with external organizations. 3 7
Peer pressure There is little pressure to implement the innovation because other key peers or competing organizations have not already implemented the innovation nor is the organization doing this in a bid for a competitive edge. 0 8
External policy and incentives External policies, regulations (governmental or other central entity), mandates, recommendations or guidelines, pay-for-performance, collaborative, or public or benchmark reporting do not exist or they undermine efforts to implement the innovation. 0 7
Structural characteristics The social architecture, age, maturity, and size of an organization hinder implementation. 0 9
Networks and communications The organization has poor quality or non-productive social networks and/or ineffective formal and informal communications. 2 7
Culture Cultural norms, values, and basic assumptions of the organization hinder implementation. 1 12
Implementation climate There is little capacity for change, low receptivity, and no expectation that the use of the innovation will be rewarded, supported, or expected. 1 6
Tension for change Stakeholders do not see the current situation as intolerable nor do not believe they need to implement the innovation. 0 8
Compatibility The innovation does not fit well with existing workflows nor with the meaning and values attached to the innovation, nor does it align well with stakeholders’ own needs and/or it heightens the risk for stakeholders. 0 10
Relative priority Stakeholders perceive that the implementation of the innovation takes a backseat to other initiatives or activities. 0 6
Organizational incentives and rewards There are no tangible (e.g., goal-sharing awards, performance reviews, promotions, salary raises) or less tangible (e.g., increased stature or respect) incentives in place for implementing the innovation. 1 7
Goals and feedback Goals are not clearly communicated or acted upon, nor do stakeholders receive feedback that is aligned with goals. 1 6
Learning climate The organization has a climate where (a) leaders do not express their own fallibility or need for stakeholders’ assistance or input; (b) stakeholders do not feel that they are essential, valued, and knowledgeable partners in the implementation process; (c) stakeholders do not feel psychologically safe to try new methods; and (d) there is not sufficient time and space for reflective thinking or evaluation. 1 6
Readiness for implementation There are few tangible and immediate indicators of organizational readiness and commitment to implement the innovation. 1 6
Leadership engagement Key organizational leaders or managers do not exhibit commitment and are not involved, nor are they held accountable for the implementation of the innovation. 0 9
Available resources Resources (e.g., money, physical space, dedicated time) are insufficient to support the implementation of the innovation. 1 7
Access to knowledge and information Stakeholders do not have adequate access to digestible information and knowledge about the innovation nor how to incorporate it into work tasks. 3 7
Knowledge and beliefs about the intervention Stakeholders have negative attitudes toward the innovation, they place low value on implementing the innovation, and/or they are not familiar with facts, truths, and principles about the innovation. 1 11
Self-efficacy Stakeholders do not have confidence in their capabilities to execute courses of action to achieve implementation goals. 0 12
Individual stage of change Stakeholders are not skilled or enthusiastic about using the innovation in a sustained way. 0 12
Individual identification with organization Stakeholders are not satisfied with and have a low level of commitment to their organization. 0 9
Planning A scheme or sequence of tasks necessary to implement the intervention has not been developed or the quality is poor. 2 6
Opinion leaders Opinion leaders (individuals who have a formal or informal influence on the attitudes and beliefs of their colleagues with respect to implementing the intervention) are not involved or supportive. 2 6
Formally appointed internal implementation leaders A skilled implementation leader (coordinator, project manager, or team leader), with the responsibility to lead the implementation of the innovation, has not been formally appointed or recognized within the organization. 1 11
Champions Individuals acting as champions who support, market, or “drive-through” implementation in a way that helps to overcome indifference or resistance by key stakeholders are not involved or supportive. 1 6
External change agents Individuals from an outside entity formally facilitating decisions to help move implementation forward are not involved or supportive. 0 10
Key stakeholders Multifaceted strategies to attract and involve key stakeholders in implementing or using the innovation (e.g., through social marketing, education, role modeling, training) are ineffective or non-existent. 1 9
Patients/customers Multifaceted strategies to attract and involve patients/customers in implementing or using the innovation (e.g., through social marketing, education, role modeling, training) are ineffective or non-existent. 3 6
Executing Implementation activities are not being done according to plan. 0 12
Reflecting and evaluating There is little or no quantitative and qualitative feedback about the progress and quality of implementation nor regular personal and team debriefing about progress and experience. 2 8
  1. Note: Level 1 includes strategies endorsed by at least 50% of respondents. Level 2 includes strategies endorsed by 20–49.9% of respondents (top quartile of endorsements)