Skip to main content

Table 1 Summary of included studies

From: Evaluating and optimizing the consolidated framework for implementation research (CFIR) for use in low- and middle-income countries: a systematic review

AuthorCountryHealth topicResearch objective(s)MethodsUnit of analysisPhase of CFIR applicationNature of CFIR application
Barac [10]Chile, India, Pakistan, Bangladesh, Thailand, Vietnam, South Africa, and NigeriaTyphoidTo identify typhoid-relevant interventions implemented between 1990 and 2015 and explore contextual factors perceived to be associated with their implementationMixed-methodsOrganizations involved in implementation; Health policy and health system leaders at national or subnational levelsPost-implementationUsed to guide data collection; used to guide data analysis
Bardosh [11]Canada, KenyaHIV (Kenya)To evaluate how a two-way SMS communication system to increase patient adherence to medication and engagement in care was perceived, diffused, and adopted in ongoing project sitesQualitative designHealth providers in facilities involved in implementationMid-implementationUsed to guide data collection
Chu [12]ChinaHepatitis C virus (HCV)To explore social and structural factors affecting HCV treatment access at an HIV treatment facility and methadone maintenance treatment centers to inform strategies for expanding accessQualitative designPatients benefiting from interventionPost-implementationUsed to guide data analysis; used to interpret/contextualize findings
Cole [13]MozambiqueMaternal healthTo explore the contextual factors that may have contributed to observed increases in institutional deliveries from 2009-2014 in Nampula province.Mixed-methodsHealth providers in facilities involved in implementation; Patients benefiting from interventionPost-implementationUsed to guide data collection; used to guide data analysis
Cooke [14]TanzaniaOpioid treatment and HIVTo understand the contextual factors that influence the effectiveness of integrated methadone and anti-retroviral therapy implementationQualitative designPatients benefiting from intervention; Health providers in facilities involved in implementationPost-implementationUsed to guide data analysis
Dansereau [15]Chad, CameroonImmunizationsTo retrospectively evaluate the implementation of Gavi’s health system strengthening support and identify drivers of and barriers to implementationMixed-methodsOrganizations involved in implementationPost-implementationUsed to interpret/contextualize findings
Dogar [16]Nepal, PakistanTuberculosis (TB)To describe challenges and lessons learned of implementing tobacco cessation in routine TB careQualitative designPatients benefiting from intervention; health providers in facilities involved in implementationPost-implementationUsed to interpret/contextualize findings
English [17]KenyaPediatric inpatient careTo explore why a facility-based intervention to introduce care based on best-practice guidelines varied in effect across place and timeMixed-methodsOrganizations involved in implementationPost-implementationUsed to interpret/contextualize findings
English [18]KenyaPediatric inpatient careTo develop a system-oriented intervention to improve services for children in district hospitalsQualitative designOrganizations involved in implementationPre-implementationUsed to frame/design the intervention
Gimbel [19]Mozambique, Kenya, Cote d'IvoireHIVTo define the core and adaptable components of a facility-based intervention to address implementation challenges in prevention of mother to child transmission (PMTCT), and identify contextual influences that explain implementation heterogeneityQualitative designOrganizations involved in implementationPost-implementationUsed to guide data collection; used to guide data analysis; used to interpret/contextualize findings
Gimbel [20]Mozambique, Rwanda, and ZambiaPrimary health careTo describes and categorize data quality assessment and improvement activities of a multi-country initiative and identify core intervention components and implementation strategy adaptations to improve data qualityMixed-methodsOrganizations involved in implementationPost-implementationUsed to guide data collection, used to guide data analysis, used to interpret/contextualize findings
Gutierrez-Alba [21]MexicoClinical practice guidelines generallyTo identify and prioritize barriers and facilitators facing the implementation of Clinical Practice Guidelines in hospitals.Qualitative designOrganizations involved in implementationMid-implementationUsed to guide data collection; used to guide data analysis; used to interpret/contextualize findings
Hosey [22]US Associated Pacific IslandsChronic diseaseTo describe the implementation and evaluation of a non-communicable disease (NCD) pilot project to systematically strengthen NCD health care quality and outcomes across five health systemsMixed-methodsOrganizations involved in implementationMid-implementationUsed to guide data analysis; used to interpret/contextualize findings
Huang [23]UgandaPediatric mental healthTo assess the feasibility and effectiveness of implementing professional development programs for early childhood teachers and determine if children with teachers exposed to professional development programs have better mental health outcomesMixed-methodsHealth providers in facilities involved in implementationMid-implementationUsed to guide data collection
Jones [24]ZambiaHIVTo identify predictors of a voluntary male medical circumcision program’s success or failure to create an “early warning” system that enables remedial action during implementationMixed-methodsHealth providers in facilities involved in implementationMid-implementationUsed to guide data collection; used to guide data analysis’ used to interpret/contextualize findings
Landis-Lewis [25]MalawiHIVTo identify and describe barriers to using electronic medical record data for individualized audit and feedback for healthcare providers in Malawi and to consider how to design technology to overcome these barriersQualitative designHealth providers in facilities involved in implementationMid-implementationUsed to guide data collection
Malham [26]MoroccoMaternal healthTo identify the factors hindering full implementation of a national action plan to strengthen the professional role of midwives in two regions and to identify recommendations that could increase the effectiveness of the action planQualitative designHealth providers in facilities involved in implementationMid-implementationUsed to guide data analysis; used to interpret/contextualize findings
Malham [27]MoroccoMaternal healthTo assess the extent to which a national action plan to strengthen the professional role of midwives was delivered in two regions, and the barriers and facilitators influencing implementationQualitative designHealth providers in facilities involved in implementationMid-implementationUsed to guide data analysis; used to interpret/contextualize findings
McRobie [28]UgandaHIVTo assess implementation of national HIV policies regarding testing, treatment, and retention at health facilities serving two health and demographic surveillance sitesMixed-methodsHealth providers in facilities involved in implementationPre-implementationUsed to frame/design the intervention
Myburgh [29]South AfricaHIVTo identify barriers and facilitators in the implementation of an antiretrovirals electronic register at facility, sub-district, and district levelsMixed-methodsHealth providers in facilities involved in implementationPost-implementationUsed to interpret/contextualize findings
Naidoo [30]South AfricaHIVTo explore barriers and facilitators to implementation of community-based HIV programs in order to produce actionable findings to improve themQualitative designPatients benefiting from intervention; health providers in facilities and in communities involved in implementationPost-implementationUsed to interpret/contextualize findings
Nathavitharana [31]BangladeshTBTo present operational data and discuss the challenges of implementing FAST (Find cases Actively, Separate safely and Treat effectively) as a TB transmission control strategy in health facilitiesQualitative designHealth providers in facilities involved in implementationPost-implementationUsed to guide data analysis
Naude [32]South Africa, CameroonEvidence based health policy generallyTo describe the different contexts in which health policies are formulated and identify the facilitators and barriers to incorporating research evidenceQualitative designHealth policy and health system leaders at national or subnational levelsPost-implementationUsed to interpret/contextualize findings
Petersen Williams [33]South AfricaMaternal healthTo investigate health care providers’ perceptionsof the acceptability and feasibility of providing screening, brief intervention, and referral to treatment to address substance use among pregnant women attending antenatal careQualitative designHealth providers in facilities involved in implementationPre-implementationUsed to frame/design the intervention; used to guide data collection
Phulkerd [34]ThailandObesityTo identify barriers and potential facilitators to implementing regulations to restrict unhealthy radio and television food advertising to children and policies to promote healthier productsQualitative designOrganizations involved in implementationPre-implementationUsed to guide data collection
Rodriguez [35]South AfricaHIVTo identify barriers and facilitators in the implementation, uptake, and sustainability of PMTCT protocols in a rural areasQualitative designHealth providers in facilities involved in implementation; health policy and health system leaders at national or subnational levels; patients benefiting from interventionPost-implementationUsed to guide data analysis; Used to interpret/contextualize findings
Rwabukwisi [36]Ghana, Mozambique, Rwanda, Tanzania, and ZambiaPrimary healthcareTo retrospectively evaluate a multi-country consortium aiming to implement and evaluate district-level health system strengthening interventionsQualitative designOrganizations involved in implementationPost-implementationUsed to guide data analysis
Saluja [37]N/ASurgeryTo discuss key factors influencing implementation of national surgical planning in LMICsQualitative designOrganizations involved in implementationPost-implementationUsed to guide data analysis; used to interpret/contextualize findings
Sax [38]PakistanPrimary healthcare (healthcare accreditation)To identify perceived factors influencing introduction and adaptation of international healthcare accreditation to improve healthcare qualityQualitative designOrganizations involved in implementationPost-implementationUsed to guide data analysis
Shi [39]ChinaEvidence-based public health generallyTo assess implementation of evidence based public health and identify barriers to evidence based public health in the public sectorQualitative designHealth providers in facilities involved in implementation; health policy and health system leaders at national or subnational levelsPre-implementationUsed to frame/design the intervention; used to guide data collection; used to guide data analysis
Soi [40]MozambiqueHuman papillomavirus (HPV) vaccinationTo identify implementation barriers and facilitators affecting the scale-up of HPV vaccination in MozambiqueQualitative designHealth providers and educators in facilities and schools involved in implementation; health and education policy and health system leaders at national or subnational levelsPost-implementationUsed to guide data collection; used to guide data analysis
VanDevanter [41]VietnamTobacco cessationTo identify potential barriers and facilitators to implementing system changes to increase adoption of tobacco use treatment guidelinesQualitative designHealth providers in facilities involved in implementationPre-implementationUsed to guide data collection; used to guide data analysis
Warren [42]KenyaMaternal healthTo describe the complex processes, strengths, and challenges of an intervention aiming to address mistreatment during childbirth and promote respectful maternity careQualitative designPatients benefiting from intervention; health providers in facilities involved in implementationPost-implementationUsed to guide data analysis
White [43]BeninSurgical safetyTo measure the sustainability of surgical safety checklist use and to evaluate the acceptability, adoption, appropriateness, feasibility and fidelity of nationwide checklist implementation, including penetration of the checklist into operating room cultureMixed-methodsHealth providers in facilities involved in implementationMid-implementationUsed to interpret/contextualize findings