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Table 2 Proposed additional constructs

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

DomainConstructDefinition
Characteristics of SystemsSystems architectureThe administrative design of a health system or interacting systems that contribute to the health of the public (e.g., Ministries of Health, Education, Welfare, Sanitation, etc.) and that influence how programs are designed and/or implemented. This includes the nature of interactions across specific administrative level(s) that influence implementation. Examples of architectural attributes that may influence implementation include (de)centralized healthcare systems, remuneration and employment structures, governance, and supervisory structures, the role of health information systems, official roles and responsibilities of formal and informal health worker cadres.
External funding agent prioritiesStakeholders’ perception regarding the degree to which funding agent preferences and priorities influence implementation. Examples may include mismatched priorities between donors and implementers, donor resources influencing implementer policy, or implementer policies influencing donor activities.
Strategic policy alignmentThe degree to which the perceived priorities and needs of relevant stakeholders are aligned with system policies and vice versa. Examples may include the perceived degree to which key stakeholders have input into strategic plans or that performance indicators accurately reflect health worker views of their professional responsibilities.
Resource continuityThe presence of sufficient resources (financial, human, or material) over durations of time necessary for ongoing implementation at scale and without interruption or delays.
Resource sourceThe origin of available resources used to test, launch, and sustain implementation. Plausible resource origins include domestic government resources directed to routine healthcare services, pilot programs or research, bilateral developmental aid, foreign governmental support for research, private foundation support, and multilateral organizations.
Characteristics of the InterventionPerceived scalabilityThe perceived potential of implementation expansion so that the innovation/intervention is available across wider geographic or practice settings.
Perceived sustainabilityThe perceived likelihood of continued use of program components and activities for the continued achievement of desirable program and population outcomes [45].
Inner SettingTeam characteristicsFeatures of a team including team composition, processes, and psycho-social traits. Examples of these features might include team diversity, interdependence/collaboration, and practice norms [46].
Collective efficacyA team’s shared belief in their capability to execute activities and achieve their common implementation goals.
Outer SettingCommunity characteristicsThe extent to which community characteristics affect the willingness or ability for organizations to engage in implementation. Community characteristics that might influence implementation include socio-cultural and religious features of healthcare consumers or health knowledge, attitudes, and beliefs influencing demand for healthcare services.
Process of ImplementationDecision-makingThe type, duration and timing of the activities involved in making decisions about the intervention. Examples of decision-making characteristics that influence implementation may include decisions requiring highly bureaucratic approval systems, decisions that must be made far in advance or in conjunction with implementation, or even the absence of decision-making authority.