Table 1 Brief description of CFIR constructs
Domain | Construct | Description |
|---|---|---|
INTERVENTION CHARACTERISTICS | Intervention Source | Understanding about whether the intervention was developed internally or externally |
Evidence Strength and Quality | Beliefs about the quality and validity of evidence for the intervention and whether it will achieve the intended outcomes | |
Relative Advantage | The advantages of implementing the intervention compared to other possible alternatives | |
Adaptability | How readily the intervention can be adapted to the specificities of the local context | |
Trialability | Whether the intervention can be piloted on a small scale initially and undone if necessary | |
Complexity | How difficult the intervention is to implement (duration, scope, departure from norm, number of steps required) | |
Design Quality and Packaging | How well the intervention was bundled, presented and assembled | |
Cost | The cost of using and implementing the intervention (investment, supply and opportunity costs) | |
OUTER SETTING | Patient Needs and Resources | How well the organisation prioritises understanding barriers and facilitators to meeting patient needs |
Cosmopolitanism | How well networks have been established with external organisations | |
Peer Pressure | Whether pressure is felt to implement the intervention in order to compete with fellow organisations, who have already done so | |
External Policy and Incentives | Externally imposed (policy, regulations, government) strategies (e.g. guidelines, benchmark reporting) designed to increase use of the intervention | |
INNER SETTING | Structural Characteristics | The age, maturity and size and social structure of the organisation |
Networks and Communications | The effectiveness of social networks and communication (formal and informal) | |
Culture | Organisational norms, values and assumptions | |
Implementation Climate | The organisation’s capacity for making the necessary changes, whether individuals within the organisation are receptive to change, and how well the organisation supports, rewards and anticipates use of the intervention | |
- Tension for Change | Whether there is a perception that change is necessary | |
- Compatibility | How well the underlying meaning and values of the intervention complement existing norms, values, opinions about risk, and workflows and systems | |
- Relative Priority | The degree of importance given to the implementation compared to other competing priorities | |
- Organisational Incentives and Rewards | These may include reaching shared goals, performance reviews, promotions, pay increases, recognition | |
- Goals and Feedback | How well goals are established and whether meaningful feedback is provided along the way | |
- Learning Climate | A positive learning climate involves: leaders who accept fault and encourage team input; team members who feel essential, valued and knowledgeable; a psychologically safe context for uptake of the intervention; and time and space to reflect on and evaluate progress | |
Readiness for Implementation | Whether the organisation demonstrates a tangible and immediate commitment to implement the intervention | |
- Leadership Engagement | How committed, involved and accountable leaders and managers are to implementation | |
- Available Resources | Whether adequate resources have been allocated to the implementation and sustainment of the intervention (e.g. money, training, education, space, time) | |
- Access to Knowledge and Information | The availability of information and knowledge about the intervention that is easy to understand and incorporate into work tasks | |
CHARACTERISTICS OF INDIVIDUALS | Knowledge and Beliefs about the Intervention | Attitudes related to the value of the intervention, and knowledge of the evidence and principles behind the intervention |
Self-efficacy | Whether the individual believes they are capable of performing tasks required to achieve implementation goals | |
Individual Stage of Change | Phase of change from pre-contemplation to skilled, enthusiastic and sustained implementation of the intervention | |
Individual Identification with Organisation | The individual’s perception of the organisation, their place within it, and their commitment to it | |
Other Personal Attributes | Other personal factors influencing the implementation (intellectual ability, motivation, values, competence, learning style | |
PROCESS | Planning | How well the preliminary methods of behaviour and implementation tasks are developed and how appropriate they are |
Engaging | Execution of strategies (social marketing, education, training) for attracting and involving the right people | |
Opinion Leaders | Individuals who have influence over their colleagues’ attitudes and beliefs about the intervention | |
Formally Appointed Internal Implementation Leaders | Individuals who have been given responsibility for implementing the intervention within the organisation | |
Champions | Individuals who elect to support, market and assist with overcoming resistance to the implementation | |
External Change Agents | Individuals from an external entity who have a formal role in promoting the implementation of the intervention | |
Executing | Whether the implementation is carried out as planned | |
Reflecting and Evaluating | Regular individual and team debriefing about the progress and experience of the implementation, and the nature and quality of quantitative and qualitative feedback used |