Applying a Race(ism)-Conscious Adaptation of the CFIR Framework to Understand Implementation of a School-Based Equity-Oriented Intervention

Abstract

Objectives: To use the Consolidated Framework for Implementation Research (CFIR) adapted to a race-conscious frame to understand ways that structural racism interacts with intervention implementation and uptake within an equity-oriented trial designed to enhance student-school con­nectedness.Design: Secondary analysis of qualitative implementation data from Project TRUST (Training for Resiliency in Urban Students and Teachers), a hybrid effectiveness-imple­mentation, community-based participatory intervention.Setting: Ten schools across one urban school district.Methods: We analyzed qualitative ob­servational field notes, youth and parent researcher reflections, and semi-structured interviews with community-academic re­searchers and school-based partners within CFIR constructs based on framing questions using a Public Health Critical Race Praxis approach.Results: Within most CFIR constructs and sub-constructs, we identified barriers to implementation uptake not previously recognized using standard race-neutral definitions. Themes that crossed constructs included: 1) Leaders’ willingness to examine Black, Indigenous, People of Color (BIPOC) student and parent experiences of school discrimination and marginalization had a cascading influence on multiple factors related to implementation uptake; 2) The race/ethnicity of the principals was related to intervention engagement and interven­tion uptake, particularly at the extremes, but the relationship was complex; 3) External change agents from BIPOC communities facilitated intervention uptake in indirect but significant ways; 4) Highly networked implementation champions had the ability to enhance commitment to intervention uptake; however, perceptions of these indi­viduals and the degree to which they were networked was highly racialized.Conclusions: Equity-oriented interventions should consider structural racism within the CFIR model to better understand inter­vention uptake.Ethn Dis. 2021;31(Suppl 1):375-388; doi:10.18865/ed.31.S1.375

The updated Consolidated Framework for Implementation Research based on user feedback

“…Although the updated CFIR includes new constructs to better assess determinants related to equity in implementation, we urge users to collaborate with equity experts [ 99 ] to combine use of equity, justice, or non-discrimination theories with the CFIR as a lens through which to view all facets of implementation [ 100 ]. For example, Allen et al adapted the CFIR using the Public Health Critical Race Praxis to understand the ways structural racism influence implementation of an equity program across all constructs [ 101 ]. Researchers have produced decades of findings focused on the role of individual (e.g., race) and structural (e.g., access to care) determinants of health in highlighting inequities in services and outcomes [ 102 ].…”

Promises and pitfalls in implementation science from the perspective of US-based researchers: learning from a pre-mortem

“…Deeper application and evolution of methods from other adjacent fields applied to implementation are opportunities to harness well-vetted theory, advance our science, and increase rigor and impact, particularly in promoting health equity. For example, we have seen recent innovations in adapting existing theories, models, and frameworks to focus more on equity (e.g., see [23,[49][50][51]). We note opportunities to learn from and integrate theories and frameworks from fields with a long history of health equity scholarship, including anthropology, sociology, and public health [52].…”

Preenchimento do quesito raça/cor na identificação dos pacientes: aspectos da implementação em um hospital universitário

“…Focando a produção de conhecimento, conceitualização e medidas, o uso do CFIR, além de dar informações sobre as barreiras na implementação de políticas por meio da análise de seus constructos, pode também ser avaliado dentro da metodologia PHCR, na tentativa de se elucidar as maneiras pelas quais o racismo estrutural interage com as implementações de intervenções voltadas para a equidade 47 .…”