Assessing receptiveness to change among primary healthcare providers by adopting the consolidated framework for implementation research (CFIR)

Abstract

Background Amid the current burden of non-communicable (NCD) diseases in Malaysia, there is a growing demand for more efficient service delivery of primary healthcare. A complex intervention is proposed to improve NCD management in Malaysia. This exploratory study aimed to assess primary healthcare providers’ receptiveness towards change prior to implementation of the proposed complex intervention. Method This study was conducted using an exploratory qualitative approach on purposely selected healthcare providers at primary healthcare clinics. Twenty focus group discussions and three in-depth interviews were conducted using a semi-structured interview guide. Consent was obtained prior to interviews and for audio-recordings. Interviews were transcribed verbatim and thematically analysed, guided by the Consolidated Framework for Implementation Research (CFIR), a framework comprised of five major domains promoting implementation theory development and verification across multiple contexts. Results The study revealed via CFIR that most primary healthcare providers were receptive towards any proposed changes or intervention for the betterment of NCD care management. However, many challenges were outlined across four CFIR domains—intervention characteristics, outer setting, inner setting, and individual characteristics—that included perceived barriers to implementation. Perception of issues that triggered proposed changes reflected the current situation, including existing facilitating aspects that can support the implementation of any future intervention. The importance of strengthening the primary healthcare delivery system was also expressed. Conclusion Understanding existing situations faced at the primary healthcare setting is imperative prior to implementation of any intervention. Healthcare providers’ receptiveness to change was explored, and using CFIR framework, challenges or perceived barriers among healthcare providers were identified. CFIR was able to outline the clinics’ setting, individual behaviour and external agency factors that have direct impact to the organisation. These are important indicators in ensuring feasibility, effectiveness and sustainability of any intervention, as well as future scalability considerations. Electronic supplementary material The online version of this article (10.1186/s12913-019-4312-x) contains supplementary material, which is available to authorized users.

Implementing culturally competent transplant care and implications for reducing health disparities: A prospective qualitative study

“…14,21 Intervention characteristics identified as facilitators include the following: strength of evidence 28 and relative advantage over existing practice, 29,30 adaptability, 28 trialability 28,29 and design quality and packaging. 31 The primary intervention characteristic barrier found in prior research is complexity. 28,29,32 Outer setting characteristics enabling intervention implementation in healthcare settings include the following: relationships between the healthcare organization and other organizations 31 and the presence of best practice examples in other healthcare organizations.…”

“…32 Characteristics of individuals identified as facilitators in healthcare settings include the following: knowledge and beliefs about the intervention, 28 self-efficacy 29 and a sense of belonging among the staff. 31 Individual characteristic barriers include the following: resistance to new routines, 28 limited knowledge or negative attitudes about the intervention, 30,32,33 and turnover. 29 The only process factor identified as a facilitator was a stepwise rollout.…”

“…Few studies to date have used CFIR (or other implementation science frameworks) to examine barriers and facilitators to interventions in healthcare settings during the preparation stage 14,21 . Intervention characteristics identified as facilitators include the following: strength of evidence 28 and relative advantage over existing practice, 29,30 adaptability, 28 trialability 28,29 and design quality and packaging 31 . The primary intervention characteristic barrier found in prior research is complexity 28,29,32 .…”

“…The primary intervention characteristic barrier found in prior research is complexity 28,29,32 . Outer setting characteristics enabling intervention implementation in healthcare settings include the following: relationships between the healthcare organization and other organizations 31 and the presence of best practice examples in other healthcare organizations 28 . No outer setting barriers have been identified in CFIR research in the preparation phase.…”

“…No outer setting barriers have been identified in CFIR research in the preparation phase. Inner setting characteristics identified as facilitators in healthcare settings include the following: readiness for the implementation, 30 particularly having sufficient resources to implement the intervention, 29 the nature and quality of teamwork 31 and communicated leadership commitment 28 . Inner setting characteristics identified as barriers to interventions were: competing organizational priorities 29,31 and perceived lack of compatibility with existing work routines and technology systems 32 .…”