Choosing implementation strategies to address contextual barriers: diversity in recommendations and future directions

Abstract

Background A fundamental challenge of implementation is identifying contextual determinants (i.e., barriers and facilitators) and determining which implementation strategies will address them. Numerous conceptual frameworks (e.g., the Consolidated Framework for Implementation Research; CFIR) have been developed to guide the identification of contextual determinants, and compilations of implementation strategies (e.g., the Expert Recommendations for Implementing Change compilation; ERIC) have been developed which can support selection and reporting of implementation strategies. The aim of this study was to identify which ERIC implementation strategies would best address specific CFIR-based contextual barriers. Methods Implementation researchers and practitioners were recruited to participate in an online series of tasks involving matching specific ERIC implementation strategies to specific implementation barriers. Participants were presented with brief descriptions of barriers based on CFIR construct definitions. They were asked to rank up to seven implementation strategies that would best address each barrier. Barriers were presented in a random order, and participants had the option to respond to the barrier or skip to another barrier. Participants were also asked about considerations that most influenced their choices. Results Four hundred thirty-five invitations were emailed and 169 (39%) individuals participated. Respondents had considerable heterogeneity in opinions regarding which ERIC strategies best addressed each CFIR barrier. Across the 39 CFIR barriers, an average of 47 different ERIC strategies (SD = 4.8, range 35 to 55) was endorsed at least once for each, as being one of seven strategies that would best address the barrier. A tool was developed that allows users to specify high-priority CFIR-based barriers and receive a prioritized list of strategies based on endorsements provided by participants. Conclusions The wide heterogeneity of endorsements obtained in this study’s task suggests that there are relatively few consistent relationships between CFIR-based barriers and ERIC implementation strategies. Despite this heterogeneity, a tool aggregating endorsements across multiple barriers can support taking a structured approach to consider a broad range of strategies given those barriers. This study’s results point to the need for a more detailed evaluation of the underlying determinants of barriers and how these determinants are addressed by strategies as part of the implementation planning process. Electronic supplementary material The online version of this article (10.1186/s13012-019-0892-4) contains supplementary material, which is available to authorized users.

Overcoming barriers to evidence-based patient blood management: a restricted review

“…Data extracted were exported into an Excel™ spreadsheet and collated into tables to facilitate the coding of barriers, implementation strategies and agreement with the ERIC tool recommendations [33]. The CFIR framework supported the classification and coding of barriers [29], and the ERIC classification tool supported implementation strategy coding [33]. Both associated data dictionaries provided coding guidance [29,33,34].…”

“…The CFIR framework supported the classification and coding of barriers [29], and the ERIC classification tool supported implementation strategy coding [33]. Both associated data dictionaries provided coding guidance [29,33,34]. Multiple coding and classification of individual statements occurred where necessary.…”

“…On its own, the CFIR is useful, but historically, it was not easily mapped to other tools to assist with implementation strategy selection, following barrier identification. A recently developed tool: Expert Recommendations for Implementing Change (ERIC) helps to address this limitation [33]. The ERIC implementation strategy selection tool comprises 73 strategies to enhance implementation [34].…”

“…The definitions of the implementation strategies are also outlined in a data dictionary to help guide correct classification [34]. The ERIC tool allows the user to select the relevant local barriers (as classified by the CFIR) and generate a list of implementation strategies that, according to expert opinion, should be effective in addressing them [33]. The ERIC tool is one of the many options that can be used to understand implementation problems.…”

“…The ERIC tool is one of the many options that can be used to understand implementation problems. To date, the reported use of such frameworks and tools to guide implementation of patient blood management guidelines has been limited [33].…”