The Consolidated Framework for Implementation Research (CFIR): a useful theoretical framework for guiding and evaluating a guideline implementation process in a hospital-based nursing practice

Breimaier, Helga E.; Heckemann, Birgit; Halfens, Ruud J.G.; Lohrmann, Christa

doi:10.1186/s12912-015-0088-4

Cited by 170 publications

(156 citation statements)

References 10 publications

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“…CFIR's 39 constructs are organized into five domains: Intervention Characteristic; Outer Setting; Inner Setting; Characteristics of Individuals; and Process (20). Like CCM and PRISM, CFIR draws on theories of behavior change, improvement science, and Diffusion Theory, but also provides a taxonomy with definitions, codebook, and interview questions, to facilitate its usefulness as an explanatory model (21). Understanding which constructs, or sets of constructs promote or inhibit adoption, implementation, and maintenance, can inform development during planning of tailored and testable implementation strategies (22) to balance internal and external validity (4), as well as push and pull (3).…”

Section: Introductionmentioning

confidence: 99%

Planning for Implementation Success Using RE-AIM and CFIR Frameworks: A Qualitative Study

King

Shoup

Raebel

et al. 2020

Front. Public Health

110

105

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Background: RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) and CFIR (Consolidated Framework for Implementation Research) dissemination and implementation frameworks define theory-based domains associated with the adoption, implementation and maintenance of evidence-based interventions. Used together, the two frameworks identify metrics for evaluating implementation success, i.e., high reach and effectiveness resulting in sustained practice change (RE-AIM), and modifiable factors that explain and enhance implementation outcomes (CFIR). We applied both frameworks to study the implementation planning process for a technology-delivered asthma care intervention called Breathewell within an integrated care organization. The goal of the Breathewell intervention is to increase the efficiency of delivering resource-intensive asthma care services. Methods: We reviewed historical documents (i.e., meeting agendas; minutes) from 14 months of planning to evaluate alignment of implementation team priorities with RE-AIM domains. Key content was extracted and analyzed on topics, frequency and amount of discussion within each RE-AIM domain. Implementation team members were interviewed using questions adapted from the CFIR Interview Guide Tool to focus their reflection on the process and contextual factors considered during pre-implementation planning. Documents and transcripts were initially coded using RE-AIM domain definitions, and recoded using CFIR constructs, with intent to help explain how team decisions and actions can contribute to adoption, implementation and maintenance outcomes. Results: Qualitative analysis of team documents and interviews demonstrated strong alignment with the RE-AIM domains: Reach, Effectiveness, and Implementation; and with the CFIR constructs: formal inclusion of provider and staff stakeholders in implementation planning, compatibility of the intervention with workflows and systems, and alignment of the intervention with organizational culture. Focus on these factors likely contributed to RE-AIM outcomes of high implementation fidelity. However, team members expressed low confidence that Breathewell would be adopted and maintained post-trial. A potential explanation was weak alignment with several CFIR constructs, including tension for change, relative priority, and leadership engagement that contribute to organizational receptivity and motivation to sustain change. King et al. Planning Using RE-AIM and CFIR Conclusions: While RE-AIM provides a practical framework for planning and evaluating practice change interventions to assure their external validity, CFIR explains why implementation succeeded or failed, and when used proactively, identifies relevant modifiable factors that can promote or undermine adoption, implementation, and maintenance.

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Section: Introductionmentioning

confidence: 99%

Planning for Implementation Success Using RE-AIM and CFIR Frameworks: A Qualitative Study

King

Shoup

Raebel

et al. 2020

Front. Public Health

110

105

View full text Add to dashboard Cite

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“…The CFIR, along with other IS theories and frameworks, has been considered useful by the nursing profession, although remains underused in midwifery contexts (Bayes, Fenwick, & Jennings, ). Breimaier, Heckemann, Halfens, and Lohrmann () assert the frameworks to be too generic, needing adaptions to improve the usability and value of such tools in clinical contexts. Suggestion for the use of IS tools in midwifery has been considered a pathway to improving the uptake and use of evidence in practice, however, as yet existing tools have not significantly contributed to improving the use of best available evidence in practice (Seers et al, ).…”

Section: Discussionmentioning

confidence: 99%

Section: Is Instruments Is the Consolidated Framework For Implementationmentioning

confidence: 99%

Midwives' use of best available evidence in practice: An integrative review

Leo

Bayes

Geraghty

et al. 2019

Journal of Clinical Nursing

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Aims and objectives To synthesise international research that relates to midwives' use of best available evidence in practice settings and identify key issues relating to the translation of latest evidence into everyday maternity care. Background Midwifery is a research‐informed profession. However, a gap persists in the translation of best available evidence into practice settings, compromising gold standard maternity care and delaying the translation of new knowledge into everyday practice. Design A five‐step integrative review approach, based on a series of articles published by the Joanna Briggs Institute (JBI) for conducting systematic reviews, was used to facilitate development of a search strategy, selection criteria and quality appraisal process, and the extraction and synthesis of data to inform an integrative review. Methods The databases CINAHL, MEDLINE, Web of Science, Implementation Science Journal and Scopus were searched for relevant articles. The screening and quality appraisal process complied with the PRISMA 2009 checklist. Narrative analysis was used to develop sub‐categories and dimensions from the data, which were then synthesised to form two major categories that together answer the review question. Results The six articles reviewed report on midwives' use of best available evidence in Australia, the UK and Asia. Two major categories emerged that confirm that although midwifery values evidence‐based practice (EBP), evidence‐informed maternity care is not always employed in clinical settings. Additionally, closure of the evidence‐to‐practice gap in maternity care requires a multidimensional approach. Conclusion Collaborative partnerships between midwives and researchers are necessary to initiate strategies that support midwives' efforts to facilitate the timely movement of best available evidence into practice. Relevance to clinical practice Understanding midwives' use of best available evidence in practice will direct future efforts towards the development of mechanisms that facilitate the timely uptake of latest evidence by all maternity care providers working in clinical settings.

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“…The CFIR has now been used by a number of studies to identify factors affecting implementation, including the implementation of complex service initiatives, [78][79][80] and has been found to be an effective tool to identify barriers to and facilitators of implementation. 81 Within the CFIR, constructs are divided between five major domains:…”

Section: Theoretical/conceptual Frameworkmentioning

confidence: 99%

Factors influencing utilisation of ‘free-standing’ and ‘alongside’ midwifery units for low-risk births in England: a mixed-methods study

Walsh

Spiby

McCourt

et al. 2020

Health Serv Deliv Res

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Background Midwifery-led units (MUs) are recommended for ‘low-risk’ births by the National Institute for Health and Care Excellence but according to the National Audit Office were not available in one-quarter of trusts in England in 2013 and, when available, were used by only a minority of the low-risk women for whom they should be suitable. This study explores why. Objectives To map the provision of MUs in England and explore barriers to and facilitators of their development and use; and to ascertain stakeholder views of interventions to address these barriers and facilitators. Design Mixed methods – first, MU access and utilisation across England was mapped; second, local media coverage of the closure of free-standing midwifery units (FMUs) were analysed; third, case studies were undertaken in six sites to explore the barriers and facilitators that have an impact on the development of MUs; and, fourth, by convening a stakeholder workshop, interventions to address the barriers and facilitators were discussed. Setting English NHS maternity services. Participants All trusts with maternity services. Interventions Establishing MUs. Main outcome measures Numbers and types of MUs and utilisation of MUs. Results Births in MUs across England have nearly tripled since 2011, to 15% of all births. However, this increase has occurred almost exclusively in alongside units, numbers of which have doubled. Births in FMUs have stayed the same and these units are more susceptible to closure. One-quarter of trusts in England have no MUs; in those that do, nearly all MUs are underutilised. The study findings indicate that most trust managers, senior midwifery managers and obstetricians do not regard their MU provision as being as important as their obstetric-led unit provision and therefore it does not get embedded as an equal and parallel component in the trust’s overall maternity package of care. The analysis illuminates how provision and utilisation are influenced by a complex range of factors, including the medicalisation of childbirth, financial constraints and institutional norms protecting the status quo. Limitations When undertaking the case studies, we were unable to achieve representativeness across social class in the women’s focus groups and struggled to recruit finance directors for individual interviews. This may affect the transferability of our findings. Conclusions Although there has been an increase in the numbers and utilisation of MUs since 2011, significant obstacles remain to MUs reaching their full potential, especially FMUs. This includes the capacity and willingness of providers to address women’s information needs. If these remain unaddressed at commissioner and provider level, childbearing women’s access to MUs will continue to be restricted. Future work Work is needed on optimum approaches to improve decision-makers’ understanding and use of clinical and economic evidence in service design. Increasing women’s access to information about MUs requires further studies of professionals’ understanding and communication of evidence. The role of FMUs in the context of rural populations needs further evaluation to take into account user and community impact. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 12. See the NIHR Journals Library website for further project information.

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The Consolidated Framework for Implementation Research (CFIR): a useful theoretical framework for guiding and evaluating a guideline implementation process in a hospital-based nursing practice

Cited by 170 publications

References 10 publications

Planning for Implementation Success Using RE-AIM and CFIR Frameworks: A Qualitative Study

Planning for Implementation Success Using RE-AIM and CFIR Frameworks: A Qualitative Study

Midwives' use of best available evidence in practice: An integrative review

Factors influencing utilisation of ‘free-standing’ and ‘alongside’ midwifery units for low-risk births in England: a mixed-methods study

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