Four Major Plays, Volume II: 2 Download |VERIFIED| Pdf
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The CFIR is composed of five major domains: intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation. Eight constructs were identified related to the intervention (e.g., evidence strength and quality), four constructs were identified related to outer setting (e.g., patient needs and resources), 12 constructs were identified related to inner setting (e.g., culture, leadership engagement), five constructs were identified related to individual characteristics, and eight constructs were identified related to process (e.g., plan, evaluate, and reflect). We present explicit definitions for each construct.
The fourth major domain of the CFIR is the individuals involved with the intervention and/or implementation process. Individuals have agency; they make choices and can wield power and influence on others with predictable or unpredictable consequences for implementation. Individuals are carriers of cultural, organizational, professional, and individual mindsets, norms, interests, and affiliations. Greenhalgh et al. describe the significant role of individuals :
Process theories can be used to guide how implementation should be planned, organized, and scheduled, and impact theories can be used to develop hypotheses about how implementation activities will facilitate a desired change The CFIR is a pragmatic meta-theoretical framework that can be used to complement these theories with its comprehensive taxonomy of specific constructs related to the intervention, inner and outer setting, individuals, and implementation process. For example, the CFIR complements a process theory published by Pronovost and colleagues from the Johns Hopkins Quality and Safety Research Group for large-scale translation of scientific evidence into practice that encompasses four major steps . The second step in this process theory is to identify local barriers to implementation without specifying what those barriers may be; the CFIR provides a list of constructs to consider. The RE-AIM framework is used to guide comprehensive evaluation of interventions in terms of Reach, Effectiveness, Adoption, Implementation, and Maintenance (sustainability) . The CFIR opens the 'black box' of the 'I' (implementation) component.
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