Introducing Version 2 CFIR Updates
Laura Damschroder, MS, MPH
Veterans Affairs Ann Arbor Center for Clinical Management Research
ABSTRACT:
Background:
Organizational context includes many active forces that work for or against implementation of innovations. Determinant frameworks help conceptualize, assess, and address contextual factors to increase the likelihood of successful implementation. The CFIR is among the most frequently cited determinant frameworks within implementation science and real-world settings. However, as implementation science has matured, gaps in the CFIR have been identified and updates are needed.
Methods:
We identified recommendations through a literature review of articles that mentioned the CFIR in the title and/or abstract. We surveyed corresponding authors of included articles, who involved their co-authors as appropriate. The survey elicited specific recommendations at the domain and construct levels and ratings of framework quality (e.g., clarity, relevance).
Findings:
We identified 377 articles; 130 (39%) of 334 unique corresponding authors responded to the survey. Of those who responded, 67% used the CFIR in more than one project, 83% used the CFIR within health services research, and 55% used the CFIR combined with another framework. Most respondents (>50%) affirmed 10 different quality ratings (e.g., the CFIR is applicable, useful). However, most respondents indicated that the CFIR was not (29%) or only partially (37%) easy for non-researchers to use.
The CFIR V2 will encapsulate changes based on recommendations from the literature and survey responses, including better centering patients, teams, and equity, as well as adding an Outcomes Addendum. Patients will be centered more prominently by adding Patient-Centered Culture to the Inner Setting and including Patients as a role on the implementation team. The key role of teams will be acknowledged by adding Teamness to the Inner Setting and Teaming to the Process Domain. Equity will be discussed by linking to the Health Equity Implementation Framework and by adding constructs, e.g., Socioecological Characteristics to the Outer Setting, which includes consideration of racism/anti-racism in the community. Finally, an Outcomes Addendum will distinguish between CFIR contextual determinants versus patient determinants and between implementation versus innovation outcomes.
Implications for D&I Research:
As implementation science matures as a discipline, frameworks must mature too. The CFIR V2 includes significant improvements based on user recommendations.
