Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science
Laura J. Damschroder,David C. Aron,Rosalind E. Keith,Susan Kirsh,Jeffery A. Alexander,Julie C. Lowery +5 more
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TLDR
The CFIR provides a pragmatic structure for approaching complex, interacting, multi-level, and transient states of constructs in the real world by embracing, consolidating, and unifying key constructs from published implementation theories.Abstract:
Many interventions found to be effective in health services research studies fail to translate into meaningful patient care outcomes across multiple contexts. Health services researchers recognize the need to evaluate not only summative outcomes but also formative outcomes to assess the extent to which implementation is effective in a specific setting, prolongs sustainability, and promotes dissemination into other settings. Many implementation theories have been published to help promote effective implementation. However, they overlap considerably in the constructs included in individual theories, and a comparison of theories reveals that each is missing important constructs included in other theories. In addition, terminology and definitions are not consistent across theories. We describe the Consolidated Framework For Implementation Research (CFIR) that offers an overarching typology to promote implementation theory development and verification about what works where and why across multiple contexts. We used a snowball sampling approach to identify published theories that were evaluated to identify constructs based on strength of conceptual or empirical support for influence on implementation, consistency in definitions, alignment with our own findings, and potential for measurement. We combined constructs across published theories that had different labels but were redundant or overlapping in definition, and we parsed apart constructs that conflated underlying concepts. 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 CFIR provides a pragmatic structure for approaching complex, interacting, multi-level, and transient states of constructs in the real world by embracing, consolidating, and unifying key constructs from published implementation theories. It can be used to guide formative evaluations and build the implementation knowledge base across multiple studies and settings.read more
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Toward an Objective Assessment of Implementation Processes for Innovations in Health Care: Psychometric Evaluation of the Normalization Measure Development (NoMAD) Questionnaire Among Mental Health Care Professionals
Christiaan Vis,Jeroen Ruwaard,Tracy Finch,Tim Rapley,Derek de Beurs,Henk F. van Stel,Britt van Lettow,Mayke Mol,Annet Kleiboer,Heleen Riper,Jan Smit +10 more
TL;DR: NoMAD’s theoretical factor structure was confirmed in Dutch mental health settings to acceptable standards but with room for improvement and the hierarchical model might prove useful in increasing the practical utility of the NoMAD questionnaire by combining a total score with information on the 4 generative mechanisms.
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Information-seeking behaviors and other factors contributing to successful implementation of evidence-based practices in local health departments.
TL;DR: Findings from the case studies suggest that these health departments, successful in implementing evidence-based practices, have strong relationships and good communication channels established with their academic partner(s), and strong leadership engagement from within the health department and in the academic institution.
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Implementation of infection control best practice in intensive care units throughout Europe: a mixed-method evaluation study
Hugo Sax,Lauren Clack,Sylvie Touveneau,Fabricio da Liberdade Jantarada,Didier Pittet,Walter Zingg +5 more
TL;DR: A mixed-methods study of this scale with longitudinal follow-up highlights the ‘Why’ and ‘How’ of best practice implementation, revealing key factors that determine success of a uniform intervention in the context of several varying cultural, economic, political, and medical systems across Europe.
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Implementation Lessons: The Importance of Assessing Organizational “Fit” and External Factors When Implementing Evidence-Based Teen Pregnancy Prevention Programs
Hilary Demby,Alethia Gregory,Marsha Broussard,Jennifer Dickherber,Shantice Atkins,Lynne W. Jenner +5 more
TL;DR: The organizational and external implementation factors the authors experienced during the implementation process are explored, the lessons learned throughout this process are described, and strategies for other practitioners to proactively address these factors from the start of program planning are offered.
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Lessons learned about the effective operationalization of champions as an implementation strategy: results from a qualitative process evaluation of a pragmatic trial
TL;DR: An analysis of data from a pragmatic trial comparing implementation strategies supporting the adoption of guideline-concordant cardioprotective prescribing in community health centers in the USA confirms the important role of champions in implementation efforts and offers insight into the context-specific mechanisms through which champions enact practice change.
References
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Journal ArticleDOI
The theory of planned behavior
TL;DR: Ajzen, 1985, 1987, this article reviewed the theory of planned behavior and some unresolved issues and concluded that the theory is well supported by empirical evidence and that intention to perform behaviors of different kinds can be predicted with high accuracy from attitudes toward the behavior, subjective norms, and perceived behavioral control; and these intentions, together with perceptions of behavioral control, account for considerable variance in actual behavior.
Book
Diffusion of Innovations
TL;DR: A history of diffusion research can be found in this paper, where the authors present a glossary of developments in the field of Diffusion research and discuss the consequences of these developments.
Journal ArticleDOI
Self-efficacy: toward a unifying theory of behavioral change.
TL;DR: An integrative theoretical framework to explain and to predict psychological changes achieved by different modes of treatment is presented and findings are reported from microanalyses of enactive, vicarious, and emotive mode of treatment that support the hypothesized relationship between perceived self-efficacy and behavioral changes.
Journal ArticleDOI
Self-efficacy: Toward a unifying theory of behavioral change☆☆☆
TL;DR: In this article, the authors present an integrative theoretical framework to explain and predict psychological changes achieved by different modes of treatment, including enactive, vicarious, exhortative, and emotive sources.