Background
Methods
Search strategy
Inclusion criteria
Study selection process
Data extraction and analysis
Results
Description of studies that have used CFIR + TDF
Study | Objective | Setting | Phase of intervention | Study design | Methods | Data collection | Data analysis | Unit of analysis | Outcomes assessed |
---|---|---|---|---|---|---|---|---|---|
Bunger et al. [29] | To investigate how a learning collaborative focusing on trauma-focused cognitive behavioral therapy impacted advice seeking patterns between clinicians and key learning sources | Behavioral Health Agencies (USA) | Evaluation | Observational | Quantitative | Questionnaires | Social network analysis | Individual and organization | Change in professional networks |
Elouafkaoui et al. [33] | To analyze the impact of individualized audit and feedback interventions on dentists’ antibiotic prescribing rates | NHS general dental practices in Scotland | Implementation and evaluation | Experimental | Cluster randomized controlled trial; comparative effectiveness and process evaluation | Prescribing and claims data | Single principle analysis, analyses of covariance, intra-cluster correlations | Organization | Total number of antibiotic items dispensed per 100 NHS treatment claims over 12 months after intervention |
English [28] | To design an intervention to improve district hospital services for children | Hospitals (Kenya) | Design | Observational | N/A | Environmental scans/literature searches; a priori knowledge about context | Repeatedly moving backwards and forwards between identified causes, proposed interventions, identified theory, and knowledge of the existing context to develop the intervention | N/A | N/A |
Gould et al. [22]a
| Design 2: theoretically enhanced audit and feedback interventions and investigate their feasibility and acceptability | Hospitals (England) | Feasibility assessment, piloting | Observational | Mixed | Study A: existing feedback documents (e.g., written reports, action planning templates) Study B: semi-structured interviews and observations Study C: semi-structured interviews, observations, surveys | Study A: structured content analysis Study B: qualitative case study analysis Study C: content analysis of interviews and descriptive statistics from questionnaires | Organization | Specific beliefs relating to ordering blood transfusion, determinants of implementation |
Graham-Rowe et al. [25]a
| To identify and synthesize modifiable barriers and enablers in screening for diabetic retinopathy | Multiple | Evaluation | Systematic review | Systematic literature search | Qualitative and quantitative data extracted from identified literature | Theory-based structured content analysis | Individual and organization | The potential role and relative importance of each TDF and CFIR domain in influencing retinopathy screening attendance; plus variations in barriers and enablers across demographic groups |
Manca et al. [24]a
| To implement and evaluate the Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Primary Care program | Primary care (Canada) | Evaluation | Observational | Mixed | Descriptive data; semi-structured interviews | Descriptive statistics; qualitative content analysis | Individual | Program reach, effectiveness, adoption, maintenance |
Moullin et al. [30] | To investigate professional service implementation in community pharmacy, to contextualize and advance a generic implementation framework | Community pharmacies (Australia) | Evaluation | Observational | Qualitative | Semi-structured one-on-one interviews | Framework analysis | Individual and organization | General themes surrounding the process of implementation, and influences on implementation |
Murphy et al. [27] | Design and implement a capacity-building program to enhance pharmacist’ roles in mental health care | Pharmacies (Canada) | Design | Observational | N/A | Environmental scans/literature searches; a priori knowledge about context | Identified target behavior, conducted a capability-opportunity-motivation and behavior assessment, and identified specific behavior change techniques | N/A | N/A |
Newlands et al. [31] | To elucidate barriers and facilitators of using local measures instead of prescribing antibiotics to manage dental infections | NHS general dental practices in (Scotland) | Evaluation | Observational | Qualitative | Semi-structured one-on-one interviews | Theory-based structured content analysis | Individual | Self-reported barriers and facilitators of using just local measures, and not antibiotics, to treat dental infections |
Prior et al. [23]a
| Compare effectiveness of and evaluate processes associated with individualized audit and feedback strategies for translating evidence-based guidelines on antibiotic prescribing into dentistry practice | General dentist practices (Scotland) | Implementation | Experimental | Partial factorial cluster randomized controlled trial; comparative effectiveness, process evaluation | Claims data, semi-structured interviews | Analysis of covariance and content analysis | Organization | Number of antibiotic items dispensed, specific beliefs regarding prescribing behavior, barriers and facilitators to implementation |
Sales et al. [26]a
| Determine the context, barriers, and facilitators to providing advanced care planning and goals of care conversations with veterans, to support providers in meeting a new system-wide mandate for these conversations | Veterans Affairs nursing homes, Veterans Affairs home-based primary care programs in five regional Veterans Affairs networks (USA) | Design and implementation | Observational | Mixed | Context and barrier and facilitator assessments | Interrupted time series/segmented regression analysis with matched comparisons | Individual and organization | (1) Proportion of veterans who have documented goals of care conversations after admission; (2) variation in goals of care conversation practice measures; (3) development of tools to improve implementing goals of care conversations |
Templeton et al. [32] | Identify patient-, organization-, and system-level factors influencing dental caries management | NHS primary care dentist offices in (Scotland) | Evaluation | Observational | Mixed | Questionnaires assessing current practices and beliefs sent to 651 dentists; eight in-depth case studies that observed routine dental visits and interviewed providers and patients | Descriptive statistics, univariate analyses, logistic regressions, and qualitative content analysis | Individual and organization | Perceptions of barriers and facilitators to improve caries prevention and management, from the point of view of patients, providers, the dental practices themselves and policy-makers |
Objective
Setting
Intervention phase
Design
Methods
Data collection
Data analysis
Unit of analysis
Stated rationale for using CFIR + TDF
Study | Rationale for using CFIR + TDFa
| Purpose | Conceptual level | Degree of theoretical heritage | Operationalizability |
---|---|---|---|---|---|
Bunger et al. [29] | “We highlight the theoretical justification for the different components of the [learning collaboratives]…the [CFIR]…and the [TDF]. These frameworks highlight many important constructs that may need to be addressed in implementation efforts.” (p. 85) | No stated rationale | |||
Elouafkaoui et al. [33] | “The [CFIR] and the [TDF] for health psychology were used as coding frameworks.” (p. 9) | No stated rationale | |||
English [28] | “[The CFIR and TDF] were used to explore how and why potential intervention activities might be valuable in influencing hospital practice change. This helped to identify [intervention activities] felt to address core problems and that might both fit the context and support the overall effectiveness of a package of activities.” (p. 6) | No stated rationale | |||
Gould et al. [22] | “[U]se of the TDF to identify potential barriers to change individuals’ behaviour, may not be the only approaches to improving transfusion practice or optimising A&F in the hospital context. Behaviour change within a healthcare setting is a complex process, and due to the multi-level nature of healthcare organisations, elements of change in response to feedback may be outside the control of any individual healthcare professional… The [CFIR] provides a framework for identifying what works where and why across different organisational levels within multiple settings.” (p. 3) | x | |||
Graham-Rowe et al. [25] | “The [TDF]…[includes] theoretical domain[s] represent[ing] a range of related constructs that may mediate behaviour change at the level of the individual, team or healthcare organisation…. However, it is possible that barriers and enablers could operate at multiple levels in the healthcare system…The [CFIR]…offers a framework of theory-based constructs as a practical guide for systematically assessing potential barriers and facilitators to successful implementation across different organizational levels.” (p. 2) | X | |||
Manca et al. [24] | “The TDF is a comprehensive framework that includes all of the important constructs of implementation. Since it is inclusive and addresses a large number of domains (14) and constructs (84), it may not be the best tool to identify and prioritize the key elements of the implementation. However, an awareness of the constructs in the TDF will help ensure that no important construct is missed during the qualitative evaluation…The CFIR framework is a pragmatic synthesis of several frameworks and models and will inform the implementation process by identifying key elements in the program implementation in a systematic way.” (p. 7) | X | |||
Moullin et al. [30] | “Factors [influencing professional service implementation in community pharmacy] were assessed at each stage of implementation using the [CFIR]. CFIR was augmented with factors not included, or implied within broad constructs of the framework, in order to make them more explicit. Additional factors included behavioural influences from Theoretical Domains Framework.” (p. 4) | X | |||
Murphy et al. [27] | “[T]he CFIR provided a foundation for a meta-view of understanding important variables to consider with the implementation of a complex intervention designed for changing behaviour vis-a-vis community pharmacists in mental health care… We then followed a step-wise approach…to intervention design and development using the body of work by Michie and colleagues [including the TDF] to organize and conceptualize strategies to change behaviours.” (p. 2) | X | |||
Newlands et al. [31] | “Section 1 of the interview related to participants’ experiences and responses to the RAPiD trial audit and feedback intervention and were based on the…[CFIR]. Section 2 of the interview used a topic guide based on the TDF to explore the factors influencing GDPs’ management of patients with bacterial infections.” (p. 2) | No stated rationale | |||
Prior et al. [23] | “[U]sing the [CFIR] to explore the acceptability of the interventions and the [TDF] to identify barriers and enablers to evidence-based antibiotic prescribing behaviour by GDPs… [The TDF] allows for consideration of a comprehensive range of potential influences on health professional behavior… The CFIR consists of common constructs from published implementation theories and offers an over-arching typology to promote implementation theory development and verification to understand the mechanism about what works, where, and why across various contexts.” (p. 1; p. 7) | X | X | ||
Sales et al. [26] | “Our primary rationale for using both frameworks is that one (TDF) specializes in individual-level behavior change, while the other (CFIR) focuses more on the organizational level, above the individual.” (p. 3) | X | |||
Templeton et al. [32] | “The [TDF] was used to identify and describe patient-, organization-, and system-level barriers and facilitators to care…[Practice characteristics] were selected using the [CFIR] as a complement to the TDF to increase specificity of organizational assessment.” (p. 1) | X |