Conceptualizing outcomes for use with the Consolidated Framework for Implementation Research (CFIR): the CFIR Outcomes Addendum

Laura J Damschroder; Caitlin M Reardon; Marilla A Opra Widerquist; Julie Lowery

doi:10.1186/s13012-021-01181-5

Conceptualizing outcomes for use with the Consolidated Framework for Implementation Research (CFIR): the CFIR Outcomes Addendum

Implement Sci. 2022 Jan 22;17(1):7. doi: 10.1186/s13012-021-01181-5.

Authors

Laura J Damschroder¹, Caitlin M Reardon², Marilla A Opra Widerquist², Julie Lowery²

Affiliations

¹ VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA. Laura.Damschroder@va.gov.
² VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA.

Abstract

Background: The challenges of implementing evidence-based innovations (EBIs) are widely recognized among practitioners and researchers. Context, broadly defined as everything outside the EBI, includes the dynamic and diverse array of forces working for or against implementation efforts. The Consolidated Framework for Implementation Research (CFIR) is one of the most widely used frameworks to guide assessment of contextual determinants of implementation. The original 2009 article invited critique in recognition for the need for the framework to evolve. As implementation science has matured, gaps in the CFIR have been identified and updates are needed. Our team is developing the CFIR 2.0 based on a literature review and follow-up survey with authors. We propose an Outcomes Addendum to the CFIR to address recommendations from these sources to include outcomes in the framework.

Main text: We conducted a literature review and surveyed corresponding authors of included articles to identify recommendations for the CFIR. There were recommendations to add both implementation and innovation outcomes from these sources. Based on these recommendations, we make conceptual distinctions between (1) anticipated implementation outcomes and actual implementation outcomes, (2) implementation outcomes and innovation outcomes, and (3) CFIR-based implementation determinants and innovation determinants.

Conclusion: An Outcomes Addendum to the CFIR is proposed. Our goal is to offer clear conceptual distinctions between types of outcomes for use with the CFIR, and perhaps other determinant implementation frameworks as well. These distinctions can help bring clarity as researchers consider which outcomes are most appropriate to evaluate in their research. We hope that sharing this in advance will generate feedback and debate about the merits of our proposed addendum.

Keywords: Actual outcomes; Antecedent assessments; Anticipated outcomes; Consolidated Framework for Implementation Research; Evaluation methods; Implementation framework; Implementation outcomes; Implementation science; Innovation outcomes; Theory.

Publication types

Research Support, U.S. Gov't, Non-P.H.S.
Review

MeSH terms

Humans
Implementation Science*
Motivation*