Forms

Article APA Reference

Escoffery, C., Riehman, K., Watson, L., Priess, A. S., Borne, M. F., Halpin, S. N., ... & Kegler, M. C. (2019). Facilitators and barriers to the implementation of the HPV VACs (vaccinate adolescents against cancers) program: a consolidated framework for implementation research analysis.  Preventing Chronic Disease,  16, E85.

Justification/Rationale for Study

The rationale for the study is based on the fact that despite its known efficiency in cervical and other cancers, the HPV vaccine is not widely used. FQHCs are important in delivering health services to those who lack access to other health care services, but even here, cultural and structural factors limit program effectiveness.

Gap in Practice

However, although vaccination programs are available and have been well embarked on for HPV vaccination, its utilization by adolescents has not reached the desired rates and is relatively low, especially among the less privileged groups. To the best of the authors' knowledge, few studies have investigated implementation barriers and facilitators related to these contexts, and even fewer have used the CFIR framework.

Purpose of the Study

(Include list of independent variables [IVs] and dependent variables [DVs])

The study's design was to assess the enablers and challenges to integrating the HPV VACs program in FQHCs using the CFIR framework.

Independent Variables (IVs): Elements of the intervention, the inner context, outer context, participants and processes of implementing the intervention. Dependent Variables (DVs): Effectiveness of the perceived adoption of the HPV vaccination program as captured by the percentage of vaccinated females.

Theoretical or Conceptual Framework

The overall study framework used to inform the research questions and identify factors influencing the intervention's implementation success was the Consolidated Framework for Implementation Research (CFIR). They include intervention characteristics, inner and outer contexts, and the individual and process domains.

Study Design and Sampling Procedures

An exploratory, descriptive, and cross-sectional research design was employed. Qualitative telephone surveys were administered to 32 participants from 9 FQHCs engaged in the VACs Program pilot. Participants were purposively selected to ensure that the study had respondents of different attitudes.

Data Collection Procedures

Semi-structured interviews were held based on the Interview Guide formulated to fit the CFIR domains. Employers were asked about the start-up activities surrounding their strategy, strategies chosen or selected against, changes in policy and practice, perceived issues, and triumphs. The first interviews were transcribed in full detail, and at least two research team members entered all codes.

Data Analyses Used

Framework analysis was used, and each transcript was coded against all the CFIR domains. This enabled the successful realization and categorization of the implementation facilitators and barriers.

Description of Significant Results

Facilitators: Use of EHR, staff participation in training and education, tangible and accessible support tools and provider advocates. Barriers: Insufficient workforce, EHR barriers, SIR concerns, patient education and mistrust in vaccines, linguistic and diversity, time conflict, restricted funds, administrative support, professional engagement, education, employers, and low health literacy.

Discussion of Findings, including Limitations of the Study

From these findings, one gets a sense that it is ultimately important to eradicate structural and cultural barriers that hinder vaccine uptake. Main stakeholders agree regarding comprehensive support resources and staff orientation in the service field. Some of the limitations include that it only targeted FQHCs and that due to self-administered questionnaires, there is a possibility of biased responses. The authors called for further research on additional healthcare settings and on creating more specific approaches for dealing with these factors.

Article APA Reference

Rodrigues, I. B., Fahim, C., Garad, Y., Presseau, J., Hoens, A. M., Braimoh, J., ... & Straus, S. E. (2023). Developing the intersectionality supplemented Consolidated Framework for Implementation Research (CFIR) and tools for intersectionality considerations.  BMC Medical Research Methodology,  23(1), 262.

Justification/Rationale for Study

The current social determinants of health show health disparities among vulnerable, disadvantaged communities. While intersectionality is well established in the frameworks of feminist and gender studies, its use by implementation scientists is scarce. This study seeks to fill that gap by adopting an intersectional perspective in the Extended CFIR Framework.

Gap in Practice

Many contextual factors, as outlined in implementation science frameworks such as the CFIR, need to be considered in relation to intersectionality in healthcare. This restricts the effort to redress health disparities in the affected population, which bear multiple dimensions of marginalization and oppression.

Purpose of the Study

(Include list of independent variables [IVs] and dependent variables [DVs])

Independent Variables (IVs): Implementation of intersectionality in CFIR conceptualization of application areas.

Dependent Variables (DVs): A chance to identify facilitators or barriers related to intersectionality in the implementation of science projects.

Views, Ideas or Perspective: The following research question was formulated: How has the CFIR framework been adapted to accommodate intersectionality concerns? This supplemented framework retains the original five domains but expands to include 28 constructs, with two new constructs added under the outer setting domain: exterior systems and structures and exterior cultures.

Theoretical or Conceptual Framework

This research was designed to extend the CFIR framework by integrating intersectionality perspectives. It allows researchers to use practical methods to understand how self- and power dynamics inform the behaviour change process and the implementation of interventions in the healthcare context.

Study Design and Sampling Procedures

Nominal group techniques for developing the expert-consensus approach were adopted. Another group of 7 participants used the refined nominations to review and update the CFIR framework through six cycles of meetings.

Data Collection Procedures

The CFIR subgroup checked the framework for domains and constructs where intersectionality considerations might be needed. A consensus-building process generated recommendations and prompts for each prioritized domain and construct, achieving operationalization of each.

Data Analyses Used

Explicit purposive sampling and a consensual, qualitative method were used to review and update the CFIR framework. Additional constructs and prompts were reviewed and assessed through moderated focus group discussions.

Description of Significant Results

The final framework added two constructs:" outer systems and structures" and "outer cultures." Intersectionality language was incorporated into 13 of 28 constructs with prompts to guide investigators when thinking intersectionally about personal and structural factors influencing implementation. The changes allow for improvement in the sociocultural and systemic factors to be considered and integrated into comprehending the patient's access to health services and physiological and psychological treatment results.

Discussion of Findings, including Limitations of the Study

The study proves that an intersectional approach can be incorporated into implementation science frameworks, something scholars have noted as needing more literature. Concerns are that achieving consensus may be biased and that the supplemented framework requires more research. Further investigations are necessary to assess its utility in various healthcare organizations' environments to redress structural imbalances in health.

Article APA Reference

Damschroder, L. J., Reardon, C. M., Widerquist, M. A. O., & Lowery, J. (2022). The updated Consolidated Framework for Implementation Research is based on user feedback. Implementation science,  17(1), 75.

Justification/Rationale for Study

The CFIR framework has been declared dominant for measuring the contextual determinants that affect the effective implementation of evidence-based practice. However, after more than ten years of use, it became obvious that responding to users' comments and refining the framework to adapt to changing implementation environments requires continuous development.

Gap in Practice

The first set of CFIR constructs failed to address implementation concerns involving innovation recipients and equity aspects, and some of the constructs based on the framework needed to be refined to capture existing implementation issues accurately.

Purpose of the Study

(Include list of independent variables [IVs] and dependent variables [DVs])

The present study's goal was to revise the CFIR framework and improve its applicability and usefulness by collecting feedback from implementation researchers.

Theoretical or Conceptual Framework

Independent Variables (IVs): Participation of users in the questionnaire about the instrument's applicability, usefulness of its components, and relevance to the construct.

Dependent Variables (DVs): Changes in the distinctions between selected CFIR constructs and their domains, as well as in the general structure of the CFIR framework.

Study Design and Sampling Procedures

The CFIR framework was at the center of the update. Overall, the revised framework maintains the components' conceptual architecture but integrates feedback to enhance its application to examine contextual factors that define implementation success.

This research adopts a cross-sectional survey study design and purposive and random sampling techniques. This paper has adopted a combined approach of systematic review and interview of authors who have employed the CFIR framework. The authors identified 376 articles, and 134 of the 334 surveyed authors responded.

Data Collection Procedures

Data was gathered by reviewing articles citing CFIR and completing a survey completed by the CFIR authors. Specifically, the survey aimed at collecting data on the framework's feasibility for utilization, critique of the framework, and suggestions for the proposed alterations.

Data Analyses Used

Some of the themes included article feedback and survey feedback. To meet both the users' input and scientific precision, a consensus approach was also used to make the last changes to the CFIR updates.

Description of Significant Results

Small modifications to the construction of existing domains and constructs are needed to enhance the face validity of the model. Extension of determinants to equity and locus of innovation recipient groups. Eliminations or transfers of some constructs towards the simplification of the framework. There is evidence of the ability to use the proposed framework based on positive feedback from the users.

Discussion of Findings, including Limitations of the Study

The updates represent progress in implementation science and respond to deficiencies in the initial model, the CFIR framework, with equity and recipient-focused approaches. They include possible biases in the feedback due to a small sample of surveyed authors. Subsequent versions should also integrate user feedback to ensure the framework is useful in the continued development of implementation science in the future.