Consolidated Framework for Implementation Research

Welcome to the CFIR Technical Assistance Website

You have come to the right place if you are looking for more information about the Consolidated Framework for Implementation Research (CFIR) that was originally published in Implementation Science in 2009. This site is created for individuals considering using the CFIR to evaluate an implementation or design an implementation study.

CRISP Online Interactive eBook:
The Colorado Research on Implementation Science Program (CRISP)’s new eBook provides an informative overview of the science of implementation. Their eBook contains resources on selecting a theory and developing methods for evaluation, along with several links to tools and toolkits researchers may find useful.

QUERI Guide to Implementation Research
The Diabetes Quality Enhancement Research Initiative (QUERI) created an extensive introductory guide for implementation research. The guide is a resource for help selecting theory and developing methods and formative evaluation approaches. It also contains links to tools and toolkits that researchers may find useful.

NCI’s Advanced Topics in Implementation Research:
NCI Advanced Topics in Implementation Research maintains a list of archived and scheduled webinars on key topics related to implementation science, including an archived presentation by Laura Damschroder on applying and advancing work related to the CFIR.

The CFIR provides a menu of constructs that have been associated with effective implementation. It reflects the state-of-the-science at the time of its development in 2009; including constructs from, for example, Everett Rogers’ Diffusion of Innovations Theory and Greenhalgh and colleagues’ significant compilation of constructs based on their review of 500 published sources across 13 scientific disciplines. In addition to these two sources, the CFIR incorporates 18 other sources. The CFIR considered the spectrum of construct terminology and definitions and compiled them into one organizing framework.

The CFIR provides a menu of constructs that can be used in a range of applications – as a practical guide for systematically assessing potential barriers and facilitators in preparation for implementing an innovation, to providing theory-based constructs for developing context-specific logic models or generalizable middle-range theories.

The CFIR was developed by implementation researchers affiliated with Veterans Affairs (VA) Diabetes Quality Enhancement Research Initiative (QUERI). The VA QUERI was launched in 1998 as part of a system-wide transformation aimed at improving the quality of healthcare for Veterans and continues to contribute to this effort by implementing research findings and innovations into routine clinical practice.

By providing a framework of constructs, the CFIR promotes consistent use of constructs, systematic analysis, and organization of findings from implementation studies. The CFIR is easily customized to diverse settings and scenarios. Many users have resonated with it and found it to be a practical tool. Over 300 published articles cite the CFIR and this number is growing by about four new articles per week. Dr. David Atkins , Director of the Veterans Affairs Health Services Research & Development (VA HSR&D) has recognized the need for a framework like the CFIR:

“It is time to move beyond attempts to develop the perfect theoretical model to explain the ‘black box’ of the implementation process. We have numerous models to help organize and structure our observations and frame more specific hypotheses.”

The need for a common, consistently applied set of constructs is recognized and the CFIR has been recommended for use, most notably in a recent publication by Drs. Powell, Proctor and Glass. In their 2014 article, they highlighted the benefits of using the CFIR to increase scientific knowledge about the effectiveness of implementation strategies:

““…while the CFIR’s utility as a framework to guide empirical research is not fully established, it is consistent with the vast majority of frameworks and conceptual models in dissemination and implementation research in its emphasis of multilevel ecological factors... Examining research (and real-world implementation efforts) through the lens of the CFIR gives us some indication of how comprehensively strategies address important aspects of implementation.”

The CFIR has been found to be helpful across a diverse array of scenarios (including low-income contexts). For example, based on Iliot and colleagues’ test of the CFIR as a useful framework for guiding evaluations of complex implementations, they conclude:

“The Framework captured the complexity of implementation across 11 diverse examples, offering theoretically informed, comprehensive coverage….Our analysis suggests that this conceptual framework has the potential to offer useful insights, whether as part of a situational analysis or by developing context-specific propositions for hypothesis testing. Such studies are vital now that innovation is being promoted as core business for health care.”

It is important to note that these researchers and others have made recommendations to improve or extend the framework. Our team is evaluating these recommendations for inclusion in an updated version of the CFIR.

Go to our publicly available Zotero library for an up to date list of references, organized by type of article. We have also provided a readily accessible pdf file that lists the key references, though it may not be quite as up to date.

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Several initiatives are underway. Check back periodically for updates:

  • A revised version of the CFIR (Version 2) is being developed and will be published.
  • Quantitative measurement instruments are being mapped to the CFIR. Let us know about other instruments you have mapped or would like to suggest for mapping.
  • We are planning to develop a mapped set of implementation techniques (e.g., audit and provide feedback) that can be used to address or avoid constructs that may be barriers. We look forward to your feedback.
  • Design an Implementation Strategy - we offer a few futuristic ideas about how a repository of findings could promote knowledge-building and provide insights to help select techniques that are tailored to your scenario.