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.

Please view our Articles and Highlights page to see the list of resources that cite CFIR, including PubMed and Google Scholar.