Birken et al. 2017. Combined use of the Consolidated Framework for Implementation Research (CFIR) and the Theoretical Domains Framework (TDF): a systematic review
Birken SA, Powell BJ, Presseau J, Kirk MA, Lorencatto F, Gould NJ, Shea CM, Weiner BJ, Francis JJ, Yu Y, Haines E. Combined use of the Consolidated Framework for Implementation Research (CFIR) and the Theoretical Domains Framework (TDF): a systematic review. Implement Sci. 2017;12(1):2. Published 2017 Jan 5. doi:10.1186/s13012-016-0534-z
Constructs within the CFIR are primarily (though not exclusively) focused on organization-level constructs. The Individual Characteristics domain within CFIR is purposefully underdeveloped because of the decades of science and models that define determinants of individual-level behavior change. The Theoretical Domains Framework (TDF), developed by Susan Michie and colleagues, is comprised of 84 constructs organized across 14 domains. Constructs within the CFIR and TDF do overlap but their predominant focus varies. For example, within the Inner Setting domain in CFIR, the Goals & Feedback construct is defined as, “The degree to which goals are clearly communicated, acted upon, and fed back to staff and alignment of that feedback with goals.” This construct relates to goals, their communication, alignment, monitoring, and action planning at the organization-level. Within the TDF, several constructs may be related to these concepts but operate at the individual level, including constructs within the Goals domain and additional constructs within the Behavioral Regulation domain including self-monitoring and action planning.
This review (based on articles published through October 2016) identified 5 study protocols and 7 completed studies that combined use of CFIR and TDF. The authors found the single most common rationale for combined use of CFIR + TDF was the perception that they addressed different conceptual levels: organization and individual, respectively. Combining use of these frameworks has value but also adds considerable complexity. The authors call out the need for tools and guidance for how and when to combine use of multiple frameworks to help ensure that each adds value.