CFIR Outcomes Addendum

Implementation outcomes measure the extent to which the innovation is in place or being delivered as intended in the Inner Setting (e.g., organization). In other words, implementation outcomes measure the extent to which staff in the Inner Setting to provide the innovation.

• Anticipated implementation outcomes measure the likelihood of future implementation success or failure, e.g., Adoptability, implementability, sustainability
• Actual implementation outcomes measure current or past implementation success or failure, e.g., Adoption, implementation, and sustainment

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‍Anticipated and actual implementation outcomes are influenced by constructs in CFIR.

Implementation outcomes measure the extent to which the innovation is in place or being delivered as intended in the Inner Setting(e.g., organization). In other words, implementation outcomes measure the extent to which staff in the Inner Setting to provide the innovation.

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Implementation outcomes are influenced by constructs in CFIR.

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Reach measures "the absolute number, proportion, and representativeness of [recipients] who are willing to participate in a given initiative, intervention, or program” (Glasgow et al. 2019). In other words, reach outcomes measure the extent to which recipients receive or participate in the innovation.

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‍Reach is influenced by implementation effectiveness, i.e., reach is unlikely to occur without effective implementation, but it is also influenced by recipient-level characteristics, perceptions, and choices.

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Innovation effectiveness outcomes measure the degree of success or failure of the innovation and include innovation impact on 1) innovation recipients (e.g., patients), 2) innovation deliverers (e.g., clinical providers), and 3) key decision-makers/the system (e.g., hospital leadership).

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Innovation effectiveness outcomes are not influenced by constructs in CFIR.

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‍Note: We conceptualize Reach as distinct from Implementation Outcomes in alignment with RE-AIM developers and the RE-AIM Outcomes Cascade. In this conceptualization, Reach proceeds implementation (innovation agent fidelity to the various elements of an innovation’s protocol, including consistency of delivery) and precedes innovation effectiveness (the impact of an innovation on important outcomes) (Jolles et al. 2024, Glasgow et al. 2019). We recognize that Reach is often conceptualized as an implementation outcome given the diverse types of innovations and contexts being studied in implementation science. In many instances, Reach is used as a proxy for the initiation of implementation.

CFIR-based implementation determinants are Inner Setting-level barriers and facilitators that predict or explain reach and implementation outcomes.

Data is best collected from individuals who have influence and/or power related to implementation in the Inner Setting (e.g., implementation leads, innovation deliverers, and key decision-makers) – and this rarely includes innovation recipients

Innovation effectiveness determinants are recipient-level characteristics and perceptions of the innovation that predictor explain innovation effectiveness outcomes (e.g., patient outcomes). Data are best collected from innovation recipients.

‍CFIR constructs represent implementation determinants – not innovation effectiveness determinants.

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As a result, it is usually not recommended to use CFIR when collecting data from recipients. See the FAQ: Should I use CFIR to collect data from innovation recipients (e.g., patients, students)? for more information.

Note: Implementation determinants and innovation effectiveness determinants influence reach; in order to reach recipients, you need both effective implementation and an effective innovation.