Strategy Design

Although the prospective use of the CFIR has been relatively infrequent, the CFIR can be used to inform design of implementation strategies. After completing a context assessment and identifying barriers and facilitators to implementing an innovation, strategies to mitigate barriers and leverage facilitators can be identified. This process can also be used to refine implementation processes through the course of implementation.

If you are using the CFIR to identify potential barriers to implementation, this knowledge can be used to help guide choice of implementation strategies to mitigate those barriers.

We have developed a tool that helps you “match” strategies to address barriers that were identified using the CFIR. Our published article describes how this tool was developed and its limitations. This article is also highlighted in our Blog section.

Implementation strategies were drawn from the Expert Recommendations for Implementing Change (ERIC) list of strategies. These strategies are described within the following articles:

  • Powell et al 2015: This article lists all 73 ERIC strategies with short descriptions. Longer rationale and descriptions are documented in Additional File 6 published with this article.
  • Waltz et al 2015: This article groups 73 ERIC strategies into 9 clusters based on concept mapping methods.
  • Perry et al 2019: This article lists recommended refinements to the list of ERIC strategies based on findings from the ESCALATES National Evaluation. 

The CFIR-ERIC Matching tool was developed based on survey responses from “implementation experts” (n=169) who chose up to 7 implementation strategies they believed would best address each CFIR barrier. But respondents had considerable heterogeneity in opinions. The wide heterogeneity of endorsements suggests that there are relatively few consistent relationships between CFIR-based barriers and ERIC implementation strategies. More research is needed to better guide strategy choices. However, results provide a starting point to build on.

The matching tool will provide a list of implementation strategies to consider based on the CFIR-based barriers you enter.

Implementation Strategy Selection Tool

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Case illustration

An implementation evaluation of the Telephone Lifestyle Coaching program (TLC) was conducted within 11 Veterans Affairs (VA) medical centers. This study identified seven determinants of implementation outcomes based on a CFIR construct assessment.

The CFIR-ERIC Matching Tool can be used to select the seven CFIR barriers and generate a list of potential strategies to address those barriers. An output table (condensed to include strategies with the highest level of endorsement) lists the seven CFIR barriers across the top of the table. ERIC implementation strategies are listed in the first column. Strategies are sorted by cumulative level of endorsement. “Cumulative Percent” indicates the strength of endorsement for that strategy across all 7 CFIR barriers. For example, “Identify and Prepare Champions” has the highest cumulative endorsement (248%) for this strategy to address all 7 barriers. In fact, this strategy is color coded GREEN for 2 of the 7 barriers, indicating that a majority of respondents endorsed this strategy for those 2 barriers (Engaging: Formally Appointed Internal Implementation Leader & Engaging: Key Stakeholders) The YELLOW color-coded cells indicate that at least 20% of respondents endorsed that strategy to address each of the indicated barriers.

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