Michie et al. include psychological and physical ability (Michie et al., 2011) within Capability. Intrapersonal competence, knowledge, and skills to fulfill roles are important for successful implementation (Ashok et al., 2018; Dy et al., 2015). Past experiences with implementation and/or the innovation helps build capability (King et al., 2019). Capabilities including personal traits of competence and learning style are important for tailoring training strategies (Barwick et al., 2020; Greenhalgh, Robert, et al., 2004).
The original CFIR elaborated further saying that the competence of individuals to judge the effectiveness of an innovation is facilitated by their understanding of underlying principles that justify using the innovation (E. Rogers, 2003). Skilled use and delivery of the innovation is a key outcome metric for effective implementation (Klein & Sorra, 1996), but assessments of skill can also be a key implementation determinant; see the CFIR Outcomes Addendum for more detail about the nuanced but important distinctions between determinants and outcomes (Damschroder et al., 2022). Capability is important to assess at individual and sub-group levels to assess quality of implementation and prospects for sustainability. If knowledge, for example through training (see Inner Setting: Access to Knowledge and Information), is not obtained prior to an individual having to use the innovation, rejection and discontinuance are likely (Klein et al., 2001). When knowledge can be codified and transferred across contexts, implementation is more likely to be successful (Greenhalgh, Robert, et al., 2004).
Self-efficacy, confidence in one’s ability to make the change, has been widely studied and is among the most common individual measures in theories of individual change (Bandura, 1977; R. P. Grol et al., 2007; US DHHS-National Cancer Institute, 2005). Individuals with high confidence in their capability are more likely to embrace the innovation and exhibit committed use even in the face of obstacles. If individuals are not confident in their ability to use the innovation or experience a level of failure early-on, they may not be motivated to persist in the face of challenges that may arise (US DHHS-National Cancer Institute, 2005).
Qualitative coding guidelines that are aligned with the Updated CFIR will be added in the future.
Regarding quantitative measurement of this construct: In a systematic review of quantitative measures related to implementation, Stanick et al. identified 104 measures plus 28 subscale measures of knowledge and beliefs about the innovation and 24 measures plus 16 subscale measures of self-efficacy (Stanick et al., 2021). Using PAPERS criteria of measurement quality with an aggregate scale ranging from -9 to +36 (Lewis, Mettert, Stanick, et al., 2021), The Texas Christian University Training Needs Survey (Simpson, 2002) achieved the highest measurement score of 13 out of a maximum quality score of 36 for knowledge and beliefs. The Counselor Activity Self-Efficacy Scales (CASES) (Lent et al., 2003) achieved the highest PAPERS score for self-efficacy, scoring 15. These findings indicate the need for continued development of high-quality measures.
As we become aware of measures, we will post them here. Please contact us with updates.
Ashok, M., Hung, D., Rojas-Smith, L., Halpern, M. T., & Harrison, M. (2018). Framework for Research on Implementation of Process Redesigns: Quality Management in Health Care, 27(1), 17–23. https://doi.org/10.1097/QMH.0000000000000158.
Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychol Rev, 84(2), 191–215.
Barwick, M., Barac, R., Kimber, M., Akrong, L., Johnson, S. N., Cunningham, C. E., Bennett, K., Ashbourne, G., & Godden, T. (2020). Advancing implementation frameworks with a mixed methods case study in child behavioral health. Translational Behavioral Medicine, 10(3), 685–704. https://doi.org/10.1093/tbm/ibz005.
Damschroder, L. J., Reardon, C. M., Opra Widerquist, M. A., & Lowery, J. (2022). Conceptualizing outcomes for use with the Consolidated Framework for Implementation Research (CFIR): The CFIR Outcomes Addendum. Implementation Science, 17(1), 7. https://doi.org/10.1186/s13012-021-01181-5.
Dy, S. M., Ashok, M., Wines, R. C., & Rojas Smith, L. (2015). A Framework to Guide Implementation Research for Care Transitions Interventions: Journal for Healthcare Quality, 37(1), 41–54. https://doi.org/10.1097/01.JHQ.0000460121.06309.f9
Greenhalgh, T., Robert, G., Macfarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of innovations in service organizations: Systematic review and recommendations. Milbank Q, 82(4), 581–629.
Grol, R. P., Bosch, M. C., Hulscher, M. E., Eccles, M. P., & Wensing, M. (2007). Planning and studying improvement in patient care: The use of theoretical perspectives. Milbank Q, 85(1), 93–138.
King, E. S., Moore, C. J., Wilson, H. K., Harden, S. M., Davis, M., & Berg, A. C. (2019). Mixed methods evaluation of implementation and outcomes in a community-based cancer prevention intervention. BMC Public Health, 19(1), 1051. https://doi.org/10.1186/s12889-019-7315-y.
Klein, K. J., & Sorra, J. S. (1996). The Challenge of Innovation Implementation. The Academy of Management Review, 21(4), 1055–1080.
Klein, K. J., Conn, A. B., & Sorra, J. S. (2001). Implementing computerized technology: An organizational analysis. Journal of Applied Psychology, 86(5), 811–824.
Lent, R. W., Hill, C. E., & Hoffman, M. A. (2003). Development and validation of the Counselor Activity Self-Efficacy Scales. Journal of Counseling Psychology, 50(1), 97–108. https://doi.org/10.1037/0022-0188.8.131.52.
Lewis, C. C., Mettert, K. D., Stanick, C. F., Halko, H. M., Nolen, E. A., Powell, B. J., & Weiner, B. J. (2021). The psychometric and pragmatic evidence rating scale (PAPERS) for measure development and evaluation. Implementation Research and Practice, 2, 263348952110373. https://doi.org/10.1177/26334895211037391.
Michie, S., Atkins, L., & West, R. (2014). The behaviour change wheel: A guide to designing interventions. Silverback.
Michie, S., van Stralen, M. M., & West, R. (2011). The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science : IS, 6, 42. https://doi.org/10.1186/1748-5908-6-42.
Rogers, E. (2003). Diffusion of innovations: 5th ed. Free Press.
Simpson, D. D. (2002). A conceptual framework for transferring research to practice. Journal of Substance Abuse Treatment, 22(4), 171–182.
Stanick, C. F., Halko, H., Mettert, K., Dorsey, C., Moullin, J., Weiner, B., Powell, B., & Lewis, C. C. (2021). Measuring characteristics of individuals: An updated systematic review of instruments’ psychometric properties. Implementation Research and Practice, 2, 263348952110004. https://doi.org/10.1177/26334895211000458.
US DHHS-National Cancer Institute. (2005). Theory at a Glance: A guide for health promotion practice 2nd Edition. https://cancercontrol.cancer.gov/sites/default/files/2020-06/theory.pdf.