Note: This construct was added to CFIR to address situations in which the Inner Setting requires explicit support, e.g., participation, funding, from the Outer Setting to implement and/or deliver the innovation. If support from the Outer Setting is not needed, it’s unlikely this construct is relevant.
Attitudes in the local community can encourage the Outer Setting to support implementation and/or delivery of the innovation (Dy et al. 2015; Means et al. 2020). Local attitudes can be related to values (e.g., equity) (Merlo et al. 2019) and beliefs (e.g., white supremacy, racial bias) (Tiderington et al. 2020); examples include widespread attitudes about organ donation (Squires et al. 2019) and bias against tenants with housing choice vouchers (Tiderington et al. 2020). While not all innovations require support from the Outer Setting, these themes are important when the innovation is community-based or relies on the community for support or resources; with these innovations, local attitudes may influence implementation outcomes and equity in implementation.