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.
Conditions of the local community can enable the Outer Setting to support implementation and/or delivery of the innovation (Dy et al. 2015; Means et al. 2020). Conditions can include economic (e.g., recession) (Kerins et al. 2020), environmental (e.g., built environment), political (e.g., instability or corruption) (Flottorp et al. 2013), and/or technological (e.g., IT infrastructure) factors (Ashok et al. 2018; Dy et al. 2015; Means et al. 2020; Yuan et al. 2019). 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, especially in low- to middle- income countries, where resource constraints are common (Means et al. 2020); with these innovations, local conditions may influence implementation outcomes and equity in implementation.