Motivation includes brain processes that energize and direct behavior (Michie et al. 2011) and commitment, the act of binding oneself to a course of action intellectually and/or emotionally (Cane et al. 2012). This construct includes commitment of individuals to fulfill their role (Ashok et al. 2018; Dy et al. 2015). Perceptions of the commitment of leaders was captured in the original CFIR (Damschroder, Aron, et al. 2009) as part of the Inner Setting, but the updated CFIR (Damschroder, Reardon, Widerquist, et al. 2022) recognizes the importance of capturing this theme for all individual roles. Enthusiastic use of an innovation is reflected by a positive affective response to the innovation (Klein and Sorra 1996). Klein et al. define implementation outcomes based on measures of enthusiastic versus compliant use (Klein and Sorra 1996); thus, care should be taken to clearly capture these concepts as determinants of implementation versus implementation outcomes; refer to the CFIR outcomes addendum (Damschroder, Reardon, Opra Widerquist, et al. 2022) for more detail. Often, subjective opinions obtained from peers based on personal experiences are convincing and help to generate enthusiasm (Pronovost et al. 2006). The converse is true as well, creating a negative source of active or passive resistance (P. W. Meyers et al. 1999; Saint et al. 2009). The degree to which new behaviors are positively or negatively valued heightens intention to change, which is a precursor to actual change (Gershon et al. 2004).
The following paragraphs provide further elaboration for individual-level constructs from the original CFIR (Damschroder, Aron, et al. 2009) that are included as themes within the new Motivation construct.
Championing as a behavior can be an important indicator of Motivation (Bonawitz et al. 2020; Miech et al. 2018). Individuals exhibiting this level of commitment are actively involved with the implementation and willing to risk informal status and reputation because they believe so strongly in the innovation (Schon 1963). Such highly committed, championing behavior may occur across roles. For example, deliverers are most effective when they can defend and develop cross-functional coalitions of individuals who strongly believe in the innovation and are able to articulate the benefits in a way to move other individuals to fully embrace the innovation.
Individual stage of change reflects the phase an individual is in, as they progress toward skilled, enthusiastic, and sustained use of the innovation (R. P. Grol et al. 2007; Klein et al. 2001). Prochaska’s trans-theoretical model characterizes stages of change as pre-contemplation, contemplation, preparation, and action and maintenance (Prochaska and Velicer 1997). Rogers’ diffusion theory delineates five stages (E. Rogers 2003). Grol et al. describe a five-stage model with ten sub-stages based on their synthesis of the literature (R. P. Grol et al. 2007).
How individuals perceive their organization (Inner Setting) and their relationship and commitment to the Inner Setting may affect willingness to fully engage in implementation efforts or to use the innovation (Abraham 2000; Cummings et al. 2007; Estabrooks et al. 2007; Greenberg 1990). How strongly organizational identity is taken on by individuals may bolster implementation or delivery of the innovation (Pearce and Ensley 2004; A. C. Smith et al. 1983). Within the Inner Setting, the alignment between the meaning individuals attach to the innovation versus the meaning communicated by upper management has a strong influence on whether key individuals will commit to the innovation (Greenhalgh, Robert, et al. 2004). For example, an innovation that leadership believes will improve performance may be perceived as a threat to autonomy in treatment decisions by physicians. Meaning in this context can be negotiated and reframed through discussions across organizational networks (Greenhalgh, Robert, et al. 2004).