Local Attitudes

Sociocultural values (e.g., shared responsibility in helping recipients) and beliefs (e.g., convictions about the worthiness of recipients) encourage the Outer Setting to support implementation and/or delivery of the innovation.

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 (Merlo et al., 2019) (e.g., equity) 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.

Qualitative coding guidelines that are aligned with the Updated CFIR will be added in the near future.


As we become aware of measures, we will post them here. Please contact us with updates.

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.

Mendel, P., Meredith, L. S., Schoenbaum, M., Sherbourne, C. D., & Wells, K. B. (2008). Interventions in organizational and community context: A framework for building evidence on dissemination and implementation in health services research. Adm Policy Ment Health, 35(1–2), 21–37.

Squires, J. E., Aloisio, L. D., Grimshaw, J. M., Bashir, K., Dorrance, K., Coughlin, M., Hutchinson, A. M., Francis, J., Michie, S., Sales, A., Brehaut, J., Curran, J., Ivers, N., Lavis, J., Noseworthy, T., Vine, J., Hillmer, M., & Graham, I. D. (2019). Attributes of context relevant to healthcare professionals’ use of research evidence in clinical practice: A multi-study analysis. Implementation Science, 14(1), 52. https://doi.org/10.1186/s13012-019-0900-8

Tiderington, E., Ikeda, J., & Lovell, A. (2020). Stakeholder Perspectives on Implementation Challenges and Strategies for Moving On Initiatives in Permanent Supportive Housing. The Journal of Behavioral Health Services & Research, 47(3), 346–364. https://doi.org/10.1007/s11414-019-09680-6