Policies & Laws

This construct includes externally promulgated (governmental or other external entity) policies, regulations, rules, codes, mandates, recommendations, guidelines, directives, or accreditation requirements (Aarons et al., 2011; Flottorp et al., 2013; Greenhalgh et al., 2017; Leeman et al., 2019; Mendel et al., 2008; Nilsen & Bernhardsson, 2019; Squires et al., 2019), and alignment of implementation of the innovation with these policies and laws (Means et al., 2020). This construct also includes externally generated malpractice liability (Flottorp et al., 2013) and continuing education requirements (Raghavan et al., 2008).

The original CFIR expanded more on this construct to include “political directives,” “policy push,” and “external mandates.” Greenhalgh et al. cite strong evidence of the direct effects of these concepts; they may also have indirect effects by increasing motivation (but not capacity) of settings to implement innovations (Greenhalgh, Robert, et al., 2004 p610).

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

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

Aarons, G. A., Hurlburt, M., & Horwitz, S. M. (2011). Advancing a Conceptual Model of Evidence-Based Practice Implementation in Public Service Sectors. Administration and Policy in Mental Health and Mental Health Services Research, 38(1), 4–23. https://doi.org/10.1007/s10488-010-0327-7

Flottorp, S. A., Oxman, A. D., Krause, J., Musila, N. R., Wensing, M., Godycki-Cwirko, M., Baker, R., & Eccles, M. P. (2013). A checklist for identifying determinants of practice: A systematic review and synthesis of frameworks and taxonomies of factors that prevent or enable improvements in healthcare professional practice. Implementation Science, 8(1), 35. https://doi.org/10.1186/1748-5908-8-35

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.

Greenhalgh, T., Wherton, J., Papoutsi, C., Lynch, J., Hughes, G., A’Court, C., Hinder, S., Fahy, N., Procter, R., & Shaw, S. (2017). Beyond Adoption: A New Framework for Theorizing and Evaluating Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies. Journal of Medical Internet Research, 19(11), e367. https://doi.org/10.2196/jmir.8775

Leeman, J., Baquero, B., Bender, M., Choy-Brown, M., Ko, L. K., Nilsen, P., Wangen, M., & Birken, S. A. (2019). Advancing the use of organization theory in implementation science. Preventive Medicine, 129, 105832. https://doi.org/10.1016/j.ypmed.2019.105832

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

Means, A. R., Kemp, C. G., Gwayi-Chore, M.-C., Gimbel, S., Soi, C., Sherr, K., Wagenaar, B. H., Wasserheit, J. N., & Weiner, B. J. (2020). Evaluating and optimizing the consolidated framework for implementation research (CFIR) for use in low- and middle-income countries: A systematic review. Implementation Science, 15(1), 1–19. https://doi.org/10.1001/jamasurg.2017.5565

Nilsen, P., & Bernhardsson, S. (2019). Context matters in implementation science: A scoping review of determinant frameworks that describe contextual determinants for implementation outcomes. BMC Health Services Research, 19(1), 189. https://doi.org/10.1186/s12913-019-4015-3

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

Raghavan, R., Bright, C. L., & Shadoin, A. L. (2008). Toward a policy ecology of implementation of evidence-based practices in public mental health settings. Implementation Science, 3(1), 26. https://doi.org/10.1186/1748-5908-3-26