The Inner Setting is often the unit of analysis in an implementation study and can be divided into multiple levels (McEachern et al. 2019) to account for teams or units (Miake-Lye et al. 2020; Safaeinili et al. 2020). For example, Safaeinili et al. adapted the CFIR to accommodate three embedded levels: 1) pilot clinics, 2) peer clinics, and 3) the larger health system (Safaeinili et al. 2020). Constructs A – D below capture persistent general characteristics of the Inner Setting (e.g., Relational Connections), while Constructs E – K are specific to implementation and/or delivery of the innovation (e.g., Access to Knowledge & Information).
The original CFIR (Laura J. Damschroder et al. 2009) elaborated on this domain, stating that the Inner Setting may be composed of tightly or loosely coupled entities (e.g., a loosely affiliated medical center and outlying contracted clinics or tightly integrated service lines within a health system). The Inner Setting is an active interacting force and not just a backdrop in implementation (Sue Dopson and Louise Fitzgerald 2006). Objective descriptions of the Inner Setting may include its size, age, maturity, and specialization (the uniqueness of the niche or market for the organization’s products or services); each of these features may influence implementation (T. Greenhalgh, Robert, et al. 2004). Size and age are sometimes used as proxy measures and may be negatively associated with implementation when bureaucratic structure is increased as a result (Van de Ven 1986; Walston, Kimberly, and Burns 2001).