Use of CFIR in published articles through January 2015
Colleagues at University of North Carolina led a systematic review of all published articles that cite the CFIR. In early 2015, only 26 of 429 articles that cited the CFIR, actually used it in a meaningful way (i.e., applied it in an implementation study). Nearly all studies used qualitative or mixed methods, but two studies developed quantitative items to assess a subset of CFIR constructs. Over half of articles did not identify implementation outcomes which limited their ability to identify determinants of implementation. Four recommendations were made to further advance rigorous use of the CFIR (or any framework): 1) apply the framework across multiple phases of implementation; 2) be transparent about how/why subsets of constructs were chosen for evaluation; 3) identify and assess implementation outcomes so that determinants (based on constructs’ association with those outcomes) can be identified; 4) more deeply integrate the framework into evaluation work, using it to guide data collection, analysis, and interpretation. Also, the authors reflect on the CFIR’s usefulness and they recommend refinements so that it can continue to improve and lead to robust development and testing of theory and models.
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