Waltz et al. 2019. Choosing implementation strategies to address contextual barriers: diversity in recommendations and future directions
Waltz TJ, Powell BJ, Fernández ME, Abadie B, Damschroder LJ. Choosing implementation strategies to address contextual barriers: diversity in recommendations and future directions. Implement Sci. 2019;14(1):42. Published 2019 Apr 29. doi:10.1186/s13012-019-0892-4
Implementation scientists have long recognized the need to assess context and then tailor implementation strategies to fit. The CFIR is often used to identify contextual determinants (barriers and facilitators) that can then be used to guide selection of appropriate strategies. Our team, led by Dr. Tom Waltz, published results from 169 self-identified implementation experts who selected strategies most likely to address each CFIR barriers. Each expert identified up to 7 strategies for an average of 6.1 barriers based on CFIR constructs. Mappings were highly heterogenous; each CFIR barrier had an average 47 different strategies endorsed by at least one expert. With 73 ERIC strategies and 39 CFIR constructs, there are 2847 possible unique combinations of strategy-construct mappings. Level 1 endorsements (i.g., strategy selections that were endorsed by at least 50% of respondents for a specific CIFR barrier) comprised 33 combinations (e.g., over half of respondents agreed that “Audit and Provide Feedback” was highly likely to address lack of “Reflecting and Evaluating”). Level 2 strategies (n=332) were endorsed by 20-49% of respondents. One reason for the diversity of recommendations may have been rooted in the diversity of assumed underlying mechanisms of change. ERIC strategies are not operationalized for specific scenarios and may be enacted under an array of assumptions driving their selection. We have posted a tool that users can apply based on results from this work. Dr. Maria Fernandez and colleagues recently published a 5-step Implementation Mapping process that can be used to operationalize strategy choices based on the Strategy Matching Tool, by explicitly identifying and designing based on hypothesized underlying change theories.