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. 2019 Apr 29;14(1):42.
doi: 10.1186/s13012-019-0892-4.

Choosing implementation strategies to address contextual barriers: diversity in recommendations and future directions

Thomas J Waltz  1   2 , Byron J Powell  3 , María E Fernández  4 , Brenton Abadie  1 , Laura J Damschroder  5
Affiliations

Choosing implementation strategies to address contextual barriers: diversity in recommendations and future directions

Thomas J Waltz et al. Implement Sci. .

Abstract

Background: A fundamental challenge of implementation is identifying contextual determinants (i.e., barriers and facilitators) and determining which implementation strategies will address them. Numerous conceptual frameworks (e.g., the Consolidated Framework for Implementation Research; CFIR) have been developed to guide the identification of contextual determinants, and compilations of implementation strategies (e.g., the Expert Recommendations for Implementing Change compilation; ERIC) have been developed which can support selection and reporting of implementation strategies. The aim of this study was to identify which ERIC implementation strategies would best address specific CFIR-based contextual barriers.

Methods: Implementation researchers and practitioners were recruited to participate in an online series of tasks involving matching specific ERIC implementation strategies to specific implementation barriers. Participants were presented with brief descriptions of barriers based on CFIR construct definitions. They were asked to rank up to seven implementation strategies that would best address each barrier. Barriers were presented in a random order, and participants had the option to respond to the barrier or skip to another barrier. Participants were also asked about considerations that most influenced their choices.

Results: Four hundred thirty-five invitations were emailed and 169 (39%) individuals participated. Respondents had considerable heterogeneity in opinions regarding which ERIC strategies best addressed each CFIR barrier. Across the 39 CFIR barriers, an average of 47 different ERIC strategies (SD = 4.8, range 35 to 55) was endorsed at least once for each, as being one of seven strategies that would best address the barrier. A tool was developed that allows users to specify high-priority CFIR-based barriers and receive a prioritized list of strategies based on endorsements provided by participants.

Conclusions: The wide heterogeneity of endorsements obtained in this study's task suggests that there are relatively few consistent relationships between CFIR-based barriers and ERIC implementation strategies. Despite this heterogeneity, a tool aggregating endorsements across multiple barriers can support taking a structured approach to consider a broad range of strategies given those barriers. This study's results point to the need for a more detailed evaluation of the underlying determinants of barriers and how these determinants are addressed by strategies as part of the implementation planning process.

Keywords: Consolidated Framework for Implementation Research; Expert Recommendations for Implementing Change; Implementation; Implementation strategies; Intervention mapping.

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Conflict of interest statement

Ethics approval and consent to participate

This evaluation was approved by the Institutional Review Board at the VA Ann Arbor Healthcare System.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Screenshot of the ranking task. Participants were instructed to drag and drop strategies from the left-hand column to the ranking box on the right. Once placed in the ranking box, the relative position of the strategies could be manipulated
See this image and copyright information in PMC

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