1 Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA.
2 Division of Reproductive Health, Field Support Branch, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, GA, USA.
Public Health Rep. 2019 Mar/Apr;134(2):189-196. doi: 10.1177/0033354918824329. Epub 2019 Jan 30.
Implementation science provides useful tools for guiding and evaluating the integration of evidence-based interventions with standard practice. The objective of our study was to demonstrate the usefulness of applying an implementation science framework-the Consolidated Framework for Implementation Research (CFIR)-to increase understanding of implementation of complex statewide public health initiatives, using the example of Medicaid immediate postpartum long-acting reversible contraception (LARC) policies.
We conducted semistructured telephone interviews with the 13 state teams participating in the Immediate Postpartum LARC Learning Community. We asked teams to describe the implementation facilitators, barriers, and strategies in 8 focus areas of the Learning Community. We audio-recorded and transcribed interviews and then coded each interview according to the domains and constructs (ie, theoretical concepts) of the CFIR.
Cosmopolitanism (ie, networking with external organizations) was the most frequently coded construct of the framework. A related construct was networks and communications (ie, the nature and quality of social networks and formal and informal communications in an organization). Within the construct of cost, state teams identified barriers that were often unable to be overcome. Trialability (ie, ability to test the intervention on a small scale) and engaging champions (ie, attracting and involving persons who dedicate themselves to supporting the intervention in an organization) were among the most salient constructs of the framework and were the sources of many implementation strategies.
State leaders and program staff members may benefit from considering the CFIR domains and constructs in the planning, implementation, and evaluation of complex statewide public health initiatives.
实施科学为指导和评估循证干预措施与标准实践的整合提供了有用的工具。我们研究的目的是展示应用实施科学框架-实施研究综合框架（CFIR）的有用性，以增加对复杂的全州公共卫生倡议实施的理解，以医疗补助即刻产后长效可逆避孕（LARC）政策为例。
我们对参与即刻产后 LARC 学习社区的 13 个州级团队进行了半结构化电话访谈。我们要求团队在学习社区的 8 个重点领域描述实施促进因素、障碍和策略。我们对访谈进行了录音和转录，然后根据 CFIR 的领域和结构（即理论概念）对每个访谈进行了编码。
世界主义（即与外部组织建立联系）是该框架中最常编码的结构。一个相关的结构是网络和沟通（即组织中的社会网络的性质和质量以及正式和非正式沟通）。在成本结构中，州级团队确定了许多无法克服的障碍。试验性（即小规模测试干预措施的能力）和吸引拥护者（即吸引和参与致力于在组织中支持干预措施的人）是该框架中最突出的结构之一，也是许多实施策略的来源。
州领导和项目工作人员可能会受益于在规划、实施和评估复杂的全州公共卫生倡议时考虑 CFIR 领域和结构。
