Eastern Michigan University, Ypsilanti, USA.
Ann Arbor VA Center for Clinical Management Research, P.O. Box 130170, Ann Arbor, MI, 48113-0170, USA.
Implement Sci. 2019 Apr 29;14(1):42. doi: 10.1186/s13012-019-0892-4.
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.
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.
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.
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.
实施的一个基本挑战是确定情境决定因素（即障碍和促进因素），并确定哪些实施策略将解决这些问题。已经开发了许多概念框架（例如，实施研究综合框架；CFIR）来指导情境决定因素的识别，并且已经开发了实施策略的汇编（例如，实施变革的专家建议汇编；ERIC），这可以支持实施策略的选择和报告。本研究的目的是确定哪些 ERIC 实施策略最能解决基于 CFIR 的特定情境障碍。
招募实施研究人员和从业者参与一系列在线任务，涉及将特定的 ERIC 实施策略与特定的实施障碍相匹配。参与者收到了基于 CFIR 构建定义的障碍简要描述。他们被要求对每个障碍排名前七的实施策略。障碍以随机顺序呈现，参与者可以选择回答障碍或跳到另一个障碍。还要求参与者回答影响他们选择的最重要因素。
共发送了 435 封电子邮件邀请，有 169 人（39%）参与。受访者对哪些 ERIC 策略最能解决每个 CFIR 障碍的意见存在相当大的差异。在 39 个 CFIR 障碍中，平均有 47 种不同的 ERIC 策略（SD=4.8，范围 35 到 55）至少被一次选为最能解决该障碍的七种策略之一。开发了一个工具，允许用户指定基于 CFIR 的高优先级障碍，并根据参与者提供的认可获得基于优先级的策略列表。
本研究任务中获得的广泛异质性表明，基于 CFIR 的障碍和 ERIC 实施策略之间相对较少存在一致的关系。尽管存在这种异质性，但汇总多个障碍认可的工具可以支持在考虑到这些障碍的情况下采用结构化方法来考虑广泛的策略。本研究的结果表明，需要更详细地评估障碍的潜在决定因素以及策略如何解决这些决定因素，作为实施规划过程的一部分。
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