O'Donovan B, Kirke C, Pate M, McHugh S, Bennett K, Cahir C
Data Science Centre, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
Quality Improvement Division, Health Service Executive (HSE), Medication Safety, Dublin, Ireland.
Implement Sci Commun. 2023 Aug 24;4(1):100. doi: 10.1186/s43058-023-00466-8.
Implementation researchers often combine the Theoretical Domain Framework (TDF) and Consolidated Framework for Implementation Research (CFIR) in their studies. However there is some debate on the merits of using multiple frameworks-whether they contribute to results or provide superfluous analysis. Our recent research combined the TDF and CFIR to identify determinants to widespread incorporation of patient held medication lists (PHML) in healthcare practice. The aim of this report is to provide guidance on the use of the TDF and CFIR; by assessing the degree of overlap between the two frameworks in their application to interviews about PHML.
Semi-structured telephone interviews were conducted with healthcare professionals (HCPs) and non HCPs (people taking multiple medicines and caregivers).Interview data were transcribed and analysed using the TDF and CFIR. Within paired domains substantial intersection/overlap across constructs and domains within the two frameworks was classified as > 75% of coding references, consistent intersection/overlap was defined as > 50% and ≤ 75%, average intersection/overlap was defined as ≤ 50% and > 25% and non-substantial intersection/overlap was classified as ≤ 25% of coding references.
Interview data were collected from 39 participants - 21 HCPs and 18 non HCPs. Mapping of TDF domains to CFIR domains/constructs identified key determinants in six TDF domains: Environmental context & resources, Beliefs about capabilities, Beliefs about consequences, Social influences, Behavioural regulation and Social/professional role & identity; and five CFIR domains: Intervention Characteristics, Outer Setting, Inner Setting, Characteristics of Individual and Process. A pattern of substantial intersection/overlap in coding emerged with broad TDF domains such as Environmental context & resources often linked to well-defined CFIR domains and constructs (e.g. design quality & packaging within Intervention Characteristics). Broad CFIR constructs such as knowledge & beliefs about intervention within Characteristics of Individuals also linked to more descriptive TDF domains like Beliefs about capabilities. In addition there was some unexpected non-substantial intersection/overlap in coding with the TDF domain Social influences less frequently linked to the CFIR Inner Setting domain and constructs such as networks and communications.
Identifying intersections/overlaps in coding between CFIR and TDF can assist interpretation of findings in implementation research. The strengths of each framework were exploited in a reciprocal process which provided more information to broad/poorly defined domains and enabled identification of implementation determinants and innovation determinants.
实施研究人员在其研究中经常将理论领域框架（TDF）和实施研究综合框架（CFIR）结合使用。然而，对于使用多个框架的优点存在一些争论——它们是否有助于得出结果或提供多余的分析。我们最近的研究结合了TDF和CFIR，以确定在医疗实践中广泛采用患者持有的药物清单（PHML）的决定因素。本报告的目的是通过评估这两个框架在应用于关于PHML的访谈时的重叠程度，为TDF和CFIR的使用提供指导。
对医疗保健专业人员（HCP）和非HCP（服用多种药物的人和护理人员）进行了半结构化电话访谈。访谈数据被转录并使用TDF和CFIR进行分析。在配对领域中，两个框架内各构念和领域之间的大量交叉/重叠被分类为编码参考的>75%，一致交叉/重叠被定义为>50%且≤75%，平均交叉/重叠被定义为≤50%且>25%，非实质性交叉/重叠被分类为编码参考的≤25%。
从39名参与者那里收集了访谈数据——21名HCP和18名非HCP。将TDF领域映射到CFIR领域/构念，确定了TDF的六个领域中的关键决定因素：环境背景与资源、对能力的信念、对后果的信念、社会影响、行为调节以及社会/专业角色与身份；以及CFIR的五个领域：干预特征、外部环境、内部环境、个体特征和过程。在编码中出现了大量交叉/重叠的模式，广泛的TDF领域，如环境背景与资源，通常与定义明确的CFIR领域和构念相关联（例如，干预特征中的设计质量和包装）。CFIR的广泛构念，如个体特征中的关于干预的知识和信念，也与更具描述性的TDF领域相关联，如对能力的信念。此外，在编码中还存在一些意外的非实质性交叉/重叠，TDF领域社会影响与CFIR内部环境领域以及网络和通信等构念的关联较少。
识别CFIR和TDF在编码中的交叉/重叠可以帮助解释实施研究中的结果。在一个相互补充的过程中利用了每个框架的优势，这为广泛/定义不明确的领域提供了更多信息，并能够识别实施决定因素和创新决定因素。
