The Updated Consolidated Framework for Implementation Research: CFIR 2.0

Abstract

BackgroundMany implementation efforts fail, even with highly developed plans for execution, because contextual factors can be powerful forces working against implementation in the real-world. The Consolidated Framework for Implementation Research (CFIR) is one of the most commonly used determinant frameworks to assess these contextual factors, however, it has been 10 years since publication and there is a need for updates. The purpose of this manuscript is to describe the updated CFIR 2.0, which addresses important user critiques of the framework.MethodsUser feedback was obtained from two sources: 1) a literature review with a systematic search; and 2) a survey of authors who used the CFIR 2009 in a published study. Data were combined across both sources and reviewed to identify themes; a consensus approach was used to finalize all CFIR 2.0 updates. The VA Ann Arbor Healthcare System IRB declared this study exempt from the requirements of 38 CFR 16 based on category 2. ResultsThe systematic search yielded 376 articles and 334 unique authors with contact information; 59 articles included feedback on the CFIR. Forty percent (n=134/334) of authors responded to the survey. The CFIR received positive ratings on most framework sensibility items, e.g., applicability, usability, but respondents also provided recommendations for changes. Overall, updates to the CFIR 2.0 include revisions to existing constructs as well as the addition, removal, or relocation of constructs. These changes serve to facilitate use of the CFIR, address gaps in themes, and better center recipients. ConclusionThe updates in the CFIR 2.0 reflect feedback from the growing community of CFIR users; although there are many updates, constructs can be mapped back to the CFIR 2009 to ensure longitudinal consistency. We invite users to continuing critiquing the framework in order it continue to evolve.