Identifying actionable strategies: using Consolidated Framework for Implementation Research (CFIR)-informed interviews to evaluate the implementation of a multilevel intervention to improve colorectal cancer screening

Implementation Science Communications

Fornessa Randal¹  Helen Lam¹  Emily Koebnick¹  Manasi Jayaprakash¹  Karen Kim¹  Michael Quinn²  David Liebovitz³  Blasé Polite⁴  Toni Cipriano-Steffens⁵ 

[1] Center for Asian Health Equity, University of Chicago;Department of Internal Medicine Section of General Internal Medicine, University of Chicago;Division of General Internal Medicine & Geriatrics, Feinberg School of Medicine, Northwestern University;University of Chicago Medicine Hematology and Oncology;University of Chicago Medicine;

关键词: Federally Qualified Health Center;    Implementation;    Colorectal cancer screening;    Evidence-based intervention;    Consolidated Framework for Implementation Research;    Implementation strategy;   

DOI  :  10.1186/s43058-021-00150-9

来源: DOAJ

【 摘 要 】

Abstract Background Many evidence-based interventions (EBIs) found to be effective in research studies often fail to translate into meaningful patient outcomes in practice. The purpose of this study was to identify facilitators and barriers that affect the implementation of three EBIs to improve colorectal cancer (CRC) screening in an urban federally qualified health center (FQHC) and offer actionable recommendations to improve future implementation efforts. Methods We conducted 16 semi-structured interviews guided by the Consolidation Framework for Implementation Research (CFIR) to describe diverse stakeholders’ implementation experience. The interviews were conducted in the participant’s clinic, audio-taped, and professionally transcribed for analysis. Results We used the five CFIR domains and 39 constructs and subconstructs as a coding template to conduct a template analysis. Based on experiences with the implementation of three EBIs, stakeholders described barriers and facilitators related to the intervention characteristics, outer setting, and inner setting. Implementation barriers included (1) perceived burden and provider fatigue with EHR (Electronic Health Record) provider reminders, (2) unreliable and ineffectual EHR provider reminders, (3) challenges to providing health care services to diverse patient populations, (4) lack of awareness about CRC screening among patients, (5) absence of CRC screening goals, (6) poor communication on goals and performance, and (7) absence of printed materials for frontline implementers to educate patients. Implementation facilitators included (1) quarterly provider assessment and feedback reports provided real-time data to motivate change, (2) integration with workflow processes, (3) pressure from funding requirement to report quality measures, (4) peer pressure to achieve high performance, and (5) a culture of teamwork and patient-centered mentality. Conclusions The CFIR can be used to conduct a post-implementation formative evaluation to identify barriers and facilitators that influenced the implementation. Furthermore, the CFIR can provide a template to organize research data and synthesize findings. With its clear terminology and meta-theoretical framework, the CFIR has the potential to promote knowledge-building for implementation. By identifying the contextual determinants, we can then determine implementation strategies to facilitate adoption and move EBIs to daily practice.

【 授权许可】

Unknown