Table 2 Implementation determinants and outcomes in eight determinant frameworks
From: Making sense of implementation theories, models and frameworks
Characteristics of the implementation object | Characteristics of the users/adopters (e.g. health care practitioners) | Characteristics of the end users (e.g. patients) | Characteristics of the context | Characteristics of the strategy or other means of facilitating implementation | Outcomes | |
|---|---|---|---|---|---|---|
Characteristics of the evidence | Characteristics of the clinical experience (addressed as an aspect of the evidence element) | Characteristics of the patient experience (addressed as an aspect of the evidence element) | Characteristics of the context (comprising culture, leadership and evaluation) | Characteristics of the facilitation, i.e. the process of enabling or making easier the implementation | Successful implementation of research | |
Conceptual Model (Greenhalgh et al. [17]) | Innovation attributes | Aspects of adopters (e.g. psychological antecedents and nature of the adoption decision) and assimilation by organizations | Not addressed | Features of the inner context (organizational antecedents and organizational readiness for innovation) and outer context (e.g. informal interorganizational networks and political directives) | Influences (e.g. opinion leaders, champions and network structure) lying on a continuum from diffusion to dissemination | Successful diffusion, dissemination and implementation of innovations |
Grol et al. [22] | Features of the innovation | Features of the professionals who should use the innovation | Features of the patients | Features of the social setting (e.g. attitudes of colleagues, culture and leadership) and of the economic, administrative and organizational context | Features of the methods and strategies for dissemination and implementation used | Implementation of new evidence, guidelines and best practices or procedures |
Nutley et al. [21] | Nature of the research to be applied | Personal characteristics of researchers and potential research users and links between research and its users | Not addressed | Context for the use of research | Strategies to improve the use of research | Use of research |
Cochrane et al. [59] | Guidelines and evidence barriers | Cognitive and behavioural barriers, attitudinal and rational-emotional barriers, health care professional and physician barriers | Patient barriers | Support and resource barriers, system and process barriers | Not addressed | Adherence to guidelines or implementation of evidence into clinical practice |
Ecological Framework (Durlak and DuPre [57]) | Characteristics of the innovation | Provider characteristics | Not addressed | Community-level factors (comprising general organizational features, specific organizational practices and processes, and specific staffing considerations) | Features of the prevention support system (comprising training and technical assistance) | Successful implementation of innovations |
CFIR (Damschroder et al. [60]) | Intervention characteristics | Characteristics of individuals | Patient needs and resources (addressed as an aspect of the outer setting) | Characteristics of the inner setting (e.g. structural characteristics, networks and communications, culture) and outer setting (e.g. cosmopolitanism, external policies and incentives) | Effectiveness of process by which implementation is accomplished (comprising planning, engaging, executing, reflection and evaluating) | Successful implementation of interventions |
Gurses et al. [58] | Guideline characteristics | Clinician characteristics | Not addressed | Systems characteristics (e.g. physical environment, organizational characteristics) and implementation characteristics (e.g. tension for change and getting ideas from outside the organization) | Implementation characteristics (e.g. change agents’ characteristics, relative strengths of supporters and opponents) | Adherence to guidelines |