Examples of how implementation science determinant frameworks can be applied to identify contextual determinants that influence implementation effectiveness of evidence-based practice
| Implementation framework | Framework description | Example determinant | Example of the determinant in the literature |
| Consolidated Framework for Implementation Research (CFIR) | The CFIR includes five domains (inner setting, outer setting, intervention characteristics, characteristics of individuals involved and the processes of implementation).34 Within the five domains, are 37 constructs that can behave as a barrier and/or enabler to the implementation of the EBP. | Opinion leaders: individuals in an organisation who have a formal or informal influence on the attitudes and beliefs of their colleagues concerning the implementation of the intervention.34 | Excluding religious leaders from a community that is highly religious, may find issues with the acceptability of Human Papilloma Virus (HPV) vaccination in Mozambique. This arises with programmes that are context sensitive and need to be supported and publicly advocated by local religious leaders.35 |
| The Context and Implementation of Complex Interventions (CICI) framework | The CICI framework is both a determinant and evaluation framework that contains seven external contextual domains (ie, geographical, epidemiological, sociocultural, socioeconomic, ethical, legal, political) that are known to influence the effectiveness of the methods to deliver EBP.36 | Sociocultural: behaviour patterns surrounding the core of culture including historically derived and selected ideas, and values that are shared among members of a group.36 | A systematic review on access barriers to, and facilitators of, voluntary medical male circumcision to prevent HIV transmission found that male circumcision negatively perceived as being practiced by other or foreign cultures and religions was a major barrier.37 |
| Theoretical Domains Framework (TDF) | The implementation of evidence-based interventions is dependent on changing multiple behaviours of different people38 where the use of theory to inform behaviour change interventions has been shown to improve the implementation effectiveness.39 The TDF represents a synthesis of 128 determinants of behavioural change.32 | Social influences (those interpersonal processes that can cause individuals to change their thoughts, feelings or behaviours).32 | A qualitative synthesis using interviews with key stakeholders assessed for barriers in implementing evidence-based mental healthcare into primary healthcare in six LMICs.40 Findings suggest stigma associated with a mental health diagnosis was a significant barrier in implementation. |
EBP, evidence-based practice; LMICs, low/middle-income countries.