Table 1

Examples of how implementation science determinant frameworks can be applied to identify contextual determinants that influence the implementation of evidence-based care

Implementation frameworkFramework descriptionDescription of a determinant and associated domainExample of the determinant in the global health literature
Consolidated Framework for Implementation Research (CFIR)91The CFIR includes five categories (domains) of contextual determinants that are known to influence implementation effectiveness: inner setting; outer setting; intervention characteristics; characteristics of individuals involved; and the processes of implementation.91 Nested within the different domains are specific contextual determinants that are known to influence implementation outcomes.Adaptability (intervention characteristics): The extent to which an intervention can be adapted, tailored and refined to suit the local needs can influence the effectiveness of of implementing an intervention in a new context.91A study in Madagascar on the implementation and evaluation of a nationwide scale-up of the Surgical Safety Checklist, found that the WHO surgical checklist was adaptable to the local setting. A checklist course facilitated multidisciplinary workshops to adapt the checklist to the local environment.92 The adaptability of the checklist facilitated implementation of the checklist in this context.
The Context and Implementation of Complex Interventions (CICI) framework3The CICI framework is both a determinant and evaluation framework that contains seven categories of contextual determinants that can influence the effectiveness of implementation effects. Unique to the CICI framework, these categories focus on factors external to the health system: geographical; epidemiological; sociocultural; socioeconomic; ethical; legal; political.Sociocultural (external setting): Behavioural patterns surrounding the core of culture including historically derived and selected ideas, and values that are shared among members of a group can influence effectiveness of delivering evidence-informed care in a new context.3The stigmatising nature of depression in many societies can deter a patient from accessing care and completing a course of treatment.24
Theoretical Domains Framework (TDF)93The implementation of evidence-informed interventions is dependent on changing multiple behaviours of different people.94 The TDF represents a synthesis of 128 determinants of behaviour that are known to influence the implementation of evidence-informed care.93 Identifying these determinants can help to select appropriate behavioural change interventions to facilitate the implementation of evidence-informed care.Knowledge of scientific rationale (knowledge) : An awareness of the existence of something.
Fear (emotion): A complex reaction pattern involving experiential, behavioural, and physiological elements by which the individual attempts to deal with a personally significant matter or event.93
A qualitative study in the preimplementation phase of a quality improvement project used the TDF to explore reasons for missed opportunities for vaccination among children in Kano, Nigeria. Findings revealed that several determinants of behaviours including caregivers lack of knowledge of the benefits in vaccinating children. There was also the complex emotion of fear. People were afraid of the side effects of the vaccination.95