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Table 1 Operational Definitions by Consolidated Framework for Implementation Research (CFIR) Constructs

From: Barriers and facilitators to implementing a pragmatic trial to improve advance care planning in the nursing home setting

CFIR Construct DefinitionaOperational Definition
DOMAIN 1: Intervention Characteristics
 Evidence Strength & Quality
Stakeholders’ perceptions of the quality and validity of evidence supporting the belief that the intervention will have desired outcomes. Perceived quality, effectiveness, and validity of the ACP videos in facilitating ACP conversations.
 Relative Advantage
Stakeholders’ perception of the advantage of implementing the intervention versus an alternative solution. Perception that the ACP videos were more effective than other ACP methods.
 Adaptability
The degree to which an intervention can be adapted, tailored, refined, or reinvented to meet local needs. Perceived extent to which ACP video (e.g., modes of presentation) can be customized to individual patient needs.
 Cost
Costs of the intervention and costs associated with implementing the intervention including investment, supply, and opportunity costs. Perception that ACP videos consume facility resources.
DOMAIN 2: Inner Setting
 Available Resources (within Readiness for Implementation)
The level of resources dedicated for implementation and on-going operations, including money, training, education, physical space, and time. Perceived availability of organizational resources for ACP video program implementation.
 Networks & Communications
The nature and quality of webs of social networks and the nature and quality of formal and informal communications within an organization. Opportunities for communication between Champions and other facility staff about the ACP program.
 Compatibility (within Implementation Climate)
The degree of tangible fit between meaning and values attached to the intervention by involved individuals, how those align with individuals’ own norms, values, and perceived risks and needs, and how the intervention fits with existing workflows and systems. Impact of how well the ACP video program could be integrated into established workflow upon implementation.
DOMAIN 3: Characteristics of Individuals
 Knowledge & Beliefs about the Intervention
Individuals’ attitudes toward and value placed on the intervention as well as familiarity with facts, truths, and principles related to the intervention. Champions’ and patients’/family members’ personal attitudes towards and familiarity with ACP.
 Individual Stage of Change
Characterization of the phase an individual is in, as s/he progresses toward skilled, enthusiastic, and sustained use of the intervention. Perceptions of patient/family level of emotional readiness to participate in the ACP video program.
DOMAIN 4: Outer Setting
 External Policy & Incentives
A broad construct that includes external strategies to spread interventions, including policy and regulations (governmental or other central entity), external mandates, recommendations and guidelines, pay-for-performance, collaboratives, and public or benchmark reporting. Perceived influence of mandates regarding ACP video program implementation relayed by corporate leaders (but actually driven by trial design).
DOMAIN 5: Process
 Engaging
Attracting and involving appropriate individuals in the implementation and use of the intervention through a combined strategy of social marketing, education, role modeling, training, and other similar activities. Perceived effectiveness of Champion training and opportunities to engage other facility staff members in the program.
 Executing
Carrying out or accomplishing the implementation according to plan. Ways in which Champions adhered to or customized the implementation process as originally planned.
 Reflecting & Evaluating
Quantitative and qualitative feedback about the progress and quality of implementation accompanied with regular personal and team debriefing about progress and experience. Perceptions of ongoing feedback on program implementation provided by HCS leadership (e.g., through cross-facility conference calls).
  1. aCFIR Construct definitions are cited verbatim from: https://cfirguide.org/constructs/
  2. ACP advance care planning, HCS health care system
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