CFIR Archives - Implementation Science at UW

✪ Implementation science frameworks and strategies to promote adoption of and adherence to oncology clinical practice guidelines in low- and middle-income countries: a scoping review

Authors:

Anya Romanoff, Kathleen Lynch, Lily Martin, Olayide Agodirin, Shilpa Murthy, Olalekan Olasehinde, Chukwuma Okereke, Julia M. Jackman, Betel Yibrehu, William E. Rosa, Catherine Zivanov, Erica Mann, Joy O. Ogunmuyiwa, Colleen E. Witty, Victoria L. Mango, Olusegun Isaac Alatise, T. Peter Kingham, Rachel Vreeman, Benjamin O. Anderson & Jamie S. Ostroff

^{University of Washington affiliated authors are displayed in bold.}

✪ Open Access

Published: July 2026

Read the full text in the open access journal BMC Global Public Health

Abstract:

Background

Clinical practice guidelines (CPGs) were developed to standardize and optimize cancer care delivery in low- and middle-income countries (LMICs). The aim of this scoping review is to identify implementation science (IS) frameworks and strategies to promote CPG adoption and adherence in LMICs.

Methods

We identified studies that describe, develop, reference, or utilize IS frameworks or strategies to deliver or evaluate adoption of oncology CPGs in LMICs. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), we searched Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), African Journals Online, Latin American and Caribbean Health Sciences Literature, Scopus, Web of Science, and PsycINFO on 3/21/2022, 12/20/2022, 01/26/2024, and 10/03/2025. Publications in all languages and of all study types were eligible for inclusion. Titles, abstracts, and full text were screened by two reviewers with conflicts resolved by a third reviewer. Excluded studies did not use an IS framework or strategy, did not focus on cancer care, or were conducted in a high-income country.

Results

Searches identified 17,806 unique publications for title/abstract screening. 182 studies met criteria for full-text review; 35 were included. Twenty-four studies were country-specific, most commonly India (n = 5) and Nigeria (n = 5). The most frequent CPGs referenced were national/country-specific guidelines (n = 13) and Breast Health Global Initiative (BHGI) guidelines (n = 9). Only 16 full-text publications described original research to promote or evaluate evidence-based CPG interventions in LMICs. Established IS frameworks used in more than one study were the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework (n = 2) and Consolidated Framework for Implementation Research (CFIR) (n = 2).

Conclusions

There is limited research utilizing IS frameworks and strategies to promote CPG adoption and adherence in LMICs and substantial heterogeneity in reporting. Greater utilization of IS frameworks, strengthening implementation capacity and improving consistency in reporting, are needed to improve CPG uptake in LMICs.

Systematic review registration

Open Science Framework (https://osf.io/nb75s).

^{**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**}

✪ Identifying Community-Sourced Implementation Strategies for Delivering a Task-Shared Mental Health Intervention for Fathers in Kenya

Abstract:

Background

To design accessible interventions, understanding how best to implement them in context is essential. Strategies that reflect community perspectives may be most relevant and impactful. This study aimed to identify and specify community-sourced implementation strategies for delivering a mental health and alcohol use intervention for fathers in Kenya and to map them to the Expert Recommendations for Implementing Change (ERIC) taxonomy.

Method

In Eldoret, Kenya, focus groups (seven groups; 31 participants) and key informant interviews (n = 18) were conducted with hospital leaders, policymakers, mental health providers, community leaders, fathers, lay providers, patients, and men currently experiencing mental health and alcohol use challenges. Data were analyzed using the framework method to generate high-level codes, followed by a second phase to extract, specify, and review implementation strategies.

Results

Community members identified lay providers recruited from the community as a promising delivery approach, with professional providers contributing to linkage to care and support for more acute needs. Engagement of community leaders and leveraging existing infrastructure were seen as key to enhancing implementation and reach, particularly among men. Multiple delivery settings (e.g., church, hospital, school) were considered acceptable depending on patient preference. A total of 25 unique community-sourced strategies were identified: three directly matched ERIC strategies, 19 were adapted, and two were unique to the community context.

Conclusions

This study identified locally grounded implementation strategies to guide early-stage intervention delivery for fathers in Kenya. Findings contribute to the growing body of implementation science in non-Western contexts and highlight a participatory approach for identifying and specifying strategies relevant to local systems and populations.

Plain Language Summary

This study explored how to deliver mental health and alcohol use treatment to Kenyan fathers based on community and father input. Key strategies included using local helpers, familiar spaces, and engaging leaders. Findings emphasize co-design and context-based delivery to make interventions more accessible, relevant, and ready for testing.

^{**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**}

✪ Advancing global pediatric cancer survivorship care: barriers, facilitators, and implementation strategies

Abstract:

Background

As more children with cancer experience improved treatment outcomes across the world, challenges arise with ongoing care needs due to a higher risk of mortality and chronic health conditions compared to the general population. Addressing global pediatric cancer survivorship care, especially in low- and middle-income countries (LMICs), is of growing importance. The current study used the Consolidated Framework for Implementation Research (CFIR) and the Expert Recommendations for Implementing Change (ERIC) to examine the barriers, facilitators, and strategies for implementing childhood cancer survivorship care in LMICs.

Methods

Using a larger review (PROSPERO registration CRD42021242548), a total of 8,456 articles were considered. The search identified nine eligible articles mentioning determinants of survivorship care across LMICs. Data were extracted from these articles using the CFIR domains of outer setting, inner setting, and individuals. Assigned CFIR constructs were then paired with ERIC strategies using the CFIR–ERIC matching tool.

Results

The nine studies were published between 2003 and 2020, representing the following countries: India, Brazil, Turkey, China, and Thailand. Inner setting barriers included lack of available resources—funding, space, materials, and guidelines. Outer setting barriers were related to financing, policies, and laws. Individual patient barriers reported were low health literacy, distance to care centers, and low prioritization of follow-up. No common facilitators were noted. The most feasible ERIC strategies for the barriers identified were accessing new funding, developing and distributing educational materials, developing resource-sharing agreements, and conducting local survivorship care needs assessments.

Conclusions

There are limited existing data evaluating childhood cancer survivorship care barriers in LMICs. Of the studies we identified, low resource availability was a frequently reported barrier. As accessing funding can be difficult, resource sharing of contextually adapted guidelines and educational materials can serve as an implementation strategy to improve survivorship care globally.

^{**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**}

✪ HIV Prevention for People Releasing from Incarceration: A Qualitative Pre-implementation Study

Abstract:

Background

Release from prison or jail is a high-risk time for HIV acquisition, yet prior efforts to expand access to pre-exposure prophylaxis (PrEP) and other HIV prevention services for people releasing from jail or prison have faced substantial implementation barriers.

Objective

Characterize the implementation landscape for HIV prevention for people releasing from prison or jail in Washington State, gathering input from staff at carceral institutions and community-based organizations to inform implementation of evidence-based HIV prevention strategies.

Design

Qualitative study.

Participants

Healthcare and reentry staff in prisons and jails (n = 15) and staff at community-based organizations that may serve people releasing from jail or prison (n = 20), selected through chain referral sampling.

Approach

Semi-structured qualitative interviews were conducted to theoretical saturation, then coded using a mixed inductive-deductive approach, based on the Consolidated Framework for Implementation Research.

Key Results

Carceral institutions had few programs aimed specifically at HIV prevention. Carceral institutions had PrEP available but did not offer it widely, focusing on behavioral health or acute medical needs. Some community-based organizations offered PrEP or other forms of HIV prevention, but many focused on meeting basic needs or building community. Five themes characterized the implementation landscape for HIV prevention: 1) primacy of basic needs means HIV prevention is lower priority, 2) adding HIV prevention programming would require new funding, 3) differences in culture and philosophy influence interest in providing PrEP, 4) disconnection between carceral institutions and providers in the community limits linkage to care, 5) organizations balance protecting confidentiality while coordinating care.

Conclusion

Rather than directly focusing on HIV prevention, carceral institutions and community-based organizations often focused on substance use disorder treatment, and there are opportunities to integrate additional HIV prevention education and interventions into substance use care. Closer relationships between carceral institutions and community organizations may improve care coordination but would require staff capacity.

^{**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**}

✪ Protocol for the process evaluation of a randomised clinical trial of incremental-start versus conventional haemodialysis: the TwoPlus study

Authors:

Mariana Murea, Kristie L Foley, Samir C Gautam, Jennifer E Flythe , Jochen G Raimann, Emaad Abdel-Rahman, Alaa S Awad, Vandana Dua Niyyar, Cassandra Kovach, Glenda V Roberts, Nicole M Jefferson, Paul T Conway, Laura M Rosales, Jobira Woldemichael, Hiba I Sheikh, Gaurav Raman, Anne M Huml, Daphne H Knicely, Irtiza Hasan, Bhaktidevi Makadia , Janice Lea, John T Daugirdas, Nihan Gencerliler, Jasmin Divers, Peter Kotanko, TwoPlus Research Consortium & Ucheoma C Nwaozuru

^{University of Washington affiliated authors are displayed in bold.}

✪ Open Access

Published: November 2025

Read the full text in the open access journal BMJ Open

Abstract:

Introduction

Process evaluation provides insight into how interventions are delivered across varying contexts and why interventions work in some contexts and not in others. This manuscript outlines the protocol for a process evaluation embedded in a hybrid type 1 effectiveness-implementation randomised clinical trial of incremental-start haemodialysis (HD) versus conventional HD delivered to patients starting chronic dialysis (the TwoPlus Study). The trial will simultaneously assess the effectiveness of incremental-start HD in real-world settings and the implementation strategies needed to successfully integrate this intervention into routine practice. This manuscript describes the rationale and methods used to capture how incremental-start HD is implemented across settings and the factors influencing its implementation success or failure within this trial.

Methods and analysis

We will use the Consolidated Framework for Implementation Research (CFIR) and the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) frameworks to inform process evaluation. Mixed methods include surveys conducted with treating providers (physicians) and dialysis personnel (nurses and dialysis administrators); semi-structured interviews with patient participants, caregivers of patient participants, treating providers (physicians and advanced practice practitioners), dialysis personnel (nurses, dieticians and social workers); and focus group meetings with study investigators and stakeholder partners. Data will be collected on the following implementation determinants: (a) organisational readiness to change, intervention acceptability and appropriateness; (b) inner setting characteristics underlying barriers and facilitators to the adoption of HD intervention at the enrollment centres; (c) external factors that mediate implementation; (d) adoption; (e) reach; (f) fidelity, to assess adherence to serial timed urine collection and HD treatment schedule; and (g) sustainability, to assess barriers and facilitators to maintaining intervention. Qualitative and quantitative data will be analysed iteratively and triangulated following a convergent parallel and pragmatic approach. Mixed methods analysis will use qualitative data to lend insight to quantitative findings. Process evaluation is important to understand factors influencing trial outcomes and identify potential contextual barriers and facilitators for the potential implementation of incremental-start HD into usual workflows in varied outpatient dialysis clinics and clinical practices. The process evaluation will help interpret and contextualise the trial clinical outcomes’ findings.

^{**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**}

✪ Perceptions and practices of long-acting injectable antipsychotic administration in community pharmacies within Washington state: A qualitative implementation science study

Abstract:

Background

Use of long-acting injectable antipsychotics (LAIAs) for schizophrenia are associated with improved medication adherence and reduce relapse and hospitalizations compared to oral antipsychotics; however, despite these advantages LAIAs remain underutilized. Community pharmacies could improve access and reduce logistical barriers to LAIA administration; however, relatively few deliver this service, and we do not yet fully understand why.

Objective

To assess the contextual fit of administering LAIAs in community pharmacies, identify determinants influencing implementation, and inform implementation strategies to optimize and increase LAIA delivery across Washington State.

Methods

Key informant interviews were conducted with community pharmacy staff in Washington State using a hybrid deductive–inductive qualitative approach to explore determinants and compatibility of LAIA administration. Interviews were conducted using a semi-structured guide informed by Proctor's Implementation Outcomes Framework. Using rapid analysis, transcripts were summarized in a structured matrix and coded into a priori domains. Barriers and facilitators were inductively categorized and then deductively-mapped to the Consolidated Framework for Implementation Research domains; recommendations were identified to inform future implementation strategies.

Results

Ten interviews were conducted with 9 community pharmacists and one pharmacy technician. Current practices varied across participants administering LAIAs in community pharmacies. Reimbursement and payment for LAIA administration emerged as the top barrier. Appointment-based models were seen as facilitators by improving predictability for staffing and medication inventory. Participants recommended streamlining reimbursement and turnkey toolkits for training, care coordination, and communication between prescribers.

Conclusion

For community pharmacies within Washington State, payment models and reimbursement present a critical barrier to LAIA administration. Optimizing billing processes, improving funding and contracting mechanisms, and engaging payers may expand LAIA services. These represent both outer-setting and inner-setting factors, meaning that optimizing LAIA administration in community pharmacies will require system-level, multistakeholder involvement and research.

^{**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**}

Tailored strategies to increase the use of an evidence-based psychotherapy for posttraumatic stress disorder: A stepped-wedge randomized trial in military clinics

Authors:

Craig S Rosen, Alan L Peterson, David S Riggs, Christopher K Haddock, Chunki Fong, Stacey Young-McCaughan, Jeffrey Cook, Katherine Anne Comtois, Elisa V Borah, C Adrian Davis, Katherine A Dondanville, Erin P Finley, Sara A Jahnke, Melissa Mistretta, Andrea Neitzer, Shannon Wiltsey-Stirman, Erin R Frick, Olivia Hayes, Spencer Clayton, Allison M Conforte, Araceli Flores, Jeremy Jinkerson , Zachary K Jones, Hana J Kim, Margaret Letendre, Jared S Link, Debra Nofziger, Erik N Ringdahl, John W Waggoner, Craig Woodworth, Emily Ho, Carmen P McLean & TACTICS Research Group

^{University of Washington affiliated authors are displayed in bold.}

Subscription Required for Full Text Access

Published: October 2025

Read the full text in the subscription access journal Journal of Anxiety Disorders

From Tanzania to Washington, DC: Application of the Consolidated Framework for Implementation Research and ADAPT-ITT Model to Guide the Development of a Community-Based PrEP Intervention for Black Adults

Authors:

Waimar Tun, Jennifer Gomez-Berrospi, Samuel Janson, Demarc Hickson, Christian Morris, Julie Pulerwitz, Mamaswatsi Kopeka, Jesse Yao, Rikiyah Mixson, Amanda McHale, Rachel Macey, Christian Buchanan, Bukola Rinola, Naana Koranteng-Yorke, Deanna Kerrigan, Oluwaseun Adebayo Bamodu, Donaldson F. Conserve & BRIDGE Research Team

^{University of Washington affiliated authors are displayed in bold.}

Subscription Required for Full Text Access

Published: October 2025

Read the full text in the subscription access journal AIDS and Behavior

✪ Implementing Social Media Strategies in Community-Partnered HIV Research: Practical Considerations From 3 Ongoing Studies

Abstract:

Background

In recent years, social media has emerged as a pivotal tool in implementation science efforts to address the HIV epidemic. Engaging community partners is essential to ensure the successful and equitable implementation of social media strategies. There is a notable lack of scholarship addressing the operational considerations for studies using social media strategies in community-partnered HIV research. This article seeks to bridge this gap by consolidating field notes and practical considerations derived from 3 ongoing NIH-supported studies focused on Ending the HIV Epidemic in the United States.

Objective

This article aims to inform the design, planning, and implementation of operationally effective community-partnered social media strategies in HIV research, ultimately contributing to enhancements in HIV practice and improved outcomes across the HIV prevention and care continua.

Methods

Supported by the University of California, Los Angeles Rapid, Rigorous, Relevant (3R) Implementation Science Hub, the 3 Ending the HIV Epidemic projects convened to form the community-partnered social media campaigns working group. The working group used the Consolidated Framework for Implementation Research to help identify and organize key barriers and facilitators of relevance to implementation of the projects’ social media strategies. Given the high degree of interrelatedness across reported factors, the working group thematically synthesized the content into 5 practical considerations to inform use of community-partnered social media strategies in HIV research.

Results

The practical considerations identified by the community-partnered social media campaigns working group include the following: (1) the power and pitfalls of social media platforms (ie, opportunities and challenges inherent to social media platforms that may affect use of social media strategies in HIV research), (2) messengers and messages matter (ie, ensuring the appropriateness, acceptability, and quality of social media messengers and content), (3) the significance of the sociopolitical environment (ie, characterizing the sociopolitical environment surrounding HIV and its potential impact on implementing social media strategies to reach priority populations), (4) investing in academic-community partnerships (ie, cultivating positive and productive academic-community partnerships to support implementation of social media strategies in HIV research), and (5) the alignment of the institutional environment and research approach (ie, assessing and working to address features of institutional environments that may impact implementation of social media strategies in community-partnered HIV research).

Conclusion

As use of social media in HIV research and practice continues to grow, the practical considerations presented in this paper can help research teams anticipate factors that may impact implementation of community-partnered social media strategies and take early action to mitigate potential challenges. By understanding and addressing the unique challenges and opportunities of social media in community-partnered HIV research, we can leverage these platforms to accelerate progress toward ending the HIV epidemic.

^{**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**}

✪ Improving fever management of hospitalized children with cancer: barriers, facilitators, and proposed interventions from healthcare providers in Kenya

Abstract:

Children with cancer in lower-middle-income countries (LMICs) are at increased risk of dying from infections. Prompt treatment of fever episodes improves outcomes, yet poorly described challenges impair management. This qualitative study explored healthcare provider perspectives on barriers to and facilitators of inpatient fever management in children with cancer at a public tertiary referral children’s hospital in Kenya. Healthcare providers involved in fever management were recruited. Semi-structured interviews were audio-recorded, transcribed verbatim, and entered into NVivo software. Coding was informed by a theoretical fever framework and the Consolidated Framework for Implementation Research. Thematic analysis and mind mapping identified recurrent themes and subthemes. Strategies were mapped to identified barriers. The sixteen participants included nurses (n = 2), clinicians (n = 6), pharmacists (n = 2), phlebotomists (n = 2), and microbiology laboratory staff (n = 4). We identified three overarching themes: empowerment of healthcare providers and caregivers, the importance of timely management, and teamwork/human resource availability. Healthcare provider attributes served as facilitators: motivation to improve care, eagerness to learn, willingness to change practice, and need for treatment guidance. Factors within the hospital system were barriers, with subthemes including poor communication between cadres, delays in laboratory results, and staffing shortages. Participants suggested knowledge sharing, a treatment guideline, task shifting, and hiring additional healthcare providers as potential interventions. Managing fever episodes in children with cancer is complex, requiring multiple cadres of healthcare providers and caregiver participation. The proposed interventions may overcome barriers, but future studies are needed to assess the effectiveness of these strategies in improving fever management.

^{**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**}

Authors:

✪ Open Access

Read the full text in the open access journal BMC Global Public Health

Abstract:

Background

Methods

Results

Conclusions

Systematic review registration

Authors:

✪ Open Access

Read the full text in the open access journal Implementation Research and Practice

Abstract:

Background

Method

Results

Conclusions

Plain Language Summary

Authors:

✪ Open Access

Read the full text in the open access journal Journal of Cancer Survivorship: Research and Practice

Abstract:

Background

Methods

Results

Conclusions

Authors:

✪ Open Access

Read the full text in the open access journal Journal of General Internal Medicine

Abstract:

Background

Objective

Design

Participants

Approach

Key Results

Conclusion

Authors:

✪ Open Access

Read the full text in the open access journal BMJ Open

Abstract:

Introduction

Methods and analysis

Authors:

✪ Open Access

Read the full text in the open access journal Journal of the American Pharmacy Association

Abstract:

Background

Objective

Methods

Results

Conclusion

Authors:

Subscription Required for Full Text Access

Read the full text in the subscription access journal Journal of Anxiety Disorders

Authors:

Subscription Required for Full Text Access

Read the full text in the subscription access journal AIDS and Behavior

Authors:

✪ Open Access

Read the full text in the open access journal JMIR Public Health Surveillance

Abstract:

Background

Objective

Methods

Results

Conclusion

Authors:

✪ Open Access

Read the full text in the open access journal Frontiers in Oncology

Abstract: