Key determinants in implementation processes: a systematic review using the Consolidated Framework for Implementation Research (CFIR)

BACKGROUND: Contextual factors, or determinants, are commonly assessed in implementation studies due to their impact on the implementation process. While a substantial number of determinants have been identified, less research has examined the strength of their impact on the implementation process. Identification of key determinants, or those found to play the biggest role in the implementation process more frequently, may assist in guiding implementation of health programs and services. Damschroder & Lowery (2013) developed a rating system to assess which Consolidated Framework for Implementation Research (CFIR) constructs have the strongest impact on implementation. The purpose of this article was to systematically review articles that have utilized this rating system in order to identify key determinants. METHODS: We conducted forward citation searching of articles citing Damschroder & Lowery's (2013) rating criteria in three databases (PubMed, Web of Science, and Google Scholar) in February 2023. Included articles examined the magnitude and valence of factors affecting the implementation process. Quality appraisal was completed using the Mixed Methods Appraisal Tool (MMAT). Articles were included regardless of design, setting, location, or target population. A comprehensive examination of the determinants through numerous graphs and tables was conducted to identify key determinants. RESULTS: Forty-eight articles were included in the final review. Eight key determinants were identified: Leadership Engagement, Formally Appointed Internal Implementation Leaders, Compatibility, Available Resources, External Change Agents, Champions, Relative Advantage, and Key Stakeholders. CONCLUSIONS: A more systematic approach to guiding implementation efforts will lead to the development of effective implementation strategies that could ultimately improve implementation outcomes. While quantifying qualitative data inherently removes some important nuance, by identifying key determinants, we hope to help researchers and practitioners identify which factors are likely to facilitate success of their implementation efforts. TRIAL REGISTRATION: The protocol for this systematic review was published with PROSPERO (CRD42023416340).