Use of the Consolidated Framework for Implementation Research (CFIR) 2.0 and the Theoretical Domains Framework (TDF) to guide implementation of communication partner training in acquired brain injury: a qualitative focus group study

Background Communication partner training (CPT) is an effective treatment for cognitive-communication disorders (CCD) following an acquired brain injury and is recommended as part of evidence-based practice. Despite this, its uptake in routine clinical practice remains limited. Concepts from implementation science can be leveraged to identify multi-level determinants and guide solutions. This study aims to explore the perspectives of speech and language therapists (SLT) on barriers and facilitators to providing CPT and identify implementation strategies. Methods This qualitative descriptive study used focus groups with a purposive sample of 17 UK-based SLTs. Three online focus groups were conducted, with two sessions for each group. A topic guide was used, with questions guided by the Consolidated Framework for Implementation Research 2.0 (CFIR) and the Theoretical Domains Framework (TDF). Data were deductively analysed using CFIR 2.0 (outer setting, inner setting and individual domains) and TDF for individual barriers and facilitators. A CFIR 2.0 codebook was created to aid data coding. Strategies suggested by participants were coded using manifest content analysis and matched to Expert Recommendations for Implementing Change (ERIC) strategies using the CFIR-ERIC Implementation Strategy Matching Tool. Results Seventeen SLTs participated in the focus groups. Data were coded to 23 CFIR 2.0 constructs across three domains (outer setting n=7; inner setting n=9; individuals n=7). The most prominent constructs, discussed in all three groups, included Partnerships & Connections, External Pressure and Policies & Laws (outer setting) ; Culture, Relational Connections, Available Resources, Structural Characteristics and Compatibility (inner setting) and Innovation Deliverers and Innovation Recipients (individuals). Data from the individual’s domain was further coded to 12 TDF domains including Knowledge and Skills (Capability), Beliefs about Capabilities (Motivation), and Environmental Context and Resources (Opportunity). Participants generated 21 strategies and the research team added three (24 in total). These were grouped as foundational (n=10), supporting (n=10) and system-level (n=5) strategies, with one strategy in two groups. Participants provided concrete examples of strategies that may guide implementation of CPT. Conclusions Implementation science frameworks provided a structured approach to identifying contextual factors influencing the delivery of CPT in routine clinical practice, thereby informing strategies to support implementation. Findings underscore the importance of tailored, context-specific approaches rather than one-size-fits-all solutions. By integrating participant-generated strategies with ERIC-derived strategies, this study offers a set of actionable, practice-relevant approaches to support the implementation of CPT in clinical settings.