The Consolidated Framework for Implementation Research (CFIR) User Guide: a five-step guide for conducting implementation research using the framework

The Consolidated Framework for Implementation Research (CFIR) is a determinant framework that includes constructs from many implementation theories, models, and frameworks; it is used to predict or explain barriers and facilitators to implementation success. CFIR is among the most widely applied implementation science frameworks, and after 15 years of use in the field, the framework was updated based on user feedback obtained via literature review and survey. Dissemination of the updated CFIR and accompanying outcomes addendum resulted in hundreds of requests from users for further guidance in applying the framework. In addition, observations of potential and actual misuse of CFIR in grant reviews and published manuscripts were the catalyst for the development of this user guide. As a result, the objective of this article is to provide a user guide and essential tools and templates for using CFIR in implementation research. This user guide was generated from the combined wisdom and experience of the CFIR Leadership Team, which includes the lead developers of the original and updated CFIR (LJD, CMR), and has collectively used CFIR in more than 50 projects. The five steps as well as the tools and templates were finalized via consensus discussions. The five steps below guide users through an entire research project using CFIR and include 1) Study Design; 2) Data Collection; 3) Data Analysis; 4) Data Interpretation; and 5) Knowledge Dissemination. In addition, the article provides a Frequently Asked Questions (FAQs) section based on user queries and six tools and templates: 1) CFIR Construct Example Questions; 2) CFIR Construct Coding Guidelines; 3) Inner Setting Memo Template; 4) CFIR Construct Rating Guidelines; 5) CFIR Construct x Inner Setting Matrix Template; and 6) CFIR Implementation Research Worksheet. This user guide details how to use CFIR in implementation research, from the design of the study through dissemination of findings, answers frequently asked questions, and offers essential tools and templates. We hope this guidance will facilitate appropriate and consistent application of the framework as well as generate feedback and critique to advance the field.