Abstract
Background: The Consolidated Framework for Implementation Research (CFIR) is widely used in implementation science but rarely applied to the patient perspective. We undertook a theory-informed process evaluation, in a hybrid trial testing real world delivery of an innovation in primary care. The evaluation assessed strategies to incorporate the innovation into everyday clinical practice, from multiple perspectives, including patients. The overall study design was CFIR-informed. During our data analysis period, the updated CFIR was published, with an increased emphasis on innovation recipients; this prompted our interest in comparing the two versions of CFIR in terms of their utility for the patient perspective.
Methods: We conducted semi-structured interviews with patients. Data were subjected to data-driven, inductive thematic analysis and theory-based, deductive CFIR analyses, using the original and updated versions of CFIR. We compared our analyses against one another, in terms of the resulting accounts of the patient perspective, assessing the utility of the two versions of CFIR and comparing the inductive and deductive analyses.
Results: Our dataset consisted of interviews with 56 patients. The thematic analysis resulted in three themes: experience of living with high cholesterol; views about the treatment; accessing and receiving the treatment. The thematic analysis provided the fullest account of what mattered to patients. The CFIR analyses accommodated most of our data, via 11 constructs across five domains in the original framework and 16 constructs across four domains in the updated CFIR; the updated version has better utility for the patient perspective. Patient preference for general practice as a place, concerns about costs for future financing of the treatment and views on what a future service could look like, were key factors that could impact wider spread.
Conclusions: Patient preferences, concerns and views expressed in this study could influence uptake of the innovation. The updated CFIR had good utility for accommodating these implementation determinants and should be applied to patient data generated in other settings and with other innovations. Doing so would increase diversity within the implementation science evidence base. Researchers could also further consider the utility of CFIR-based analyses compared with inductive approaches.
Trial registration Registration number: NCT04807400 Date of registration: 19/03/2021 Name of the registry: ClinicalTrials.gov URL of trial registry record: https://www.clinicaltrials.gov/study/NCT04807400