Table 3 Factors identified using the Adapted-CFIR influencing PCOM implementation.
Adapted CFIR domains and constructs | Description | Total, n (%) |
|---|---|---|
I Intervention characteristics | Aspects of PCOMs that might affect implementation success in paediatric healthcare | |
Stakeholders’ perception of the source of the PCOM—whether it has been developed internally or externally | 4 (5.8) | |
Stakeholders’ perception of the strength of the evidence supporting the belief that the use of a new PCOM will have the desired outcomes e.g., improve care | 6 (8.7) | |
C. Relative advantage [44,45,46, 48,49,50, 53,54,55,56, 61, 62, 64, 65, 69, 70, 72, 79, 80, 82, 83, 85, 89,90,91, 93, 100, 103, 105, 106, 108, 110] | Whether stakeholders perceive a new PCOMS as advantageous over current practice | 31 (44.9) |
D. Adaptability [42, 52, 55, 57, 72, 78, 94, 100, 106, 108, 109] | The degree to which a new PCOM can be adapted to current systems and practices of the healthcare setting | 11 (15.9) |
E. Trialability | The ability to test the use of a new PCOM on a small scale in the hospital or hospice first, and to be able to revert back to previous practice is necessary | 0 (0) |
F. Complexity [43, 44, 49, 52, 56,57,58,59,60,61,62,63, 65, 67,68,69,70,71,72, 75, 76, 78, 80, 82, 86, 88,89,90, 94, 99, 100, 102,103,104, 106, 108, 110] | Perceived difficulty or challenges for implementing and using a new PCOM in routine practice by stakeholders | 37 (53.6) |
Stakeholder perception of the presentation of the PCOM | 5 (7.2) | |
Cost associated with implementing a new PCOM | 8 (11.6) | |
II. Outer setting | External influences on implementation of a new PCOM | |
The degree to which the healthcare setting is networked with others | 7 (10.1) | |
Pressure experienced by the healthcare setting to implement a new PCOM; typically, because most or other peer healthcare settings have already implemented | 3 (4.3) | |
External influences such as policy, regulations, recommendations, or public/benchmark reporting that encourage or discourage implementing a new PCOM in the healthcare setting | 5 (7.2) | |
III. Inner setting | Characteristics of the implementing healthcare setting | |
The social architecture, age, maturity, and size of the healthcare setting | 4 (5.8) | |
The nature and quality of social networks and communication within a healthcare setting | 6 (8.7) | |
Norms, values, and basic assumptions of the healthcare setting | 2 (2.9) | |
D. Implementation climate | The capacity for change and shared receptivity of individuals involved in implementing a new PCOM and the extent to which it will be rewarded, supported, and expected within the healthcare setting | |
The degree to which stakeholders perceive the need to change current practices | 3 (4.3) | |
2. Compatibility [49, 55, 60, 61, 63, 69, 70, 82, 87, 93, 94, 98,99,100, 108] | The degree of fit between meaning and values attached to the use of the PCOM by healthcare professionals and families, and how those align with their own norms, values, perceived risks and needs, and the extent to which the introduction of a new PCOM fits with existing workflows and systems | 15 (21.7) |
Individuals’ shared perception of the importance of implementation of a new PCOM within the healthcare setting | 5 (7.2) | |
4. Organizational incentives and rewards [50, 55, 61, 67, 82, 108] | Incentives to increase and encourage the use of the PCOM in routine practice such as awards, recognition, or promotions | 6 (8.7) |
5. Goals and feedback [86] | The degree to which the goals of using a new PCOM are clearly communicated, acted upon, and fed back to staff, and the alignment of that feedback with the goals | 1 (1.4) |
6. Learning climate [75] | A climate in which: a) leaders express their own fallibility and need for team members’ assistance and input; b) team members feel that they are essential, valued, and knowledgeable partners in the change process; c) individuals feel psychologically safe to try new methods; and d) there is sufficient time and space for reflective thinking and evaluation | 1 (1.4) |
E. Readiness for implementation | Indicators of healthcare settings' commitment to the decision to implement a new PCOM into routine practice | |
Commitment, involvement, and accountability of leaders and managers of the healthcare setting to the implementation | 6 (8.7) | |
2. Available resources [42, 43, 46, 47, 53, 55, 57, 58, 60, 63, 65, 67, 71, 72, 80, 82, 86, 93,94,95, 98, 101, 108, 109] | The level of resources the healthcare setting dedicates to implementation and on-going use of the PCOM, including money, training, education, and time | 24 (34.8) |
3. Access to knowledge and information [18, 42, 46,47,48, 50, 52, 57, 64, 72, 80, 85, 92, 93, 95, 100, 108] | Ease of access to sufficient and appropriate information and knowledge about the PCOM and how to incorporate it into routine practice | 17 (24.6) |
IV. Individual characteristics | Individual beliefs, knowledge, and attitudes of stakeholders toward a new PCOM and its implementation | |
A. Knowledge and beliefs about the intervention [44, 46, 49,50,51, 53, 55, 57, 58, 61, 67,68,69,70,71,72,73,74, 76, 78,79,80,81, 84,85,86, 89,90,91,92, 94, 100, 102,103,104, 106,107,108] | Individuals’ attitudes toward and value placed on PCOMs and familiarity with their use and impact on care | 37 (53.6) |
Healthcare professionals’ belief in their own capabilities to execute the course of action to achieve implementation goals, and children and parents’ belief in their ability to use the PCOM | 10 (14.5) | |
C. Individual stage of change | The phase an individual is in as they progress toward skilled, enthusiastic, and sustained use of the new PCOM | 0 (0) |
Stakeholders’ perception of their relationship with the healthcare setting | 3 (4.3) | |
E. Other personal attributes [42, 43, 50, 55, 57, 59, 60, 63, 67, 70, 72,73,74, 76, 83, 85, 87, 89,90,91, 93, 96, 99, 108] | Individuals’ attributes that affect implementation such as, motivation, values, experience, capacity, and learning style | 14 (20.3) |
V. Process | Stages of the implementation process that can impact its success | |
The degree to which guidance and tasks for healthcare professionals implementing a new PCOM intervention are developed and agreed upon in advance | 11 (15.9) | |
B. Engaging | Attracting and involving stakeholders in the implementation of the PCOM through social marketing, education, training, or other similar activities | |
Individuals in the healthcare setting who have a formal or informal influence on the attitudes and beliefs of others in relation to the implementation of a new PCOM | 2 (2.9) | |
2. Formally appointed internal implementation leaders [43, 56, 57, 65, 97, 107] | Individuals from within the healthcare setting who have been formally appointed with responsibility for implementing the PCOM | 6 (8.7) |
Individuals who dedicate themselves to driving the implementation of the PCOM and overcoming indifference or resistance to using the PCOM in the healthcare setting | 4 (5.8) | |
Individuals from outside the healthcare setting who formally influence or facilitate the implementation of the PCOM in a desirable direction e.g., commissioners of healthcare services | 4 (5.8) | |
Carrying out or accomplishing the implementation of the PCOM into routine practice according to plan | 7 (10.1) | |
D. Reflecting and evaluating | Quantitative and qualitative feedback about the progress and quality of the implementation of the PCOM accompanied with regular personal and team debriefing about progress and the experience of using the PCOM | 0 (0) |
VI. Patient needs and resources [45, 46, 48, 53, 54, 56, 57, 60, 63, 64, 69, 70, 76, 77, 82, 87, 89,90,91,92, 100, 102, 103, 105, 106, 108] | The extent to which children’s needs, as well as barriers and facilitators to meet those needs, are known and prioritized by the healthcare setting | 25 (36.2) |