Evaluating the utility of an abbreviated Consolidated Framework for Implementation Research (CFIR) for rapid qualitative analysis: a suicide prevention program case study.

Abstract

Background: The Consolidated Framework for Implementation Research (CFIR) is widely used and comprehensive. Yet the number of constructs can overwhelm users and slow qualitative analysis. The Pragmatic Context Assessment Tool (pCAT), an abbreviated CFIR-derived instrument with 14 items, may offer a streamlined approach for rapid qualitative analysis. However, the adequacy of this abbreviated tool for capturing key implementation determinants across different contexts remains unexplored.

Methods: This study assessed whether the pCAT-derived CFIR constructs adequately capture implementation determinants, using a suicide prevention program case study. Semi-structured interviews (n = 16) were conducted across four VA medical centers with frontline mental health providers about the Suicide Prevention 2.0 Clinical Telehealth program (SP 2.0). Using methodological triangulation, we compared rapid directed content analysis using the 14 pCAT-derived constructs versus the full CFIR. The team summarized each interview using a note template that was organized by site. First, we reviewed the interview notes and used an inductive approach to identify barriers and facilitators (determinants). Determinants were copied into a matrix. Second, we conducted deductive coding of the determinants using the abbreviated pCAT construct list. Third, we expanded coding to the full CFIR when determinants did not fit the limited pCAT set. We used a consensus-based process to identify anticipated determinants and finalize the coding.

Results: Of the 14 initial pCAT constructs, 11 were identified in the SP 2.0 dataset, with six representing major cross-site determinants. However, 12 additional constructs from the full CFIR were needed to comprehensively capture all barriers and facilitators, resulting in 23 total relevant constructs. Three pCAT constructs were not identified as relevant determinants. Major facilitators included Innovation Relative Advantage, Communications, Compatibility, and Innovation Deliverer Motivation. Key barriers encompassed Structural Characteristics (work infrastructure), Innovation Deliverer Capability, Reflecting & Evaluating, and Innovation Design. Most added constructs (8 of 12) belonged to the updated CFIR's Individual Roles and Characteristics domain.

Conclusion: The pCAT provides a useful starting point for rapid CFIR analysis when contexts are similar to its original development, capturing most relevant constructs while requiring significantly less analytical resources. However, the abbreviated approach provides incomplete assessment compared to full CFIR analysis. We recommend using pCAT for rapid implementation practice assessments when timely, high level results are prioritized over comprehensiveness but utilizing full CFIR when thorough determinant evaluation is paramount for research purposes.