title: A systematic review of the use of the Consolidated Framework for Implementation Research.
abstract: BACKGROUND
  In 2009, Damschroder et al. developed the Consolidated Framework for Implementation Research (CFIR), which provides a comprehensive listing of constructs thought to influence implementation. This systematic review assesses the extent to which the CFIR's use in implementation research fulfills goals set forth by Damschroder et al. in terms of breadth of use, depth of application, and contribution to implementation research.
  
  
  METHODS
  We searched Scopus and Web of Science for publications that cited the original CFIR publication by Damschroder et al. (Implement Sci 4:50, 2009) and downloaded each unique result for review. After applying exclusion criteria, the final articles were empirical studies published in peer-review journals that used the CFIR in a meaningful way (i.e., used the CFIR to guide data collection, measurement, coding, analysis, and/or reporting). A framework analysis approach was used to guide abstraction and synthesis of the included articles.
  
  
  RESULTS
  Twenty-six of 429 unique articles (6 %) met inclusion criteria. We found great breadth in CFIR application; the CFIR was applied across a wide variety of study objectives, settings, and units of analysis. There was also variation in the method of included studies (mixed methods (n = 13); qualitative (n = 10); quantitative (n = 3)). Depth of CFIR application revealed some areas for improvement. Few studies (n = 3) reported justification for selection of CFIR constructs used; the majority of studies (n = 14) used the CFIR to guide data analysis only; and few studies investigated any outcomes (n = 11). Finally, reflections on the contribution of the CFIR to implementation research were scarce.
  
  
  CONCLUSIONS
  Our results indicate that the CFIR has been used across a wide range of studies, though more in-depth use of the CFIR may help advance implementation science. To harness its potential, researchers should consider how to most meaningfully use the CFIR. Specific recommendations for applying the CFIR include explicitly justifying selection of CFIR constructs; integrating the CFIR throughout the research process (in study design, data collection, and analysis); and appropriately using the CFIR given the phase of implementation of the research (e.g., if the research is post-implementation, using the CFIR to link determinants of implementation to outcomes).
authors.affiliation: Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-7411, USA. kqmeredi@live.unc.edu.|Performance Measure Development and Implementation Program, RTI International, 3040 Cornwallis Road, Research Triangle Park, NC, 27709, USA. kqmeredi@live.unc.edu.
authors.forename: M Alexis
authors.initials: MA
authors.lastname: Kirk
authors.affiliation: VA Health Services Research & Development Center for Clinical Management Research, VA Ann Arbor Healthcare System, P.O. Box 130170, Ann Arbor, MI, 48113-0170, USA.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Kelley
authors.affiliation: VA Health Services Research & Development Center for Clinical Management Research, VA Ann Arbor Healthcare System, P.O. Box 130170, Ann Arbor, MI, 48113-0170, USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Yankey
authors.affiliation: Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-7411, USA.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Birken
authors.affiliation: Psychology Department, Eastern Michigan University, 341 Science Complex, Ypsilanti, MI, 48197, USA.
authors.forename: Brenton
authors.initials: B
authors.lastname: Abadie
authors.affiliation: VA Health Services Research & Development Center for Clinical Management Research, VA Ann Arbor Healthcare System, P.O. Box 130170, Ann Arbor, MI, 48113-0170, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Damschroder
mesh_terms: D006040:Goals; D006284:Health Plan Implementation; D006302:Health Services Research; D006801:Humans
keywords: Consolidated Framework for Implementation Research; Frameworks; Implementation research; Synthesis; Theory