title: Combined use of the Consolidated Framework for Implementation Research (CFIR) and the Theoretical Domains Framework (TDF): a systematic review.
abstract: Over 60 implementation frameworks exist. Using multiple frameworks may help researchers to address multiple study purposes, levels, and degrees of theoretical heritage and operationalizability; however, using multiple frameworks may result in unnecessary complexity and redundancy if doing so does not address study needs. The Consolidated Framework for Implementation Research (CFIR) and the Theoretical Domains Framework (TDF) are both well-operationalized, multi-level implementation determinant frameworks derived from theory. As such, the rationale for using the frameworks in combination (i.e., CFIR + TDF) is unclear. The objective of this systematic review was to elucidate the rationale for using CFIR + TDF by (1) describing studies that have used CFIR + TDF, (2) how they used CFIR + TDF, and (2) their stated rationale for using CFIR + TDF.
  
  
  
  We undertook a systematic review to identify studies that mentioned both the CFIR and the TDF, were written in English, were peer-reviewed, and reported either a protocol or results of an empirical study in MEDLINE/PubMed, PsycInfo, Web of Science, or Google Scholar. We then abstracted data into a matrix and analyzed it qualitatively, identifying salient themes.
  
  
  
  We identified five protocols and seven completed studies that used CFIR + TDF. CFIR + TDF was applied to studies in several countries, to a range of healthcare interventions, and at multiple intervention phases; used many designs, methods, and units of analysis; and assessed a variety of outcomes. Three studies indicated that using CFIR + TDF addressed multiple study purposes. Six studies indicated that using CFIR + TDF addressed multiple conceptual levels. Four studies did not explicitly state their rationale for using CFIR + TDF.
  
  
  
  Differences in the purposes that authors of the CFIR (e.g., comprehensive set of implementation determinants) and the TDF (e.g., intervention development) propose help to justify the use of CFIR + TDF. Given that the CFIR and the TDF are both multi-level frameworks, the rationale that using CFIR + TDF is needed to address multiple conceptual levels may reflect potentially misleading conventional wisdom. On the other hand, using CFIR + TDF may more fully define the multi-level nature of implementation. To avoid concerns about unnecessary complexity and redundancy, scholars who use CFIR + TDF and combinations of other frameworks should specify how the frameworks contribute to their study.
  
  
  
  PROSPERO CRD42015027615.
authors.affiliation: Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 1103E McGavran-Greenberg, 135 Dauer Drive, Campus Box 7411, Chapel Hill, NC, 27599-7411, USA. birken@unc.edu.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Birken
authors.affiliation: Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 1105C McGavran-Greenberg, 135 Dauer Drive, Campus Box 7411, Chapel Hill, NC, 27599-7411, USA.
authors.forename: Byron J
authors.initials: BJ
authors.lastname: Powell
authors.affiliation: Centre for Practice Changing Research, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada.
authors.forename: Justin
authors.initials: J
authors.lastname: Presseau
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.|End-of-Life, Palliative, and Hospice Care Program, RTI International, 3040 Cornwallis Road, Research Triangle Park, NC, 27709, Chapel Hill, USA.
authors.forename: M Alexis
authors.initials: MA
authors.lastname: Kirk
authors.affiliation: School of Health Sciences, City University London, Northampton Square, London, EC1V 0HB, UK.
authors.forename: Fabiana
authors.initials: F
authors.lastname: Lorencatto
authors.affiliation: School of Health Sciences, City University London, Northampton Square, London, EC1V 0HB, UK.
authors.forename: Natalie J
authors.initials: NJ
authors.lastname: Gould
authors.affiliation: Department of Health Policy and Management, University of North Carolina at Chapel Hill, 1102C McGavran-Greenberg Hall, CB# 7411, Chapel Hill, NC, 27599-7411, USA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Shea
authors.affiliation: Department of Global Health, Department of Health Services, University of Washington, Box 357965, Seattle, WA, 98195-7965, USA.
authors.forename: Bryan J
authors.initials: BJ
authors.lastname: Weiner
authors.affiliation: School of Health Sciences, City University London, Northampton Square, London, EC1V 0HB, UK.
authors.forename: Jill J
authors.initials: JJ
authors.lastname: Francis
authors.affiliation: Department of Family Medicine, University of Calgary, 8th Floor, Sheldon M. Chumir Health Centre, 1213-4 Street SW, Calgary, Alberta, T2R 0X7, Canada.
authors.forename: Yan
authors.initials: Y
authors.lastname: Yu
authors.affiliation: Department of Health Policy and Management, University of North Carolina at Chapel Hill, 1101B McGavran-Greenberg Hall, CB# 7411, Chapel Hill, NC, 27599-7411, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Haines
authors.affiliation: VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA.|VA Personalizing Options through Veteran Engagement (PROVE) QUERI Program, 2800 Plymouth Road, Building 16, Floor 3, Ann Arbor, MI, 48109, USA.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Damschroder
mesh_terms: D006284:Health Plan Implementation / Q000379:methods*; D006302:Health Services Research / Q000379:methods*; D006801:Humans; D011787:Quality of Health Care
keywords: Consolidated Framework for Implementation Research; Implementation frameworks; Implementation theories; Systematic review; Theoretical Domains Framework