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While evidence-based research has been recognized as critical to addressing health concerns and tailoring interventions, appropriate methods of health delivery into communities or organizations are rarely included. The Consolidated Framework for Implementation Research (CFIR) is a systemic approach to guiding research, implementation of health delivery interventions, and rapid-cycle evaluation, all aimed at meeting the practical needs of involved stakeholders (Keith, Crosson, O’Malley, Cromp, & Taylor, 2017).
CFIR consists of five domains, each with numerous constructs and subconstructs. The first is intervention characteristics, which are adapted within the given context and include constructs such as complexity and compatibility. The second domain is an outer setting that may either facilitate implementation or create barriers, such as external policies and patient needs. The third and arguably most complex is the inner setting that analyzes everything from resources and culture to the learning climate implementation readiness. The fourth domain is characteristics of individuals that analyze knowledge and beliefs, personal attributes, and the appeal of the intervention. Finally, the last domain is the process of implementation that conceptualizes the planning, engaging execution, and evaluation of the actual intervention (Kegler et al., 2018).
Therefore, following the five domains, and effective diabetes prevention community health program can be established, and will be applied in the following paragraphs. The intervention domain which focuses on the strength and quality of evidence is taken from the numerous cohort studies done on the issue, highlighting the generally positive outcomes of such interventions. The outer setting is analyzed based on community resources and the health needs of the population that require addressing, including the levels of obesity and pre-diabetes among the population, general health access, and income levels, and availability of healthy food choices and fitness-related infrastructure.
The inner setting focuses on culture and engagement, which may vary depending on the community as some cultures inherently promote certain lifestyle choices and food preferences and may not as easily engage with public health interventions due to mistrust or misunderstanding.
Individual characteristics are going to depend on a patient-to-patient basis once the intervention is implemented, but also shapes the general beliefs and attitudes toward the health program, and how appealing the intervention will be in the context of all the previously listed factors. Finally, the process will encompass a carefully developed plan based on community needs and characteristics, a regular evaluation method that will determine the success of the intervention, such as diabetes screenings and BMI monitoring, and a reflection process during which conclusions will be made and findings published for potential replication in other similar programs.
As a model, the CFIR presents numerous opportunities for implementing a highly effective community public health program on diabetes prevention through diet and exercise. It allows to examine community factors such as setting, resources, and population and determine whether certain strategies which have been successful in evidence-based research or other programs would apply in this context. It considers the transferability of findings and implementation factors which have differing influence based on setting and circumstances, while also ensuing evaluation processes to make necessary changes (Damschroder & Lowery, 2013).
The “comprehensive typology of contextual factors” that is a characteristic of CFIR is directly associated with successful implementation in a great variety of contexts (Keith et al., 2017, p. 4). As health care delivery interventions are becoming more common, the evidence-based research and targeted evaluations are better compared to be most effective for a specific community using CFIR by allowing researchers to use standardization and a common approach across “comprehensive implementation of multicomponent interventions” (Keith et al., 2017, p. 11). The organization, coding and analysis, break-down of complex data, and a systemic process and division of implementation procedures are vital to large-scale public health projects.
References
Damschroder, L. J., & Lowery, J. C. (2013). Evaluation of a large-scale weight management program using the consolidated framework for implementation research (CFIR). Implementation Science, 8(51), 1-17. Web.
Kegler, M. C., Liang, S., Weiner, B. J., Tu, S. P., Friedman, D. B., Glenn, B. A., … Fernandez, M. E. (2018). Measuring constructs of the consolidated framework for implementation research in the context of increasing colorectal cancer screening in federally qualified health center. Health Services Research, 53(6), 4178-4203. Web.
Keith, R. E., Crosson, J. C., O’Malley, A. S., Cromp, D., & Taylor, E. F. (2017). Using the Consolidated Framework for Implementation Research (CFIR) to produce actionable findings: A rapid-cycle evaluation approach to improving implementation. Implementation Science, 12(1), 1-12. Web.
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