Implementation scientists have developed a number of instruments and frameworks to guide implementation of evidence-based interventions (EBI) in real world settings . The Consolidated Framework for Implementation Research (CFIR) is a determinants framework that provides a menu of constructs or determinants (potential barriers and facilitators to implementation) by which to assess and describe context [2-3]. It is among the most widely used implementation frameworks, which makes it a useful tool for reporting and referencing findings across studies . The Organizational Resource and Context Assessment (ORCA) was developed based on the Promoting Action Research into Health Services (PARiHS) framework and assesses PARiHS’ three key domains: strength of evidence for a specific EBI; the favorability of the organizational context for change; and capacities to facilitate the implementation of the EBI. Measurement is based on individuals’ perceptions of factors within these domains [5,6]. The CFIR includes constructs based on the original PARiHS and thus, items within the three domains assessed by the ORCA are conceptually similar to constructs in the CFIR, but do not match directly. Because of similarities, the subscales and individual items of the ORCA could potentially be mapped to CFIR constructs.
Implementation researchers need guidance about how constructs may overlap or link to one another across multiple instruments and frameworks to promote synthesis of findings across studies. In theory, measures could be mapped back to a common set of constructs, catalogued in one or more determinants frameworks . Such a mapping would serve a practical purpose by providing a repository of quantitative measures (ORCA) linked to qualitative constructs (CFIR) that can be used in mixed methods research. Previous work has identified five major reasons for using mixed methods in implementation work including: to use quantitative methods to measure implementation outcomes and qualitative methods to understand process, to conduct both exploratory and confirmatory research, to examine intervention content and context, to incorporate the perspective of consumers of EBIs, and to compensate for one set of methods by the use of another set of methods .
Mapping specific items within a measurement tool, such as the ORCA, to a framework that defines conceptual constructs that are important to implementation research, such as the CFIR, would facilitate more efficient comparison and synthesis of findings across a broader array of studies. Therefore, the purpose of this work was to map the items from the ORCA instrument to CFIR constructs.
Brief overview of the CFIR
The CFIR is a meta-theoretical framework and provides a foundational taxonomy that sought to provide a uniform and defined set of conceptual constructs by which to study the role of context within implementation . The CFIR provides a menu of constructs along with published approaches for using the framework to assess implementation determinants [,8, 9, 10]. The CFIR is widely used; as of February 2020, there were nearly 1700 unique articles in PubMed, citing the original CFIR paper .
The CFIR constructs were derived from 19 different published theories, models and frameworks and are organized in five domains: Intervention characteristics; Outer setting; Inner setting; Characteristics of individuals; and Process. The five domains describe 39 underlying constructs and sub-constructs related to each of the domains under which they are nested.
Brief overview of the ORCA
The ORCA is a self-report, structured survey instrument to assess evidence and organizational-level perceptions, posited to influence implementation of a specific EBI (or discrete set of EBIs). It has been used as part of several evidence-based practice implementation efforts in the Veterans Health Administration and elsewhere [e.g., 12, 13].
The PARIHS framework, on which the ORCA is based, presents a model focused on a multi-level approach (intervention and organization) to implementing EBIs . The ORCA operationalizes constructs in the PARIHS framework and consists of three scales:
Evidence - the nature and strength of the evidence for the proposed change/innovation;
Context - quality of the organizational context to support change; and
Facilitation - organizational capacity to help people change their attitudes, behaviors, skills and ways of thinking and working to facilitate the proposed change/innovation .
Understanding an organization’s perception of the evidence supporting the proposed change/innovation, available resources and context, and capacity to facilitate change will help determine if the organization is ready to implement the EBI . By conducting a readiness assessment, organizations can identify determinants (barriers and facilitators) that can be used to prioritize sites for implementation; guide choices of implementation strategies to improve the likelihood of effective implementation; and/or be measured over time to assess effectiveness of implementation strategies .