Abstract
This paper proposes a conceptual framework for understanding the implementation process of a complex intervention concerned with professional role change. The proposed framework holds that the intervention must address three interacting systems (socio-cultural, educational and disciplinary) through which a health professional role is evolved. Each system is operationalized by four dimensions (values, methods, actors and targets). As for the implementation, the framework posits that it can be analyzed, by depicting the barriers and facilitators located within the dimensions of the three interacting systems and within the intervention involved in the process through using the “menu of constructs” approach suggested by the Consolidated Framework for Implementation Research (CFIR). The implications of this framework, on theoretical research and practical levels, are reviewed.
Highlights
Professional role change has been the focus of many policy initiatives in a context of rising social pressures, new technologies, higher demands of care and health needs
We propose a comprehensive framework that includes a holistic view of the three systems interacting with the intervention, that can assist in understanding the numerous potentially relevant factors influencing the implementation through the “menu of constructs” approach identified in the Consolidated Framework for Implementation Research (CFIR)
With the aim of meeting health needs of countries, we propose our framework as a conceptual map to gain a rich understanding to analysis of changes to a health professional role
Summary
Professional role change has been the focus of many policy initiatives in a context of rising social pressures, new technologies, higher demands of care and health needs. The CFIR offers a typology of constructs classified in five key domains, without specifying causal relationships between them, that are critical to successful implementation These domains are identified as: 1) The characteristics of individuals involved with the implementation process represented by five constructs (e.g., knowledge, self-efficacy, stage of change, personal attributes, identification with organization, etc.); 2) The outer setting which refers to the broad environment in which implementation occurs, and includes the political, social and economic context, involving four constructs (e.g., external policy and incentives, patient needs and resources); 3) The inner setting comprises five constructs concerned with features of the organization (e.g., structural characteristics, culture, networks and communication, readiness for implementation, etc.); 4) The characteristics of the intervention influencing implementation which consider eight constructs that must be taken into account (e.g., intervention source, evidence strength and quality, relative advantage, adaptability, complexity); and 5) The process of implementation which is the active change process embracing four essential constructs (planning, engaging, executing, reflecting, evaluating).
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