Top

BMC Health Services Research

Published in:

Open Access 01-12-2021 | Care | Research article

Using the Consolidated Framework for Implementation Research to design and implement a perinatal education program in a large maternity hospital

Authors: Sheridan Guyatt, Megan Ferguson, Michael Beckmann, Shelley A. Wilkinson

Published in: BMC Health Services Research | Issue 1/2021

Abstract

Background

Implementation science aims to embed evidence-based practice as ‘usual care’ using theoretical underpinnings to guide these processes. Conceptualising the complementary purpose and application of theoretical approaches through all stages of an implementation project is not well understood and is not routinely reported in implementation research, despite call for this. This paper presents the synthesis and a collective approach to application of a co-design model, a model for understanding need, theories of behaviour change with frameworks and tools to guide implementation and evaluation brought together with the Consolidated Framework for Implementation Research (CFIR).

Method

Using a determinant framework such as the CFIR provides a lens for understanding, influencing, and explaining the complex and multidimensional variables at play within a health service that contribute to planning for and delivering effective patient care. Complementary theories, models, frameworks, and tools support the research process by providing a theoretical and practical structure to understanding the local context and guiding successful local implementation.

Results

This paper provides a rationale for conceptualising the multidimensional approach for implementation using the worked example of a pregnancy, birth, postnatal and early parenting education intervention for expectant and new parents at a large maternity hospital.

Conclusion

This multidimensional theoretical approach provides useful, practical guidance to health service researchers and clinicians to develop project specific rationale for their theoretical approach to implementation projects.

Lewin K, Cartwright D. Field theory in social science : selected theoretical papers. London: Tavistock; 1952.

Australian Institute of Health and Welfare. Australias Mothers and Babies 2016. Perinatal statistics series number 34. Cat.no. PER 97. Canberra: AIHW; 2018.

Olander EK, Smith DM, Darwin Z. Health behaviour and pregnancy: a time for change. J Reprod Infant Psychol. 2018;36(1):1–3. https://doi.org/10.1080/02646838.2018.1408965.CrossRefPubMed

Balogun OO, O'Sullivan EJ, McFadden A, Ota E, Gavine A, Garner CD, et al. Interventions for promoting the initiation of breastfeeding. Cochrane Database Syst Rev. 2016;11(11):CD001688. https://doi.org/10.1002/14651858.CD001688.pub3.CrossRefPubMed

Lumbiganon P, Martis R, Laopaiboon M, Festin MR, Ho JJ, Hakimi M. Antenatal breastfeeding education for increasing breastfeeding duration. Cochrane Database Syst Rev. 2016;12(12):CD006425.PubMed

Levett KM, Smith CA, Bensoussan A, Dahlen HG. Complementary therapies for labour and birth study: a randomised controlled trial of antenatal integrative medicine for pain management in labour. BMJ Open. 2016;6(7):e010691. https://doi.org/10.1136/bmjopen-2015-010691.CrossRefPubMedPubMedCentral

Brown J, Alwan NA, West J, Brown S, McKinlay CJD, Farrar D, et al. Lifestyle interventions for the treatment of women with gestational diabetes. Cochrane Database Syst Rev. 2017;5(5):CD011970. https://doi.org/10.1002/14651858.CD011970.pub2.CrossRefPubMed

Kearns A, Caglia J, ten Hoope-Bender P, Langer A. Antenatal and postnatal care: a review of innovative models for improving availability, accessibility, acceptability and quality of services in low-resource settings. BJOG. 2016;123(4):540–8. https://doi.org/10.1111/1471-0528.13818.CrossRefPubMed

Mahesh PKB, Gunathunga MW, Arnold SM, Jayasinghe C, Pathirana S, Makarim MF, et al. Effectiveness of targeting fathers for breastfeeding promotion: systematic review and meta-analysis. BMC Public Health. 2018;18(1):1140. https://doi.org/10.1186/s12889-018-6037-x.CrossRefPubMedPubMedCentral

10.

Gagnon AJ, Sandall J. Individual or group antenatal education for childbirth or parenthood, or both. Cochrane Database Syst Rev. 2007;3:CD002869. https://doi.org/10.1002/14651858.CD002869.pub2.CrossRef

11.

Queensland Health. Recommendations for antenatal education. Content, development and delivery. Brisbane: Queensland Government; 2018.

12.

Murphy TS. An exploration of the attitudes of attenders and non-attenders towards antenatal education. Midwifery. 2010;26(3):294–303. https://doi.org/10.1016/j.midw.2008.06.005.CrossRef

13.

Svensson J, Barclay L, Cooke M. Effective antenatal education: strategies recommended by expectant and new parents. Jo Perinat Educ. 2008;17(4):33–42. https://doi.org/10.1624/105812408X364152.CrossRef

14.

Artieta-Pinedo I, Paz-Pascual C, Grandes G, Espinosa M. Framework for the establishment of a feasible, tailored and effective perinatal education programme. BMC Pregnancy Childbirth. 2017;17(1):58.CrossRefPubMedPubMedCentral

15.

Womersley K, Ripullone K, Hirst JE. Tackling inequality in maternal health: beyond the postpartum. Future Healthc J. 2021;8(1):31–5. https://doi.org/10.7861/fhj.2020-0275.CrossRefPubMedPubMedCentral

16.

Suto M, Takehara K, Yamane Y, Ota E. Effects of prenatal childbirth education for partners of pregnant women on paternal postnatal mental health and couple relationship: a systematic review. J Affect Disord. 2017;210:115–21. https://doi.org/10.1016/j.jad.2016.12.025.CrossRefPubMed

17.

Daly LM, Horey D, Middleton PF, Boyle FM, Flenady V. The effect of Mobile app interventions on influencing healthy maternal behavior and improving perinatal Health outcomes: systematic review. JMIR Mhealth Uhealth. 2018;6(8):e10012. https://doi.org/10.2196/10012.CrossRefPubMedPubMedCentral

18.

Nieuwenhuijze M, Downe S, Gottfreðsdóttir H, Rijnders M, du Preez A, Vaz RP. Taxonomy for complexity theory in the context of maternity care. Midwifery. 2015;31(9):834–43. https://doi.org/10.1016/j.midw.2015.05.009.CrossRefPubMed

19.

Levett K, Dahlen HG. Perspective: childbirth education in Australia: have we lost our way? Women Birth. 2019;32(4):291–3. https://doi.org/10.1016/j.wombi.2018.05.007.CrossRefPubMed

20.

Cannon S, Lastella M, Vincze L, Vandelanotte C, Hayman M. A review of pregnancy information on nutrition, physical activity and sleep websites. Women Birth. 2020;33(1):35–40. https://doi.org/10.1016/j.wombi.2018.12.007.CrossRefPubMed

21.

Enkin MW, Glouberman S, Groff P, Jadad AR, Stern A. Beyond evidence: the complexity of maternity care. Birth. 2006;33(4):265–9. https://doi.org/10.1111/j.1523-536X.2006.00117.x.CrossRefPubMed

22.

Greenhalgh T. How to improve success of technology projects in health and social care. Public Health Res Pract. 2018;28(3):2831815. https://doi.org/10.17061/phrp2831815.CrossRefPubMed

23.

Wensing M, Grol R. Knowledge translation in health: how implementation science could contribute more. BMC Med. 2019;17(1):88. https://doi.org/10.1186/s12916-019-1322-9.CrossRefPubMedPubMedCentral

24.

Braithwaite J, Churruca K, Long JC, Ellis LA, Herkes J. When complexity science meets implementation science: a theoretical and empirical analysis of systems change. BMC Med. 2018;16(1):63. https://doi.org/10.1186/s12916-018-1057-z.CrossRefPubMedPubMedCentral

25.

Nilsen P. Making sense of implementation theories, models and frameworks. Implementation Sci. 2015;10(1):53-79.

26.

Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ. 2014;348(mar07 3):g1687. https://doi.org/10.1136/bmj.g1687.CrossRefPubMed

27.

Pinnock H, Barwick M, Carpenter CR, Eldridge S, Grandes G, Griffiths CJ, et al. Standards for reporting implementation studies (StaRI) statement. BMJ. 2017;356:i6795. https://doi.org/10.1136/bmj.i6795.CrossRefPubMedPubMedCentral

28.

Hales S, Lesher-Trevino A, Ford N, Maher D, Ramsay A, Tran N. Reporting guidelines for implementation and operational research. Bull World Health Organ. 2016;94(1):58–64. https://doi.org/10.2471/BLT.15.167585.CrossRefPubMed

29.

Borek AJ, Abraham C, Smith JR, Greaves CJ, Tarrant M. A checklist to improve reporting of group-based behaviour-change interventions. BMC Public Health. 2015;15(1):963. https://doi.org/10.1186/s12889-015-2300-6.CrossRefPubMedPubMedCentral

30.

Staniszewska S, Brett J, Simera I, Seers K, Mockford C, Goodlad S, et al. GRIPP2 reporting checklists: tools to improve reporting of patient and public involvement in research. Res Involv Engagem. 2017;3(1):13. https://doi.org/10.1186/s40900-017-0062-2.CrossRefPubMedPubMedCentral

31.

Damschroder LJ. Clarity out of chaos: use of theory in implementation research. Psychiatry Res. 2020;283:112461. https://doi.org/10.1016/j.psychres.2019.06.036.CrossRefPubMed

32.

Cowdell F, Dyson J. How is the theoretical domains framework applied to developing health behaviour interventions? A systematic search and narrative synthesis. BMC Public Health. 2019;19(1):1180. https://doi.org/10.1186/s12889-019-7442-5.CrossRefPubMedPubMedCentral

33.

Gould GS, Bar-Zeev Y, Bovill M, Atkins L, Gruppetta M, Clarke MJ, et al. Designing an implementation intervention with the behaviour change wheel for health provider smoking cessation care for Australian indigenous pregnant women. Implement Sci. 2017;12(1):114. https://doi.org/10.1186/s13012-017-0645-1.CrossRefPubMedPubMedCentral

34.

Murphy A, Gardner D, Kutcher S, Martin-Misener R. A theory-informed approach to mental health care capacity building for pharmacists. Int J Ment Health Syst. 2014;8(1):46.CrossRefPubMedPubMedCentral

35.

Atkins L, Francis J, Islam R, O’Connor D, Patey A, Ivers N, et al. A guide to using the theoretical domains framework of behaviour change to investigate implementation problems. Implement Sci. 2017;12(1):77. https://doi.org/10.1186/s13012-017-0605-9.CrossRefPubMedPubMedCentral

36.

Taylor J, Coates E, Brewster L, Mountain G, Wessels B, Hawley MS. Examining the use of telehealth in community nursing: identifying the factors affecting frontline staff acceptance and telehealth adoption. J Adv Nurs. 2015;71(2):326–37. https://doi.org/10.1111/jan.12480.CrossRefPubMed

37.

Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4(1):50. https://doi.org/10.1186/1748-5908-4-50.CrossRefPubMedPubMedCentral

38.

Barwick M, Dubrowski R, Damschroder L. Factors associated with effective implementation: research and practical implications. In: Albers B, Shlonsky A, Mildon R, editors. Implementation Science 30. Cham: Springer International Publishing; 2020. p. 81–100. https://doi.org/10.1007/978-3-030-03874-8_4.

39.

Nilsen P. Making sense of implementation theories, models, and frameworks. Implementation Science 30: Springer; 2020. p. 53–79.

40.

Lynch EA, Mudge A, Knowles S, Kitson AL, Hunter SC, Harvey G. “There is nothing so practical as a good theory”: a pragmatic guide for selecting theoretical approaches for implementation projects. BMC Health Serv Res. 2018;18(1):857.CrossRefPubMedPubMedCentral

41.

Kitson A, Harvey G, McCormack B. Enabling the implementation of evidence based practice: a conceptual framework. BMJ Qual Saf. 1998;7(3):149–58. https://doi.org/10.1136/qshc.7.3.149.CrossRef

42.

Ilott I, Gerrish K, Booth A, Field B. Testing the consolidated framework for implementation research on health care innovations from South Yorkshire. J Eval Clin Pract. 2013;19(5):915–24. https://doi.org/10.1111/j.1365-2753.2012.01876.x.CrossRefPubMed

43.

Consolidated framework for implementation research guide. https://www.cfirguide.org. Accessed 24 April 2021.

44.

Safaeinili N, Brown-Johnson C, Shaw JG, Mahoney M, Winget M. CFIR simplified: pragmatic application of and adaptations to the consolidated framework for implementation research (CFIR) for evaluation of a patient-centered care transformation within a learning health system. Learn Health Syst. 2020;4(1):e10201. https://doi.org/10.1002/lrh2.10201.CrossRefPubMed

45.

King DK, Shoup JA, Raebel MA, Anderson CB, Wagner NM, Ritzwoller DP, et al. Planning for Implementation Success Using RE-AIM and CFIR Frameworks: A Qualitative Study. Front Public Health. 2020;8:59. https://doi.org/10.3389/fpubh.2020.00059.CrossRefPubMedPubMedCentral

46.

Birken SA, Powell BJ, Presseau J, Kirk MA, Lorencatto F, Gould NJ, et al. Combined use of the Consolidated Framework for Implementation Research (CFIR) and the Theoretical Domains Framework (TDF): a systematic review. Implement Sci. 2017;12(1):2.CrossRefPubMedPubMedCentral

47.

Kumar M, Huang KY, Othieno C, Wamalwa D, Hoagwood K, Unutzer J, et al. Implementing combined WHO mhGAP and adapted group interpersonal psychotherapy to address depression and mental health needs of pregnant adolescents in Kenyan primary health care settings (INSPIRE): a study protocol for pilot feasibility trial of the integrated intervention in LMIC settings. Pilot Feasibility Stud. 2020;6(1):136. https://doi.org/10.1186/s40814-020-00652-8.CrossRefPubMedPubMedCentral

48.

Bryan MA, Smid MC, Cheng M, Fortenberry KT, Kenney A, Muniyappa B, et al. Addressing opioid use disorder among rural pregnant and postpartum women: a study protocol. Addict Sci Clin Pract. 2020;15(1):33. https://doi.org/10.1186/s13722-020-00206-6.CrossRefPubMedPubMedCentral

49.

Whybrow R, Webster L, Girling J, Brown H, Wilson H, Sandall J, et al. Implementation of national antenatal hypertension guidelines: a multicentre multiple methods study. BMJ Open. 2020;10(10):e035762. https://doi.org/10.1136/bmjopen-2019-035762.CrossRefPubMedPubMedCentral

50.

Waltz TJ, Powell BJ, Fernández ME, Abadie B, Damschroder LJ. Choosing implementation strategies to address contextual barriers: diversity in recommendations and future directions. Implement Sci. 2019;14(1):42. https://doi.org/10.1186/s13012-019-0892-4.CrossRefPubMedPubMedCentral

51.

Slattery P, Saeri AK, Bragge P. Research co-design in health: a rapid overview of reviews. Health Res Policy Syst. 2020;18(1):17. https://doi.org/10.1186/s12961-020-0528-9.CrossRefPubMedPubMedCentral

52.

Greenhalgh T, Papoutsi C. Studying complexity in health services research: desperately seeking an overdue paradigm shift. BMC Med. 2018;16(1):95. https://doi.org/10.1186/s12916-018-1089-4.CrossRefPubMedPubMedCentral

53.

IAP2 International Federation. IAP2 Spectrum for Public Participation. Australasia: IAP2; 2018. https://iap2.org.au. Accessed 24 Sept 2020]

54.

Smart J. Needs assessment in: Australian Institute of Family Studies. Southbank, Victoria: Australian Government; 2019.

55.

Wright J, Williams R, Wilkinson JR. Health needs assessment: development and importance of Health needs assessment. BMJ. 1998;316(7140):1310–3. https://doi.org/10.1136/bmj.316.7140.1310.CrossRefPubMedPubMedCentral

56.

World Health Organisation. Framework on integrated people-centred health services. Geneva: World Health Organisation; 2016. https://www.who.int/servicedeliverysafety/areas/people-centred-care/en/. Accessed 24 Sept 2020

57.

Australian Government. Woman-centred care: strategic directions for Australian maternity services was prepared under the auspices of the COAG Health council. Canberra: Department of Health; 2019.

58.

Kunnen N, MacCallum D, Young S. Research strategies for assets and strengths based community development. In: Moulaert F, MacCallum D, Mehmood A, Hamdouch A, editors. The international handbook on social innovation: collective action, social learning and transdisciplinary research. Cheltenham: Edward Elgar Publishing Limited; 2013. p. 285–98. https://doi.org/10.4337/9781849809993.00037.CrossRef

59.

Marosszeky N, Rix MD, Owen AG. Knowing what you need to know about needs assessment. National Health Outcomes Conference. Woolongong: Australian Health Outcomes Collaboration; 2006.

60.

Carver NA, Ward BM, Talbot LA. Using Bradshaw's taxonomy of needs: listening to women in planning pregnancy care. Contemp Nurse. 2008;30(1):76–82. https://doi.org/10.5172/conu.673.30.1.76.CrossRefPubMed

61.

AlDossary S, Martin-Khan MG, Bradford NK, Armfield NR, Smith AC. The development of a telemedicine planning framework based on needs assessment. J Med Syst. 2017;41(5):74. https://doi.org/10.1007/s10916-017-0709-4.CrossRefPubMed

62.

Bradshaw J. Taxonomy of social need. In: McLachlan G, editor. Problems and progress in medical care : essays on current research. London: Oxford University Press; 1972. p. 71–82.

63.

Entsieh AA, Hallström IK. First-time parents’ prenatal needs for early parenthood preparation-a systematic review and meta-synthesis of qualitative literature. Midwifery. 2016;39(C):1–11. https://doi.org/10.1016/j.midw.2016.04.006.CrossRefPubMed

64.

Smith R, Homer C. Literature review on antenatal education - content and delivery. Sydney: Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology, Sydney; 2017.

65.

Glanz K, Rimer BK, Viswanath K. Health behavior and health education : theory, research, and practice. 4th ed. ed. San Francisco: Jossey-Bass; 2008.

66.

Glanz K, Bishop DB. The role of behavioral science theory in development and implementation of public health interventions. Annu Rev Public Health. 2010;31(1):399–418. https://doi.org/10.1146/annurev.publhealth.012809.103604.CrossRefPubMed

67.

Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. J Implementation Science. 2011;6(1):42. https://doi.org/10.1186/1748-5908-6-42.CrossRef

68.

Maddux JE, Gosselin JT. Self-efficacy. In: Leary MR, Tangney JP, editors. Handbook of self and identity. New York: Guilford Press; 2012. p. 198–224.

69.

Bandura A. Social foundations of thought and action : a social cognitive theory. Englewood Cliffs: Prentice-Hall; 1986.

70.

Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84(2):191–215. https://doi.org/10.1037/0033-295X.84.2.191.CrossRefPubMed

71.

Holloway A, Watson HE. Role of self-efficacy and behaviour change. Int J Nurs Pract. 2002;8(2):106–15. https://doi.org/10.1046/j.1440-172x.2002.00352.x.CrossRefPubMed

72.

Willcox JC, Wilkinson SA, Lappas M, Ball K, Crawford D, McCarthy EA, et al. A mobile health intervention promoting healthy gestational weight gain for women entering pregnancy at a high body mass index: the txt4two pilot randomised controlled trial. BJOG. 2017;124(11):1718–28. https://doi.org/10.1111/1471-0528.14552.CrossRefPubMed

73.

Buultjens M, Murphy G, Milgrom J, Poinen D. Improving Conceptual Clarity of Antenatal Interventions: A Scoping Review. J Fam Med Dis Prev. 2016;2(3).

74.

Hoddinott P, Kroll T, Raja A, Lee AJ. Seeing other women breastfeed: how vicarious experience relates to breastfeeding intention and behaviour. Matern Child Nutr. 2010;6(2):134–46. https://doi.org/10.1111/j.1740-8709.2009.00189.x.CrossRefPubMed

75.

de Quattro L. Co-producing childbirth knowledge: a qualitative study of birth stories in antenatal sessions. BMC Pregnancy Childbirth. 2019;19(1):437.CrossRefPubMedPubMedCentral

76.

Armanasco A, Miller Y, Fjeldsoe B, Marshall A. Preventive Health behavior change text message interventions: a Meta-analysis. Am J Prev Med. 2017;52(3):391–402. https://doi.org/10.1016/j.amepre.2016.10.042.CrossRefPubMed

77.

Fernandez ME, Ten Hoor GA, van Lieshout S, Rodriguez SA, Beidas RS, Parcel G, et al. Implementation Mapping: Using Intervention Mapping to Develop Implementation Strategies. Front Public Health. 2019;7:158. https://doi.org/10.3389/fpubh.2019.00158.CrossRefPubMedPubMedCentral

78.

Green LW, Kreuter MW. Health program planning : an educational and ecological approach. 4th ed. Boston: McGraw-Hill; 2005.

79.

Powell BJ, Waltz TJ, Chinman MJ, Damschroder LJ, Smith JL, Matthieu MM, et al. A refined compilation of implementation strategies: results from the expert recommendations for implementing change (ERIC) project. Implement Sci. 2015;10(1):21. https://doi.org/10.1186/s13012-015-0209-1.CrossRefPubMedPubMedCentral

80.

Presseau J, McCleary N, Lorencatto F, Patey AM, Grimshaw JM, Francis JJ. Action, actor, context, target, time (AACTT): a framework for specifying behaviour. Implement Sci. 2019;14(1):102.CrossRefPubMedPubMedCentral

81.

Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 1999;89(9):1322–7. https://doi.org/10.2105/AJPH.89.9.1322.CrossRefPubMedPubMedCentral

82.

Glasgow RE, Estabrooks PE. Pragmatic applications of RE-AIM for health care initiatives in community and clinical settings. Prev Chronic Dis. 2018;15:E02. https://doi.org/10.5888/pcd15.170271.CrossRefPubMedPubMedCentral

83.

RE-AIM (Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance) framework. https://www.re-aim.org. Accessed 24 September 2020.

84.

Pinnock H, Barwick M, Carpenter CR, Eldridge S, Grandes G, Griffiths CJ, et al. Standards for reporting implementation studies (StaRI): explanation and elaboration document. BMJ Open. 2017;7(4):e013318. https://doi.org/10.1136/bmjopen-2016-013318.CrossRefPubMedPubMedCentral

Title: Using the Consolidated Framework for Implementation Research to design and implement a perinatal education program in a large maternity hospital
Authors: Sheridan Guyatt
Megan Ferguson
Michael Beckmann
Shelley A. Wilkinson
Publication date: 01-12-2021
Publisher: BioMed Central
Keyword: Care
Published in: BMC Health Services Research / Issue 1/2021
Electronic ISSN: 1472-6963
DOI: https://doi.org/10.1186/s12913-021-07024-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Using the Consolidated Framework for Implementation Research to design and implement a perinatal education program in a large maternity hospital

Abstract

Background

Method

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Method

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2021

Development of a brief, generic, modular resource-use measure (ModRUM): cognitive interviews with patients

The impact of personalized clinical decision support on primary care patients’ views of cancer prevention and screening: a cross-sectional survey

A qualitative study on patients’ and their support persons’ preferences for receiving one longer consultation or two shorter consultations when being informed about allogeneic hematopoietic stem cell transplantation

The influence of home care supply on delayed discharges from hospital in England

Validation of the German version of the work and social adjustment scale in a sample of depressed patients

Exploring the usefulness of medical clowns in elevating satisfaction and reducing aggressive tendencies in pediatric and adult hospital wards