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Implementation Science
Published in: Implementation Science 1/2017

Open Access 01-12-2017 | Research

Making sense of complexity in context and implementation: the Context and Implementation of Complex Interventions (CICI) framework

Authors: Lisa M. Pfadenhauer, Ansgar Gerhardus, Kati Mozygemba, Kristin Bakke Lysdahl, Andrew Booth, Bjørn Hofmann, Philip Wahlster, Stephanie Polus, Jacob Burns, Louise Brereton, Eva Rehfuess

Published in: Implementation Science | Issue 1/2017

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Abstract

Background

The effectiveness of complex interventions, as well as their success in reaching relevant populations, is critically influenced by their implementation in a given context. Current conceptual frameworks often fail to address context and implementation in an integrated way and, where addressed, they tend to focus on organisational context and are mostly concerned with specific health fields. Our objective was to develop a framework to facilitate the structured and comprehensive conceptualisation and assessment of context and implementation of complex interventions.

Methods

The Context and Implementation of Complex Interventions (CICI) framework was developed in an iterative manner and underwent extensive application. An initial framework based on a scoping review was tested in rapid assessments, revealing inconsistencies with respect to the underlying concepts. Thus, pragmatic utility concept analysis was undertaken to advance the concepts of context and implementation. Based on these findings, the framework was revised and applied in several systematic reviews, one health technology assessment (HTA) and one applicability assessment of very different complex interventions. Lessons learnt from these applications and from peer review were incorporated, resulting in the CICI framework.

Results

The CICI framework comprises three dimensions—context, implementation and setting—which interact with one another and with the intervention dimension. Context comprises seven domains (i.e., geographical, epidemiological, socio-cultural, socio-economic, ethical, legal, political); implementation consists of five domains (i.e., implementation theory, process, strategies, agents and outcomes); setting refers to the specific physical location, in which the intervention is put into practise. The intervention and the way it is implemented in a given setting and context can occur on a micro, meso and macro level. Tools to operationalise the framework comprise a checklist, data extraction tools for qualitative and quantitative reviews and a consultation guide for applicability assessments.

Conclusions

The CICI framework addresses and graphically presents context, implementation and setting in an integrated way. It aims at simplifying and structuring complexity in order to advance our understanding of whether and how interventions work. The framework can be applied in systematic reviews and HTA as well as primary research and facilitate communication among teams of researchers and with various stakeholders.
Appendix
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Literature
1.
Waters E, Hall BJ, Armstrong R, Doyle J, Pettman TL, de Silva-Sanigorski A. Essential components of public health evidence reviews: capturing intervention complexity, implementation, economics and equity. J Public Health (Oxf). 2011;33:462–5.CrossRef
2.
Wells M, Williams B, Treweek S, Coyle J, Taylor J. Intervention description is not enough: evidence from an in-depth multiple case study on the untold role and impact of context in randomised controlled trials of seven complex interventions. Trials. 2012;13:95.CrossRefPubMedPubMedCentral
3.
Medical Research Council. A framework for development and evaluation of RCTs for complex interventions to improve health. London: Medical Research Council; 2000.
4.
Van Herck P, Vanhaecht K, Deneckere S, Bellemans J, Panella M, Barbieri A, Sermeus W. Key interventions and outcomes in joint arthroplasty clinical pathways: a systematic review. J Eval Clin Pract. 2010;16:39–49.CrossRefPubMed
5.
Rychetnik L, Frommer M, Hawe P, Shiell A. Criteria for evaluating evidence on public health interventions. J Epidemiol Community Health. 2002;56:119–27.CrossRefPubMedPubMedCentral
6.
Morfeld PSR, Builtjes PJH, Groneberg DA, Spallek M. Introduction of a low-emission zone and the effect on air pollutant concentration of particulate matter (PM10)—a pilot study in Munich. Zbl Arbeitsmed. 2013;63:104–15.CrossRef
7.
Fensterer V, Küchenhoff H, Maier V, Wichmann H-E, Breitner S, Peters A, Gu J, Cyrys J. Evaluation of the impact of low emission zone and heavy traffic ban in Munich (Germany) on the reduction of PM10 in ambient air. Int J Environ Res Public Health. 2014;11:5094.CrossRefPubMedPubMedCentral
8.
Atkinson RW, Barratt B, Armstrong B, Anderson HR, Beevers SD, Mudway IS, Green D, Derwent RG, Wilkinson P, Tonne C, Kelly FJ. The impact of the congestion charging scheme on ambient air pollution concentrations in London. Atmos Environ. 2009;43:5493–500.CrossRef
9.
Tonne C, Beevers S, Armstrong B, Kelly F, Wilkinson P. Air pollution and mortality benefits of the London Congestion Charge: spatial and socioeconomic inequalities. Occup Environ Med. 2008;65:620–7.CrossRefPubMed
10.
11.
Green L, Kreuter M. Health program planning: an educational and ecological approach. New York: McGrawhill; 2005.
12.
Meyers DC, Durlak JA, Wandersman A. The Quality Implementation Framework: a synthesis of critical steps in the implementation process. Am J Community Psychol. 2012;50:462–80.CrossRefPubMed
13.
Kitson A, Harvey G, McCormack B. Enabling the implementation of evidence based practice: a conceptual framework. Quality in Health Care. 1998;7:149–58.CrossRefPubMedPubMedCentral
14.
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.
15.
Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O. Diffusion of Innovations in Service Organizations: systematic review and recommendations. Milbank Q. 2004;82:581–629.CrossRefPubMedPubMedCentral
16.
Rogers EM. Diffusion of innovations. 5th ed. Free Press; 2003.
17.
Klein KJ, Sorra JS. The challenge of innovation implementation. Acad Manag Rev. 1996;21:1055–80.
18.
Zahra SA, George G. Absorptive capacity: a review, reconceptualization, and extension. Acad Manag Rev. 2002;27:185–203.
19.
Mathisen GE, Einarsen S, Jorstad K, Bronnick KS. Climate for work group creativity and innovation: Norwegian validation of the team climate inventory (TCI). Scand J Psychol. 2004;45:383–92.CrossRefPubMed
20.
Goh SC, Quon TK, Cousins JB. The organizational learning survey: a re-evaluation of unidimensionality. Psychol Rep. 2007;101:707–21.PubMed
21.
Lubomski LH, Marsteller JA, Hsu YJ, Goeschel CA, Holzmueller CG, Pronovost PJ. The team checkup tool: evaluating QI team activities and giving feedback to senior leaders. Jt Comm J Qual Patient Saf. 2008;34:619–23. 561.CrossRefPubMed
22.
Duckers ML, Wagner C, Groenewegen PP. Developing and testing an instrument to measure the presence of conditions for successful implementation of quality improvement collaboratives. BMC Health Serv Res. 2008;8:172.CrossRefPubMedPubMedCentral
23.
Good L, Nelson D. Effects of person-group and intragroup attitude similarity on perceived group attractiveness and cohesiveness. Psychon Sci. 1971;25:215–7.CrossRef
24.
Marsick VJ, Watkins KE. Demonstrating the value of an organization’s learning culture: the dimensions of the learning organization questionnaire. Adv Dev Hum Resour. 2003;5:132–51.CrossRef
25.
Helfrich CD, Li YF, Mohr DC, Meterko M, Sales AE. Assessing an organizational culture instrument based on the Competing Values Framework: exploratory and confirmatory factor analyses. Implement Sci. 2007;2:13.CrossRefPubMedPubMedCentral
26.
Fineout-Overholt E, Melnyk B. Organizational Culture and Readiness for System-Wide Implementation of EBP (OCR-SIEP) scale. Gilbert: ARCC llc Publishing; 2006.
27.
Stetler CB, Damschroder LJ, Helfrich CD, Hagedorn HJ. A guide for applying a revised version of the PARIHS framework for implementation. Implement Sci. 2011;6.
28.
McCormack B, Kitson A, Harvey G, Rycroft-Malone J, Titchen A, Seers K. Getting evidence into practice: the meaning of ‘context’. J Adv Nurs. 2002;38:94–104.CrossRefPubMed
29.
Pawson R, Greenhalgh T, Harvey G, Walshe K. Realist review—a new method of systematic review designed for complex policy interventions. J Health Serv Res Policy. 2005;10 Suppl 1:21–34.CrossRefPubMed
30.
Rabin BA, Brownson RC, Haire-Joshu D, Kreuter MW, Weaver NL. A glossary for dissemination and implementation research in health. J Public Health Manag Pract. 2008;14:117–23.CrossRefPubMed
31.
Simpson DD. A framework for implementing sustainable oral health promotion interventions. J Public Health Dent. 2011;71:S84–94.CrossRefPubMedCentral
32.
Rehfuess EA, Durao S, Kyamanywa P, Meerpohl JJ, Young T, Rohwer A, Cebha, consortium. An approach for setting evidence-based and stakeholder-informed research priorities in low- and middle-income countries. Bull World Health Organ. 2016;94:297–305.CrossRefPubMed
33.
Rohwer A, Pfadenhauer LM, Burns J, Brereton L, Gerhardus A, Booth A, Oortwijn W, Rehfuess EA. Logic models help make sense of complexity in systematic reviews and health technology assessments. J Clin Epidemiol. 2016.
34.
Morse JM, Mitcham C, Hupcey JE, Tason MC. Criteria for concept evaluation. J Adv Nurs. 1996;24:385–90.CrossRefPubMed
35.
Morse J, Hupcey J, Mitcham C, Lenz E. Choosing a strategy for concept analysis in nursing research: moving beyond Wilson. In: Gift AG, editor. Clarifying concepts in nursing research. New York: Springer; 1997. p. 73–96.
36.
Morse JM. Exploring pragmatic utility: concept analysis by critically appraising the literature. In: Rodgers BL, Knafl K, editors. Concept development in nursing: foundations, techniques, and applications. 2nd ed. Philadelphia: W.B. Saunders; 2000. p. 333–52.
37.
Pfadenhauer LM, Mozygemba K, Gerhardus A, Hofmann B, Booth A, Lysdahl KB, Tummers M, Burns J, Rehfuess EA. Context and implementation: a concept analysis towards conceptual maturity. Z Evid Fortbild Qual Gesundhwes. 2015;109:103–14.CrossRefPubMed
38.
Brereton L, Wahlster P, Lysdahl KB, Mozygemba K, Burns J, Chilcott JB, Ward S, Brönneke JB, Tummers M, Van Hoorn R, Van Der Wilt GJ, Pfadenhauer L, Gerhardus A, Rowher A, Rehfuess E, Oortwijn W, Refolo P, Sacchini D, Leppert W, Blazeviciene A, Preston L, Clark J, Goyder E, on behalf of the INTEGRATE-HTA team. Integrated assessment of home based palliative care with and without reinforced caregiver support: ‘a demonstration of INTEGRATE-HTA methodological guidances’. 2016.
39.
Carroll C, Booth A, Cooper K. A worked example of “best fit” framework synthesis: a systematic review of views concerning the taking of some potential chemopreventive agents. BMC Med Res Methodol. 2011;11:29.CrossRefPubMedPubMedCentral
40.
Burns J, Boogaard H, Turley R, Pfadenhauer LM, van Erp AM, Rohwer AC, Rehfuess E. Interventions to reduce ambient particulate matter air pollution and their effect on health (Protocol). Cochrane Database Syst Rev. 2014; Issue 1. Art. No.: CD010919. doi:10.​1002/​14651858.​CD010919.
41.
Burns J, Polus S, Brereton L, Ward S, Chilcott J, Pfadenhauer L, Rehfuess E. Effectiveness of home-based and reinforced home-based palliative care: a systematic review with semi-structured expert consultations. in submission process 2016.
42.
Pfadenhauer LM, Burns J, Rohwer A, Rehfuess EA. Effectiveness of interventions to reduce exposure to lead through consumer products and drinking water: a systematic review. Environ Res. 2016;147:525–36.CrossRefPubMed
43.
Ostrom E. An assessment of the institutional analysis and development framework. In: Sabatier PA, editor. Theories of the policy process. 1st ed. Colorado: Westview Press; 1999.
44.
Kitson AL, Rycroft-Malone J, Harvey G, McCormack B, Seers K, Titchen A. Evaluating the successful implementation of evidence into practice using the PARiHS framework: theoretical and practical challenges. Implementation science : IS. 2008;3:1–1.CrossRefPubMedPubMedCentral
45.
Dockery DW, Rich DQ, Goodman PG, Clancy L, Ohman-Strickland P, George P, Kotlov T, Committee HEIHR. Effect of air pollution control on mortality and hospital admissions in Ireland. Res Rep Health Eff Inst. 2013;3–109.
46.
Rohwer A, Pfadenhauer LM, Burns J, Brereton L, Gerhardus A, Booth A, Oortwijn W, Rehfuess EA: Logic models help make sense of complexity in systematic reviews and health technology assessments. J Clin Epidemiol. 2016, in press.
47.
Mendel P, Meredith LS, Schoenbaum M, Sherbourne CD, Wells KB. Interventions in organizational and community context: a framework for building evidence on dissemination and implementation in health services research. Adm Policy Ment Health. 2008;35:21–37.CrossRefPubMed
48.
Fellin P. Understanding American communities. In: Rothamn J, Erlich J, Tropman J, editors. Strategies of community organizations. Itasca: Peacock; 1995.
49.
Scott W. Conceptualizing organizational fields: Linking organizations and societal systems. In: Derlien H, Gerhardt U, Scharpf F, editors. Systemrationalitat und Partial Interesse [System Rationality and Partial Interests]. Baden Baden: Nomos Verlagsgesellschaft; 1994. p. 203–21.
50.
Schulz AJ, Israel BA, Lantz P. Instrument for evaluating dimensions of group dynamics within community-based participatory research partnerships. Evaluation and Program Planning. 2003;26:249–62.CrossRef
51.
DiMaggio PJ, Powell WW. The iron cage revisited: institutional isomorphism and collective rationality in organizational fields. Am Sociol Rev. 1983;48:147–60.CrossRef
52.
Aarons GA, Fettes DL, Hurlburt MS, Palinkas LA, Gunderson L, Willging CE, Chaffin MJ. Collaboration, negotiation, and coalescence for interagency-collaborative teams to scale-up evidence-based practice. J Clin Child Adolesc Psychol. 2014;43:915–28.CrossRefPubMedPubMedCentral
53.
Aarons GA, Hurlburt M, Horwitz SM. Advancing a conceptual model of evidence-based practice implementation in public service sectors. Adm Policy Ment Health. 2011;38:4–23.CrossRefPubMed
54.
Fixsen DL, Blase KA, Naoom SF, Wallace F. Core implementation components. Res Soc Work Pract. 2009;19:531–40.CrossRef
55.
Tomoaia-Cotisel A, Scammon DL, Waitzman NJ, Cronholm PF, Halladay JR, Driscoll DL, Solberg LI, Hsu C, Tai-Seale M, Hiratsuka V, et al. Context matters: the experience of 14 research teams in systematically reporting contextual factors important for practice change. Ann Fam Med. 2013;11 Suppl 1:S115–23.CrossRefPubMedPubMedCentral
56.
Bergstrom A, Peterson S, Namusoko S, Waiswa P, Wallin L. Knowledge translation in Uganda: a qualitative study of Ugandan midwives’ and managers’ perceived relevance of the sub-elements of the context cornerstone in the PARIHS framework. Implement Sci. 2012;7:117.CrossRefPubMedPubMedCentral
57.
Helfrich CD, Li Y-F, Sharp ND, Sales AE. Organizational readiness to change assessment (ORCA): Development of an instrument based on the Promoting Action on Research in Health Services (PARIHS) framework. Implement Sci. 2009;4.
58.
Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84:191–215.CrossRefPubMed
59.
Glisson C, Landsverk J, Schoenwald S, Kelleher K, Hoagwood KE, Mayberg S, Green P, Research Network on Youth Mental H. Assessing the organizational social context (OSC) of mental health services: implications for research and practice. Adm Policy Ment Health. 2008;35:98–113.CrossRefPubMed
60.
Bandura A. Social foundations of thought and action: a social cognitive theory. Prentice Hill: Englewood Cliffs, New Jersey; 1986.
61.
Lehman WE, Greener JM, Simpson DD. Assessing organizational readiness for change. J Subst Abuse Treat. 2002;22:197–209.CrossRefPubMed
62.
Packard T. Organizational change: a conceptual framework to advance the evidence base. J Hum Behav Soc Environ. 2013;23.
63.
Cane J, O’Connor D, Michie S. Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci. 2012;7:37.CrossRefPubMedPubMedCentral
64.
Aunger R, Curtis V. Consolidating behaviour change theory. London: LSHTM/Hygiene Centre for Unilever PLC; 2007.
65.
Rogers EM. Diffusion of innovations. 4th ed. New York: Free Press; 1995.
66.
Fishbein M, Ajzen I. Belief, attitude, intention, and behavior: an introduction to theory and research. Reading, MA: Addison-Wesley; 1975.
67.
Weiner BJ, Lewis MA, Linnan LA. Using organization theory to understand the determinants of effective implementation of worksite health promotion programs. Health Educ Res. 2009;24:292–305.CrossRefPubMed
68.
Emmons KM, Weiner B, Fernandez ME, Tu S-P. Systems antecedents for dissemination and implementation: a review and analysis of measures. Health Educ Behav. 2012;39:87–105.CrossRefPubMed
69.
Flottorp SA, Oxman AD, Krause J, Musila NR, Wensing M, Godycki-Cwirko M, Baker R, Eccles MP. A checklist for identifying determinants of practice: a systematic review and synthesis of frameworks and taxonomies of factors that prevent or enable improvements in healthcare professional practice. Implement Sci. 2013;8.
70.
Hage E, Roo JP, van Offenbeek MAG, Boonstra A. Implementation factors and their effect on e-health service adoption in rural communities: a systematic literature review. BMC Health Serv Res. 2013;13.
71.
Castro F, Barrera M, Martinez C. The cultural adaptation of prevention interventions: resolving tensions between fidelity and fit. Prev Sci. 2004;5:41–5.CrossRefPubMed
72.
Sabatier PA. Theories of the policy process. Westview Press; 2007.
73.
Mozygemba K, Hofmann B, Lysdahl KB, Pfadenhauer L, Van Der Wilt GJ, Gerhardus A. Guidance to assess socio-cultural aspects. In: Lysdahl KB, Mozygemba K, Burns J, Chilcott JB, Brönneke JB, Hofmann B, editors. Guidance for assessing effectiveness, economic aspects, ethical aspects, socio-cultural aspects and legal aspects in complex technologies. 2015.
74.
Victora C, Armstrong Schellenberg J, Huicho L, Amaral J, El Arifeen S, Pariyo G, Manzi F, Scherpbier R, Bryce J, Habicht J. Context matters: interpreting impact findings in child survival evaluations. Health Policy Plan. 2005;20:i18–1.CrossRefPubMed
75.
European Network for Health Technology Assessment (EUnetHTA): HTA Core Model for screening technologies. Work Package 4 Core HTA EUnetHTA Joint Action 2010 - 2012. 2011.
76.
Lehoux P, Williams-Jones B. Mapping the integration of social and ethical issues in health technology assessment. Int J Technol Assess Health Care. 2007;23:9–16.CrossRefPubMed
77.
Potter BK, Avard D, Graham ID, Entwistle VA, Caulfield TA, Chakraborty P, Kennedy C, McGuire M, Griener GG, Montgomery M, et al. Guidance for considering ethical, legal, and social issues in health technology assessment: application to genetic screening. Int J Technol Assess Health Care. 2008;24:412–22.CrossRefPubMed
78.
Statens Beredning för Medicinsk Utvärdering (SBU). Utvärdering av metoder i hälso- og sjukvården, en handbok. Etiska och sociala aspekter. Stockholm: SBU (Statens beredning för medicinsk utvärdering); 2014.
79.
Nash R, Hudson A, Luttrell C. Mapping political context: A toolkit for Civil Society Organisations Overseas Development Institute—Research and Policy in Development Programme; 2006.
80.
Bradford NK, Young J, Armfield NR, Herbert A, Smith AC. Home telehealth and paediatric palliative care: clinician perceptions of what is stopping us? BMC Palliat Care. 2014;13:29.CrossRefPubMedPubMedCentral
81.
Brönneke JB, Hofmann B, Lysdahl KB, Van Der Wilt GJ, Buchner B. Guidance to assess legal aspects. In: Lysdahl KB, Mozygemba K, Burns J, Chilcott JB, Brönneke JB, Hofmann B, editors. Guidance for assessing effectiveness, economic aspects, ethical aspects, socio-cultural aspects and legal aspects in complex technologies. 2015.
82.
Metz A, Bartley L. Active implementation frameworks for program success. Zero to One. 2012;32:11–8.
83.
Proctor EK, Powell BJ, McMillen JC. Implementation strategies: recommendations for specifying and reporting. Implement Sci. 2013;8.
84.
May CR, Mair F, Finch T, MacFarlane A, Dowrick C, Treweek S, Rapley T, Ballini L, Ong BN, Rogers A, et al. Development of a theory of implementation and integration: normalization process theory. Implement Sci. 2009;4.
85.
May C. Towards a general theory of implementation. Implement Sci. 2013;8.
86.
87.
Palmer D, Kramlich D. An introduction to the multisystem model of knowledge integration and translation. ANS Adv Nurs Sci. 2011;34:29–38.CrossRefPubMed
88.
Damschroder LJ, Hagedorn HJ. A guiding framework and approach for implementation research in substance use disorders treatment. Psychol Addict Behav. 2011;25:194–205.CrossRefPubMed
89.
Chaudoir SR, Dugan AG, Barr CHI. Measuring factors affecting implementation of health innovations: a systematic review of structural, organizational, provider, patient, and innovation level measures. Implement Sci. 2013;8.
90.
Squires JE, Graham ID, Hutchinson AM, Linklater S, Brehaut JC, Curran J, Ivers N, Lavis JN, Michie S, Sales AE, et al. Understanding context in knowledge translation: a concept analysis study protocol. J Adv Nurs. 2015;71:1146–55.CrossRefPubMed
91.
Rycroft-Malone J, Seers K, Chandler J, Hawkes CA, Crichton N, Allen C, Bullock I, Strunin L. The role of evidence, context, and facilitation in an implementation trial: implications for the development of the PARIHS framework. Implement Sci. 2013;8.
92.
93.
Luoto J, Shekelle PG, Maglione MA, Johnsen B, Perry T. Reporting of context and implementation in studies of global health interventions: a pilot study. Implement Sci. 2014;9:1–9.CrossRef
94.
Mohler R, Kopke S, Meyer G. Criteria for reporting the development and evaluation of complex interventions in healthcare: revised guideline (CReDECI 2). Trials. 2015;16:204.CrossRefPubMedPubMedCentral
95.
Benchimol EI, Smeeth L, Guttmann A, Harron K, Moher D, Petersen I, Sorensen HT, von Elm E, Langan SM, Committee RW. The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement. PLoS Med. 2015;12, e1001885.CrossRefPubMedPubMedCentral
96.
Pinnock H, Epiphaniou E, Sheikh A, Griffiths C, Eldridge S, Craig P, Taylor SJ. Developing standards for reporting implementation studies of complex interventions (StaRI): a systematic review and e-Delphi. Implement Sci. 2015;10:1–10.CrossRef
97.
Moore GF, Audrey S, Barker M, Bond L, Bonell C, Hardeman W, Moore L, O’Cathain A, Tinati T, Wight D, Baird J. Process evaluation of complex interventions: Medical Research Council guidance. BMJ. 2015;350.
98.
World Health Organization, Division of Health Promotion Education and Communication. Health promotion glossary. Geneva: World Health Organization; 1998.
99.
Peters M, Harmsen M, Laurant M, Wensing M. Ruimte voor verandering? Knelpunten en mogelijkheden voor verbeteringen in de patiëntenzorg [Room for improvement? Barriers to and facilitators for improvement of patient care]. Nijmegen: Centre for Quality of Care Research (WOK), Radboud University Nijmegen Medical Centre; 2002.
100.
May C, Finch T, Mair F, Ballini L, Dowrick C, Eccles M, Gask L, MacFarlane A, Murray E, Rapley T, et al. Understanding the implementation of complex interventions in health care: the normalization process model. BMC Health Serv Res. 2007;7:148.CrossRefPubMedPubMedCentral
Metadata
Title
Making sense of complexity in context and implementation: the Context and Implementation of Complex Interventions (CICI) framework
Authors
Lisa M. Pfadenhauer
Ansgar Gerhardus
Kati Mozygemba
Kristin Bakke Lysdahl
Andrew Booth
Bjørn Hofmann
Philip Wahlster
Stephanie Polus
Jacob Burns
Louise Brereton
Eva Rehfuess
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2017
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/s13012-017-0552-5

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