Tailoring the CFIR to Medication Adherence Interventions: A Delphi and Living Lab Study

Area of Science:

• Implementation Science
• Health Services Research
• Pharmacy Practice

Background:

• Medication adherence interventions are often poorly implemented.
• Existing implementation frameworks need context-specific tailoring for effective use.
• Predicting intervention success requires understanding key implementation determinants.

Purpose of the Study:

• To tailor the Consolidated Framework for Implementation Research (CFIR) for medication adherence interventions.
• To assess the predictive accuracy of expert opinion on implementation determinants.
• To compare expert assessments with real-world implementation outcomes.

Main Methods:

• A Delphi study was conducted with experts rating CFIR determinants for medication adherence interventions.
• Four Dutch living labs prospectively evaluated these determinants during intervention implementation.
• Expert ratings were compared against observed importance in practice.

Main Results:

• 16 out of 40 CFIR determinants were identified as important across living labs, primarily related to inner setting, individuals, and process.
• Expert opinions matched real-world practice for only 18 of 40 determinants (45%) regarding importance.
• The CFIR framework was adapted for primary care medication adherence interventions.

Conclusions:

• Tailored determinant frameworks can aid in assessing intervention implementability prior to rollout.
• Expert predictions of implementation importance have limitations; real-world data is crucial.
• Integrating practice-based evidence enhances the utility of implementation frameworks.