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Learn about implementation science theories, models and frameworks and their application to primary health care and immunization
Comprehensive reference guide for using implementation science theories, models and frameworks in primary health care and immunization

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CFIR: Five Places to Look

Lesson 2 of 8 · about 10 minutes

Goal Use CFIR to list what helps or blocks an immunization activity in your facility or local government area (LGA).

The Consolidated Framework for Implementation Research (CFIR) is a checklist of places to look when something is not working. Its authors updated it in 2022. Its five domains hold 48 named constructs.

Innovatione.g. the HPV vaccineOuter settingState, LGA, community, policy,funding, partners, insecurity,outbreaksInner settingYour PHC or LGA team: staff,cold chain, culture, priorities,communicationIndividualsOIC, vaccinators, LIO, WDC chair,caregivers. Each has a need, capability,opportunity and motivation.Implementation processteaming, planning, engaging, doing,reflecting, adapting
CFIR's five domains. The innovation enters a setting through people, and the implementation process moves it forward over time. A simplified drawing for teaching. OIC: officer-in-charge. LIO: Local Immunization Officer. WDC: Ward Development Committee.
DomainAskNigerian example
InnovationIs the innovation, here vaccination, easy to take up?A single-dose HPV schedule needs no return visit.
Outer settingWhat outside your team shapes the work?Late LGA funds, insecurity, a market rumour.
Inner settingWhat inside your team helps or blocks it?A faulty solar fridge, too few vaccinators.
IndividualsDoes each person have the need, capability, opportunity and motivation to act?A vaccinator unsure how to use the tracking register.
Implementation processDid we plan, engage, review and adapt?Nobody reviews the defaulter list.
From Nigerian researchAdamu and colleagues used CFIR in five PHC facilities in Kano to study a programme aimed at reducing missed opportunities for vaccination. Barriers included vaccine stock-outs, faulty cold chain equipment, a lack of incentives and socio-cultural beliefs.

Draw your boundary first. For a PHC, the LGA sits in the outer setting. For an LGA team, the state does.

Use It on MondayPick one problem. Write the five domains down the side of a page. List one factor per domain with your team in five minutes.

Go deeper: all 48 CFIR constructs · CFIR scan template