Utility of the Consolidated Framework for Implementation Research for the patient perspective; comparison of the framework with a thematic analysis

Background The Consolidated Framework for Implementation Research (CFIR) is widely used in implementation science but rarely applied to the patient perspective. We undertook a theory-informed process evaluation, in a hybrid trial testing real world delivery of an innovation in primary care. The evaluation assessed strategies to incorporate the innovation into everyday clinical practice, from multiple perspectives, including patients. The overall study design was CFIR-informed. Methods We conducted semi-structured interviews with patients. Data were subjected to data-driven, inductive thematic analysis and theory-based, deductive CFIR analyses. We compared our analyses against one another, in terms of the resulting accounts of the patient perspective, assessing the utility of CFIR and comparing the inductive and deductive analyses. Results Our dataset consisted of interviews with 56 patients. The thematic analysis resulted in three themes: experience of living with high cholesterol; views about the treatment; accessing and receiving the treatment. The thematic analysis provided the fullest account of what mattered to patients. The CFIR analysis accommodated most of our data, via 11 constructs across five domains within the framework. Patient preference for general practice as a place, concerns about costs for future financing of the treatment and views on what a future service could look like, were key factors that could impact wider spread. Conclusions Patient preferences, concerns and views expressed in this study could influence uptake of the innovation. The CFIR had good utility for accommodating these implementation determinants and should be applied to patient data generated in other settings and with other innovations. Doing so would increase diversity within the implementation science evidence base. Researchers could also apply the updated CFIR for the patient perspective and further consider the utility of CFIR-based analyses compared with inductive approaches. Trial registration Registration number: NCT04807400 Date of registration: 19/03/2021 Name of the registry: ClinicalTrials.gov URL of trial registry record: https://www.clinicaltrials.gov/study/NCT04807400