Healthcare settings and systems have been slow to adopt and implement many effective cancer prevention and control interventions. Understanding the factors that determine successful implementation is essential to accelerating the translation of effective interventions into practice. Many scholars have studied the determinants of implementation, and much of this research has been guided by the Consolidated Framework for Implementation Research (CFIR). The CFIR categorizes implementation determinants at five levels (characteristics of the intervention, inner setting, individual, processes, and outer setting). Of these five levels, determinants at the level of the outer setting are the least developed. Extensive research in fields other than healthcare suggest that determinants at the level of the outer setting (e.g., funding streams, contracting practices, and public policy) play a central role in shaping when and how an organization implements new structures and practices. Thus, a more comprehensive understanding of outer-setting determinants is critical to efforts to accelerate the implementation of effective cancer control interventions. The Cancer Prevention and Control Research Network (CPCRN) created a cross-center workgroup to review organizational theories and begin to contribute to the creation of a future framework of constructs related to outer setting determinants. In this paper, we report findings from the review of three organizational theories: Institutional Theory, Transaction Cost Economics, and Contingency Theory. To demonstrate the applicability of this work to implementation science and practice, we have applied findings to three case studies of CPCRN researchers' efforts to implement colorectal cancer screening interventions in Federally Qualified Health Centers.
Bibliographical noteFunding Information:
This research was funded in part by grants from the Centers for Disease Control and Prevention to the University of North Carolina at Chapel Hill ( U48 DP005017-01S8 ) and the University of Washington ( U48 DP005013-01S1A3 ), through the Prevention Research Center program.
This research was funded in part by grants from the Centers for Disease Control and Prevention to the University of North Carolina at Chapel Hill (U48 DP005017-01S8) and the University of Washington (U48 DP005013-01S1A3), through the Prevention Research Center program. Publication of this supplement was supported by the Cancer Prevention and Control Network (CPCRN), University of North Carolina at Chapel Hill and the following co-funders: Case Western Reserve University, Oregon Health & Science University, University of South Carolina, University of Iowa, University of Kentucky, University of Pennsylvania and University of Washington.
The Cancer Prevention and Control Research Network (CPCRN) is a network of eight centers funded by the Centers for Disease Control and Prevention (CDC) and the National Cancer Institute to accelerate the adoption and implementation of evidence-based cancer prevention and control interventions and reduce cancer burden, especially in underserved populations ( cpcrn.org ). In 2018, the CPCRN created a cross-center workgroup to collaborate on the Organizational Theory in Implementation Science (OTIS) project. Researchers from CPCRN centers at the University of North Carolina at Chapel Hill and University of Washington participated in this workgroup. The aims of the OTIS project are to (1) identify organizational theories that are potentially relevant to implementation, (2) abstract constructs and propositions from each theory related to the outer setting, and (3) consolidate constructs and propositions into a framework. In addition to collaborating on these aims, the CPCRN workgroup developed case studies to illustrate the application of organizational theory to implementation science, building on CPCRN researchers' extensive experience studying the implementation of CRC screening interventions in FQHCs.
© 2019 Elsevier Inc.
- Colorectal cancer screening
- Implementation science
- Organizational theory