Tailoring the CFIR to medication adherence interventions: a Delphi and living lab study.

Objective
The implementation of medication adherence interventions is suboptimal. To guide implementation, this study aimed to tailor an existing implementation determinant framework to support the assessment of the implementability of such interventions in a specific context prior to implementation, and to investigate whether experts can assess in advance which determinants are important for implementing medication adherence interventions. 

Method
In a Delphi study, experts rated determinants based on constructs of the Consolidated Framework for Implementation Research (CFIR) in terms of their importance for implementing medication adherence interventions. Determinants were then prospectively evaluated in four Dutch living labs implementing medication adherence interventions. The results were compared to assess agreement between expert opinion and real-world practice. 

Results
Of 40 evaluated CFIR determinants, 16 were important in the majority of the living labs. These determinants concerned the inner setting, characteristics and roles of involved individuals, and implementation process domains of the CFIR. After comparing the prospective evaluation with Delphi results, expert opinions matched living lab observations for 18 out of 40 determinants (45%) regarding (un)importance. The CFIR was tailored to primary care medication adherence interventions based on practice observations, offering a potentially helpful framework to assess implementability of these interventions in specific contexts in advance. 

Conclusion
Determinant frameworks could benefit from incorporating real-world practice data.