13 General introduction number of constructs focusing on different aspects of implementation (Table 1) [30,57]. With the increasing interest in PROM implementation, several barriers have been identified in the literature within the different CFIR domains [30]. Table 1 provides an overview of these barriers. Table 1. Barriers in the PROM implementation described using the CFIR framework Domain Description Barriers identified in literature Intervention characteristics For PROM implementation, the design of PROMs, PROM administration, and feedback, e.g., complexity - PROMs are perceived as burdensome - PROMs are not comparable due to different scoring methods Outer setting External factors that may impact the implementation, e.g., patients’ needs - Patients are not involved in the selection of PROMs - Patients do not have the ability to complete PROMs due to literacy issues Inner setting Internal factors that may impact the implementation, e.g., available resources - Clinicians experience a lack of time - Insufficient support from ICT Characteristics of individuals The views of individuals working with the intervention on implementation, e.g., knowledge about the intervention - Lack of knowledge on how to utilize and interpret PROMs Implementation process Factors related to the implementation process, e.g., planning and evaluation - Difficulties with embedding PROMs in the existing workflow Applying the CFIR model to the KLIK implementation process might yield valuable insights into barriers and facilitators, where after strategies can be identified to optimize the KLIK implementation. The involvement of patients/parents is of great importance in determining these factors. PROMIS To overcome the challenges associated with the burden of completing PROMs (i.e., long completion time, repetitive and irrelevant questions) [58,59], the National Institute of Health (NIH) developed the Patient-Reported Outcomes Measurement Information System (PROMIS®) [60,61]. PROMIS provides a set of person-centred, standardized instruments to measure a broad range of health domains (physical, mental, and social health) in both adults and children [60,62]. In contrast to legacy instruments, based on Classical Test Theory, PROMIS measures were developed according to Item Response Theory (IRT) [63,64]. An important advantage of IRT is the option of using Computerized Adaptive Testing (CAT) [62,63]. With CAT, questions are presented to patients based on their previous responses. In this way, patients answer a few questions per construct to get a reliable score. Consequently PROMIS measures are shorter, items are more tailored to the patients’ situation, and 1
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