154 Chapter 6 community settings in order to improve patient outcomes and benefit population health” [21]. Therefore, a scientific approach to the change process is crucial. In order to know what drives successful implementation of PROMs in clinical practice, we need to study the mechanisms that influence implementation outcomes [17,22,23]. Implementation science models, theories, or frameworks support in identifying factors that influence an implementation process or outcome. In general, three overarching aims of theoretical approaches and five categories of theories, models and frameworks used in implementation science can be distinguished [24]: (1) guiding the process of translating research into practice (process models), (2) understanding and/or explaining what influences implementation outcomes (determinant frameworks, classic theories, and implementation theories), and (3) evaluating implementation (evaluation frameworks). Specifically, determinant frameworks are useful in understanding or explaining what influences implementation outcomes and to support the design of implementation strategies or maximizing the use of enablers to implementation [24]. A widely cited and comprehensive determinant framework in the implementation science literature in health is the Consolidated Framework for Implementation Research (CFIR). Damschroder et al. [22] aimed to develop a framework that comprises common constructs from published implementation theories and includes, therefore, missing key constructs in other theories. It contains 39 constructs which are organized in five general domains: (1) intervention characteristics (e.g., evidence, complexity, adaptability, costs), (2) outer setting (e.g., peer pressure and external policies), (3) inner setting (e.g., structural characteristics, implementation climate, and culture), (4) characteristics of individuals (e.g., knowledge about the intervention and self-efficacy), and (5) implementation process (e.g., planning, engaging stakeholders, champions, and execution), see Fig 3. Determinant frameworks, such as CFIR, are specifically useful in understanding or explaining what influences implementation outcomes and to support the design of implementation strategies or maximizing the use of enablers to implementation [24]. This paper aimed to (A) retrospectively describe the most prominent determinants and reasons of successful KLIK PROM implementation using CFIR and (B) use the CFIR-ERIC Implementation Strategy Matching tool to identify current barriers of the KLIK PROM portal implementation and match implementation strategies that address the identified barriers. In our specific study context, the CFIR framework seemed particularly useful as it covers a wide range of implementation constructs and domains and it allowed
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