159 Assessment of the KLIK PROM portal implementation construct as barrier, this was entered in the matching tool. Specific agreement (both positive and negative, including 95% confidence intervals) was calculated according to De Vet et al. [33] using R. Consequently, the tool provided output with percentages showing which ERIC implementation strategies can best be used to reduce these specific CFIR barriers. Percentages reflect the proportion of panelists endorsing a strategy appropriate for that barrier. Strategies are sorted by the cumulative percentage value. According to the tool, the strategies with the highest cumulative percentages are most effective in reducing the combined identified barriers [30]. In the results, the ten highest cumulative percentages, and, therefore, the overall advised strategies for the specific KLIK barriers will be shown. In addition, for every identified barrier using the CFIR-ERIC tool, the authors discussed what was already done in the past to reduce the impact of this barrier on the KLIK implementation process and the reasons why it still remains a barrier. Results A. Retrospectively describing the most prominent determinants of successful KLIK PROM implementation using CFIR Based on previous research and on multiple years of experience implementing the KLIK PROM portal in clinical practice, the most prominent determinants were identified by the KLIK expert team (Fig 3) and reasons for successful KLIK implementation are depicted in Table 1. Several of the CFIR constructs were not applicable to the implementation of the KLIK PROM portal, unknown or differ too much between the different multidisciplinary teams and hospitals. These constructs include patient needs, networks & communications, culture, relative priority, learning climate, individual identification with organization, other personal attributes, and executing. B. CFIR-ERIC Implementation Strategy Matching Tool to identify current barriers of the KLIK PROM portal implementation Of the 39 CFIR constructs, 13 were identified by the KLIK expert team as current barriers for implementing the PROM portal using the CFIR-ERIC matching tool. The total specific agreement was 68.1% (95% CI 59.6%-77.6%), positive agreement (CFIR barrier) was 75.9% (95% CI 68.1%-84.6%), and negative agreement (no CFIR barrier) was 53.1% (95% CI 44.0%-63.2%). In Table 2 and Fig 3, the 13 barriers are shown. Per barrier is described what is already done as well as the challenges that remain. 6
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