168 Chapter 6 which can make it complicated to use. The five domains of the framework are intertwined and interacting, making it hard to determine where points of attention can be placed without iteration. In particular, the domain inner setting consists of many overlapping subdomains with intangible concepts. In addition, a recent systematic review on implementing e-health interventions shows blind spots in current literature about contextual factors (such as the organization), which makes it difficult for clinicians and researchers to understand these concepts and to translate it to clinical practice [41]. In previous literature, other weaknesses of CFIR are mentioned. In their systematic review on PROM implementation, Foster et al. identified the importance of different stages of the implementation process, which is not captured by CFIR [1]. The CFIR can be described as a determinant framework [24]. Determinant frameworks specify which factors (determinants) have a facilitating or inhibiting effect on the implementation. These frameworks thus describe the influence of processes on the implementation outcomes, but do not address these implementation outcomes, in contrary to evaluation frameworks. Therefore, it would be useful to use the CFIR in combination with another type of model. For instance, a widely used model on implementation outcomes is the “conceptual model of implementation research”, as described by Proctor and colleagues [18]. In order to improve outcomes for patients, it is important to be able to determine which determinants relate to which specific implementation outcomes. Only then can be reliably concluded which specific strategies work for which implementation outcomes. The CFIR-ERIC Implementation Strategy Matching tool provided implementation strategies for the identified CFIR barriers [30]. Some of the suggested implementation strategies can be explored and used in the KLIK PROM portal implementation in the upcoming years. For example, assess key stakeholders for readiness is an ongoing process and still a challenge. By conducting individual interviews with the more reluctant clinicians underlying resistance can be better understand and addressed. In addition, identifying expected barriers and facilitators in the implementation process by actively discussing these topics in multidisciplinary team meetings in a more structured way is necessary. Also, incentives for patients in using the KLIK PROM portal could be explored further by increasing patient engagement. However, not all suggested strategies by the matching tool provided new insights as they were directly linked to the perceived barrier (e.g., identify and prepare champions for the barrier ‘champions’ and access new funding for the barrier ‘cost’) and therefore were already known by the KLIK expert team. In addition, some
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