170 Chapter 6 to be taken into account can lead to a more successful implementation in a specific context. The CFIR authors have developed an Interview Guide Tool (https://cfirguide. org/tools/) that can help researchers to question constructs of the CFIR that apply for the specific context. As every individual implementation process is different, also the constructs that are applicable differ. Strengths of this study include the broad view of the retrospective description; multiple populations and multicenter experiences have been taken into account. In addition, the description is based on long-term experience and on published literature. However, this paper has several limitations. First, although a deliberate choice, no standardized qualitative research methods were used in this paper as the aim of this paper was to give a retrospective description of the KLIK PROM implementation process using the CFIR framework with the overarching purpose to create more awareness for the use of implementation science in PROM research. Second, the determinants and barriers for successful KLIK PROM implementation were described based on the experiences of the KLIK expert team (existing of members from two different centers) and this could have led to a selective view from the KLIK expert team. However, the KLIK expert team works closely with a variety of stakeholders on a day-to-day basis, including clinicians, patients and parents. They furthermore provide opportunities for stakeholders to provide feedback during regular evaluation meetings. In addition, recently two evaluation studies were carried out to gain more insight into the perspectives of clinicians [35] and pediatric patients and parents [44]. Thus, even though other stakeholders were not literally represented as co-authors, it can be assumed that their opinions are represented throughout this study. In conclusion, this retrospective approach showed that the CFIR provides clinicians and scientists guidance during a healthcare implementation process and can be used in all phases of implementation, although it is a quite extensive and complex framework with some overlapping constructs. For example, the CFIR can be used retrospectively, reflected in this article, to describe the implementation process and its determinants and to identify remaining barriers. An advantage of using this theoretical framework prior to start of implementation is that clinicians become aware of the possible facilitating determinants and barriers for implementation. Using an implementation science framework, like the CFIR, is recommended for groups starting to use PROMs in clinical care as knowing which factors need to be taken into account can lead to a more successful implementation in a specific context.
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