Advancing the use of organization theory in implementation science
Open accessAbstract
Healthcare settings and systems have been slow to adopt and implement many effective cancer prevention and control interventions. Understanding the factors that determine successful implementation is essential to accelerating the translation of effective interventions into practice. Many scholars have studied the determinants of implementation, and much of this research has been guided by the Consolidated Framework for Implementation Research (CFIR). The CFIR categorizes implementation determinants at five levels (characteristics of the intervention, inner setting, individual, processes, and outer setting). Of these five levels, determinants at the level of the outer setting are the least developed. Extensive research in fields other than healthcare suggest that determinants at the level of the outer setting (e.g., funding streams, contracting practices, and public policy) play a central role in shaping when and how an organization implements new structures and practices. Thus, a more comprehensive understanding of outer-setting determinants is critical to efforts to accelerate the implementation of effective cancer control interventions. The Cancer Prevention and Control Research Network (CPCRN) created a cross-center workgroup to review organizational theories and begin to contribute to the creation of a future framework of constructs related to outer setting determinants. In this paper, we report findings from the review of three organizational theories: Institutional Theory, Transaction Cost Economics, and Contingency Theory. To demonstrate the applicability of this work to implementation science and practice, we have applied findings to three case studies of CPCRN researchers' efforts to implement colorectal cancer screening interventions in Federally Qualified Health Centers.
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Users noted the absence of equity considerations, including racism, patriarchy and misogyny, in the CFIR.
“users noted the absence of equity considerations [40, 42], including “more specifically racism, patriarchy and misogyny, that [are] so much a part of the care that we provide” (survey response).”
From The updated consolidated framework for implementation research based on user feedback (2022) · cites this paper as [40]
The Discussion identifies outer-setting determinants that extend CFIR, but does not report users noting an absence of equity considerations. Searches for equity, racism, patriarchy, misogyny, and users’ criticisms found no passage addressing the attributed point; page numbers were unavailable in our copy. (LLM, conf=0.73)
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Bamber, J. D. L., Ahlberg, S., & Cordier, R. (2026) · Global Implementation Research and Applications · doi:10.1007/s43477-026-00249-y
- Authors
- Leeman, J., Baquero, B., Bender, M., Choy-Brown, M., Ko, L. K., Nilsen, P., Wangen, M., & Birken, S. A.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- University of Washington (US)
- University of California, Irvine (US)
- University of Minnesota (US)
- Corresponding author
- Leeman, Jennifer
- ORCID
- Venue
- Preventive Medicine
- Publisher
- Elsevier BV
- Published
- 2019-12
- Volume
- 129
- Pages
- 105832
- ISSN
- 0091-7435 (ISSN-L)
- PMC
- PMC7076554
- OpenAlex
- W2972624834
- Cited by
- 53
- References
- 40
- Citations by year
- 2026: 8 · 2025: 5 · 2024: 6 · 2023: 13 · 2022: 11 · 2021: 8 · 2020: 2
- FWCI
- 7.15
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Preventive Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- Centers for Disease Control and Prevention
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
- Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Organizational Change and Leadership
- Keywords
- implementation factors, organizational theory, institutional theory, transaction cost economics, contingency theory, Consolidated Framework for Implementation Research, colorectal cancer screening, federally qualified health centers, translation of evidence into practice, public policy
- MeSH terms
- Implementation Science, Delivery of Health Care, Humans, Colorectal Neoplasms, Early Detection of Cancer
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