5 Practical Tips for Mapping Barriers and Facilitators to an Implementation Framework
By Dr. Julia E. Moore, Executive Director, and Dr. Sobia Khan, Director of Implementation
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Over the past few years, there has been a growing awareness and understanding of the importance of collecting barriers and facilitators data and mapping it to an implementation framework – in fact, the “how to” of this process is one of the most common questions we receive. While the burgeoning commonality of this practice is an amazing step forward for the application of implementation science, the lack of guidance on the process means that there is still a huge gap. In this Implementation in Action Bulletin, we highlight some of the key resources and tips to guide you in collecting and mapping barriers and facilitators. Essentially, when we say mapping, this is the process of categorizing or coding – taking large pieces of information and distilling them to a central category, code or theme that reflects what that large piece of information is trying to convey. This makes the information more meaningful and manageable to work with. If you’re used to the process of qualitative analysis, these steps will be very familiar to you
Tip 1: Select an appropriate framework
First you need to select an appropriate framework or multiple frameworks to map to your barriers and facilitators. For example, if you are mapping individual level barriers and facilitators, the theoretical domains framework (TDF) is one of the go-to frameworks in implementation science. If you are mapping to contextual level barriers and facilitators, you might use the consolidated framework for implementation research (CFIR), exploration preparation implementation sustainment (EPIS), or integrated - promoting action on research implementation in health services (iPARIHS). If you are collecting individual and contextual level barriers and facilitators, you will need to use one of each.
If you’re mapping to an individual level framework like the TDF, here are some go to resources:
Doing barriers and facilitators assessments with limited time and resources
A guide to using the TDF of behaviour change to investigate implementation problems
If you are mapping to a contextual framework like the CFIR, EPIS, or iPARIHS:
Tip 2: Use quotes to map barriers and facilitators
Having mapped thousands of barriers and facilitators, we have found that one of the most helpful tips in mapping barriers and facilitators is to leave them as direct quotes (assuming that you have collected these barriers and facilitators through qualitative means). When statements are in the form of quotes, it is often easier to understand what the person is trying to tell you. If you don’t have quotes, we recommend using raw data. This is because once barriers and facilitators get grouped into themes, the level of detail needed to map them to certain frameworks sometimes disappears. Let’s walk through a typical example to illustrate. Imagine we are mapping individual level barriers to the TDF.
A commonly reported barrier is: “Resistance to change”. This is an individual-level barrier, but it’s pretty hard to know where to map this to in the TDF. That’s because we don’t have enough information to know why people are resistant to change.
Instead when we use raw data like a quote that someone said, there is more detail for you to grasp what they are trying to convey. For example: “it’s not my job to do X”. If we were mapping to the TDF, we would map this to “social/professional role/identity”. Whenever possible, we recommend using quotes or raw data over themes for your mapping.
When we map barriers and facilitators, sometimes we need to map not only what is said, but also make some inferences to help inform our future implementation of strategies. We recommend considering three different types of mapping:
mapping what people say
mapping what people don’t say
mapping interpretive themes
Tip 3: Map what people say (or write)
It is easiest and most obvious to map what people tell you. Essentially you take their direct quotes and map them to your selected framework.
Tip 4: Look for what people don’t say (or write)
However, sometimes people don’t make any comments about certain construct in your framework that might be really important; the fact that they didn’t say anything may be just as important as the things they did say. A common example is leadership support, which all contextual frameworks (CFIR, EPIS, iPARIHS) tap into. If people did not report that leadership supported the change, the lack of information on leadership support may indicate that leadership is not very supportive. Be careful though - you don’t want to make assumptions, so collecting more data (formally or even informally) is warranted to explore this.
Tip 5: Consider whether there are interpretive themes to inform your implementation strategies
You may also discover that some data does not fit cleanly into the framework domains and/or may require some interpretation to understand important themes – “it seems to be..” or “what they are trying to say is...". You can be interpretive if you have sufficient amounts of data that support your interpretation and if you're working with people who are interpreting the information in the same way. Do not assume your interpretations are correct, but use them as a starting place to collect more information and probe more deeply about certain topics or barriers.
We have just seen an example of this in a project we did collecting barriers and facilitators to physical distancing during the COVID-19 pandemic (note: we have made the data open access, so you are welcome to get a copy of the data – to inform behavior changes or to practice mapping the barriers and facilitators). Many of the themes were directly related to the TDF-mapped data, for example clarity around what is and is not allowed for physical distancing was a frequently described barrier – mapped to knowledge. But there were also interpretive themes. For example, no one directly stated that they wanted acknowledgement and recognition for the changes they have made, but when reading the quotes back to back, we are able to interpret some of the things they said and identified a theme that people wanted recognition add acknowledgement for all of their efforts (mapped to TDF domain “reinforcement”). This information could be valuable in developing implementation strategies and crafting messages to support changes.
We hope these tips help you in your barriers and facilitators mapping.
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