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Related to the Outer Setting is the notion of complexity in the Inner Setting Domain. As noted above, the updated CFIR now captures the Structural Characteristics: Physical Infrastructure and Characteristics: Opportunity constructs. Whereas the original CFIR provided guidance for how to operationalize the concept of complexity, the updated CFIR now provides examples of how these constructs can be operationalized, such as by using the Complexity Index. The updated CFIR also provides examples of how Characteristics: Opportunity can be operationalized. The updated CFIR includes examples of how to operationalize the Special Disadvantages construct. It is important to note that the Special Disadvantages construct is intended to be applied in cases where the innovation necessitates a certain degree of adaptation to the physical or social environment and there is potential for harm if those adaptations are not implemented. This includes inventions or innovations that require funding for large-scale implementations and adaptations. This potential harm can result in innovation implementation failures. This construct can be applied to any innovation that requires adaptations. The updated CFIR therefore provides a useful framework for identifying conditions that may impede or facilitate implementation, such as through the use of context-specific case studies, indicators, and questions. For example, there are more than 20 contexts for implementing innovations to address mental health needs, including Chronic physical and mental illness, Social determinants, and Mental Health. With this in mind, the updated CFIR provides guidance on how to operationalize constructs to identify opportunities and setbacks for innovation implementation in those contexts. The Inner Setting Domain now includes constructs for the social and political context and the risk environment. The updated CFIR also recognizes the importance of Implementation Climate, which may be affected by local beliefs and cultural values. The updated CFIR provides guidance for how to operationalize constructs to measure the belief or trust of an organization in leadership, as well as innovation teams. The updated CFIR also recognizes the importance of contextual factors, such as Compatibility, which are conceptually similar to factors in the original CFIR . The updated CFIR provides guidance for how to operationalize these constructs and offers examples to facilitate interpretation and dissemination of the results of a scoping review.
Additional file 6: Updated CFIR guidance, including the following: (i) Definitions of the CFIR constructs; (ii) Sample list of frequently asked questions; (iii) References for the updated CFIR guidance; and (iv) References for the updated CFIR guidance (e.g., the Background section includes a link to a publication by Kapiriri, Oxfam, and the UNFCCC on the design and development of a new CFIR). 827ec27edc