Adapted CFIR interview questions (Step 2)

System and Clinic Level Barriers and Facilitators Adapted to Address Adherence	CFIR Guide Root Interview Questions	Adapted Interview Question
Intervention Characteristics
System Level Implications Barriers: Process and cost of tracking Facilitators: Efficacy of need for optimal adherence well documented from clinical trial evidence Provider/clinic Level Implications Barriers: Process and cost of tracking Facilitators: Efficacy of need for optimal adherence well documented from clinical trial evidence	What do influential stakeholders think of the intervention?	In your opinion, what are the most important aspects of a successful lung cancer screening program? How do you define success for a lung cancer screening program?
	Please consider the following aspects of the intervention: duration, scope, intricacy and number of steps involved and whether the intervention reflects a clear departure from previous practices	If you could wave a magic wand, is there anything you change about the work-flow of your LCS program overall? Specific to adherence?
	What costs will be incurred to implement the intervention?	Is cost a current barrier for your magic wand idea? Do you believe cost is a prohibitive parameter for success of your program? Implementation procedures? Adherence?
Outer Setting
System Level Implications: Barriers: Insurance and reimbursement issues Facilitators: None Provider/clinic Level Implications: Barriers: Logistical and cost barriers for LCS participants Facilitators: Barrier reduction and understanding of population being served by LCS program	To what extent were the needs and preferences of the individuals served by your organization considered when deciding to implement the intervention?	To what extent were the needs and preferences of your LCS population considered when deciding on your adherence procedures? Reminder materials? How about the needs and preferences of your ordering providers?
	Have you elicited information from participants regarding their experiences with the intervention?	Have you or your health system asked your LCS participants regarding their experiences with your tracking or reminder procedures?
	Have you heard stories about the experiences of participants with the intervention?	Are you familiar with barriers your LCS participants’ experience that may keep them from being adherent to annual screening/follow-up?  Does your program have any programs or solutions in place to help address these barriers?
Inner Setting
System Level Implications: Barriers: Staffing problems Facilitators: Support for LCS from administrative and leadership team Provider/clinic Level Implications: Barriers: Insurance, adequate staffing, and time requirements to perform shared decision-making. Deficiencies of the electronic health record to find eligible participants also problematic. Facilitators: Giving personnel opportunities to inform LCS process.	How will the infrastructure of your organization (social architecture, age, maturity, size, or physical layout) affect the implementation of the intervention? How will the infrastructure facilitate/hinder implementation of the intervention?	In your opinion, are there certain aspects of your LCS program structure or organization that helps or hinders adherence rates?
	Are meetings, such as staff meetings, held regularly?	Does your LCS program hold regular meetings? Are problem areas and potential solutions discussed at these meetings?
	When you need to get something done or to solve a problem, who are your "go-to" people?	In your opinion, is your screening program leadership receptive to changes in workflow if identified from program personnel?
	Describe activities or initiatives that (appear to) have highest priority for you (for the organization)?	Describe activities or initiatives that appear to have the highest priority for your screening program.
	Do you expect to have sufficient resources to implement and administer the intervention?	Do you believe you have sufficient resources to address the adherence challenge?
	How do you expect to procure necessary resources?	What is the process to procure necessary support and resources for changes in workflow or quality improvement initiatives?
Characteristics of Individuals
System Level Implications: Barrier: Limited awareness and knowledge about LCS and adherence Facilitators: None Provider/clinic Level Implications: Barriers: Low knowledge and awareness among referring providers for shared decision-making and referrals. Patients also unaware of screening and are uncertain of positive results. Facilitators: High knowledge and awareness increases referrals	What do you know about the intervention or its implementation?	In your opinion, are primary care/referring providers knowledgeable about LCS procedures/eligibility/guidelines? Are eligible participants becoming more knowledgeable?
	Do you think the intervention will be effective in your setting?	Do you feel your adherence/tracking/reminder processes are efficient? What are the strengths? What are the weaknesses
Process
System Level Implications: Barriers: Process of setting up tracking mechanisms Facilitators: Having leadership or champion and being able to learn from other LCS programs Provider/clinic Level Implications: Barriers: Institutional policies may complicate clinic processes and availability of resources Facilitators: Buy-in from administration and having a navigator or coordinator to oversee the process	Can you describe the plan for implementing the intervention?	Please tell me about the process your program uses for tracking annual and shorter term follow-up? How many reminders are sent?