Table 3.

Barriers and facilitators to implementation of the STEPSTONES transition program according to the consolidated framework for implementation research (CFIR) [16]

CFIR Domain	Facilitators	Barriers
Intervention characteristics	• Clear structure • Useful tools such as HEADDS, transition plan, active learning • Good applicability and alignment to current practices	• Scope of program • Insecurity on the level of adaptation and flexibility of the program
Outer setting	• External demands from patients, caregivers and society on the need for structured transitional care	• Unequal care • Limited support and care to vulnerable groups, i.e., neurodevelopmental conditions • High expectations on implementation but difficulties in finding structures
Inner setting	• Engaged local teams • Existing usual care practices for transitional care that the transition program can dock in too	• Lack of resources, e.g., time, staffing, structures • High staff turnover • Unclear responsibilities within the team
Characteristics of the individuals involved in implementation	• Strong engagement in the team • Local implementation champions • High professional motivation in providing excellent care	• Uncertainties regarding nurse’s role and responsibility in transitional care • Lack of self-efficacy in performing all components of the program, for instance sexual and mental health conversations
Implementation processes	• Local drive to facilitate implementation • Positive attitudes from managers • Good examples of positive implementation initiatives	• Lack of formal coordinator role in some settings • Lack of clear evaluation or follow-up from management • Implementation is dependent on champions