Table 1 Codebook summary by CFIR domain

CFIR domain: outer setting

1

Patient needs and resources

This outer setting characteristic refers to “the extent to which patient needs, as well as barriers and facilitators to meeting those needs, are recognized and prioritized by the organization” in usual care or by the START

2

Linking

Linking is adapted from the Outer Setting code, “Cosmopolitanism” meaning “the degree to which an organization is” or can be “networked with other external organizations.” We adapted this code because of specific features of the START including connecting PWOUD with community clinicians

CFIR domain: intervention characteristics and inner setting

3

Relative advantage and tension for change

Relative advantage is an intervention characteristic meaning “stakeholders’ perception of the advantage of implementing the intervention versus an alternative solution.”

Tension for change is an inner setting characteristic describing “the degree to which stakeholders perceive the current situation as intolerable or needing change.”

Although these codes reflect a mix of intervention/innovation and Inner setting constructs, in the context of the START they are used to address comments that reflect the extent to which there is a sense of urgency or need for the intervention

4

Adaptability and culture

Adaptability is an intervention characteristic on

“the degree to which an innovation can be adapted, tailored, refined, or reinvented to meet local needs.”

Culture is an Inner Setting characteristic describing the “norms, values, and basic assumptions of a given organization”

Although these codes stem from intervention and inner setting domains, they reflect comments that capture the extent to which the intervention may fit different subcultures (including both organizational and patient-oriented cultures) within the hospital setting

CFIR domain: inner setting

5

Clinician/hospital needs and resources

This code is adapted from the inner setting characteristic, implementation climate meaning “The absorptive capacity for change, shared receptivity of involved individuals to an intervention, and the extent to which use of that intervention will be rewarded, supported, and expected within their organization.” Comments focus on organizational topics including clinician experience and acceptability. This code tends to focus on clinicians’ points of view (versus perspectives of people with OUD)

6

Communication

This inner setting code is based on the CFIR characteristic “networks and communications” meaning “the nature and quality of webs of social networks,” and “formal and informal communications” at each site

7

Compatibility

This inner setting characteristic means “the degree of tangible fit between meaning and values attached to the intervention by involved individuals, how those align with individuals’ own norms, values, and perceived risks and needs, and how the intervention fits with existing workflows and systems.”

CFIR domain: process

8

Key stakeholders

Two CFIR categories were used to define the stakeholders code. Opinion Leaders is a Process code pertaining to “individuals in an organization that have formal or informal influence on the attitudes and beliefs of their colleagues with respect to implementing the innovation.”

We also included the process code, “formally appointed internal implementation leaders,” here to address comments about “individuals from within the organization that are directly impacted by the innovation, e.g., staff responsible for making referrals to a new program or using a new work process.”

Sorting codes: codes that are used for double- or m1-8 to allow analysis to explore topics by code category (e.g., “linking” barriers vs. facilitators)

9

Barrier

Excerpts that describe a barrier or constraint. Can include barriers related to either usual care or the implementation of the START intervention

10

Recommendation, facilitator, or idea

Recommendation, facilitator, idea, or suggestion about how to deal with a barrier or constraint. Can include recommendations related to either usual care or the implementation of the START intervention

11

COVID

Comments related to COVID; for example, how COVID has affected services and how it could affect the START intervention