Applying hard core/soft periphery (HC/SP) definitions to the CMR case study
| Perspective | Application to empirical findings | |
| HC | SP | |
| Denis et al19 | Components that are well defined and fixed CMR/STOPP evidence base is well defined but all components (including the evidence base) were adapted, for example, nothing was fixed | Components that are less clear and more flexible to manipulation by the adopting system All interventions’ components partially met this definition as all components were adapted to some extent |
| Greenhalgh et al4 | Irreducible elements of the innovation itself All CMR components potentially considered HC, due to participants considering all to be irreducible elements due to their interdependent nature | Organisational structures and systems required for the full implementation of the innovation Two spheres of the CMR initiative—‘dependent processes’ and ‘dependent sociocultural issues’—may be considered SP as they represent structures and systems supporting implementation—but also reflected ‘irreducible elements’ of the intervention and therefore could be viewed as both HC and SP |
| Medical Research Council (Craig et al)44 | ‘Active ingredients’ or components essential to achieving good outcomes for consumers at an implementation site All components could be perceived as HC as all were perceived as being required to operationalise the CMR/STOPP evidence base and achieve positive outcomes for patients | Components of an intervention which can be adapted without impacting outcomes Inconclusive. All components were adapted in response to local resources/needs/evidence, and yet these adaptations were viewed as essential to successful implementation and achieving outcomes |
CMR, comprehensive medication review; STOPP, Screening Tool of Older People’s Prescriptions.