Table 2

Applying hard core/soft periphery (HC/SP) definitions to the CMR case study

PerspectiveApplication to empirical findings
Denis et al 19 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 al 4 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.