TY - JOUR
T1 - Developing measures to assess constructs from the Inner Setting domain of the Consolidated Framework for Implementation Research
AU - Fernandez, Maria E.
AU - Walker, Timothy J.
AU - Weiner, Bryan J.
AU - Calo, William A.
AU - Liang, Shuting
AU - Risendal, Betsy
AU - Friedman, Daniela B.
AU - Tu, Shin Ping
AU - Williams, Rebecca S.
AU - Jacobs, Sara
AU - Herrmann, Alison K.
AU - Kegler, Michelle C.
N1 - Funding Information:
This paper describes the work of the Cancer Prevention and Control Research Network (CPCRN) to develop measures for the Inner Setting domain of CFIR and assess the psychometric properties of those measures using data from a multi-state sample of FQHCs. The CPCRN is a group of collaborating centers funded by the Centers for Disease Control and Prevention (CDC) and the National Cancer Institute (NCI), through the Prevention Research Centers Program since 2002 [12, 13]. Each CPCRN center has regional networks of academic, public health, and community organizations that work together to further the dissemination and implementation of EBAs for cancer prevention and control [14]. This article is based on research carried out by the CPCRN FQHC Workgroup. The goal of the FQHC Workgroup was to advance the dissemination and implementation of evidence-based cancer prevention and control programs in FQHCs that provide primary care to underserved populations. Aligned with this goal was the aim to identify factors that influence the implementation of cancer control EBAs beginning with the development of validated measures of CFIR constructs. This study focuses on the development and testing of measures for 7 constructs related to the Inner Setting domain. Work to develop measures of other CFIR constructs is described elsewhere [15].
Funding Information:
This research was supported by the CDC and NIH through Cooperative Agreements supporting Cancer Prevention and Control Research Network centers: U48DP001911, U48DP001949 (UT), U48DP001936 (USC), U48DP0010909 (Emory), U48DP001938, U48DP001934 (UCLA), U48DP001903, U48DP001944, U48DP001946, U48DP001924, and U48DP001938. This research was also supported by the National Cancer Institute grants R01CA124397, R21CA136460, R25CA116339, and R25CA057712. Contents of this manuscript are solely the responsibility of the authors and do not represent the official view of the Centers for Disease Control and Prevention or the National Cancer Institute.
Publisher Copyright:
© 2018 The Author(s).
PY - 2018/3/27
Y1 - 2018/3/27
N2 - Background: Scientists and practitioners alike need reliable, valid measures of contextual factors that influence implementation. Yet, few existing measures demonstrate reliability or validity. To meet this need, we developed and assessed the psychometric properties of measures of several constructs within the Inner Setting domain of the Consolidated Framework for Implementation Research (CFIR). Methods: We searched the literature for existing measures for the 7 Inner Setting domain constructs (Culture Overall, Culture Stress, Culture Effort, Implementation Climate, Learning Climate, Leadership Engagement, and Available Resources). We adapted items for the healthcare context, pilot-tested the adapted measures in 4 Federally Qualified Health Centers (FQHCs), and implemented the revised measures in 78 FQHCs in the 7 states (N=327 respondents) with a focus on colorectal cancer (CRC) screening practices. To psychometrically assess our measures, we conducted confirmatory factor analysis models (CFA; structural validity), assessed inter-item consistency (reliability), computed scale correlations (discriminant validity), and calculated inter-rater reliability and agreement (organization-level construct reliability and validity). Results: CFAs for most constructs exhibited good model fit (CFI>0.90, TLI>0.90, SRMR<0.08, RMSEA<0.08), with almost all factor loadings exceeding 0.40. Scale reliabilities ranged from good (0.7≤α<0.9) to excellent (α≥0.9). Scale correlations fell below 0.90, indicating discriminant validity. Inter-rater reliability and agreement were sufficiently high to justify measuring constructs at the clinic-level. Conclusions: Our findings provide psychometric evidence in support of the CFIR Inner Setting measures. Our findings also suggest the Inner Setting measures from individuals can be aggregated to represent the clinic-level. Measurement of the Inner Setting constructs can be useful in better understanding and predicting implementation in FQHCs and can be used to identify targets of strategies to accelerate and enhance implementation efforts in FQHCs.
AB - Background: Scientists and practitioners alike need reliable, valid measures of contextual factors that influence implementation. Yet, few existing measures demonstrate reliability or validity. To meet this need, we developed and assessed the psychometric properties of measures of several constructs within the Inner Setting domain of the Consolidated Framework for Implementation Research (CFIR). Methods: We searched the literature for existing measures for the 7 Inner Setting domain constructs (Culture Overall, Culture Stress, Culture Effort, Implementation Climate, Learning Climate, Leadership Engagement, and Available Resources). We adapted items for the healthcare context, pilot-tested the adapted measures in 4 Federally Qualified Health Centers (FQHCs), and implemented the revised measures in 78 FQHCs in the 7 states (N=327 respondents) with a focus on colorectal cancer (CRC) screening practices. To psychometrically assess our measures, we conducted confirmatory factor analysis models (CFA; structural validity), assessed inter-item consistency (reliability), computed scale correlations (discriminant validity), and calculated inter-rater reliability and agreement (organization-level construct reliability and validity). Results: CFAs for most constructs exhibited good model fit (CFI>0.90, TLI>0.90, SRMR<0.08, RMSEA<0.08), with almost all factor loadings exceeding 0.40. Scale reliabilities ranged from good (0.7≤α<0.9) to excellent (α≥0.9). Scale correlations fell below 0.90, indicating discriminant validity. Inter-rater reliability and agreement were sufficiently high to justify measuring constructs at the clinic-level. Conclusions: Our findings provide psychometric evidence in support of the CFIR Inner Setting measures. Our findings also suggest the Inner Setting measures from individuals can be aggregated to represent the clinic-level. Measurement of the Inner Setting constructs can be useful in better understanding and predicting implementation in FQHCs and can be used to identify targets of strategies to accelerate and enhance implementation efforts in FQHCs.
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U2 - 10.1186/s13012-018-0736-7
DO - 10.1186/s13012-018-0736-7
M3 - Article
C2 - 29587804
AN - SCOPUS:85044382180
SN - 1748-5908
VL - 13
JO - Implementation Science
JF - Implementation Science
IS - 1
M1 - 52
ER -