Developing measures to assess constructs from the Inner Setting domain of the Consolidated Framework for Implementation Research

Details

• Alternative Title:
  Implement Sci
• Personal Author:
  Fernandez, Maria E. ; Walker, Timothy J. ; Weiner, Bryan J. ; Calo, William A. ; Liang, Shuting ; Risendal, Betsy ; Friedman, Daniela B. ; Tu, Shin Ping ; Williams, Rebecca S. ; Jacobs, Sara ; Herrmann, Alison K. ; Kegler, Michelle C.
• Description:
  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.
  
  
• Subjects:
  Delivery Of Health Care Factor Analysis, Statistical Female Health Plan Implementation Humans Implementation Science Outcome Assessment, Health Care Psychometrics Reproducibility Of Results Research
• Source:
  Implement Sci. 13.
• Pubmed ID:
  29587804
• Pubmed Central ID:
  PMC5870186
• Document Type:
  Journal Article
• Funding:
  U48DP001911/Centers for Disease Control and Prevention/ ; U48 DP001938/DP/NCCDPHP CDC HHS/United States ; R21 CA136460/CA/NCI NIH HHS/United States ; R01 CA124397/CA/NCI NIH HHS/United States ; U48 DP001911/DP/NCCDPHP CDC HHS/United States ; U48DP0010909/Centers for Disease Control and Prevention/ ; U48 DP001936/DP/NCCDPHP CDC HHS/United States ; U48DP001946/Centers for Disease Control and Prevention/ ; R01CA124397/National Cancer Institute/ ; U48 DP001903/DP/NCCDPHP CDC HHS/United States ; U48DP001934/Centers for Disease Control and Prevention/ ; U48DP001938/Centers for Disease Control and Prevention/ ; R25CA116339/National Cancer Institute/ ; U48 DP001946/DP/NCCDPHP CDC HHS/United States ; U48DP001936/Centers for Disease Control and Prevention/ ; U48 DP001924/DP/NCCDPHP CDC HHS/United States ; R25 CA057712/CA/NCI NIH HHS/United States ; R25 CA116339/CA/NCI NIH HHS/United States ; U48DP001924/Centers for Disease Control and Prevention/ ; U48DP001949/Centers for Disease Control and Prevention/ ; U48DP001903/Centers for Disease Control and Prevention/ ; R21CA136460/National Cancer Institute/ ; U48DP001944/Centers for Disease Control and Prevention/ ; R25CA057712/National Cancer Institute/ ; U48 DP001949/DP/NCCDPHP CDC HHS/United States ; U48 DP001934/DP/NCCDPHP CDC HHS/United States
• Volume:
  13
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:4be6eb3eaffce46c869fd0142d16faf1d0f3d52c268a5ffe90e5181bca1f84ef
• Download URL:
  https://stacks.cdc.gov/view/cdc/53736/cdc_53736_DS1.pdf
• File Type:
  [PDF - 532.36 KB ]