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

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Creator
  • Tu, Shin P
    • Other Affiliation: Department of Internal Medicine, University of California Davis, Suite 2400 , 4150 V Street, Sacramento, CA 95817, USA
  • Herrmann, Alison K
    • Other Affiliation: UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, 650 Charles E. Young Dr. S., A2-125 CHS, Box 690015, Los Angeles, CA 90095-6900, USA
  • Risendal, Betsy
    • Other Affiliation: Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Comprehensive Cancer Center, 13001 E. 17th Place, MSF538, Aurora, CO 80045, USA
  • Calo, William A
    • Other Affiliation: Department of Public Health Sciences, Penn State College of Medicine, Mail Code CH69 | 500 University Drive, Hershey, PA 17033, USA
  • Walker, Timothy J
    • Other Affiliation: University of Texas Health Science Center at Houston, Center for Health Promotion and Prevention Research, School of Public Health, 7000 Fannin St, Houston, TX 77030, USA
  • Weiner, Bryan J
    • Other Affiliation: Department of Global Health, University of Washington, Box 357965, 1510 San Juan Road, Seattle, WA 98195, USA
  • Friedman, Daniela B
    • Other Affiliation: Department of Health Promotion, Education, and Behavior and the Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
  • Fernandez, Maria E
    • Other Affiliation: University of Texas Health Science Center at Houston, Center for Health Promotion and Prevention Research, School of Public Health, 7000 Fannin St, Houston, TX 77030, USA
  • Jacobs, Sara
    • Other Affiliation: Public Health Research Division, RTI International, 3040 East Cornwallis Road, Research Triangle Park, Durham, NC 27709-2194, USA
  • Kegler, Michelle C
    • Other Affiliation: Emory Prevention Research Center, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30033, USA
  • Liang, Shuting
    • Other Affiliation: Emory Prevention Research Center, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30033, USA
  • Williams, Rebecca S
    • Affiliation: N.C. Cancer Hospital, UNC Lineberger Comprehensive Cancer Center, UNC Center for Health Promotion and Disease Prevention, School of Medicine
Abstract
  • Abstract 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.
Date of publication
Identifier
  • doi:10.1186/s13012-018-0736-7
Resource type
  • Article
Rights statement
  • In Copyright
Rights holder
  • The Author(s).
Language
  • English
Bibliographic citation
  • Implementation Science. 2018 Mar 27;13(1):52
Publisher
  • BioMed Central
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