@article{aeee86e75d3541cfaa1e1f8ef18496ff,
title = "Using cognitive interviews to improve a measure of organizational readiness for implementation",
abstract = "Background: Organizational readiness is a key factor for successful implementation of evidence-based interventions (EBIs), but a valid and reliable measure to assess readiness across contexts and settings is needed. The R = MC2 heuristic posits that organizational readiness stems from an organization{\textquoteright}s motivation, capacity to implement a specific innovation, and its general capacity. This paper describes a process used to examine the face and content validity of items in a readiness survey developed to assess organizational readiness (based on R = MC2) among federally qualified health centers (FQHC) implementing colorectal cancer screening (CRCS) EBIs. Methods: We conducted 20 cognitive interviews with FQHC staff (clinical and non-clinical) in South Carolina and Texas. Participants were provided a subset of items from the readiness survey to review. A semi-structured interview guide was developed to elicit feedback from participants using “think aloud” and probing techniques. Participants were recruited using a purposive sampling approach and interviews were conducted virtually using Zoom and WebEx. Participants were asked 1) about the relevancy of items, 2) how they interpreted the meaning of items or specific terms, 3) to identify items that were difficult to understand, and 4) how items could be improved. Interviews were transcribed verbatim and coded in ATLAS.ti. Findings were used to revise the readiness survey. Results: Key recommendations included reducing the survey length and removing redundant or difficult to understand items. Additionally, participants recommended using consistent terms throughout (e.g., other units/teams vs. departments) the survey and changing pronouns (e.g., people, we) to be more specific (e.g., leadership, staff). Moreover, participants recommended specifying ambiguous terms (e.g., define what “better” means). Conclusion: Use of cognitive interviews allowed for an engaged process to refine an existing measure of readiness. The improved and finalized readiness survey can be used to support and improve implementation of CRCS EBIs in the clinic setting and thus reduce the cancer burden and cancer-related health disparities.",
keywords = "Cognitive interviewing, Evidence-based interventions, Measure development, Organizational readiness, Qualitative methods, cancer prevention",
author = "Maria McClam and Lauren Workman and Dias, {Emanuelle M.} and Walker, {Timothy J.} and Brandt, {Heather M.} and Craig, {Derek W.} and Robert Gibson and Andrea Lamont and Weiner, {Bryan J.} and Abraham Wandersman and Fernandez, {Maria E.}",
note = "Funding Information: Emanuelle Dias is supported by the University of Texas Health Science Center at Houston School of Public Health Cancer Education and Career Development Program –National Cancer Institute/NIH Grant T32/CA057712. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health. Research reported in this publication was supported by the American Lebanese and Syrian Associated Charities (ALSAC) of St. Jude Children{\textquoteright}s Research Hospital. Funding Information: Federally qualified health centers (FQHCs) provide affordable healthcare for many Americans, many of which are at or below the federal poverty level and come from underserved communities with lower CRCS rates []. Despite serving many patients, CRCS rates among FQHCs (40.1% in 2020) remain below national averages (65.2%) [, ]. CRCS is also a Uniform Data System clinical quality measure for health centers. To help increase CRCS rates, FQHCs utilize evidence-based interventions (EBIs), such as provider assessment and feedback, provider reminders, client reminders, and reducing structural barriers [, ]. .EBIs provide guidance on strategies to implement and promote use of CRCS []. Additionally, the Guide to Community Preventive Services (the Community Guide) [] disseminates recommended EBIs. Despite having these EBIs available, implementation remains a challenge; Hannon et al. and Adams et al. found FQHCs often discontinue an EBI because of capacity issues [, ]. Thus, there is a gap in the motivation and capacity to effectively implement and sustain EBIs to improve CRCS. For example, when electronic health records cannot support integration of provider reminder systems or provider assessment and feedback reports, uptake, implementation success and the sustainability of the EBI is compromised. Additionally, provider related EBIs require strategic partnerships that take time to build, showing readiness can be an ongoing and shifting process []. Moreover, CRCS is often a lower priority for providers, especially amongst patients with multiple chronic conditions or complex medical histories []. Several initiatives exist to increase implementation of EBIs to promote CRCS in FQHCs including the Centers for Disease Control and Prevention{\textquoteright}s (CDC) Colorectal Cancer Control Program [], the Cancer Prevention and Control Research Network (CPCRN) [], the American Cancer Society{\textquoteright}s (ACS) Community Health Advocates Implementing Nationwide Grants for Empowerment and Equity (CHANGE) grant program [], and the Evidence-Based Cancer Control Programs (EBCCP) []. Funding Information: Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under award number 1R01CA228527-01A1, PI: Maria E. Fernandez. Publisher Copyright: {\textcopyright} 2023, The Author(s).",
year = "2023",
month = dec,
doi = "10.1186/s12913-022-09005-y",
language = "English (US)",
volume = "23",
journal = "BMC Health Services Research",
issn = "1472-6963",
publisher = "BioMed Central",
number = "1",
}