Walker Timothy J, Rodriguez Serena A, Vernon Sally W, Savas Lara S, Frost Erica L, Fernandez Maria E
Center for Health Promotion and Prevention Research, Department of Health Promotion & Behavioral Sciences, University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin St., Houston, TX, 77030, USA.
Department of Population and Data Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA.
BMC Health Serv Res. 2019 Mar 29;19(1):205. doi: 10.1186/s12913-019-4021-5.
Accurate and valid measures for implementation constructs are critical to advance research and guide implementation efforts. However, there is a continued need for valid and reliable measures for implementation research. The purpose of this study was to assess the psychometric properties of measures for the Inner Setting domain of the Consolidated Framework for Implementation Research (CFIR) in a network of pediatric clinics.
This study used cross-sectional survey data collected from physicians, advanced practice providers, clinic managers, and clinical staff (n = 546) working in a pediatric clinic network (n = 51). Surveys included measures assessing Inner Setting constructs from CFIR (culture, learning climate, leadership engagement, and available resources). We used a series multilevel confirmatory factor analysis (CFA) models to assess factorial validity. We also examined measure correlations to test discriminant validity and intraclass correlation coefficients, ICC(1) and ICC(2), to assess inter-rater reliability.
Factor loadings were high (≥0.60) for all but one of the measurement items. Most CFA models for respective constructs demonstrated adequate or good model fit (CFI > 0.90, TLI > 0.90, RMSEA< 0.08, and SRMR< 0.08). The measures also demonstrated good discriminant validity (correlations< 0.90) aside from some evidence of overlap between leadership engagement and learning climate at the clinic level (0.91). The ICC(1) values ranged from 0.05-0.16 while the ICC(2) values ranged from 0.34-0.67.
The measures demonstrated good validity and adequate reliability with the exception of available resources, which had some evidence of lower than desired reliability and validity at the clinic level. Our findings extend previous work by providing additional psychometric evidence to support the use of these Inner Setting measures in pediatric clinics implementing human papillomavirus programs.
用于实施构建的准确且有效的测量方法对于推进研究和指导实施工作至关重要。然而，实施研究仍持续需要有效且可靠的测量方法。本研究的目的是评估在儿科诊所网络中实施研究综合框架（CFIR）内部环境领域测量方法的心理测量特性。
本研究使用了从儿科诊所网络（n = 51）中的医生、高级执业提供者、诊所经理和临床工作人员（n = 546）收集的横断面调查数据。调查包括评估CFIR内部环境构建（文化、学习氛围、领导参与度和可用资源）的测量方法。我们使用一系列多层次验证性因素分析（CFA）模型来评估因素效度。我们还检查了测量相关性以测试区分效度，并检查组内相关系数ICC(1)和ICC(2)以评估评分者间信度。
除一项测量项目外，所有项目的因素负荷均较高（≥0.60）。各个构建的大多数CFA模型显示出足够或良好的模型拟合（CFI > 0.90，TLI > 0.90，RMSEA < 0.08，SRMR < 0.08）。这些测量方法还显示出良好的区分效度（相关性 < 0.90），不过在诊所层面领导参与度和学习氛围之间存在一些重叠证据（0.91）。ICC(1)值范围为0.05 - 0.16，而ICC(2)值范围为0.34 - 0.67。
除可用资源外，这些测量方法显示出良好的效度和足够的信度，可用资源在诊所层面有一些可靠性和效度低于预期的证据。我们的研究结果通过提供额外的心理测量证据来支持在实施人乳头瘤病毒项目儿科诊所中使用这些内部环境测量方法，扩展了先前的工作。
